1. Within 25 patients, 12 had complications :  3 patients had more than 1 complication.  12 early complications :  The most frequent was the pancreatic fistula (5 patients).  2 late complications:  Both were intestinal obstructions.  Every one had before a early complication.  In 3 cases surgical reexploration was needed:  Intraperitoneal bleeding, subfrenic abscess and obstruction due to bridas.  In the rest of the cases, patients had a positive evolution with conservative treatment. EVALUATION OF COMPLICATIONS

2.  EARLY COMPLICATIONS (within first month after surgery):  5 Pancreatic fistula  4 Subfrenic abscess  3 Peripancreatic abscess  2 Intrabdominal bleeding  1 Intestinal fistula  1 Biliar fistula  1 Paracolic abscess  LATE COMPLICATIONS (after the first month after surgery):  2 Intestinal obstruction EVALUATION OF COMPLICATIONS

3.  PANCREATIC FISTULA:  PANCREATIC FISTULA: Secondary to a little pacreatojejunostomy dehiscence. Fig. 33: 10 days after surgery we observed a separation between pancreas (P) and the jejunum (J), with the guide of the anastomosis in the middle (G). P G J J C 3433 Fig. 34: In the same patient, we observed a collection (C) adjacent to the pancreatojejunostomy dehiscence. C G EVALUATION OF COMPLICATIONS

4.  RIGHT SUBFRENIC ABSCESS: Fig. 35: After 7 days of the surgery, persists liquid of low attenuation (L) in perihepatic and periesplenic spaces. C L L 36 35 Fig. 36: The same patient, after 21 days of the surgery, show persistent liquid as an important perihepatic collection of low attenuation (C) with walls that enhance with the intravenous contrast. It was confirmed as an abscess after a percutaneus needle punction. EVALUATION OF COMPLICATIONS

5.  PERIPANCREATIC SURGICAL BED ABSCESS: Fig. 37: After 21 days of the surgery, this patient begin with fever and abdominal pain. A collection (C) was observed with borders that enhanced with the intravenous contrast, in the bed of the pancreas's head, adjacent to the jejunum (J). Fig. 38: Other patient after 21 days of the surgery, with a collection (C) adjacent to the remaining body of the pancreas (P), which was drained (D), and it was confirmed as an abscess. J C D C 3837 EVALUATION OF COMPLICATIONS

6.  INTRABDOMINAL BLEDDING : Fig. 39: 24 hours after surgery, this patient turn hemodinamically unstable. An heterogeneous collection was observed in left parietocolic space, with a leak (L) of the intravenous contrast. It was confirmed as a haematoma (H) in an immediate surgical reexploration, secondary a arterial lesion in the surgical bed. H L 39 EVALUATION OF COMPLICATIONS

7.  INTESTINAL FISTULA :  INTESTINAL FISTULA : Secondary to a enteroenteric anastomosis dehiscence Fig. 40, 41 and 42: 7 days after surgery, this patient persists with abdominal pain and begin with fever. The hiperenhanced lines in the jejunum (J) represents the suture (S) of the enteroenteric anastomosis (A). Liquid (L) surrounding this anastomosis, was observed, in the left anterior pararrenal space. It was suggestive of intestinal fistula, which was confirmed after a laboratory examination of the liquid. This patient had a positive evolution with conservative treatment. A S L J 424140 J JJ J J A EVALUATION OF COMPLICATIONS

8.  BILIAR FISTULA :  BILIAR FISTULA : Secondary to a biliojejunostomy dehiscence. B L J H 454443 Fig. 43, 44 and 45: 10 days after surgery, this patient persists with abdominal pain. Liquid (L) surrounding the biliojejunostomy (B) was observed, in the hepatoduodenal ligament (H), as the common bile duct (C) and the jejunum (J), both with inflammatory changes. It was suggestive of biliar fistula, which was confirmed after a laboratory examination of the liquid. This patient had a a positive evolution with conservative treatment. EVALUATION OF COMPLICATIONS

9.  PARACOLIC ABSCESS: Fig. 46: 14 days after surgery, this patient presents increases of the abdominal pain and fever. A little collection (C) with borders that enhanced with the intravenous contrast was observed, in the left paracolic space, also was observed peritoneal effusion (L) in different spaces. It was suggestive of a little paracolic abscess, which was confirmed after a laboratory examination of the liquid. This patient had a a positive evolution with conservative treatment. L CLL 46 EVALUATION OF COMPLICATIONS

10.  14 patients developed recurrent disease:  The 2 earliest signs (within first month after surgery) were:  Peritoneal effusion  Hepatic metastasis  The latest (60 months after surgery) were:  Increased fat density and soft tissue surrounding the surgical bed.

11.  5 patients developed peritoneal effusion as the first sign of recurrent disease:  2 : Within the 1 st month after surgery  The rest of cases within the 5 th, 10 th and 18 th month after surgery  4 patients developed increased fat density and soft tissue surrounding the surgical bed as the first sign of recurrent disease:  Within the 8 th, 10 th, 19 th and 60 th months after surgery, respectively.  5 patients developed hepatic metastasis as the first sign of recurrent disease:  Within the 1 st,2 nd.6 th, 7 th and 8 th months after surgery, respectively.

12.  PERITONEAL EFFUSION AS SIGN OF RECURRENT DISEASE: Fig. 47 and 48: 5 month after surgery, this patient presents peritoneal effusion (L) in different spaces. A month later this patient developed clear sign of recurrent neoplasm. L L 4847

13.  BILE DUCTS DILATATION SECONDARY TO NEOPLASM RECURRENT WHICH AFFECTS THE BILE LIMB : Fig. 49: 15 months after surgery, we observed a decreasing of the liver density (D), especially in the left lobule without biliar pathology. Fig. 50: shows 20 month after surgery in the same patient, a diffuse bile duct dilatation (B). 5049 D B B B

14.  BILE DUCTS DILATATION SECONDARY TO A RECURRENT NEOPLASM WHICH AFFECTS THE BILE LIMB : 53 52 51 Fig. 51: shows 15 months after surgery, a normal bile limb (B). Fig. 52: 20 month after surgery we observed in the same patient, a not clear identification of the bile limb borders (B). Fig. 53: show a clear decreasing of the diameter of the bile limb (B), secondary to a recurrent neoplasm, which produces a proximal bile ducts dilatation (D). B B BD D

15.  INCREASED FAT DENSITY AND ADENOPATIES SURROUNDING THE SURGICAL BED AS SIGN OF RECURRENT DISEASE : Fig. 54: 5 months after surgery, this patient presents small mesenteric lympadenopathies (A). Fig. 55: 31 months after surgery, this patient presents an increasing of the mesenteric fat density (F), and peritoneal effusion (L). In both cases a recurrent neoplasm was confirmed. 55 54 A A F A L L

16.  HEPATIC METASTASIS AS SIGN OF RECURRENT DISEASE : Fig. 56: shows 5 months after surgery a light dilatation of bile ducts, nevertheless, those are smaller than before the surgery. There is not any metastasis sign. Fig. 57: shows 6 months after surgery a little metastasis (black arrow) in VIº hepatic segment, which was not present in the previous month. Fig. 58: shows many hepatic metastasis (black arrows). 585756