The 2018 ALPS meeting took place between 31st January and 4th February 2018 at the venue that has been used by the meeting from the outset 12 years ago, Hotel Carlo Magno in Madonna di Campiglio. This is the first year that the meeting has been organisationally run by a professional conference organiser, ACS Global, who many will know from the organisation of IHPBA meeting, rather the longsuffering staff of the academic surgical unit in Southampton! The move was unavoidable as the complexity of the meeting continues to increase. This presented challenges, not least to the meeting budget. Over the years the proportion of meeting budget derived from industry has reduced year on year and is now zero. When we first started the meeting some 13 years ago problems there was quite considerable industry input but thorough increasing regulation, and very much contrary to their wishes, this has disappeared. However, the financial model for the meeting has always been “lean and mean” in that all the speakers, even international andtheorganiserspayinfulltoattend. This is an unusual model for a meeting but certainly transparent! And it does make the meeting sustainable. Despite having to unbundle some of the costs of the 2018 meeting there was no there was no significant reduction in attendance. However, the relative numbers of UK versus non UK attendees has continued to change over the years such that the Dutch are now the biggest single national group at the meeting and the Scandinavian countries together come a close third. The post BREXIT fall in the pound relative to the Euro (the meeting is now run entirely in Euros) may have had impact disproportionally on UK trainees. Despite the strict financial controls needed for the meeting we hope we can increase the number of trainee bursaries to encourage attendance. It is a significant and essential feature of the meeting that we are able to attract an outstanding world class faculty, comparable to the best of global HPB meetings, despite the fact that we don’t cover costs. At the 2018 meeting we had outstanding talks from Chris Wolfgang (Baltimore) and Peter Allen (New York) on pancreas cancer, with a focus on how the strategy for managing the disease must change (towards neo-adjuvant treatment) if outcomes are to be improved. Peter Bailey (previously Sydney and now Glasgow) spoke on the molecular subtypes of pancreas cancer, work published in Nature Medicine cancer and which proved a basis for personalised oncology in this disease. The “personalised” theme was continued in the area of colorectal liver metastasis with Vegar Dagenborg (Oslo) describing the molecular subtypes in resected colorectal liver metastases and Peter Kingham discussing how molecular analysis could impact upon treatment (only to conclude that at present it could not!). Chris Wolfgang also reported that the Appleby procedure is more and more used at Johns Hopkins for pancreatic tumours involving the coeliac trunk. At Memorial Sloan Kettering the same good results have not been observed, leading Peter Allen to question if the soul actually resides in the coeliac trunk. Dr Allen also brilliantly explained how follow up of pancreatic cysts can be done by a nurse practitioner, and showed details from a cyst registry that currently includes over 3500 patients. Steven Olde Damink (Maastricht, Netherlands) talked on the significance of body composition in cancer patients, focusing on cancer related cachexia. Especially low muscle mass, Olde Damink explained, is a bad prognostic factor, and is easily diagnosed on CT scans where cachexia patients have muscle with lower attenuation. However, patients who maintain their muscle mass (evaluated by CT) during neoadjuvant chemotherapy have a favourable prognosis compared to those who lose muscle mass. As a tradition, we do try and include talks that are little eclectic, and this year Marieke de Boer (Groningen) talked amusingly on altruistic liver donation (the conclusion being that anyone who altruistically offers to donate liver should be excluded from so doing!) The meeting concluded with Rob Padbury (Adelaide) talking on “The behavioural characteristics of high performing surgeons”, providing a dose of well needed insight. We are grateful to all of the excellent speakers who contributed to the meeting, particularly as it is at their own cost! An important feature of the meeting are proffered presentations from trainees and this year again the standard was very high. The prize for the best presentation given by a trainee was awarded to Jony van Hilst (Amsterdam) for her presentation “Minimally invasive versus open distal pancreatectomy (LEOPARD Trial): Multicentre, patient-blinded RCT. Jony won the poster prise the prior year so hopefully in 2019 she will give somebody else a chance! The social aspects of the meeting have always been particularly enjoyable. The Chalet Fiat Mountain Party on the Thursday night remains very popular with all but a few of the more “mature” members of the organising committee and other attendees! It was especially enjoyable this year as the whole building had been demolished and rebuilt (over the summer) to a much better standard. The traditional lunch with Faculty on the Friday was also a highlight, again held in the refurbish restaurant at Chalet Fiat, now with panoramic AUGIS Summer 2018 Newsletter ALPS 2018 Report 31 January - 4 February 2018 Madonna di Campiglio, Italy views of the Dolomites. The Gala Dinner on the Saturday in the hotel is a somewhat more eclectic event and attemptsover12yearstomoulditinto something nearer to our wishes has proved fairly unsuccessful. However it has an excellent atmosphere and gives us a venue for (short) speeches, academic prizes and also the coveted prize for the worst ski injury, awarded this year after a two-year gap (a head injury with transient neurology and requiring a CT scan but fortunately associated with no permanent deficit). 2018 was an excellent year in the Alps for snow after 2 prior years where mostly skiing relied on snowmaking. Fortunately, the ski area is equipped to be able to be fully skied without any natural snow. This was certainly not needed in 2018 when conditions were perfect. In fact there was more heavy snow during the meeting, as some of the Norwegians (who parked a car on the road rather than underground to save money) found to their cost. In 2019 we will return to the same venue for the 13th meeting 6th to 10th February. As many of us have been at the same venue for many years we have regularly looked for another option to alternate with the current one. Despite looking in some detail, we have not managed to find any other centre that combines quality of conference hotel, extent of ski area and cost. And bearing in mind financial model of the meeting the latter is a critical important consideration. To give variety in 2019 we plan a post conference trip to another ski area in a mountain lodge only accessible by ski. Details will be available with registration. Åsmund Fretland John Primrose AUGIS Summer 2018 Newsletter ALPS 2018 Report 22