Comparison of three lymph node staging schemes for predicting the outcome in patients with small bowel adenocarcinoma: A population-based cohort and international multicentre cohort study.

BACKGROUND: The prognostic roles of three common lymph node staging schemes, number of positive lymph nodes (pN), lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in small bowel adenocarcinoma (SBA) are unclear. We assessed their prognostic ability in SBA. METHODS: A total of 2128 patients diagnosed with SBA between 1988 and 2010 from the Surveillance, Epidemiology, and End Results (SEER) database and 186 patients from 15 hospitals in France and China were identified. We evaluated the prognostic ability of the schemes in both continuous and stratified patterns using R2, Harrell's C, and time-dependent receiver operating characteristic curve analyses. FINDINGS: For continuous pattern, the LODDS had a better capacity of discrimination and higher accuracy of prognosis than pN and LNR. Similarly, the stratified LODDS classification had a better performance of discrimination and higher accuracy of prognosis than the pN and LNR classification. The multivariable model using the LODDS classification also showed superiorly predictive accuracy and discriminatory capacity to those of the 7th and, 8th TNM node and LNR classification. These results were fully validated in an independent international multicentre cohort. INTERPRETATION: The LODDS scheme showed a better prognostic performance than the LNR or pN schemes in patients with SBA regardless of continuous or stratified pattern. The LODDS scheme could serve as an auxiliary to lymph node staging systems in future revisions of the American Joint Committee on Cancer (AJCC) manual. FUND: This work was funded by the Zhejiang Province Natural Science Fund of China.

Diagnosis and surgical treatment of intrahepatic hepatolithiasis associated cholangiocarcinoma.

Liver malignancy is known to be associated with hepatolithiasis. The present report summarises the results and our experience for management of 23 patients with intrahepatic hepatolithiasis associated cholangiocarcinoma (IHHCC). The correct diagnosis rates of US (ultrasonography), CT (computed tomography), and MRCP (magnetic resonance cholangiopancreatography) were 82.6% (19/23), 95.7% (22/23), and 91.7% (11/12), respectively. Carbohydrate antigen 19-9 (CA 19-9) was helpful in the diagnosis of IHHCC. All 23 patients with IHHCC underwent laparotomy. The surgical procedure consisted hepatectomy with a bile duct exploration in 16 patients (69.6%), a hepatectomy and drainage procedure such as sphincteroplasty and choledo-jejunostomy in three patients (13.0%), a bile duct exploration with biopsy in two patients (8.7%), and simple laparotomy and biopsy in two patients (8.7%). All the IHHCC patients who underwent a palliative procedure or laparotomy died within 1 year, and the overall cumulative survival rates at 1, 3, and 5 years were 43.8% (10/23), 13.0% (3/23), and 4.3% (1/23), respectively, and those patients who underwent curative resection were 88.9% (8/9), 33.3% (3/9), and 11.1% (1/9), respectively, which significantly longer than those (20.0%, 2/10; 0.0%, 0/10; and 0.0%, 0/10) patients who underwent palliative resection, respectively (p < 0.05). A suspicion of malignancy is necessary when managing patients with long-term hepatolithiasis. Hepatic resection with postoperative treatment is the treatment of choice for cholangiocarcinoma when it is resectable.

Indications and surgical treatment of chronic pancreatitis.

BACKGROUND: Some patients with chronic pancreatitis (CP) may require surgery mainly because of intractable pain, suspicion of malignancy, or complications related to CP. This study aimed to analyze the efficacy of surgical treatment for patients with CP in terms of pain relief, control of local complications, and pancreatic endocrine/exocrine function. METHODS: Twenty-six patients with CP were treated surgically at our hospital from June 1985 to November 2005. The clinical data of these patients were analyzed retrospectively. RESULTS: The follow-up time ranged from 8 to 130 months with a median of 60.6 months. No patients were lost to follow-up. All patients had improvement of clinical symptoms such as abdominal pain, steatorrhea and weight loss, to some degree, especially pain relief in patients with good dilation and high pressure of the main pancreatic duct. The endocrine and exocrine functions were not alleviated in all patients, otherwise the impaired glucose tolerance was improved in 8 (30.8%), 15 (57.7%) maintained the same body weight, one (3.8%) had an acute attack of CP, and 2 (7.7%) developed pancreatic carcinoma in the 16th and 28th month postoperatively and died within 3 years after operation for CP. The 1-, 3-, 5-year pain-free rates of CP patients were 96.2% (25/26), 88.5% (23/26) and 84.6% (22/26), respectively. CONCLUSIONS: In selected patients with CP, surgical treatment is a safe procedure and can effectively relieve pain and control local complications; also, it is helpful to improve the quality of life for patients with pancreatitis, and to control the development of this disease.