To evaluate the correlation between biliary-enteric surgical drainage and the late development of cholangiocarcinoma of the biliary tract. In patients with biliary-enteric drainage, reflux of intestinal contents into the bile duct may occur and cause cholangitis, which is regarded as the most serious complication of these procedures. Lithiasis of the biliary tract and a previous biliary-enteric anastomosis have both been suggested to favor the late onset of cholangiocarcinoma. Consecutive patients (n = 1,003) undergoing three different procedures of biliary-enteric anastomosis (transduodenal sphincteroplasty, choledochoduodenostomy, and hepaticojejunostomy) between 1967 and 1997 were included in this study. The postoperative clinical course and long-term outcome were evaluated by a retrospective review of the hospital records and follow-up. Mean follow-up was 129.6 months. Fifty-five (5.5%) cases of primary bile duct cancer were found among the 1,003 patients at intervals of 132 to 218 months from biliary-enteric anastomosis. The incidence of cholangiocarcinoma in the three groups was 5.8% in transduodenal sphincteroplasty patients, 7.6% in choledochoduodenostomy patients, and 1.9% in hepaticojejunostomy patients. The incidence of malignancy related to the different underlying diagnosis was 5.9%, 7.2%, and 1.9% in patients with choledocholithiasis, sphincter of Oddi stenosis, and postoperative benign stricture, respectively. Although only one patient who developed cholangiocarcinoma had previous concurrent lithiasis of the biliary tract, 40 patients had experienced mostly severe, recurrent cholangitis. No case of malignancy occurred in patients scored as having no cholangitis in the early and long-term postoperative outcome. Univariate and multivariate analyses have shown the presence of cholangitis as the only factor affecting the incidence of cholangiocarcinoma. Chronic inflammatory changes consequent to biliary-enteric drainage should be closely monitored for the late development of biliary tract malignancies.

STANDARD surgical techniques offer a good chance of cure for the majority of patients affected by extrahepatic benign biliary stricture.^1-11 Nevertheless, operative repair has a long-term recurrence rate of stricture in 10% to 30% of patients. Advances in endoscopic procedures have provided alternative options of relieving biliary obstructions, but prolonged length of treatment and rehospitalization have to be considered if endoscopy is performed.^12-15 The purpose of this study was to compare the effectiveness of endoscopic and surgical treatments of benign stenosis of the bile duct.

Research from JAMA Surgery — Surgical Treatment of Pancreatic Head Carcinoma in Elderly Patients

Research from JAMA Surgery — Adenocarcinoma of the Third and Fourth Portions of the Duodenum — Results of Surgical Treatment

PELVIC RECURRENCE following curative surgery for rectal cancer is common, ranging between 5% and 45%.^1-4 This considerable variation in different series is probably due to differing quality of surgical treatment.^3,4 It is increasingly believed that many of these local recurrences are due to incomplete excision of metastatic deposits scattered in the supporting structures around the rectum.^1,3,5,6 Most frequently, local cancer spread discontinuous with the primary rectal tumor takes place in the mesorectal lymph nodes (nodal metastases [NM]). However, nonnodal metastases (NNM), which have been described in other organs,⁷ have been found within the mesorectum and outside it along lateral pelvic vessels, autonomic nerves, and the pelvic wall.^1,2,5,7-9 Our aim was to determine the incidence of NM and NNM, their relation to other clinicopathologic characteristics, and their influence on survival and recurrence rate in patients treated with curative low anterior resection (LAR).