Background: Because of advances in medical treatment, the survival of cancer patients is prolonged. In line with the prolonged survival time of cancer the incidence of second primary cancer has increased. There is currently no effective way to prevent the occurrence of secondary primary cancer (SPC). Objectives: The aim of this study is to evaluate whether Chinese Herbal Medicine (CHM) is correlated with reduced occurrence of second primary cancer (SPC) of head and neck (H&N) in patients with esophageal cancer (EC). Method: We identified 15,546 patients who were diagnosed with esophageal cancer between Jan 1, 2000, and Dec 31, 2010. The patients with H&N cancer before receiving CHM were excluded. After the selection and matching process, both CHM and non-CHM cohorts each contained 850 individuals. We compared the cumulative incidence of SPC of H&N with or without CHM treatment in patients with EC by the Kaplan-Meier method. NodeXL is used to run a network analysis of CHM to examine the association between herbs and formulas. Results: Compared with non-CHM users, CHM-users showed a reduced incidence rate of SPC of H&N among the patients with EC. Reduced cumulative incidence of SPC of H&N among patients with EC was noted in the CHM cohort compared to the non-CHM cohort. The most commonly used single herbs and formulas were associated with reducing SPC occurrence. Conclusion: We propose that CHM as an adjuvant therapy may prevent the occurrence of SPC of H&N in patients with EC.

Endoscopists frequently encounter severe tight strictures during therapeutic endoscopic retrograde cholangiopancreatography. Dilation using a Soehendra stent retriever (SSR) can be the approach of choice. However, reports of SSR use for the aforementioned strictures are scant. Patients presenting with strictures of the biliary or pancreatic ducts between July 2015 and March 2019 were prospectively screened. The aforementioned strictures allowed the passage of only a guidewire but denied 5.5‐French (Fr) catheter advancement and conventional balloon or catheter dilation. After guidewire passage and endoscopic sphincterotomy, an (7‐Fr) SSR was screwed clockwise over a guidewire and advanced progressively to traverse and dilate the stricture proximally. A plastic stent was then placed in the biliary or pancreatic duct for internal drainage. The stricture and procedural characteristics and immediate postprocedural status were analyzed. Eleven patients (nine men and two women; median age 58 [range 43‐75] years) with severe benign strictures of the biliary (n = 5) or pancreatic (n = 6) ducts were included. The median length of the strictures was 5 (range 2‐9) mm. All 11 severe strictures were successfully dilated using an SSR followed by stenting with a plastic stent (range 5‐7 Fr). Only one patient had brief minor hemobilia immediately after the procedure, and another briefly experienced acute cholangitis. Five (5/6, 83.3%) patients in the pancreatic group eventually achieved stent removal. None of the patients achieved stent removal in the biliary duct group until the end of follow‐up. Nonetheless, the patients did not require percutaneous or surgical interventions. Dilation using the SSR is safe, tolerable, and successful for the tight biliary and pancreatic duct strictures that defy conventional wire‐guided endoscopic access.

SummaryBackground and aimIntrahepatic cholangiocellular carcinoma (ICC) is an uncommon but lethal cancer. The aim of this study is to assess the factors affecting the survival of ICC patients and to evaluate the benefit of these factors when various therapeutic modalities are used.MethodsBetween October 2007 and June 2012, 66 ICC cases among 2255 liver cancer patients were identified by pathology and divided into two groups: Group I (surgery group; n = 17) and Group II (nonsurgery group; n = 49). Group II was further divided into Group IIa (those receiving palliative treatment; n = 19) and Group IIb (no treatment received; n = 30). Factors affecting patient survival over the study period were assessed (3‐ and 6‐month results were reported) and therapeutic benefits identified within each of the groups were evaluated.ResultsOf the 66 patients identified (male/female = 36/30), 10.6% (7/66) were in the early stages of illness. Overall, the mean patient survival duration was 3.50 ± 0.92 months (1.69–5.31 months). The mean survival duration of Group I patients was 10.50 ± 2.84 months (4.94–16.06 months). The mean survival duration of Group II patients was 3.50 ± 0.65 months (2.24–4.76 months) with Group IIa patients surviving on average 9.50 ± 3.27 months (3.10–15.90 months) and Group IIb patients surviving on average 1.50 ± 0.12 months (1.26–1.74 months). Better survival outcomes were observed in the groups receiving treatment, Group I and Group IIa, than in Group Iib, which did not receive treatment [9.50 ± 1.73 months (6.12–12.89 months) vs. 1.50 ± 0.12 months (1.26–1.74 months), p < 0.001]. Lower albumin, higher bilirubin, higher CA19‐9, advanced tumor stage, and no treatment were identified as important predictors of patient mortality at the 3‐ and 6‐month time‐points. These factors remained relevant throughout the entire study period (p = 0.002, 0.029, 0.027, 0.028, < 0.001, respectively).ConclusionThis study identified surgery as the treatment that provided the best survival prognosis for patients with ICC. Treatment involving either chemotherapy or radiotherapy could also prolong ICC patient survival. Better liver preservation, lower CA19‐9, and less aggressive tumor conditions were identified as factors which play crucial roles in enhancing patient survival.