BACKGROUNDFibrolamellar hepatocellular carcinoma (FL‐HCC) is a rare variant of hepatocellular carcinoma, has distinct pathologic features, and typically occurs in young patients without underlying hepatitis or cirrhosis.METHODSForty‐one patients with the pathologic diagnosis of FL‐HCC evaluated at our institution between 1986 and 2003 were identified from a prospective database.RESULTSMedian age of all patients was 27 years. None of these patients had underlying hepatitis or cirrhosis, and only 3 (7%) patients had an α‐fetoprotein level > 200 ng/mL. Twenty‐eight patients with primary disease underwent complete gross resection, and 13 patients were unresectable. In patients treated with resection, median tumor size was 9 cm (range, 3–17), 9 (36%) had vascular invasion, and 14 (50%) had lymph node metastases. There were no perioperative deaths. With a median follow‐up of 34 months, 5‐year overall survival for resected patients was 76%. However, 5‐year recurrence‐free survival was only 18%, and of the 9 resected patients with more than 5 years of follow‐up, 7 had recurrences. Lymph node metastasis was the only significant negative prognostic factor. Seventeen (61%) patients underwent a second operation for recurrent disease. Median survival for unresected patients with FL‐HCC was only 12 months, and no patient survived beyond 5 years.CONCLUSIONSFL‐HCC occurs in a distinctly different population of patients than common HCC, and patients with FL‐HCC generally fare better after complete resection. These tumors have a relatively indolent tumor biology, and late recurrences are common. Repeat resections for recurrence should be considered given the lack of other effective treatment options. Cancer 2006. © 2006 American Cancer Society.

Rectal cancer patients with pCR after preoperative CMT have improved RFS, OS, and sphincter preservation compared with patients without downstaging. Because pCR seems to be associated with better outcome, an understanding of the factors governing the response to CMT should be pursued.

After local excision of early rectal cancer, a substantial local recurrence rate is observed. Patients with recurrent Tis/T1 cancers who undergo a salvage operation may achieve good long-term outcome. Local treatment without adjuvant therapy for T2 rectal cancers appears inadequate.

Background Routine drainage after laparoscopic cholecystectomy is still debatable. The present study was designed to assess the role of drains in laparoscopic cholecystectomy performed for nonacutely inflamed gallbladder. Methods After laparoscopic gallbladder removal, 53 patients were randomized to have a suction drain positioned in the subhepatic space and 53 patients to have a sham drain. The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24 h after surgery. Secondary outcome measures were postoperative abdominal and shoulder tip pain, use of analgesics, nausea, vomiting, and morbidity. Results Subhepatic fluid collection was not found in 45 patients (84.9 %) in group A and in 46 patients (86.8 %) in group B (difference 1.9 (95 % confidence interval -11.37 to 15.17; P = 0.998). No significant difference in visual analogue scale scores with respect to abdominal and shoulder pain, use of parenteral ketorolac, nausea, and vomiting were found in either group. Two (1.9 %) significant hemorrhagic events occurred postoperatively. Wound infection was observed in three patients (5.7 %) in group A and two patients (3.8 %) in group B (difference 1.9 (95 % CI -6.19 to 9.99; P = 0.997). Conclusions The present study was unable to prove that the drain was useful in elective, uncomplicated LC.

Reflux esophagitis may result from the action of both acid and non-acid agents. The aim of this study was to test a new system able to measure the quantity of the bilirubin contained in the esophageal lumen. The analysis of esophageal reflux composition was conducted in two phases. In the first bile and pancreatic enzyme, concentration of 136 fluid samples obtained with ambulatory esophageal long-term reflux aspiration test were measured. For the second, the total bilirubin content of each sample was measured in vitro with a fiberoptic probe (Bilitec 2000, Synetics Medical Inc., Sweden). Studies were performed on 48 subjects: 43 patients with esophageal reflux and five healthy volunteers. The results of both techniques were then compared. Higher concentration of bile and pancreatic enzymes were found in esophageal fluid samples of patients with endoscopic esophagitis. Bile and pancreatic enzyme concentrations of esophageal fluid samples were higher in patients after gastrectomy compared to patients with intact stomachs. There was a significant correlation between the total bilirubin concentration of fluid specimens and the fiberoptic probe reading of bilirubin (r = 0.72, P < 0.001). The presence of bilirubin and bile acids within the esophageal refluxate can be determined reliably with continuous fiberoptic measurement. The correlation between total bilirubin content and the concentrations of pancreatic enzymes contained in the esophageal refluxate suggests that bilirubin is a good tracer for non-acid, duodenal or intestinal reflux in the esophagus.