The results of the present study indicate that the GPS, before surgery, predicts overall and cancer-specific survival after resection of colon and rectal cancer.

There is increasing evidence that the presence of a systemic inflammatory response plays an important role in predicting survival in patients with colorectal cancer. However, it is not clear what components of the systemic inflammatory response best predict survival. The aim of the present study was to compare the prognostic value of an inflammation-based prognostic score (modified Glasgow Prognostic Score (Mgps) 0 ¼ C-reactive protein o10 mg l À1 , 1 ¼ C-reactive protein 410 mg l À1 , and 2 ¼ C-reactive protein 410 mg l À1 and albumino35 g l À1 ) with that of components of the white cell count (neutrophils, lymphocytes, monocytes and platelets using standard thresholds) in patients with colorectal cancer. Two patient groups were studied: 149 patients who underwent potentially curative resection for colorectal cancer and 84 patients who had synchronous unresectable liver metastases. In those patients who underwent potentially curative resection the minimum follow-up was 36 months and 20 patients died of their cancer. On multivariate survival analysis only TNM stage (HR 3.75, 95% CI 1.54 -9.17, P ¼ 0.004), monocyte count (HR 3.79, 95% CI 1.29 -11.12, P ¼ 0.015) and mGPS (HR 2.21, 95% CI 1.11 -4.41, P ¼ 0.024) were independently associated with cancer-specific survival. In patients with synchronous unresectable liver metastases the minimum follow-up was 6 months and 71 patients died of their cancer. On multivariate survival analysis only single liver metastasis 45 cm (HR 1.78, 95% CI 0.99 -3.21, P ¼ 0.054), extrahepatic disease (HR 2.09, 95% CI 1.05 -4.17, P ¼ 0.036), chemotherapy treatment (HR 2.40, 95% CI 1.82 -3.17, Po0.001) and mGPS (HR 1.44, 95% CI 1.01 -2.04, P ¼ 0.043) were independently associated with cancer-specific survival. In summary, markers of the systemic inflammatory response are associated with poor outcome in patients with either primary operable or synchronous unresectable colorectal cancer. An acute-phase protein-based prognostic score, the mGPS, appears to be a superior predictor of survival compared with the cellular components of the systemic inflammatory response.

Background: Chyle leaks are a rare complication following abdominal surgery. The aim of this study is to describe the management of chyle leaks following surgery for pancreatico-duodenal malignancy. Methods: Data were collated from a consecutive series of 105 patients who had undergone a pancreatico-duodenectomy for malignancy. From this cohort, patients who developed significant chyle leaks, defined as drainage of more than 600 ml of amylase-poor chylous fluid per day, were identified and their management reviewed. Results: A total of 7 (6.7%) patients with significant chyle leaks were identified. All but one of the chyle leaks were identified between the 5th and 9th post-operative day. Early restoration of enteral feeding appeared to increase the incidence of chyle leak. Six of the 7 patients were successfully treated conservatively with total parenteral nutrition and after a median of 7.5 days the chyle leak had resolved. One patient required a peritoneovenous shunt for chylous ascites. Conclusion: This study has described a high incidence of chyle leak among patients undergoing surgery for pancreatico-duodenal malignancy. Early introduction of enteral feed may encourage development. However, patients who develop an abdominal chyle leak remain clinically well and the leak can be managed relatively easily with parenteral nutrition.

SELDI-TOF MS identified potential biomarker profiles strongly associated with activity in LN. Identification of these proteins will allow us to devise specific assays to routinely monitor disease progression, and alter immunosuppressive drug regimens accordingly. These proteins may also play a critical role in the pathogenesis of glomerulonephritis, and could therefore provide targets for therapeutic intervention.

Emergency presentation is recognized to be associated with poorer cancer specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival. In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29%) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS) which is the combination of an elevated C-reactive protein (>10mg/l) and hypoalbuminaemia (<35g/l). In the emergency group, tumour stage was greater (p<0.01), more patients received adjuvant therapy (p<0.01) more patients had an elevated mGPS (p<0.01) and more patients died of their disease (p<0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3 year cancer specific survival in those patients aged 65-74 years (p<0.01), males and females (p<0.05), in the deprived (p<0.01), in TNM stage II (p<0.01), in no adjuvant therapy (p<0.01) disease and in the mGPS 0 and 1 (p<0.05) groups.On multivariate survival analysis of those patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (p<0.05) and the mGPS (p<0.05) were independently associated with cancer specific survival. Therefore, these results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing likely outcome of these patients.2