Background: Little is known about the effect of additional resection for a frozen-section-positive distal bile duct margin (DM) in perihilar cholangiocarcinoma. Methods: Patients who underwent surgical resection for perihilar cholangiocarcinoma between 2001 and 2015 were analysed retrospectively, focusing on the DM. Results: Of 558 consecutive patients who underwent frozen-section examination for a DM, 74 (13⋅3 per cent) had a frozen-section-positive DM with invasive cancer or carcinoma in situ. Eventually, 53 patients underwent additional resection (bile duct resection in 44 and pancreatoduodenectomy in 9), whereas the remaining 21 patients did not. Ultimately, R0 resection was achieved in 30 of the 53 patients (57 per cent). No patient who underwent additional resection died from surgical complications. The 44 patients with additional bile duct resection had a 5-year overall survival rate of 31 per cent. Overall survival of the nine patients who had pancreatoduodenectomy was better, with a 10-year rate of 67 per cent. Survival of the 21 patients without additional resection was dismal: all died within 5 years. Multivariable analyses identified nodal status and additional resection as independent prognostic factors (lymph node metastasis: hazard ratio (HR) 2⋅26, 95 per cent c.i. 1⋅26 to 4⋅07; bile duct resection versus no additional resection: HR 0⋅32, 0⋅17 to 0⋅60; pancreatoduodenectomy versus no additional resection: HR 0⋅08, 0⋅02 to 0⋅29). Conclusion: Additional resection for frozen-section-positive DM in perihilar cholangiocarcinoma frequently yields R0 margins. It offers a better chance of long-term survival, and thus should be performed in carefully selected patients. Prognostic factors in patients with a frozen-section-positive distal marginPrognostic factors were analysed in the 74 patients with a frozen-section-positive DM ( Table 2). On univariable analysis, microscopic venous invasion, pathological tumour

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Background: Differentiation between perihilar cholangiocarcinoma (PHCC) and benign strictures is frequently difficult. The aim of this study was to investigate the incidence and long-term outcome of patients with tumours resected because of suspicion of PHCC, which ultimately turned out to be benign (malignancy masquerade). Methods: Patients who underwent surgical resection with a diagnosis of PHCC between 2001 and 2016 were reviewed retrospectively. Results: Among 707 consecutive patients, 685 had PHCC and the remaining 22 (3⋅1 per cent) had benign biliary stricture. All patients with benign disease underwent major hepatectomy, with no deaths. Preoperative histological assessment using bile duct biopsy or aspiration cytology had a high specificity (90 per cent), low sensitivity (62 per cent) and unsatisfactory accuracy (63 per cent). Despite the increasing use of histological assessment, the incidence of benign strictures resected did not decrease over time, being 0⋅9 per cent in 2001-2004, 4⋅0 per cent in 2005-2008, 3⋅8 per cent in 2009-2012 and 2⋅9 per cent in 2013-2016. The final pathology of benign strictures included IgG4-related sclerosing cholangitis (9 patients), hepatolithiasis (4), granulomatous cholangitis (3), non-specific chronic cholangitis (3), benign strictures after cholecystectomy (2), and a benign stricture possibly caused by parasitic infection (1). The 10-year overall survival rate for the 22 patients with benign stricture was 87 per cent, without recurrence of biliary stricture.Conclusion: The incidence of benign strictures resected as PHCC as a proportion of all resections was relatively low, at 3⋅1 per cent. Currently, unnecessary surgery for suspected PHCC is unavoidable.

To date, no elder care facilities in Japan have formally introduced the Eden Alternative philosophy of care. The purpose of this cross-sectional descriptive study was to identify the perceptions of care workers and nurses regarding the lives of the older adults in care facilities to consider the prospects for introducing the Eden Alternative to Japan. The participants included 139 care workers and 41 nurses who responded to a survey questionnaire based on Eden Alternative principles developed by the researchers for this study. More than half of the participants indicated that they sometimes thought the older adults experienced feelings of helplessness, loneliness, and boredom and hoped for changes in the manner of care to improve the lives of residents. Participants were also in favor of the residents having plants and visits from children, but opinions about having animals on site were split. The fact that the survey respondents noticed the problems indicated by the Eden Alternative suggests there is great potential for introducing the Eden Alternative to Japan.

OCICI for ALMCO did not increase the rate of morbidity or prolong the hospital stay duration compared to treatment of a control population.