PWE-140 Persistent symptoms following cholecystectomy is unacceptably high and in need of further evaluation

Abstract

significantly associated with raised liver function tests (ALT>100, ALT>350) nor with pre-operative diagnoses of cholecystitis, pancreatitis, jaundice or cholangitis. Out of the 248 patients, 4% of patients presented with pain post operatively (N¼11). <1% (N¼2/ 248) presented with CBD stones post-operatively despite a negative IOC. No patients presented with pancreatitis or cholangitis postoperatively. In addition, out of a larger cohort of 1957 LC performed by the senior author, 4.5% of cases had CBD stones detected on IOC. Conclusion The incidence of CD stones is not well reported in published literaturedthe data that exists is mainly following repeat cholecytectomy for PCS rather than intraoperative detection. PCS is widely reported and can cause a therapeutic and diagnostic challenge. The presence of stones in the CD or within a retained gall bladder remnant may be the cause of residual symptoms, but are difficult to diagnose. We propose that the IOC is not only a diagnostic tool for identification of CBD stones and to delineate anatomy, but also serves a therapeutic purpose, allowing "milking" of the CD to remove any stones/debris which in our cohort has resulted in low rates of post-operative pain. Introduction The liver is a frequent site for tumour metastases, and surgery for colorectal liver metastases (CRLM) is well established, with survival rates accepted to be 50% in 5 years. However, surgery for NCRNNE has been approached with caution. We aimed to report the outcomes of surgery for NCRNNE in our unit, to determine the patterns of disease presentation, recurrence and survival. Methods We identified 78 patients who had liver resection from NCRCNNE primary tumours from 28 December 1992 to 2 August 2011 using a prospectively maintained database; Breast (N¼19), Malignant Melanoma (N¼4), Renal (N¼10), Anal Squamous Cell Carcinoma (N¼5), Lung (N¼3), Sarcoma (N¼15), GIST (N¼13), Squamous-other (cervix, bile duct, oropharynx) (N¼6) and Gastric Adenocarcinoma (N¼3). The electronic records of all these patients were then retrospectively reviewed. We obtained data on patient demographics, presentation of disease, pathological data, recurrence and survival. Data were analysed using ANOVA and KaplaneMeier tests.Results The age at diagnosis varied with tumour type; the youngest was sarcoma (46 years) and the oldest gastric (67 years). The progression to detectable liver disease was quickest with Anal Squamous Cell Carcinoma metastases (172 days), which also had a 60% recurrence rate within a mean of 192 days. Malignant Melanomas had a 100% recurrence rate, which occurred at a mean of 321 days. Breast metastases were the least likely to recur (33%) and had a long disease-free period between recurrences (468 days). The largest metastases were seen in sarcomas (67 cm) and the smallest in melanomas (28 cm). There was no significant correlation between size or number of tumours and survival. The 1-3-and 5-year survival from the time of NCRCNNE metastectomy was 88%, 56% and 47% respectively, compared with 86%, 58% and ...