Faculty Bibliography

INTRODUCTION/BACKGROUND:Tumour location may affect oncologic outcomes for colon adenocarcinoma due to different levels of vascular ligation and nodal harvest, but the data are equivocal. The objective of this study is to determine the effect of tumor location and lymph node yield on overall survival(OS) in stage I-III colon adenocarcinoma. METHODS:The 2004-2014 National Cancer Database was queried for colectomies for non-metastatic colon adenocarcinoma, excluding transverse colon and rectal cancer. Patients were grouped based on left/right tumor location. Main outcome measure was 5-year OS. Propensity score matching created balanced cohorts. Multilevel survival analysis determined the independent effect of tumor location and nodal harvest on OS. RESULTS:There were 504,958 patients (273,198 right; 231,760 left) in the entire cohort: 26.4% stage-I, 37.3% stage-II, and 36.3% stage-III (equal distribution left/right). After 1:1 matching(n = 297,080), right cancers were associated with worse 5-year overall survival for stage-II (66% vs. 70%, p < 0.001) and -III (56% vs. 60%, p < 0.001) despite similar nodal harvest and proportion receiving systemic therapy. On multivariate analysis, right-sided cancers (HR 1.12, 95%CI 1.06-1.19) had worse OS, independent of stage and nodal harvest. Nodal harvest ≥22 nodes had the highest OS (HR 0.71, 95%CI 0.68-0.75). There was an interaction between right-sided cancer and >22 lymph node harvest towards increased survival (HR 0.86, 95%CI 0.80-0.92). CONCLUSIONS:Right-sided cancers are associated with worse oncologic outcomes compared to left-sided tumors but a higher lymph node yield improves survival. These data provide indirect evidence for a higher lymphatic harvest to improve survival.

Internal biliary fistula is a rare complication of a common surgical disease, cholelithiasis. It is seen in 0.74% of all biliary tract surgeries and is thought to be a result of repeated inflammatory periods of the gallbladder. In this report we present a case of incomplete cholecystogastric and cholecystoduodenal fistulae in a single patient missed by ultrasonography and endoscopic retrograde cholangiopancreatography and diagnosed intraoperatively. In the literature there is only one report of an incomplete cholecystogastric fistula. To our knowledge this is the first case of double incomplete internal biliary fistulae.

Aim of this study was to evaluate the characteristic features of patients with mesothelial cyst of the round ligament of the uterus and the incidence of this entity. This was a retrospective review of 3065 patients who underwent inguinal exploration for groin mass from 1998 to 2013. Clinical, radiological and histopathological features of patients with a diagnosis of mesothelial cyst of the round ligament were analyzed. Of the 405 female patients reviewed 9 mesothelial cysts of the round ligament were identified (2.2%). The median age was 37 (range 19-82 years). In all patients the groin mass was manually irreducible on physical examination. The lesions were on the right side in 6 (66.6%) patients. These were identified before surgery in 4 (all by groin ultrasonography). Three were misidentified as a hernia before surgery. The remaining 2 (22%) had both hernia and the mesothelial cyst of the round ligament. The cysts were identified after surgery at the time of histopathological examination in these two patients. In all patients histopathological examination revealed multilobular cystic lesion lined by a single layer of mesothelial cells. Cystic lesions arising from the round ligament were identified and excised along with the round ligament in 7 patients. In the remaining 2, a hernia repair was also performed. There was no recurrence at follow-up. Mesothelial cysts of the round ligament are rare. They are easily misidentified as groin hernia. An accurate diagnosis requires a high index of suspicion and is greatly aided by preoperative imaging studies.