The records of 256 patients with nasopharyngeal carcinoma have been reviewed to determine the incidence and location of distant metastases. Sixty-three patients underwent autopsy. The incidence of distant metastases was 36% overall, and 51% in the autopsy patients. Bones, distant lymphnodes, liver, and lungs were the most common sites of distant metastases. Liver was the most common site in the autopsy patients. Compared to other major histological subtypes, undifferentiated carcinoma had the highest incidence of bone but lowest incidence of lung metastases. There was a strong correlation between advanced locoregional disease and distant metastases. Of those patients who developed distant metastases, 98% were discovered within 3 years or earlier. Thorough evaluation of the above organs/systems is indicated at the time of initial staging work-up and at follow-up, specifically for patients with advanced locoregional disease. A literature review of distant metastases in nasopharyngeal carcinoma is presented.

Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

No abstract

Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Background Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. Methods Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1–4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. Results Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11–34) versus 18 (10–28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. Conclusion Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com).

The list of the CholeS management group, Collaborators and Data Validators were omitted from the Acknowledgments.