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When applied regionally, combined chemoimmunotherapy is simple, safe, and effective. This type of therapy offers substantial advantages in terms of prolonging overall survival and improving disease-free survival compared to surgical resection alone or to surgical resection and adjuvant regional chemotherapy.

The prognosis for patients with advanced (stage III and IV) hepatocellular carcinoma (HCC) remains poor. Liver resection and liver transplantation have limited effects on overall survival. Our study was carried out to assess a novel therapeutic approach, which includes transarterial locoregional chemotherapy and in vivo locoregional dual immunostimulation, in patients with unresectable HCC. A group of 20 patients with stage III and IV hepatocellular carcinoma had 10 courses (once per day) of transarterial targeted locoregional immunotherapy with interferon-gamma (IFN-gamma) and interleukin-2 (IL-2), emulsified in a Lipiodol-Urografin mixture. The target organs were the spleen and the liver tumor itself. One course of intrahepatic locoregional targeting transarterial chemotherapy was given 10 days after completion of immunotherapy (mitomycin C, carboplatin, Farmorubicin, Leucovorin, 5-fluorouracil, and IFN-gamma). This was followed after 2 months by another course of transarterial targeted locoregional immunotherapy-chemotherapy. All patients survived the operation and had a mean survival time of 18 months (4-22 months). There was a decrease in the tumor size of 14 of the 20 patients. Serum alpha-fetoprotein (AFP) levels declined in 14 patients, reaching normal levels in 12 patients. These preliminary results indicate that combined locoregional immunotherapy-chemotherapy is a promising therapeutic approach in patients suffering from advanced nonresectable HCC and merits further evaluation.

During a 14-year period ending in June 1979, 342 patients with calculous biliary disease underwent choledochoduodenostomy either as a primary procedure or during reoperation. Eighty per cent of the patients were aged 50 years or more. Follow-up was either by personal interview and physical examination or by means of a questionnaire, 90 per cent of the patients being assessed at periods ranging from 6 months to 14 years. A high incidence of common bile duct dilatation was found in older patients, in patients with a long history and in patients submitted to reoperation. There were no operative deaths. Postoperative complications occurred in 22 cases (6.4 per cent) and, in particular, no patient developed ascending cholangitis or symptoms related to the "blind segment". Choledochoduodenostomy is a valuable and safe procedure and can be used on wide indications, especially where peroperative cholangiography is not available.