Since the early 1990s, the laparoscopic technique has been increasingly used for the treatment of perforated peptic ulcer. It is important to validate a risk scoring system that can stratify patients into various risk groups before comparing the treatment outcome of laparoscopic repair against that of conventional open surgery. The scoring system should be able to predict the likelihood of mortality and morbidity. Boey score and APACHE II (Acute Physiology and Chronic Health Evaluation II) score may be of use in patient stratification.Design: Retrospective review of relevant case notes by one reviewer.Setting: A teaching hospital treating 0.5 million to 1 million patients during the study period.

Background-For rectal carcinoma, the presence of tumour within 1 mm of the circumferential margin is an important independent prognostic factor for both local recurrence and survival. Similar prospective data have not been reported for oesophageal carcinoma and we wished to ascertain the prognostic importance of this variable following potentially curative resection for oesophageal carcinoma. Aim-To prospectively assess the impact of circumferential margin involvement (tumour within 1 mm) following potentially curative resection for oesophageal carcinoma. Patients and methods-In a prospective study, resection specimens of 135 patients treated with potentially curative oesophageal resection alone were studied for the presence of tumour within 1 mm of the circumferential margin (margin positive), using inked margins and cross sectional slicing of the specimen. All tumours were also staged using the 1987 UICC TNM classification. Patients were followed for a mean of 19 months, and overall and cancer specific survival analysed. Results-The finding of tumour cells within 1 mm of the circumferential margin (CRM+) was a significant and independent predictor of survival following potentially curative oesophageal resection. Overall, 64 (47%) patients were CRM+. Median survival in this group was 21 months compared with 39 months in the CRM− group (p=0.015). The impact of CRM status on survival was only seen in patients with a low nodal metastatic burden (<25% nodes positive). The odds ratio for the risk of dying from oesophageal cancer was 2.08 when the CRM was involved (p=0.013). Conclusions-The presence of tumour within 1 mm of the circumferential margin following potentially curative resection for oesophageal carcinoma is an important independent prognostic variable and should be reported routinely. (Gut 2001;48:667-670)

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Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation.

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Patients with surveillance-detected adenocarcinoma of the oesophagus are diagnosed at an earlier stage and have a better prognosis than those who present with symptomatic tumours.

Radical thoracoscopic mobilization of the esophagus is feasible, but the potential for complications remains high and requires further study.

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