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60] in VOG (p = NS). Duration of surgical procedure was 349141 minutes [150e820], 375161 minutes [90e800] and 315153 minutes [115e745] in YG, OG and VOG, respectively (p = NS). Intraoperative blood transfusions were 245510 mL [0e3300], 262506 mL [0e2500] and 168327 mL [0e1200] in YG, OG and VOG, respectively (p = NS). Postoperative hospital stay was 10.384.17 days [6e33], 11.217.79 days [6e68] and 10.246.29 days [4e 32] respectively (p = NS). Postoperative complications were 13.13%, 19.56% and 17.24% in YG, OG and VOG respectively (p = NS). Two patients died, one in OG and one in VOG groups, respectively (p = NS). Conclusions: Advanced age should not be considered a deterrent for liver resection in patients with CRLM.

BACKGROUND Clinical risk scores (CRS) within the context of neoadjuvant chemotherapy for colorectal liver metastases (CRLM) has not been validated. The predictive value of clinical risk scoring in patients administered neoadjuvant chemotherapy prior to liver surgery for CRLM is evaluated. METHODS A prospective database over a 15-year period (April 1999 to March 2014) was analysed. We identified two groups: A, neoadjuvant chemotherapy prior to CRLM surgery; and B, no neoadjuvant chemotherapy. RESULTS Overall median survival in groups A and B were 36 (2-137) months and 33 (2-137) months. In group A, nodal status, size, number of metastases and carcinoembryonic antigen levels were not found to be independent predictors of overall survival (OS). However, patients with a shorter disease-free interval of less than 12 months had an increased OS (P = 0.0001). Multivariate analysis of high- and low-risk scores compared against survival in group B (P < 0.05) confirms the applicability of the scoring system in traditional settings. CONCLUSION Traditional CRS are not a prognostic predictive tool when applied to patients receiving neoadjuvant chemotherapy for CRLM. Disease-free interval may be one independent variable for use in future risk score systems specifically developed for the neoadjuvant chemotherapy era.

BackgroundDifferentiating between benign and malignant causes of obstructive jaundice can be challenging, even with the advanced imaging and endoscopic techniques currently available. In patients with obstructive jaundice, the predictive accuracy of bilirubin levels at presentation was examined in order to determine whether such data could be used to differentiate between malignant and benign disease.MethodsA total of 1026 patients with obstructive jaundice were identified. Patients were divided into benign and malignant groups. The benign patients were subgrouped into those with choledocholithiasis and those with inflammatory strictures of the biliary tree. Bilirubin levels at presentation and other demographic data were obtained from case records.ResultsArea under the curve (AUC) values for bilirubin as a predictor of malignancy were highly significant for all benign presentations and for those with benign biliary strictures (AUC: 0.8 for both groups; P < 0.001). A bilirubin level > 100µmol/l was determined to provide the optimum sensitivity and specificity for malignancy in all patients and in those without choledocholithiasis (71.9% and 86.9%, 71.9% and 88.0%, respectively). The application of a bilirubin level > 250µmol/l achieved specificities of 97.1% and 98.0% in each subgroup of patients, respectively.ConclusionsIn patients with obstructive jaundice, bilirubin levels in isolation represent an important tool for discriminating between benign and malignant underlying causes.