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Background: Surgery for perihilar cholangiocarcinoma (pCCA) offers the only possibility of long-term survival, but remains a formidable undertaking. Traditionally, 90-day post-operative complications and death are used to define operative risk. However, there is concern that this metric may not accurately capture long-term morbidity after such complex surgery., Methods: A retrospective review of a prospective database of patients undergoing surgery for pCCA at a Western centre between January 2009-2020., Results: Eighty-five patients underwent surgical resection for pCCA with a median overall survival of 36.3 months. Post-op (<90day) morbidity rates were high with 46% of patients developing a major complication (Clavien-Dindo grade 3-4). Post-op mortality rate was 13%. In total 38% (28/74) of patients experienced at least 1 episode of delayed morbidity (>90-days of surgery) resulting in 53 separate admissions with a median LOS of 7 days (IQR 2-15). These episodes were predominately secondary to biliary obstruction with the majority requiring radiological intervention (Clavien-Dindo grade 3). The development of long-term morbidity was associated with increased recurrence rates and correlated with poorer OS (27.6 months vs. 65.7 months HR 2.2 CI 1.63-2.77)., Conclusions: Routinely cited 90-day morbidity and mortality does not accurately capture the patient morbidity experienced following surgery for pCCA. Surgery clearly offers a survival benefit and should be pursued in selected patients, but they must be fully counselled on the potential for long-term morbidity before embarking on this strategy., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Policy makers have assumed that increase in medical demands and costs are attributable to the increasing age of the population and the inability of health and social care to limit demand., Methods: Analysis of data obtained from NHS and Office of National Statistics., Results: Population-adjusted age-specific patterns in medical admissions and deaths have increased over the period 2012/13 to 2015/16 in the NHS in England. The growth is both age and year of birth specific, and the youngest appear to be worst affected. Overall there has been a growth of 30,870 admissions (15% increase) in 25-29year olds compared to 119,280 extra admissions (7% increase) for 70-74year olds. Admissions of younger medical patients have also increased more so than for pneumonia, and the increase in all-cause mortality appears to be influenced by the patients' year of birth., Conclusion: In England, medical admissions and deaths (all-cause mortality) have recently displayed very high unexplained growth. The fact that these are associated with patient year of birth suggests that the cause(s) may be related to infectious or other environmental factors encountered earlier in life., (Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Colorectal cancer is the fourth most common cancer diagnosis in the world (around 1.2 million diagnoses each year), and accounts for the second highest number of deaths. Over half of patients with colorectal cancer will develop liver metastases, with one quarter presenting in stage IV. There is growing evidence that patients with liver-limited disease represent a distinct biological cohort who will benefit from aggressive management. Only a minority of patients are technically resectable, but around 40% of patients with resected liver limited disease are alive 5 years after diagnosis compared with less than 1% for those with disseminated disease. Novel surgical techniques have been developed to allow more patients to undergo resection and there is also growing recognition that the chemotherapeutic manipulation of irresectable disease may bring some patients to resection with good long-term outcome. Perioperative chemotherapy can also improve long-term outcome through improved biological selection and destruction of occult micrometastases. This review outlines current oncosurgical treatment strategies for liver-limited stage IV colorectal cancer, and discusses some of the controversies surround the management of these complex patients., (Copyright © 2014 Elsevier Ltd. All rights reserved.)