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To evaluate the effect of advanced age on peri-operative complications, recovery of liver function and overall survival in patients undergoing hepatectomy for colorectal liver metastases. Consecutive patients with colorectal liver metastases, who underwent potentially curative hepatectomy in two institutions in the UK from 2005 to 2012, were enrolled in this retrospective study. For each patient the institutional electronic records were interrogated and data were collected. A total of 260 patients were enrolled, 150/260 (57.7%) of whom were older than 60 years of age. 113 complications were recorded occurring in 97/260 of patients (37.3%). Univariate analysis of factors influencing the peri-operative morbidity showed that there was a significant association with an age greater than 60 years. This association remained significant in multivariate analysis (HR 1.92; 95% CI, 1.10-3.36; P=0.02). The number of technical surgical complications was comparable between the young and older group of patients (p=0.449). However, complications, which were not surgical such as pulmonary and cardiovascular, were higher in the older age group (p=0.031). Indices of pre-operative liver function (bilirubin, albumin, ALT) were comparable between the two age groups (p>0.5) and there was no difference in functional recovery of the liver. Although age greater than 60 years was not associated with reduced DFS, it was associated with decreased OS both in univariate and multivariate analysis (HR 2.45; 95% CI, 1.41-4.25;P=0.001). An age greater than 60 years is an independent prognostic factor of an increased postoperative nonsurgical complication rate and of decreased overall survival in patients undergoing partial hepatectomy for colorectal liver metastases. In this age group of patients significant post-operative complications relate not to the technical complexities or scale of procedure, but to the baseline physiological performance characteristics of the patient.

The importance of preoperative chemotherapy in a multimodality management of patients with colorectal liver metastases (CRLM) has been demonstrated. We analyse the carcinoembryonic antigen (CEA) changes following neoadjuvant chemotherapy in patients with CRLM who underwent liver resection. The final cohort included 107 eligible patients. Increased CEA levels following neoadjuvant chemotherapy were defined as the increase of baseline CEA level at diagnosis of CRLM compared with the CEA level after completion of neoadjuvant chemotherapy. Disease-free survival (DFS), post-recurrence survival (PRS) and overall survival (OS) were calculated using both Kaplan-Meier and multivariate Cox-regression methods. CEA increase was associated with decreased PRS and OS (HR 2.69; 95 % CI, 1.28–5.63; p = 0.009, and HR 2.50; 95 % CI, 1.12–5.56; p = 0.025, respectively) in multivariate analysis, but there was no association between CEA changes and DFS. CEA increase was only associated with disease progression during preoperative chemotherapy (p = 0.014). Interestingly, this association was not absolute, as only 5 of the 11 patients with disease progression demonstrated CEA increase. Regarding the remaining 12 patients with CEA increase, according to RECIST criteria, eight patients demonstrated partial response and four patients stable disease. In this study, we demonstrated the CEA increase following neoadjuvant chemotherapy as an adverse prognostic factor for PRS, and OS but not for DFS in patients undergoing liver resection for liver-only colorectal metastases.

Totally implantable venous access ports are widely used for the administration of chemotherapy in patients with cancer. Although there are several approaches to implantation, here we describe Port-A-Cath(®) (PAC) placement by percutaneous puncture of the subclavian vein with ultrasonographic guidance.Data on our vascular access service were collected prospectively from June 2004. This service included port-a-caths and Hickman lines. Once 1000 consecutive port-a-caths(®) had been reached the study was closed and data analysed for the port-a-caths(®) alone. The left subclavian vein was the preferred site for venous access, with the right subclavian and jugular veins being the alternative choices if the initial approach failed. Patients were followed up in the short-term, and all the procedures were carried out by a single surgeon at each one of two institutions.Venous access by PAC was established in 100 % of the 1,000 cases. Of the 952 patients where the left subclavian vein was chosen for the first attempt of puncture, the success rate of PAC placement was 95 % (n = 904). Pneumothorax occurred in 12 patients (1.2 %), and a wound haematoma occurred in 4 (0.4 %) out of the total 1,000 patients. No infections were recorded during the immediate post-operative period but only in the long-term post-operative use with 8 patients requiring removal of the PAC due to infection following administration of chemotherapy.This is a very large series of PAC placement with an ultrasound-guided approach for left subclavian vein and X-ray confirmation, performed by a single surgeon, demonstrating both the safety and effectiveness of the procedure.

Background Renal cell carcinoma accounts for 90 % of renal neoplasms and metastatic disease is common. One third of newly diagnosed cases will have synchronous metastases at diagnosis and further 25–50 % will develop metachronous disease. Case Presentation This study presents two new cases of gallbladder metastasis from renal cell carcinoma (RCC) from our institution and reviews the published literature. The final cohort included 52 evaluable patients. M/F ratio was 2:1 and median age was 62.5 years. Most patients were diagnosed incidentally after follow-up or staging imaging for RCC. Of the patients with available histology, all except one were clear cell type (n = 39) and 92 % were polypoid. Thirty-six patients demonstrated metachronous gallbladder metastasis with median disease-free interval (DFI) from nephrectomy of 4 years. The most frequent site of metastasis was the contralateral kidney (46.7 %) followed by the pancreas and lung. The median disease-free interval (DFS) after cholecystectomy was 37 months. Three- and five-year OS rates were 74 and 62 %, respectively. Age younger than 45 years (p = 0.008) and DFI