Ten-year experience in the management of XXXX from a single hepatobiliary and pancreatic centre with review of the literature.

@entity1 @entity66 @entity648 @entity1372 @entity1086 @entity623
BACKGROUND: There is no consensus regarding the optimum surgical approach to @entity1086 . This study reviews the management of @entity1086 in a single unit. METHODS: Retrospective study of 73 consecutive @entity1 diagnosed with @entity1086 . Twenty-three @entity1 underwent surgery with curative intent (surgical group), 28 @entity1 underwent exploratory surgery but had @entity66 (surgically inoperable group) and 22 @entity1 had @entity66 radiologically (radiologically inoperable group). Within the surgical group, nine @entity1 (cholecystectomy group) were diagnosed with @entity1086 after routine cholecystectomy. RESULTS: The inoperable groups had significantly higher @entity648 and @entity623 ( @entity623 ) than the surgical group (p=0.02 and p<0.01, respectively). Age>68, white cell count (WCC)>7.6 x 109/L, platelet>345 x 109/L, @entity648 >16 mol/L, @entity623 >124 iu/L and @entity1372 < or = 137 mmol/L were markers of inoperability. Age, haemoglobin and neutrophil:lymphocyte ratio (NLR) were predictors for survival following surgery (p=0.04, p=0.01 and p<0.01, respectively). The surgical and cholecystectomy groups had significantly higher median survivals than the surgically and radiologically inoperable groups (18.97 and 26.17 months versus 5.03 and 12.20 months, p=0.04). CONCLUSION: Curative surgical resection of @entity1086 improved survival. Exploratory laparotomy which revealed @entity66 reduced survival. Preoperative WCC, platelet, @entity648 and @entity623 may be used as additional discriminators during the investigation and work up prior to surgery.
