Major abdominal cancer resections in cirrhotic patients: how frequent is postoperative hepatocellular decompensation?

Background: The reported incidence of postoperative liver failure in cirrhotic patients is highly varied with diverse risk factors identified to predict risk, mainly drawn from organ or disease-specific studies. We aimed to assess risk factors for the development of postoperative liver failure in a specific cohort of patients with cirrhosis undergoing abdominal cancer resection.

Methods: From November 2007 to October 2012, 30 cirrhotic patients who underwent curative resection for abdominal cancer were analyzed.

Patterns of failure and determinants of outcomes following radical re-resection for incidental gallbladder cancer.

Background: Better appreciation of the course and factors that influence incidental gallbladder cancer is needed to develop treatment strategies aimed at improved outcomes. The purpose of this study was to determine pattern of disease recurrence and influencing factors in patients undergoing radical re-resection for incidental gallbladder cancer.

Methods: Patients undergoing radical re-resection from February 2003 to May 2010 were analyzed.

Rectal cancer in young Indians--are these cancers different compared to their older counterparts?

Background: The incidence of rectal cancer in young Indians is increasing. Recent evidence suggests a probable existence of noncanonical tumorigenesis pathways in early-onset colorectal cancer patients in India. The aim of the study was to evaluate rectal cancer outcomes in patients ≤40 years with those >40 years.

Post-operative abdominal drainage following major upper gastrointestinal surgery: single drain versus two drains.

Background: Traditionally, surgeons have resorted to placing drains following major gastrointestinal surgery. In recent years, the value of routine drainage has been questioned, especially in the light of their role in post-operative pain, infection, and prolonged hospital stay. The aim of this study was to compare the peri-operative outcomes following the use of a single versus two drains for gastric and pancreatic resections.

Studies on stabilization mechanism and stealth effect of poloxamer 188 onto PLGA nanoparticles.

In nanoparticulate engineering for drug delivery systems, poloxamers tri block copolymers are employed as adsorbing molecules to modify the aggregation state and impart stability to products. The aim was to prepare nanoparticles using poloxamer188 as stabiliser and investigate the mechanism of stabilisation of the prepared particles. Nanoparticles were prepared by solvent diffusion method with poloxamer 188 as stabiliser.

Regorafenib: carving a niche in the crowded therapeutic landscape.

The oral multikinase inhibitor regorafenib targets both tumor cell proliferation and vasculature and is active in heavily pretreated patients with metastatic colorectal cancer, for which the US FDA granted its approval in September 2012. The benefit for regorafenib was seen in these patients in most prespecified subgroups. The drug is also being used in other tumor types where it has shown exciting potential especially in gastrointestinal stromal tumors.

Evolution of pancreatoduodenectomy in a tertiary cancer center in India: improved results from service reconfiguration.

Background: Pancreatic cancer incidence in India is low. Over the years, refinements in technique of pancreatoduodenectomy (PD) may have improved outcomes. No data is available from India, South-Central, or South West Asia to assess the impact of these refinements.

D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy.

Background: Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature.

Methods: Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed.

Surgery for pancreatic carcinoma: state of the art.

Carcinoma of the pancreas remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. To date, surgery affords the best outcomes when a complete resection can be achieved. Improvements in imaging, surgical techniques and adjuvant therapies are perceived advancements in the management of this cancer.

Escalated radiation dose alone vs. concurrent chemoradiation for locally advanced and unresectable rectal cancers: results from phase II randomized study.

Purpose: This trial was undertaken to compare the rates of resectability between patients treated with neoadjuvant concurrent chemoradiation vs. boosted radiotherapy alone.

Materials And Methods: Patients with clinically unresectable rectal cancer were randomized to receive external beam radiation therapy (EBRT) to pelvis (45 Gy) with concurrent oral Capecitabine (CRT group; Arm 1) or EBRT to pelvis (45 Gy) alone followed by 20 Gy dose of localized radiotherapy boost to the primary tumor site (RT with boost group, Arm 2).

Epidemiology of pandemic H1N1 strains in a tertiary hospital of Maharashtra.

Swine-flu is a viral fever caused by a new mutated strain Influenza A virus subtype H1N1, which infects humans. Pandemic H1N1 (pH1N1/2009) virus was detected in the first quarter of 2009 in the west coastal region of North America and spread very rapidly to the other countries during April-June, 2009. This study was conducted to assess the epidemiology of pandemic H1N1 strains using a cross-sectional study design in a tertiary hospital.

Pancreatic neuroendocrine tumors.

Pancreatic neuroendocrine tumors (pancreatic NETs) are rare, low- to intermediate-grade neoplasms thought to arise from the pancreatic islets. Recent advances in pathology and our understanding of the biological behavior of this group of tumors has resulted in changes in their nomenclature and how we treat them. This review puts into perspective our current understanding of pancreatic NETs in terms of their incidence, pathology, and management.

Solid pseudopapillary tumor of the pancreas: 'experiences' and 'lessons' at a tertiary-care oncology center.

Solid pseudopapillary tumor of the pancreas (SPT) is a rare and fascinating entity of elusive histogenesis and unpredictable biology. It has a peculiar proclivity to afflict young females and involve the pancreatic body-tail region. Cytology diagnosis of these rare neoplasms remains a challenge.

Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature.

Background: Accurate pre-operative imaging in pancreatic cancer helps avoid unsuccessful surgical explorations and forewarns surgeons regarding aberrant anatomy. This review aimed to determine the role of current imaging modalities in the diagnosis and determination of resectability of pancreatic and peri-ampullary adenocarcinomas.

Methods: A systematic search of the scientific literature was carried out using EMBASE, PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials for the years 1990 to 2011 to obtain access to all publications, especially randomized controlled trials, reporting on the diagnostic accuracy of ultrasonography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) or positron emission tomography (PET)-computed tomography (CT) and the evaluation of resectability of pancreatic and peri-ampullary adenocarcinomas.

Perioperative outcomes after ultra low anterior resection in the era of neoadjuvant chemoradiotherapy.

Purpose: Data on perioperative outcomes of sphincter preserving ultra low anterior resections (ULAR) following neoadjuvant chemoradiotherapy (NA-CTRT) is sparsely reported in literature.

Methods: Prospective data of 68 patients was reviewed retrospectively. Patients who received preoperative chemoradiotherapy (CTRT, Group A, n = 45) were compared with those who were operated upfront (Group B, n = 23).

'Artery-first' approaches to pancreatoduodenectomy.

Background: The technique of pancreatoduodenectomy (PD) has evolved. Previously, non-resectability was determined by involvement of the portal vein-superior mesenteric vein. Because venous resection can be achieved safely and with greater awareness of the prognostic significance of the status of the posteromedial resection margin, non-resectability is now determined by involvement of the superior mesenteric artery (SMA).

Are we achieving the benchmark of retrieving 12 lymph nodes in colorectal carcinoma specimens? Experience from a tertiary referral center in India and review of literature.

Introduction: The number of lymph nodes (LNs) retrieved from a specimen of colorectal carcinoma may vary. Factors that can possibly affect LN yield are age of the patient, obesity, location of the tumor, neoadjuvant therapy, surgical technique and pathologist's handling of the specimen.

Aim: The aim of our study is to look at lymph node retrieval from colorectal cancer (CRC) specimens in our hands and review the literature.

Gastrointestinal stromal tumors: case series of 29 patients defining the role of imatinib prior to surgery.

Background: The aim of this study was to assess the role of neoadjuvant imatinib in redefining treatment for gastrointestinal stromal tumors (GISTs).

Methods: A total of 76 patients were reviewed. Among them, 29 patients who were administered neoadjuvant imatinib for borderline resectable and locally advanced GISTs followed by surgery were analyzed.

Surgical treatment of liver metastases in neuroendocrine neoplasms.

Neuroendocrine neoplasms (NENs) are a distinctive entity, and nearly 10% of patients already have liver metastases at presentation. The management of neuroendocrine liver metastases (NEN-LM) is complex with differing patterns of metastatic presentation. An aggressive approach should be used to resect the primary tumor, to remove regional lymph nodes, and to resect or treat appropriate distant metastases (including liver tumors).

Complications as indicators of quality assurance after 401 consecutive colorectal cancer resections: the importance of surgeon volume in developing colorectal cancer units in India.

Background: The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing.

Methods: We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author.

The evolution of pancreatoduodenectomy.

Till this day, surgery remains the only chance Pancreas of improving long-term survival in patients with periampullary and pancreatic head cancer. The procedure of choice in these cancers is pancreatoduodenectomy (PD). Associated with high morbidity, PD continues to pose a formidable challenge to pancreatic surgeons around the world.

Managing leaks following anterior resections: a new classification system.

Background/aims: Anastomotic leak rates following rectal resections and anastomosis stand at 2.9-15.3%, with an attendant mortality rate of 6- 39.

Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes.

Purpose: During pancreatoduodenectomy (PD), two techniques have been described to dissect the head of pancreas, viz. the superior mesenteric artery (SMA) approach by dissecting the uncinate process and the uncinate process first approach.

Methods: Forty-four consecutive patients, who underwent PD between June 2009 and April 2010, were analyzed.

Desmoplastic small round cell tumor of the pancreas: An unusual primary site for an uncommon tumor.

Pancreas is a rare location for desmoplastic small round cell tumor. The present case highlights the dilemma in diagnosis and ascertaining the site of tumor origin. Morphologic and immunohistochemical features were complemented with the molecular markers and tumor origin which was initially nebulous was subsequently confirmed on exploratory laparotomy.