Laparoscopic gastrectomy and metastasectomy for stage IV gastric cancer.

Background: The standard recommended treatment of stage IV gastric cancer is palliative chemotherapy. The aim of this study is to evaluate the role of radical gastrectomy with metastasectomy in these patients, as well as to explore the feasibility and safety of a laparoscopic approach.

Methods: 117 consecutive patients with pathologically proven Stage IV gastric cancer who underwent radical gastrectomy with metastasectomy were enrolled in this study.

Coexisting Moyamoya Syndrome and Type 1 Diabetes Mellitus: A Case Report and Review of the Literature.

Moyamoya disease (MMD) is an incompletely understood malady that affects many age groups, primarily in a bimodal age distribution. We present a patient with the association of type 1 diabetes mellitus (type 1 DM) and MMD followed by a review of the existing literature. We found five papers that describe this association, in the form of one case report, one case series, and three retrospective reviews.

Patient-Reported Outcomes and Long-Term Results of a Randomized Controlled Trial Comparing Single-Port Versus Conventional Laparoscopic Inguinal Hernia Repair.

Background: Surgical techniques for inguinal hernia repair have evolved rapidly from open methods to conventional laparoscopic totally extra-peritoneal (CTEP) and recently single-port TEP (STEP). As there is currently no randomized controlled trial (RCT) reporting long-term patient-reported outcomes between CTEP and STEP, we reviewed patients who were randomized to CTEP or STEP 5 years after surgery.

Methods: Telephone interviews were administered to patients with primary unilateral inguinal hernia recruited for the RCT comparing CTEP and STEP in 2011.

Nasal Cavity Metastasis From Colorectal Cancer Represents End-Stage Disease and Should Be Palliated.

Nasal metastases from colorectal cancer is rare. The presentation of nasal metastases is often very similar to primary nasal sinus adenocarcinoma. A high index of suspicion is required, especially in patients who have had a previous history of colorectal carcinoma.

Prehabilitation and Its Role in Geriatric Surgery.

As the world's population ages rapidly, many elderly people are living to a much more advanced age than before. Consequently, medical conditions that require surgical interventions such as solid organ cancers are also getting more common. While young and fit patients may be able to withstand surgical stresses and recover rapidly after operation, older adults may find these challenging.

Use of prefrontal cortex activity as a measure of learning curve in surgical novices: results of a single blind randomised controlled trial.

Background: Neurobiological feedback in surgical training could translate to better educational outcomes such as measures of learning curve. This work examined the variation in brain activation of medical students when performing laparoscopic tasks before and after a training workshop, using functional near-infrared spectroscopy (fNIRS).

Methods And Procedures: This single blind randomised controlled trial examined the prefrontal cortex activity (PFCA) differences in two groups of novice medical students during the acquisition of four laparoscopic tasks.

Complete mesocolic excision for colon cancer: is it worth it?

Total mesorectal excision (TME) has been the miracle surgical technique which has since allowed the outcomes of rectal cancer to surpass that of colon cancer. Complete mesocolic excision (CME) attempts to adopt the same principles as that of TME and apply it to colon cancer surgery. Initial retrospective case series and comparative studies have shown promising oncological outcomes.

Diagnostic and management strategies for lateral pelvic lymph nodes in low rectal cancer-a review of the evidence.

Patients with low rectal cancer who have enlarged lateral pelvic lymph nodes are known to have a worse prognosis. There is however uncertainty over what constitutes a lateral pelvic lymph node of clinical significance. As the main modality for the detection of such lymph nodes is magnetic resonance imaging (MRI), characteristics of these lateral lymph nodes identified may have prognostic value and assist with guiding treatment.

Endoscopic stenting in colorectal cancer.

Acute malignant large bowel obstruction presents as one of the few emergencies of colorectal cancer (CRC). Management of this condition can either be by (I) upfront surgery or (II) the use of self-expanding metallic stent (SEMS) as a bridge to elective surgery. For patients with metastasis, the use of SEMS is reported to enable earlier commencement of chemotherapy.

Journey for patients following ileostomy creation is not straightforward.

Background: An ileostomy is usually created to avert systemic sepsis in a patient with a tenuous anastomosis. However, what is often not reported are the numerous issues facing these patients subsequently, ranging from readmissions, non-reversal of the stoma, and complications from the closure. This study was performed to identify these issues among patients following creation of an ileostomy.

Increased Morbidity and Mortality of Emergency Laparotomy in Elderly Patients.

Background: There is an increasing incidence of elderly patients requiring emergency laparotomy. Our study compares the outcomes of elderly patients undergoing emergency laparotomy against the outcomes of non-elderly patients.

Methodology: Patients who underwent emergency laparotomy between 2015 and 2017 from the National University Hospital, Singapore, were included.

New High-Throughput Screening Identifies Compounds That Reduce Viability Specifically in Liver Cancer Cells That Express High Levels of SALL4 by Inhibiting Oxidative Phosphorylation.

Background & Aims: Some oncogenes encode transcription factors, but few drugs have been successfully developed to block their activity specifically in cancer cells. The transcription factor SALL4 is aberrantly expressed in solid tumor and leukemia cells. We developed a screen to identify compounds that reduce the viability of liver cancer cells that express high levels of SALL4, and we investigated their mechanisms.

Report of the third Asian Prostate Cancer study meeting.

The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016.

Changing Demographic Profiles of Patients With Traumatic Brain Injury: An Aging Concern.

Trauma continues to be a common cause of mortality in Singapore. By understanding the epidemiology of Traumatic Brain Injury (TBI), healthcare professionals can be better equipped to tackle the increasing socioeconomic burden of disease, adopting better strategies in healthcare planning. A retrospective review of 367 patients admitted with TBI to a tertiary medical institution from January to December 2014 was performed, studying demographic profiles, injury details and outcomes of these patients.

Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies.

Objective: The aim of the study was to assess the impact of pouch reconstruction on perioperative outcomes, postprandial symptoms, nutritional and anthropometric parameters, and overall quality of life after total gastrectomy for gastric malignancy.

Summary Background Data: The short-term perioperative risks and longer term functional value of creating a small-bowel reservoir after total gastrectomy are contended.

Methods: A search for randomized and non-randomized studies comparing reconstruction with or without a pouch was conducted.

Big data and machine learning algorithms for health-care delivery.

Analysis of big data by machine learning offers considerable advantages for assimilation and evaluation of large amounts of complex health-care data. However, to effectively use machine learning tools in health care, several limitations must be addressed and key issues considered, such as its clinical implementation and ethics in health-care delivery. Advantages of machine learning include flexibility and scalability compared with traditional biostatistical methods, which makes it deployable for many tasks, such as risk stratification, diagnosis and classification, and survival predictions.

Adherence to surveillance guidelines following colonic polypectomy is abysmal.

Background: Surveillance guidelines following excision of colonic tubular adenomas are well established. However, adherence to the guidelines are rarely audited. The aim of our study was to evaluate the rate of compliance to the recommended guidelines following polyp removal.