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The objective of the study is to investigate the benefits of pathological assessment of donuts removed during coloanal anastomosis after anterior resection. Methodology During three years, 220 patients underwent circular stapled anastomosis. It is a retrospective study with convenient sampling. Involvement of donuts, the involvement of margins, length of donuts, and margins were primarily recorded. Ethical review approval was taken from the Institutional Review Board. Hospital electronic system was used to retrieve the data.

Objective: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. Method: The retrospectively study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. Results: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). Conclusion: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome. Key Words:  Breast cancer, Breast conserving surgery, 5-year disease free survival, 5-year overall survival Continuous...

0.24). 11(34.4%) & 4 (20%) had endocrine insufficiency in dunking and duct to mucosa groups respectively (P=0.21). Endocrine insufficiency was significantly higher in adjuvant chemoradiotherapy group (P=0.04). The relative risk of developing nutritional impairment in presence of severe pancreatic exocrine insufficiency was 2.68. Conclusion: Exocrine and Endocrine dysfunction post PD can occur irrespective of the type of pancreatic anastomosis and is comparable between the two groups. There appears to be a significant risk of nutritional impairment post PD.

Introduction Peritonitis secondary to gastrointestinal perforation causes high morbidity and mortality rates in the emergency department with an immediate need for surgical intervention. Despite improved surgical management procedures, patients are still suffering from gastrointestinal leak causing peritonitis that demands surgical management by highly skilled surgeons in high-quality surgical units. Material and methods This paper presents one year of experience in the surgical treatment of gastrointestinal perforation-related peritonitis by surgeons in Lahore General Hospital, Lahore, Pakistan. Data was retrospectively collected from patient records and quantitatively analyzed. Involved patients developed peritonitis secondary to gastrointestinal perforation requiring surgical exploration and interventions in the emergency department between November 2020 and October 2021. Results One hundred and fifty-eight patients were involved; the mean age was 43.46 years. The number of males was 87 (55.06%). The patients mostly presented with generalized abdominal pain (57.6%). All the patients had perforation-related peritonitis, which was most prevalent in the ileum (62%). The most performed surgical intervention was loop ileostomy (36.71%). Compared to other published reports, the incidence rate of wound dehiscence in the hospital was relatively higher. Postoperatively, wound infection was low if the skin was left open (23.62%) compared to closed skin (38.7%). Patient outcomes were acceptable as the death rate was low (3.2%, 5/158). Conclusion Peritonitis caused by gastrointestinal perforation is associated with a high risk of morbidity that necessitates surgical exploration. Leaving skin wound open after the surgical intervention is recommended to decrease the incidence of wound infection and dehiscence.

Objectives: Extra Levator Abdominoperineal Excision (ELAPE) is an emerging technique for the management of locally advanced distal rectal cancers. Current evidence suggests that this technique is associated with better oncological outcomes and hence survival. Extra levator abdominoperineal excision is associated with significant perineal complications both in short and long term. The objective of the current study is to emphasize on the early wound complications of the above-mentioned procedure. Study Design: It was a retrospective observational study with continent sampling. Place and Duration of Study: The study was conducted at department of Surgical Oncology Shaukat Khanum Memorial Cancer Hospital & Research Center Lahore, Pakistan. The study period was from 1st January 2014 to 31st December, 2019. Patients and Methods: A total of 84 patients were included in the study who underwent extra levator abdominoperineal excision (ELAPE). All patients undergoing extra levator abdominoperineal excision during the said period were included. Results: A total of 84 patients underwent Extra Levator Abdominoperineal Excision between January 2014 and December 2019. Wound infection was observed in 32 (38.09%) of the patients. Wound dehiscence was seen is five patients. Median day of detection of infection was day 10 (5-22). Median hospital stay was 7 (4-22) days. Conclusion: Extra Levator Abdominoperineal Excision is a procedure with significant perineal wound complication rate. The occurrence of perineal wound complications is multifactorial. Judicial use of the procedure is warranted

Objective: To review the impact of age on perioperative and postoperative outcomes in patients following pancreaticoduodenectomy. Method: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2014 to December 2018 of all patients who underwent pancreatoduodenectomy. Postoperative morbidity and oncological outcomes were compared between patients aged  60 years in group A and those aged >60 years in group B. Data was analysed using SPSS 20. Results: Of the 161 patients, 103(64%) were males and 58(36%) were females.  There were 117(73%) patients in group A; 72(61.5%) males and 45(38.5%) females with an overall mean age of 46±11 years. The remaining 44(27%) were in group B; 31(70.5%) males and 13(29.5%) females with an overall mean age of 67±05 years.The most common pathology was adenocarcinoma 130(81%), commonest site was periampullary 85(53%) and the most common pancreatic reconstruction technique employed was pancreaticogastrostomy 110(68%). Patients in group B had significantly higher comorbidities compared to those in group A (p<0.05). Estimated blood loss during surgery was significantly higher in group B (p=0.004). There was no significant difference in overall morbidity (p=0.856), reoperation (p=1.000), 30-day readmission rate (p=0.097), 90-day mortality rate (p=0.324)) and overall survival (p=0.551) between the groups. Conclusion: Pancreatoduodenectomy could be performed in the elderly with comparable morbidity and oncological outcomes as younger patients. Comorbid conditions remained higher in elderly patients and preoperative optimisation may help improve postoperative outcomes. Key Words: Pancreatoduodenectomy. Outcomes in elderly, Age, Morbidity.

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