Background and Objectives: The COVID-19 pandemic has wreaked havoc in the healthcare infrastructure. While we change our surgical practice, cancer care will take a toll on unprecedented long-term outcomes. We elucidate our experience that has unfolded during this period. Methods: This study included retrospective data of patients being treated for colorectal cancer and peritoneal surface malignancy between January and May 2020. We compared the treatment changes before and after the national emergency was declared. Results: There was a 65% decrease in outpatients with a 90% drop in endoscopy procedures. Treatment protocols were changed with a 200% increase in short course radiation in rectal cancer. Colon cancer and anal melanoma were triaged to undergo 'essential' surgery. No robotic or exenteration procedures were performed in April and May. Patients with a low peritoneal cancer index underwent surgery alone. The relative number of emergency surgeries were unchanged. Conclusion: There is no standard approach to deliver cancer care during the COVID-19 pandemic. Treatment decisions were made based on the state of affairs that COVID-19 had created during that cross-section of time and protocols were redrawn to strike a balance between the risk of death from colorectal cancer and the risk of death from COVID-19 infection.

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Adenoid cystic carcinoma (ACC) of breast is a rare tumour with a low malignant potential. Though negative for oestrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (Her2/neu), it is different from triple negative breast cancer (TNBC); ACC has an indolent course with a good prognosis.We present a case of a 40 year old premenopausal female initially diagnosed with ductal carcinoma in situ (DCIS) on core needle biopsy. She underwent breast-conserving surgery (BCS) and her final histopathological diagnosis was ACC. She subsequently underwent adjuvant external beam radiotherapy. The patient is on follow-up for more than a year with no recurrence till date.

The health services across the world have been deeply impacted by the ongoing COVID-19 pandemic which has resulted in diversion of resources to testing, isolating and treating COVID-19 patients. This meant cutting down resources and manpower away of various healthcare facilities and severely hampering the functioning of various cancer services across the world. It is however, important to understand, cancer itself is a life-threatening condition, and there is a need to continue running cancer care services, at least for those who needed the most. Various clinical societies have put forward guidelines and protocols to help continue surgical services during the pandemic. The role of minimally invasive surgery (MIS) was initially questioned at the start of the pandemic, however gradually increasing evidence favored MIS as it reduced hospital stay and complication. Enhanced recovery programs which have been introduced to various fields of surgery to improve outcomes and reduce hospital stay. It plays an essential role in times like this, where the optimal usage of minimal resources is essential. We embraced these methods to ensure safety of our patients and staff and at the same time provide the highest standards of care. Here we are presenting our experience of running a colorectal surgical unit during these difficult times with emphasis on promotion of minimally invasive surgery, at the epicenter of the pandemic in India.

colic insertion (Fig. 3). An articulating linear stapler (EziSurg Medical Co., Shanghai, China), introduced through the D-Port, was used to section the sigmoid colon just below the circular anvil (Fig. 4). The rectal stump was closed by a laparoscopic transanal pursestring suture, keeping the spike of the anvil in the centre of the suture. The circular stapler was introduced transanally and a side-to-end anastomosis was performed. The anastomosis was finally checked by contrast-enhanced indocyanine green perfusion (Video S1 in the online Supporting Information). The operating time required for the described step was 93 min. The postoperative course was uneventful, and the patient was discharged after 6 days. At followup, no anastomotic complications were recorded. Different colorectal anastomoses can be performed during TaTME. The technique described here can be considered as one of the laparoscopic options.

We present a stepwise approach to performing laparoscopic anterior resection along with Total Mesorectal Excision (TME). The video illustrates a modular approach for set up and resection, performed on a 68-years old female patient with low rectal cancer. We have divided the procedure into its key steps, which include: patient position, port placement and anatomical exposure, medial to lateral dissection and vessel control, lateral and splenic flexure mobilisation, TME and division and anastomosis of the rectum. We have included animated graphics highlighting key regional anatomy. We also believe that using monopolar hook diathermy allows precise dissection and helps in the clear demonstration of surgical planes. This is valuable when teaching the steps of the surgery to trainees.

Small bowel neuroendocrine tumours (SBNETs) are increasingly prevalent in surgical practice, with approximately 0.67 cases per 100 000 population in the United States [1]. Patients with SBNETs often present at an advanced stage, when obstruction, pain, bleeding and symptoms associated with metastatic carcinoid syndrome arise. The gold-standard surgical management of SBNETs is an exploratory laparotomy and resection, with thorough palpation of the entire jejunum and ileum to identify subcentimetre multifocal tumours [2]. Although minimally invasive surgical techniques are discouraged as primary interventions for SBNETs, they may prove useful in continued management of these cases and their potential complications [3]. A 67-year-old woman with an asymptomatic right lower quadrant mass underwent an open ileocolic resection with stapled side-to-side anastomosis. Pathology revealed a 2 cm low-grade neuroendocrine tumour (T3N1, < 2% Ki67) and her postoperative course was complicated by prolonged ileus. Six weeks later, she presented to the emergency department with abdominal pain, nausea and vomiting, but was otherwise haemodynamically stable. Work-up involved a CT scan and small bowel series as there was concern about obstruction, and a robotic evaluation of the anastomosis was performed (Video S1). Upon visualization of the anastomosis, a contained leak was noted, surrounded by many interloop adhesions between oedematous loops of bowel. Utilizing the fourth robotic arm for retraction and exposure, sharp dissection was used to lyse adhesions and mobilize the anastomosis. An intracorporeal isoperistaltic side-to-side anastomosis was then constructed, and perfusion was checked with indocyanine green. The postoperative course was uncomplicated, and the patient was discharged on postoperative day 5. Follow-up 1 year later showed no recurrence.

BACKGROUND Nutrients form the fuel for the body, which comes in the form of carbohydrates, proteins and lipids. The body is intended to burn fuels in order to perform work. Starvation with malnutrition affects the postoperative patients and patients with acute pancreatitis. There is an increased risk of nosocomial infections and a delay in the wound healing may be noted. They are more prone for respiratory tract infections. Enteral Nutrition (EN) delivers nutrition to the body through gastrointestinal tract. This also includes the oral feeding. This study will review the administration, rationale and assess the pros and cons associated with the early initiation of enteral feeding. The aim of this study is to evaluate if early commencement of enteral nutrition compared to traditional management (delayed enteral feeding) is associated with fewer complications and improved outcome- In patients undergoing elective/emergency gastrointestinal surgery.  In patients with acute pancreatitis. It is also used to determine whether a period of starvation (nil by mouth) after gastrointestinal surgery or in the early days of acute pancreatitis is beneficial in terms of specific outcomes.