PLR may be useful to differentiate PDAC from benign IHM in patients with chronic pancreatitis.

The post-surgical complications and oncological clearance of LRR done with low-tie IMA and selective D3 lymphadenectomy were found equivalent to ORR. Low-tie IMA without routine splenic flexure mobilisation had no technical issues regarding the anastomosis.

This study aims to assess quality of life (QoL), functional outcome, and social impact following ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) since Indian data is limited. Data was collected prospectively from patients who underwent IPAA for UC or FAP from 2004 to 2013. QoL and functional outcome at 1, 3, and 5 years after surgery, return to work, and change of job (social impact) were documented. QoL was assessed using the validated Cleveland Global Quality of Life (CGQL) score, the normal score being 1.0. Twenty-five patients were analyzed. Mean CGQL scores before surgery and at 1, 3, and 5 years were 0.5, 0.63, 0.73, and 0.8, respectively. FAP patients had better scores at 3 and 5 years. Only 40 % returned to same job. Sixty-four percent returned to work within a year. The median number of bowel movements per 24 h was less for FAP patients at 3 and 5 years. UC patients on long-term steroids had poorer function at 3 years. Long-term QoL and functional outcomes following IPAA are acceptable. Initial deterioration in QoL, mainly in FAP and long-term adverse social impact in both groups should not be underestimated. UC patients on long-term steroids showed delayed improvement in pouch function.

Background: Laparoscopic Cholecystectomy one of the commonest procedures performed worldwide isn't spared from the risks of disastrous iatrogenic complications. In patients with obscured anatomy, the idea of performing a safe total cholecystectomy can be hindered with a high risk of biliovascular injuries. In such a situation STC (subtotal cholecystectomy) comes to the rescue, where the diseased organ can be tackled fairly, without any further damage. Aims and Objectives: The primary aim was to look at the immediate and long-term outcomes of subtotal cholecystectomy. Subgroup analysis was done based on demographics, indications and surgical approach. Materials and Methods: We reviewed our prospectively maintained computerized operation database over nine years. STC was defined as leaving behind any portion of gallbladder other than the cystic duct. They were subclassified as per the description given by Palanivelu. Patients were evaluated with laboratory and radiological assessment. Results: A total of 70 out of 602 patients (11.6%) underwent STC. Dense adhesion at the calot's was the most important reason for STC. Subtype B was the most common. Nine patients (12.85%) had a bile leak in the postoperative period. There were no biliary/vascular injuries and 30-day mortality was zero. 22.8% developed SSI (surgical site infection). Over a median follow up of 38 months (range 5-98), clinical examination, LFT and USG revealed no abnormality in any of the patients. Conclusion: Subtotal cholecystectomy is a useful alternative during difficult gallbladder surgery. It should be considered early into the procedure preferably prior to conversion to an open procedure. Biliovascular injuries can be avoided and the Immediate and long-term outcomes are acceptable.

High-grade PanIN-3 lesions showed significant association with pancreatic malignancy. Obstructive jaundice and CA 19-9 ≥ 137.5 could predict PanIN positivity.

No abstract

Gold described a nomogram for prediction of recurrence-free survival (RFS) after surgery for gastrointestinal stromal tumors (GIST). This retrospective study was intended to evaluate the utility of this nomogram for predicting a 2-year RFS in our patients. Twenty-eight consecutive eligible patients from January 2009 to January 2013 who underwent R0 resection and had histopathologically proven GIST were included in the study. Nomogram predicted RFS was compared with observed RFS in four groups as in the National Institutes of Health (NIH)-Fletcher classification. Calibration was assessed by plotting the predicted probabilities of RFS against the actual outcome. For validation of the nomogram, the graph obtained should be closer to the 45-degree line. The observed overall 2-year RFS was 85.7 % (24 patients). Four patients had recurrence within 2 years. The observed RFS was 87.5 %, 77.8 %, 90 %, and 100 % in the high, intermediate, low, and very low risk groups, respectively. The nomogram predicted the 2-year RFS was 40 %, 84.8 %, 88.6 %, and 90 % for high, intermediate, low, and very low risk groups, respectively. Thus, the predicted probabilities of the 2-year RFS in intermediate, low, and very low risk groups were similar to the observed outcomes. However, for the high risk group, the observed RFS was better than predicted RFS. This variation in the high risk group may be due to the use of adjuvant imatinib in our study.

When chronic pancreatitis (CP) presents with obstructive jaundice, though there is a risk for malignancy, possibility of benign biliary stricture should also be considered on treatment planning. Imaging and tumour markers have limitations in distinguishing benign and malignant lesions in CP. Here, MRI has effectively picked up a mass lesion as the cause for obstructive jaundice in CP; the patient underwent pancreaticoduodenectomy and the histopathology proved it as adenocarcinoma in CP.