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Extended pancreatic resections and lymphadenectomy:An appraisal of the current evidence

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World Journal of gastrointestinal Surgery 2010年第2期2卷 39-46页

作者： Shailesh V Shrikhande savio g barreto Department of Hepato-Pancreato Biliary Surgical Oncology Tata Memorial Hospital Department of general and Digestive Surgery Flinders Medical Centre and Flinders University

Surgery remains the mainstay of treatment for pancreatic ductal adenocarcinoma and complete removal of the cancer confers a definite survival advantage,especially in early disease.However,the majority of patients do not present with early disease,thus precluding the chance of a cure by standard pancreatoduodenectomy(PD),distal pancreatectomy or total pancreatectomy.For this reason,pancreatic surgeons have attempted to push the limits of resection over the last three decades.The aim of these resections has been to determine whether obtaining a complete resection by extending the limits of conventional resection in patients with advanced disease will yield the results seen with PD alone in early disease.This article revisits the data from such studies in an attempt to determine if the available literature supports the performance of extended resections for pancreatic cancer in terms of improvement of survival.

关键词： Pancreas Cancer Vein Lymphadenectomy Artery Reconstruction

Cell-type specificity of β-actin expression and its clinicopathological correlation in gastric adenocarcinoma

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World Journal of gastroenterology 2014年第34期20卷 12202-12211页

作者： Shafqat A Khan Monica Tyagi Ajit K Sharma savio g barreto Bhawna Sirohi Mukta Ramadwar Shailesh V Shrikhande Sanjay gupta Epigenetics and Chromatin Biology group Cancer Research InstituteAdvanced Centre for Treatment Research and Education in CancerTata Memorial CentreKhargharNavi MumbaiMH 410210India gastrointestinal and Hepato-Pancreato-Biliary Service Department of Surgical OncologyTata Memorial HospitalTata Memorial CentreMumbaiMH 400012India Medanta Institute of Hepatobiliary and Digestive Sciences MedantaThe MedicityGurgaonHaryana 122001India Medical Oncology-gI and Breast Unit Tata Memorial HospitalTata Memorial CentreMumbaiMH 400012India Department of Pathology Tata Memorial HospitalTata Memorial CentreMumbaiMH 400012India

AIM:To investigate cell type specific distribution ofβ-actin expression in gastric adenocarcinoma and its correlation with clinicopathological parameters.METHODS:β-actin is a housekeeping gene,frequently used as loading control,but,differentially expresses in cancer.In gastric cancer,an overall increased expression ofβ-actin has been reported using tissue disruptive techniques.At present,no histological data is available to indicate its cell type-specific expression and distribution pattern.In the present study,we analyzedβ-actin expression and distribution in paired normal and tumor tissue samples of gastric adenocarcinoma patients using immunohistochemistry(IHC),a tissue non-disruptive technique as well as tissue disruptive techniques like reverse transcriptase-polymerase chain reaction(RT-PCR)and western blotting.Correlation ofβ-actin level with clinicopathological parameters was done using univariate analysis.RESULTS:The results of this study showed significant overexpression,at both mRNA and protein level in tumor tissues as confirmed by RT-PCR(1.47±0.13 vs2.36±0.16;Pg(1.92±0.26 vs 2.88±0.32;Pgnificantly higher expression compared to epithelial cells in normal(2.46±0.13 vs 5.92±0.23,Pg between normal and tumor tissues revealed that both epithelial and inflammatory cells overexpressβ-actin in tumor tissues,however,significant difference was observed only in inflammatory cells(5.92±0.23vs 6.71±0.14,Pgnificant increase(4.19±0.15 vs 4.75±0.14,Pgrade(Pgative correlation(P>0.05).CO

关键词： gastric cancer β-actin Immunohistochemistry Epithe

Surgery for gallbladder cancer:The need to generate greater evidence

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World Journal of gastrointestinal Surgery 2009年第1期1卷 26-29页

作者： Shailesh V Shrikhande savio g barreto Department of gastrointestinal Surgical Oncology Tata Memorial Hospital Department of general and Digestive Surgery Flinders Medical Centre

The outcomes for gallbladder cancer remain largely dismal to this day.Overall,the low incidence of gallbladder cancer around the world coupled with an even lower number of patients amenable to surgery at the time of presentation,has precluded the generation of evidence-based guidelines for the management of this cancer.However,while the incidence of the cancer may be decreasing in some parts of the world,in other countries such as India,Japan and Chile,gallbladder cancer continues to affect a sizeable population of patients.As such,there is a growing need to define what constitutes an adequate surgery for each stage of this cancer,based on sound evidence.This editorial provides a broad overview of the existing problems in the management of gallbladder cancer and appeals for multi-institutional studies aimed at answering some of the pertinent questions on the surgical management of gallbladder cancer.

关键词： Treatment outcome Lymphadenectomy Incidence Survival rate

Screening for colorectal neoplastic lesions following acute diverticulitis: Would a sigmoidoscopy suffice?

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World Journal of Surgical Procedures 2013年第2期3卷 13-17页

作者： Leong Ung Tiong Ryan Jalleh Edward J Travers Thomas Paxton Cecilia Innes-Wong savio g barreto Randall Williams Department of Surgery Modbury Hospital Modbury SA 5092 Australia

AIM: To investigate the yield of colorectal malignant or premalignant lesions during colonoscopy performed following an episode of acute diverticulitis.METHODS: A prospectively maintained electronic database of a public teaching hospital(Modbury Hospital, South Australia) was searched for international classification of diseases codes for acute diverticulitis from July 2007 to June 2011. The electronic database and each patient's medical records were reviewed for demographic data, clinical presentation, investigation results, colonoscopy details and surgical intervention.RESULTS: Two hundred and nineteen patients were diagnosed with acute diverticulitis with a median age of 60 years(range 24-93). One hundred and thirty-nine patients(63.5%) had follow-up screening colonoscopy, with the median interval between the episode of acute diverticulitis and colonoscopy being 8 wk(range: 1-66). Colonoscopy revealed polyps in 21 patients(15%) and no cases of colorectal cancer. Of the 21 patients with polyps, there were 14 patients(10%) with tubular/villous adenomas(13 in rectosigmoid region and 1 in descending colon). CONCLUSION: Detection of colorectal cancer in patients undergoing routine colonoscopy following acute diverticulitis is rare. However, colonic polyps in the left colon are noted. A flexible sigmoidoscopy is an adequate screening tool in such patients. A complete colonoscopy reserved for patients with family history of colorectal cancer or with polyps detected on flexible sigmoidoscopy to evaluate the rest of the colon.

关键词： Polyps Surgery Diverticulitis Colonoscopy Colorectal cancer

Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

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World Journal of Clinical Cases 2021年第13期9卷 3024-3037页

作者： Monish Karunakaran Pavan Kumar Jonnada savio george barreto Department of gastrointestinal Surgery Gastrointestinal Oncologyand Bariatric SurgeryMedanta Institute of Digestive and Hepatobiliary SciencesGurgaon 122001HaryanaIndia Department of Liver Transplantation and Regenerative Medicine Medanta-The MedicityGurgaon 122001HaryanaIndia Surgical Oncology Kidwai Memorial Institute of OncologyBengaluru 560029KarnatakaIndia Division of Surgery and Perioperative Medicine Flinders Medical CenterBedford Park 5042South AustraliaAustralia College of Medicine and Public Health Flinders UniversityBedford Park 5042South AustraliaAustralia

BACKgROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery,including pancreatoduodenectomy(PD).While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay,compliance to these pathways,and their relevance is poorly understood.The aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.AIM To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.METHODS A systematic review of major reference databases was undertaken,according to preferred reporting items for systematic reviews and meta-analysis guidelines,between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD.A meta-analysis was performed using fixed-effects or random-effects models.RESULTS Eleven studies including 1852 patients were identified.Median overall compliance to all components of the clinical pathway was 65.7%[interquartile range(IQR):62.7%-72.3%]with median compliance to post-operative parameters of the clinical pathway being 44%(IQR:34.5%-52.25%).Meta-analysis using a fixed-effects model showed that≥50%compliance to a clinical pathway predicted significantly fewer post-operative complications[pooled odds ratio(OR):9.46,95%confidence interval(CI):5.00-17.90;Pgnificantly shorter length of hospital stay[pooled mean difference(MD):4.32,95%CI:-3.88 to-4.75;Pgnificantly fewer post-operative complications(pooled OR:11.25,95%CI:4.71-26.84;Pgth of hospital stay.Understanding the relevance of deviations to clinical pathways post-PD presents pancreatic surgeons with opportuniti

关键词： Outcomes Morbidity Mortality Quality Surgery Recovery

Borderline resectable pancreatic tumors:Is there a need for further refinement of this stage?

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 319-324页

作者： Shailesh V Shrikhande Supreeta Arya savio george barreto Sachin Ingle Melroy A D'Souza Rohini Hawaldar Parul J Shukla Department of Hepato-Pancreato-Biliary Surgical Oncology Department of Radiology Tata Memorial Hospital Department of Surgery Royal Adelaide Hospital Clinical Research Secretariat

BACKgROUND:The ideal treatment of patients with 'borderline resectable pancreatic tumors (BRTs)' needs to be established.Current protocols advise neoadjuvant chemo(radio)therapy,although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection.The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection,with or without vascular resection (VR),could be achieved.METHODS:Twelve patients with BRTs were identified.Tumor location,maximum degree of circumferential contact (CC),length of contact of the tumor with major vessels (LC),and luminal narrowing of vessels at the point of contact with the tumor (venous deformity,VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR.RESULTS:A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin.Four of the 10 patients required VR (40%).In 3 of the 4 patients whose tumors required VRs,CC was ≥grade III and VD was grade 2.LC did not influence the need for VR.CONCLUSIONS:It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging.Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients,thus avoiding any delay in curative resections in such patients.

关键词： pancreatic head carcinoma pancreatic cancer pancreatic neoplasms resection