Surgical Outcomes Associated with Operable Gastric Cancer in a Tertiary Care Indian Hospital

PURPOSE: Data on operable gastric cancer from India is sparse. The purpose of this study was to investigate the clinical details, histopathological demographics, and 5-year overall survival (OS) and disease free survival (DFS) associated with operable, non-metastatic gastric cancer in a dedicated upper gastrointestinal (GI) surgical unit in India. MATERIALS AND METHODS: Data for patients diagnosed with operable gastric cancer between January 2006 and December 2014 were retrospectively analyzed. Data were collected from electronic hospital records in addition to mail and telephonic interviews when possible. RESULTS: A total of 427 patients were included. The tumor was located in the pyloro-antral region in 263 patients (61.7%). Subtotal gastrectomy was performed in 291 patients and total gastrectomy in 136 patients. Tumor stage classification revealed 43 patients (10.0%) with stage I, 40 patients (9.4%) with stage IIA, 59 patients (13.9%) with stage IIB, 76 patients (17.8%) with stage IIIA, 96 patients (22.5%) with stage IIIB, and 113 patients (26.4%) with stage IIIC disease. Follow-up data were available for 71.6% of the patients with a mean duration of 32.4 months. Five-year DFS and OS were 39% and 59%, respectively. CONCLUSIONS: Despite presenting at an advanced stage, the 5-year DFS and OS of patients with operable gastric cancer treated at a dedicated upper GI unit of a tertiary care center in India was good.

Gastrointestinal Stromal Tumours: Review of 150 Cases from a Single Centre.

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract. They constitute a significant percentage ranging from 1-2 % of all the gastrointestinal neoplasms [11]. Knowledge on the molecular biology and behavior of these tumours is still not very clear. The clinicopathologial features are variable and surgical resection with chemotherapy is the main modality of treatment. We have retrospectively analyzed the clinicopathological features, treatment and prognosis of 150 patients managed in the Department of Surgery. Retrospective review of the records of 150 patients diagnosed with gastrointestinal stromal tumours and managed during the period January 2006 to December 2011. Clinicopathological features, immunohistochemistry, mitotic index, surgical resection adjuvant chemotherapy and survival analyzed. One hundred and fifty patients diagnosed with GIST and treated were reviewed. Ninety five of them were males (63.3 %). The tumour was most commonly seen during the fourth and fifth decades of life. Abdominal pain (52 %), intestinal bleeding (40 %) and abdominal mass (25 %) were the common clinical symptoms. Sixty percent of the tumours (90/150) were located in the stomach followed by small bowel (20 %) and duodenum (14.6 %). One hundred and thirty-five patients underwent excision of the tumour and five patients had multi organ resection of the adjacent organs like spleen, tail of the pancreas and kidney. Fifteen patients (10 %) received neoadjuvant Imatinib for down staging of the tumour prior to surgery. The tumour size ranged from 1 to 34 cm. One third of the tumours (42/150) belonged to the high-grade category. KIT protein (CD117) was positive in 90 %( 135/150), while CD34 was positive in 50 % (74/150) of tumours. Majority of the patients with high and intermediate-risk category received adjuvant Imatinib (65/77). Seventeen patients (11.3 %) developed recurrence of the tumour on follow-up and rest of the patients had stable disease. Eight of the 15 patients (53 %) who had advanced disease developed recurrence of the disease over 6 months to 1 year. Fifteen patients died on follow-up between 2 and 5 years. Gastrointestinal tumours are the most common non epithelial tumour of the GIT. GISTS are found to show a male preponderance and are common during the fourth and fifth decades. Abdominal pain and intestinal bleeding are the most common clinical presentation. Most of the tumours were located in the stomach. Surgical resection is the best modality of treatment for operable lesions. Tyrosine kinase receptor (KIT) inhibitor like imatinib is used for adjuvant treatment. Regular follow-up with ultra sonogram or computed tomogram helps in diagnosing disease recurrence.

Blue rubber bleb nevus syndrome: a rare cause of chronic gastrointestinal bleed in adults

Blue rubber bleb nevus syndrome (BRBNS) is a rare condition characterised by venous malformations in the skin, gastrointestinal tract and other parts of the body. Its presentation is usually sporadic, although cases of autosomal dominant inheritance have been reported. Usually seen in children, BRBNS presentation in adults is rare. Symptoms at presentation depend on the organs involved; patients with BRBNS may present with acute or chronic gastrointestinal bleed. We herein report a rare presentation of BRBNS in an adult who suffered from intermittent abdominal pain and melaena for three years. Contrast-enhanced computed tomography revealed a jejunojejunal intussusception with a vascular malformation as the lead point. The patient underwent laparotomy with resection of the intussuscepted bowel segment. Recovery was uneventful. In spite of a wide range of therapeutic options for the management of BRBNS described in the literature, the efficacy of those available therapies, including surgical excision, is not well established.