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Background and Study Aims: Self-Expanding Metallic Stents (SEMS) are a surgery-sparing option for malignant colonic obstruction. They can be inserted as a "bridge to surgery" (BTS) for potentially curable disease, or as a palliative measure, thereby avoiding the higher morbidity and mortality associated with surgery. The objective of this study was to report our local experience of left-sided colonic stents., Methods: Data on 49 patients was collected retrospectively from Oct 2008 to Nov 2014 at our cancer centre. This included demographics, baseline clinical characteristics, indications for SEMS placement (bridge to surgery/palliative), technical and clinical success, complications, and the mean patency of duration. Survival in both groups was also plotted on a Kaplan-Meier chart., Results: A total of 49 patients with colorectal carcinoma (CRC) of the left side were enrolled. The mean age was 50 years (range 18-86). Ninety percent of patients had disease involving the rectum, sigmoid colon, or both. Forty-seven percent (n = 23) of patients had stent insertion as a BTS, whereas 53% (n = 26) had the procedure with palliative intent. Technical and clinical success rates were 96 and 88%, respectively. The clinical success rate of the palliative arm was lower than that of the BTS arm (p = 0.024). 87.5% (n = 42) had no procedure-related complications. Technical failure, perforation, and stent migration/expulsion, were each observed in 4% of cases. Mean stent patency duration was 83.9 days., Conclusion: SEMS insertion for left-sided malignant colonic obstruction is a safe and effective procedure when used either as a bridge to surgery or with palliative intent.

Background: There are scarce data regarding the impact of diabetes mellitus on the prognosis of hepatocellular carcinoma managed conservatively. The objective of this study was to compare the overall survival among diabetic and non-diabetic patients suffering from hepatocellular carcinoma and treated mainly by non-surgical means., Methods: We identified patients who underwent treatment for hepatocellular carcinoma over a period of 6.5 years at a single center in Lahore, Pakistan. Data regarding age, gender, morphology of tumor, size of tumor, Child-Pugh class, the Barcelona-Clínic Liver Cancer (BCLC) stage, treatment given, and outcome was retrieved from the medical records. Patients were classified as diabetic if there were at least two documented readings of fasting blood glucose level of more than 126 mg/dl or random blood glucose of more than 200 mg/dl or the patient was already diagnosed and on oral hypoglycemic agents or insulin. Statistical tests were applied to test for differences between diabetic and non-diabetic patients in terms of clinical features at presentation, treatments received, and disease outcomes., Results: A total of 282 patients were diagnosed as having hepatocellular carcinoma during the study period. Diabetic and non-diabetic patients were comparable in terms of the mean age at diagnosis of hepatocellular carcinoma, sex, whether the tumor was unifocal or multifocal, Child-Pugh class, BCLC stage, and infection with hepatitis B and/or C virus. Diabetic patients were significantly more likely to have initial alpha-feto protein levels lower than 200 IU/ml compared to non-diabetic patients. There was no difference among diabetic and non-diabetic patients in terms of the treatments they received or the outcomes. Non-diabetic and diabetic patients had a mean disease-free survival of 8.29 and 6.95 months, respectively, and overall survival of 15.48 and 15.36 months, respectively. Multivariate linear regression analyses, after adjusting for age and gender of the patient and the BCLC stage of the tumor among the subset of patients documented to have died during the follow-up period, showed that there was no significant difference between diabetic and non-diabetic patients in terms of overall survival. BCLC stage, however, was significantly associated with overall survival., Conclusion: Diabetes mellitus has no prognostic significance in patients with hepatocellular carcinoma.

Aim: Dysphagia, with associated malnutrition is a common feature in up to 64 % of patients with cancers of the head and neck region, the oesophagus and the gastro-oesophageal junction (Donaldson and Lenon Cancer 43(Suppl 5):2036-52, 1979). These patients usually require alternate routes of feeding during treatment. However, these methods of feeding are not without associated complications. This study was carried out to assess the complications associated with percutaneous endoscopic gastrostomy tube insertion, the commonest means of providing nutrition in this patient group., Methods: Two hundred and sixty patients with successful percutaneous endoscopic gastrostomy (PEG) tube insertion were retrospectively reviewed to assess the complications of the procedure., Results: The overall complication rate was 25 % (65 patients). Fifty-five patients (21 %) patients had minor complications. Ten patients (3.8 %) suffered a major complication, including peritonitis and major peri-PEG infection each in three patients (1.2 %), while oesophageal perforation, collection around the PEG insertion site requiring operative drainage, bleeding from the PEG insertion site and tumour seeding at the gastrostomy site were each seen in one (0.4 %) patient., Conclusion: Percutaneous endoscopic gastrostomy tube insertion is a useful means of providing enteral nutrition to patients with swallowing problems. Patients with head and neck cancer who are likely to develop dysphagia should be assessed promptly for PEG tube insertion before the start of radiation. Early recognition and prompt treatment of serious complications can avoid potential fatality associated with PEG tubes.