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Introduction: There are standard treatment guidelines for the surgical management of rectal cancer, that are advocated by recognized physician societies. But, owing to disparities in access and affordability of various treatment options, there remains an unmet need for personalizing these international guidelines to Indian settings. Methods: Clinical Robotic Surgery Association (CRSA) set up the Indian rectal cancer expert group, with a pre-defined selection criterion and comprised of the leading surgical oncologists and gastrointestinal surgeons managing rectal cancer in India. Following the constitution of the expert Group, members identified three areas of focus and 12 clinical questions. A thorough review of the literature was performed, and the evidence was graded as per the levels of evidence by Oxford Centre for Evidence-Based Medicine. The consensus was built using themodified Delphi methodology of consensus development. A consensus statement was accepted only if =75% of the experts were in agreement. Results: Using the results of the review of the literature and experts' opinions; the expert group members drafted and agreed on the final consensus statements, and these were classified as "strong or weak", based on the GRADE framework. Conclusion: The expert group adapted international guidelines for the surgical management of localized and locally advanced rectal cancer to Indian settings. It will be vital to disseminate these to the wider surgical oncologists and gastrointestinal surgeons' community in India. [ABSTRACT FROM AUTHOR]

Small bowel transplants are performed all over the world with acceptable success rates. Although there are isolated reports of small bowel transplants from India, a robust intestinal transplant programme similar to western countries is lacking. Our aim is to share our experience to build up on the evolving field of small bowel transplants in India. Deceased donor small bowel transplant was performed for three patients with intestinal failure, two for short gut syndrome following surgery and one for visceral myopathy. All were on preoperative total parenteral nutrition for varying periods of time (6 to 13 months). There were multiple episodes of line sepsis in all patients. Post-transplant, all received induction immunosuppression with anti-thymocyte globulin (first two patients) or alemtuzumab (3rd patient). All had systemic venous drainage and stoma. Protocol weekly intestinal biopsies were done in all patients. All died in hospital at 24, 12 and 28 days following surgery. Biopsy-proven rejection was observed in only patient who had received ABO-compatible non-identical graft (O to A). This patient subsequently developed vascular thrombosis necessitating explant of the graft. Sepsis due to multidrug resistant bacteria was the reason for mortality in the remaining two patients. Despite the absence of technical complications, successful small bowel transplant seems to be an elusive entity for the Indian transplant community. [ABSTRACT FROM AUTHOR]

AIMS: To audit the information content of the pathology report on Low Anterior Resection (LAR) specimens and to provide recommendations in order to improve the existing standard of reporting. MATERIALS AND METHODS: All the reports of LAR specimens during 2004 – 2005 were collected from the Hospital Information System (HIS). Individual items of information were compared with the minimum data sets provided by the Royal College of Pathologists (RCP). RESULTS: Fifty–nine reports were audited. Nineteen percent of the reports were classified as satisfactory. Although many items were well reported, only 30.5% (18/59) of the reports contained a statement on the completeness of excision at the circumferential resected margin and only 25.4% of all reports mentioned the relation of tumors to the peritoneal reflection. CONCLUSION: The information content of the reports on colorectal cancer resection specimens is inadequate. The use of the standard proforma (template) for reporting rectal cancer is therefore recommended, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management. [ABSTRACT FROM AUTHOR]

Introduction- The incidence of Gastroesophageal junction (GEJ) adenocarcinoma is increasing rapidly. Data separately on GEJ tumors management is rare. Objectives- to evaluate the clinicopathological characteristics of GEJ tumors, to compare two modalities of treatment- Neoadjuvant treatment followed by surgery(group-N) and upfront surgery(group-S) in GEJ tumors in terms of recurrence and survival. Materials and methods- Records of all the patients diagnosed and treated with curative intent as GEJ tumors as per Siewert classification, between 2005-2013 were reviewed. Patients of age above 18yrs, ECOG PS 0, 1, 2, clinical, radiological, endoscopic and histologically proven GEJ tumor limited loco-regionally were included. Kaplan-Meire graph utilized to calculate survival and recurrence pattern. Chi-square(X2) test used to assess association between clinico-pathological parameters and outcome. The comparison of survival and recurrence rate was computed by log rank test. Results- Among 68 eligible patients group-S were 43(63.2%) and group-N 25(36.8%). Predominant histology was adenocarcinoma (85?ch). Group-N received either neoadjuvant chemotherapy-19(76%) or concurrent chemoradiation-6(24%). Surgery in both groups was Ivor- Lewis 52(76.4%) or Minimally invasive Mckeowns 16(23.6%). Median follow-up period was 21months. In group-S, high grade tumors had worse survival (OS-grade III 20 months Vs grade I, II 36 months. p-0.015). No clinico-pathological factors affected outcome in group-N. In group-N 5/25(20%) had grade 3 toxicity. Severe postoperative complications occurred 10(23%) in group-S and 4(16%) in group-N. Group-N has higher DFI (17.5months) and OS (30.5 months) compared to group-S (DFI 14months; OS 21.5months) but without statistical significance (p-0.56 and p-0.83 respectively.) Conclusion- In our single institute study, improved recurrence free period and survival with neoadjuvant treatment over primary surgery group in the management of GEJ carcinoma is not reflected statistically. Further prospective randomized studies are required to assess the effect of neoadjuvant therapy in GEJ tumors. [ABSTRACT FROM AUTHOR]

Introduction: In live donor liver transplantation (LDLT), bile duct division is a critical step in donor hepatectomy. Biliary complications hence are a feared sequelae even among donors. Long term data on biliary complications in donors from India are sparse., Methods: Prospective evaluation of 452 live donors over 10 years was performed to ascertain the incidence & risk factors of clinically significant biliary complications., Results: Of the 452 donor hepatectomies (M: F = 114:338, median age = 38), 66.2% (299) were extended right lobe grafts, 24.1% (109) modified right lobe and 9.7% (44) were left lobe grafts. Portal vein anatomy was Type-I in 85% (386), Type-II in 7.5% (34) and Type-III in 7.1% (32). Following donor hepatectomy, a single bile duct opening occurred only in 46.5% (210) of the grafts. Of the remaining 53.5% grafts, 2 ductal openings were noted in 217 (48%) and three ductal openings in 25 (5.5%). Incidence of multiple openings in the duct were more commonly noted in Type II (70.6%) and III (75%) portal vein anatomy than in grafts with Type I (50.4%) portal anatomy (P = 0.001) Bile leak was noted in 15 (3.3%) donors which included one broncho-biliary fistula and bilio-pleural fistula. Analysis revealed no association between post-operative biliary complications and type of graft, portal vein anatomy or biliary anatomy. There was a single mortality in this series secondary to biliary sepsis. On long term follow, there were no biliary strictures in any of the patients., Conclusions: Biliary complications although rare (3.3%), present significant peri-operative morbidity to the donors., (Copyright © 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Congenital esophageal duplications represent about 15% of digestive tract duplications. We report a 38-year-old man who presented with longstanding heartburn and recent dysphagia. Endoscopy showed communicating tubular duplication of lower esophagus with ulceroproliferative growth at the gastric cardia extending into the lower esophagus. Histology of radical esophagogastrectomy specimen showed poorly differentiated adenocarcinoma of gastric cardia without evidence of Barrett's esophagus.