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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]

Auxiliary partial orthotopic liver transplantation (APOLT) entails the removal of part of the native liver and replacement with the corresponding part of donor liver. APOLT is usually performed for acute liver failure and metabolic liver disease. However, many technical concerns limit its acceptance globally. In this study, we describe our experience of 6 APOLT performed for acute liver failure. Out of the 68 liver transplants performed in our center for acute liver failure, six were APOLT. APOLT was performed in the setting of hyperacute liver failure with no other organ failure. The recovery of the native liver was assessed using hepatobiliary scintigraphy every six months. Immunosuppressant withdrawal was attempted once 50% recovery of the native liver was attained in the scan. All donors were first-degree relatives. Etiology was hepatitis A in 4 patients, yellow phosphorous poisoning in 1, and cryptogenic fulminant hepatic failure in the remaining 1 patient. Five of them were blood group identical and one was ABO incompatible (AB to A). Post-operatively, three patients died, two due to massive cerebral edema, and one due to sepsis. All the survivors at a follow-up period of 2 years are off immunosuppressants and are doing well. Auxiliary liver transplant in acute liver failure has a poor success rate. However, the technique can be considered in a very selected group of patients with hepatitis A-related hyperacute liver failure. [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]