Real-World Evidence of Porto-Mesenteric Vein Resections with Pancreatectomy and the Development of Predictive Clinical Nomograms for Postoperative Outcomes-An Analysis of 389 Cases: The "Porto-Mesenteric Vein Resection-Indian MulticentrE" (PRIME) Study.

Background: With better surgery and chemotherapeutic agents, borderline resectable or locally advanced pancreatobiliary tumours are being treated with curative intent. This study presents real-world evidence of porto-mesenteric vein resections (PVR) with pancreatectomy and generates predictive nomograms for postoperative mortality (POM) and major complications (MC).

Methods: A retrospective multicentre study, including 11 high-volume centres, evaluated patients undergoing PVR.

Consensus-based recommendations for optimizing perioperative nutritional support and muscle health in major surgery in India.

Background: Malnutrition and sarcopenia significantly affect outcomes in patients undergoing major surgery, leading to increased postoperative complications, prolonged recovery, and higher healthcare costs. Adequate perioperative nutritional support and muscle health optimization are crucial to improving these outcomes. This study aims to provide consensus-based recommendations for integrating perioperative nutritional practices along with the standard of care in patients undergoing major surgery.

Prospective Evaluation of Multimodal Prehabilitation in Esophagogastric Cancer Surgery: Enhancing Patient Outcomes.

Background: The significance of prehabilitation in contemporary esophagogastric surgical procedures is yet to be fully understood, due to heterogeneity in the available research. This research was conducted to assess the impact of a structured home-based multimodal prehabilitation approach on the postsurgical outcomes of patients undergoing surgery for esophagogastric cancer.

Methods: This study was a prospective, nonrandomized investigation carried out on individuals scheduled for curative esophagogastric cancer surgery.

Surgical Management of Postcholecystectomy Strasberg Type E4 Bile Duct Injuries.

Introduction: High-biliary injuries are associated with worse outcomes. Most series do not mention failure rates specific to the injury grade. In our experience, Strasberg E4 injuries are associated with a higher failure rate.

Complete Mesocolic Excision for Colon Cancer: The New Standard of Care?

Complete mesocolic excision (CME) for colorectal cancer builds on the success of total mesorectal excision (TME), the international gold standard for rectal cancer. In TME, removal of the primary tumor along with associated mesocolon and accompanying structures as single intact specimen allows in toto excision of all structures that could potentially lead to dissemination. Recent meta-analysis has confirmed that CME results in better disease-free survival (DFS) and overall survival (OS) rates.

Effect of Multimodal Prehabilitation on Muscle Mass in Rectal Cancer Patients Receiving Neoadjuvant Treatment.

Colorectal cancer is the second most prevalent type of cancer in the world. Surgical complications occur in up to 50% of patients which results in increased morbidity, mortality, and poor health-related quality of life. The negative impact on survival and physical function is exacerbated in those receiving neoadjuvant treatment.

Adjuvant therapy may improve overall survival in high-risk periampullary adenocarcinomas patients - A match-pair analysis from a multi-institutional cohort study (The MIPPAP study).

Background: The role of adjuvant therapy in resected periampullary adenocarcinomas is equivocal due to contrasting data and limited prospective trials.

Methods: The Multicentre Indian Pancreatic & Periampullary Adenocarcinoma Project (MIPPAP), included data from 8 institutions across India. Of the 1679 pancreatic resections, 736 patients with T3/T4 and/or Node positive adenocarcinomas (considered as high risk for recurrence) were included for analysis.

Factors predicting 30-day mortality after pancreaticoduodenectomy-the impact of elevated aspartate aminotransferase.

Purpose: High preoperative bilirubin levels and cholangitis are associated with poor peri-operative outcomes following pancreaticoduodenectomy (PD). However, the impact of deranged preoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on immediate postoperative outcomes is relatively unexplored. We hypothesized that deranged AST and ALT lead to worse postoperative outcomes after PD.

Economic burden of hospital malnutrition: A cost-of-illness model.

Background & Aims: Hospital malnutrition is a highly prevalent condition that leads to an increased risk of clinical complications and a corresponding increase in healthcare resource utilisation. Despite the high prevalence and adverse clinical consequences, limited data are available on the magnitude of the economic burden associated with hospital malnutrition in Asian countries. The aim of the present analysis was to calculate country-specific estimates of the economic burden of hospital malnutrition in Asia.

Can we predict the need for nutritional support following pancreatoduodenectomy?

Background: The practice of routine placement of a tube jejunostomy at the time of pancreatoduodenectomy has given way to a more selective approach. However, the indications of establishing enteral access at the time of surgery remain poorly defined. This study aimed to assess the preoperative and intraoperative factors associated with the need for nutritional support after pancreatoduodenectomy, to guide decision-making for the establishment of intraoperative feeding access.

Enhanced recovery after pancreatoduodenectomy-does age have a bearing?

Introduction: With the proven benefits of enhanced recovery protocols (ERP) after pancreatoduodenectomy (PD), their implementation has become a well-accepted clinical practice across the major pancreatic surgery centres of the world. The impact of age on the execution of ERP has remained an area of ambiguity. The aim of this study was to assess the impact of age on the feasibility of various postoperative elements of ERP after PD.

Successful Outcome of Bariatric Surgery in Living Donor Liver Transplant Recipients With Multidisciplinary Approach: A Preliminary Experience.

Introduction: Liver transplant recipients may develop weight gain, metabolic syndrome, and subsequent nonalcoholic steatohepatitis of the transplanted liver which impairs graft function. Bariatric surgery is an effective modality for management of morbid obesity and metabolic syndrome. Our aim is to review the role of bariatric surgery in such high-risk posttransplant patients not responding to medical management and highlight the important considerations.

A multinational observational study of clinical nutrition practice in patients undergoing major gastrointestinal surgery: The Nutrition Insights Day.

Background And Aims: Patients undergoing major gastrointestinal (GI) surgery, particularly those with malignancies, have a high risk for malnutrition, requiring perioperative nutritional support to reduce complications. During the Nutrition Insights Day (NID), nutritional data of this patient population were documented in seven Asian countries.

Methods: Observational, cross-sectional study with retrospective data collection of nutritional status, calorie/protein targets/intake, and type of clinical nutrition for up to 5 days before NID.

Forecasting surgical costs: Towards informed financial consent and financial risk reduction.

Background: Health care expenditure is increasing around the world and surgery is a major cause of financial hardship to patients and their families. Using pancreatoduodenectomy (PD), one of the most complex, morbid and costly operation as an example, this study aimed to identify the cost drivers of surgery, estimate relative contribution of these drivers, and derive and validate a cohort-specific cost forecasting tool.

Methods: Data on the costs of 1406 patients undergoing PD in three tertiary hospitals in India, Italy and the United States were analysed.

Surgical Oncology Practice in the Wake of COVID-19 Crisis.

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome (SARS-CoV-2) outbreak has placed unprecedented challenges globally dismantling healthcare systems and forcing rapid transformations of healthcare services. In patients with cancer, these changes are having profound effects on vital aspects of their care. It has been advised that hospitals discontinue elective surgery and work on triage of nonemergent surgical procedures during the pandemic.

Elective Gastrointestinal Surgery in COVID Times.

With the COVID pandemic claiming deaths the world over, the healthcare systems were overburdened. This led to the cancellation and delay in elective surgical cases which can have far-reaching consequences This study reports our experience of elective gastro-intestinal surgical procedures during the COVID pandemic, after instating preventive strategies and screening protocols to prevent the transmission of COVID infection. This is a case series analysis of elective gastro-intestinal surgical procedures performed from March 24, 2020, to July 31, 2020.

Hospital malnutrition in northeast and southeast Asia: A systematic literature review.

Background & Aims: Hospital malnutrition is a prevalent yet frequently under-recognised condition that is associated with adverse clinical and economic consequences. Systematic reviews from various regions of the world have provided regional estimates of the prevalence of malnutrition and the magnitude of the associated health and economic burden; however, a systematic assessment of the prevalence and consequences of hospital malnutrition in northeast and southeast Asia has not been conducted.

Methods: We performed a systematic literature search for articles on hospital malnutrition in 11 Asian countries published in English between January 1, 1997 and January 15, 2018.

Deviations from a clinical pathway post pancreatoduodenectomy predict 90-day unplanned re-admission.

To determine the frequency and relevance of deviations from a post pancreatoduodenectomy (PD) clinical care pathway. A retrospective analysis using a prospectively maintained database of a post-PD clinical care pathway was carried out between May 2016 and March 2018. Patients were divided based on the number of factors deviating from the clinical care pathway (Group I: no deviation; Group II: deviation in 1-4 factors; Group III: deviation in 5-8 factors).

Pancreatic Exocrine Insufficiency as a Complication of Gastrointestinal Surgery and the Impact of Pancreatic Enzyme Replacement Therapy.

Background: Pancreatic exocrine insufficiency (PEI) is characterized by inadequate production, insufficient secretion, and/or inactivation of pancreatic enzymes, resulting in maldigestion. The aim of this review was to analyze the prevalence and pathophysiology of PEI resulting from gastrointestinal (GI) surgery and to examine the use of pancreatic enzyme replacement therapy (PERT) for effectively managing PEI.

Summary: A targeted PubMed search was conducted for studies examining the prevalence and pathophysiology of PEI in patients following GI surgery and for studies assessing the effects of PERT in these patients.

Extra-mucosal enucleation is still a safe and feasible treatment option of giant esophageal leiomyomas.

Esophageal leiomyoma (EL) is rare but still the most common benign tumor of the esophagus. Extra-mucosal enucleation (EME) is the treatment of choice. Many recent reports have favored esophageal resection for giant Esophageal leiomyomas (ELs).

Perioperative antimicrobial therapy in preventing infectious complications following pancreatoduodenectomy.

Background & Objectives: Infectious complications have been reported to occur in up to 45 per cent of patients, following pancreatoduodenectomy (PD). The incidence of perioperative infectious and overall complications is higher in patients undergoing preoperative invasive endoscopic procedures. The aim of the study was to compare the role of a carbapenem administered as three-once daily perioperative doses on infectious complications in patients at high risk for these complications versus those at low risk.

Management of achalasia cardia: Expert consensus statements.

Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature, and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade.

Maximum surgical blood order schedule for pancreatoduodenectomy: a long way from uniform applicability!

Background: Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable life-saving resource and poses a significant financial burden on healthcare systems.

Aim: To determine patient-specific factors associated with intra-operative transfusions, and if intra-operative blood transfusions impact postoperative morbidity.

Patients & Methods: Analysis of consecutive patients undergoing pancreatoduodenectomy (PD) for pancreatic tumors.