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RISS 인기검색어
- 검색키워드
- 저자 : Sundeep Saluja (검색결과 4 건)
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Impact of lymph node staging systems in predicting outcome in patients with ampullary cancer
Sundeep Singh Saluja,Pramod Kumar Mishra,Shashi Kiran,Harsh J. Shah,Sandip Chandrasekar,Mohammed Nayeem,Aditya Sharma,Vaibhav Kumar Varshney 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.4
Backgrounds/Aims: Lymph node (LN) metastasis though, is a poor prognostic factor for ampullary carcinoma (APC), the impact of Lymph node ratio (LNR) and Logarithm odds of positive lymph node (LODDS) in the long-term survival remains controversial. We evaluated the factors affecting the long-term outcome in APC patients with emphasis on LNR and LODDS. Methods: The prospectively collected data of 198 patients who underwent pancreatoduodenectomy for APC was analyzed after excluding 12 patients for various reasons. Factors affecting Disease specific survival (DSS) and Recurrence free survival (RFS) were analyzed with special reference to LN positivity, LNR and LODDS. Results: Out of 186, 117 (62.9%) patients were alive at a median follow-up of 39.5 months and 72 (38.7%) developed recurrence. The overall 5-year DSS was 59.3% & RFS 54.9%. Univariate analysis showed T-stage, tumor differentiation, perineural invasion, LN positivity, LNR and LODDS was significantly affected DSS and RFS. On multivariate analysis, perineural invasion, LN positivity, LNR and LODDS lost its significance for DSS and RFS. AUC for prediction of DSS and RFS for LNR was 0.654 (p<0.001) & 0.629 (p=0.003) respectively and for LODDS, it was 0.697 (p<0.001) & 0.677 (p=0.001) respectively. Sensitivity and specificity of LNR (0.1) for DSS were 37.7% & 83.8% and for RFS were 36.1% & 83.3%; for LODDS (−1.00), sensitivity and specificity for DSS was 62.3% and 67.5% and for RFS it was 59.7% and 66.7% respectively. Conclusions: LNR and LODDS although independently seem to affect the RFS and DSS, albeit have a low sensitivity and specificity in predicting DSS and RFS.
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Sundeep Singh Saluja,Ajay Kumar,Hari Govind,Vaibhav Kumar Varshney,Rahul Khullar,Pramod Kumar Mishra 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.2
Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients. Methods: The consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis. Results: Among 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis. Conclusions: Splenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.
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RWON Study: The Real-World Walled-off Necrosis Study
Ankush Pawar,Ujjwal Sonika,Manish Kumar,Sundeep Saluja,Siddharth Srivastava 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: The management of walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgicalmodalities. Real-world data on the management of symptomatic WON are scarce. Methods: Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities usedwere medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage (ED), or a combination of PCD andED. We compared clinical outcome among these modalities. Results: A total of 264 patients were evaluated. The most common indications for drainage were pain and fever. Of the patients,28% was treated with medical therapy alone, 31% with ED, 37% with PCD, and 4% with a combined approach. Technical successand clinical success were achieved in 93% and 91% of patients in the endoscopic arm and in 90% and 81% patients in the PCD arm,respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04),and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopicgroup than in the PCD group. Conclusions: ED of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.
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( Niharika Jain ),( Surbhi Goyal ),( Puja Sakhuja ),( Sundeep Saluja ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.3
Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity. (Korean J Gastroenterol 2021;78:188-194)
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