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Devayani Niyogi,Mahesh Goel,Rajesh S Shinde,Shraddha Patkar 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.1
Primary hepatic tuberculosis is a rare entity and can closely mimic malignancy with respect to clinical presentation and imaging features. We identified five patients at a high volume tertiary care cancer center, whose clinical features and imaging closely mimicked primary liver malignancy or metastases but final histopathology was suggestive of hepatic tuberculosis. Three patients underwent a surgical resection whereas two were diagnosed on a biopsy. Anti-tuberculosis therapy was started for all the patients which was well tolerated. All patients are doing well at the time of the last follow up. This case series stresses the importance of having a high index of suspicion and preoperative biopsy in cases where imaging features are equivocal.
Primary hepatic neuroendocrine tumours of liver- a rarity: Single centre analysis of 13 patients
Amir Parray,Shraddha Patkar,Mahesh Goel 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.1
Backgrounds/Aims: Primary hepatic neuroendocrine tumours (PHNETs) are a rarity and this rarity imparts management complexities. Methods: A retrospective analysis of prospectively maintained liver database from 2009 to 2018 was performed and patients with PHNETs were identified and studied for clinical, imaging and pathological features, surgical outcomes, disease free and overall survival. Results: Thirteen patients of PHNET were identified following rigorous investigational protocols, which constituted 0.6% of all liver tumours (2095) in our series. The median age of patients was 50 years (14-65), with male to female ratio of 9:4. Eight patients (62%) underwent hepatic resections as primary treatment, while 5 (38%) patients received peptide receptor radiotherapy, trans-arterial chemotherapy, trans-arterial radiotherapy or a combination of these. In the surgical group at a median follow up of 36 months (range 5-114 months), 4 (50%) patients were alive without disease and disease free survival was 20 months. Median OS in surgical group was 47 months (40-53, 95% confidence interval) that was better but not statistically significant from that of non-surgical treatment group (36 months). Conclusions: PHNETs are rare tumours that require multidisciplinary treatment approach. Liver directed surgery centred management leads to better clinical outcomes in these selected patients.
Characteristics of Cholangiocarcinoma in India - Experience from a Tertiary Care Centre
( Krunal Khobragade ),( Shraddha Patkar ),( Mahesh Goel ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Cholangiocarcinoma is a rare disease in India with no major studies published till date due to paucity of epidemiological and surgical data. The aim was to evaluate the clinical profile of patients presenting with intrahepatic and peri-hilar cholangiocarcinoma to a tertiary care cancer centre. Methods: All patients diagnosed with intrahepatic cholangiocarcinoma (IHCC) and perihilar cholangiocarcinoma (PHCC) at Tata Memorial Hospital, Mumbai, between January 2012 to July 2016 were retrospectively analyzed. Results: A total of 726 patients were evaluated of which 273 patients had IHCC and 358 were diagnosed with PHCC. The median age of presentation for IHCC and PHCC were 57yrs and 56.7yrs. Majority of patients were males - 59% for IHCC and 56.7% for PHCC. Commonest symptoms were pain in abdomen and jaundice with average duration of symptoms being 8 weeks (IHCC) and 9.4 weeks (PHCC) respectively. Most patients with IHCC had metastatic disease (184, 67.9%) on presentation. For patients with PHCC, 50.8% (182) had localized disease, 17% (61) had locally advanced and 24.3% (87) were metastatic. Chemotherapy with palliative intent was offered to 144 patients with IHCC and 60 patients with PHCC. Surgery or chemoradiotherapy could be offered to only 59 patients with IHCC and 128 patients of PHCC. 56 patients with IHCC and 136 of PHCC patients did not take treatment due to socioeconomic reasons. Conclusions: With less than 15% patients receiving surgery, awareness and early referral with centralization is required to detect disease at a stage where treatment can offer a meaningful survival.
Vikas Ostwal,Arvind Sahu,Anant Ramaswamy,Bhawna Sirohi,Subhadeep Bose,Vikas Talreja,Mahesh Goel,Shraddha Patkar,Ashwin Desouza,Shailesh V. Shrikhande 대한위암학회 2017 Journal of gastric cancer Vol.17 No.1
EOX chemotherapy with curative resection and D2 lymphadenectomy is a suggested alternative to the existing perioperative regimens. The acceptable postoperative complication rate and relatively high resections, chemotherapy completion, and survival rates obtained in this study require further evaluation and validation in a clinical trial.
Mufaddal Kazi,Shraddha Patkar,Prerak Patel,Aditya Kunte,Ashwin Desouza,Avanish Saklani,Mahesh Goel 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.1
Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell’s C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%–31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.