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( Krunal Khobragade ),( Shraddha Patkar ),( Vijayraj Patil ),( Sagar Kurunkar ),( Mahesh Goel ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The extent of liver resection for gall bladder cancer (GBC) is still debated. We evaluated the post-operative and oncological outcomes of patients who underwent liver wedge excision. Methods: Patients who underwent radical cholecystectomy (with a liver wedge excision of 2.5-3 centimetres) from June 2010 to December 2015 were retrospectively analysed. Results: 97 cases of primary GBC out of 558 patients undergoing surgery for GBC were selected. Majority of our patients had stage III disease (52 %). At a median follow up of 29 months, 65.9 % of patients were disease free where as 13.4% were alive with disease. 2.1 % died in postoperative period, 12.3% patients died of disease and 6.1% died of unrelated causes.9 patients had loco- regional recurrence and 16 failed at distant sites. Only one patient recurred in the gall bladder bed. 3-year overall survival of stage II was 85 % and of stage III was 60 %. Conclusions: Surgical outcomes of radical cholecystectomy with wedge resection of the liver at our centre, parallels published international literature. With low morbidity and mortality, it emphasizes oncological equivalence of liver wedge resection as compared to formal segment IVb/V excision, provided a margin negative resection is achieved.
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.
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.
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.
Shravan Nadkarni,Shraddha Patkar,Rajgopal Acharya,Aekta Shah,Swapnil Patel,Amir Parray,Mahesh Goel 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.1
Hepatocellular carcinoma, a disease of the developing world, is known to present with extrahepatic metastases. Most common site being the lungs, it is not uncommon for metastases to present at unusual sites like the rectum, spleen and the diaphragm, among others. Metastases to the oral cavity is rare, with the most common primaries being lung, breast and the kidney. Metastases of a hepatocellular carcinoma to the oral cavity is a rare entity with extremely limited data in literature. We present one such unique case of oral cavity metastases from a hepatocellular carcinoma who presented to the Division of Head and Neck Oncology services of our hospital with a large oral cavity lesion, on subsequent workup of which, a hepatocellular carcinoma was identified. Awareness of this possibility can aid in accurate diagnosis and early management of a condition associated with an advanced stage at presentation and poorer prognosis.
Mufaddal Kazi,Shraddha Patkar,Avanish Saklani 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.4
Neuroendocrine tumors (NET) are relatively uncommon rectal neoplasms, and the liver is the most common site of distant metastasis. Simultaneous liver and colorectal resections by minimally invasive surgery and natural orifice specimen extraction are gaining popularity, reducing morbidity. We describe a case of rectal NET with liver metastasis operated simultaneously by laparoscopy with both specimens extracted via the anal canal. Transanal or transvaginal natural orifice specimen extraction surgery for suitable cases is underutilized and only isolated case reports for simultaneous resections exist.