Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

BACKGROUND/AIM: Up to a third of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) of appendiceal or colorectal origin receive a stoma during primary surgery. Stoma reversal provides an opportunity for second-look surgery. PATIENTS AND METHODS: We performed a retrospective analysis of prospectively collected data of patients with colorectal cancer (CRC) or high-grade appendiceal cancer (AC) from 2006 to 2021 from our database. A total of 34 consecutive stoma closure patients with no evidence of preoperative disease recurrence (tumor markers and CT scans) were compared with 141 consecutive re-do CRS/HIPEC patients with known recurrence. RESULTS: Eleven patients (32.4%) were identified to have peritoneal recurrence at stoma closure. Time between first and second CRS was 12 months (4 to 64.2) in the stoma closure group vs. 24.6 months (5.8 to 119.8) in the re-do group, while median peritoneal cancer index (PCI) was 4 (3 to 6) vs. 8 (1 to 39), respectively (p=0.0143). CONCLUSION: Second-look laparotomy during stoma closure identified unexpected PC in 32.4% of our patients with significantly lower PCI than planned re-do operations.

Bromelain and acetylcysteine (BromAc®) alone and in combination with gemcitabine inhibit subcutaneous deposits of pancreatic cancer after intraperitoneal injection.

Gemcitabine (GEM) is commonly chosen for treating pancreatic cancer. However, its use is limited by toxicity. Earlier in vitro studies with GEM in combination with Bromelain (Brom) and Acetylcysteine (Ac) indicated a substantial reduction in IC50. In this study, immunocytochemistry and Western blot were used to explore the mechanistic effects of Brom and Ac (BromAc®) in vitro. Then, we explored the efficacy and safety of BromAc® only and with GEM in a pancreatic cancer model in vivo. Immunocytochemistry results revealed a reduction in both MUC1 and MUC4 post-treatment. There was a decrease in VEGF, MMP-9, NF-κß and cleavage of PARP. There was also a decrease in the cell cycle regulators Cyclin B and D as well as TGF-ß and the anti-apoptotic Bcl-2. In vivo, the low and high doses of BromAc® alone and with chemotherapy agents were safe. A very significant reduction in pancreatic tumour volume, weight, and ki67 were seen with BromAc® therapy and was equal to treatment with GEM alone and better than treatment with 5-FU. In addition, tumour density was significantly reduced by BromAc®. In conclusion, the anticancer effect of BromAc® is probably related to its mucin depletion activity as well as its effect on proteins involved in cell cycle arrest, apoptosis and modulation of the tumour microenvironment. The in vivo results are encouraging and are considered the first evidence of the efficacy of BromAc® in pancreatic cancer. These results also provide some mechanistic leads of BromAc®.

Evaluation of Micronutrient Status Post Laparoscopic Sleeve Gastrectomy: an Australian Perspective.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a type of bariatric technique that has comparable outcomes to Roux-en-Y gastric bypass, the current gold standard. However, it can be associated with nutritional deficiencies postoperatively. The aim of this study was to evaluate micronutrient status post LSG. METHODS: This is a retrospective study of 565 patients who underwent an LSG from January 2015 to September 2018. Patients lost to follow-up at 3, 6 and 12 months were 6.3%, 18.6% and 32.4%, respectively. Follow-up of the patients included regular dietetic input and micronutrient supplementation. Data that was collected included both anthropometry and nutritional markers. RESULTS: The mean preoperative weight and body mass index (BMI) were 118.13 ± 25.36 kg and 42.40 ± 7.66 kg/m2, respectively. Statistically, significant reductions in anthropometric parameters including weight, BMI (30.50 kg/m2), total weight loss (28.03%), excess weight loss (72.03%) and BMI loss (12.32 kg/m2) were observed at all timepoints up to 12 months follow-up. At 12 months, there were significant increases in 25-OH vitamin D with the incidence of deficiency decreasing from 45.7 to 15.0% compared to baseline. The incidence of hyperparathyroidism also decreased from 32.2 to 18.9% compared to baseline, and incidence of folate deficiency increased from 7.7 to 19.2%. Other nutritional parameters including calcium, iron, ferritin, vitamin B12, holotranscobalamin (active B12) and haemoglobin did not significantly change. CONCLUSIONS: Modest effects on micronutrient status were observed in the 12-month postoperative period. Of clinically significant, de novo folate deficiencies increased, and vitamin D deficiency and hyperparathyroidism decreased. Thus, optimizing postoperative micronutrient status is imperative following LSG.