Microbiology and clinical characteristics of acute cholangitis with their impact on mortality; a retrospective cross sectional study.

OBJECTIVE: To evaluate microbiological and clinical characteristics of acute cholangitis along with their impact on mortality, and to compare the role of early versus late biliary drainage in the management of cholangitis. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital Research Centre, Lahore, Pakistan, and comprised records of all patients presenting with acute cholangitis from June, 2012, to June, 2017. The risk factors, presence of bacteremia, resistance pattern of microbial pathogens and severity were assessed according to Tokyo guidelines in addition to associated mortality and recurrence at 3 months. Data was analysed using SPSS 20. RESULTS: Of the 230 patients, 137(59.6%) were male. The overall mean age was 56±13 years. The most common isolated organism was Escherichia coli 54(70.1%). Clinical severity (p=0.001), late biliary drainage (p=0.001) and use of multiple stents (p=0.03) were associated with increased mortality. However, in multivariable analysis, only high body mass index (p=0.01) and Tokyo severity grades II (p=0.04) and III (p=0.001) were significant factors associated with mortality. CONCLUSIONS: Early identification of risk factors, administration of appropriate antibiotics and establishing early biliary drainage were found to be the key management steps to reduce cholangitis-related mortality.

Surgical Outcome of Pancreaticoduodenectomy in Pancreatic and Periampullary Neoplasms.

OBJECTIVE: To report the results in the surgical treatment of pancreatic and periampullary neoplasms with emphasis on surgical technique, short-term postoperative outcome and the lessons learnt. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: This study was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from October 2014 to May 2016. METHODOLOGY: Patients undergoing surgical treatment of pancreatic and periampullary neoplasms were selected. Patients' characteristics including demographics, surgical technique, and 30-day morbidity and mortality were recorded. International Study Group of Pancreatic Fistula (ISGPF) classification was used to define postoperative pancreatic fistula and Clavien-Dindo classification to grade complications. RESULTS: Atotal number of 65 patients underwent the trial of dissection; 50 had pancreaticoduodenectomy and 15 patients underwent palliative bypass and were excluded from analysis. Sixty-four percent were males and 36% were females. The most common tumor was periampullary (n=29, 58%) followed by pancreatic head (14, 28%) and duodenal tumors (n=07, 14%). Mean age was 52.92 ±13.27 years; mean operating time was 470 ±358.28 minutes and median blood loss was 400 (287-500) ml. Pancreaticogastrostomy (PG) was the preferred reconstruction technique in 37 (74%) verses pancreaticojejunostomy (PJ) in 13 (26%) patients. Four (08%) patients needed portal vein reconstruction and two (04%) replaced right hepatic artery resection and reconstruction due to tumor involvement. There were seven Grade A, and one Grade B and C pancreatic fistulae each. Three patients (06%) needed endoscopic therapy for gastrointestinal hemorrhage from pancreatic stump. There was one death in postoperative period. CONCLUSION: Pancreaticoduodenectomy is a safe procedure with excellent postoperative outcome, if carried out in a specialized hepato-pancreato-biliary unit. APG reconstruction can be a safer alternative to PJ.

Right-Sided and Left-Sided Colon Cancers are Two Distinct Disease Entities: an Analysis of 200 Cases in Pakistan.

BACKGROUND: There is growing evidence that there are differences in histological and genetic characteristics along with clinical behavior between right- and left-sided colon carcinomas. We have compared various parameters of the two types and assessed associations of the results with prognosis in patients in Pakistan. MATERIALS AND METHODS: We reviewed 200 cases from our institutional database; 100 cases of right-sided and 100 cases of left-sided colon cancer. Parameters including age, gender, TNM stage, histological features and clinical outcome were analyzed. RESULTS: The patients with right-sided colon cancer were significantly older as compared to their counterparts with left-sided cancer. They presented with a lumbar mass rather than symptoms of obstruction and perforation as seen in left-sided colon cancers, and the histology showed higher percentage of poorly differentiated tumors with advanced pT stage. Moreover, Crohn's-like reactions, intra tumoral lymphocyte responses and other poor prognostic factors like lymph vascular invasion and perineural invasion were more common in right-sided cancers. CONCLUSIONS: We found that right- and left-sided colon cancers are different from each other in terms of clinical presentation, histology and clinical behavior. Right-sided colon cancers are more aggressive and are associated with poorer clinical outcome as compared to left sided colon cancers in our population.

Profile of patients with colorectal cancer at a tertiary care cancer hospital in Pakistan.

The following study describes the basic demography of colorectal cancer patients and characteristics of the disease seen at a regional tertiary care cancer hospital. The study highlights the influence of gender and age on the occurrence of this malignancy in patients in Pakistan. In general, this population shares many epidemiological features of developing countries for colorectal carcinoma. These include a younger age at presentation (mean age of patients was 46.5 years), subsite distribution (72.5% had left-sided tumors), and delayed presentation of the disease in an advanced stage. We stress the significance of public awareness regarding colorectal cancer to improve the outcome.