Is there any role of staging laparoscopy in pancreatic adenocarcinoma?

This is a letter to the editor on a study by Jambor et al. on the role of staging laparoscopy in identifying occult and distant metastases in pancreatic adenocarcinoma patients. In this study, inclusion of staging laparoscopy as an adjunct to computed tomography resulted in an absolute risk reduction of 12.5% for non-therapeutic laparotomy. The study found no correlation between the presence of occult and distant metastases, and serum CA 19-9 level, tumour size or location, which was in significant contrast to a number of other studies. This was likely due to the smaller sample size of the study and restriction to a single high-volume referral centre. It is also noted that staging laparoscopy cannot detect vascular invasion, lymph node involvement and deep hepatic metastases. The sensitivity of peritoneal lavage cytology in detecting occult metastases is low as well. Inclusion of biomarkers like peritoneal lavage tumour DNA may improve sensitivity. Hence, even as this study adds to the evidence supporting staging laparoscopy, further studies on improving the sensitivity of staging laparoscopy are warranted.

An Observational Study of Anticipatory Coping Behavior of Women for Chemotherapy-Induced Alopecia for Breast Cancer Treatment.

Background It is necessary to explore patients' expectations of chemotherapy-induced alopecia, anticipate reactions to alopecia, and how women intend to prepare for an altered body appearance. Studies regarding women's critical aspects of anticipatory coping behavior (anticipate reactions to alopecia and how women intend to prepare for a modified body appearance) towards hair loss and factors influencing it are sparse, especially from India. This study helped identify the factors influencing the anticipatory coping behavior toward chemotherapy-induced alopecia. Methodology This was a cross-sectional analytic study carried out for three months, including all breast cancer patients admitted for neo-adjuvant chemotherapy. Anticipatory coping behavior before and during each chemotherapy cycle period (minimum one cycle) was assessed using the World Health Organization scale. Study patients received two sets of questionnaires. The first question is asked before the start of chemotherapy, and the second is requested at least four weeks after completing the first chemotherapy. The first question included baseline demographic data, disease details, and awareness about hair loss. The second question had hair loss pattern, severity of cancer-induced alopecia, and rated the degree of alopecia in a visual analog scale score. Individual psychosocial and social factors associated with the anticipatory coping behavior were documented using a self-administered questionnaire. Results A total of 40 patients were included in the study. All of the participants reported anticipating hair loss. Five percent of the patients came to terms with the inevitability of hair loss. Around 22.5% of them became ready, 67.5% of the patients took control and 52.5% of the patients felt shame in front of society due to a lack of anticipatory behavior. About 47.5% of the participants felt that not being willing to wear a wig is a reason for deficient anticipatory coping behavior. Conclusion The study patients' main reasons for lack of anticipatory coping behavior were shame in society, insecure thoughts about the future, and unwillingness to live with a wig. It should be advised to such patients that losing hair is not a health problem (though it is an emotional issue), and clinicians can encourage them to use hats. Further multi-institutional prospective studies are required to assess the poor motivation of health care professionals to achieve target anticipatory coping behavior.

Outcomes of Emergency Abdominal Wall Hernia Repair: Experience Over a Decade.

Background Abdominal wall hernias are a common surgical entity encountered by the general surgeon. Approximately 10% of abdominal wall hernia patients require emergency surgery. However, these surgeries are associated with a high rate of postoperative morbidity and mortality. This study aimed to analyze the morbidity and mortality in patients undergoing emergency abdominal wall hernia repair and to determine the factors associated with surgical site infection (SSI) and recurrence in these patients attending a tertiary care hospital in south India. Methodology Our study was a single-centered, 10-year retrospective and a one-year prospective study conducted in a tertiary care center in India. All patients who underwent emergency abdominal wall hernia repair between April 2009 and May 2020 were included. Patients' demographic details, comorbidities, intraoperative findings, 30-day surgical outcomes including SSI, and recurrence were studied. Results Out of 383 patients in our study, 63.9% had an inguinal hernia, and 54% of the patients underwent tissue repair. SSI was the most common morbidity (21.9%). Postoperative sepsis was the only independent factor associated with perioperative mortality according to the logistic regression analysis (odds ratio = 22.73, p = 0.022). Conclusions Tissue repair for emergency hernia surgery has better outcomes than mesh repair in clean-contaminated cases.