Risk factors effecting development of metachronous liver metastasis in rectal cancer patients after curative surgical resection. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore experience.

OBJECTIVE: To determine risk factors affecting development of metachronous liver metastasis in rectal cancer patients after curative surgical resection. METHODS: The retrospective cohort study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of patients with histologically proven rectal carcinoma admitted to the department of surgical oncology from January 2005 to December 2015. Clinical data of all patients, including age, gender, clinical presentation, clinical and pathological tumour-nodes-metastasis classification, neoadjuvant chemo-radiotherapy, surgery, adjuvant chemotherapy, pre- and postoperative carcinoembryonic antigen levels, histopathological findings and tumour recurrence were analysed. SPSS 23 was used for data analysis.. RESULTS: Of the 434 patients, 26(6%) developed liver metastasis. Of them, 18(69%) were male and 16(61.5%) were aged below 50 years. On clinical staging, 2(7.7%) patients had stage II disease, 22(84.6%) had stage III, and 2(7.7%) patients had stage IV disease. At last follow-up, 2(7.7%) patients were alive without disease, 7(27%) had expired, while 17(65.4%) were alive with disease.. CONCLUSIONS: Tumour depth, lymph node metastasis, postoperative carcinoembryonic antigen levels, complete tumour response on histopathology were found to beresponsible for metachronous liver metastases in rectal cancer patients following curative resection.

A clinical study and treatment results of adrenocortical carcinoma patients presented in Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore.

Adrenocortical carcinoma is a rare and aggressive malignancy with an incidence of 0.5-2 per million per year and its overall prognosis is very poor. This study was aimed to point out the factors associated with tumour recurrence and patient's survival after complete surgical resection of this aggressive malignancy. Patients admitted from January 2011 till December 2015 were retrospectively reviewed using case notes. In these five years 29 patients were admitted with adrenal tumour out of which 13 had adrenocortical carcinoma. On five year follow up, six (46.2%) patients developed recurrence. MEAN disease free survival was 31.0 ± 23.92 (2-63) months 53.8% while MEAN overall survival was 46.69 ± 22.81 (14-80) months 92.3%. Results concluded that hormonally active tumour on clinical presentation, positive surgical resection margins, positive nodal status and poorly differentiated tumour on histopathology are the factors associated with tumour recurrence and patient's survival.

Prognostic significance of pre- and post-operative serum carcinoembryonic antigen levels in patients presented with rectal carcinoma; an experience from Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore.

OBJECTIVE: To explore the importance of serum carcinoembryonic antigen level as a tumour marker in rectal carcinoma. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of patients with rectal carcinoma from January 1996 to December 2015. Serum carcinoembryonic antigen levels were analysed using immulite@2000 system analyser. On the basis of serum carcinoembryonic antigen levels, data of patients was divided into four groups. Group A had normal serum levels both before and after surgical resection; Group B had normal levels pre-surgery but post-surgery levels were raised; Group C had raised levels pre-surgery that went down to normal post-surgery; and Group D had raised levels both before and after surgery. SPSS 23 was used for data analysis. RESULTS: Of the 401 patients, 267(66.6%) were males, and 204(50.9%) were aged <50 years. Group A had 267(66.6%) patients, Group B 26(6.5%), Group C 79(`9.7) and Group D had 29(7.2%) patients. Stage III disease was the most common 343(85.5%) and it was true across the groups. Overall recurrence was in 141(35.2%) patients. Group D had the highest recurrence rate 26(89.7%), while Group C had the lowest 18(22.8%). CONCLUSIONS: Fluctuating levels of carcinoembryonic antigen affected post-operative outcome.

Impact of Serum Triglyceride Levels on Severity and Outcomes in Acute Biliary Pancreatitis: A Retrospective Cohort Study.

Background Acute biliary pancreatitis (ABP), a major inflammatory illness, is primarily caused by gallstone blockage of the common bile duct. The pathophysiology of ABP has been linked to serum triglyceride (TG) levels, suggesting a potential role for TG in predicting disease severity. Objective The research objective was to investigate the association between serum TG levels and the severity of ABP. Methodology This retrospective cohort study sought to determine the relationship between blood TG levels and the severity of ABP. It was conducted at Lady Reading Hospital in Peshawar, Pakistan, from September 2023 to March 2024. A total of 530 ABP patients were divided into two groups based on their TG levels: normal (<150 mg/dl) and elevated (≥150 mg/dl). Clinical data were gathered, including demographics, comorbidities, laboratory results, severity ratings (APACHE II and Ranson's criteria), and clinical outcomes. Descriptive statistics, Chi-square tests, and multivariate logistic regression were used in the statistical analysis. Results Patients with elevated TG levels (n=130) demonstrated higher median Ranson's criteria (3.24 vs. 2.53, p<0.001) and APACHE II scores (10.53 vs. 8.73, p<0.001) compared to those with normal TG levels (n=400). Elevated TG levels were associated with increased severity of ABP, with ORs of 2.41 (95% CI: 1.23-4.74) for mild vs. severe ABP. Clinical outcomes such as ICU admission (21.54% vs. 3.25%, p<0.001), mortality (6.15% vs. 0.50%, p<0.001), and pancreatic necrosis (10.77% vs. 1.25%, p<0.001) were significantly worse in the elevated TG group. Conclusion Elevated serum TG levels (≥150 mg/dl) are independently associated with increased severity of ABP, as indicated by higher severity scores and poorer clinical outcomes.