Palliative Surgical Treatment Research Articles

Serial cardiopulmonary exercise testing in young patients after one-and-half ventricle repair and Fontan procedure: a comparative study.

The Fontan procedure is the palliative surgical treatment for different congenital heart diseases (CHD) with a univentricular heart, but it has been associated with decreased exercise capacity, cardiovascular morbidity, and premature mortality. The one-and-half ventricle repair (1.5VR) was introduced as an alternative to the Fontan procedure, specifically for selected patients with borderline hypoplastic right ventricle (HRV), aiming for a more physiological circulation. Despite these efforts, the benefit of 1.5VR over Fontan circulation comparison on clinical and functional outcomes remains unclear. The aim of this study was to investigate and compare young patients with HRV after 1.5VR with those with functional single right or left ventricles (FSRV or FSLV) after Fontan palliation over a 10-year follow-up period. In this retrospective observational study, serial cardiopulmonary exercise tests (CPETs) performed in patients with 1.5VR and Fontan circulation between September 2002 and March 2024 have been analyzed. Only patients with at least 10 years of follow-up were considered. A total of 41 patients were included (age at baseline 8.6±2.6 years): 21 with FSLV, 12 with FSRV, and 10 with 1.5VR. No differences in cardiorespiratory fitness and efficiency were shown at the first CPET assessment among the three groups. At 10-year follow-up, 1.5VR had higher cardiorespiratory fitness and efficiency compared to FSLV and FSRV patients. These findings suggest that the 1.5VR may provide superior long-term functional outcomes than the Fontan procedure in patients with borderline HRV. Further studies are needed to evaluate the impact on hard clinical endpoints.

Neonatal Ebsteins Anomaly presenting with unique features: Rare case report

Ebstein’s anomaly (EA) of the tricuspid valve is an uncommon malformation, representing an estimate 0.3% to 0.6% of all cases of congenital heart disease. The basic defect involves a deformed and displaced tricuspid valve, resulting in symptoms that vary with age of the patient and severity of the defect. Symptoms are referable to progressive heart failure and cyanosis resulting from severe tricuspid insufficiency. Once symptoms appear the only treatment for Ebstein’s anomaly is surgical intervention. Infants with symptomatic Ebstein’s anomaly have a poor prognosis, with an expected mortality rate of 50% to 75%. Previous attempts at palliative surgical treatment in this neonatal group have produced equally dismal results. Herein, we are reporting a very sick 3 day old neonate afflicted with Ebsteins anomaly with double-outlet left ventricle (DOLV) associated with myriads of other significant congenital heart defects.

Minimally invasive interventions on celiac plexus in patients with persistent abdominal pain caused by pancreatic cancer

Background. Chronic abdominal pain is common in 50 % of patients with intra-abdominal malignancies and has a huge impact on quality of their lives. As the number and doses of systemic analgesics increase, so does the frequency of side effects that can further worsen functional status, which is important for this cohort of patients who have a five-year survival rate of only 8 %. The purpose of the study: to assess the efficacy and safety of computed tomography-guided celiac plexus neurolysis as a method of reducing persistent, severe pain in patients with pancreatic cancer that affects their functional status. Materials and methods. The analysis of the results of 17 interventional procedures on the celiac plexus in 16 participants was conducted, sympatholysis was performed twice in one patient. Inclusion criteria: pancreatic cancer with persistent pharmacoresistant neuropathic abdominal pain for ≥ 3 months, which did not respond to medications, including opioids, anti-inflammatory drugs, and other conservative methods of treatment. Age of patients was 39 to 72 years (mean of 62.6 ± 8.2 years), 10 (62.5 %) research participants were male and 6 (37.5 %) were female. Results. Interventions were successfully performed for all patients on the first attempt. There were no cases of perforations of hollow organs, damage to blood vessels, pleural sinuses, or other structures of the abdominal and thoracic cavities. No neurological complications were recorded, and no one required blood transfusion. All study patients had a significant reduction in pain on the visual analogue scale compared to baseline, both one week after the procedure, from 9.7 ± 0.6 to 4.7 ± 1.4 (P < 0.001), and in six months, from 9.7 ± 0.6 to 4.1 ± 1.4 (P < 0.001). The average Karnofsky Performance Status Scale score compared to the data before the procedure, one week after increased from 64.7 ± 7.9 to 78.2 ± 6.4 (P < 0.001). A significant improvement in functional status was maintained up to three months — 71.2 ± 6.9 (P < 0.001). However, in six months, this indicator was 63.5 ± 6.0 (Р = 0.668), which may be related not only to the intensity of the pain syndrome, but also to other complications of the underlying disease (ascites, cachexia, tumor growth, palliative surgical interventions, etc.). Conclusions. Computed tomography-guided celiac plexus neurolysis is a safe and effective procedure for patients with abdominal pain caused by inoperable pancreatic cancer. Sympatholysis provides a long-term significant reduction in pain syndrome according to the visual analogue scale after 1, 3, 6 months (Р < 0.001) and increases the functional status of patients according to the Karnofsky Performance Status Scale in 1 (Р < 0.001), 3 months (Р = 0.023). Celiac plexus neurolysis should be considered as part of a multidisciplinary approach to the comprehensive treatment of upper abdominal pain associated with cancer in the early stages of the disease.

Long-Term Follow-Up After Laparoscopic Radical Prostatectomy for Localized and Locally Advanced Prostate Cancer

Objective To explore the impact of laparoscopic radical prostatectomy (LRP) on lower urinary tract symptoms and erectile function. Materials and Methods A retrospective study was conducted on patients who underwent LRP at the Civil Hospital Ahmedabad’s Urology Department from June 2008 to June 2023. Results Major complications following LRP are generally rare, including bladder neck stenosis, erectile dysfunction, and urinary incontinence. The incidence of erectile dysfunction varies widely, ranging from 11-87%, and urinary incontinence ranges from 0-87%, depending on the definitions used. Functional decline typically peaks shortly after surgery, with the most rapid recovery occurring within the first year post-LRP. Some patients continue to improve gradually over time. However, for some men, these adverse effects can be long-lasting. Other, less common side effects should also be considered. Despite significant technological advancements in the past 20 years, no single surgical technique has emerged as superior in terms of long-term outcomes, as surgical volume, surgeon experience, and patient characteristics remain key determinants. Conclusion When discussing treatment options for prostate cancer, it is crucial to consider potential complications like erectile dysfunction and urinary incontinence following LRP, as well as the expected recovery period. Counseling is provided to patients, taking into account their age and overall health profile. Surgical advice is given to eligible patients after evaluating the risk-benefit ratio. Patients who are older or do not meet the criteria are given appropriate guidance. All patients are informed about the possible complications after surgery and are presented with the option of palliative care or surgical treatment.

Colon cancer survival in the elderly without curative surgery.

The aim of this study was to chart the natural history of elderly patients with colon cancer who are managed nonoperatively, with the primary outcome being life expectancy from diagnosis to death. This was a retrospective analysis of patients aged 80 years and above diagnosed with colon cancer in a tertiary care referral hospital in England between 1 January 2012 and 31 December 2017. Thirty-two patients were diagnosed with non-metastatic colon cancer and managed non-operatively. The median age of patients in this study was 86 years. The group had a median Charlson Comorbidity Index of 7 (range 6-12) and the median frailty score was 6 (range 3-8). Progression to metastatic disease was identified in two patients; two further patients showed locoregional progression of cancer and therefore required palliative surgical intervention. Survival of these patients ranged from 105 to 1,782 days with a median life expectancy of 586 days. Place of death was identified in 15/31 patients: 4 (27%) died in hospital, 12 (38%) died at home and 15 (47%) died in a nursing or residential home; data were missing for 1 patient (3%). Nonoperative management of elderly patients with colon cancer yields reasonable life expectancy and a low risk of life-threatening local complications.

Palliative surgical treatment in patients with breast cancer

Last many years breast cancer on a leading position in the structure of oncological pathology among the female population. Patients with metastatic breast cancer, as well as with the presence of tumors with incipient decay or bleeding, are currently considered as patients for complex palliative systemic treatment. The question of the expediency of performing an operation in such a pathology occurs quite often in the daily practice of an oncologist-surgeon. Of course, such life-threatening conditions as decaying breast tumors, bleeding from them, do not raise doubts about the urgency of providing palliative surgical treatment, which is often it is sanitation mastectomy. However, the need for a surgical stage of treatment in the complex palliative therapy of metastatic breast cancer raises many questions. The possibilities of treating metastatic breast cancer have expanded significantly due to the development of drug therapy regimens, up to treating it as a chronic disease. The success of drug breast cancer treatment gives a chance to prolong the life of patients for many years. Thus, in the process of long-term treatment of these patients, various situations arise that require an individual solution. Based on the results of studies, the authors conclude that the decision to remove the primary breast lesion in such patients should be individualized and based on the opinion of the oncologist-surgeon, chemotherapist and radiation therapist, taking into account the potential risk, as well as the subsequent quality of life. In addition, as it turned out, the surgical stage of treatment in such patients not only improves the subsequent quality of life, but also improves oncological indicators. This article discusses the indications and contraindications for performing palliative surgical treatment of patients with breast cancer, based on world studies and our own experience and a clinical study.

Ductus Arteriosus Stenting as a Method of Palliative Treatment of Truncus Arteriosus Type A3: Literature Review and Clinical Case

Introduction. Van Praagh A3 variant of truncus arteriosus (TA A3) is a condition when the one pulmonary artery branch origins from the TA, the other is filled through the patent ductus arteriosus (PDA).
 PDA constriction in the early neonatal period can cause absence of blood supply to the one pulmonary artery branch. To prevent this, prolonged infusion of prostaglandin E1, PDA stenting or systemic-to-pulmonary shunt are used. These methods allow to postpone total repair (TR) and reduce mortality risks associated with neonatal period.
 The aim. To analyze research papers dedicated to endovascular approach of TA A3 staged treatment and to present our own experience.
 Materials and methods. We conducted a systematic literature search and analyzed various options for the TA A3 staged treatment. After the review, we used endovascular approach as the first stage of treatment in our clinical case.
 We studied a newborn weighing 4 kg with TA A3 (left pulmonary artery branch origins from the non-coronary sinus of the truncal valve, right pulmonary artery branch filling through the PDA). Nakata index was 83 mm2/m2. McGoon ratio was 1. We decided to perform PDA stenting with the aim of postponing surgical correction until the patient’s optimal age and weight.
 Discussion. In total, the number of publications about TA A3 staged treatment is limited. Most institutions prefer TA A3 staged treatment in newborns, because it is associated with a lower risk of complications than early TR. In our clinical case, the first step was PDA stenting. The staged approach allowed us to perform TR with a good result at the age of 3 months. Before TR, Nakata index and McGoon ratio were increased to 248 mm2/m2 and 1.9, respectively.
 Conclusions. The current trend of TA A3 repair has few different options of staged treatment. Staged approach helps to get out of the newborn period and achieves the optimal condition for TR. Our patient successfully received PDA stenting as the first stage of treatment, which created conditions for the pulmonary artery branches growth. The second stage was TR with good long-term results. After analyzing the publications, we noted that the use of endovascular PDA stenting is a good and safe alternative to surgical palliative treatment.

The use of endovascular hemostasis to prevent recurrence of ulcerative gastroduodenal bleeding in an emergency hospital

According to the Department of ambulance organization of the I. I. Dzhanelidze Research Institute of Joint Venture in the structure of the “acute abdomen” UGDB takes 4th place in 2021. Transcatheter arterial embolization (TAE) is an alternative to palliative surgical interventions when conservative treatment of ulcerative bleeding using endoscopic hemostasis methods is ineffective, especially in patients with a high risk of surgery and an unfavorable outcome. The aim of the work is to evaluate its role in improving the results of treatment of patients with UGDB who underwent TAE in an ambulance hospital in order to prevent recurrence of bleeding, to assess its role in improving the results of treatment of this category of patients. Materials and methods. The analysis of the results of treatment of 30 patients with UGDB who were on inpatient treatment at the I. I. Dzhanelidze Research Institute of SP from 2018 to 2021, the use of TAE is an alternative to open palliative surgery. As a result of the conducted examination, it was found that the use of endovascular hemostasis in order to prevent recurrence of bleeding in a group of somatically severe patients with UGDB is advisable.

Optimal Surgical Method and Timing for Low-birth-weight Esophageal Atresia Babies: Multi-institutional Observational Study

Aim of the studyPrevious research has shown that low birth weight is one of the risk factors for esophageal atresia. However, there remains a paucity of evidence on the timing and the treatment method. MethodData were collected using a multi-institutional observational study in 11 hospitals that performed surgeries on esophageal atresia babies whose birth weights were ≤1500 g from 2001 to 2020. ResultsOf the 46 patients analyzed, median birth weight was 1233 (IQR 1042–1412) g. Within 46 cases, 19 (41%) underwent definitive esophageal anastomosis at the median of age in 8 (IQR 2–101) days. Thirteen out of 19 experienced either closure of tracheoesophageal fistula, gastrostomy, or esophageal banding at the first operation, followed by esophageal anastomosis. Seven infants, including four cases of <1000 g, underwent anastomosis after one month of age to wait for weight gain (variously 2–3000 g). Twenty-one out of 27 infants (78%) who did not receive anastomosis died within one year of age, including 21 (78 %) with major cardiac anomalies and 24 (89%) with severe chromosomal anomalies (trisomy 18). Six survivors in this group, all with trisomy 18, lived with palliative surgical treatments. ConclusionIn our study, the definitive esophageal anastomosis was effective either at the first operation or as a later treatment after gaining weight. Although having severe anomalies, some infants receive palliative surgical treatments, and the next surgery was considered depending on their condition. Evidence LevelII.

Palliative surgery

Palliative surgery is defined as surgery for symptoms attributable to an advanced or incurable malignancy or symptoms due to malignancy treatment. Palliative surgery is a frequent occurrence at cancer centers and represents almost a quarter of a surgical oncologist’s practice. Common indications for palliative surgical consultation include gastrointestinal obstruction, gastrointestinal bleeding, obstructive jaundice, wound problems, bowel perforation, ascites, and abdominal pain. This chapter will discuss the frequent indications for palliative surgery, management options, surgical interventions, and variables associated with outcome. Keywords: palliative surgery; communication; risk-benefit analysis.

Implementation of a Multi-Disciplinary Team and Quality of Goals of Care Discussions in Palliative Surgical Oncology Patients

BackgroundPalliative surgical oncology patients represent a unique group with complex needs who often require multidisciplinary input for the provision of timely and holistic care. The authors assembled a multi-disciplinary palliative intervention team and evaluated its association with the quality of discussions on goals of care (GOC) among advanced cancer patients undergoing palliative interventions.MethodsThis prospective cohort study analyzed advanced cancer patients undergoing palliative interventions at a single urban academic center from October 2019 to March 2022. In January 2021, a multi-disciplinary palliative surgical intervention (MD-PALS) team was assembled. All palliative surgical oncology patients were discussed at multi-disciplinary meetings and managed by members of the MD-PALS team. An interrupted time series (ITS) model was built to evaluate the association of MD-PALS implementation and the quality of GOC discussions as measured by a consensus-derived four-point GOC discussion quality score.ResultsThe study recruited 126 palliative surgical oncology patients: 44 in the pre-MD-PALS group and 82 in the post-MD-PALS group. The two groups did not differ significantly in baseline demographics, treatment, or postoperative and survival outcomes. Compared with the pre-MD-PALS group, the post-MD-PALS group had a significantly higher mean GOC discussion quality score (1.34 vs 2.61; p < 0.001). Based on the ITS model, the average quarterly GOC discussion quality score increased significantly among patients after implementation of the MD-PALS team (change = 1.93; 95 % confidence interval, 0.96–2.90; P = 0.003).ConclusionThe implementation of an MD-PALS team was associated with improvements in the quality of GOC discussions among palliative surgical oncology patients.

Palliative surgical treatment using photodynamic therapy for biliary cancer complicated by obstructive jaundice

The article presents the results of a study of survival, markers of hemostasis, proteolysis, and tumor invasion after complex palliative treatment of patients with histologically verified malignant tumors of the bile ducts complicated by obstructive jaundice in two comparable groups of patients. The aim of the study was to evaluate the effectiveness of palliative surgical treatment using photodynamic therapy in patients with malignant tumors of the biliary system complicated by obstructive jaundice. In 10 patients of the main group, palliative surgical treatment was performed using photodynamic therapy; in 20 patients of the comparison group, palliative surgical treatment was performed without photodynamic therapy. In patients of the main group, a statistically significant increase in life expectancy by 104 days (p=0.033) was observed compared to the comparison group. At the same time, a statistically significant effect of tumor necrosis factor α, a marker of tumor invasion, on survival (p = 0.012) and a decrease in its level after photodynamic therapy by 15 pg/ml (p=0.041) was revealed. Thus, palliative treatment using photodynamic therapy of malignant tumors of the bile ducts, complicated by obstructive jaundice, can increase the survival rate of patients by reducing tumor invasion.

Charting the Path: Navigating Embryonic Development to Potentially Safeguard against Congenital Heart Defects.

Congenital heart diseases (CHDs) are structural or functional defects present at birth due to improper heart development. Current therapeutic approaches to treating severe CHDs are primarily palliative surgical interventions during the peri- or prenatal stages, when the heart has fully developed from faulty embryogenesis. However, earlier interventions during embryonic development have the potential for better outcomes, as demonstrated by fetal cardiac interventions performed in utero, which have shown improved neonatal and prenatal survival rates, as well as reduced lifelong morbidity. Extensive research on heart development has identified key steps, cellular players, and the intricate network of signaling pathways and transcription factors governing cardiogenesis. Additionally, some reports have indicated that certain adverse genetic and environmental conditions leading to heart malformations and embryonic death may be amendable through the activation of alternative mechanisms. This review first highlights key molecular and cellular processes involved in heart development. Subsequently, it explores the potential for future therapeutic strategies, targeting early embryonic stages, to prevent CHDs, through the delivery of biomolecules or exosomes to compensate for faulty cardiogenic mechanisms. Implementing such non-surgical interventions during early gestation may offer a prophylactic approach toward reducing the occurrence and severity of CHDs.

Experience in surgical treatment of vertebral metastatic tumors of craniovertebral localization

Purpose of the study. Elaboration of a surgical technique to manage patients with metastatic lesions of the craniovertebral region.Patients and methods. The study included 7 patients with metastatic lesions of the craniovertebral region, who’ve been operated on for severe instability, pain syndrome, neurological deficit in the period from 01/01/2014 to 09/30/2022. To assess the neurological status and patients’ condition the Frankel and Karnofsky scales were used on the day of admission and discharge of the patients from the hospital. Pain intensity was assessed using a visual analog pain scale (VAS). To assess instability in the affected spinal motion segment the SINS scale was used. All patients underwent palliative surgical treatment in the amount of occipitospondylodesis with a biopsy of the neoplasm from the posterior approach.Results. The average age of patients was 60 [44; 66] years. All patients had a marked pain syndrome prior to the surgery. The average pain intensity according to the visual analog pain scale was 8 points. In the preoperative period, 6 (85 %) patients on the Frankel scale were assigned to group E, 1 (14 %) – to group C. In 6 (85 %) patients there was no dynamics in the neurological status following the surgery, however according to the Karnofsky scale there was an improvement up to 10 points due to the regression of the pain syndrome down to 1 point on the visual analog scale. Hemiparesis developed in 1 (14 %) patient due to malposition of the laminar hook in the postoperative period. The average duration of surgical interventions made up 337.5 [315; 345] min, the average intraoperative blood loss made up 300 [300; 800] ml. In 6 out of 7 patients (85 %) there was no neurological status dynamics after the surgery, and according to the Karnofsky scale an improvement up to 10 points was noted due to regression of the pain syndrome to an average value of 1 [1; 2] VAS score. Conclusion. The obtained results indicate the clinical application possibilities of minimally traumatic surgical technologies for the treatment of craniovertebral zone metastatic tumors.

Experience in surgical treatment of vertebral metastatic tumors of craniovertebral localization

Purpose of the study. Elaboration of a surgical technique to manage patients with metastatic lesions of the craniovertebral region.Patients and methods. The study included 7 patients with metastatic lesions of the craniovertebral region, who’ve been operated on for severe instability, pain syndrome, neurological deficit in the period from 01/01/2014 to 09/30/2022. To assess the neurological status and patients’ condition the Frankel and Karnofsky scales were used on the day of admission and discharge of the patients from the hospital. Pain intensity was assessed using a visual analog pain scale (VAS). To assess instability in the affected spinal motion segment the SINS scale was used. All patients underwent palliative surgical treatment in the amount of occipitospondylodesis with a biopsy of the neoplasm from the posterior approach.Results. The average age of patients was 60 [44; 66] years. All patients had a marked pain syndrome prior to the surgery. The average pain intensity according to the visual analog pain scale was 8 points. In the preoperative period, 6 (85 %) patients on the Frankel scale were assigned to group E, 1 (14 %) – to group C. In 6 (85 %) patients there was no dynamics in the neurological status following the surgery, however according to the Karnofsky scale there was an improvement up to 10 points due to the regression of the pain syndrome down to 1 point on the visual analog scale. Hemiparesis developed in 1 (14 %) patient due to malposition of the laminar hook in the postoperative period. The average duration of surgical interventions made up 337.5 [315; 345] min, the average intraoperative blood loss made up 300 [300; 800] ml. In 6 out of 7 patients (85 %) there was no neurological status dynamics after the surgery, and according to the Karnofsky scale an improvement up to 10 points was noted due to regression of the pain syndrome to an average value of 1 [1; 2] VAS score. Conclusion. The obtained results indicate the clinical application possibilities of minimally traumatic surgical technologies for the treatment of craniovertebral zone metastatic tumors.

Management of Desmoid Disease in Familial Adenomatous Polyposis.

Desmoid disease, though technically a benign condition, is nevertheless a leading cause of morbidity and mortality in patients with familial adenomatous polyposis (FAP). Desmoid disease impacts approximately 30% of FAP patients, with several known risk factors. It runs the gamut in terms of severity-ranging from small, slow-growing asymptomatic lesions to large, focally destructive, life-threatening masses. Desmoids usually occur following surgery, and several patient risk factors have been established, including female sex, family history of desmoid disease, 3' APC mutation, and extraintestinal manifestations of FAP. Desmoid disease-directed therapy is individualized and impacted by desmoid stage, severity, postsurgical anatomy, and consequences of disease. Medical therapy consists of options in multiple classes of drugs: nonsteroidal anti-inflammatory drugs, hormonal therapy, tyrosine kinase inhibitors, and cytotoxic agents. Surgical excision is sometimes an option, but can be limited by common location of disease at the root of the small bowel mesentery. Palliative surgical treatments are often considered in management of desmoid disease. Intestinal transplantation for severe desmoid disease is an emerging and promising option, though long-term data on efficacy and survival is limited.

Lower gastrointestinal bleeding due to pancreatic cancer: an unusual presentation

Pancreatic cancer is a malignant neoplasm with a poor prognosis. When it manifests clinically with cold jaundice, general repercussion or dyspepsia, it usually corresponds to a locally advanced tumor. Enterorrhagia as a form of presentation of pancreatic cancer is extremely infrequent; it corresponds to a severe form with an ominous prognosis. We present the case of a 61-year-old man who attended emergency service for enterorrhagia associated with organic abdominal pain and general repercussions, to whom a diagnosis of pancreatic tail cancer was diagnosed. Colonoscopy revealed mucosal infiltration with intense edema, erythema, necrosis, and spontaneous bleeding at the level of the splenic flexure of the colon. Histology confirmed colonic infiltration by pancreatic neoplasm. Computed tomography allowed staging in stage IV. Palliative surgical treatment was performed, with a survival of 3 months.

Surgical outcomes of open and laser interstitial thermal therapy approaches for corpus callosotomy in pediatric epilepsy.

Corpus callosotomy (CC) is a palliative surgical intervention for patients with medically refractory epilepsy that has evolved in recent years to include a less-invasive alternative with the use of laser interstitial thermal therapy (LITT). LITT works by heating a stereotactically placed laser fiber to ablative temperatures under real-time magnetic resonance imaging (MRI) thermometry. This study aims to (1) describe the surgical outcomes of CC in a large cohort of children with medically refractory epilepsy, (2) compare anterior and complete CC, and (3) review LITT as a surgical alternative to open craniotomy for CC. This retrospective cohort study included 103 patients <21 years of age with at least 1 year follow-up at a single institution between 2003 and 2021. Surgical outcomes and the comparative effectiveness of anterior vs complete and open versus LITT surgical approaches were assessed. CC was the most common surgical disconnection (65%, n = 67) followed by anterior two-thirds (35%, n = 36), with a portion proceeding to posterior completion (28%, n = 10). The overall surgical complication rate was 6% (n = 6/103). Open craniotomy was the most common approach (87%, n = 90), with LITT used increasingly in recent years (13%, n = 13). Compared to open, LITT had shorter hospital stay (3 days [interquartile range (IQR) 2-5] vs 5 days [IQR 3-7]; p < .05). Modified Engel class I, II, III, and IV outcomes at last follow-up were 19.8% (n = 17/86), 19.8% (n = 17/86), 40.2% (n = 35/86), and 19.8% (n = 17/86). Of the 70 patients with preoperative drop seizures, 75% resolved postoperatively (n = 52/69). No significant differences in seizure outcome between patients who underwent only anterior CC and complete CC were observed. LITT is a less-invasive surgical alternative to open craniotomy for CC, associated with similar seizure outcomes, lower blood loss, shorter hospital stays, and lower complication rates, but with longer operative times, when compared with the open craniotomy approach.

P-239 Effectiveness and safety of palliative surgical interventions for bowel obstruction in advanced staged colorectal cancer: A systematic review and network meta-analysis

P-239 Effectiveness and safety of palliative surgical interventions for bowel obstruction in advanced staged colorectal cancer: A systematic review and network meta-analysis

Resectability and prognosis of gallbladder cancer: a cross-sectional study of 100 cases from a tertiary care centre of Eastern Nepal.

It is a prospective observational study including all cases of primary cancers of the gallbladder in the Department of Surgical Gastroenterology at a tertiary care center over the period from January 2014 to December 2019. The primary endpoint was resectability and overall survival. During the study period, 100 patients with GBC were reported. The mean age at the time of diagnosis was 52.5 years, with a female predominance (67%). The curative intent resection (radical cholecystectomy) was possible in 30 (30%) patients; while 18 (18%) required palliative surgical treatment. The overall survival of the entire group was 9 months; while those patients who underwent surgery with curative intent had a median overall survival of 28 months after a median follow-up of 42 months. This study found that only one-third of patients achieve radical surgery with curative intent. Overall, the prognosis of patients is poor with a median survival of less than a year due to the advanced stage disease. Multimodality treatment, screening ultrasound, and neo-/adjuvant therapy may improve survival.