Tumor Perforation Research Articles

A case of thymoma that caused hemothorax due to tumor perforation

A case of thymoma that caused hemothorax due to tumor perforation

The pathological and immunohistochemical profile of tumor angiogenesis in perforated sigmoid carcinoma–Case report and short literature review

<b>Background:</b> Little is known about the physiopathological factors or mechanisms that underlie tumor invasion of the serosa and lead to perforation in the peritoneal cavity. The aim of the work was to analyze the pathological and immunohistochemical factors of tumor neoangiogenesis which could influence tumor perforation in colorectal cancer.<br /> <b>Results and discussions:</b> 451 cases of complicated colorectal carcinomas were statistically analyzed, of which 19 cases were perforated sigmoid tumors. The immunohistochemical detection of mutant p53 proteins was the first molecular parameter examined in the context of the search for markers predicting the natural evolution mode in colorectal carcinomas.<br /> <b>Conclusions</b>: Both loss of p53 and overexpression of bcl-2 proteins confer immortalization on cancer cells by inhibiting the processes leading to apoptosis. The paper proposes a review of the specialized literature, but also the presentation of a clinical case.

Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy.

Up to 30% of patients with colorectal cancer present as an emergency and have worse outcomes than elective patients. Compared with left-sided cancers, malignancies arising in the right colon are significantly under-researched. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer (RCC). This multicentre, retrospective study included all patients who underwent operative management for a RCC, from 1 April 2017 to 31 March 2022. Data were collected from electronic patient records, and host and tumour factors as well as outcomes between emergency and elective cohorts were compared. Overall, 806 patients (median age 72 years) were included. Some 175 patients (22%) presented as an emergency: 140 in obstruction and 35 with tumour perforation, compared with 1 patient with tumour perforation in the elective group (p < 0.001). The emergency group had higher rates of postoperative complications (59.1% vs 20.0%, p < 0.001), increased 90-day mortality (13.7% vs 1.3%, p < 0.001) and a longer hospital stay (5 vs 10 days, p < 0.001). From the emergency cohort only 29.2% of eligible patients received adjuvant chemotherapy and in multivariate regression analysis emergency presentation was associated with a decreased likelihood of receiving adjuvant chemotherapy (odds ratio 0.26 [0.14-0.47], p < 0.001). Both short- and long-term outcomes after emergency presentation of RCC are poor, with inadequate access to subsequent chemotherapy. Strategies addressing emergency presentations of left-sided tumours have moved towards temporisation and elective surgery. Delaying major resectional surgery for optimisation may improve outcomes and access to adjuvant therapies for RCC.

Особливості виникнення поширеного перитоніту та вплив поліморфізму гена 5,10-метилентетрагідрофолатредуктази

It is relevant in modern surgery to clarify the risk factors of widespread peritonitis and to improve the treatment and diagnostic algorithms for the management of such patients. Aim - to establish the features of the occurrence of widespread peritonitis and the influence of MTHFR gene polymorphisms on the risk of its occurrence. Materials and methods. The study included 100 patients who underwent surgical interventions for acute abdominal diseases complicated by peritonitis: acute appendicitis (48%), acute cholecystitis (32%), perforated ulcer of the stomach or duodenum (8%), tumor perforation (3%), injuries of the abdominal cavity (3%), pinched hernia (2%) and intestinal obstruction (4%). Genotypes of MTHFR gene polymorphisms rs1801131 and rs1801133 were determined by real-time polymerase chain reaction. Mathematical processing of the research results was carried out using the Statistica 10 program. Results. The risk of disseminated peritonitis was increased with perforated gastric or duodenal ulcer, tumor perforation, abdominal trauma, herniated hernia, or intestinal obstruction compared with acute appendicitis and cholecystitis. The risk of disseminated peritonitis was lower in II blood group carriers compared and was associated with temperature at hospitalization and pulse rate. Conclusions. The factors determining the risk of disseminated peritonitis in the multivariate regression model were the diagnosis, heart rate, and the rs1801131 genotype of the MTHFR gene. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Comparison of short-term outcomes of D2 and D3 lymph nodes dissection for colon cancer

Background. D3 lymph node dissection remains controversial in colon cancer surgery.Aim. To compare the short-term of D2 and D3 lymph nodes dissection for colon cancer.Materials and methods. Design of the study – prospective randomize controlled study. Inclusion criteria: age over 18 years, colon adenocarcinoma cT3–4n0–2m0, patient consent to participate in the study. Exclusion criteria: distant metastases diagnosed preoperatively, cTis–T2, cT4b (pancreas, stomach, small intestine, ureter, bladder, kidney), emergent cases (limited to tumor perforation, acute bowel obstruction), history of previous chemotherapy or radiation therapy, synchronous or metachronous cancer, pregnancy or breastfeeding, refusal to participate in the study. withdrawal criteria were exploratory laparotomy/laparoscopy or other reasons for refusing resection.Results. A total of 436 patients were included in the study no differences were found in the clinical characteristics of groups D2 and D3. In the D2 lymph node dissection group the incidence of unintentional vascular injuries was in 7 (3.2 %) patients, in the D3 lymph node dissection group – in 15 (6.9 %) patients (p = 0.12). The operating time increased by 30 minutes in D3 lymph node dissection group (p p = 0.42). Hartmann’s procedure was performed in 2 (0.9 %) patients in the D2 lymph node dissection group. Complications IIIb were recorded in 5 (2.3 %) and 9 (4.1 %) patients in lymph node dissection groups D2 and D3, respectively (p = 0.42). Anastomotic leakage was not observed in the D2 lymph node dissection group; in the D3 lymph node dissection group, it was diagnosed in 3 (1.4 %) patients (p = 0.25). postoperative multiple-organ failure (Iv) or mortality (v) were not observed. grade 3 quality of the specimen was observed in 160 (73.4 %) patients in the D2 lymph node dissection group, 163 (74.8 %) in the D3 lymph node dissection group (p = 0.79). The median number of lymph node harvested was 11 more in the D3 lymph node dissection group (p &lt; 0.001). Apical lymph nodes were positive in 5 (2.3 %) patients in the D3 lymph node dissection group. There was no difference between the groups in R0 resection margin.Conclusion. D3 lymph node dissection is safe in terms of short-term outcomes in the treatment of colon cancer.

Results of patient survival after surgical interventions for complicated forms of colon cancer performed in general surgical hospitals

The aim of the study: to evaluate the 1- and 3-year survival of patients operated for complicated forms of colon cancer (СC) in general surgical hospital. Materials and methods. The study group included 71 (100 %) patients with complicated forms of СС. Acute intestinal obstruction was detected in 49 (69.1 %) patients, tumor perforation – in 13 (18.3 %), acute colonic bleeding – in 3 (4.2 %) patients, a combination of acute intestinal obstruction with tumor perforation – in 4 (5.6 %) and intestinal obstruction with bleeding – in 2 (2.8 %) operated patients. Radical operations were performed in 48 (67.6 %) patients, palliative operations – in 18 (25.4 %), symptomatic operations – in 5 (7.0 %) patients. II stage of the disease was diagnosed in 15 (21.1 %), III stage – in 32 (45.1 %), IV stage – in 24 (33.8 %) operated patients. 19 (30.2 %) patients underwent specific chemotherapy after surgery. Results. Among patients with the II stage of the oncological process 1-year survival was 76.9 ± 11.7 %, 3-year – 53.8 ± 13.8 %; with stage III, 1-year survival was 65.6 ± 8.4 %, 3-year – 50.0 ± 8.8 %; in persons with IV stage of СC – 29.2 ± 9.3 % and 8.3 ± 2.6 % respectively (χ2 = 21.8, p = 0.0001). Among male patients, 1-year survival was 51.4 ± 8.5 %, 3-year – 31.4 ± 7.9 %; women – 61.1 ± 8.1 % and 44.4 ± 8.3 %, respectively (χ2 = 2.3, p = 0.1302). Better indicators were found in the case of cancer of the left sections of the large intestine than the right sections – the 1-year survival rate was 60.4 ± 7.1 % and 43.5 ± 10.3 % respectively; 3-year – 39.6 ± 7.1 % and 30.4 ± 9.6 % (χ2 = 0.74, p = 0.3906). Conclusions. The conducted analysis indicates a clear dependence of the survival results on the stage of the disease, gender and localization of the tumor process.

Data-Driven Surveillance Protocol for Patients at Risk for Peritoneal Recurrence of Primary Colon Cancer: Surveillance for Peritoneal Carcinomatosis.

Peritoneal carcinomatosis (PC) is rarely discovered early due to low sensitivity of screening imaging and tumor markers, however, earlier identification may improve outcomes. This study assesses risk factors and time to recurrence of PC and implementation of a surveillance system. Patients with stage II-III colon adenocarcinoma undergoing curative colectomy between 2005-2022 were retrospectively reviewed at a single tertiary care institution. Patients were divided into three cohorts: no recurrence (NR), PC, and other types of recurrence (OTR). Baseline characteristics between cohorts were compared with univariate analysis. Overall survival and PC risk were assessed using multivariate analysis with Cox's proportional-hazard modelling. 412 patients were included; 78.4% had NR, 7.8% had PC, and 13.8% had OTR. Patient demographics, comorbidities, tumor side, and histologic features were similar between cohorts. Patients with PC were more likely to have microscopic tumor perforation (25% vs. 8.8% vs. 6.8%, p = 0.002), margin involvement (25% vs. 8.8% vs. 4.6%, p < 0.001), lymphovascular invasion (56.2% vs. 33.3%, vs. 24.5%, p < 0.001), perineural invasion (28.1% vs. 15.8% vs. 11.5%, p = 0.026) compared to OTR or NR. Median time to PC after colectomy was 11 months. Tumor characteristics of stage II-III colon cancer define a high-risk profile for PC. An early surveillance program sensitive for peritoneal disease should be adopted for these patients.

Effect of colorectal cancer screening on colorectal cancer surgery outcomes: nationwide cohort study.

National colorectal cancer screening commenced in Denmark in 2014. Little is known about the effects of organized colorectal cancer screening on intraoperative and postoperative events. The aim of this nationwide cohort study was to evaluate the difference in intraoperative and postoperative outcomes between patients with screen-detected colorectal cancer and non-screen-detected colorectal cancer within the first 90 days after surgery. National register data were collected for Danish residents diagnosed with colorectal cancer between January 2014 and March 2018. Outcomes for the two cohorts were reported as relative risk or weighted mean difference. Intraoperative outcomes were blood loss, blood transfusion, tumour perforation, and organ lesion. Postoperative outcomes were complications (surgical and non-surgical) and 90-day mortality. Discrete data estimates were calculated from a general linear model. Analyses were adjusted for potential healthy user bias with respect to sex, age, location of the cancer (colon/rectum), and Charlson co-morbidity index. In total, 10 606 patients were included. Compared with patients in the non-screen-detected colorectal cancer group (4497 patients), patients in the screen-detected colorectal cancer group (6109 patients) had reduced intraoperative blood loss (-52 mL, 95% c.i. -67 to -37, P < 0.001), a shorter duration of hospitalization (-2.3 days, 95% c.i. -2.8 to -1.8, P < 0.001), and reduced rates of intraoperative organ lesion (0.76, 95% c.i. 0.59 to 0.99, P = 0.042), surgical complications (0.79, 95% c.i. 0.73 to 0.87, P < 0.001), non-surgical complications (0.68, 95% c.i. 0.60 to 0.78, P < 0.001), and 90-day mortality (0.29, 95% c.i. 0.21 to 0.39, P < 0.001). In comparison with non-screen-detected colorectal cancer, surgery for screen-detected colorectal cancer remains associated with improvement in several intraoperative and early postoperative outcomes after considering healthy user bias.

Diagnostic criteria and case definitions for abdominal angiostrongyliasis: a systematic review from the Brazilian experience.

Although rare, Angiostrongylus costaricensis infection may be a more prevalent etiology of inflammatory bowel disease than ulcerative colitis and Chron's disease in endemic areas in Central and South America. The present study reviewed the occurrence of A. costaricensis in Brazil, its clinical presentation and pathology; and proposed diagnostic criteria and case definitions for abdominal angiostrongyliasis (AA). Southern and southeastern Brazilian regions are the main endemic areas, and AA affects both genders and all age groups. A review of all 23 published reports of 51 Brazilian patients highlighted the following features that were subsequently classified as minor diagnostic criteria: abdominal pain, palpable mass in the right lower abdominal quadrant, history of exposure, ileocecal tumor, and intestinal perforation with wall thickening. Proposed major criteria include right lower quadrant abdominal pain, blood eosinophilia, positive serology (antibody detection), intense eosinophilic infiltration that involves all strata of the intestinal wall, eosinophilic granulomatous reaction, and eosinophilic vasculitis. In addition to the definitions of suspected and possible cases according to increasing strength of evidence of this infection, demonstration of worms/eggs/larvae in tissues or Angiostrongylus DNA in tissues or serum are required for a confirmed diagnosis. The application of the proposed criteria and definitions may improve patient management, epidemiologic surveillance, and identification of new endemic areas.

Gastro Intestinal Stromal Tumor -Supra Pubic Region

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract and mesentery. They are usually found in the stomach or small intestine but can occur anywhere along the GIT and rarely have extra GI involvement. They are associated with high rates of malignant transformation. Most GISTs present asymptomatically but also present with bleeding, abdominal pain, and rarely gastric outlet obstruction. There have been many risk stratification classifications systems which are calculated based on tumour size, mitotic rate, location, and perforation. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. The approaches to treating GISTs are to resect primary low-risk tumours, high-risk tumours and further treated with imatinib therapy and unresectable tumours treated with neoadjuvant imatinib 400 mg daily followed by surgical resection and regular follow up by abdominal CT scan.

Aetiology, Clinical Manifestations, Diagnosis, and Treatment of Oesophageal Perforation: A Review.

Oesophageal perforation (OP) is a life-threatening condition and refers to a tear or disruption in the oesophageal wall. It is considereda medical emergency due to its significant implications, oftenrelated to its various causes, such as iatrogenic perforation during endoscopy, Boerhaave syndrome, traumatic injury, foreign body ingestion, and tumour perforation. Early interventions, diagnosis, and a thorough physical examinationare essential for better clinical outcomes.Diagnostic procedures and imaging techniques, play a crucial role in confirming OP. The diagnostic workup, based on the index of suspicion, may involve barium oesophagram or contrast-enhanced CT. Once diagnosed, classification of severity using the Pittsburgh clinical severity score guides treatment decisions. Management can be non-surgical or surgical and focuses on a multi-disciplinary approach combining conservative, surgical, or endoscopic methods.Surgical control remains crucial, with the approach dependent on the location of the leak. Improved knowledge of this life-threatening condition is important among healthcare professionals. The objective of this review is to provide information about oesophageal perforation and its early detection, management, and multidisciplinary interventions for optimal patient outcomes.

Comparative analysis of clinical and morphological data of patients of different age groups who underwent emergency surgical interventions for complicated colon cancer

The aim of the study was to conduct a comparative analysis of clinical and morphological data of patients of different age groups after emergency resection interventions for complicated colon cancer. Materials and methods. The retrospective cohort study included 227 patients who underwent emergency operations for complicated colon cancer during the period from September 2016 to December 2022. Two groups of patients were selected: group 1 – under 60 years old, group 2–60 years old and older. In the 2nd group, 2 subgroups were selected: patients aged between 60 to 74 years and patients between 75 years and older. The primary point of the study was assessment of postoperative complications according to the Clavien–Dindo classification within 30 days after surgery. The secondary point was study of oncological adequacy of the operation. Results. The study included 128 (56.4 %) women and 99 (43.6 %) men. The median age was 66 years. Forty seven (20.7 %) patients were included in the group of persons younger than 60 years; 180 (79.3 %) patients were included in the group 60 years and older. There were no differences between the groups by gender and tumor localization. Tumor perforation was more often recorded in group 2 (23.3 % and 4.3 %, p = 0.017). High comorbidity was also more often observed in group 2 (46.8 % and 100 %, p = 0.023). In group 2, the physical status mostly corresponded to ASA grade 3 and 4 (p = 0.031). The difference between the groups by T-status was revealed: in group 1, there were more cases of T2-T3 (76.6 % vs. 46.7 %), and in group 2 – of T4 (53.3 % vs. 23.4 %), p = 0.034. Most patients in group 1 had the pN2 status (68.1 %), however, the pN1 status prevailed in the 2nd group (70 %). There were more oncologically inadequate operations in group 2: 54 (30 %) compared with group 1–2 (4.3 %) (p = 0.004). The main factors influencing the radicality of the performed operation were the type of urgent complication – tumor perforation (odds ratio (OR) 1.81, 95 % CI 1.43–3.96, p = 0.002); type of surgery (the Hartmann type surgery) (OR 1.62, 95 % CI 1.22–3.83, p &lt;0.001); age OR 0.76, 95 % CI 0.54–1.33, p = 0.004); comorbidity (OR 0.61, 95 % CI 0.43–1.28, p = 0.02); physical status of patients according to ASA classification grade 3–4 at admission (OR 0.52, 95 % CI 0.30–1.49, p = 0.002); tumor localization (OR 0.43, 95 % CI 0.28–1.15, p = 0.011). Conclusion. Emergency operations for complicated colon cancer are characterized by a high risk of serious postoperative complications, especially in elderly and senile patients. In patients younger than 60 years of age, the malignant tumors are often characterized by more aggressive course with damage to regional lymph nodes (N2 status).

Case Report] Clear Cell Carcinoma of the Ovary with Disseminated Intravascular Coagulation and Haemoperitoneum with Tumour Perforation

We report a case of a 34-year-old woman with haemoperitoneum and acute disseminated intravascular coagulation (DIC) following the rupture of ovarian clear cell carcinoma (OCCC), the first documented case of its kind. Although DIC is known to be associated with ovarian cancer, acute DIC with bleeding in the clear cell variant has not been reported. The patient, who had a right adnexal lesion, was found to have anaemia and thrombocytopenia. Intra-abdominal bleeding due to the rupture of a malignant ovarian cyst associated with DIC was identified as the cause. After surgery, the DIC resolved, suggesting that OCCC can be an aetiology for acute DIC and bleeding.

Laparoscopic extralevator abdominoperineal resection for low rectal cancer: The myth of reinventing the wheel.

To review oncological outcomes of laparoscopic extralevator abdominoperineal excision (LAP-ELAPE) for low rectal cancer.In locally advanced low rectal cancer, ELAPE which is en-bloc resection of levator muscles along with the tumor in a prone position has significantly decreased the rate of having either positive circumferential resection margin (CRM) or tumor perforation. The aim of the study was to determine the oncological outcomes of laparoscopic extralevator abdominoperineal excision (LAP-ELAPE) for low rectal cancer. This retrospective study was performed at Shaukat Khanum Cancer Hospital and Research Centre Lahore. Patients who underwent ELAPE for low rectal and anal cancer from January 2014 to December 2019 were selected. Data was collected using an electronic database through a hospital information system. A total of 82 patients were included in the study having a median age of 39 years. Clinically preoperative tumor sizes were T2:2, T3:65, T4:15. Neo-adjuvant chemo radiotherapy was administered to 79 (96.3%) patients. Pathologically tumor sizes were T0:12, T2:15, T3:50, T4:5 with 79.2% (n=65) R0 resections. The mean operative time was 340.36±64.51 minutes and the mean blood loss was 99 milliliters. The mean postoperative hospital stay was 6.58±4.64 days. Seventeen (20.7%) cases had pathological circumferential resection margins positive (pCRM<1mm). However, tumor perforation was found in 8(9.8%) patients. Ninety days mortality was none while 36 patients experienced recurrence (local: 23, distant: 30, local + distant 17). The median survival time was 53.00±2.69 months. For locally advanced low rectal cancer, ELAPE has evolved as a safe oncological procedure with acceptable outcomes.

WTP7.14 The ‘Right’ Strategy? Can we change the risk profile of emergency presentations of right sided colorectal cancers?

Abstract Background Up to 30% of patients with colorectal cancer present acutely and have worse outcomes than elective patients. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer. Methods This single-centre, retrospective study included all patients who underwent operative management (emergency and elective) for a right-sided colon cancer, from 1st April 2017 to 31st March 2022. Data were collected from electronic patient records and analysed to compare host and tumour factors as well as outcomes between emergency and elective cohorts. Results Overall 303 patients (median age 72) were included. 65 patients (22%) presented as an emergency: 36 presented in obstruction and 11 with tumour perforation, compared to 1 patient with tumour perforation in the elective group (p=&amp;lt;0.0001). Emergency presentation was associated with more advanced tumour stage (p=0.001). The emergency group had lower rates of laparoscopic surgery (32% vs 86% p=&amp;lt;0.0001); higher rates of post-operative complications (47% vs 27% p=0.05); increased 90-day mortality (20% vs 3% p=0.001); and a longer hospital stay (9 vs 4 days p=0.048). 50% of emergency patients received adjuvant chemotherapy compared to 56% of elective patients (p=0.71). No differences were found between the two groups regarding demographics, comorbidities, or time to MDT discussion. Discussion Outcomes of acute right-hemicolectomy are poor, with inadequate access to subsequent chemotherapy. Strategies addressing acute presentations of left-sided tumours have moved towards temporisation and elective surgery; this strategy is rarely adopted for acute presentations of right-sided tumours. Delaying major resectional surgery for optimisation may improve short-term outcomes, and access to adjuvant therapies.

Long-term survival by surgery and adjuvant chemotherapy in a patient with perforated extranodal NK/T-cell lymphoma of the small intestine: a retrospective case study

BackgroundExtranodal natural killer/T-cell lymphoma, nasal type (ENKL) of the small intestine, is a disease with extremely poor prognosis. We describe treatment in a case which is novel in that it demonstrated long-term survival.Case presentationA 68-year-old man was admitted to the emergency department of our hospital with the complaint of severe umbilical pain with tenderness and muscular defense. An abdominal computed tomography scan revealed a thick-wall mass on the small intestine and intra-abdominal free air. He was suspected of perforation of a small intestinal tumor and underwent emergency surgery. The surgery revealed a perforated tumor ulcer, and ENKL was diagnosed from the postoperative pathological findings. The patient’s postoperative course was uneventful. He was further treated with adjuvant chemotherapy by hematologist comprising six courses of dexamethasone, etoposide, ifosfamide, and carboplatin. The patient demonstrated long-term survival and was in remission at the time of writing, four years and five months after surgery.ConclusionsWe report a rare case of long-term survival of perforated ENKL of the small intestine achieved by surgery and adjuvant chemotherapy with dexamethasone, etoposide, ifosfamide, and carboplatin. It is essential to consult with a hematologist to determine the most appropriate chemotherapy such as DeVIC if one encounters rare postoperative pathological findings of ENKL. To elucidate the pathophysiology of this disease and to prolong survival of affected patients, accumulation of cases of long-term survival and examination of associated characteristics is necessary.

Appendiceal Goblet Cell Carcinoma: Role of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

Goblet cell carcinoma (GCC) encompasses a separate entity in appendiceal neoplasms with mixed glandular and neuro-endocrine pathological features. GCC mostly presents as an acute appendicitis duo to luminal obstruction or as an incidental finding on the surgical appendectomy specimen. In case of tumour perforation or presence of other risk factors, guidelines suggest additional treatment with a completing right hemicolectomy or cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). We report the case of a 77-year-old male with symptoms of appendicitis for which an appendectomy was performed. The appendix was ruptured during the procedure. There was an incidental finding of GCC on the pathological specimen. Because of possible tumour soiling, the patient received a prophylactic CRS-HIPEC. A literature review was performed to investigate the potential role for CRS-HIPEC as a curative treatment in patients with GCC. GCC of the appendix is an aggressive type of tumour with a high risk of peritoneal and systemic dissemination. CRS and HIPEC is a treatment option: both in a prophylactic setting and in patients with established peritoneal metastases.

Unusual presentation of a large GIST: a challenging diagnostic dilemma

Introduction: Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated withhigh rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computedtomography (CT) scan and most stain positive for CD 117 (C-Kit), CD34, and/ or DOG-1. There have been many riskstratification classifications systems which are calculated based on tumor size, mitotic rate, location and perforation. Case presentation: A 42 years old man presented with dysphagia and weight loss for 2.5 months. On examination, hewas severely anaemic having a huge intra-abdominal lump. He underwent laparotomy followed by removal of tumormass with partial left lobectomy of the Liver. Conclusion:We present a case of GIST of unusual location and presentation pattern. In general, only completeresection of tumor can lead to cure, although recurrence is common after surgery. Bangladesh Crit Care J March 2023; 11 (1): 54-60

Cytoreductive Surgery and Hyperthermic Peritoneal Chemotherapy in Appendiceal and Colorectal Cancer: Outcomes and Survival.

We reviewed outcomes following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with appendiceal or colorectal neoplasms and evaluated key prognostic indicators for treatment. All patients who underwent cytoreductive surgery/HIPEC for appendiceal and colorectal neoplasms were identified from an IRB-approved database. Patient demographics, operative reports, and postoperative outcomes were reviewed. 110 patients [median age 54.5 (18-79) years, 55% male] were included. Primary tumor location was colorectal (58; 52.7%) and appendiceal (52; 47.3%). 28.2%, .9%, and 12.7% had right, left, and sigmoid tumors, respectively; 11.8% had rectal tumors. 12/13 rectal cancer patients underwent preoperative radiotherapy. Mean Peritoneal Cancer Index was 9.6 ± 7.7; complete cytoreduction was achieved in 90.9%. 53.6% developed postoperative complications. Reoperation, perioperative mortality, and 30-day readmission rates were 1.8%, .09%, and 13.6%, respectively. Recurrence at a median of 11.1 months was 48.2%; overall survival at 1 and 2years was 84% and 56.8%, respectively; disease-free survival was 60.8% and 33.7%, respectively, at a median follow-up of 16.8 (0-86.8) months. Univariate analysis of preoperative chemotherapy, primary malignancy location, primary tumor perforated or obstructive, postoperative bleeding complication, and pathology of adenocarcinoma, mucinous adenocarcinoma and negative lymph nodes were identified as possible predictive factors of survival. Multivariate logistic regression analysis showed that preoperative chemotherapy (P < .001), perforated tumor (P = .003), and postoperative intra-abdominal bleeding (P < .001) were independent prognostic indicators for survival. Cytoreductive surgery/HIPEC for colorectal and appendiceal neoplasms has low mortality and high completeness of cytoreduction score. Preoperative chemotherapy, primary tumor perforation, and postoperative bleeding are adverse risk factors for survival.

Gene Expression Analysis of Immune Regulatory Genes in Circulating Tumour Cells and Peripheral Blood Mononuclear Cells in Patients with Colorectal Carcinoma.

Information regarding genetic alterations of driver cancer genes in circulating tumour cells (CTCs) and their surrounding immune microenvironment nowadays can be employed as a real-time monitoring platform for translational applications such as patient response to therapeutic targets, including immunotherapy. This study aimed to investigate the expression profiling of these genes along with immunotherapeutic target molecules in CTCs and peripheral blood mononuclear cells (PBMCs) in patients with colorectal carcinoma (CRC). Expression of p53, APC, KRAS, c-Myc, and immunotherapeutic target molecules PD-L1, CTLA-4, and CD47 in CTCs and PBMCs were analysed by qPCR. Their expression in high versus low CTC-positive patients with CRC was compared and clinicopathological correlations between these patient groups were analysed. CTCs were detected in 61% (38 of 62) of patients with CRC. The presence of higher numbers of CTCs was significantly correlated with advanced cancer stages (p = 0.045) and the subtypes of adenocarcinoma (conventional vs. mucinous, p = 0.019), while being weakly correlated with tumour size (p = 0.051). Patients with lower numbers of CTCs had higher expression of KRAS. Higher KRAS expression in CTCs was negatively correlated with tumour perforation (p = 0.029), lymph node status (p = 0.037), distant metastasis (p = 0.046) and overall staging (p = 0.004). CTLA-4 was highly expressed in both CTCs and PBMCs. In addition, CTLA-4 expression was positively correlated with KRAS (r = 0.6878, p = 0.002) in the enriched CTC fraction. Dysregulation of KRAS in CTCs might evade the immune system by altering the expression of CTLA-4, providing new insights into the selection of therapeutic targets at the onset of the disease. Monitoring CTCs counts, as well as gene expression profiling of PBMCs, can be helpful in predicting tumour progression, patient outcome and treatment.