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   Table of Contents - Current issue
May-August 2020
Volume 3 | Issue 2
Page Nos. 33-57

Online since Wednesday, April 28, 2021

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Surgeons as community teachers in times of pandemic - Spreading cheer, not fear p. 33
Brij B Agarwal, Roy V Patankar, Sneh Agarwal, Kushal Mital, Niranjan Agarwal
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Transanal minimally invasive surgery short- and mid-term outcomes p. 35
Mohammad Taha Mustafa Sheikh
Introduction: Transanal minimally invasive surgery (TAMIS) is a very efficient and safe technique for the management of rectal lesions that are large or not amenable to colonoscopic removal. Both benign and malignant lesions can be excised with higher rates of specimen nonfragmentation and margin negativity. Introduced in 2010 by Atallah it has undergone tremendous growth with respect to indications and instrumentation. We present our short- and mid-term experience in this novel technique. Materials and Methods: A retrospective study from September 2016 (when the first TAMIS case was done in our institution) up to February 2020 was carried out. Case records were analyzed and their outpatient follow-up was traced. Results: A total of 20 patients had undergone TAMIS from September 2016 to February 2020. The most common indication for undergoing TAMIS was rectal adenomas in 6 (30%) patients. This was followed by rectal carcinomas in situ or carcinoma suspected in a previously biopsied polyp in 4 (20%) patients. Hyperplastic polyps constituted 4 (20%) of the TAMIS procedures. We also had two patients with juvenile polyposis. There was no specimen fragmentation in any of the specimens. Only one patient had a positive margin and underwent low anterior resection. The final biopsy showed no residual tumor. There were no procedure-related complications. The average hospital stay was 24 h. All procures were done under general anesthesia. Our longest follow-up is 40 months. The mean follow-up was of 16.1 months. There has been no procedure-related complication. None of our patients have recurrence. Conclusion: TAMIS is a safe and effective technique for the management of benign and early rectal cancer lesions of the rectum. Our short- and mid-term outcomes are encouraging to continue using this technique for our patients.
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Low rectal gastrointestinal stromal tumor-multimodality therapy: Reports and Review p. 38
JS Rajkumar, Nabeel Nazeer, Jayakrishna Reddy, S Akbar, Anirudh Rajkumar, Shreya Rajkumar, R Prabhakaran, KR Dharmendra
Gastrointestinal stromal tumor (GIST) is one among the most common mesenchymal tumors of the gastrointestinal tract. Common in the stomach, these are also found in other segments, and there has recently been a spate of reports about rectal and colonic GIST. This article highlights two rectal GISTs that were encountered and underwent laparoscopic abdominoperineal resection (APR) and laparoscopic APR plus Total laparoscopic hystrectomy (TLH) (laparoscopic posterior pelvic exenteration) for the involvement of the posterior vaginal wall. The patients both had smooth postoperative periods and are on tyrosine kinase inhibitors, refusing local external radiotherapy. This article highlights the issues surrounding the management of low rectal GIST, a rare but potentially deadly disease.
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Role of lateral pelvic lymph node dissection in rectal cancer: A systematic review and meta-analysis p. 41
Ashwin Rajendiran, Sachin Shenoy, Ahmed Shalaby, Y KS Viswanath, Venkatesh Shanmugam
Introduction: Total Mesorectal excision (TME) is globally accepted as the standard treatment for rectal cancer. Lateral lymph node dissection (LLND) is still an oncological debate among colorectal surgeons and practiced routinely in some centers of the Eastern world (Japan and Korea) based on limited evidence. Aims: This review aims to determine the oncological and survival benefit of adding LLND to standard TME and also the additional morbidity associated. Outcomes Measured: The primary outcomes are local recurrence, 5-year overall survival and disease-free survival. The secondary outcomes are the incidence of urinary and sexual dysfunction. Materials and Methods: A systematic review protocol was followed. A structured search was run across MEDLINE, OVID, and COCHRANE databases. Five articles from three randomized trials were included. Meta-analysis was performed using Revman 5.3™. Results: No difference was noted between TME and TME + LLND for local recurrence (odds ratio [OR] 0.77, 0.44, 1.35), disease-free survival (OR 1.04, 0.81, 1.34), and overall survival (OR 1.05, 0.79, 1.41). The degree of heterogeneity was within acceptable limits. The OR for urinary dysfunction (OR 2.02, 0.45, 9.11) and male sexual dysfunction (OR 3.96, 0.54, 28.82) had wide confidence intervals and significant heterogeneity; the overall effect was not statistically significant. Conclusion: Our study included only randomized controlled trials and noted no difference in the oncological or survival outcomes. Previous reviews have included nonrandomized studies in a desperate attempt to produce evidence for or against LLND. A carefully arranged International controlled trial is necessary to settle this East-West controversy.
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Gastrointestinal autonomic nerve tumor of the rectum - A rare case report p. 52
Santhosh Kumar Ganapathi, Sankar Subramanian, Susruthan Muralitharan, Chandrasekar Murugesan
Gastrointestinal stromal tumour (GIST) is the most common mesenchymal, or nonepithelial, neoplasm of the gastrointestinal (GI) tract. Gastrointestinal autonomic nerve tumour (GANT) is a subset of GIST and a very rare mesenchymal tumour with neuronal differentiation. We report a 33-year-old gentleman presented with a chief complaint of perianal pain, itching, and mucus discharge per rectum for the past 4 months. There was no history of bleeding per rectum/loss of weight/loss of appetite. On digital rectal examination: Hard fixed growth at 2–8 O' clock approximately 5 cm from the anal verge and proximal extent could not be felt. Magnetic resonance imaging pelvis revealed a mass lesion involving the inferior two third of the rectum and anal canal predominantly the posterior and lateral walls. Contrast-enhanced computed tomography abdomen and pelvis revealed a heterogeneously enhancing mass involving the lower rectum (involving posterior and both lateral walls) and also circumferentially involving the entire length of anal canal with severe luminal narrowing. Upper border 10 cm from anal verge. Multiple enlarged perirectal/ para-aortic/presacral lymph nodes. Colonoscopy demonstrated an ulceroproliferative growth of 7 cm from anal verge, extending from 2 to 7 o' clock position. Examination was carried out under anaesthesia and biopsy was also done. Biopsy with Immunohistochemical analysis suggestive of GI autonomic nervous system tumour. Treatment Palliative end colostomy was done in view of large locally advanced infiltrating growth involving the lower rectum and anal canal and coccyx.
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COVID-19 pandemic and cancer surgery: Tracing solutions p. 56
Himanshu Agrawal, Raghav Yelamanchi, Nikhil Gupta, CK Durga
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