Publications by authors named "Syed Aamir"

57 Publications

Non-compliance to social distancing during COVID-19 pandemic: A comparative cross-sectional study between the developed and developing countries.

J Public Health Res 2021 Oct 29. Epub 2021 Oct 29.

Biological and Biomedical Sciences, Aga Khan University, Karachi.

Background: Despite mass vaccination campaigns, the world has seen a steady rise in the number of SARS-CoV-2 cases, with 178,765,626 cases and 3,869,994 COVID-19 related deaths by June 19th, 2021. Therefore, it is important to enforce social distancing to control its spread. With the variation observed in the severity of the pandemic in different countries, it is also imperative to study the social distancing behaviors amongst the population in developed and developing countries.

Design And Methods: In this cross-sectional study, a total of 384 participants from 14 different countries were surveyed via an online REDCap form.

Results: In this study, it was highlighted that despite adequate knowledge, the overall compliance to COVID-19 related preventive measures remains poor, the lowest being in the senior age group (≥ 65 years), and the highest being in adults aged between 25-64 years (p-value =0.003). Population from the developing countries were more compliant to all preventative measures against COVID-19 spread, except for handwashing, where the difference between the two populations remained insignificant (p-value = 0.038, <0.001, 0.016). Socioeconomic status, prior history of COVID-19 infection, or presence of comorbidities did not significantly affect compliance rates, however, participants with no prior history of this infection were found to be more compliant to donning a mask in public as compared to those with a positive history (p-value = 0.044).  Conclusions: Since compliance remains subpar in both the developing and the developed countries, mass campaigns about COVID-19 related preventive measures remain essential in controlling the disease spread.
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http://dx.doi.org/10.4081/jphr.2021.2614DOI Listing
October 2021

Clinical Practice Guidelines For The Management Of Colorectal Cancer, A Consensus Statement By The Society Of Surgeons® And Surgical Oncology Society Of Pakistan®.

J Pak Med Assoc 2021 Sep;71(Suppl 6)(10):S1-S7

Professor of Surgery, University of Lahore Medical College, President SOS PK.

A joint effort by the Society of Surgeons Pakistan and Society of Surgical Oncology Pakistan, these guidelines provide a framework for the practicing surgeons involved in care and management of patients with colorectal cancer. The guidelines take into account the issues related to our local circumstances and provide a minimum standard of care that must be given to these patients. The Guideline Committee had members from all disciplines, including surgery, surgical oncology, medical oncology and radiation oncology. The guidelines have attempted to simplify things to understand and follow for the practicing surgeons. With these guidelines we wish to eliminate disparities in treatment among institutions and prevent any under treatment of patients.
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September 2021

Psychological, social and economic impact of COVID 19 on the working population of India: Exploratory factor analysis approach.

Int J Disaster Risk Reduct 2021 Dec 1;66:102617. Epub 2021 Oct 1.

Motilal Nehru National Institute of Technology, Allahabad, India.

The purpose of this study is to unravel the effects of COVID-19 on the psychological, social, and economic well-being of the working population of India. To achieve the objectives of the study, an online survey was conducted, focusing on aspects like psycho-social well-being, safety, financial stability, and work from home implications. We have used exploratory factor analysis (EFA), -test, and analysis of variance technique to find the underlying factors. The findings suggest that the female population of the society is more vulnerable to social-psychological and organizational stress. In terms of financial stability, private employees are more unstable as compared to government employees. Based on the standard of living, people of type 1 cities are more affected by the COVID-19 outbreak compared to the people of type 2 and type 3 cities. Hence, by and large, female employees, employees working in the private sector, and employees residing in type 1 cities are more likely to have the behavioral manifestation of negative psychological states caused by this pandemic. The findings will assist policymakers in understanding and devising appropriate policies considering the psycho-social and work-related economic issues faced by the working population of India during the COVID- 19 pandemic.
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http://dx.doi.org/10.1016/j.ijdrr.2021.102617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494622PMC
December 2021

Optimizing the Performance of Pure ALOHA for LoRa-Based ESL.

Sensors (Basel) 2021 Jul 26;21(15). Epub 2021 Jul 26.

School of Automation, Beijing Institute of Technology, Beijing 100081, China.

(1) Background: The scientific development in the field of industrialization demands the automization of electronic shelf labels (ESLs). COVID-19 has limited the manpower responsible for the frequent updating of the ESL system. The current ESL uses QR (quick response) codes, NFC (near-field communication), and RFID (radio-frequency identification). These technologies have a short range or need more manpower. LoRa is one of the prominent contenders in this category as it provides long-range connectivity with less energy harvesting and location tracking. It uses many gateways (GWs) to transmit the same data packet to a node, which causes collision at the receiver side. The restriction of the duty cycle (DC) and dependency of acknowledgment makes it unsuitable for use by the common person. The maximum efficiency of pure ALOHA is 18.4%, while that of slotted ALOHA is 36.8%, which makes LoRa unsuitable for industrial use. It can be used for applications that need a low data rate, i.e., up to approximately 27 Kbps. The ALOHA mechanism can cause inefficiency by not eliminating fast saturation even with the increasing number of gateways. The increasing number of gateways can only improve the global performance for generating packets with Poisson law having a uniform distribution of payload of 1~51 bytes. The maximum expected channel capacity usage is similar to the pure ALOHA throughput. (2) Methods: In this paper, the improved ALOHA mechanism is used, which is based on the orthogonal combination of spreading factor (SF) and bandwidth (BW), to maximize the throughput of LoRa for ESL. The varying distances (D) of the end nodes (ENs) are arranged based on the K-means machine learning algorithm (MLA) using the parameter selection principle of ISM (industrial, scientific and medical) regulation with a 1% DC for transmission to minimize the saturation. (3) Results: The performance of the improved ALOHA degraded with the increasing number of SFs and as well ENs. However, after using K-mapping, the network changes and the different number of gateways had a greater impact on the probability of successful transmission. The saturation decreased from 57% to 1~2% by using MLA. The RSSI (Received Signal Strength Indicator) plays a key role in determining the exact position of the ENs, which helps to improve the possibility of successful transmission and synchronization at higher BW (250 kHz). In addition, a high BW has lower energy consumption than a low BW at the same DC with a double-bit rate and almost half the ToA (time on-air).
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http://dx.doi.org/10.3390/s21155060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348389PMC
July 2021

Laparoscopy Offers Better Clinical Outcomes and Long-term Survival in Patients With Right Colon Cancer: Experience From National Cancer Center.

Ann Coloproctol 2021 Jun 24. Epub 2021 Jun 24.

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Purpose: Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer.

Methods: Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study.

Results: A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant.

Conclusion: This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
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http://dx.doi.org/10.3393/ac.2021.00045.0006DOI Listing
June 2021

An empirical investigation of nuclear energy and environmental pollution nexus in India: fresh evidence using NARDL approach.

Environ Sci Pollut Res Int 2021 Oct 20;28(39):54744-54755. Epub 2021 May 20.

Department of Humanities and Social Sciences, Motilal Nehru National Institute of Technology, Allahabad, India.

Environmental pollution caused by carbon emissions is an emerging issue to study among researchers. The nexus between environmental pollution and carbon emissions has motivated researchers to evaluate the impact of cleaner energy on carbon emissions. This study further contributes to the research by examining the above relationship by studying the asymmetric influence of nuclear energy (NE), industrial productivity (IP), and economic growth rate (GDP) on carbon emissions (CO) in India from 1975 to 2018 using the asymmetric autoregressive distribution lag approach. The results of the bound test and the Wald test show that in the long run, there is an asymmetric relationship between CO, NE, GDP, and IP, and in the short run, there is a symmetric relationship between CO, GDP, and IP. The result implies that increased usage of nuclear energy over fossil fuels and improvement in industrial productivity, in the long run, reduces CO emission in India. Furthermore, the study concludes that the government should consider the asymmetric relationship between the variables and devise appropriate policies to increased nuclear energy and industrial productivity in India for environmental sustainability.
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http://dx.doi.org/10.1007/s11356-021-14365-9DOI Listing
October 2021

Retrospective study of ovarian malignancy managed in surgical unit at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

J Pak Med Assoc 2021 Feb;71(2(B)):696-698

Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan.

Objective: To determine the oncological outcome and pattern of ovarian tumours in patients who underwent surgical management.

Methods: The retrospective, descriptive hospital-based study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of all patients who underwent surgical intervention for ovarian cancer between January 2010 and December 2015. Data was retrieved from the hospital database and analysed using SPSS 20.

Results: Of the 236 patients, 203(86%) had undergone open surgery, while 33(14%) had had laparoscopic surgery. Neo-adjuvant chemotherapy was given in 60(25.42%) cases and adjuvant chemotherapy in 102(43.22%). Epithelial ovarian cancer in 201(85.16%) cases was the most common tumour type. Mortality was recorded in 36(15.5%) cases, while 41(19.9%) were lost to follow-up.

Conclusions: Ovarian tumours were found to be difficult to treat and were associated with frequent recurrence.
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http://dx.doi.org/10.47391/JPMA.07-727DOI Listing
February 2021

Pancreaticoduodenectomy: Outcomes of a complex surgical procedure from a developing country.

Pancreatology 2020 Oct 26;20(7):1534-1539. Epub 2020 Aug 26.

Shaukat Khanam Memorial Cancer Hospital & Research Centre, Lahore, Pakistan. Electronic address:

Background: Pancreaticoduodenectomy (PD) plays an integral part in the management of pancreatic, periampullary and duodenal cancers, along with a few other pathologies of this region. Despite advances in surgery PD continues to have significant morbidity and noteworthy mortality. The aim of this study is to provide an in-depth report on the patient characteristics, indications and the outcomes of PD) in a tertiary cancer hospital in Pakistan.

Materials And Methods: The study population included patients who underwent PD between January 1, 2014 and march 31, 2019, at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) in Pakistan. The data was retrospectively analyzed from the Hospital Information System (HIS), which is a prospectively maintained patient electronic database of SKMCH&RC. Patient characteristics, procedural details and post-operative outcomes according to internationally accepted definitions were reported.

Results: A total of 161 patients underwent PD at our hospital in the study period at a median age of 53 years, ranging from 19 to 78 years. 62% of the patients were males while 37% were females. Jaundice was the most common presenting symptom (64.6%), followed by abdominal pain (26.7%). PD with pancreaticogastrostomy was performed in 110 patients (68.3%), while pancreaticojejunostomy was performed in the rest of the cohort. Surgical site infection (SSI) was observed in 64 patients (40%). The incidence of Pancreatic Fistula grade C based on the International Study Group on Pancreatic Fistula (ISGPF) definition was 7.45% (n = 12). The 30 days mortality rate was 3.1%. Median survival of the cohort was 21 ±1.13 months and disease-free survival was 16±2.62 months.

Conclusion: PD can be performed with acceptable morbidity and mortality in a resource constrained country, as long as it is undertaken in a high-volume center. This is in keeping with data published from other well-reputed international centers.
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http://dx.doi.org/10.1016/j.pan.2020.08.013DOI Listing
October 2020

Laparoscopic Curative Resection for Right-Sided Colonic Tumors: Initial Experience From a Specialized Cancer Hospital of a Developing Country.

Cureus 2020 Jul 29;12(7):e9465. Epub 2020 Jul 29.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Introduction Laparoscopic colonic resection is increasingly becoming popular worldwide and aims to provide curative resection in addition to the inherent benefits of laparoscopic surgery. The aim of this study was to evaluate the long-term outcomes of laparoscopic right hemicolectomy in a Pakistani cohort of patients. Methods and procedures We retrospectively analyzed the medical records of all patients who presented to our hospital with the diagnosis of right-sided colon carcinoma from January 2010 to December 2018 and underwent laparoscopic right or extended right hemicolectomy. Demographics, operative findings, histopathology report, and follow-up of patients were recorded and the analysis was performed on Statistical Packages for the Social Sciences (SPSS) Version 20 (IBM Corp, Armonk, NY). Results Seventy-five patients were included, 56 (74.7%) of whom were males and 19 (25.3%) were females. The median age was 52 years (range 25-82 years). The median hospital stay was five days (Range 3-13 days). The median blood loss was 70 milliliters and the mean operative time was 195.5±77.6 minutes. Laparoscopic extended right hemicolectomy was performed in 23 (16.67%) patients and standard right hemicolectomy in 52 (83.33%) patients. Most (72%) of the patients had a pathological T3 tumor, and the majority (61.3%) of the patients had no nodal involvement (pN0). The mean number of lymph nodes removed was 20+8. The median numbers of involved lymph nodes were 1.14+2.19. All the patients had R0 resection. Postoperatively, two patients had pelvic collection, and there was no 30-day mortality. Local recurrence occurred in four patients and distant metastases were observed in nine patients. The median follow-up in our study was 40.5±18.35 months. The median disease-free survival was 42±2.17 months and the median overall survival was 44±2.16 months. Conclusion Our experience with laparoscopic right colon resections has confirmed the safety and feasibility of the procedure.
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http://dx.doi.org/10.7759/cureus.9465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455377PMC
July 2020

Synchronous Primary Endometrial and Ovarian Cancers: Trends and Outcomes of the Rare Disease at a South Asian Tertiary Care Cancer Center.

Cureus 2020 Jul 13;12(7):e9163. Epub 2020 Jul 13.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background and objective The incidence of synchronous primary endometrial and ovarian cancer is uncommon and poses a diagnostic challenge to the treating physician about their origin as either primary or metastasis. The purpose of this study was to evaluate the clinicopathological behavior, treatment modality-related outcomes, and prognosis related to primary endometrial and ovarian cancers at a tertiary care referral center in South Asia. Methods We retrospectively analyzed 30 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan from January 2005 to August 2017. Results The median age of the patients at the time of diagnosis was 51 years (range: 25-72 years). The common presenting symptoms were irregular uterine bleeding (30%), post-menopausal bleeding (26.7%), abdominal mass (16.7%), and abdominal pain (26.7%). Endometrial adenocarcinoma type was the most common histological variant found among the participants: 90% (n=27) of uterine and 56.7% (n=17) of ovarian cancers. All patients underwent surgical intervention. Among them, 25 patients received platinum-based adjuvant chemotherapy, four received neoadjuvant chemotherapy, and 18 received adjuvant radiotherapy. The early-stage group [International Federation of Gynecology and Obstetrics (FIGO) stage I and II] had a more favorable prognosis than the advanced stage group (FIGO stages III and IV). Conclusion Based on our findings, patients with synchronous primary endometrial and ovarian cancers have better overall survival rates than patients with single primary ovarian or endometrial cancers. Also, synchronous primary endometrial and ovarian cancer endometroid types have better overall survival than patients with non-endometrioid or mixed histologic types.
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http://dx.doi.org/10.7759/cureus.9163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419146PMC
July 2020

Malignant Melanoma of the Female Genital Tract: Experience of an Oncology Center in Pakistan.

Cureus 2020 Jun 7;12(6):e8484. Epub 2020 Jun 7.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Introduction Malignant melanoma, which arises from melanocytes or pigment cells, is one of the most common forms of epithelial cancer. Cutaneous and noncutaneous melanomas differ clinically and genetically. Mucosal melanomas are rare. In the female genital tract, the most frequent location of melanoma is the vulva, whereas the vagina is seldom affected. The occult nature of their anatomical location contributes to the late presentation and late diagnosis of vaginal melanoma, resulting in an exceedingly poor patient prognosis. The present study describes the incidence, symptoms, management, and prognosis of women in Pakistan with malignant melanoma of the vulva, vagina, and cervix. Materials and methods The Hospital Information System of Shaukat Khanam Memorial Cancer Hospital and Research Center was searched electronically to identify patients diagnosed with malignant melanoma from January 1995 to December 2017. Patients with cutaneous malignant melanoma, multiple primary tumors, and metastases to the female genital tract from primary tumors located elsewhere were excluded. All included patients had been diagnosed with primary malignant melanoma of the female genital tract. Results The search of medical records identified 271 patients with malignant melanoma, of whom 13 had primary malignant melanomas of the female genital tract. Of these 13 patients, nine, three, and one had primary vaginal, vulvar, and cervical melanomas, respectively. Median age at presentation was 60 years (range, 30-70 years), with 10 patients being post-menopausal. The most common presentations were per-vaginal bleeding and per-vaginal discharge (five patients each). The mean duration of symptoms was 7.46 months. Seven patients underwent wide local excision. Six patients had nodular type malignant melanoma, two had superficial spreading type, and five were unclassified. Nine patients had pathological T4 disease, and two had pathological T3. Mean Breslow depth was 5.4 millimeters (mm), with 10 patients having tumor depth >4 mm. Eight patients were positive for the microscopic involvement of margins. The mean time to recurrence was 11.8 months (range, 1-24 months), and the mean time to metastasis was 17.6 months (range, 2-44 months). The median survival after surgery was 25 months (range, 2-75 months). Conclusion This study is the first to report the incidence, symptoms, management, and prognosis of patients in Pakistan with malignant melanoma of the female genital tract. Meta-analyses and prospective multicenter studies are needed.
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http://dx.doi.org/10.7759/cureus.8484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336621PMC
June 2020

Prognostic Factors for Recurrence in Esophageal Cancer Patients Treated With Neoadjuvant Therapy and Surgery: A Single-institution Analysis.

Cureus 2020 May 14;12(5):e8108. Epub 2020 May 14.

Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background The purpose of this study is to analyze potential predisposing factors for a higher risk of recurrence in our esophageal cancer patients managed with neoadjuvant chemotherapy, radiation therapy, and surgery, and to determine their impact on disease-free survival (DFS) and time to recurrence. Methods A total of 154 of 232 patients staged T1b to T4a managed electively at our institute from July 2005 through July 2015 with a tri-modality approach were retrospectively evaluated. Basic demographic, clinical, radiological, operative, and pathological disease-related parameters, along with waiting time for surgery and type of neoadjuvant modality used, were assessed as potential risk factors. The primary endpoint was the impact of these on the risk of recurrence. The secondary endpoint was to study their relation on DFS and time to recurrence. Results The recurrence rate in this particular study was 33.1% over a median follow-up of 35 months (interquartile range = 19-50.3). The median time to recurrence was 12 months, and 94% of recurrences occurred within two years. The median DFS was 33 months, and the one- and three-year DFS was 90% and 72%, respectively. On univariate and multivariate analysis, a complete pathological response (hazard ratio [HR]: 3.8, 95% confidence interval [CI]: 1.41-10.11), negative resection margins (HR: 5.9, 95% CI: 1.69-20.45), and a low nodal index (HR: 6.3, 95% CI: 1.37-28.67 for an index of 0.1-0.2; and HR: 15.2, 95% CI: 0.96-241.73 for an index of >0.2) were found as statistically significant (P = < 0.05) for risk to recurrence. In addition to these three, a low comorbidity index (P = 0.03; HR: 3.5; 95% CI: 1.16-10.52) was an individual positive predictor of DFS. Conclusions A complete pathological response, low nodal index, and margin-negative resection were the identified predictors of freedom from recurrence, with a better DFS and a low comorbidity index as additional indicators of prolonged DFS.
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http://dx.doi.org/10.7759/cureus.8108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292711PMC
May 2020

Benefits of Outcomes of the Microscopic Examination of Anastomotic Donuts After Colorectal Resection for Oncological Purposes: A Medical Record-Based Study.

Cureus 2020 May 2;12(5):e7932. Epub 2020 May 2.

Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Objective  The objective of the study is to investigate the benefits of pathological assessment of donuts removed during coloanal anastomosis after anterior resection. Methodology During three years, 220 patients underwent circular stapled anastomosis. It is a retrospective study with convenient sampling. Involvement of donuts, the involvement of margins, length of donuts, and margins were primarily recorded. Ethical review approval was taken from the Institutional Review Board. Hospital electronic system was used to retrieve the data. Results Two hundred and twenty patients underwent circular end to end anastomosis (CEEA) stapled gun anastomosis. All had adenocarcinoma. Most of the patients had T3 disease (n=113). Low anterior resection was the most common procedure followed by anterior resection and sigmoid colectomy, respectively. We performed all rectal cancers anastomosis with a circular stapling gun. On histological analyses among 220 patients, only two patients were found to have a positive distal donut. No proximal donuts were positive. Both patients were also found to have positive distal margins. The mean length of the proximal donut was 1.79±0.45 cm. The mean length of the distal donut was 1.68±0.48 cm. Two distal margins and none of the proximal margins were positive for cancer. The mean length of the proximal margin was 8.69±4.48 cm. The mean length of the distal margin was 4.9±5.98 cm. Both patients had already received six months of pre-operative chemoradiotherapy and were not offered any additional treatment. Both patients were kept on close surveillance. Conclusion Routine analyses of the donuts after anterior resection has no impact on the management and outcome of the disease.
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http://dx.doi.org/10.7759/cureus.7932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265751PMC
May 2020

A retrospective study of endometrial stromal sarcoma: an institutional review.

J Pak Med Assoc 2020 May;70(5):926-929

Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan.

This is a retrospective study conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, from January 1995 to April 2016, to determine the clinical presentations, pathological features, cancer free survival and rate of recurrence in patients with Endometrial Stromal Sarcoma (ESS). Data was collected from May to August 2017. A total of 31 patients with a mean age of 40.0±11.72 years were treated. Among them, 12 (38.7%) had stage I, 2 (6.4%) had stage II, 6 (19.3%) had stage III and 11 (35.5%) had stage IV ESS. All patients underwent surgical management as an initial treatment modality for ESS. Out of these 31 patients, 17 were under active surveillance, 4 had expired and 10 patients were lost to follow up. Eleven (65%) patients were disease free, recurrence was noted in 4 (23.5%) patients and 2 (12%) patients had persistent disease. Recurrence of disease was managed with surgical excision and multimodality treatment. Median duration of follow-up was 38.29 months. Endometrial stromal sarcoma (ESS) is a rare uterine tumour. Our patients were young and had lower rate of recurrence. Surgical management was the mainstay of treatment in patients with resectable disease while other options used included hormonal therapy, radio therapy or chemotherapy.
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http://dx.doi.org/10.5455/JPMA.299808DOI Listing
May 2020

Hepatic arterial system anomalies encountered during pancreaticoduodenectomy - our experience.

J Pak Med Assoc 2020 Feb;70(2):337-340

Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.

We present our experience of incidence and management of aberrant hepatic arterial anatomy encountered during pancreaticoduodenectomy (PD). Patients undergoing PD between December 2014 and November 2016 at the Shaukat Khanum Memorial Cancer Hospital, Lahore were included in this short report. Preoperative imaging and operative findings of these patients were reviewed to evaluate the hepatic arterial anatomy and classified according to Hiatt classification. Sixty-four PD were performed with aberrant arterial anatomy identified in 24 (37.5%) of the cases. Most common anomaly was replaced right hepatic artery (rRHA) arising from the superior mesenteric artery seen in seven (11%) of the patients. Aberrant vessels were recognised and preserved in 23 cases. In one patient, the rRHA was coursing through the pancreatic parenchyma needing resection and reconstruction with uneventful postoperative recovery. Hepatic arterial anomalies are common and it is possible to preserve these vessels with careful surgical dissection using artery first technique.
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http://dx.doi.org/10.5455/JPMA.9783DOI Listing
February 2020

Risk Factors For Chyle Leak After Esophagectomy.

J Ayub Med Coll Abbottabad 2019 Oct-Dec;31(4):506-511

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Background: Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagectomy with poorly understood risk factors. It has a high morbidity due to loss of fluids, electrolytes, and other nutrients, loss of lymphocytes and immune dysfunction.

Methods: Retrospective chart review of adult patients who underwent esophagectomy between 2009 and 2016 was performed. Cases with chyle leak were identified according to a set criteria. Clinical features, operative findings and postoperative variables were recorded and predictors of chyle leak were analyzed.

Results: During the study period, a total of 193 adult patients underwent esophagectomy of which 186 received neo adjuvant chemotherapy. The mean age was 53 years with 118 males and 74 females. Type of procedure performed was 3-stage esophagectomy in 98, Transhiatal esophagectomy in 79 and Ivor-Lewis esophagectomy in 15 patients. Chyle leak was identified in 9 (4.6%) patients. There was no significant association of chyle leak with age, gender, co-morbid, level of tumor, Neoadjuvant therapy and Type of esophagectomy. Chest drain output on postoperative day 5 was significantly predictive of chyle leak (p-value<0.05). Drain output more than 1000 on day 4 was highly suggestive of chyle leak (p-value<0.05). Day on which chest drain was removed was also found to be significantly related to chyle leak (p-value <0.05).

Conclusions: No significant preoperative risk factors were identified for chyle leak. High chest drain output on postoperative day 5 and drain output more than 1000 on day 4 are significant predictors of chyle leak.
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April 2020

Proteomics analysis of colon cancer progression.

Clin Proteomics 2019 28;16:44. Epub 2019 Dec 28.

2Institute of Cancer Therapeutics, University of Bradford, Tumbling Hill Street, Bradford, BD7 1BD UK.

Background: The aim of this pilot study was to identify proteins associated with advancement of colon cancer (CC).

Methods: A quantitative proteomics approach was used to determine the global changes in the proteome of primary colon cancer from patients with non-cancer normal colon (NC), non-adenomatous colon polyp (NAP), non-metastatic tumor (CC NM) and metastatic tumor (CC M) tissues, to identify up- and down-regulated proteins. Total protein was extracted from each biopsy, trypsin-digested, iTRAQ-labeled and the resulting peptides separated using strong cation exchange (SCX) and reverse-phase (RP) chromatography on-line to electrospray ionization mass spectrometry (ESI-MS).

Results: Database searching of the MS/MS data resulted in the identification of 2777 proteins which were clustered into groups associated with disease progression. Proteins which were changed in all disease stages including benign, and hence indicative of the earliest molecular perturbations, were strongly associated with spliceosomal activity, cell cycle division, and stromal and cytoskeleton disruption reflecting increased proliferation and expansion into the surrounding healthy tissue. Those proteins changed in cancer stages but not in benign, were linked to inflammation/immune response, loss of cell adhesion, mitochondrial function and autophagy, demonstrating early evidence of cells within the nutrient-poor solid mass either undergoing cell death or adjusting for survival. Caveolin-1, which decreased and Matrix metalloproteinase-9, which increased through the three disease stages compared to normal tissue, was selected to validate the proteomics results, but significant patient-to-patient variation obfuscated interpretation so corroborated the contradictory observations made by others.

Conclusion: Nevertheless, the study has provided significant insights into CC stage progression for further investigation.
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http://dx.doi.org/10.1186/s12014-019-9264-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935225PMC
December 2019

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.

J Pak Med Assoc 2019 Oct;69(10):1431-1436

Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan.

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 [email protected] 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.
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October 2019

Pre-operative percutaneous endoscopic gastrostomy tube placement does not increase post-operative complications or mortality in oesophageal cancer.

J Gastrointest Oncol 2019 Jun;10(3):492-498

Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center (SKMCH & RC), Lahore, Pakistan.

Background: The percutaneous endoscopic gastrostomy (PEG) tube in patients with oesophageal cancer is controversial, owing to a perceived risk of tumour seeding at the PEG site, theoretical difficulty in formation of gastric conduit during oesophagectomy and a fear of increased post-operative complications, including anastomotic leak. We aimed to assess the impact of PEG tubes on nutritional status and post-operative complications in patients with oesophageal cancer who underwent PEG tube insertion prior to neo-adjuvant treatment.

Methods: We performed a retrospective review of 800 patients with oesophageal or gastro oesophageal junction (GOJ) cancer, who underwent PEG insertion from June, 2010 to May, 2015. Out of these, 168 patients who fulfilled the inclusion criteria were analysed further. All of them were followed up for 3 years after treatment to assess overall survival. Thus, the follow up of the last patient included in the study was completed on May, 31, 2018.

Results: The average body mass index (BMI) of patients was maintained following PEG tube, during neo-adjuvant treatment (22.34±4.84 before PEG 21.85±3.90 after PEG, P value: 0.1). Out of 168 patients, 33 (19.7%) developed a complication following PEG tube, with PEG site infection as the most common in 24 (14.2%). PEG-related mortality at 1 month was 0%. Ninety out of 168 patients (59%) underwent surgery after neo-adjuvant treatment. Three patients had tumour seeding at the PEG site and thus surgery could not be performed. Gastric conduit formation was possible in all 99 patients. Postoperative complications were seen in 17/99 (17%) patients, including surgical site infections in 7 (7.07%), anastomotic leak in 6 (6.06%) and anastomotic stricture in 4 (4.04%). Overall survival at 3 years was 87%.

Conclusions: Pre-operative PEG tube in oesophageal cancer is safe and does not compromise the future anastomosis. Also, it helps in maintaining the nutritional status during neo-adjuvant treatment.
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http://dx.doi.org/10.21037/jgo.2019.03.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534724PMC
June 2019

Demonstrating Advantages of Neuromorphic Computation: A Pilot Study.

Front Neurosci 2019 26;13:260. Epub 2019 Mar 26.

Department of Physics, Kirchhoff Institute for Physics, Heidelberg University, Heidelberg, Germany.

Neuromorphic devices represent an attempt to mimic aspects of the brain's architecture and dynamics with the aim of replicating its hallmark functional capabilities in terms of computational power, robust learning and energy efficiency. We employ a single-chip prototype of the BrainScaleS 2 neuromorphic system to implement a proof-of-concept demonstration of reward-modulated spike-timing-dependent plasticity in a spiking network that learns to play a simplified version of the Pong video game by smooth pursuit. This system combines an electronic mixed-signal substrate for emulating neuron and synapse dynamics with an embedded digital processor for on-chip learning, which in this work also serves to simulate the virtual environment and learning agent. The analog emulation of neuronal membrane dynamics enables a 1000-fold acceleration with respect to biological real-time, with the entire chip operating on a power budget of 57 mW. Compared to an equivalent simulation using state-of-the-art software, the on-chip emulation is at least one order of magnitude faster and three orders of magnitude more energy-efficient. We demonstrate how on-chip learning can mitigate the effects of fixed-pattern noise, which is unavoidable in analog substrates, while making use of temporal variability for action exploration. Learning compensates imperfections of the physical substrate, as manifested in neuronal parameter variability, by adapting synaptic weights to match respective excitability of individual neurons.
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http://dx.doi.org/10.3389/fnins.2019.00260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444279PMC
March 2019

A Mixed-Signal Structured AdEx Neuron for Accelerated Neuromorphic Cores.

IEEE Trans Biomed Circuits Syst 2018 10 24;12(5):1027-1037. Epub 2018 Jul 24.

Here, we describe a multicompartment neuron circuit based on the adaptive-exponential I&F (AdEx) model, developed for the second-generation BrainScaleS hardware. Based on an existing modular leaky integrate-and-fire (LIF) architecture designed in 65-nm CMOS, the circuit features exponential spike generation, neuronal adaptation, intercompartmental connections as well as a conductance-based reset. The design reproduces a diverse set of firing patterns observed in cortical pyramidal neurons. Further, it enables the emulation of sodium and calcium spikes, as well as N-methyl-D-aspartate plateau potentials known from apical and thin dendrites. We characterize the AdEx circuit extensions and exemplify how the interplay between passive and nonlinear active signal processing enhances the computational capabilities of single (but structured) on-chip neurons.
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http://dx.doi.org/10.1109/TBCAS.2018.2848203DOI Listing
October 2018

Comparison of efficacy and pharmacoeconomics of two eradication regimens in peptic ulcer disease.

Perspect Clin Res 2018 Jan-Mar;9(1):4-8

Department of Gastroenterology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India.

Background: , the cause of most peptic ulcer diseases, infects approximately 50% of the population worldwide. Indian data on cost and effectiveness of the standard first-line therapies for eradication are scarce. Thus, the present study was aimed at comparing the cost and efficacy of two standard first-line therapies: Regimen I comprising pantoprazole (40 mg) plus amoxicillin (750 mg) plus clarithromycin (500 mg) (PAC) and Regimen II comprising rabeprazole (20 mg) plus amoxicillin (625 mg) plus metronidazole (200 mg) (RAM).

Methodology: This prospective, observational, bottom-up study collected demographic, economic, diagnostic, and therapeutic data from 60 -positive patients. The study was carried out for 6 months in the Gastroenterology Department of a Tertiary Care Hospital in Hyderabad, Telangana, India.

Results: Health-care system perspective was used to account for direct costs. Average cost per patient for complete eradication was Rs. 10,221 and Rs. 8568 for Regimen I and Regimen II, respectively. Inpatient cost was considerably higher than the outpatient cost. Diagnostic costs ranked first in direct costs, followed by hospitalization costs, medication costs, and finally, physician's office visit cost. Individual patient's costs difference between two regimens was found to be statistically significant. Overall, Regimen I proved to be more efficacious than Regimen II, but Regimen II proved to be more cost-effective than Regimen I. Furthermore, incremental cost-effectiveness analysis revealed additional cost of Rs. 127 per patient if the patient was treated with Regimen I instead of Regimen II.

Conclusion: Our study showed that Regimen II (RAM) was more cost-effective than Regimen I (PAC), but PAC achieved faster eradication than RAM. We assume that this study provides local clinical data as to which regimen may be useful in a particular patient. National Level Clinical Trials are required to further ascertain this conclusion.
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http://dx.doi.org/10.4103/picr.PICR_99_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799951PMC
February 2018

Impact of Different Treatment Modalities on the Outcome of Pancreatic Cancer.

J Coll Physicians Surg Pak 2017 Aug;27(8):470-474

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore.

Objective: To analyze overall survival patterns of our pancreatic cancer patient population managed with a curative or palliative intent.

Study Design: Analytical study.

Place And Duration Of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2000 till February 2015.

Methodology: Aretrospective review of the data of all of our pancreatic cancer patients was performed, using the hospital information system. Patients with tumor other than adenocarcinoma or a histopathologic diagnosis not made at our hospital are excluded from the study, along with patients having an incomplete medical record for all included variables. The main outcome measure was overall survival in months from the date of diagnosis. All results were segregated and analyzed according to the intervention modality used, i.e. group A: surgery with curative intent, group B: Palliative chemotherapy, and group C: Supportive care. Results were controlled for the confounding variables including age, gender, significant comorbid conditions, stage of disease at initial presentation, tumor location, and histological grade.

Results: Among the 197 patients fulfilling the inclusion criteria, 21 (10.7%) were excluded as they were lost to follow-up. Overall Kaplan-Meier survival analysis gave a 56% one-year survival, 22% at 3- and 16% at 5-year. The subset analysis on Cox-regression survival plot showed inferior survival with advancing stage of the disease and a treatment less than definitive surgical resection and adjuvant chemotherapy. On Cox-proportional regression analysis, stage of the disease and treatment modality were only independent predictive factors for overall survival (p < 0.01).

Conclusion: Stage for stage, surgery with curative intent (group A) or palliative chemotherapy (group B) showed a trend towards improved survival as compared to supportive management (group C) alone. The results were more significant for surgical resection arm.
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http://dx.doi.org/2672DOI Listing
August 2017

Rectal Carcinoma: Demographics and Clinicopathological Features from Pakistani Population Perspective.

Cureus 2017 Jun 20;9(6):e1375. Epub 2017 Jun 20.

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.

Background: Colorectal carcinoma is ranked as the second most common cancer diagnosis in females and third in males. It is the third leading cause of cancer-related deaths worldwide. Disease burden has been attributed to a myriad of factors comprising genetic, environmental, and dietary factors. Rectal cancer has been shown to demonstrate variance according to the geographical location.

Methods: A retrospective review of 477 rectal cancer patients treated at Shaukat Khanum Memorial Cancer Hospital & Research Centre from 2006 to 2014 was performed. Demographic and clinicopathological features were compared between the two age groups (≤40 or >40 years). These included sex, ethnicity, family history of cancer, the location of tumor, clinical staging, histopathological type, and response to chemoradiation. Chi-square was used to compare the frequencies between the two age groups. p-value < 0.05 was taken as significant.

Results: Mean age of the study group was 44.62 ± 16.11 years. 43.8% were ≤40 years of age, and 70.2% were male. 50.3% patients belong to Punjab province, 287 (60.2%) had lower rectal cancer, family history of cancer was present in 82 (17.2%) patients. 432 (90.5%) patients had T1/T2 disease and 296 (62.1%) had N2 disease. Metastatic disease at presentation was observed in 37 (7.8%). Progressive disease was found in 90 (18%) patients.

Conclusion: High frequency of young onset rectal cancers and the lack of family history emphasize the need of indigenous strategies and national awareness of this disease for an early identification of these patients.
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http://dx.doi.org/10.7759/cureus.1375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519317PMC
June 2017

Morbidity analysis in minimally invasive esophagectomy for oesophageal cancer versus conventional over the last 10 years, a single institution experience.

J Minim Access Surg 2017 Jul-Sep;13(3):192-199

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC), Lahore, Pakistan.

Background: There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer.

Objectives: The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute.

Methods: All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Clavien-Dindo classification system. Long-term outcomes are long-term procedure related complications over a minimum follow-up of 1 year. Trends were analysed by visually inspecting the graphic plots for mean number of events in each group each year.

Results: Our results showed no difference in mortality, length of hospital and ICU stays and incidence of major complications between three groups on uni- and multi-variate analysis (P > 0.05). The operative time was significantly longer in MIE group (odds ratio [OR]: 1.66, confidence interval [CI]: 2.4-11.5). The incidence of long-term complication was low for MIE (OR: 1.0, CI: 133-1.017). However, all post-operative surgical outcomes trended to improve in both groups over the course of this study and stayed better for MIE group except for the operative time.

Conclusion: MIE has overall comparable surgical outcomes to its conventional counterpart. Furthermore, the peri-operative outcomes tend to improve in our centre with the maturation of program and experience.
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http://dx.doi.org/10.4103/0972-9941.199606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485808PMC
June 2017

Association of tumor size and focality with recurrence/persistence in papillary thyroid cancer patients treated with total thyroidectomy along with radioactive-iodine ablation and TSH suppression.

Updates Surg 2018 Mar 26;70(1):121-127. Epub 2017 May 26.

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.

Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual's PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14-5.11), and 3.48 for micro-multifocal PTMC (CI 1.19-10.2). Disease free survival patterns on Kaplan-Meier's plots were alike for micro- and macro-unifocal groups, and similarly stayed comparable among the two multifocal groups. Our analysis showed that tumor multifocality rather than size is the significant factor determining prognosis; hence, total thyroidectomy is indicated for an optimal assessment of true focality in micro-PTC.
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http://dx.doi.org/10.1007/s13304-017-0465-5DOI Listing
March 2018

Surgical Management for Symptomatic Giant Liver Hemangiomas: A Meta-Analysis.

J Coll Physicians Surg Pak 2017 Mar;27(3):173-182

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH/RC), Lahore.

Objective: To conduct a meta-analysis of reported evidence on surgical management for symptomatic giant liver hemangiomas.

Methodology: A systematic literature search was conducted to identify studies on adult patient surgeries for symptomatic giant liver hemangiomas from January 2009 to July 2015. The primary outcome measures included postoperative symptom resolution, mortality, complications, and blood transfusions. Quality of life after surgery was taken as a secondary outcome. Meta-analysis was performed using a random-effect model with comprehensive meta-analysis software.

Results: Fourteen studies with 1,557 patients were included. There were only two mortalities. Overall event rate for minor and major complications was low as 0.15 and 0.14, respectively, with a high symptom resolution rate of 0.69 (95%, CI 0.64-0.73). Pooled analysis for blood transfusion stayed insignificant due to high calculated heterogeneity across studies. Quality of life results after surgery are reported good by three studies, in most of their patients. The adverse outcome rate between enucleation and resection was comparable.

Conclusion: Liver hemangioma surgery is a safe treatment option with negligible mortality and low morbidity. It is effective in terms of symptom control and overall quality of life.
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http://dx.doi.org/2579DOI Listing
March 2017

Early multifocal recurrence of hepatoblastoma in the residual liver after R0 liver resection with ALPPS procedure: a case report.

Ann Transl Med 2016 Oct;4(19):375

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been successfully employed in adults to avoid potential liver insufficiency in patient with small future liver volume (FLV) when subjected to conventional right trisectionectomy. We are reporting an infant with hepatoblastoma, who underwent a technically successful ALPPS procedure with R0 resection. However he developed very early recurrence within the first month after the procedure. We present this report with a view to share our unexpected finding of early multifocal recurrence of hepatoblastoma in the residual liver after ALPPS procedure in a very young patient.
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http://dx.doi.org/10.21037/atm.2016.10.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075851PMC
October 2016

Changes in oncological outcomes: comparison of the conventional and minimally invasive esophagectomy, a single institution experience.

Updates Surg 2016 Dec 15;68(4):343-349. Epub 2016 Sep 15.

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre SKMCH & RC, 7-A Block R-3, Johar Town, Lahore, 54000, Pakistan.

Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal cancer. The aim of this retrospective study is to analyze the oncologic adequacy of these two procedures at our Centre. Out of 1252 registered esophageal cancer patients at our institute from 2006 to 2015, 206 patients who underwent a surgical resection with curative intent and a complete medical record were retrospectively evaluated thru hospital medical record system (HIS). Patients were allocated into the conventional open OE, and minimally invasive MIE and Hybrid esophagectomy groups. Primary outcomes are tumor recurrence and disease-free survival over a minimum follow-up of 1 year along with assessment of adequacy of pathological specimen in terms of lymph nodes harvested and clear longitudinal <1 cm and circumferential (≥1 mm) resection margins for patients with post-neo-adjuvant residual disease. Secondary endpoint is to look for trends in the adequacy of oncologic clearance in each group over the study period. Overall, there was no statistically significant difference (p > 0.05) between groups (OE vs. MIE vs. Hybrid) for median number of lymph nodes retrieved (13 vs.14 vs.15), resection margin positive disease (55.8 vs. 35.7 vs. 44 % of patients with any residual disease N = 103,50 %), or tumor recurrence (45.2 vs. 37.3 vs. 25 %). Disease-free survival over a mean follow-up of 2.3 years was higher in the conventional group (13.8 months vs. 9.7MIE and 11.8hybrid) without any statistical significance. Learning curve for MIE to achieve a comparable mean lymph nodes harvest to OE was 1 year, while pathological complete resection stayed persistently better with minimally invasive approach. Minimally invasive esophagectomy is found to be oncologically adequate and gives results matching their conventional analogue with an increasing experience.
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http://dx.doi.org/10.1007/s13304-016-0390-zDOI Listing
December 2016

Resection-Reconstruction of Aberrant Right Hepatic Artery During Whipple Procedure (Pancreaticoduodenectomy).

J Coll Physicians Surg Pak 2016 06;26(6 Suppl):S24-5

Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore.

Aberrant hepatic arterial anatomy poses a challenge for the surgeon during Whipple procedure. Intraoperative injury to the aberrant vasculature results in hemorrhagic or ischemic complications involving the liver and biliary tree. We report a case of replaced right hepatic artery arising from the superior mesenteric artery in a patient with periampullary carcinoma of the pancreas, undergoing pancreaticoduodenectomy. The aberrant artery was found to be coursing through the pancreatic parenchyma. This is a rare vascular anomaly. Resection of the arterial segment and end-to-end anastomosis was fashioned. Intrapancreatic course of the replaced right hepatic artery is a rare anomaly and is best managed by preoperative identification on radiology and meticulous intra-operative dissection and preservation. However, for an intrapancreatic course, resection and reconstruction may occasionally be required.
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June 2016
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