Our experience with CEA in the management of colorectal cancer – a prospective study

Introduction : In India, colorectal cancer is the 6th most prevalent cancer and population based time trend studies show a rising trend in its incidence. CEA is expressed in significant amounts post-natally by the carcinomas arising from large intestine. Currently, the most useful application of CEA is in the detection of liver metastasis from colorectal cancers and serial determination of CEA is recommended for detecting cancer spread to the liver. Aim: To assess the role of CEA in the management of colorectal cancer, and detection of early recurrence. Methods and Material: 30 patients with colorectal cancer admitted in Vydehi Institute of Medical Sciences & Research Centre during the period of November 2012 to April 2014 were included in a prospective study. Statistical analysis used: Descriptive statistics were calculated for all variables. Analysis was performed using the SPSS 14.0 statistical package. Results: Total patients included in the study was 30. The mean age at presentation was 48.66yrs. The most common site of malignancy was rectum (46.66%), and most of the patients presented in stage I. Pre-operatively CEA was raised in 22 cases. On postoperative follow-up, CEA was found to be elevated in 7 cases. 6 out of these cases had proven recurrence. One case was found to have peritoneal deposit in spite of CEA levels being normal. The sensitivity and specificity of using CEA as an indicator for recurrence were 85.71% and 95.65% respectively. Conclusions: Since colorectal cancer is associated with considerable morbidity and mortality, early diagnosis and management provide a chance for better survival. The use of CEA as an early indicator for recurrence has been evaluated in this study and can be used for the same. However, a larger size and longer duration of study is needed to effectively prove the same

Role of hunger hormone “Ghrelin” in long-term weight loss following laparoscopic sleeve gastrectomy

Introduction: Laparoscopic sleeve gastrectomy (LSG) has become a popular weight loss technique in morbidly obese patients. The aim of our study was to evaluate the changes in plasma ghrelin levels in relation to weight loss following LSG and to study the efficacy of LSG in terms of long‑term glycemic control and resolution of diabetes.Methodology: The study was conducted on 70 morbidly obese patients (body mass index [BMI] >40 kg/m2) or severely obese patients (BMI >35 kg/m2) with comorbidities who underwent LSG in Dayanand Medical College and Hospital, Ludhiana, India. Ghrelin levels were measured preoperatively and postoperatively at 1 week, 3 months, and 6 months along with measurements of various weight loss parameters and glycosylated hemoglobin.Results: A significant decrease in plasma ghrelin levels was observed in relation to the mean weight and percentage excess weight loss at 3 months postoperatively. However, at 6 months, fall in ghrelin reached a plateau phase while weight loss was still sustained and significant. There was a significant fall in glycosylated hemoglobin levels with patients achieving good control/resolution of diabetes Type II.Conclusion: LSG is an effective weight loss surgery and brings about excellent weight loss in morbidly obese individuals in addition to achievement of good glycemic control in diabetic individuals. Serum levels of ghrelin fall significantly after sleeve gastrectomy. However, long term implications of ghrelin induced weight loss cannot be elucidated.Keywords: Ghrelin, laparoscopic sleeve gastrectomy, morbid obesity surger

Quantitative multiparametric MRI allows safe surgical planning in patients undergoing liver resection for colorectal liver metastases: report of two patients

It is not uncommon for clinicians to encounter varying degrees of hepatic steatosis in patients undergoing resection for colorectal liver metastases (CRLM). Magnetic resonance imaging is currently the preferred investigation for identification and pre-operative planning of these patients. An objective assessment of liver quality and degree of steatosis is paramount for planning a safe resection, which is seldom provided by routine MRI sequences. We studied two patients who underwent an additional pre-operative multiparametric MRI scan (LiverMultiScan(TM)) as a part of an observational clinical trial (HepaT1ca, NCT03213314) to assess the quality of liver. Outcome was assessed in the form of post-hepatectomy liver failure. Both patients (Patient 1 and 2) had comparable pre-operative characteristics. Both patients were planned for an extended right hepatectomy with an estimated future liver remnant of approximately 30%. Conventional preoperative contrast MRI showed mild liver steatosis in both patients. Patient one developed post-hepatectomy liver failure leading to prolonged hospital stay compared to patient two who had uneventful post-operative course. Retrospective evaluation of multiparametric MRI scan revealed findings consistent with fibro-inflammatory disease and steatosis (cT1 829 ms, PDFF 14%) for patient 1 whereas patient two had normal parameters (cT1 735 ms, PDFF 2.4%). These findings corresponded with the resection specimen histology. Multiparametric MRI can objectively evaluate future liver health and volume which may help refine surgical decision-making and improve patient outcome