Solitary Pancreatic Metastasis from Renal Cell Carcinoma: A Case Report from India with a Review of Literature

ABSTRACT: Metastatic cancer to the pancreas accounts for less than 2% of all pancreatic malignancies, with renal cell carcinoma being the predominant type. We report the case of an elderly patient detected with a solitary lesion in the head of the pancreas, 6 years after a nephrectomy for renal cell carcinoma. The patient underwent a pancreaticoduodenectomy for the same. A review of literature showed isolated pancreatic metastasis to be rare, ranging from 0.5 to 3%. Patients are usually asymptomatic, unless the tumor enlarges. Spread usually takes place by the hematogenous route or via lymphatics, direct spread being very unusual. Surgical resection seems to be the standard of care for isolated metastasis from renal cell carcinoma as the other modalities of treatment seem unresponsive. Typically, patients undergo a pancreaticoduodenectomy or distal pancreatectomy depending on the location of the tumor. Atypical resections are done in certain situations. Surgery is carried out in favourable candidates and a thorough evaluation needs to be done intraoperatively for multiple metastases. Histology revealed a metastatic renal cell carcinoma confirmed on immunohistochemistry. All margins were free of tumor without lymphnodal involvement. Eight months after the surgery the patient is doing well. As compared to primary pancreatic cancer, metastasis from renal cell carcinoma has a higher resectability rate. Solitary metastasis to the pancreas has a good prognosis especially in renal cell carcinoma, with a 5 years survival rate of 43 to 88%.KEYWORDS: Renal Cell Carcinoma; Pancreatic Metastasis; PancreaticoduodenectomyInternet Journal of Medical Update 2012 January;7(1):62-

Complications as indicators of quality assurance after 401 consecutive colorectal cancer resections: the importance of surgeon volume in developing colorectal cancer units in India

<p>Abstract</p> <p>Background</p> <p>The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing.</p> <p>Methods</p> <p>We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author. In addition to patient demographics and types of resections, perioperative data like intraoperative blood loss, duration of surgery, complications, re-operation rates and hospital stay were recorded and analyzed.</p> <p>Results</p> <p>The median age was 52 years (10-86 years). 279 were males and 122 were females. The average duration of surgery was 220.32 minutes (range 50 - 480 min). The overall complication rate was 12.2% (49/401) with a 1.2% (5/401) mortality rate. The patients having complications had an increase in their median hospital stay (from 10.5 days to 23.4 days) and the re-operation rate in them was 51%. The major complications were anastomotic leaks (2.5%) and stoma related complications (2.7%).</p> <p>Conclusions</p> <p>This largest ever series from India compares favorably with global standards. In a nation where colorectal cancer is on the rise, it is imperative that high volume centers develop specialized units to train future specialist colorectal surgeons. This would ensure improved quality assurance and delivery of health care even to outreach, low volume centers.</p

Is early feeding after major gastrointestinal surgery a fashion or an advance? Evidence-based review of literature

Early enteral nutrition (EN) after major digestive surgery has been receiving increasing attention. Supporting evidence has not been clear. This evidence-based review traces the development of early EN and analyses whether it is indeed an advance. We performed a PubMed search in October 2009 with the key words enteral nutrition, early feeding, and gastrointestinal surgery. Our emphasis was on earliest studies documenting the benefits or adverse effects of EN, comparative studies, documenting the benefits or adverse effects of EN, comparative studies, and randomized controlled trials. Thirty-one results were returned from which 17 were included for evaluation (1979-2009). Fifteen papers concluded that early EN was beneficial. In general, patients put on early EN and immunonutrition postoperatively seemed to have decreased hospital stay, decreased complication rates, decreased treatment and hospital costs, and even decreased morbidity and mortality; however, judicious use has been suggested. One study did not recommend early enteral feeding in well-nourished patients at low risk of nutrition-related complications and another suggested that immunonutrition is not beneficial and should not be used routinely. Early EN has been safely given after major digestive surgery since 1979. It benefits patients undergoing major gastrointestinal (GI) surgeries, with reduction in perioperative infection, better maintainance of nitrogen balance, and shorter hospital stay. Early EN may be superior to total parenteral nutrition (TPN). However, TPN is perhaps better tolerated in the immediate postoperative period. Early enteral immunonutrition should be used only in malnourished and in transfused patients. Early EN after major digestive surgery is an old advance that is now in fashion

Development and performance evaluation of novel nanoparticles of a grafted copolymer loaded with curcumin

Inflammatory bowel disease (IBD) is an inflammatory condition with mucosal ulceration, edema and hemorrhage of gastrointestinal tract. Curcumin has been shown to mitigate colitis in animal models. However, its usefulness is reduced due to poor pharmacokinetic behavior and low oral bioavailability. To address this, novel pH-sensitive hydrolyzed polyacrylamide-grafted-xanthan gum (PAAm-g-XG) nanoparticles (NPs) loaded with curcumin were prepared for colonic delivery. Optimized nanoparticles (CN20) were spherical, with an average size of 425 nm. A negligible amount of curcumin (approximate to 8%) was released from CN20 NPs in pH 1.2 and 4.5 solutions. When the pH was increased to 7.2, curcumin release was comparatively faster than that observed with pH 1.2 and 4.5 collectively. In pH 6.8 solution, excellent release of curcumin was observed. Highest curcumin release was observed when rat caecal contents were incorporated in pH 6.8 solution, indicating microflora-dependent drug release property of NPs. In acetic acid-induced IBD in rats, curcumin NPs reduced myeloperoxidase and nitrite levels, prevented weight loss and attenuated colonic inflammation. Curcumin was better absorbed systemically in nanoparticulate form with increased C-max (similar to 3 fold) and AUC (similar to 2.5 fold) than when delivered as free curcumin. We demonstrate successful development of grafted co-polymeric NPs containing drug suitable for colon targeting. (C) 2016 Elsevier B.V. All rights reserved