If proper investigations are done, radical surgery including multi-organ resection can be curative with acceptable morbidity and mortality. Stage at presentation and ability to perform curative resection are the most important prognostic factors predicting survival. Palliative chemotherapy should be considered for metastatic GBC.

Since curative resection is the only chance of cure, aggressive surgical approach adopted by us is justified with acceptable mortality and morbidity and encouraging overall survival.

In the present era of modern surgical practice, the incidence of intra-abdominal suture granuloma is extremely rare with reduced use of non-absorbable silk sutures and even rarer following laparoscopic procedures. We report herein a case of silk granuloma presenting as large submucosal polypoidal lesion in a recently operated case of gastrointestinal stromal tumor (GIST) of stomach. Though endoscopic biopsy showed chronic non-specific gastritis with no evidence of malignancy, our patient underwent excision of lesion due to high likelihood of neoplastic lesion suggested by radiological evaluation and recent history of surgery for GIST but histopathology surprisingly showed Giant cell silk granuloma. In summary, the possibility of suture granulomas should always be considered while evaluating postoperative CT scan/ PET scan for a mass lesion at operated site, particularly in patients who have undergone surgery with non-absorbable silk sutures.

Gallbladder cancer (GBC) is the most common biliary tract malignancy. Incidence varies widely with geographic regions, with northern India being the endemic area for GBC. Curative surgery offers the only chance of cure, but most of patients present with unresectable or metastatic disease and are candidates for palliative treatment only. This study was designed to evaluate efficacy of chemotherapy over best supportive care in unresectable/metastatic GBC. Patients with unresectable/metastatic GBC with proven tissue diagnosis were enrolled for single institution non-randomized prospective cohort study between May 2012 and April 2014. A total of 65 patients received palliative chemotherapy; either combination chemotherapy (n = 59) or single agent chemotherapy (n = 6). Combination chemotherapy regimen were either three weekly Gemcitabine-Cisplatin (n = 45) or Gemcitabine-Oxaliplatin (n = 14) for a maximum of six cycles. Twenty patients, either unfit for chemotherapy or unwilling for the same were advised best supportive care (BSC). The overall response rate to chemotherapy was 34 %. Median survival for chemotherapy group and BSC group were 35.6 and 13 weeks, respectively (p value < 0.001). Median OS for combination chemotherapy (n = 59) and single agent chemotherapy (n = 6) were 37 and 26.7 weeks, respectively (p value- 0.002). Median PFS for combination chemotherapy and single agent chemotherapy were 26 and 15 weeks, respectively (p value-0.012). The results of this study are quite encouraging and support use of chemotherapy for unresectable GBC patients over best supportive care, and that gemcitabine based combination chemotherapy may be a better choice for response rates, OS, and PFS.

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