Background: Pancreatic adenocarcinoma (PDAC) is highly lethal. Surgery offers the only chance of cure, but 5-year overall survival (OS) after surgical resection and adjuvant therapy remains dismal. Adjuvant trials were mostly conducted in the West enrolling fit patients. Applicability to a general population, especially Asia has not been described adequately.Aim: We aimed to evaluate the clinical outcomes, prognostic factors of survival, pattern, and timing of recurrence after curative resection in an Asian institution. Methods and Results:The clinicopathologic and survival outcomes of 165 PDAC patients who underwent curative resection between 1998 and 2013 were reviewed retrospectively. Median age at surgery was 62.0 years. 55.2% were male, and 73.3% had tumors involving the head of pancreas. The median OS of the entire cohort was 19.7 months. Median OS of patients who received adjuvant chemotherapy was 23.8 months. Negative predictors of survival include lymph node ratio (LNR) of >0.3 (HR = 3.36, P = .001), tumor site involving the body or tail of pancreas (HR = 1.59, P = .046), presence of perineural invasion (PNI) (HR = 2.36, P = .018) and poorly differentiated/undifferentiated tumor grade (HR = 1.86, P = .058). The median time to recurrence was 8.87 months, with 66.1% and 81.2% of patients developing recurrence at 12 months and 24 months respectively. The most common site of recurrence was the liver. Conclusion:The survival of Asian patients with resected PDAC who received adjuvant chemotherapy is comparable to reported randomized trials. Clinical characteristics seem similar to Western patients. Hence, geographical locations may not be a necessary stratification factor in RCTs. Conversely, lymph node ratio and status of PNI ought to be incorporated.

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Introduction: Acute malignant large bowel obstruction (MBO) occurs in 8-15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge-to-surgery (BTS). We aimed to conduct a clinical audit on safety and efficacy of SEMS for MBO in our institution. Methods: Data from a prospectively maintained electronic database in a tertiary referral centre in Singapore was reviewed for all consecutive patients undergoing SEMS insertion for MBO. Technical success defined as successful SEMS deployment across tumour without complications. Clinical success defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. Results: 79 patients underwent emergent SEMS placement from September 2013 to February 2020. Mean age 68.8±13.8 years, male 43/79 (54%). Mean tumour length 4.2cm±2.2cm; 89.9% (71/79) distal to splenic flexure. Technical and clinical success was 94.9% (75/79) and 98.7% (74/75), respectively. Perforation occurred in 5.1% (4/79), with no cases of stent migration or bleeding. 50/79(63.3%) of SEMS inserted as BTS. Median time to surgery was 20 days (range 6-57). Majority (41/50;82%) underwent minimally invasive surgery (robotic-assisted 7/50,14%; laparoscopic 34/50,68%). Primary anastomosis rate was 98% (49/50). 39 patients had follow-up beyond 1-year post-treatment (median 34 months). Local recurrence and distant metastasis were observed in 4/39(10.3%) and 5/39(12.8%), respectively. Conclusion: SEMS acute MBO has high technical and clinical success rates with a good safety profile. Majority of patients in our audit underwent minimally invasive surgery and primary anastomosis after successful BTS.

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