Introduction: Patients are kept nil per oral (NPO) after surgery for gastric cancer and all patients receives intravenous fluids till oral feed is commenced. There is established benefit of enteral nutrition after surgery for gastric cancer. Early oral feeding comes with lots of hesitation for execution, so to offer benefits of early enteral nutrition and to avoid early oral feeding, nasojejunal tube (NJ) feeding can be used as alternative to feeding jejunostomy (FJ) and also total parenteral nutrition (TPN) can be avoided. The aim of this study is to present our experience of early enteral feeding using NJ tube and to convey the message that early feeding using NJ tube is safe, effective and has less complications. Methods: This is a retrospective study of patients operated between April 2019 to March 2022, who had nasojejunal tube placed at the time of surgery. NJ tube was placed in the efferent limb of jejunum. Feeding was started from post operative day 1 and gradually progressed over days. NJ tube was removed after adequate oral intake. Results: Sixty patients were eligible for final analysis. Median age of patients was 61 years, IQR (53-69). Thirty-three patients underwent D2-subtotal gastrectomy, 16 underwent D2-total gastrectomy and 10 underwent gastro-jejunostomy. Median time for discharge is 12 days, IQR (12-14). The median time for NJ removal is 10 days, IQR (9-12). Thirty-four patients reported complications related to NJ feed, all were minor and easily manageable. Conclusion: NJ tube feeding offers the advantages of early enteral feeding after gastric cancer surgery. It is technically easy to use and should be advocated for its simplicity, low costs and great advantages as compared to FJ and TPN.

PURPOSE Breast cancer is the second commonest cancer among female in Nepal. This is our first attempt to audit breast cancer management in our institute and compare with standard quality indicators (QIs) available. METHODS The retrospective study included 104 female patients with breast cancer who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected on the basis of convenience sampling. Of 33 QIs in breast cancer management according to European Society of Breast Cancer Specialists guidelines, 19 QIs were chosen relevant to our setup. These QIs were calculated for all patients and compared with the European Society of Breast Cancer Specialists standard target. Frequencies and percentages were calculated and presented in tables. Binomial 95% of the rates for QI adherence were also calculated for each QI. RESULTS One hundred four patients had a median age of 47.5 years (range 24-70 years). Applicable QIs were in the range of 5-15 with a mean of 9.66 per patient. Of 19 evaluable QIs, very high adherence rates were observed in six QIs, high adherence in three Qis, and low adherences in 10 QIs. High adherence rates were for QI 5 and QI 10a, which were 88.46% and 94.73%, respectively. The low compliance was for QI 1, QI 4a, QI 8, QI 9d, QI 10b, QI 11a, QI 11b, QI 13b, QI 13e, and 14b, which were 53.84%, 78.21%, 0%, 83.16%, 76.92%, 36.0%, 33.33%, 4.76%, 30.55%, and 10.81%, respectively. CONCLUSION There are several QIs that have low levels of adherence in our setting and suggest that there is significant room for improvement. We will be continuing auditing these QIs regularly to improve our quality of care.

Introduction: Liver metastasis is frequently encountered in patients with rectal cancer; it can be synchronous or metachronous. Some selected patients can be treated with curative intent using multimodality therapy under the care of a dedicated team in a comprehensive cancer center. However, the treatment is long and tiring for the treating team, the patient, and the relatives. Treatment is difficult to execute in a country like ours with a limited number of cancer centers. We present a patient from a remote village with stage IV disease, who completed all modalities of treatment with a favorable outcome. Case Presentation: A fifty-five-year-old man from a remote village presented to us with a complaint of per rectal bleeding. He was diagnosed with rectal carcinoma with solitary liver metastases. He received multimodality treatment in the form of chemotherapy, radiotherapy, and surgery. He attained a complete pathological response at both primary and metastatic sites.Conclusions: Good outcomes can be achieved in selected stage IV rectal cancer. This requires multimodality treatment and a proper plan, preferably in a comprehensive cancer center