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Background: In India, Oesophageal cancer ranks as the 6th most common cause of cancer-related deaths. SCC is the most common histology with middle and lower third of the oesophagus as most common location. Often, it is diagnosed in elderly individuals with multiple comorbidities, and at an advanced stage with malignant strictures, where SEMS is treatment of choice. The current retrospective study aims to evaluate efficacy and the risk factor assessment of outcomes of SEMS deployment in patients with advanced oesophageal cancer.Methods: All consecutive patients referred to Department of SGE and LT of BMCRI, with advanced oesophageal cancer from March 2012 to October 2019 were studied. Patients details viz. demography, dysphagia grade, stricture details and SEMS related adverse events and 30-day, 90-day and long-term mortality data was charted and significance of these study parameters along with survival analysis was carried out by using relevant statistical tools.Results: Of the 69 patients, SCC in mid-oesophagus was the most common presentation. 36 patients (52.2%) received prior CRT, TEF (n=11) and distant metastasis (n=7). SEMS intention was palliation in all patients. Overall procedural success using 'Endoscopy alone' was achieved in all 69 patients (100%). Post SEMS period uneventful (n=36), transient haemorrhage (n=5) patients, aspiration (n=11), tumour overgrowth and ingrowth (n=11), SEMS on SEMS (n=5), double SEMS for TEF (n=2). Significant adverse events necessitating reinterventions were seen in 17 patients (24.5%). Kaplan-Meier graph showed lower survival in patients with metastasis and TEF and no statistical difference in-terms of adverse events was noted based on fully covered versus partially covered SEMS.Conclusions: SEMS aids in early resumption of oral feeds and the outcomes of fully covered and partially covered SEMS are comparable in a palliative setting.

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Background: The prevalence of protein-energy malnutrition in surgical patients is seen in 30-50% of surgical patients with gastrointestinal disease. Malnutrition and hypalbuminaemia contribute to increased morbidity and mortality. Serum albumin level is a low-cost key element in nutritional assessment. Clavien-Dindo classification of post-operative complications enables stratification of post-operative complication.Methods: We retrospectively analysed the prospectively maintained data of 136 patients who underwent major gastro intestinal procedures from October 2019 to March 2020. We assessed the pre-operative; intra operative parameters, outcome variables and the postoperative complications were graded according to Clavien-Dindo severity, length of ICU stay, length of hospitalization and mortality.Results: Out of the 136 patients (M: F=3:2), the procedures were hepatopancreaticobiliary (n=40), colorectal (n=39), small bowel (n=36) and esophago-gastric (n=19). Pre-operative serum albumin was identified to be single most statistically significant pre-operative variable predicting post-operative complication of Clavien-Dindo severity grade III and above. The ROC curve of the serum albumin level predicting the severe post-operative complication suggested optimal cut off value of 3.1 gm/dl (AUC=0.76; 5% CI=0.64-0.87; p<0.001). Linear regression analysis of serum albumin level predicting the severe post-operative complication suggested good correlation with (r2=0.133; b=0.689; p<0.001). Further analysis of serum albumin level in predicting the length of ICU and the hospital stays suggested a significant negative correlation with both of these dependent outcome variables. The serum albumin level correlated inversely with the length of ICU stay and hospitalization.Conclusions: Low pre-operative albumin (serum level <3.1 gm/dl) in patients undergoing major gastrointestinal surgery predicts severe post-operative complications, prolonged ICU and hospital stays.