Primary cardiac spindle cell sarcomas are extremely rare and have poor prognosis. Complete surgical resection represents the only treatment option proven to work. We report a case of a 28-year-old man who was referred to our cardiothoracic unit with a right ventricular mass extending to the main pulmonary artery with a provisional diagnosis of a thrombus or a right ventricular myxoma. He sought medical attention after experiencing shortness of breath, cough, chest pain, abdominal pain and bilateral leg swelling for about 6 weeks. Two dimensional transthoracic echocardiogram showed a mass arising from the right ventricle and extending into the main pulmonary artery; findings that were confirmed with contrast chest CT scan.He underwent extensive resection of the mass and had uneventful postoperative period with immediate symptomatic relieve. He is on adjuvant chemotherapy using vincristine, adriamycin and cyclophosphamide (VAC). Right ventricular sarcoma is a very rare cause of right sided heart failure, a very aggressive tumour whose only chance of successful treatment is complete surgical excision.

Background The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks. Methods A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three-stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income. Results In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis. Conclusion Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.

Dermato-fibro-sarcomas are known for high-recurrence rates. The gold standard of management is surgical excision with clear margins. Such margins on the chest results in large defects which require complex reconstructive procedures. We report a case series of patients managed by a multidisciplinary team with good outcomes. A total of 12 patients with extensive dermato-fibro-sarcoma of the anterior chest wall were treated over a period of 5 years in our setting. The age range was 25 to 54 years. Skeletal defects were reconstructed with Prolene mesh and methyl acrylate cement in 10 of the 12 patients. Pedicle flaps were used in nine patients. All margins were clear of tumors, with the nearest margin being 1.5 cm. One patient had a recurrence. No donor-site morbidity was recorded in any of the patients.In conclusion, a multidisciplinary approach provides improved outcomes in the management of large dermato-fibro-sarcomas of the chest wall. With this approach, extensive dissection of the tumor is achieved, and reconstruction is performed with minimal complication.

Institute of Cardiovascular Diseases, ChennaiBackground: Right ventricle to pulmonar T arter T conduits are a necessar T part of the pediatric cardiac surgical armanmntariunL While homografls have been the main stay of such situations the search for other conduits continues. Commercially available bovine jugular vein preparations like Contegra | are vet T expensive in the Indian scenario.Methods: We have used bovine jugular veins, procured and prepared by us locally in 15 patients undergoing a range of pediatric cardiac surgical procedmes including truncus arteriosus repair, tetralogy correction and Rastelli procedmes. The mean age of these patients was 1.6 years. Bovine jugular vein conduits in the size ranges of 12 16 mm were used in these patients.Results: The mortality in this group was 2. Postoperative RV to PA gradients in these patients have been recorded below a mean pressure of 10ram Hg. Postoperative echocardiography assessment revealed well functioning conduits with good valve competency. Follow up period ranges from 3 months to 1 year and no patient has required reintervention or conduit change.Conclusions: The ready availability of bovine jugular vein off the shelf as it were, the smaller sizes, cheaper preparation method and good surgical handling characteristics makes it an attractive option for RVOT conduits.

Background CASE REPORT ON SUCCESFUL SURGICAL INTERVENTION FOR RECURRENT CA OESOPHAGUS 45 year old female diagnosed with cancer of the oesophagus in 2013, CT Scan showed operable tumour. Patient underwent Ivor Lewis oesophagectomy. Histopatholgy showed pT2N0Mx(Stage IIA). Patient was followed up and was noted to be loosing weight in April 2016, upper GI Endoscopy showed recurrence of the tumour, at the intrathoracic stomach level.CT Scan revealed a tumour involving the stomach but no pulmonary nodules. In Multidisciplinary discussion it was agreed to offer patient surgical resection. At surgery the intrathoracic stomach was mobilised and resection done. Formal laparotomy was performed and the transverse colon prepared for colonic interposition at the cervical region. At the time of surgery the patient's weight was 38 kg, this increased to 45kg within the first 6 months after surgery. Patient underwent adjuvant chemotherapy and is doing well 2 years after the second surgery. Methods this is a case report. Results case report. Conclusion recurrence after esophagectomy is high and some patients can benefit from redo surgery. Disclosure All authors have declared no conflicts of interest.