IntroductionAlthough surgery is the preferred treatment for grade III&IV pancreatic trauma, there is a growing movement for non-operative management. in blunt pancreatic trauma. Very few studies compare operative versus non-operative management in adult patients.MethodsRetrospective analysis of a prospectively maintained database was performed from 2004 to 2013 in the department of gastrointestinal surgery, NIMS, Hyderabad. Comparative analysis was performed between patients who failed versus those who were successfully managed with non-operative management.Results34 patients had grade III/IV trauma out of which 8 were operated early with the remaining 26 initially under a NOM strategy, 10 of them could be successfully managed without any operation. Post-traumatic pancreatitis, Necrotizing pancreatitis, Ileus, contusion on CT, surrounding organ injuries are independently associated with failure of NOM on a univariate analysis. On multivariate logistic regression presence of necrosis& associated organ injury are factors that predict failure of NOM independently. Development of a pseudocyst is the only significant factor that is associated with a success of NOM.ConclusionsNon-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma. In hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.

SUMMARY Aims: An increase in incidence of early-onset colorectal cancer (EOCRC) in developing countries, including India, is reported recently; however, systematic analyses of clinico-pathological features and disease prognosis has seldom been undertaken. Materials & methods: We studied clinical data pertaining to 1259 colorectal adenocarcinoma patients from two tertiary cancer centers in south India. Results: Approximately 45% of patients were aged below 50 years and poor grade and late-stage tumors were significantly associated with early disease onset. Although tumor grade and stage significantly influenced disease-free survival independently, significant association between survival and age of onset or tumor location was not detected unlike previous observations. Conclusion: Given the sizeable proportion of EOCRC, implementation of the revised Bethesda guidelines may not be tenable in India. More importantly, the previous observation of EOCRC being significantly associated with poor survival could, in part, be due to a higher proportion of advanced-stage tumors.

Lynch syndrome (LS), the most common form of familial CRC predisposition that causes tumor onset at a young age, is characterized by the presence of microsatellite instability (MSI) in tumors due to germline inactivation of mismatch repair (MMR) system. Two MMR genes namely MLH1 and MSH2 account for majority of LS cases while MSH6 and PMS2 may account for a minor proportion. In order to identify MMR genes causing LS in India, we analyzed MSI and determined expression status of the four MMR genes in forty eight suspected LS patient colorectal tumor samples. Though a majority exhibited MSI, only 58% exhibited loss of MMR expression, a significantly low proportion compared to reports from other populations. PCR-DNA sequencing and MLPA-based mutation and exonic deletion/duplication screening respectively, revealed genetic lesions in samples with and without MMR gene expression. Interestingly, tumor samples with and without MMR expression exhibited significant differences with respect to histological (mucin content) and molecular (instability exhibited by mononucleotide microsatellites) features. The study has revealed for the first time a significant proportion of LS tumors not exhibiting loss of MMR expression.

Background: Laparoscopic sleeve gastrectomy (LSG) is a restrictive type of bariatric surgery. It is safe and effective with its many advantages like relative simplicity of the procedure, lack of malabsorption component and anastomoses and retaining the anatomical gastrointestinal continuity. Obesity, a chronic disease, with the significant rise of its comorbidities and mortality is attributing to the major financial and health burden globally.  Methods: We conducted a prospective study of over 43 patients (male 32, female 11) over 5 years period i.e., from 2012 to 2017. These patients were assessed with contrast enhanced computerized tomography (CECT) for detection of post-operative complications.Results: The patients with the body mass index (BMI) >40 kg/m2 and or with a BMI >35 and <40 kg/m2 but with significant weight related comorbidities underwent Laparoscopic sleeve gastrectomy. Both intravenous (IV) and oral contrasts are used accordingly. With increasing number of surgeries and with associated co-morbidities complications following LSG are increasing, necessitating the need for a good understanding of clinical symptoms and post-operative complications of LSG. Post-operative imaging plays a crucial role in the early detection of complications resulting in reduced mortality rate.Conclusions: We suggest multidetector computed tomography (CT) with oral and IV contrast as an excellent tool for the patients having a nonspecific abdominal symptom post LSG.

Hereditary Non-Polyposis Colorectal Cancer (HNPCC) is an autosomal dominant familial syndrome resulting in colorectal cancer at a young age. It is caused mainly due to germline mutational inactivation of any one of four mismatch repair (MMR) genes viz. MSH2, MLH1, MSH6 and PMS2 resulting in the ‘mutator’ phenotype called microsatellite instability (MSI). The mutations often result in loss of protein expression which can be detected using immunohistochemistry (IHC). IHC and MSI analysis have been suggested as pre-screening methods for selection of patients for mutation analysis of MMR genes. Studies from several populations have indicated that MLH1/MSH2 inactivation may account for a majority of HNPCC cases. We earlier reported unique clinico-pathological and molecular genetic features in Indian sporadic colorectal cancer patients. We have now carried out a multi pronged analysis of suspected HNPCC patients from India. MSI screening and IHC for MLH1 and MSH2 followed by mutation analysis was employed on a panel of Indian CRC patients who were aged below 50 years at the time of diagnosis and exhibited HNPCC-specific family history. We also included patients who had multiple primary tumors or were of older age but exhibited HNPCC-specific familial involvement. As expected, a significant majority of patients (upto 80%) harbored tumors exhibiting high MSI (MSI-H) as compared to young patients without family history (only upto 20%). Surprisingly, a significantly low proportion (only about 30%) of young patients positive for family history and MSI-H exhibited loss of MLH1/MSH2 expression, perhaps due to mutations not resulting in loss of protein expression or the involvement of MSH6/PMS2 in Indian patients at a frequency higher than other populations. IHC for MSH6/PMS2 is currently underway. Mutation screening for the appropriate gene was carried out in eight patients negative for IHC using genomic DNA isolated from blood samples. Six heterozygous germline mutations (including four novel mutations) were identified; three each in MLH1 and MSH2. Studies are ongoing to determine whether the second allele in each of the six cases was inactivated through loss of heterozygosity. Interestingly, all patients in whom mutation was identified harbored tumor in the ascending colon. Three of the six mutations generate premature termination codons expected to trigger nonsense mediated decay resulting in reduced transcript levels of the respective genes. A fourth mutation (in MLH1) resulted in drastic reduction in transcript levels as determined by quantitative reverse transcription polymerase chain reaction; no such reduction was discernable in a microsatellite stable sporadic CRC sample. Analysis of effect of the remaining two mutations is currently underway. Our results therefore reveal unique features in Indian HNPCC patients; IHC for MLH1/MSH2 may not be an ideal primary screening tool to identify HNPCC patients in India. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3766. doi:10.1158/1538-7445.AM2011-3766