Journal of Gastrointestinal Cancer最新文献

Purpose: Gallbladder cancer is an aggressive malignancy with disproportionately high incidence in North India. Most patients present at advanced stages, limiting curative options. This study aimed to prospectively evaluate outcomes of multimodal treatment-including neoadjuvant chemotherapy, surgery, and palliative chemotherapy-in a high-volume endemic center.

Methods: In this prospective observational cohort, 1,500 newly diagnosed gallbladder cancer patients were enrolled between September 2023 and May 2024. Clinical details, treatment intent, type of therapy, and survival outcomes were systematically recorded. Patients were stratified into three groups: neoadjuvant chemotherapy for borderline resectable disease, upfront curative surgery, and palliative chemotherapy for metastatic disease. Kaplan-Meier analyses were performed for overall survival (OS).

Results: Of 1,500 patients, 1,203 (80.2%) presented with metastatic disease. Among 75 patients who received neoadjuvant chemotherapy, 61.3% progressed and only 12.7% could undergo curative surgery. Overall, 116 patients underwent surgical exploration and 92 received definitive surgery, achieving a 1-year overall survival of 88.5%. Of 768 patients planned for palliative chemotherapy, 294 received ≥ 1 cycle, with a median overall survival of 5 months.

Conclusion: In this real-world prospective cohort, surgery remains the only treatment associated with meaningful survival, while neoadjuvant chemotherapy and palliative chemotherapy yielded limited benefit. Early detection and standardized treatment pathways are urgently needed in endemic regions.

Purpose: Small intestinal neuroendocrine tumour (siNET) has distinct features and disease course compared to other gastrointestinal neuroendocrine tumours. While they mostly present with subtle symptoms, they also can present acutely requiring emergency surgical intervention. We assessed the impact of surgical intervention timing on oncological outcomes of siNET.

Method: A retrospective observational single centre cohort study of all patients diagnosed with siNET, and received surgical intervention at a tertiary level hospital between 2008 and 2025.

Results: A total of 66 patients were diagnosed with SiNET. 22 patients were excluded due to incomplete data (9 patients) and not meeting the eligibility criteria (13 patients). Total of 44 patients met the inclusion criteria, with 30% underwent emergency resection (n = 13) and 70% underwent elective resection (n = 31). Small bowel obstruction represented the most common cause for emergency presentations (61%), while incidental radiological findings (39%) and carcinoid syndrome (35%) accounted for most elective presentations. Emergency cases were associated with the absence of pre-operative somatostatin receptor imaging, less findings of mesenteric mass (31% vs. 81%), more likelihood of post operative macroscopic residual disease (46% vs. 23%) and disease specific mortality (75% vs. 23%). However, there was no statistically significant difference between the two groups in primary and secondary oncological outcomes. There were no operative or in-hospital mortality in either group as well as no significant difference in complications rates between the groups.

Conclusions: Although emergency surgery was associated with limited preoperative staging and higher proportion of R2 resections, no statistically significant differences in overall survival, recurrence-free survival, carcinoid symptom resolution or local complications were observed. However, these results need to be interpreted cautiously due to the small sample size of the study.