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Fick A, Tran K, Kandpal H, Burge M, Chandrasegaram M. An Unusual Case of Large Cell Neuroendocrine Cancer of the Gallbladder With Mixed Adenocarcinoma Component in a Patient With Pancreatobiliary Maljunction. Cureus 2023; 15:e37398. [PMID: 37056222 PMCID: PMC10089643 DOI: 10.7759/cureus.37398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
Gallbladder neuroendocrine tumors (GB-NETs) and gallbladder neuroendocrine carcinomas (GB-NECs) are rare forms of neuroendocrine neoplasms (NENs). Most GB-NENs present as incidental findings or as gallbladder polyps in the course of investigation of nonspecific symptoms such as upper abdominal pain and nausea. Given the rarity of GB-NENs, only a few small case series are currently available describing this entity, and even fewer guiding consensus on standard treatment and the role of adjuvant therapy. We present the case of a 65-year-old South American female referred for a chronic history of intermittent post-prandial epigastric pain, bloating, nausea, and occasional diarrhea. Pancreaticobiliary maljunction with dilation was present and she was diagnosed with primary gallbladder large cell neuroendocrine carcinoma (GB-LCNEC) mixed with a minor component of gallbladder adenocarcinoma.
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Affiliation(s)
- Anton Fick
- General Surgery, The Prince Charles Hospital, Brisbane, AUS
| | - Kayla Tran
- Pathology, The Prince Charles Hospital, Brisbane, AUS
| | - Harsh Kandpal
- Radiology, The Prince Charles Hospital, Brisbane, AUS
| | - Matthew Burge
- Medical Oncology, The Prince Charles Hospital, Brisbane, AUS
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Fang R, Yerkovich S, Chandrasegaram M. Pre-operative predictive factors for gangrenous cholecystitis at an Australian quaternary cardiothoracic centre. ANZ J Surg 2021; 92:781-786. [PMID: 34904358 DOI: 10.1111/ans.17410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to determine associations between pre-operative factors and gangrenous cholecystitis. Gangrenous cholecystitis represents a severe spectrum of cholecystitis and is associated with an increased risk of complications. Early recognition and diagnosis of gangrenous cholecystitis can optimize prioritization for surgery and improve outcomes. METHODS A retrospective case-control study was undertaken. Patient demographics, medical comorbidities, pre-operative biochemical and ultrasound findings as well as post-operative outcomes were assessed. Four hundred and fourteen patients who underwent an emergency cholecystectomy between 2018 and 2020 were reviewed. RESULTS One hundred and nine (26%) patients who underwent emergency cholecystectomy during this 3-year period had gangrenous cholecystitis. These patients were older (median age 65 versus 45, P < 0.001) and more likely to be male (58.7% versus 32.5%, P < 0.001). Patients with coronary disease (OR 2.55, P < 0.001), hypertension (OR 2.25, P = 0.001), or arrhythmias (OR 3.64, P = 0.001) were two-to-three times more likely to have gangrenous cholecystitis. Patients with renal disease (OR 1.92, P = 0.004) or using antiplatelet medication (OR 2.27, P = 0.003) were twice as likely to have gangrenous cholecystitis. Patients who had gangrenous cholecystitis presented with a higher white cell count (median 13 x 109 /L versus 8 x 109 /L, P < 0.001) and a higher C-reactive protein (median 196 versus 18 mg/L, P < 0.001). Patients with gangrenous cholecystitis had poorer post-operative outcomes. CONCLUSION We verified predictive factors from existing literature and identified a number of novel pre-operative predictive factors for gangrenous cholecystitis which could help with development of a scoring system for clinical use.
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Affiliation(s)
- Robert Fang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephanie Yerkovich
- The Common Good Foundation, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Manju Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Maurice AP, Simpson FH, Chandrasegaram M. Peritoneal defect causing small bowel obstruction following laparoscopic extraperitoneal inguinal hernia repair. ANZ J Surg 2021; 92:927-928. [PMID: 34550641 DOI: 10.1111/ans.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Phillip Maurice
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Fraser Hugh Simpson
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Manju Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Flynn DE, Mao D, Yerkovich S, Franz R, Iswariah H, Hughes A, Shaw I, Tam D, Chandrasegaram M. Should we resect colorectal cancer in patients over the age of 85? World J Gastrointest Oncol 2021; 13:185-196. [PMID: 33738046 PMCID: PMC7953345 DOI: 10.4251/wjgo.v13.i3.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of colorectal cancer in the elderly is rising, with increasing numbers of older patients undergoing surgery. However, there is a paucity of information on the surgical outcomes and operative techniques used in this population.
AIM To evaluate the post-operative outcomes for patients ≥ 85 years old following colorectal cancer resection as well as evaluating the outcomes of laparoscopic resection of colorectal cancer in patients over 85.
METHODS Patients who underwent colorectal cancer resection at our institution between January 2010 and December 2018 were included. The study was divided into two parts. For part one, patients were divided into two groups based on age: Those age ≥ 85 years old (n = 48) and those aged 75-84 years old (n = 136). Short term surgical outcomes and clinicopathological features were compared using appropriate parametric and non-parametric testing. For part two, patient’s over 85 years old were divided into two groups based upon operative technique: Laparoscopic (n = 37) vs open (n = 11) colorectal resection. Short-term post-operative outcomes of each approach were assessed.
RESULTS The median length of stay between patients over 85 and those aged 75-85 was eight days, with no statistically significant difference between the groups (P = 0.29). No significant difference was identified between the older and younger groups with regards to severity of complications (P = 0.93), American Society of Anaesthesiologists grading (P = 0.43) or 30-d mortality (2% vs 2%, P = 0.96). Patients over 85 who underwent laparoscopic colorectal resection were compared to those who underwent an open resection. The median length of stay between the groups was similar (8 vs 9 d respectively) with no significant difference in length of stay (P = 0.18). There was no significant difference in 30-d mortality rates (0% vs 9%, P = 0.063) or severity of complication grades (P = 0.46) between the laparoscopic and open surgical groups.
CONCLUSION No significant short term surgical differences were identified in patients ≥ 85 years old when compared to those 75-85 years old. There is no difference in short term surgical outcomes between laparoscopic or open colorectal resections in patients over 85.
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Affiliation(s)
- David E Flynn
- Department of General Surgery, The Prince Charles Hospital, Chermside 4032, Queensland, Australia
| | - Derek Mao
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Stephanie Yerkovich
- The Common Good Foundation, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Robert Franz
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Harish Iswariah
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Andrew Hughes
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Ian Shaw
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Diana Tam
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Manju Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
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Maurice AP, Dickfos M, Mousa P, Bhardwaj H, Godinho S, Iswariah H, Chandrasegaram M. Meckel's diverticulum enteroliths causing small bowel obstruction. ANZ J Surg 2016; 88:E475-E476. [PMID: 26762683 DOI: 10.1111/ans.13423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew Phillip Maurice
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Marilla Dickfos
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul Mousa
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hemant Bhardwaj
- Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Radiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Savio Godinho
- Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Radiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Harish Iswariah
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Manju Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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