Rahul Gadde

Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis

Prognosis with current management strategies continues to be dismal in metastatic gastric cancer (MGC) patients. We aimed to evaluate the role of metastasectomy in improving survival.

Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis

BACKGROUND Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods. DATA SOURCES Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed (2000-2014); key bibliographies were reviewed. Qualified studies comparing patients undergoing SPDP with either SVP or WP, and assessing postoperative complications were included. Calculated pooled risk ratio (RR) with the corresponding 95% confidence interval (CI) by random effects methods were used in the meta-analyses. RESULTS The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 (69%) underwent SVP and 291 (31%) underwent WP. Overall, there was a lower incidence of splenic infarction (RR=0.17; 95% CI: 0.09-0.33; P<0.001), gastric varices (RR=0.16; 95% CI: 0.05-0.51; P=0.002), and intra/postoperative splenectomy (RR=0.20; 95% CI: 0.08-0.49; P<0.001) in the SVP group. There was no difference in incidence of pancreatic fistula (WP vs SVP, 23.6% vs 22.9%; P=0.37), length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity. CONCLUSIONS SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suitable for large tumors close to the splenic hilum or those associated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.

Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy--does gastrointestinal reconstruction technique matter?

BACKGROUND The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients. DATA SOURCES Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio = .44, confidence interval = .24 to.77, P = .005) and retrospective studies (risk ratio .21, confidence interval .14 to .30, P < .001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections. CONCLUSIONS AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

Distal pancreatectomy for benign and low grade malignant tumors: Short-term postoperative outcomes of spleen preservation—A systematic review and update meta-analysis

The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short‐term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP).

PERIOPERATIVE ADMINISTRATION OF AMIODARONE OR BETA BLOCKERS IN CARDIAC SURGERY: WHICH IS MORE EFFECTIVE IN REDUCING POSTOPERATIVE ATRIAL FIBRILLATION?

Background: Optimum prophylaxis for post-operative atrial fibrillation (AF) in cardiac surgery patients is controversial. We aimed to compare the utility of amiodarone (A) versus beta blockers (BB) in decreasing the postoperative incidence of AF. Methods: Online search of PubMed, MEDLINE, EMBASE,

Abstract B35: Association between acute leukemias and levels of leptin in blood: A meta-analysis

Background: Leptin, a secretory protein of adipocytes, shown to induce differentiation, proliferation, anti-apoptotic and activation of hematopoietic cells through paracrine interaction in the bone marrow microenvironment. Existing literature provides conflicting evidence as to the association between levels of serum leptin and acute leukemia9s. Purpose: The aim of this study is to conduct a meta-analysis to investigate the association between serum leptin levels and presence of acute leukemia9s. Methods: We searched MEDLINE, CIINHAL and COCHRANE databases for studies reporting serum leptin levels in the peripheral blood and bone marrow with and without acute leukemia9s [Acute lymphoblastic leukemia (ALL)/Acute myleogenous leukemia (AML)]. We included case controls, cohort and cross-sectional studies. We calculated the weighted standardized mean difference (SMD) in serum leptin levels between the acute leukemia9s patients and control groups. Results: Our search strategy yielded 70 articles and we included 10 studies enrolling 354 participants with 176 patients and 178 controls of matched age, sex and BMI (body mass index). We included 108 ALL patients compared with 126 controls and136 AML patients compared with 104 controls. The median age of the ALL and AML group compared to controls was 8.12 yrs. (IQR 7.17 - 26.25) and 42 yrs. (IQR 28.8 – 52.88). The median percentage of females of ALL and AML compared to controls was 45 (IQR 27 – 66) and 52.5 (IQR 47 – 60). The unweighted median serum leptin levels in the ALL and AML groups were 21.2 ng/ml (13.4 – 27.4) and 29.9 ng/ml (5.55 – 55.83) compared to 9.43 ng/ml (6.6 – 17.8) and 31.5 ng/ml (6.43 – 89.77) in the control groups. The SMD9s of having abnormal serum leptin levels of ALL and AML compared to controls was 1.27 (95% CI 0.53 - 2.00) P = 0.001 and – 0.97 (95% CI -1.39 - -0.55) P Conclusion: Increased and decreased serum leptin levels are significantly associated with ALL and AML respectively. Further investigation into the molecular mechanism underlying leptin9s role in acute leukemia9s and its use as an adjunctive screening tool are warranted. Citation Format: Vijaya SenaReddy Dendi, Sivakanth Aloor, Rahul Gadde, Kranthi Kunkalla, Roopesh Reddy Sadashiva Reddy, Jeffrey Gryn. Association between acute leukemias and levels of leptin in blood: A meta-analysis. [abstract]. In: Proceedings of the AACR Special Conference: Metabolism and Cancer; Jun 7-10, 2015; Bellevue, WA. Philadelphia (PA): AACR; Mol Cancer Res 2016;14(1_Suppl):Abstract nr B35.