Kazim, Sayed Moosa

Abstract Introduction Multiple Primary Malignancies (MPMs) are characterized by the presence of at least two distinct primary malignancies in a patient. The occurrence rate of MPMs is between 1.63% and 10.9% across articles. To our knowledge, this combination of tumours has not been documented in the existing literature. Case: A 44-year-old male, presented with complaints of abdominal pain, chronic constipation, and multiple episodes of bleeding per rectum for one month. Colonoscopy showed proliferative irregular growth at junction of recto-sigmoid colon; Biopsy showed well-differentiated adenocarcinoma. CT scan abdomen and MRI pelvis showed focal eccentric thickening at the rectosigmoid region and enhancing, partly exophytic left renal mass 3.6 x 2.2 x 2.0 cm from the lower pole, another exophytic soft tissue nodule 2.2 x 1.6 x 1.9 cm on inferior surface of body of pancreas. The biopsy of pancreatic mass was neuroendocrine tumour WHO grade 1. KRAS, BRAF, and MSI were negative. A multidisciplinary team discussion was done, and patient underwent laparoscopic-assisted low anterior resection, open left partial nephrectomy, and enucleation of the pancreatic mass in a single setting. The postoperative course remained uneventful. Histopathology showed rectosigmoid tumour: moderately differentiated mucinous adenocarcinoma, 3/19 lymph nodes positive for metastatic carcinoma. Renal tumour Histopathology: 28mm clear cell renal carcinoma. Pancreatic tumour histopathology: solid pseudopapillary neoplasm. All resection margins free of tumour. He received 4 cycles of adjuvant chemotherapy and now he is on surveillance. Conclusions The occurrence of synchronous triple primary malignancies presents a complex clinical challenge and requires meticulous diagnostic evaluation, multidisciplinary collaboration, and personalized treatment strategies.

Abstract Aim To measure the textbook outcomes of pancreaticoduodenectomy for pancreatic adenocarcinoma. Textbook outcomes include negative surgical margin, >12 Lymph nodes examined, no prolonged hospitalization >14 days, no ≥ 3 days ICU treatment, no 30-day readmission or mortality, and no Clavien-Dindo complication grade≥ 3 or above. It is all or none response, if all of these parameters are met in a single patient, then the textbook outcome is met for that individual patient. Method All patients from 1st January 2014 to 31st December 2023 who were >18 years old. Patients who underwent emergency surgery, those with histopathologies other than adenocarcinomas, who had pancreaticoduodenectomies for duodenal cancers were also excluded. Results Total number of patients were 269, of which 68% were male and 32% female. Mean age was 53 years, mean BMI 23.3 kg/m2. Classical Whipple’s procedure performed in 224 patients, 36 underwent Pylorus preserving pancreaticoduodenectomy and 7 patients had Laparoscopic assisted Whipple’s resection. In Textbook surgical outcomes, Negative margin achieved in 251 patients, and more than 12 lymph nodes were retrieved in 249 patients. Prolonged ICU stay more than 3 days was in 11 patients. 39 patients had > 14 days of hospital stay. Readmission was observed in 34 patients. 114 patients had complications out of which Clavien Dindo grade ≥3 was in 28 patients. Pancreatic fistula in 81 patients and of these, 51 patients had Grade A fistula. Complete Textbook Outcomes (TO) were achieved in 57% (153) patients. Conclusions Our center achieved high Textbook outcomes compared to international standards and depicts patient-centered care of our institution.