Of all the malignant lesions of the gastrointestinal tract, cancer of the esophagus is among the most difficult to manage. Although it has fairly typical presenting clinical features in the form of an elderly patient with dysphagia; the subsequent investigations have to be fine-tuned to select which patient should undergo esophageal resection (a formidable procedure which carries a high mortality risk and is associated with serious complications), who should undergo neoadjuvant therapy and who should only be palliated with stents or chemoradiotherapy. In recent years this fine-tuning has become much more precise with many patients being saved from harmful explorations of the chest and abdomen only to encounter widespread disease and at the same time many who have large, locally invasive tumors which were thought to be unresectable being given neoadjuvant chemotherapy and subsequently being able, sometimes, to undergo curative esophagectomy. Possibly because of these improvements in diagnosis and multimodality treatment, the 5-year survival of patients with esophageal cancer that has been resected has improved from a dismal 5%, 15 years ago to a more respectable 25% now. In this book, authors, two thirds of whom are from the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, have evaluated the published evidence on different aspects of the management of patients with esophageal cancer as well as made recommendations from their own experience with the disease. Thus, we have chapters on diagnostic and therapeutic endoscopy, staging, perioperative therapy, operative treatment (transhiatal, radical, Ivor Lewis and the minimally invasive approaches) and postoperative complications. Finally there is a chapter discussing the epidemiology and difficulties in the management of patients with esophageal cancer in India where the disease is common and mainly affects poor people who cannot afford expensive treatment. The author mainly discusses the experience of the Tata Memorial Hospital in Mumbai where every year 1200 patients are seen with the disease and 180 undergo surgery. This is amongst the largest experience of the treatment of patients with esophageal cancer worldwide. All the subjects and authors have been brought together for this volume by the Editor, Manjit Singh Bains, who is a Professor of Clinical Cardiothoracic Surgery at the Cornell Weill Medical College in New York as well as an Attending Thoracic Surgeon at the MSKCC.

ECAB Adjuvant and Neoadjuvant Therapy in Gastrointestinal Cancer - E-Book

Minimal access technology has experienced an accelerated growth since its introduction into the field of diagnostic and therapeutic surgery over two decades ago. The progressive amalgamation of science and technology has lead to its ever-increasing applications in general surgery for increasingly complex procedures. Although sufficient educational material is available on minimal access surgery as textbooks and graphic atlases, here a ready reference guide in the form of surgical updates comes in handy to stay abreast with what’s new. This edition of minimal access surgery in gastrointestinal diseases is a conscientious effort by its dedicated contributors, some of the most capable persons in the field of minimal access gastrointestinal surgery. The contents of this ECAB series include topics which involve a degree of controversy and therefore are likely to be of immense help to surgical residents and practicing surgeons facing such dilemmas. The collective wisdom of these specialists is intended to yield safe and improved outcomes in the concerned patient.

Carcinoma of the gallbladder is the most common cancers in North India which is very difficult to treat as well as manage as it is associated with many important issues. The current volume covers the topic right from its etiopathology to its palliation and gives an overview on the current knowledge of the disease. The international authorship of this book reflects the multidisciplinary nature of the book and of the field of gallbladder cancer care. The book promises to stimulate studies to provide specific answers to some unanswered questions. Above all it will destroy the myth that gallbladder carcinoma is incurable and will thus benefit a large number of patients. This edition focuses mainly on Etiopathogenesis of gallbladder cancer Management of gallbladder carcinoma Diagnosis and treatment outcomes Aggressive surgical management Molecular biology and pathogenesis of gallbladder cancer

Dyspepsia is a disorder which affects a large portion of the population. However, it is very important to differentiate between commonly presenting symptoms like gastroesophageal reflux disease, functional dyspepsia, and irritable bowel syndrome. Also various classifications and treatment protocols have been developed and revised to provide a rational platform for the clinicians. The ROME III classification has to a large extent given a direction to the clinicians to base their practice on, however, is a classification based on clinical trials and is really helpful in daily practice. In this issue we have tried to focus on the need for classification and approach to the patient with dyspepsia.

Diabetes is one of the most important non-communicable lifestyle diseases. Diabetes is a multifaceted disorder which possibly influences and impacts body pathophysiology by different mechanisms and in varied ways. Diabetes has a very distinguished impact on cardiovascular system and plays a detrimental role in development of cardiovascular disorders. Metabolic memory is used to describe the impact of exposure to glucotoxicity, lipotoxicity and other metabolic disturbances, either as an adverse or a beneficial cell response which determines the later development of vascular complications. Terms such as metabolic imprint, legacy effect, glycemic memory or latent hyperglycemic damage are also used. Diabetes has significant impact on different facets of life. Diabetes has a distinguished but significant impact on development of various cancers. Diabetes has a positive, negative and even neutral impact on pathogenesis and progression of cancer depending upon the tumor site. On the contrary, cancer also has a significant effect on diabetes development and management. These facets tend to get overlooked in the study of diabetes development and management. All these aspects are being thoroughly covered in this project so as to facilitate better management of diabetics.

All surgeons are convinced that they provide the best possible care to their patients and fortunately most patients are happy with their surgeons. Where safety and quality were once considered to be self-evident, these issues need to be made more explicit in modern surgery. Doctors and the general public alike are nowadays more aware of the variations in quality that exist among surgeons and institutions and of the unwarranted harmful effects surgery can have. Super- or sub-specialization seems one way to improve both its quality and safety. Surgical Gastroenterology or Gastrointestinal Surgery is one of these new superspecialties. The path towards this specialization is not easy and turf battles between General Surgery and Surgical Gastroenterology are still being fought. Professor Kaushik recounts the history and development of this superspecialty in India. He recounts that although the history of Surgical Gastroenterology in this country is short, its future is bright but, as has happened in other countries, its further division into organ-based superspecialties can be expected. ‘Practice makes one perfect’ is the motto that is probably true for the high-risk surgery which is still being performed in small institutions or by surgeons with only little expertise. The inverse correlation between volume and outcome expressed as mortality and morbidity has been shown all over the world. Wouters et al systematically analyze the literature covering this topic. They also show that concentration and regionalization do not automatically lead to an improved quality of surgery, since other issues for quality assurance are of equal importance, such as adherence to evidence-based guidelines, feedback, and monitoring. Despite all the inputs in training and instruction by experts, a uniformly high quality of surgery is hard to achieve in day-to-day gastrointestinal surgery. Sudhir Joseph and his colleagues show that a dedicated checklist can save lives and reduce postoperative morbidity in many countries with different systems and levels of healthcare. A similar beneficial effect was found in The Netherlands using a more comprehensive checklist that covers the whole period of the hospital stay. The new type of surgeon is aware of the principles of evidence-based medicine and he/she will challenge the dogmas of the ‘old’ surgery. Over the years our surgical masters have told us about the importance of good pre-operative and postoperative care for our patients. The bowel should be put at rest before operation and oral feeding restored only slowly after surgery starting with nothing by mouth to sips of clear water. Bed rest was essential for recovery. He introduced the ERAS (Enhanced Recovery after Surgery) strategy also named Fast Track Surgery. Mitchell et al provide ample evidence that all surgeons should adopt the ERAS strategy. Implementation of this will lead to better and more cost-effective operations.