Gastric cancer (GC) is a leading cause of cancer-related mortality globally, with a 5-year survival rate remaining below 50

IntroductionCytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become an established option for selected patients with peritoneal surface malignancies, though its use still depends heavily on tumor origin and clinical context. Delivering it safely takes an experienced, well-equipped multidisciplinary center, and building one in a middle-income country - without universal reimbursement for complex oncologic surgery, and in a region where patients often travel abroad for cancer care-brings challenges that go well beyond surgical technique. Here we describe the strategy, barriers, and early outcomes of what was, to our knowledge, Azerbaijan’s first dedicated CRS/HIPEC program.MethodsProgram development followed a phased approach: we formed a Peritoneal Surface Malignancy Multidisciplinary Team (MDT), launched the program in a private-hospital setting for operational flexibility, and partnered with the Azerbaijan Association of Surgery, Gastroenterology and Oncology (AASGO) for mentorship and training. We then retrospectively reviewed MDT case volume, patient flow from initial discussion to CRS/HIPEC, and 30- and 90-day postoperative mortality in the first 20 consecutive patients treated.ResultsIn the MDT’s first year of clinical operation, following its formal establishment in February 2025, 218 patients with peritoneal carcinomatosis were discussed, of whom 49 were identified as potential CRS/HIPEC candidates based on performance status and tumor burden. Twenty patients-40.8% of potential candidates and 9.2% of everyone discussed-ultimately underwent CRS/HIPEC. Among the 29 candidates who did not proceed to CRS/HIPEC, financial constraints were the most commonly documented reason, while patient indecision or refusal and other reasons were recorded less frequently; complete quantitative categorization was not available for all non-treated candidates. There was no 30-day mortality; one patient died within 90 days after developing refractory neutropenic sepsis and septic shock (Grade 4 neutropenia progressing to multiple organ failure), a 90-day mortality rate of 5%. Four implementation barriers stood out: outbound medical travel and limited trust in a newly established local service, variation in clinical practice with no standardized multidisciplinary pathway, financial and insurance constraints, and limited governmental support.ConclusionBuilding a CRS/HIPEC program in Azerbaijan proved feasible in a private-hospital setting, backed by a dedicated MDT and mentorship from a professional society. Of the first 20 patients, none died within 30 days and one died within 90. Because the cohort is small and clinically mixed, we see this as an early feasibility signal rather than proof of comparative safety or oncologic benefit. Making the program sustainable will take governmental engagement, formal reimbursement pathways, prospective outcome tracking, and continued international collaboration.

Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors. We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome. 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19–94), and 58.5

BACKGROUND:Despite advances in treatment, locally advanced gastric cancer (GC) continues to be associated with poor prognosis. Body composition, specifically the distribution of skeletal muscle and adipose tissue, has emerged as a key factor influencing cancer prognosis, yet its impact on neoadjuvant chemotherapy (NACT) dose modifications and long-term survival in GC remains unclear. The primary aim of this study was to assess the relationship between body composition and dose delay/reduction during preoperative NACT in patients with locally advanced GC. The secondary aim was to evaluate the impact of body composition on overall and disease-free survival (DFS). METHODS:This retrospective study included 97 patients with locally advanced gastric adenocarcinoma treated with NACT at Liv Bona Dea Hospital, Baku, Azerbaijan, between 2018 and 2024. Body composition parameters-skeletal muscle index, visceral adipose tissue (VAT), and subcutaneous adipose tissue-were analyzed using before and after NACT computed tomography imaging. Dose delay and reduction were defined as treatment delays of ≥5 days and dose reductions of ≥10% owing to chemotherapy-related side effects. Survival outcomes were assessed using Kaplan-Meier analysis. RESULTS:Of the 97 patients (mean age, 63 years), 33% experienced dose delays and 15% had dose reductions. Multivariate analysis revealed that lower pre-NACT VAT measurements were associated with both dose delay (P =.01; odds ratio [OR], 7.31) and dose reduction (P =.01; OR, 8.87). No significant correlation was found between body composition parameters and overall survival (OS) or DFS. However, neural (P =.013; hazard ratio [HR], 1.88) and venous invasions (P =.03; HR, 1.43) were independent predictors of poor OS, whereas poor histologic grade (P =.008; HR, 2.01) and neural invasion (P =.039; HR, 1.61) independently predicted poor DFS. CONCLUSION:This study is the first to demonstrate that lower pre-NACT VAT is a significant predictor of dose reduction and delay in patients with locally advanced GC. Although body composition did not predict survival outcomes, tumor histologic grade and invasion factors were significant for prognosis. These findings suggest that monitoring body composition, particularly VAT, could aid in optimizing chemotherapy dosing and improving treatment outcomes for patients with GC undergoing NACT. Further prospective studies are needed to validate these results.

Objectives: Neuroendocrine neoplasms consist of both well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas.[1] [1] The study aims to report the demographic, clinical, pathological, and survival characteristics of patients with GEP-NETs. Methods: Patients diagnosed with histologically confirmed GEP-NETs between 2018 and 2023 at the Liv Bona Dea International Hospital, Baku, Azerbaijan, were included in the study. Patient data, including clinical and histopathological characteristics, including age, gender, tumor location, clinical symptoms, type of treatment, ki-67 index, grade, and outcomes, were collected. Results: A total of 51 patients were included in the study. The follow-up period of the patients varied from 3 to 74 months. The most frequent tumor location of the GEP-NETs was pancreas 19 (37%). Most of the tumors were non-functional (n=44, 85%), only a few showed functionality (n=7, 15%). Ki-67 index was high (>20%) in 6 (12%) of the patients. Eighteen of our patients had distant metastasis at the time of diagnosis (35%). The most common site for metastasis was liver (n=17, 33%). Conclusion: To conclude, the high ki-67 index, functional tumor, high grade, and the presence of distant metastasis negatively affected the survival of GEP-NET patients in our setting.

Isolated pancreatic injuries that result from blunt abdominal trauma are a rare occurrence due to the retroperitoneal location of the pancreas that shields the pancreas from trauma. The nonspecific clinical presentations of patients can delay the diagnosis and complicate the decision in patient care. It is crucial that a high degree of suspicion is maintained for pancreatic injuries in cases like this one. For optimal patient care, a multidisciplinary approach should be taken, and advanced imaging techniques, such as contrast-enhanced computed tomography (CT), should be used. The patient is a 26-year-old male who was involved in a motorbike accident. The patient was initially treated in a nearby small-town hospital. The patient was transferred to our medical facility four days after the accident took place due to clinical deterioration. He complained of severe generalized abdominal pain that was especially prominent in the left upper quadrant. Initial contrast-enhanced CT scans indicated a grade III full-thickness transection of the pancreatic body and tail. Despite the initial conservative treatment, the patient's hemodynamics were unstable, and the decision for surgical intervention was made. A distal pancreatectomy and splenectomy were performed, and the patient's recovery was uneventful. This case points out the challenges that a physician might face when diagnosing isolated pancreatic injuries that result from blunt abdominal trauma. For an accurate diagnosis, advanced imaging techniques, such as contrast-enhanced CT, should be used. A multidisciplinary approach should be taken to provide the patient with optimal medical care. Finally, this study emphasizes the need for standardized transfer protocols in resource-limited settings.

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss >10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value<0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

Background: This study reviews the literature on gastric metastases (GM) in terms of diagnosis, treatment, and outcomes. The goal of this study was to provide clinicians with a reliable and beneficial source to understand gastric metastases arising from various primary tumors and to present the growing literature in an easily accessible form. Methods: Articles published in English language from implementation of MEDLINE and Cochrane databases until May 2022 were considered for the systematic review. Articles other than English language, letters to the editor, posters, and clinical images were excluded. Hematogenous and lymphogenic metastases were included whereas direct tumoral invasion and seeding were excluded. Articles and abstracts were analyzed and last selection was done after cross-referencing and by use of defined eligibility criteria. Results: In total 1,521 publications were identified and 170 articles were finally included totaling 186 patients with GM. The median age of patients was 62 years. Gynecologic cancer was the most common cancer type causing GM (67 patients), followed by lung cancer (33 patients), renal cancer (20 patients), and melanoma (19 patients). One of the main treatment methods performed for metastasis was resection surgery (n=62), sometimes combined with chemotherapy (ChT) or immunotherapy. ChT was the other most used treatment method (n=78). Also, immunotherapy was amongst the most preferred treatment options after surgery and ChT (n=10). Conclusions: As 172 case reports were screened in the systematic review from different journals, heterogeneity was inevitable. Some articles missed important information such as complete follow-up or clinical information. Moreover, since all of the included articles were case reports quality assessment could not be performed. Among 172 case reports reviewed, resection surgery was performed the most and was sometimes combined with ChT and immunotherapy. Further research about what type of treatment has the best outcomes for patients with gastric metastases is needed.

Background: Berardinelli-Seip syndrome is an infrequently seen and potentially fatal genetic disorder characterized by the absence of adipose tissue. Herein, we report a first-in-literature liver transplant done on a 7-year-old girl because of liver cirrhosis caused by the Berardinelli-Seip syndrome.Case Report: Physical examination showed prominent subdermal fat tissue loss and mild muscle hypertrophy, giving her a slim appearance, hirsutism, thick hair, a large head in contrast to the body, low anterior hairline, icterus, prominent facial contours, prominent mandibula, loss of buccal fat, low set ears, and large limbs. After the diagnosis, she admitted to our clinic because of variceal esophageal bleeding and increasing liver enzymes. Transplantation decision was made and orthothopic liver transplantation done by the surgery team.Discussion: Common causes of death in Berardinelli-Seip syndrome patients are infections and liver cirrhosis. The mean age of the patients was 27.1 at the time of death. There is no any established cure for congenital lipodystrophies so far. However, some symptomatic treatment methods are found to be helpful. The main point of the case report to be discussed is the liver transplantation done by our surgical team. There are no examples of any transplantation in Berardinelli-Seip syndrome patients, but several reports can be found of patients with kidney or liver failure.Conclusion: Berardinelli-Seip syndrome is a rare disorder with no cure but a chance of improving lifestyle and life expectancy. The transplantation option should be considered in young patients after a multidisciplinary review.

Gastric cancer is the 5th most common cancer worldwide and is one of the major causes of cancer related deaths [[1]Wahed S. Chmelo J. Navidi M. et al.Delivering esophagogastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective.Dis Esophagus. 2020; 33 (doaa091)https://doi.org/10.1093/dote/doaa091Crossref Scopus (11) Google Scholar]. The COVID-19 pandemic has significantly impacted the provision of cancer care [[1]Wahed S. Chmelo J. Navidi M. et al.Delivering esophagogastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective.Dis Esophagus. 2020; 33 (doaa091)https://doi.org/10.1093/dote/doaa091Crossref Scopus (11) Google Scholar]. The changes in health system capacity and healthcare-seeking behaviour have lead to severe disruptions in healthcare delivery worldwide causing delayed diagnosis and treatment and, therefore, increasing the risk of adverse outcomes in cancer patients [[1]Wahed S. Chmelo J. Navidi M. et al.Delivering esophagogastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective.Dis Esophagus. 2020; 33 (doaa091)https://doi.org/10.1093/dote/doaa091Crossref Scopus (11) Google Scholar]. The Upper Gastrointestinal Surgical Society (TUGSS), through its Global Level of Harm Project (GLEOHUG) conducted a survey-based study with the participation of 145 centers from 50 countries around the world. This study showed that during the first year of the pandemic the management of gastric cancer patients was globally affected by decreasing the frequency of multidisciplinary team meetings (43,4%) and the number of elective gastrectomies (54,5%). Moreover, there was a higher clinical stage migration (29,0%), a higher metastatic disease rate (33,8%), an increased need of definitive palliative treatment (26,9%), patients' frailty (21,4%), waiting list times (52,4%), the number of urgent (26,9%) and palliative surgeries (16,6%), overall complication rates (16,6%), Clavien-Dindo 3 or higher complications (13,1%), leak rate (7,5%) and pulmonary infections (26,9%). Besides this, there was a high rate of postoperative COVID-19 infection (43,8%) and associated mortality (18,7%). The COVID-19 pandemic has put cancer patients at risk of adverse outcomes due to delays in diagnosis and treatment [[2]Covidsurg Collaborative Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study.Lancet Oncol. 2021 Nov; 22 (Epub 2021 Oct 5): 1507-1517https://doi.org/10.1016/S1470-245(21)00493-9Crossref PubMed Scopus (0) Google Scholar]. Experienced multidisciplinary teams have had a critical role in tailoring management in order to ensure oncological outcomes and quality of life for these patients [[1]Wahed S. Chmelo J. Navidi M. et al.Delivering esophagogastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective.Dis Esophagus. 2020; 33 (doaa091)https://doi.org/10.1093/dote/doaa091Crossref Scopus (11) Google Scholar]. While in high-income countries gastric cancer surgical treatment could be safely delayed provided that neoadjuvant treatment (NAT) was administered [[1]Wahed S. Chmelo J. Navidi M. et al.Delivering esophagogastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective.Dis Esophagus. 2020; 33 (doaa091)https://doi.org/10.1093/dote/doaa091Crossref Scopus (11) Google Scholar], in low-medium-income countries where patients could not receive neither NAT nor surgery, these delays could lead to increased recurrence rates and excess mortality [[2]Covidsurg Collaborative Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study.Lancet Oncol. 2021 Nov; 22 (Epub 2021 Oct 5): 1507-1517https://doi.org/10.1016/S1470-245(21)00493-9Crossref PubMed Scopus (0) Google Scholar]. Furthermore, those patients who underwent surgery were prone to have a decreased compliance with ERAS protocols, higher complication rates and mortality, especially those who underwent urgent procedures or developed postoperative COVID-19 infection. Additionally, the hospital work overload may have made rescue from postoperative complications difficult, increasing the severity of complications and the mortality rate [[3]Osorio J, Madrazo Z, Videla S, et al. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic.Google Scholar]. One may think that the worst part of the COVID-19 pandemic and its effects were limited to its first year. However, in the case of cancer patients, the effects of the pandemic can go beyond its duration. A Canadian study [[4]Malagón T. Yong J.H.E. Tope P. et al.Predicted long-term Impact of COVID-19 pandemic-related care delays on cancer mortality in Canada.Int J Cancer. 2022; 150: 1244-1254Crossref PubMed Scopus (30) Google Scholar] showed that cancer care disruptions would lead to an essential increase in cancer mortality with the highest excess expected for 2022. Therefore, it is extremely important that cancer pathways are strengthened and patients' prioritization improved in order to reduce avoidable deaths before future severe care disruptions emerge [[3]Osorio J, Madrazo Z, Videla S, et al. Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic.Google Scholar]. The authors of the present work would like to thank all participants in the survey for their efforts and commitment during the COVID-19 pandemic. Special thanks to Professor Kamal Mahawar and The Upper Gastrointestinal Surgical Society (TUGSS); Professor Domenico D'Ugo and the European Society of Surgical Oncology's (ESSO) Board of Directors; Dr. Andreas Brandl, Dr. Wim Ceelen, and the ESSO-European Young Surgeons and Alumni Club (EYSAC) Research Academy for their support and distribution of the survey.

Background: This study reviews the literature on gastric metastases (GM) in terms of diagnosis, treatment, and outcomes. The goal of this study was to provide clinicians with a reliable and beneficial source to understand gastric metastases arising from various primary tumors and to present the growing literature in an easily accessible form. Methods: Articles published in English language from implementation of MEDLINE and Cochrane databases until May 2022 were considered for the systematic review. Articles other than English language, letters to the editor, posters, and clinical images were excluded. Hematogenous and lymphogenic metastases were included whereas direct tumoral invasion and seeding were excluded. Articles and abstracts were analyzed and last selection was done after cross-referencing and by use of defined eligibility criteria. Results: In total 1,521 publications were identified and 170 articles were finally included totaling 186 patients with GM. The median age of patients was 62 years. Gynecologic cancer was the most common cancer type causing GM (67 patients), followed by lung cancer (33 patients), renal cancer (20 patients), and melanoma (19 patients). One of the main treatment methods performed for metastasis was resection surgery (n=62), sometimes combined with chemotherapy (ChT) or immunotherapy. ChT was the other most used treatment method (n=78). Also, immunotherapy was amongst the most preferred treatment options after surgery and ChT (n=10). Conclusions: As 172 case reports were screened in the systematic review from different journals, heterogeneity was inevitable. Some articles missed important information such as complete follow-up or clinical information. Moreover, since all of the included articles were case reports quality assessment could not be performed. Among 172 case reports reviewed, resection surgery was performed the most and was sometimes combined with ChT and immunotherapy. Further research about what type of treatment has the best outcomes for patients with gastric metastases is needed.

Background: This study reviews the literature on gastric metastases; in terms of diagnosis, treatment and outcomes. The intended goal of this study is to provide clinicians with a reliable and beneficial source to understand gastric metastases arising from various primary tumors and to present the growing literature in an easily accessible form by reviewing the case reports of different primary tumors separately with consideration of diagnosis, treatment and clinic may vary from patient to patient depending on primary site of the tumor.

Digestive disease-caused death rates are significantly high in the South Caucasus region. The latest Global Burden of Disease (GBD) data are a subject of discussion and should lead to serious steps to be taken. Azerbaijan, Armenia, and Georgia are three countries in the region with similar cultures but different roots. The problem seems to affect every country in the region with slightly different rates. It is crucial to start investigations into the detailed cause and to take serious steps in order to prevent digestive disease-caused deaths in the region. This letter aims to arouse awareness of the problem in the region.

Background: Use of Indocynanine green in gastric cancer is a modern method, commonly used for lymph node mapping and organ perfusion. We are representing the first 6 operations with ICG lymph node mapping in Azerbaijan.

Background: Gastric cancer (GC) is the 5th most common malignancy and remains one of the major causes of worldwide cancer-related deaths. COVID-19 pandemic has had a significant impact on the provision of cancer care. This study aims to overview the global standpoint of gastric cancer patients (GCP) during the first year of pandemic (PY1). Materials and Methods: The Upper Gastrointestinal Surgeons (TUGS), within its Global Level of Harm Project, designed an online cross-sectional survey to assess how GCP’s management changed during PY1. The questionnaire included 33 questions about expertise, kind of health system, hospital organization and screening policies, personal protective equipment (PPE), change in patient’s characteristics, preoperative, operative and postoperative management of GCP. Results: There were 209 answers from 178 centres (50 countries) around the world. Results of the survey showed: most hospitals (88,2%) had restricted areas for the management of COVID-19 patients; 53,6% of participants were redeployed; most frequent COVID-19 screening methods were PCR (78,8%) and chest CT-scan (25,6%), and 55,9% thought there was a lack of PPE. Preoperative management: 43,2% decrease in the number of multidisciplinary teams (MDT) meetings; 28,4% increase in the number of cT2 or higher GCP; 34,7% increase in metastatic (M1) GCP; 26,8% increase in GCP receiving definitive palliative treatment; 23,7% increase in the number of frail patients; 50% increase in waiting list time (WLT); and 41,6% faced problems in the provision of oncological treatment. Operative management: 54,5% decrease in elective gastrectomies; 29,1% increase in the number of urgent/semi-urgent gastrectomies; 37% decrease in the number of minimally-invasive gastrectomies (MIG); and 18,5% increase in the number of surgeries with palliative intent. Postoperative management: 16,5% increase in the overall complication rate (OCR); 12,6% increase in the number of Clavien-Dindo 3 or higher complications; 8% increase in the leak rate; increase in pulmonary infections (26,8%) and bowel obstruction (2,4%); 44,5% development of postoperative COVID-19 infection; 15,4% increase in 30-days mortality rate; 23,1% mortality due to COVID-19 infection; 17,6% increase in the need for adjuvant treatment. Most patients were postoperatively assessed either through a face to face consultation or a combination of face to face and remote consultation. Conclusions: COVID-19 pandemic has affected GC management by decreased frequency of MDT’s, higher clinical-stage migration and fueled frailty. The pandemic increased WLT, the number of urgent and palliative surgeries, OCR, Clavien-Dindo 3 or higher complications, leak rate, and pulmonary infections. There was a noticeable high rate of postoperative COVID-19 infection and associated mortality. Further multicentric studies are warranted to affirm these findings.

Background: To assess the current status of gastric cancer surgery in Azerbaijan.

Cysts are uncommon congenital lesions of the fetal penis. Fetal penile cysts can develop when epithelial cells become entrapped during the fusion of the labial scrotal folds. The spectrum of diagnoses varies from simple epidermal inclusion cysts and megalourethra to hypospadias. In our case, we present a penile cyst that appeared between the 16th and 24th weeks. There was no other congenital anomaly, and since the mother did not accept an amniocentesis, we could not learn the karyotyping findings. As there were no other signs of congenital anomalies on ultrasound, we decided only to follow up, and at the 24th week's control ultrasound, the cyst was completely resolved with no other imaging findings.