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| 1 | Vascular Anomalies Encountered During Pancreatoduodenectomy: Do They Influence Outcomes?显示文摘 | Parul J. Shukla MS FRCS Savio G. Barreto MS Aniruddha Kulkarni MD Ganesh Nagarajan MS Abe Fingerhut MD FACS FRCS | 2010 | Annals of Surgical Oncology2010，，1： | 5 |
| 2 | Gallbladder Cancer: We Need to Do Better!显示文摘 | Parul J. Shukla MBBS MS FRCS Savio G. Barreto MBBS MS | 2009 | Annals of Surgical Oncology2009，，8： | 2 |
| 3 | Evolution of pancreatoduodenectomy in a tertiary cancer center in India: Improved results from service reconfiguration显示文摘 | Shailesh V. Shrikhande Savio George Barreto B.A. Somashekar Kunal Suradkar Guruprasad S. Shetty Sanjay Talole Bhawna Sirohi Mahesh Goel Parul J. Shukla | 2013 | Pancreatology2013，，1： | 2 |
| 4 | Pancreatic fistula after pancreaticoduodenectomy: the impact of a standardized technique of pancreaticojejunostomy显示文摘 | Shailesh V. Shrikhande George Barreto Parul J. Shukla | 2008 | Langenbeck’s Archives of Surgery2008，，1： | 2 |
| 5 | Vascular Anomalies Encountered During Pancreatoduodenectomy: Do They Influence Outcomes?显示文摘 | Parul J. Shukla Savio G. Barreto Aniruddha Kulkarni Ganesh Nagarajan Abe Fingerhut | 2010 | Annals of Surgical Oncology2010，，1： | 2 |
| 6 | The Impact of Obesity on Perioperative Outcomes After Laparoscopic Colorectal Resection显示文摘 | Tomoki Makino Parul J. Shukla Francesco Rubino Jeffrey W. Milsom | 2012 | Annals of Surgery2012，，2： | 2 |
| 7 | Hepatoblastoma: a single institutional experience of 18 cases显示文摘 | Parul J. Shukla Savio G. Barreto Sajid S. Qureshi Rohini Hawaldar Shailesh V. Shrikhande Mukta R. Ramadwar Shripad Banavali | 2008 | Pediatric Surgery International2008，，7： | 1 |
| 8 | The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: A case-matched study of 152 patients显示文摘 | Tomoki Makino Koiana Trencheva Parul J. Shukla Francesco Rubino Changhua Zhuo Raghava S. Pavoor Jeffrey W. Milsom | 2014 | Surgery2014，，： | 1 |
| 9 | Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?显示文摘 | Shailesh V. Shrikhande MS Sajid S. Qureshi MS Nanda Rajneesh MS Parul J. Shukla MS | 2005 | World Journal of Surgery2005，，12： | 1 |
| 10 | The Impact of Obesity on Perioperative Outcomes After Laparoscopic Colorectal Resection显示文摘 | Tomoki Makino Parul J. Shukla Francesco Rubino Jeffrey W. Milsom | 2012 | Annals of Surgery2012，，2： | 1 |
| 11 | Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers显示文摘Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume centers.However,this is not practical in small,resource-poor countries in the Caribbean.In these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general surgeons.In this paper,we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income nations.Specifically,we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries,such as those in the Caribbean.This paper has two parts.First,we performed a literature review evaluating studies published on outcomes after PD in high volume centers.The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept.In the authors’opinions,most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed countries.In these settings,their only options are to have their operations in the resource-poor,low-volume settings in the Caribbean.However,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged. | Shamir O Cawich Neil W Pearce Vijay Naraynsingh Parul Shukla Rahul R Deshpande | 2022 | World Journal of Clinical Cases2022，10，22： | 1 |
| 12 | Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols显示文摘BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,2023.Stan-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD complications.RESULTS Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this facility.Major complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their complication.Four(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protocols. | Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan | 2024 | World Journal of Gastrointestinal Surgery2024，16，3： | 0 |
| 13 | Borderline resectable pancreatic tumors:Is there a need for further refinement of this stage?显示文摘BACKGROUND:The ideal treatment of patients with 'borderline resectable pancreatic tumors (BRTs)' needs to be established.Current protocols advise neoadjuvant chemo(radio)therapy,although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection.The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection,with or without vascular resection (VR),could be achieved.METHODS:Twelve patients with BRTs were identified.Tumor location,maximum degree of circumferential contact (CC),length of contact of the tumor with major vessels (LC),and luminal narrowing of vessels at the point of contact with the tumor (venous deformity,VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR.RESULTS:A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin.Four of the 10 patients required VR (40%).In 3 of the 4 patients whose tumors required VRs,CC was ≥grade III and VD was grade 2.LC did not influence the need for VR.CONCLUSIONS:It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging.Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients,thus avoiding any delay in curative resections in such patients. | Shailesh V Shrikhande Supreeta Arya Savio George Barreto Sachin Ingle Melroy A D'Souza Rohini Hawaldar Parul J Shukla | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，3： | 0 |
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