Dr Harsh Shah, MCh

GI & HPB Surgical Oncologist @apollo_ahd @scrc_clinic📍 Ahmedabad, 🇮🇳

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

🔬 Intrahepatic cholangiocarcinoma. Who actually benefits from adjuvant therapy?
Maybe three stains can tell you.

Multi-omics found a high-risk, mucin-enriched subtype.
Marked by claudin-18, MUC1, MUC5AC.
Worst survival when left untreated.

📈 But in 174 resected patients, the marker-positive ones did markedly better with adjuvant chemo or chemoembolisation.
Marker-negative: no clear benefit.

💡 A small IHC panel to decide who to treat after resection. Needs prospective validation.
And claudin-18 keeps showing up across the biliary tree.
https://t.co/KSsEceDWTQ
#Cholangiocarcinoma

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

🤖 Robotic vs laparoscopic gastrectomy. Japan's national registry. 2023–24.
Nearly 11,000 matched pairs.

Distal gastrectomy:
📉 Lower 30-day morbidity, robotic vs lap. 4.3% vs 4.9%.
Less blood loss, fewer conversions, shorter stay.

Total gastrectomy:
Morbidity the same. 8.7% vs 8.3%.
Robotic still bled less and converted less — but didn't move the main endpoint.

💡 The robotic edge in gastric cancer is real, but it's procedure-specific.
Long-term oncology and cost still open.
https://t.co/uWWAx4LHIH
#GastricCancer

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

🧠 A "low-risk" pancreatic cyst. Stable for years.
Safe to stop watching?

1,494 IPMNs under surveillance vs the SEER population:
📈 ~10x the pancreatic cancer risk overall.
Main duct ≥5 mm: 26x. BMI ≥30: 21x.

Here is the part that matters:
Even guideline-negative cysts ran 8x the risk.
After 5 stable years, the curve kept climbing. No plateau.

⚠️ "Low-risk" is not "no-risk." And year 5 is not a finish line.
https://t.co/KcGjalJba3
#AnnalsofSurgery

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

🩺 Oesophageal cancer.
Restaging after chemoradiation comes back "uncertain."
Watch, or operate?

SANO looked at 272 uncertain responders. 205 went to surgery.
Only 15% had no residual tumour.
So 85% still had cancer. 🎯

"Uncertain" is not "complete." Default to surgery.

One exception: squamous cancer + a non-traversable stricture.
There, 33% had a pathologic complete response.
That subgroup earns a real conversation — not a reflex resection.
https://t.co/kpcnaDdZ3s
#AnnalsofSurgery

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

🧪 HER2-positive gastroesophageal cancer, first line.
For 15 years the answer was trastuzumab + chemo.
HERIZON-GEA-01 says that can change.

Zanidatamab is a dual-HER2 bispecific.
It beat trastuzumab on PFS. HR 0.65.

📈 Add tislelizumab and median OS reaches 26.4 months. HR for death 0.72.

The catch: the survival win needs the PD-1.
Zanidatamab alone — OS 24.4 months, not significant.

⚠️ And grade ≥3 toxicity ~73%. Diarrhoea in a quarter.

Real gain. Real toxicity. Pick the patient.
https://t.co/R3k7mSMDQC
#NEJM #GastricCancer

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

Nationwide Dutch data (18 hospitals, 2,384 patients): multimodal prehabilitation before colorectal cancer surgery cut overall complications from 37.8% to 30.1% (OR 0.71), nearly halved medical complications, and shaved a day off length of stay — across every age and ASA grade.

The complication you prevent in clinic is the one you don't fight in the ICU.
https://t.co/R4LzBYfaos
#JAMASurgery

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

Intraoperative AI that flags the pancreas, common hepatic artery, left gastric artery and vein during robotic gastrectomy cut unsafe incision-line choices (OR 0.25) and found the hepatic artery faster — across 67 videos and 20 surgeons.

Vessel recognition is still modest. A cognitive aid for suprapancreatic dissection, not an autopilot.
https://t.co/m4mM3px8RY
#GastricCancer

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

RESPONDER (n=844, 8 centres): in rectal cancer, when lateral pelvic nodes ≥5 mm shrink to under 5 mm after chemoradiation, omitting lateral node dissection gave the same 5-year local recurrence (5.3% vs 3.1%) and disease-free survival — with less operative morbidity.

The response carries the prognosis. Dissect the node that doesn't shrink; spare the one that does.
https://t.co/lyQZ3tWB71
#AnnalsofSurgery

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

Tissue-free ctDNA in stage III colon cancer, validated in 2,260 patients from Alliance N0147.

Detectable after surgery in 1 in 5. Recurrence HR ~6. Five-year disease-free survival 27.7% if positive vs 77.1% if negative — and the gap was widest in the lower-risk and dMMR patients we're least certain about.

No tumour block required. Clearly prognostic now; whether acting on it improves outcomes is the next trial.
https://t.co/S840WK0Tlc
#JCO

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

DRAGON-01 (phase 3, n=222, gastric cancer with peritoneal-only metastasis): adding intraperitoneal to IV paclitaxel + S-1 improved median OS from 13.9 to 19.4 months (HR 0.67), and 3-year OS from 12% to 25%.

Conversion surgery 51% vs 35%; positive cytology cleared in 84% vs 53%. No extra grade 3–4 toxicity.

First positive phase 3 for intraperitoneal chemo here — PHOENIX-GC was negative. The backbone predates chemo-immunotherapy, so integration is the next question.
https://t.co/ItGhGbmQ23
#JAMAOncology

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

MATTERHORN final OS: durvalumab + FLOT beats FLOT alone in resectable G/GEJ. HR 0.78; p=0.021.
🎯 The first checkpoint regimen to move OS in this curative-intent setting. KEYNOTE-585 couldn't.
https://t.co/HoJnYKJu1G

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

One dose of pembrolizumab. 44% pCR in stage I–III dMMR colon cancer. RESET-C in JCO.
💡 The non-operative-management trial design writes itself from here.

https://t.co/ZScjj2eLU4

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

NORDICC, 13-year follow-up.
Distal CRC: RR 0.79.
Proximal CRC: RR 0.91, not significant.
⚠️ The right colon remains the screening problem nobody has solved.
https://t.co/LzLkD4RchD

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

Sources (peer-reviewed, 2024–2026):

— Mohite et al, BMJ Public Health 2026: https://t.co/sOFozTNsdd
— Gupta et al, JGH Open 2026: https://t.co/cb9J6t4dNz
— Parveen et al, Indian J Gastroenterol 2024: https://t.co/eB2fRY6oys

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

A 2026 community study mapped gallstone disease across India in 28,395 people.

The geographic difference is 35-fold.

Five things every Indian adult should know — all backed by data published this year.

🧵

[Dr Harsh Shah, MCh @GI_Cancer_Doc]

5/ When to act:
— Pain after fatty meals
— Right upper abdomen tenderness
— Yellow eyes/skin
— Fever + chills + abdominal pain

These are not "gas." Get an ultrasound.

In high-risk regions, even silent stones deserve a surgical conversation.