Indian Journal of Surgical Oncology最新文献

{"title":"A Proposal for Orocutaneous Fistula Grading Following Oral Cancer Surgery.","authors":"Shivakumar Thiagarajan, Nithyanand Chidambaranathan, B Gurukeerthi, Devendra Chaukar","doi":"10.1007/s13193-023-01786-w","DOIUrl":"10.1007/s13193-023-01786-w","url":null,"abstract":"<p><p>Orocutaneous fistula (OCF) is a common postoperative complication encountered following surgery for oral cancers with multiple implications. There is no grading system available for this complication which has so many implications that would help in its uniform reporting and management. In this study, we have included patients with oral squamous cell carcinoma operated on between January 2021 and December 2021 and tested a proposed three-tier grading system (grades 1-3) for OCF. Out of the 284 patients at risk of OCF, 37 (13%) patients developed OCF in this cohort. Six patients had grade 1 OCF, 20 patients had grade 2 OCF, and 11 patients had grade 3 OCF. Patients with a higher grade of OCF had prolonged hospital stays and required multiple surgical debridements and/or resuturings, and a few needed another flap, which was statistically significant. The proposed grading system for OCF appears to be useful in grading this complication. However, this needs to be validated in a prospective study across multiple centres.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":" ","pages":"496-501"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44147930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Progression on Neoadjuvant Chemotherapy: An Indicator of Poor Outcomes in Extremity Osteosarcoma.","authors":"Chandra Kumar Krishnan, Madhusudan Reddy Karagiri, Venkatraman Radhakrishnan, Anand Raja","doi":"10.1007/s13193-024-02087-6","DOIUrl":"https://doi.org/10.1007/s13193-024-02087-6","url":null,"abstract":"<p><p>Osteosarcoma is a matrix-producing neoplasm. Most patients are treated with neoadjuvant chemotherapy (NACT. Various parameters are available for response assessment which include radiological and histological criteria. Data on clinical responses such as pain response and size assessment is meagre. In this study, we aimed to analyze if clinical assessment used for response evaluation can predict prognosis in patients receiving neoadjuvant chemotherapy for extremity osteosarcoma. All patients diagnosed with osteosarcoma and who underwent treatment with curative intent between January 2000 and December 2018 were identified. Patients who had progression were identified and whether clinical progression impacted overall survival (OS) and disease-free survival (DFS) was analyzed. Forty-three patients who had progression on NACT were identified. When compared to patients who did not have clinical progression, more patients in the clinical progression group had large tumors (<i>p</i> = 0.025), the majority underwent amputation (<i>p</i> = <0.001), and most were poor responders to chemotherapy (<i>p</i> = 0.011). Clinical progression on NACT predicted poor OS and DFS on univariate analysis but not on multivariate analysis. Although patients with clinical progression had poor oncological outcomes, it was not a statistically significant factor affecting oncological outcomes. The role of continuing the same chemotherapy regimen in the adjuvant setting in this subset of patients is doubtful. Large multicentric studies are needed to know the prognostic impact of clinical progression during NACT on oncological outcomes.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"567-575"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between the Devil and the Deep Sea-The Cardiac Conundrum: Report of a Contiguous Cavo-Atrial Tumor Thrombus in NSGCT Testis.","authors":"Shrinivas Venkatesh, Dakshinamurthy Suresh Kumar, Shalini Shree Krishnamurthy, Krishna Muralidharan, Navin Noushad, Kanuj Malik, Anand Raja","doi":"10.1007/s13193-024-02119-1","DOIUrl":"https://doi.org/10.1007/s13193-024-02119-1","url":null,"abstract":"<p><p>Testicular cancer is notorious for its myriad presentations. In this case report, we present a 28-year-old gentleman diagnosed with metastatic non-seminomatous germ cell tumor (NSGCT). After receiving neoadjuvant chemotherapy, he was found to have a large paracaval conglomerate nodal mass infiltrating the inferior vena cava (IVC), with a contiguous thrombus extending from the vena cava to the right atrium. The pre-operative imaging was ambiguous, with the cavo-atrial thrombus appearing to float within the vascular lumen at some places and infiltrating the caval wall at others. Hence, arrangements were made for cardiopulmonary bypass, sternotomy, and vascular surgeon backup. Intraoperatively, the vena cava was palpated in its entirety up to the mediastinum, and the thrombus was found to be freely floating. Hence, the thrombus was milked out in its entirety from the right atrium up to the vena cava, and the paracaval mass was resected en bloc with the tumor thrombus. The IVC was reconstructed with a Dacron graft. A review of the literature revealed no previously documented cases of contiguous cavo-atrial tumor thrombus. Approaching cases requires an assessment of the nature of the thrombus and the need to prepare for the worst. It is worth remembering that going the extra mile concerning obtaining a complete tumor clearance is worth it in NSGCTs, given the highly gratifying outcomes.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"639-644"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Outcomes of Oesophagectomy in a Real-World Scenario from a Tier II City in India.","authors":"Amita Sekhar Padhy, Rigved Nittala, Srikarthik Voleti, Chaitanya Raju Chalapaka","doi":"10.1007/s13193-024-01924-y","DOIUrl":"https://doi.org/10.1007/s13193-024-01924-y","url":null,"abstract":"<p><p>This study evaluates short-term outcomes of oesophagectomy at a low-volume cancer hospital in Visakhapatnam, India. Fifteen patients who underwent oesophagectomy from 2020 to 2023 were analysed. The most common histology was squamous cell carcinoma. The mean age was 55 years and the majority were male. The common approaches used were open transhiatal and transthoracic oesophagectomy. The mean operative time was 9.5 h, and the mean hospital stay was 15.92 days. There were no perioperative deaths, but complications included pulmonary issues, vocal cord paralysis, anastomotic leaks, chyle leaks and wound infections. Higher volume centres tend to have better outcomes after oesophagectomy. However, factors other than volume like patient selection, ERAS (Enhanced Recovery After Surgery) protocols, specialized critical care and trained multidisciplinary teams also impact outcomes. At our centre, though a low-volume hospital, proper patient selection, prehabilitation and a collaborative team approach helped achieve acceptable results. We recommend developing consensus on defining low- and high-volume centres for oesophagectomy in the Indian context, based on disease burden, resources and constraints. Overall, there is a lack of Indian data comparing outcomes between low and high-volume centres for oesophagectomy.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"521-527"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgically Treated Clear Cell Sarcomas - What Influences Outcomes?","authors":"Harsha S S Tadala, Ashish Gulia, Ajay Puri, Bharat Rekhi, Siddhartha Laskar","doi":"10.1007/s13193-024-02108-4","DOIUrl":"https://doi.org/10.1007/s13193-024-02108-4","url":null,"abstract":"<p><p>Clear cell sarcoma (CCS) also called as melanoma of soft parts is a rare malignant soft-tissue tumor with melanocytic differentiation, primarily located in deep soft tissue and has preference for lymph node and pulmonary metastasis. Metastatic patients have poor oncologic prognosis and so far, no adjuvant treatment seems to be effective in these cases. All cases were retrieved from our prospectively maintained surgical database. Twenty-nine patients (14 males,15 females) with a mean age of 34 years (13-69 years) were operated between 2004 and 2020. Overall survival and recurrence free survival were evaluated. At mean follow-up of 45 months, out of 29 cases, 2 lost to follow-up, 6 patients had nodal metastasis, 3 had lung metastasis, one had both at presentation, 15 patients had died due to disease and 12 are alive. Nodal metastasis rate was 24% (7/29). Positive margin is observed in 6 (19%). 24 patients had recurrence of which 6 had both local and distant. The 5-year OS, LRFS, DRFS were 53%, 56%, 35% respectively at 5 years. Survival rates were significantly poor in patients with metastasis at presentation, 66% vs. 25% (<i>p</i> = 0.016). CCS is an aggressive soft tissue malignancy with high propensity for metastasis. The overall survival of CCS is poor. Metastasis at presentation negatively impacts on survival. Distant recurrences, especially nodal recurrences are not uncommon and complete surgical resection of all recurrences if possible is advisable. Research to develop new chemotherapeutic agents and targeted therapies may help improve the prognosis of CCS.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"627-632"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elucidating Cytomorphological Features of Eccrine Porocarcinoma on The Forehead Presenting Without Pre-existing Poroma in an Adult Male: A Rarity Unveiled with a Comprehensive Review of Literature.","authors":"Shaivy Malik, Mukul Singh, Adil Aziz Khan","doi":"10.1007/s13193-024-02130-6","DOIUrl":"https://doi.org/10.1007/s13193-024-02130-6","url":null,"abstract":"<p><p>Eccrine porocarcinoma (EPC), a rare and aggressive skin adnexal malignancy, presents significant diagnostic and management challenges due to its low incidence and clinical resemblance to other skin lesions. The case report highlights its rarity, propensity for aggressive behavior, and the importance of prompt diagnosis for effective management. A 50-year-old male presented with a rapidly enlarging swelling on his forehead, clinically resembling to any other skin lesion. Fine needle aspiration biopsy (FNAB) revealed atypical basaloid cells suggestive of porocarcinoma, confirmed by histopathological examination and immunohistochemistry. The case emphasized the diverse clinical presentation and the utility of FNAB in early diagnosis. This case underscores the comprehensive understanding of EPC, including its clinical, cytological, histopathological, and immunohistological features. It also emphasizes the key cytological features and its role in early diagnosis.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"443-449"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Indian Perspective on the Management of Adolescent Ovarian Cancer.","authors":"P Rema","doi":"10.1007/s13193-024-02120-8","DOIUrl":"https://doi.org/10.1007/s13193-024-02120-8","url":null,"abstract":"<p><p>Malignant ovarian tumours often go unrecognised or improperly treated in adolescents. The treatment of adolescents with ovarian cancer requires a tailored approach aiming at a cure for the disease while at the same time considering the adverse reproductive and long-term side effects. Most of the discussions of cancer treatment do not include discussions on post-treatment reproductive functions, considering the dilemma of counselling fertility preservation to a girl who has not reached adulthood. The surgical treatment should aim at fertility preservation by retaining the uterus and remaining ovarian function with comprehensive staging to rule out occult disease. Adjuvant chemotherapy is administered taking into account the spread and aggressiveness of the tumour. There are no specific Indian guidelines for the treatment of adolescent ovarian cancers. Early identification of symptoms and multidisciplinary management can improve the survival rate and quality of life.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"421-426"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Atypical Teratoid Rhabdoid Tumor of Central Nervous System: A Case Series with Review of Literature.","authors":"Jyoti Verma, Neelima Gupta, Sushila Jaiswal, Awdhesh Kumar Jaiswal","doi":"10.1007/s13193-024-02115-5","DOIUrl":"https://doi.org/10.1007/s13193-024-02115-5","url":null,"abstract":"<p><p>Atypical teratoid rhabdoid tumor (AT/RT) of the central nervous system (CNS) is the rare, aggressive malignant neoplasm of infancy and early childhood and relatively rare in adults. Patients with ATRT typically follow a dismal course. Because of its rarity and rapid course and poor prognosis, there has been no consensus as to the optimal treatment of this tumor. We herein report a series of nine cases collected from the year 2015 to 2021 in a regional tertiary care center in North India. We retrospectively collected histologically diagnosed ATRT cases and obtained demographic and clinical data from the databases. We retrieved the archived slides and tissue blocks for analysis and found nine diagnosed cases of ATRT. The median age of presentation was 3 years (ranging from 0.9 to 13 years) and showed male preponderance (male to female ratio of 2:1). The mean duration of symptoms was 3.5 months with headache and vomiting being the commonest symptoms. The tumors showed heterogenous immunohistochemical expression. Patients with AT/RT underwent multimodal treatment comprising surgical resection, radiotherapy, and chemotherapy based on the patient's age and tumor site and its resectability. The mean overall survival was 15.1 months (range, 1.5-30 months). ATRT is a rare neoplasm with a highly variable clinical course and poor prognosis. It portends poor outcomes in spite of a multimodal approach to treatment; hence, there is a dire need to help combat this enigmatic tumor.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"611-620"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Safety and Efficacy: Laparoscopic vs. Open Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Meta-analysis of Randomized Control Trials.","authors":"Hussain Sohail Rangwala, Hareer Fatima, Mirha Ali, Burhanuddin Sohail Rangwala","doi":"10.1007/s13193-024-02132-4","DOIUrl":"https://doi.org/10.1007/s13193-024-02132-4","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma (PDAC) has an estimated 5-year survival rate of 11% and remains a formidable challenge. Despite evolving pancreaticoduodenectomy techniques, the pinnacle status of laparoscopic surgery persists. Technological advancements since Gagner and Pomp's 1994 breakthrough have expanded its reach, yet it remains complex. Although safety reports exist, large-scale studies establishing the viability of laparoscopic surgery for PDAC are scarce. This study aimed to provide an up-to-date meta-analysis, scrutinizing all relevant trials, especially recently published ones, to discern differences between laparoscopic and open pancreaticoduodenectomy procedures. This meta-analysis, following the PRISMA guidelines, systematically searched the PubMed and Cochrane Library databases for randomized controlled trials on pancreaticoduodenectomy up to November 25, 2023. Data extraction, quality assessment, and statistical analysis, including primary and secondary outcomes, were conducted using rigorous methodology. The study employed Review Manager 5.4 for analysis, with significance set at <i>P</i> < 0.05. This meta-analysis, comprising five randomized controlled trials (laparoscopic, 605; open, 601; total, 1206), utilized the Cochrane Risk of Bias 2 tool, revealing minimal bias. Primary outcome analysis indicated a shorter hospital stay with laparoscopic pancreaticoduodenectomy (S.M.D. =  - 0.18, 95% CI - 0.63 - 0.28, <i>P</i> = 0.45) and reduced blood loss (S.M.D. =  - 1.96, 95% CI - 3.05, 0.88, <i>P</i> = 0.0004), but increased operative time (S.M.D. = 1.74, 95% CI 0.95 to 2.53, <i>P</i> < 0.0001). The secondary outcomes showed no significant differences in morbidity, mortality, resection, fistula, gastric emptying, hemorrhage, bile leak, reoperation, readmission, and surgical site infection between the two procedures. Laparoscopic pancreaticoduodenectomy (LPD) offers marginal benefits over open pancreaticoduodenectomy (OPD), including reduced blood loss and shorter hospital stays. However, LPD requires a significantly longer operative time, and no substantial differences have been observed in terms of mortality or other complications. Additional studies with lower heterogeneity are needed to thoroughly evaluate the comparative effectiveness and safety of LPD and OPD.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"432-442"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Truly Inevitable-Our Perspective on the Complications After Surgery for Rectal Cancer.","authors":"Kumar Vinchurkar, Manoj Togale, Preeti Maste, Saurin Chaudhary, Imtiaz Ahmed, Sapna Krishnamurthy, Rohan Bhise, Jyoti Mane, Praveen Kumbar","doi":"10.1007/s13193-024-02125-3","DOIUrl":"https://doi.org/10.1007/s13193-024-02125-3","url":null,"abstract":"<p><p>Rectal cancer is one of the most common malignancies in the GI tract. Although recent technology and treatments are available today, complications are still there. The focus of this study is to draw attention towards the important complications and their management options in rectal cancer surgeries. Retrospective study of 57 patients diagnosed and operated with rectal cancer between 2012 and 2022 using questionnaire data. 21.05% developed complications following surgery for rectal cancer including SSI, LARS, anastomosis leak, and stomal stenosis. LARS was seen in 26.31% out of the 19 patients involved in the study (LAR + ULAR) of which 80% had minor LARS scores and 20% had major LARS scores. In LARS, 80% had received long-term chemoradiotherapy in a neoadjuvant setting. The study revealed a rising trend of rectal cancer in young individuals (35.08%). Complications are an inevitable part of rectal cancer surgery even with recent technology. Use of long-course radiotherapy in neoadjuvant settings and LAR and ULAR may improve sphincter preservation with the risk of increasing incidence of low anterior resection syndrome, and anastomosis leak should be used cautiously with proper patient selection.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"667-675"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}