Indian Journal of Surgical Oncology最新文献

Oncoplastic techniques in breast cancer therapy allow for extending the indications of breast-conservative surgery plus improving cosmetic outcomes. Breast tumours located at the upper inner quadrant particularly represent a challenge for conservative surgery due to the scarcity of breast tissue and the risk of skin involvement. We present a "matrix rotation advancement" flap for breast-conserving surgery in patients with breast tumours at this location. This retrospective observational study analyzed 15 patients who underwent breast-conserving surgery with matrix rotation mammaplasty. All patients were treated in our tertiary oncology centre. The median age at diagnosis was 49 years. The average initial tumour size was 5.2 cm, and the mean excised breast weight was 105 g. Patients required neither symmetrization nor repositioning of the nipple-areola complex. Only two patients had a minor complication (wound dehiscence). During follow-up, no local recurrences were reported. We conclude that the matrix rotation flap is a safe and effective technique to treat tumours at this difficult location. It provides adequate oncological margins, accepted cosmetic results, and contralateral symmetry, with complication rates like those of standard conservative surgery.

Breast cancer (BC) is a treatable disease, and chances of survival are higher if it is detected in time. The survival rates of BC in India are low because the detection takes place late. Awareness about BC can result in early presentation. The Breast Self-Examination (BSE) can convert the late presentation to early. The aim of the present study is to assess awareness about BC and BSE among Indian adult female students. A total of 1025 females between 17 and 30 years of age professionals working from home were approached using online platforms. Data was collected using a semi-structured demographic tool and awareness questionnaire. Majority of the medical students have better knowledge regarding BC. There is a significant difference in scores regarding knowledge, attitude, and skills between medical and non-medical stream adult students. Similarly, practice of BSE also varied in both groups. This might be the one of the first few studies in the year 2023, to be following up after years of awareness and already presented data and work done so far, the results suggest that there is still a vast gap in knowledge, attitude, and skills regarding BC and practice of BSE between female adult students of medical and nonmedical streams. The overall outcomes are better among medical stream students, but it is still unsatisfactory. There is a need to refocus on the strategies which may result in improving the awareness and practice of BSE in female students as they are the target population for improving the overall community outcome of this cancer.

Seroma and high drain output is common complication after modified radical mastectomy (MRM). MRM leaves behind a negative space which fills up with fluid from cut lymphatics and tissue leading to seroma. Tranexamic acid decreases clot degradation thereby plugging the vessels leading to decreased seroma. This study is to determine if tranexamic acid reduces the incidence of seroma formation, drain output, and wound-related complications in post-operative cases of MRM. We conducted a prospective, double blinded, parallel arm, randomized control trial of 160 women with breast cancer undergoing MRM to study the effect of tranexamic in reducing seroma and drain output. Patients were recruited from a period of 2021-2022. Tranexamic acid was given 15 mg/kg IV at the time of administration of anaesthesia and 500 mg twice a day for 5 days with the control group receiving a placebo. The cases were followed up for a period of one month. Drain output, clinical seroma formation, and wound-related complications were recorded. There was a significant reduction in the drain output compared to the patients receiving a placebo (590 ml vs 725 ml: p = 0.001). The number of patients developing a clinically detectable seroma was also reduced (16.3% vs 31.3%: p = 0.025). Tranexamic acid also led to reduction in wound infection (6.3% vs 23.8%: p = 0.002). Wound dehiscence and flap necrosis was also lower in the tranexamic acid group, but it was not statistically significant. Our results show that tranexamic acid reduces seroma formation, facilitates early drain removal, and reduces the wound infection in patients undergoing MRM.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-024-02050-5.

Conventional chondrosarcoma (CCS) is the most frequent histological subtype of chondrosarcoma (CS). Currently, researchers have paid much attention to the neutrophil-to-lymphocyte ratio (NLR) as a prognostic biomarker of various diseases. Although a specific value has not yet been established, it is widely recognized as a reflection of the immune system's balance. Studies have shown that NLR has a strong correlation with disease outcomes and has been found to be independently related to the mortality rate caused by some types of cancer. This research aimed to analyze the prognostic significance of preoperative NLR in a cohort of patients with CCS at a reference sarcoma center. We conducted a retrospective cohort study of 58 patients with a diagnosis of CCS non-metastatic to evaluate the association between preoperative NLR and overall survival (OS). We used Kaplan-Meier curves and Cox proportional models for our analysis. The study found that CCS patients with high NLR had a significantly increased risk of poor prognosis in OS. We found no association between the NLR and the DFS. Of the 58 patients included in the retrospective cohort, 51.7% were male, with a mean age at diagnosis of 42 years and a standard deviation of ± 13.4. The axial skeleton was the most common site of CCS in 56.9% of the patients (n = 33). The median follow-up time was 39.4 months, ranging from 6 to 66 months. High NLR was significantly associated with lower OS. New prospective studies are needed to better characterize the role of serum markers in the prognosis of these patients and to better plan future treatment.

While once considered "butchery," thyroid cancer surgery is now considered a safe surgery in the setting of the increasing incidence of thyroid nodules. Several changes in the approach to patients and advancements in technology have paved the way for the technical feasibility of thyroid surgery. International guidelines have enabled a personalized, and less invasive approach to patients and thus reducing the morbidity attributed tumors from potential injury to the recurrent laryngeal nerve or long-term thyroid hormone replacement- particularly for papillary microcarcinomas. Morbidity from hypocalcemia and nerve injury have further been improved by advancements including parathyroid localizing technology, nerve monitoring, molecular testing, and improved diagnostic imaging. As we continue to improve our understanding of the thyroid, so will the outcomes of patients who undergo thyroid cancer surgery. Advancements in the safety and feasibility of thyroid surgery remind us of the statement made by William Halsted: "thyroid surgery is a supreme triumph of the surgeon's heart."

Uterine cervical cancer is the fourth leading cause of cancer death in women worldwide as per GLOBOCON (2020). In view of the higher incidence in the developing world and poor prognosis in cases presenting at advanced stage, there is an unmet need to explore new therapeutic targets for this neoplasm. Herein we sought to analyze and compare the immunoexpression of survivin (antiapoptotic factor) and vascular endothelial growth factor (VEGF). The study was conducted in the Department of Pathology at a tertiary care teaching institute from November 2018 to April 2020. Immunohistochemical (IHC) expression of survivin and VEGF was evaluated in 75 cervical squamous cell carcinomas (CSCC). The immunostaining was evaluated semi-quantitatively for its intensity (mild = 1; moderate = 2; intense = 3) and proportion of positivity (< 5% = 0; 5 to 25% = 1; 26 to 50% = 2; > 50% = 3). IHC score was calculated by multiplying the two scores as low positive (1-3), medium positive (4-6) and strong positive (7-9). Immunoexpression of survivin and VEGF was correlated using the Fisher's exact test and Kendall rank correlation coefficient. The median age of the CSCC patients was 55 years. Survivin expression was found in 98.6% while VEGF expression was observed in 68% of cases. A significant positive correlation (p - 0.001, τ - 0.404) was found between immunoexpression of survivin and VEGF. Our study results highlight the proposed role of survivin in angiogenesis by promoting VEGF expression. Hence, in view of survivin being an antiapoptotic protein and having a role in angiogenesis, targeted therapy against survivin might be of use for treatment and better prognostic outcomes in cervical squamous cell carcinomas.

Vulvar carcinoma represents 3-5% of all gynecological malignancies and 1% of female cancers. Primary surgical excision is the cornerstone of treatment for early-stage invasive disease. Adjuvant radiation therapy reduces the risk of local recurrence in patients with high-risk features, and radical chemoradiation is an option for locally advanced vulvar cancer. This retrospective study aimed to analyze the clinical presentation, treatment details, outcomes, patterns of failure, and possible prognostic factors. We reviewed the electronic medical records of 53 patients diagnosed with carcinoma of the vulva from January 2005 to December 2020. All patients with biopsy-proven carcinoma of the vulva who received radiation therapy with or without surgery were included in the study. The median age at presentation was 59 years (range 35-85 years). The most common stage at presentation was Stage III (37.7%, n = 20), followed by Stage IB (22.6%, n = 12). Thirty patients (56.6%) underwent surgery, and the majority (76.7%) underwent radical vulvectomy with bilateral inguinofemoral block dissection. Nineteen patients (55.9%) received adjuvant radiation therapy for various indications, such as close margins, positive margins, or positive nodes. Twenty patients (37.7%) received definitive chemoradiation therapy, for a median dose of 66 Gy in 33 fractions. Acute toxicity in the form of Grade 3 dermatitis was observed in 19 out of 45 patients (42.2%) who received RT, and late toxicity in the form of lymphedema was observed in 5 patients (11.1%). The median follow-up was 20 months (0-170 months). At follow-up, 25 patients (47.1%) were disease free or had stable disease, 14 patients (26.4%) had local or inguinal nodal recurrence or progression, 2 patients (3.7%) had metastatic disease (lung, mediastinal node), and 13 patients (24.5%) were lost to follow-up. The median progression-free survival (PFS) was 24 months (95% CI 17.2 to 30.8 months), and the median overall survival (OS) was 29 months (95% CI 21-37 months). Radical surgery followed by adjuvant radiation therapy led to superior outcomes in terms of progression-free survival (p = 0.0001) and overall survival (p = 0.005). Radical surgery followed by adjuvant radiation therapy was associated with the most favorable PFS and OS. Definitive chemoradiation therapy with modern radiation techniques is an alternative to radical surgery for medically/surgically inoperable locally advanced vulvar cancer patients and has favorable outcomes and toxicity profiles. Given the rarity of vulvar carcinoma, further research and multicenter studies are warranted to enhance our understanding of this malignancy and optimize treatment strategies to improve patient outcomes.

The landscape of breast cancer surgery has journeyed a well-trodden path, transitioning from radical approaches to conservatism and ultimately finding a balance in rationalized radical conservatism. This evolution signifies a significant paradigm shift in breast cancer management. At its core, the concept of breast conservation gained renewed momentum with the emergence of oncoplasty. We, in this article, attempt to elaborate on the factors which led to the evolution of oncoplastic surgery as a mainstay surgical procedure for breast cancer in a tertiary cancer centre in Kerala, India. This will help centres to incorporate our strategies and thus popularize the concept of oncoplastic breast surgery in their clinical practice. 1.To ascertain the breast conservation rate and audit the various types of oncoplastic procedures done at our centre. A retrospective analysis of the prospective database of patients who underwent breast cancer surgery in a tertiary cancer centre in India over a period of 6 years from July 2017 to July 2023 was carried out. A total of 3036 breast surgeries were performed in total during the period including curative and palliative resections among which 2850 were curative resections including 1980 breast conservation surgeries and 870 mastectomies with a breast conservation rate of 69.5% (58-85%). The mean age of patients was 52.2 years with 58% in the post-menopausal age. Among the BCS, there were 1158 (Level I), 593 (Level II) and 199 (Level III) oncoplasties performed respectively. Thirty patients required additional volume replacement techniques in the form of pedicled TRAM (14/30), L.D flaps (12/30) and implants (4/30). Popularizing breast oncoplasty in a tertiary cancer centre in our state was a concerted effort with a combination of proper patient counseling, departmental training and regular ongoing conferences and workshops.