Indian Journal of Surgical Oncology最新文献

Despite early promising results with denosumab treatment in giant cell tumor of bone (GCTB), recent studies have raised concerns about a high local recurrence rate following preoperative denosumab administration and joint preservation surgery. This retrospective study evaluated data from 25 high-risk GCT patients (Campanacci grade II or III with features like soft tissue extension, pathological fracture, minimal periarticular or subarticular bone) treated with five doses of neoadjuvant denosumab injection followed by either curettage and cementing (n = 13) or joint reconstruction with fibular graft/endoprosthesis (n = 12) between 2014 and 2019. With an average follow-up of 40 months, the study found only one patient of local recurrence. All patients were independently ambulant, with a mean MSTS score of 26.32. Subgroup analysis revealed an MSTS score of 27.76 in the joint preservation group, and 24.75 in the excision with reconstruction/prosthetic replacement group (unpaired t-test, p-value < 0.001). Five patients experienced postoperative complications, including two infections, one recurrence, one mediolateral instability in the prosthetic component, and one restriction of wrist movement. A short course of neoadjuvant denosumab, followed by curettage and cementing or wide excision with joint reconstruction/prosthetic replacement, appears to be an effective strategy for high-risk GCTB patients. This approach not only minimizes surgical morbidity but also does not increase the local recurrence rate. The short course regimen may present a cost-effective and practical option in clinical practice.

Breast cancer, an exceptionally hormone-dependent tumor, exhibits a diverse clinical profile. Its therapeutic categorization relies on the expression of key receptors, namely, estrogen receptor (ER), progesterone receptor (PR), and Her2neu. The androgen receptor (AR), a member of the nuclear receptor superfamily, is a biomarker gaining attention in breast cancer research, particularly for triple-negative breast cancers. We conducted an analysis of AR expression in 113 primary breast cancer cases, using a cutoff criterion of ≥ 10% tumor cell positivity. ER, PR, and Her2neu statuses were determined based on the 2023 ASCO-CAP criteria. AR expression was then correlated with various clinicopathological factors, including age, menopausal status, centricity, histological type, grade, tumor size, nodal status, lymphovascular and perineural invasion, and ER, PR, and HER2neu statuses. Among the 113 cases, 57 (50.4%) showed positive AR expression. No statistically significant associations were found between AR expression and age, menopausal status, histological type, histological grade, nodal status, or ER and PR expression. Notably, all multicentric tumors (n = 7, 100%) were AR negative. AR expression was linked to smaller tumor sizes. Positive AR cases exhibited an association with Her2neu overexpression, particularly in ER and PR-negative tumors. Of note, 35% of triple-negative tumors displayed AR positivity. AR emerges as a promising marker in breast cancers, particularly in triple-negative cases. Larger-scale studies are warranted to comprehensively assess the relationship between AR expression and histopathological parameters, as well as other immunohistochemical markers.

In the context of dysphagia, an infiltrating squamous cell carcinoma of the esophagus was diagnosed in a 43-year-old woman with a history of two liver and one kidney transplants as a result of Alagille syndrome. An esophagectomy with retrosternal left coloplasty (esocolic, gastrocolic, and colocolic anastomoses) was performed. On postoperative day 2, her hemodynamic status deteriorated resulting in significant increases in norepinephrine doses (from 0.33 to 2 micg/kg/min). Transthoracic echocardiography was difficult to perform because the patient had limited imaging windows. Transesophageal echocardiography was contraindicated due to the nature of her surgery. An emergency thoraco-abdominal CT scan showed that the coloplasty was dilated, ischemic, and compressing the right ventricle anteriorly. Emergency surgery revealed mediastinitis with necrosis of the coloplasty. Surgical decompression of the coloplasty led to rapid improvement in hemodynamics, requiring only reduced doses of norepinephrine.

Inguinal skin flap necrosis (SFN) is a significant clinical problem associated with inguinal lymph node dissection (ILND). The aetiology of SFN is multifactorial, and its manifestations vary widely. Thermal damage caused by electrocautery during the elevation of the skin flap may contribute to this problem, which has not been studied previously. This prospective, observational study included patients undergoing ILND from January 2020 to July 2022. Based on the technique of raising the inguinal skin flaps, the patients were divided into two groups (cold knife or electrocautery). The remaining part of the procedure was the same. The inguinal wound was examined and photographed to assess the SFN. A total of 42 patients were included (21 in each group). Age, gender, body mass index (BMI), alcohol or tobacco consumption, immune compromised status, and serum albumin were comparable (p > 0.05). The average time required to elevate flaps was 13.14 vs. 11.47 min (p = 0.0231), and gauze soakage was 2.05 vs. 1.52 (p < 0.0001) with a cold knife compared to electrocautery. The incidence of SFN and surgical site infection (SSI) was significantly lower with the use of a cold knife [4.8% vs. 33.3% (p = 0.045) and 0% vs. 19% (p = 0.0378)]. Grade 3 necrosis was observed only with electrocautery use. Compared to conventional electrocautery, the cold knife technique lowers the incidence of SFN and SSI. Further research with a larger sample size and a standardized definition is needed to validate these results.

Thyroid follicular nodular disease (non-toxic multinodular goiter), the commonest thyroid disorder, can be managed with different surgical methods, including total thyroidectomy (TT), near-total thyroidectomy (NTT), subtotal thyroidectomy (STT), and Dunhill operation (DO). This systematic review and meta-analysis aimed to provide an update on the role of TT versus NTT, STT, or DO in MNG concerning goiter recurrence, thyroid cancer incidence, and reported complications. We conducted a systematic literature search in Medline, EMBASE, and CENTRAL. We included randomized controlled trials (RCTs) that compared TT to partial thyroidectomy (NTT, STT, or DO) in the management of multinodular goiter (MNG). The following outcomes, goiter recurrence, cancer incidence, and adverse events (hypoparathyroidism and recurrent laryngeal nerve injury), were evaluated. We used the risk ratio (RR) to represent the dichotomous outcome. Subgroup analysis was performed based on the different types of partial thyroidectomy (NTT, STT, and DO). A total of 7 RCTs that included 1909 individuals were deemed eligible. TT showed significantly better results compared to PT in terms of goiter recurrence (RR = 0.05, 95% CI 0.02 to 0.13, P = 0.001; I ²  = 0%), whereas it showed similar results compared to PT in terms of thyroid cancer incidence (RR = 1.09, 95% CI 0.76 to 1.57, P = 0.63; I ²  = 0%). PT was significantly better than TT concerning transient adverse events (RR = 2.18, 95% CI 1.64 to 2.89, P = 0.001: I ²  = 63%). This meta-analysis showed that TT has a lower risk of goiter recurrence. TT is comparable to PT in terms of persistent adverse events but has a higher risk for transient adverse events.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-024-02057-y.

Depth of invasion (DOI) is an established independent prognostic factor in oral squamous cell carcinoma (OSCC) and also predicts cervical nodal metastasis. Preoperative determination of DOI based on imaging can aid in decision-making regarding neck dissection or determining the prognosis of the disease. This study aimed to correlate the DOI measured on contrast enhanced computed tomography (rDOI) with the pathologically measured DOI (pDOI). Retrospective data of patients with OSCC of the gingivobuccal complex from January 2023 to July 2023 was collected. Two radiologists independently measured the DOI on axial and coronal planes of CECT. The correlation between rDOI and pDOI was determined. Stepwise multiple linear regression analysis was performed to predict the pDOI using rDOI. ROC curve analysis was performed for the rDOI as measured on both axial and coronal sections in predicting the nodal metastasis. A total of 59 patients were included in the study. The mean rDOI was 11.06 mm on axial section and 10.9 mm on coronal section, and pDOI was 9.7 mm. Spearman's correlation coefficient between pDOI and rDOI measured on axial (rho = 0.61; p value = 0.001) and coronal (rho = 0.62; p value = 0.001) sections implied strong correlation which was statistically significant. The present study attempted to establish the correlation and accuracy of CECT-determined rDOI in axial and coronal planes in gingivobuccal complex tumours. Multicentric studies with a larger sample size are mandated to augment the results obtained in this study.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-024-01998-8.

The central and peripheral nervous system cancers are the second most common cancers among the paediatric population (0-14 years). The non-specific symptoms seen in its clinical presentation make the diagnosis of these tumours extremely challenging among children compared to adults. This research study was therefore done to study the socio-demographic profile, clinical features, and management practices among paediatric patients with intracranial tumours. This was a cross-sectional medical record-based study done among 31 children aged < 18 years diagnosed with primary intracranial tumours. Data were recorded using a semi-structured proforma. The median age at diagnosis of tumours among the patients was 7(4, 15) years. Majority of them were males 17(54.8%). Medulloblastoma was the common tumour 12(38.7%). 18(58.1%) tumours originated from the infratentorial region. The most common infratentorial tumour was medulloblastoma, while the most common supratentorial tumour was meningioma. The most common site of involvement was the brainstem 11(35.5%). Majority of the tumours were presently in Stage III/IV 20(64.5%). The most common symptom was vomiting 18(58.1%). 23(74.2%) patients were managed using chemotherapy and among them the most used drug was Temozolomide 7(30.4%). Medulloblastoma was present more among patients who were diagnosed at the age ≤ 5 years (p = 0.022). Tumours involving the cerebellum were more among females (p = 0.0118). Headache was present more among patients who were diagnosed with tumours at the age > 5 years compared to the age ≤ 5 years (p = 0.0119). From the findings of this study, it can be concluded that majority of the patients were males. Medulloblastoma was the most common tumour. Close to two-third of the tumours were in Stage III/IV. The most common symptom reported was vomiting. The most used drug for treatment was Temozolomide.

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is one of the rare and aggressive cancers occurring mainly in adolescents and young women. It accounts for less than 0.01% of all ovarian malignancies, with around 500 cases reported to date in the medical literature. It has been postulated that these cases could be due to genetic alterations, and in 2014, studies discovered that SCCOHT is characterized by both germline and somatic deleterious mutations in SMARCA4. In this case series, we report two cases diagnosed with carcinoma ovary and found to be having mutations in SMARCA4. The patients in this case series were relatively young and both had germline SMARCA4 mutation. The first patient had FIGO stage IV disease and the second patient had FIGO stage III disease. The first patient started with paclitaxel plus carboplatin and the second patient started with gemcitabine plus docetaxel. One patient succumbed to disease within 1 year and another patient is alive at present with progression of disease. SCCOHT is very aggressive and needs diagnosis and treatment at an early stage. Early diagnosis and proper treatment may prolong survival. There is a need for evaluation of the possible role of targeted systemic therapeutic options as the conventional regimens are rarely sufficient.