Indian Journal of Surgical Oncology最新文献

Intraductal papillomas (IDPs) are benign breast lesions with potential for malignant transformation. This study aimed to determine the upgrade rate of de-novo IDPs to malignancy, identify associated risk factors, and assess the 6-month outcome after treatment. This retrospective cohort study included 320 patients diagnosed with de-novo IDP at a breast surgery clinic in Tehran, Iran, between March 2011 and March 2022. Patients were divided into upgraded (malignant) and non-upgraded (benign) groups based on pathology results from core needle biopsy (CNB) or vacuum-assisted excision (VAE). Baseline characteristics, pathology outcomes, and follow-up outcomes were analyzed. Multivariable logistic regression identified risk factors for malignant upgrade. Of the 320 participants, 16 (5.0%) had upgraded (malignant) IDPs, and 304 (95.0%) had non-upgraded (benign) IDPs. The median age was significantly higher in the upgraded group (53 years) compared to the non-upgraded group (43 years) (p < 0.001). Age ≥ 50 years was a significant risk factor for malignant upgrade (, p < 0.001). The most common malignant pathology was ductal carcinoma in situ (DCIS) (68.8%). Age was identified as a significant risk factor for malignancy, with older age increasing the likelihood of an upgrade (OR = 1.249, p = 0.02). After 6 months follow-up, three patients with IDP were detected by sonography. Older age was the sole significant risk factor for malignant transformation of IDPs. Continuous follow-up is recommended, especially for older patients, to promptly detect potential recurrence or malignant progression.

Triple-negative breast cancer (TNBC) is molecularly diverse and lacks known treatment targets. The possible prognostic and therapeutic implications of androgen receptor (AR) expression in TNBC have drawn attention. The purpose of this study was to assess AR expression in TNBC, as well as its relationship to p53 and Ki-67 expression and its effect on clinical outcomes. Seventy-eight female patients with non-metastatic TNBC verified by histopathology were included. Clinicopathological characteristics, such as the expression of p53, Ki-67, and AR, were noted. A positive result for AR immunohistochemistry (IHC) was defined as ≥ 10% nuclear staining. To evaluate relationships between AR expression and clinical factors, statistical studies included multivariate logistic regression and bivariate comparisons (chi-squared, t-tests). Survival results were assessed using log-rank testing and Kaplan-Meier curves. There were 15.4% AR positive cases. Significant correlations were seen between AR positivity and Ki-67 expression (p = 0.034), Nottingham grades (p < 0.001), and TNM stages (p < 0.001). Overall survival (OS, 25.0 vs. 20.0 months; p = 0.001) and disease-free survival (DFS, 14.6 vs. 10.8 months; p = 0.015) were considerably shorter in AR + individuals. Shorter OS, DFS, and duration for recurrence were independently predicted by AR positivity, along with other factors, according to multivariate analysis. Worse survival outcomes and more aggressive tumor characteristics are linked to AR expression in TNBC. AR is a promising prognostic marker and therapeutic target in TNBC, despite its low prevalence (15.4%). To confirm these results and standardize AR positive levels, larger, multi-center studies are required.

Granular cell tumors (GCT) are rare, mostly benign tumors originating from the neural sheath, with a higher prevalence in the head and neck region. This research aimed to characterize the clinical and pathological patterns of GCT presented to a tertiary care center in central Kerala, India, and to evaluate recurrence rates in this cohort over a 54.4-month follow-up period. Over the span of 8 years, 36 cases of granular cell tumors were diagnosed, with 52.8% of the patients being female. The mean age at presentation was 43 years (SD ± 18.1 years). The head and neck were the most common region of occurrence (43.75%), with the tongue being the most frequently affected site. The mean tumor size was 1.49 cm (SD ± 0.78 cm). All cases were diagnosed as benign GCTs. Among the 14 patients who were followed up, no recurrences were observed, regardless of whether their surgical margins were positive or negative.

Non-seminomatous germ cell tumors (NSGCTs) are the predominant solid malignancy affecting young males globally. This study evaluates the 5-year overall survival (OS) and recurrence-free survival (RFS) outcomes following post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in NSGCT patients at a tertiary center. A retrospective cohort study was conducted from January 2015 to January 2024, including NSGCT patients who underwent PC-RPLND. Patient demographics, tumor characteristics, operative details, and histopathological findings were analyzed. Survival analysis was performed using Kaplan-Meier curves. Among 46 patients included, the majority had mixed non-seminomatous GCTs (84.8%). The 5-year OS rates were 100%, 93.3%, and 86.2% for good, intermediate, and poor-risk groups. The 5-year RFS rates were 100%, 92.3%, and 73.3% for the same groups. Pathological examination revealed teratoma (54.3%), viable tumors (15.2%), and necrosis (30.4%) in the resected specimens. The recurrence rates were high in the poor-risk group (23.5%), as compared to good-risk (0%) and intermediate-risk patients (6.7%) (p = 0.054). Our findings demonstrate excellent outcomes in 5-year OS and RFS rates, reflecting advancements in treatment strategies for non-seminomatous GCTs. A multi-disciplinary approach is essential for providing optimum treatment for such patients.

The da Vinci Surgical System supports surgeons across various specialties, including gynecology, urology, thoracic, cardiac, and general surgeries, as well as in cancer treatments for prostate, kidney, gynecologic, and colorectal cancers. This review article explores the ethical implications of the da Vinci system, emphasizing the integration of "Purpose Good" and "Means Good" to improve patient care. It illustrates how the system enhances surgical outcomes through precision and minimally invasive techniques, supported by significant technological advancements. The ethical suitability of robotic surgery is assessed, stressing the need for thorough treatment planning and patient selection for optimal outcomes. Additionally, the impact of robotic surgery on patient autonomy is discussed, particularly regarding informed consent and the surgeon-patient relationship. The paper emphasizes the Do No Harm Principle, highlighting the necessity for stringent training and risk assessments to mitigate patient risks. While the da Vinci system enhances precision and lowers complications, challenges like limited tactile feedback and potential robotic failures persist. The pursuit of excellence in surgical practices, guided by the Performance Excellence model, advocates for continuous improvements in surgical technology and patient care. In cancer surgery, the da Vinci system raises important ethical issues such as informed consent, accountability, and equitable access to care. The incorporation of artificial intelligence in robotic-assisted surgery requires careful consideration of patient safety, data privacy, and the implications of technology reliance on human skills. Addressing these ethical concerns is crucial for responsible implementation and safeguarding patients' fundamental rights and safety in an evolving healthcare landscape. As robotic advancements progress, the da Vinci Surgical System represents a significant development in minimally invasive procedures, promising improved outcomes and safety in healthcare, with the potential for becoming standard practice in the future.

Despite the high incidence of gastric cancer in states throughout India, literature from the Indian context is sparse. Our overall objective was to determine the work-up, management and outcomes of patients with gastric cancer in a high-volume cancer centre in South India. Consecutive patients with a diagnosis of gastric cancer who were assessed in Regional Cancer Centre Trivandrum from January 1, 2018 to December 31, 2019 were included. Follow-up was conducted prospectively in person or by telephone. Patient, staging, disease, treatment, and outcomes data were collected and descriptively reported (mean, standard deviation, median, interquartile range). Overall survival (OS) was determined by the Kaplan-Meier method and factors associated with survival by multivariable Cox regression analyses [hazard ratio (HR), 95% confidence intervals (CI)]. A total of 325 patients were included in the cohort, of which 70% were male (n = 229/325). Mean age was 57.8 ± 11.4 years. Over half (54%, n = 174/325) presented with distant metastatic disease. Ultimately, 104 patients underwent surgical resection of which only 17% (n = 18/104) underwent staging laparoscopy. Most (88%, n = 92/104) underwent an open surgical approach. Most receiving surgery had advanced tumor (T) and nodal (N) stage [T3: 42%, n = 44/104; T4: 30%, n = 31/104; N1: 18%, n = 19/104; N2: 24%, n = 25/104; N3: 21%, n = 22/104], and received systemic therapy (90%, n = 94/104), initiated either prior to (38%, n = 36/94) or after (62%, n = 58/94) surgery. Median follow up for the entire cohort was 52.4 months (interquartile range: 9-73 months). Four-year OS for the entire cohort by clinical stage was as follows: 33% stage 1, 38% stage 2, 26% stage 3, and 2% stage 4. Four-year overall OS for the surgical cohort was 44%. For the entire cohort, the presence of gastric outlet obstruction [versus not, HR 1.85, 95% CI 1.37-2.50, p = 0.001] and stage 4 disease [versus stage 1a, HR 3.67, 95% CI 1.34 - 10.0, p = 0.011] were significantly associated with increased risk of death. For the surgical cohort, only the presence of N3b disease was found to be significantly associated with increased risk of death (versus N0, HR 7.24, 95% CI 2.81-18.66, p < 0.001). Most patients present with distant metastatic disease. Of the patients undergoing surgery, most have advanced disease and receive multimodality therapy, in keeping with guideline recommendations.

Pleural effusion is a decisive factor in advanced-stage ovarian cancer. The presence of malignant cells in pleural effusions in women with ovarian cancer is accepted as a poor prognostic factor. It is included in the International Federation of Gynecology and Obstetrics (FIGO) stage IVA. Still, the literature does not explain and prognoses the importance of cytology-negative pleural effusion (CNPE) in women with ovarian cancer. It is a retrospective study conducted in a tertiary cancer center. All advanced staged ovarian cancer patients with pleural effusion registered between January 2020 and December 2021 were included, and the control group consisted of all stage IIIC disease with no pleural effusion during the same duration. Survival analysis was done in these three groups-cytology-positive pleural effusion (CPPE), cytology-negative pleural effusion (CNPE), and no pleural effusion (NPE). In total, 117 patients with advanced-stage ovarian cancer, fulfilling the eligibility criteria, completed their treatment during the study period. Retrospective data was collected from hospital records, and survival analysis was done using SPSS 29.0. We included only those patients who had pleural fluid analyzed by a pathologist. During the study period, we found that 13 (11%) were CPPE, 23 (19.3%) were CNPE, and 81 (68%) were NPE. CNPE patients had poor progression-free survival (PFS) and overall survival (OS) compared to NPE patients, although both groups were labeled stage IIIC. These findings underscore the importance of cytology-negative pleural effusion in ovarian cancer prognosis, providing valuable insights for clinical practice. Patients with cytology-positive pleural effusion had the worst prognoses. However, CNPE patients labeled as stage IIIC had poor outcomes compared to NPE stage IIIC patients. So, based on our comprehensive study, we recommend a video thoracoscopic analysis of all patients with CNPE to correctly stage these patients, further modify their treatment accordingly, and improve their outcomes.

The aim of this study was to compare oncological effectiveness, morbidity, and perioperative outcomes between minimally invasive surgical staging and open surgical staging for endometrial cancer. This is a retrospective analysis of endometrial cancer patients who were treated in surgical oncology department in our institute between January 2015 and November 2024 (n = 217). The oncological effectiveness and morbidity of the two groups were compared based on disease-free survival, mean operative time, blood loss, lymph node harvest, intraoperative complications, postoperative complications, duration of hospitalization, etc., and the results were analyzed. Statistical analysis was performed using IBMSPSS statistics version 25, and clinical and pathological factors were compared between two groups with Fisher's exact test and Student's t-test for data analysis. Survival analysis was done by Kaplan-Meier method with p ≤ 0.05 considered statistically significant. Out of 217 patients, 93 underwent open surgical staging, while 124 underwent minimally invasive surgical staging. Within the minimally invasive group, 86 patients had laparoscopic surgical staging, and 38 had robotic surgical staging. The mean operative time for the minimally invasive procedure was lower than the open procedure (115 vs 136 min, p = 0.009). Intraoperative blood loss of patients undergoing minimally invasive staging was significantly less than that of laparotomy group (60 vs 140 ml, p = 0.007). There was no statistically significant difference in nodal retrieval between the two groups (13 vs 15, p = 0.09). The mean duration of hospitalization was statistically significantly higher in the laparotomy group than the minimally invasive group (6 vs 4 days, p = 0.005). Kaplan-Meier survival curve showed that the DFS rate at 3 years was more in minimally invasive group compared to open surgical staging (95.2% vs 88.3%, p = 0.003). Minimally invasive surgical staging is oncologically safe for the management of endometrial cancer with better survival rate, less morbidity compared to the open surgical staging with less blood loss, and shorter postoperative stay.

Due to the lack of clinical trials of neoadjuvant chemotherapy (NAC) for patients with human epidermal growth factor receptor 2 (HER2)-low breast cancer, the factors influencing the efficacy of NAC for HER2-low breast cancer and the relationship between the efficacy of NAC and prognosis remain unclear. This study aimed to explore the risk factors associated with pathologic complete response (pCR) and their prognostic implications in a population of HER2-low breast cancer patients. We retrospectively analyzed data of patients with HER2-low breast cancer who underwent NAC in the Affiliated Hospital of Jiujiang College between 28st of February 2018 and 28st of February 2022. Clinical treatment and follow-up data were obtained from the patients' medical electric records. A total of 510 patients were enrolled, of which 443 were included in the initial non-matched analysis. The median age was 49.5 years (standard deviation (SD) = 8.0). Of these, 143 patients (32.3%) achieved pCR (case group), and 300 (67.7%) did not achieved pCR (control group). cStage (III versus II, odds ratio (OR) = 0.498), HR status (positive vs. negative, OR = 0.513), Ki-67 (>14% vs. ≤14%, OR = 2.580), tumor Nottingham stage (III vs. I, OR = 3.197), and endocrine therapy (yes vs. no, OR = 0.513) were independent predictive factors of pCR (all P < 0.05). After propensity score matching analyses, the control group included 80 non-pCR patients and the case group 80 achieved pCR. The clinical characteristics of the two groups were well balanced (all P > 0.05). The median follow-up period for the non-pCR and pCR groups was 43.0 (95% CI 41.0-45.0) and 45.0 (95% CI 43.1-46.9) months, respectively. The disease-free survival (DFS) of the two groups was 70.0% and 87.5%, respectively, which was a significant difference (P < 0.05). However, the overall survival (OS) of the two groups was 85.0% and 88.8%, respectively, with no significant difference (P > 0.05). After the Cox proportional hazards regression analyses, we found that cStage (III versus II, hazards ratio (HR) = 4.720), HR status (positive vs. negative, HR = 0.303), endocrine therapy (yes vs. no, HR = 0.303), and pCR (yes vs. no, HR = 0.312) were independent influencing factors of DFS (all P < 0.05); additionally, cStage (III vs. II, HR = 5.654) and HR status (positive vs. negative, HR = 0.292) and endocrine therapy (yes vs. no, HR = 0.292) were independent influencing factors of OS (all P < 0.05). The results showed that cStage, HR status, Ki-67, Nottingham tumor stage, and endocrine therapy were significantly correlated with the achievement of a pCR. Additionally, pCR was associated with a reduced risk of recurrence, but survival benefits were limited.