Indian Journal of Surgical Oncology最新文献

Mortality in patients with gastric cancer (GC) remains high. Therefore, accurate postoperative staging is particularly important for follow-up/treatment and prognostic fate of these patients. In this single-centre study, we analysed retrospective data from 170 consecutive patients with histologically confirmed GC who underwent radical resection. The objective of this observational, retrospective cohort study was, therefore, to evaluate prognostic value of the positive-to-total lymph node ratio (PLNR) and log odds of positive lymph nodes (LODDS), in addition to known predictors of survival, such as TNM staging, grading and histopathological subtypes of GC. All clinically relevant variables (including patient demographics) were initially assessed evaluated as candidate predictors of overall survival (OS) in univariable regression analysis. The final prognostic model for overall mortality included five clinical factors predictive of OS. PLNR was statistically significant associated with 3-year survival (Cramér's V = 0.429, eta² = 0.178; p < 0.001). After adjusting for age, sex and disease stage, PLNR remained an independent predictor of mortality (p = 0.016; OR 1.230; 95% CI 1.039-1.455). We have found that the increased PLNR is associated with poor 3-year survival in patients with GC who underwent radical/curative resection. Inclusion of PLNR produced a model of better fit and increased its predictive power for the survival outcome of GC patients.

Tailgut cyst (TGC) is a rare congenital lesion noted in the retrorectal space and occurs due to failure of regression of tailgut appendage derived from the embryonic hindgut. Herein, a 46-year-old female presented with a painful cystic swelling in the sacral region for 3 months. Past history of swelling in the sacral region, noted since birth was excised in 2020 and diagnosed as TGC. The swelling recurred and was aspirated four times between 2021 and 2023. Examination showed a diffuse, soft, fluctuant swelling with ill-defined borders of size 10 × 8 cm along with right inguinal lymphadenopathy. PET-CT showed a well-defined, multiloculated, heterointense, solid cystic lesion measuring 11 × 9.2 × 11.7 cm in the presacral region infiltrating the S3-S5 vertebral body and gluteus medius muscle. Bilateral iliac, right inguinal and right inferior gluteal lymph nodes showed metastatic deposits. Differential diagnoses of malignant transformation of TGC with metastases and chordoma with metastases were considered. A biopsy of the right inguinal lymph node showed tumour cells arranged in clusters and acini indicating features of metastatic adenocarcinoma. Tumour cells were immunopositive for pan CK, CK 20 and CDX 2 and negative for CK 7 and S-100. Painful sacral swelling with a significant past history of TGC with recurrences, infiltration of the vertebral body, metastatic deposits in the lymph node and positivity for pan CK, CK 20 and CDX 2 helped us diagnose adenocarcinoma with lymph node metastases of a recurrent TGC. The patient is currently receiving chemotherapy and is on follow-up.

Neoadjuvant chemotherapy (NACT) in breast cancer has been used for decades in patients with inflammatory, locally advanced, or inoperable breast cancer to achieve or facilitate operability and increase both local and systemic control. This retrospective analysis aims to identify risk factors for failing to achieve a pathological complete response (pCR). Additionally, the study examines factors predicting survival outcomes in breast cancer patients who received NACT. Among 224 patients who underwent NACT between 2010 and 2020, 65 patients achieved pCR. The hormone receptor (HR) status, HER2 amplification, and biological subtype of breast cancer significantly affected the patient's ability to achieve a pCR. Stage of the disease, molecular type, and histological type of breast cancer were significant predictors of overall survival in breast cancer patients who achieved pCR after NACT. Notably, early-stage disease, the luminal subtype of breast cancer, and invasive mammary carcinoma of no special type (NST) were associated with a favorable prognosis.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02218-7.

Invasive lobular breast cancer is a rare and special subtype of breast cancer which has a different clinical behaviour and is morphologically different from other subtypes. However, it is not any different in terms of outcome as compared to invasive ductal carcinoma. It accounts for 5-15% of the invasive breast cancers (Li et al. in Br J Cancer 93:1046-1052, 2005). Her 2 Neu positivity in invasive lobular cancers (ILCs) is even rarer and has been linked to adverse outcomes, although limited literature is available. Management of ILCs with Her 2 Neu positivity is according to standard multimodality breast cancer management guidelines. Here, we report a case report of an early-stage invasive lobular breast cancer with hormone receptor and Her 2 Neu positivity.

Neuroblastic tumors are common malignancies in the pediatric population and arise from neural crest cells. Its clinical presentation is spread out over a wide range of symptoms and presents a unique challenge owing to its manifestations and outcomes. This case series explores the clinical and pathological spectrum of neuroblastic tumors in five pediatric patients treated at a quaternary care institute. The cases were reviewed, and their clinical details, histopathology reports, and operative notes were analyzed. Two posterior mediastinal and three adrenal neuroblastic tumors with varying pathology and disease process are discussed. MYCN was doubled in one of the cases and amplified in another. This series highlights the spectrum of various presentations, stratifying the risk groups and early tumor detection and workup in a resource-limited setting.

Pulmonary metastases from uterine cancer are rare, and clinical significance of pulmonary metastasectomy (PM) in such cases remains unclear due to limited data. We retrospectively reviewed 10 female patients who underwent PM for metastatic uterine cancer between 2010 and 2023. Clinical and pathological data, including disease-free interval (DFI), number and size of metastatic lesions, and overall survival (OS), were analyzed. Univariate analysis was performed to identify the prognostic factors. The median age of patients at the time of PM was 63 years. The primary tumor originated from the uterine body in seven cases and from the cervix in three cases. Histological subtypes included endometrioid adenocarcinoma (n = 6), squamous cell carcinoma (n = 3), and serous carcinoma (n = 1). Eight patients had a single metastasis and two had multiple lesions. The median DFI was 16 months and the median OS following PM was 96 months. Univariate analysis revealed that a single metastasis (p = 0.0182) and DFI ≥ 10 months (p = 0.0215) were significantly associated with better OS. Tumor size ≥ 12 mm showed a trend toward improved survival (p = 0.0529). PM was beneficial for histological confirmation in patients with uncertain preoperative diagnosis. In all 10 cases, imaging could not distinguish pulmonary metastasis from primary lung carcinoma. Thus, histopathological examination after PM was essential for final diagnosis. PM may provide diagnostic value and potential survival benefits in selected patients with uterine cancer, particularly in those with limited metastases and a longer DFI.

Thyroid cancer is globally increasing, but it is rare and more aggressive in males. This study is aimed at preliminarily evaluating the effectiveness of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) in the treatment of thyroid cancer in male patients. A prospective study was conducted on 42 male thyroid cancer patients treated with TOETVA from January 2019 to December 2023 at Hanoi Medical University Hospital. All the patients enrolled had tumors < 2 cm in diameter, no extrathyroidal extension, and cN0 status. Surgical and oncologic outcomes were analyzed. The mean patient age was 30.2 (17-56) years, with 85.7% having solitary tumors, mostly in the left lobe (54.8%). Papillary thyroid carcinoma (95.2%) was the predominant diagnosis. An mean tumor size was 8.5 mm. Lobectomies comprised 95.2% of surgeries. The mean operative time was 83.3 (60-150) min, and blood loss was minimal 6.3 (5-15) ml. Postoperative complications included transient hoarseness (4.8%) and mouth-opening difficulty (2.4%), with no permanent severe hypocalcemia or hoarseness. No cases of completion thyroidectomy or conversion to open surgery due to TOETVA failure were recorded. On average, 3 (0-12) lymph nodes were harvested, with a median of 2 (0-8) malignant nodes. Most tumors were T1 (95.2%), and pN1a was observed in 52.4% of the cases. Patient satisfaction with cosmetic results was universally high. TOETVA is a safe and effective option for male patients with early-stage thyroid cancer, offering minimal complications and excellent cosmetic results. Further studies are needed to expand its application to broader population.

Early detection and standardized management of breast cancer through triple assessment have significantly reduced mortality in developed nations. However, the adherence to these practices remains suboptimal in many resource-limited settings, with little data on primary management quality and referral practices. We retrospectively analyzed the records of 105 breast cancer patients referred to our tertiary care centre between January 2023 and December 2024, after undergoing primary evaluation and surgery at secondary care facilities. None of the patients underwent bilateral mammography or core needle biopsy, despite clear indications. Ninety-six patients had lumpectomy based solely on fine needle aspiration cytology, without axillary staging. Post-lumpectomy, all patients were referred for chemotherapy, regardless of further surgical indications. Documentation of primary surgery was often inadequate, leaving gaps in critical treatment details. Our findings reveal a significant divergence from standard breast cancer management protocols at secondary care facilities. Such non-adherence to recommended diagnostic assessments and surgical staging compromises patient outcomes. Addressing these gaps requires targeted education for secondary care physicians, infrastructural upgrades, and systemic reforms to ensure adherence to evidence-based guidelines. Bridging these gaps is essential to improve breast cancer outcomes in resource-constrained settings.

The global cancer burden is expected to rise over the next few decades, with an equally significant increase in the need for cancer surgical services. It is well known that gross inequities exist in accessing cancer surgical care on the global stage. The goal of this manuscript is to highlight the inequities in accessing cancer surgical care and outline some strategies to address them. We used GLOBOCAN 2022 to document the current and predicted rise in the future cancer burden for the various income groups, as defined by the World Bank Group. Data from relevant agencies such as the International Atomic Energy Agency (IAEA), World Bank Group, and relevant publications were used to quantify current and future workforce (surgical and relevant other health professions) needs, number of imaging modalities, hospital capacity, and healthcare expenditure per capita. Our study demonstrates that there are extreme variations in cancer burden on the global stage as well as inequities in all domains of cancer surgical care pathways, based on income status. Low-income (LICs) and lower-middle-income countries (LMICs) will experience a proportionally larger increase in cancer burden over the next few decades. At the same time, LICs and LMICs were noted to have severe shortages in all elements of the cancer surgical care pathways ranging from the number of cancer surgeons and other oncology professionals, hospital beds, and imaging modalities, when compared to high-income countries (HICs). Health care expenditure per capita also demonstrated variations with the highest rates noted in the HICs. This study highlights the inequities in access to cancer surgical care on the global stage. To address these challenges, we have proposed some strategies derived from the 2023 Lancet Oncology Commission on Global Cancer Surgery report, which can realistically be accomplished in a timeframe of 5-15 years.