Indian Journal of Surgical Oncology最新文献

Pancreatic cancer surgery represents the holy grail of hepatobiliary surgery and is the only option of curative treatment for malignancies involving this particular organ. This study aims to analyse the short-term outcomes of across the spectrum of surgeries performed for pancreatic neoplasms at a low volume hepatobiliary centre in eastern India. This is a retrospective study from our centre, from 1st January 2019 to 31st October 2024. Patients were identified from a prospectively maintained surgical database and electronic medical records, and data was collected from Electronic Medical Records. We identified 41 patients who underwent surgical resections during the study period. Median age was 56 years. Pre-operative biliary drainage was required in 24 (58.5%) cases. Pancreatico-duodenectomies represented with majority of cases (87.8%), followed by distal pancreas resections (2.4%), total pancreatectomy (2.4%) and ampullectomy (2.4%). Minimally invasive approach was attempted in 2 patients (4.9%). Post-operative complications and their incidences were post-operative pancreatic fistula (POPF) 26.8%, chyle leak 9.7%, biliary leaks 7.3%, delayed gastric emptying 19.4%, post pancreatectomy haemorrhage 4.8%, bowel-related complications 7.3, and surgical site infection 9.8%. Significant post-operative morbidity occurred in 24.4% of cases. Perioperative mortality rate was 7.3%. Although a low volume centre, our results are comparable to published literature for low volume centres, though worse than high volume centres. Safe outcomes are achievable at low volume centres with trained and dedicated surgeons, anaesthesiologists and proper patient selection.

Introduction: Surgical resection remains the standard treatment in the management of rectal cancer. Omitting surgery in carefully selected patients who achieve a clinical complete response after neoadjuvant radiotherapy is stated to provide acceptable oncological outcomes. This survey aimed to understand the preference of patients with rectal cancer towards non-operative management (NOM).

Method: A prospective cross-sectional study was conducted among patients diagnosed with locally advanced mid- or lower-third rectal cancer. A structured interview schedule was used to assess the willingness for the trial under various conditions associated with an imaginary scenario of NOM after a complete response to an intensive neoadjuvant treatment. Psychological parameters were collected using Fear of Progression (FOP)-12, Life Orientation Test-Revised, and Multidimensional Health Locus of Control-Form C (MHLC-C). The data was analyzed using descriptive statistics.

Results: Of the 59 patients included, 37.3% expressed an overall willingness for NOM. While 91.5% expressed willingness for the NOM if there were no increased side effects of neoadjuvant treatment, 44.1% reported willingness with even 10% increased side effects, 54.2% with the suggested intensive follow-up schedule, and 10.2% if there was a 25% chance of tumour regrowth. In total, 74.6% and 16.9% consented if the cure rate with NOM was similar to and less than surgery, respectively. Overall, 50% had significant FOP, and 79.7% had low optimism. Comparatively higher MHLC-C score (M = 22.29; SD = 4.33) indicates that the majority of the patients attribute events to luck or fate.

Conclusion: We observed that only one-third of patients in this study preferred a NOM to radical surgery; the decision was mainly driven by FOP and fear of increased side effects of neoadjuvant treatment. Detailed counselling of the patients about the treatment modality and NOM strategy is essential before considering any patient for an intentional watch-and-wait approach.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02390-w.

Introduction: Perineal wound infection following abdominoperineal resection for rectal cancer is a common postoperative complication. Identifying factors associated with perineal wound infection can help reduce morbidity. This study aimed to identify risk factors for perineal wound infection following abdominoperineal resection for rectal cancer.

Methods: This was a retrospective cross-sectional study involving 70 patients with rectal cancer who underwent abdominoperineal resection at Viet Duc University Hospital between January 1, 2015, and December 31, 2022. Patients were categorized into two groups based on the presence or absence of perineal wound infection. Potential risk factors were compared between the two groups, including: age, BMI, presence of diabetes mellitus, preoperative chemoradiotherapy, preoperative laboratory indices (hemoglobin, albumin, white blood cell count), tumor diameter, tumor stage, and operative time.

Results: Perineal wound infection occurred in 38 out of 70 patients (54.3%). Univariate analysis revealed that undernutrition, indicated by BMI < 18.5 kg/m² (p = 0.047), and preoperative hypoalbuminemia (albumin < 35 g/L) (p = 0.004), were significantly associated with an increased risk of perineal wound infection. Multivariate analysis identified diabetes mellitus (p = 0.02) and preoperative hypoalbuminemia (p = 0.02) as independent risk factors for perineal wound infection following abdominoperineal resection for rectal cancer.

Conclusion: Univariate analysis indicated that malnutrition (BMI < 18.5 kg/m²) and preoperative hypoalbuminemia (albumin < 35 g/L) were significantly associated with perineal wound infection. Multivariate analysis identified diabetes mellitus and preoperative hypoalbuminemia as independent risk factors that increased the likelihood of perineal wound infection following abdominoperineal resection for rectal cancer.

The purpose of this study is to assess the HRQOL and identify the potential risk factors for its deterioration in thyroid cancer (TC) survivors in India. We also aim to strengthen the existing COH-QOL (thyroid) Questionnaire by adding two missing items of tingling or numbness and scar on the neck in the physical and psychological domains, respectively. TC survivors were recruited from the ENT OPD and the Uttarakhand Thyroid Surgeries Registry System from a period of 2017 to 2022. Participants completed a Hindi-validated modified version of the COH-QOL (thyroid) Questionnaire to assess QOL domains. The correlation of QOL scores with different health conditions was done. QOL is affected after the initial TC diagnosis and treatment, with poorer scores in all domains. Quality of work is the most affected item in the social domain. The potential risk factors for deterioration in QOL scores are age, gender, employment, educational status, stage of disease, comorbidities, extent of surgery, hypocalcemia, RAI therapy, and thyroid hormone withdrawal. Given the rapidly increasing number of TC survivors, mostly of the middle age group, and the fact that it grossly affects the work performance scale, our study will help to develop robust monitoring tools, awareness programs, intervention strategies, and TC-specific survivorship plans.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02329-1.

Tumour volume is considered as one of the prognostic factor in determining outcomes after chemoradiation in head and neck cancer. In our study, we sought to analyse the use of tumour volume as a predictor of laryngeal preservation outcomes in locally advanced laryngeal carcinoma treated with chemoradiation. A total of 37 patients with locally advanced laryngeal carcinoma (stages III and IV) who underwent chemoradiation for the period of 2017 to 2024 were included. The pre-treatment tumour volumes were obtained from planning computed tomography images. The tumour volumes were compared to various treatment outcomes like overall survival (OS), disease free survival (DFS) and laryngeal preservation rates (LPR). Statistical analysis was done by testing hypotheses (chi-square test and independent sample t-test) to identify significant relationships or differences, evaluating diagnostic tests with ROC curves and estimating survival probabilities with the Kaplan-Meier method. The ideal cut-off for tumour volume was 13.04 cm³ which was obtained using receiver operating characteristic (ROC) curve. The 3-year OS was 75.91% (95% CI 62.789-89.642) vs. 59.47% (95% CI 43.985-74.937) (p = 0.187) and the 3-year DFS was 81.39% (95% CI 71.962-90.822) vs. 77.39% (95% CI 65.722-88.999) (p = 0.829). On univariate analysis, the tumour volume is statically significant when compared with laryngeal preservation rates [88.9% vs. 11.1% (p = 0.001)]. The pre-treatment tumour volume of laryngeal carcinoma has significant impact on the LPR. The use of pre-treatment volumes obtained from modern day imaging modalities may supplement the TNM staging system and can help identify patients who would benefit from laryngeal preservation approach and thereby significantly improving the quality of life in these patients.

Colorectal cancers (CRC) are the fourth most prevalent cancer in India. Treatment modalities range from surgery, chemotherapy, radiotherapy, targeted treatment, and immunotherapy, with surgery forming the cornerstone of curative treatment in combination with any of the above. We sought to explore the short-term surgical outcomes of curative colorectal resections from our center and compare them with the published outcomes elsewhere. This is a retrospective study of all colorectal cancers that underwent curative resections at our center, from 1st January 2017 to 31st October 2024. Patients were identified from a prospectively maintained surgical database and electronic medical records. The clinical, radiological, histopathological features, and 30-day surgical outcomes were evaluated. We identified 207 patients for the said duration, with the majority of them being males (60.9%, 126/207), left-sided tumors (70%, 145/207) and clinic-radiologically stage III cancers (66.2%, 137/207). Preoperative treatment was employed in 38.7% (80/207) patients who were mostly rectal primaries (78/80). A minimally invasive surgical (MIS) approach was attempted in 36 patients with a conversion rate of 16.7%. Extended resections were performed in 33 patients (15.9%). The median length of hospital stay was 7 days (range 5 to 34 days). We observed re-exploration rates of 7.2%, a readmission rate of 3.4%, major perioperative morbidity (Clavien-Dindo 3a or above) of 13%, and 30-day perioperative mortality of 2.9%. Margin-negative resections were achievable in almost all cases (99.5%, 206/207), and optimal nodal yield (12 or more) was attained in 90.8% (188/207). Our study provides preliminary evidence that safe colorectal resections, including extended resections, can be performed in low-volume and resource-constrained centers with acceptable perioperative morbidity.

Surgical removal of cancerous lesion may sometimes lead to large defects that connect the oral cavity with the exterior. The loss of a microvascular flap used to reconstruct the defect sometimes complicates the matter. A second surgery is at times refused or not amenable due to unavoidable reasons. In these situations, a facial prosthesis serves as a salvage treatment option, thus improving the quality of life (QOL) of the patients. The purpose of this clinical study is to document the non-invasive retentive aids used for the facial prosthesis and assess the improvement in QOL after rehabilitation with facial prosthesis for participants with facial defects. Data of 13 head and neck cancer patients rehabilitated with facial prosthesis was collected retrospectively. The relevant sociodemographic, clinical, surgical, histopathological, TNM staging, reconstructive flap, prosthesis, material used for prosthesis, and retentive aids related data was collected. The psychosocial perception scale (PSP) questionnaire was administered to the patient at baseline and 6 months of follow-up to evaluate the quality of life. QOL data pre and post prosthesis was subjected to statistical analysis. Wilcoxon signed rank test and paired t-test was used to analyze pre and post assessment of QOL. A total of 13 patients (10 males and 3 females) who underwent surgical resection for oral cavity cancer received facial prosthesis. Majority of the lesions occurred in the buccal mucosa followed by the maxilla. All participants had T4 lesions and had received adjuvant radiation (60 Gy, 30 fractions). Reconstruction by pectoralis major myocutaneous flap in 6 participants, free anterolateral thigh flap in 4, free fibular flap in 1, vascularized iliac crest in 1 and split thickness skin graft in 1 participant was done. Twelve prosthesis were retained with magnetic attachments and favorable undercut was used to retain 1 prosthesis. The pre and post-prosthesis scores showed statistical significant values in the domains of functions (p = 0.05) and positive emotions (p = 0.04). Given the psychosocial impact a facial defect has on a head and neck cancer patient, considerable improvement was noted in the QOL. The PSP scale is a very specific questionnaire aimed at addressing patients with extraoral prosthesis, and this study drives that point succinctly. Retaining extraoral prosthesis is challenging; careful selection of retentive undercuts or choice of retentive aids is necessary to make the prosthesis a success.

Gallbladder cancer (GBC) is a prevalent form of biliary cancer with a dismal prognosis. Most patients present in late stages of disease when surgery is not a viable option. Hence, biomarkers for early detection of GBC are desperately needed. Routine serum tumor markers have shown variable predictability in different populations. CA 242 is emerging as a promising biomarker in gastrointestinal cancers. This study explored diagnostic potential of serum CA 242 and its correlation with other tumor markers in gallbladder cancer. In this prospective cross-sectional study, 50 GBC patients, 20 benign gallbladder disease (chronic calculous cholecystitis) patients, and 10 healthy controls were included. Serum CA 242 concentration was determined using the high-sensitivity ELISA method. Serum CEA, CA 125, and CA19-9 levels were analyzed using chemiluminescence. Receiver operating characteristic (ROC) was plotted to determine diagnostic potential of CA 242. The Mann-Whitney U test was used to compare CA 242 levels among different subgroups. Spearman's correlation was done to correlate CA 242 with other tumor markers. The median level of CA 242 in the GBC group was significantly higher (29.29 [1.40-171.50]) pg/ml compared to the non-GBC group (1.60 [1.2-2.00]) pg/ml. ROC analysis revealed that area under the curve for serum CA 242 was 0.756 (95% CI, 0.651-0.862), with a sensitivity of 64.0%, specificity of 93.3%, and diagnostic accuracy of 75.0% at an appropriate cut-off value of 6.6 pg/ml. There was significant positive correlation between CA 242 and serum CEA (r = 0.487, P = 0.000) and CA19-9 (r = 0.472, P = 0.001). No difference was observed in different subgroups like abdominal pain, obstructive jaundice, liver infiltration, lymph node involvement, metastasis, TNM staging, and resectability with serum CA 242. Serum CA 242 showed a promising potential as a diagnostic biomarker in GBC more so as a confirmatory biomarker in conjunction with other tumor markers. No association was however observed in terms of clinicopathological characteristics.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02332-6.

Colorectal cancer (CRC) represents a major global health burden, with signet cell adenocarcinoma constituting a rare but aggressive subtype. Despite multimodality treatment with curative intent, recurrence rates remain significant, and outcomes are poor. Carcinoembryonic antigen (CEA) is a widely used biomarker for CRC follow-up; however, its role in signet cell CRC remains inadequately defined. This study aimed to evaluate the trends in serum CEA among baseline CEA secretors and non-secretors presenting with recurrence after curative treatment and assess its value in postoperative surveillance. This retrospective study analyzed data from a prospectively maintained database at a tertiary cancer center between June 2011 and October 2021. Inclusion criteria were patients with recurrent signet cell colorectal adenocarcinoma, treated with curative intent, and with available CEA values at baseline, treatment completion, and recurrence. Variables included demographic data, baseline CEA levels, recurrence patterns, and CEA status at recurrence. Baseline CEA secretors were defined as those with preoperative CEA > 5 ng/ml. Statistical analysis employed chi-square and Fisher's exact tests for categorical data, with significance set at p < 0.05. Out of 263 signet cell colorectal adenocarcinoma patients, 100 recurrent cases were analyzed. Baseline CEA secretors accounted for 35%, while 65% were non-secretors. Elevated CEA levels at recurrence were observed in 94.3% of baseline secretors and 67.7% of non-secretors. Among secretors, only 5.7% showed normal CEA at recurrence. Recurrence patterns revealed no significant correlation with baseline secretor status, though peritoneal recurrences were more frequent among secretors. Most recurrence cases, irrespective of baseline CEA levels, exhibited elevated CEA levels, emphasizing its relevance in surveillance. This study highlights the importance of CEA monitoring in the follow-up of recurrent signet cell colorectal adenocarcinoma. Elevated CEA levels are a reliable marker for recurrence, even in baseline non-secretors. Conversely, normal CEA in secretory patients offers a reassuring prognostic indicator. The study highlights the non-site-specific nature of CEA elevation at recurrence. The study's findings support the continued use of serial CEA measurements in the postoperative surveillance of signet cell CRC.

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor with low metastatic potential with high local recurrence rates, arising in the dermis and often mimics other benign skin conditions. FS-DFSP is a more aggressive variant, associated with higher metastatic potential. While wide local excision is considered the primary modality of treatment, patients with high risk features would necessitate adjuvant therapy. Our study looked at challenges in diagnosing and managing DFSP. This retrospective analysis involved 50 patients who had surgical management of DFSP at a tertiary care center in South India from April 2012 to September 2024. In a study of 50 patients, most were male, with a median age of 40 years. Tumors had a median size of 4 cm, primarily located in the anterior abdominal wall. Eight four percent underwent wide local excision with a 3 cm margin; 33 patients had primary closure, while eight required flap coverage. Post-operative complications occurred in 11 patients, mainly surgical site infections. FS-DFSP was observed in 14 cases, and 24 patients received adjuvant radiation therapy due to close margins or recurrence. Only two patients were treated with adjuvant imatinib. We had only one recurrence in our study. Pre-operative biopsy and imaging can help prevent inadequate excisions, reducing recurrences and the need for re-excision and adjuvant therapy. Accepted surgical margins range from 2 to 3 cm, but wider margins necessitate flap covers and wound complications. Adjuvant therapy in select patients with local recurrence, close surgical margins, and aggressive histological types can improve outcomes.