Indian Journal of Surgical Oncology最新文献

Knowledge of peripancreatic vascular anatomy is critical in performing pancreatic, splenic, and gastric surgery. The splenic vein (SV), a major vein draining the spleen, follows a predictable course. SV variations, which are encountered uncommonly, can pose a surgical challenge particularly in cases involving malignancies such as gastric cancer, potentially increasing the risk of injury and complications. This image vignette documents a uncommon anatomical variant of SV encountered during total gastrectomy with D3 lymphadenectomy, where it lies at the superior border of pancreas and the SA crosses it and moves cranially in the proximal course and then again crosses caudally in the distal course, emphasizing the need for awareness of such anomalies as well as evaluation of imaging and intraoperative vigilance to prevent complications.

Hepatocellular carcinoma (HCC) presenting as calvarial metastasis (CM) is a rare situation with limited reports in literature. We present a case of a 64-year-old gentleman, who presented with an 8-month history of swelling on the right forehead, associated with decreased vision and size of the right eye. Magnetic resonance imaging revealed a partially hemorrhagic lesion in the right frontal bone, extending into the scalp and causing a midline shift, with intra-orbital and intraconal extension. Positron emission tomography showed multiple bi-lobar liver metastases. The patient was diagnosed with hepatitis B-associated hepatocellular carcinoma on biopsy and was started on dexamethasone, anti-epileptic prophylaxis, and Lenvatinib. He also received focal radiotherapy for the CM. Advanced imaging techniques were crucial in diagnosing the disease's extent. The patient's management, involving pharmacological therapy, radiotherapy, and supportive care, highlights the need for a multidisciplinary approach in treating advanced malignancies.

Neuroblastoma (NBL) is a highly malignant neuroectodermal tumor. It is the most common childhood extracranial solid tumor. The tumor mainly affects children 1-4 years of age. The estimated incidence is around 1:10,000 children per year. The International NBL Risk Group classification system categorized the disease into very low-risk, low-risk, intermediate-risk, and high-risk (HR) groups. HR NBL is diagnosed in approximately 40% of patients > 18 months of age and is associated with very aggressive clinical behavior. Treatment strategies for HR NBL involve the use of an intensive multi-model therapy plan; however, the outcome is still poor, with event-free survival and overall survival of 30% and 40% at 3 years, respectively. HR NBL causes approximately 15% of pediatric cancer deaths. Most mortalities are caused by disease relapse (50%) and refractoriness to therapy (20%). Refractory and relapsed (R&R) NBL is commonly diagnosed in the HR NBL group and is challenging to treat. Despite the use of chemotherapy (CTR), radiotherapy, high-dose CTR with hematopoietic stem cell support, and HD I¹³¹ metaiodobenzyl guanidine therapy, the treatment outcomes are still inferior with EFS and OS of 8% and 15% at 3 years. Total change or significant modification of the current treatment strategies is urgently needed to improve outcomes. Recent developments in cell biology and molecular genetics of NBL tissue have led to the discovery of several potential molecular targets that may improve the treatment results. This review discusses the various clinical aspects of HR and R&R NBL, newer treatment interventions, targeted and immunotherapies, and applicability.

Endometrial cancer is the second most diagnosed gynecologic malignancy among women worldwide. The recent understanding of molecular classification of endometrial carcinoma have become important aspect of patient directed treatment. The importance of Microsatellite Instability (MSI) has been highlighted in the molecular classification emphasizing that patients belonging to MSI subgroup differ from other subgroups for molecular abnormalities, hereditary risk factors, prognosis, and response to treatment. This study was therefore conducted to investigate the frequency of MSI in endometrial carcinomas and its association with clinicopathological parameters. Total of 109 cases were enrolled in the study over a duration of 3 years. Patients' demographic data was recorded from requisition forms. Cases were examined in routine Hematoxylin and Eosin (HE) sections. Tumor infiltrating Lymphocytes (TIL) were assessed manually by criteria proposed by International Immunooncology Biomarkers Working Group. One representative paraffin block having sufficient number of viable tumor cells was selected for immunohistochemistry (IHC) staining for mismatch repair (MMR) proteins (MLH1, MSH2, MSH2 and MSH6). Out of toal 109 cases, 100 were endometrioid, 5 were serous carcinoma, 2 were clear cell and 2 were carcinosarcoma. Seventy-seven cases (71%) were proficient mismatch repair (pMMR) and thirty two (29.00%) cases were deficient mismatch repair (dMMR). MMR deficiency was seen only in endometrioid carcinomas. No association was seen with age, size, site, myometrial invasion, tumor grade, lympho-vascular invasion (LVI) and stage of the tumor. There was higher trend towards more frequent lymph node involvement. Strong association was seen with high TIL. MSI testing which has been used historically to identify patients with Lynch Syndrome and evaluate the severity and prognosis of MSI carcinomas now plays an important role in identifying patients who will benefit from targetable therapy. MMR study therefore recommended in all cases of endometrial carcinomas and detection of MMR proteins by IHC can indirectly reflect the status of MSI and is a reliable method of MSI detection.

The incidence of thyroid cancer has tripled in the last three decades, and papillary thyroid carcinoma is a major contributor to this increase. However, even though most patients with PTC can have excellent long-term prognosis, survival alone is not a sufficient measure for prognosis. In recent years, the primary focus of treatments and clinical diagnoses has shifted towards patient-centered care, with the preservation of quality of life being one of the most important associated areas. The present study is a cross-sectional epidemiological descriptive study investigating the quality of life and postoperative complications in patients undergoing surgery due to papillary thyroid carcinoma in the past 10 years in the hospitals of Velayat and Rajaei in Qazvin. The available information in the patient's records, including demographic data and pathological diagnosis, was utilized. Additionally, during their visits, they were asked about their quality of life and surgical complications. The female preponderance frequency belonged to women with 71.7%. The minimum age of the individuals under study was 16 years, the maximum was 81 years, and the mean age with a standard deviation of 42.5 ± 13 years was reported. The female preponderance prevalence is related to women. There was no significant difference between gender and involvement of lymph nodes, pulmonary metastasis, voice hoarseness, postoperative neck swelling, the need for reoperation, postoperative hypocalcemia, and quality of life. There was no significant relation between age, the time of diagnosis, iodine therapy, and patients after surgery for papillary thyroid carcinoma. The findings of this study indicate that the female preponderance frequency is related to women. No significant relationship was found between age and the time of diagnosis and treatment in patients after surgery for papillary thyroid carcinoma. Due to limitations in the number of samples in this study, it is recommended that a study on the quality of life of patients after thyroid surgery be conducted with a larger sample size.

The prevalent method for synthesizing evidence from multiple studies is the frequentist meta-analysis, which relies on assumptions of long-term frequencies and does not directly address the probability of hypotheses. In contrast, the Bayesian meta-analysis provides a framework that integrates prior knowledge with observed data, offering a more nuanced interpretation. This study aims to compare the outputs and interpretations of frequentist and Bayesian meta-analyses using published trials on colorectal anastomosis as examples. Two previously published meta-analyses on colorectal anastomosis-one evaluating trans-anastomotic tubes (TAT) and the other indocyanine green (ICG) fluorescence imaging-were reanalysed using frequentist and Bayesian approaches. Sequential Bayesian analyses were also conducted, updating priors with each additional study. Results were presented using odds ratios (OR), confidence intervals (CI), credible intervals (CrI), p-values, and Bayes factors (BF₁₀). Both methods produced nearly similar ORs for the TAT meta-analysis; however, the Bayesian approach yielded slightly narrower CrIs and a BF₁₀ that indicated a slight preference for the null hypothesis that was unclear with p-values alone. In the ICG meta-analysis, the Bayesian analysis produced a BF₁₀ suggesting that it was 19 times more likely to observe the data under the assumption that the alternative hypothesis is true compared to the null, considerably making the estimates more conservative than the frequentist output. The Bayesian sequential analysis demonstrated increasing confidence in the alternate hypothesis with the addition of more studies. While frequentist and Bayesian meta-analyses may produce similar point estimates based on prior evidence, their interpretations and implications for hypothesis testing differ significantly. Bayesian methods offer a more flexible and intuitive approach, particularly in contexts with prior knowledge or when sequential updating is required. While frequentist outputs depend on multiple experiments, assuming that the null is true, and heavy dependence on conventional p-value thresholds, Bayesian outputs provide the direct probability of the hypothesis in question and credible intervals that are likely to contain the true estimate.

This study looks at sexual and urinary dysfunction and quality of life in male patients undergoing extended total mesorectal excision. This cross-sectional study used International Prostatic Symptom Score (IPSS) and the International Index of Erectile Function Score (IIEF) questionnaire-based retrospective analysis of male patients who underwent extended total mesorectal excision from 2015 to 2022. Quality of life was assessed using EORTC QLQ C-30 and EORTC QLQ CR-29. Sixty-eight male patients were included, with a median age of 44 years. Urinary retention and incontinence occurred in 10.3% of patients, and 2 required lifelong catheterization. Nineteen percent and 49% patients had severe urinary and sexual dysfunction as per IPSS and IIEF scores. As per the EORTC C-30 QOL analysis, participants scored a global health status mean score of 33.3 with a standard deviation of 10.76. The highest functional scale score was for cognitive functioning: 78.7 ± 18.67. The symptom scale ranged from 9.30 ± 13.26 for nausea and vomiting to 44.19 ± 27.9 for financial difficulties. According to the EORTC CR 29, impotence (43.41 ± 55.17) and problems with stoma care (37.20 ± 22) scored highest. On the function scale, anxiety about future health (62.79 ± 24.35), interest in sex (65.11 ± 45.4), and body image (65.12 ± 16) scored lowest in this order. The patient had significant urinary and sexual symptoms, resulting in concern about weight, loss of interest in sex, and anxiety about future health. In a high-volume , eTME is not without urinary and sexual dysfunction.

Total neoadjuvant therapy (TNT) involves incorporating systemic chemotherapy in the interval between radiation and TME surgery for locally advanced rectal cancers (LARC). Patients who achieve complete clinical response can be considered for organ preservation by opting for watch and wait strategy. The studies focusing on patient's preferences for treatment are scarce. This is a cross-sectional study among patients with LARC and addresses their treatment preferences in correlation with psychological parameters. All LARC (mid or lower third) patients planned for multimodality treatment were included in the study. Patients were explained about standard treatment and non-operative management. They were then interviewed with questionnaires for the assessment of their preference. In our study, a total of 60 patients with LARC planned for neoadjuvant chemo radiation were included. Non-operative management (NOM) was preferred by about 35.0% of the subjects. NOM was preferred more by patients ≤ 65 years age group (66.7%), those with less education status (43%) (p = 0.024), and those from rural background (66.7%) (p = 0.011). Psychosocial factors like fear of progression (FOP) had statistically significant association (p = 0.001) with preference for NOM, while other factors like life orientation and locus of control failed to show significant association. Our study underlines the patient preferences and factors affecting the decision making and shows the importance of the concept of "shared decision-making" by discussing the treatment options, and its related side effects and outcomes to choose a treatment strategy.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02280-1.

Chordomas are rare malignant tumors arising from notochord remnants, predominantly in the sacral region. Due to their size and location, achieving R0 resection is challenging, with larger tumors (> 50 mm or > 25 cc) linked to worse outcomes. This study examines the surgical management and outcomes of large sacral chordomas, focusing on tumor size, resection strategy, and postoperative results. This retrospective study reviewed 14 male patients with sacral chordomas ≥ 50 mm or ≥ 25 cc. Data on demographics, tumor characteristics, surgical approaches, complications, and survival were analyzed using descriptive statistics and Kaplan-Meier survival curves. The study analyzed 14 male patients (mean age: 63.1 years) with sacral chordoma. Tumor size averaged 98.4 mm, and preoperative embolization was performed in two cases. Total sacrectomy was required in 14.3%, with spinopelvic fixation in both. Negative margins were achieved in 92.9%. Complications included wound issues (50%) and neurological deficits (57.1%)(7/12), mainly in high-level sacrectomies. High-level resections had significantly higher neurological complications (p = 0.005). Kaplan-Meier analysis estimated survival above 75% postoperatively. Surgical resection of large sacral chordomas is challenging but feasible, with high rates of R0 resection. Negative margins, tailored surgical strategies, and effective complication management are critical for optimizing outcomes.

In rectal adenocarcinoma, the diagnostic accuracy of baseline MRI for predicting circumferential resection margin (CRM) is established. However, data regarding the role of baseline and post-neoadjuvant chemoradiotherapy (NACTRT) MRI-mesorectal fascia (MRI-MRF)-positive status in predicting long-term oncological outcomes is relatively scarce and heterogeneous. The objective of the study is to evaluate the long-term oncological survival outcomes of baseline and post-neoadjuvant chemoradiation (NACTRT) MRI-MRF as predictors of long-term survival outcomes, i.e., overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free survival (LRFS). Single center retrospective analysis from a prospectively maintained database. Patients undergoing curative surgery for rectal adenocarcinoma either upfront or post-NACTRT between July 2013 and April 2014. Patients with cT3/cT4 or N + received NACTRT before surgery. The pre-NACTRT MRI was recorded as MRI 1-MRF and post-NACTRT MRI was recorded as MRI 2-MRF. MRI scans done at presentation irrespective of further treatment were labeled as MRI T-MRF. Out of 254 patients, 217 were eligible for analysis. The median follow-up duration is 132 months. Seventy-six percent of patients received NACTRT. Overall, recurrences were seen in 68/217 (31.3%) patients, with 18 local and 50 distant recurrences. Eighty-six (39.6%) deaths were recorded, most due to disease progression. The 5-year OS of the cohort was 69.1% (95% C.I 63-75.8); 5-year DFS was 67.4% (95% C.I 61.2-74.3); and the 5-year LRFS was 91% (95% C.I 87-95.2). MRI T-MRF status was significantly associated in predicting OS, DFS, and LRFS. MRI 1-MRF status is a strong predictor for OS and DFS. The MRI 2-MRF status is a weak predictor for OS and is not associated with DFS and LRFS. The path-CRM-positive status is a significant predictor of OS and DFS, however not for LRFS. Baseline MRI-MRF status is a robust and strong predictor of long-term survival outcomes (OS, DFS, LRFS). Patients with baseline MRI-CRM-positive status have poorer outcomes irrespective of neoadjuvant therapy and poor histology features.