Indian Journal of Surgical Oncology最新文献

Rectal neuroendocrine tumours are rare but increasing worldwide. However, there is limited data from regions like the Indian subcontinent, where clinical presentations and outcomes may differ due to unique demographic and biological factors. This study aimed to characterize rectal neuroendocrine tumours in our region, focusing on clinic-pathological presentation, and treatment outcomes. This was an observational single-centre retrospective cohort study from a high-volume tertiary care centre in Western India. Sixty-five consecutive patients with rectal neuroendocrine tumours treated between 2013 and 2023 were included. The main outcome measures were overall survival and disease-free survival. Secondarily, we tried to evaluate the impact of pathological grade and surgery-type on survival outcomes. The median age at diagnosis was 50 years, younger than the global median (56-57 years), with a male predominance (80%). Majority of patients were symptomatic and had locally advanced disease, with 64% showing metastatic spread. Pathologically, 82% of tumours were classified as Grade II/III, with a high median tumour size (3.7 cm) and elevated serum Chromogranin A levels. Multimodal treatment, including surgery and adjuvant therapies, was utilized for most patients. Of the 41.5% who underwent surgery, 70% had sphincter-preserving procedures. The median overall survival for the entire cohort was not reached, but 3-year and 5-year overall survival rates were 91% and 85%, respectively. Grade III tumours had significantly poorer outcomes, with a 5-year survival of 57% compared to nearly 100% in Grade I and II tumours. Apart from its retrospective nature, our study may have limited generalizability due to potential referral bias, and the lack of detailed pathological subclassification would be an opportunity for future research. As the first study from the Indian subcontinent we highlight how our patients presented at a younger age with advanced, aggressive disease. Multimodal approach could improve outcomes even in advanced disease.

The SSI MANTRA™ (Sudhir Srivastava Innovations Pvt. Ltd, Haryana, India) robotic surgical system developed in India has been used to perform various complex procedures of the abdomen and thorax. The robot-assisted nipple sparing mastectomy (RANSM) described by Toesca et al. is different from these procedures because it utilizes a confined working space created in the soft tissue of the breast and has been described on the da Vinci Intuitive Surgical System. We performed the procedure of RANSM in a woman with early breast cancer using the SSI MANTRA™ and found it feasible. Case selection, docking, and surgical technique are described here.

Anastomotic leak (AL) is a serious complication of colorectal surgery, occurring in 3-15% of patients undergoing elective left-sided resections, and is associated with significant morbidity, mortality, and healthcare costs. The Colon Leakage Score (CLS) has emerged as a promising predictive tool for AL, integrating factors such as age, comorbidities, tumor location, and surgical approach. This study aimed to validate the CLS in predicting AL in patients undergoing elective left-sided colorectal surgery. This prospective observational study was conducted at a single tertiary care center from 2020 to 2023 and included 62 patients undergoing elective left-sided colorectal surgery. The CLS was calculated preoperatively using a standardized scoring system. The primary outcome was the incidence of AL, defined as clinical or radiologic leaks. Diagnostic performance of the CLS was evaluated using ROC curve analysis, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) calculated. A cutoff value was determined using Youden's index. The mean age of participants was 59.8 ± 9.73 years, with 64.5% undergoing laparoscopic surgery. AL occurred in 8.1% of patients, with 83.3% of these having a CLS > 9. The CLS demonstrated high diagnostic performance, with sensitivity of 83.3%, specificity of 91.1%, PPV of 50.0%, NPV of 98.1%, and overall accuracy of 90.3% (p < 0.001). The AUC was 0.912, indicating strong predictive strength. Management of AL included conservative approaches in 6.5% of cases and re-exploration in 3.2%, with an in-hospital mortality rate of 1.6%. The CLS is a robust predictive tool for AL, with a cutoff > 9 showing high sensitivity, specificity, and accuracy. Its ability to stratify risk and guide postoperative management highlights its potential to reduce AL-related morbidity and improve surgical outcomes. However, the study's single-center design, small sample size, and low AL rate limit generalizability. Further validation in larger, diverse cohorts is needed to confirm its clinical utility and applicability in guiding decisions such as diverting ileostomy. The CLS represents a valuable step toward personalized risk assessment in colorectal surgery.

Although the role of pneumonectomy has declined with advances in lung-sparing techniques and multimodal therapies, it remains essential in select cases. High morbidity and mortality remain concerns, but careful patient selection and perioperative optimization have improved outcomes. This study evaluates the relevance of pneumonectomy in the current clinical setting. A retrospective analysis was conducted of all pneumonectomy cases at a tertiary cancer centre in India from January 2015 to March 2024. Demographics, clinic-pathological characteristics, postoperative outcomes, and survival data were analyzed. Among 412 patients who underwent major lung resections, 19 (4.6%) required pneumonectomy. The mean age was 51.9 years (range 27-76); 74% were male, and 52% had a history of smoking. Left-sided pneumonectomy was more frequent (68.4%). Lung cancer was the most common indication (78.9%), followed by carcinoid tumours and inflammatory conditions (10.5% each). Postoperative complications occurred in five patients (26.3%). Two patients experienced early complications-atrial fibrillation and subcutaneous emphysema-while three developed bronchopleural or esophagopleural fistula in case of pleural windows, all requiring surgery. In-hospital mortality was 10.5% (two patients). The median follow-up was 13 months. Among cancer patients, median overall survival was longer for carcinoma than sarcoma (29 vs. 2 months), and for early- vs. locally advanced stage disease, though not statistically significant. The decline in pneumonectomy rates underscores advances in lung-sparing surgical techniques and alternative treatment modalities. Nevertheless, in the Indian context, where locally advanced lung cancer and extensive inflammatory lung damage are prevalent, pneumonectomy retains a significant role. With meticulous perioperative management, acceptable postoperative outcomes can still be consistently achieved.

Head and neck cancer is among the most common cancers in India. Most of these patients present with advanced disease requiring extensive surgical resection and appropriate reconstruction. Though the expertise for surgical resection may be available, the same for reconstruction, especially microvascular reconstruction, may not always be available. We included centres that were members of National Cancer Grid (NCG) and institutes that offered academic programs such as the M.Ch, DNB (Surgical Oncology and Head and Neck Surgery), FNB (Head and Neck Oncology), and Fellowships (Head and Neck) across the country. After identifying the centres, we analysed how many of these centres had a department of Plastic and Reconstructive Surgery (PRS) and whether they offer reconstructive services, including microvascular free flaps. Three hundred and sixty-eight centres were identified across India. One hundred and eighty-eight centres (46%) had a PRS department, most of them were in the south zone (n = 57/90, 63.3%) and north zone (n = 33/65, 60%) (p < 0.001), in private centres (n = 135, 58.9%) (p < 0.001), in tier 1 cities (n = 58/100, 58%) (p < 0.001), and centres with active academic programs (p < 0.001). Out of 188 centres, 166 performed microvascular free flaps (MFF). In a few centres, reconstruction was done by surgeons who performed the resection of the cancer (n = 54, 14.6%). Overall, MFF was performed in 57.2% of hospitals across the country. There is a reasonable number of centres with PRS services available in the country for oncoreconstruction. However, their distribution seems to be skewed, with more of them located in private institutions/centres and tier 1 cities.

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms, initially characterized as primary thoracic tumors, but now recognized to occur in various anatomical locations. Primary central nervous system (CNS) SFTs are relatively rarer CNS neoplasm's described towards the end of the last century. This study aims to comprehensively profile the clinicopathological, radiological, and prognostic characteristics of SFTs of the CNS. Given the absence of prior regional studies on CNS SFTs from North-East India, our objective was also to evaluate the overall survival outcomes along with other relevant findings in the affected patients. A retrospective review was conducted on cases histopathologically diagnosed and treated as CNS SFTs. Data pertaining to clinical presentation, imaging features, histopathology, and immunohistochemistry were systematically analyzed. Additionally, treatment modalities and follow-up outcomes were evaluated. Categorical variables were assessed using Fischer's exact test. A p-value < 0.05 was considered statistically significant. All statistical tests were two-sided. Our findings indicate that CNS SFTs predominantly occur as intracranial neoplasm in elderly female patients, most commonly presenting with headache. Radiologically, they exhibited a heterogeneous appearance on magnetic resonance imaging. Histologically, tumors demonstrated hemangiopericytoma-like features, while immunohistochemical analysis consistently revealed STAT6 positivity. Gross total resection followed by adjuvant radiotherapy significantly improved both progression-free survival and overall survival. While pre-operative clinical and radiological assessments provide important diagnostic clues for this rare CNS tumor, definitive diagnosis and accurate grading rely primarily on post-operative histopathological and immunohistochemical evaluation. The study underscores the importance of an integrated diagnostic approach to optimize patient outcomes in CNS SFTs.

Presternal extension of papillary carcinoma thyroid is extremely rare and inexplicable. Infiltration of pretracheal fascia and strap muscle may be the possible explanations for the presternal extension in malignant thyroid lesions. Here, we report a rare case of presternal papillary thyroid carcinoma in a 64-year-old gentleman, treated with radical surgery.

Tamil Nadu contributes to around 6% of the cancer burden annually, wherein colorectal cancer is one of the most common cancers. Assessing the quality of life provides a comprehensive understanding of a cancer patient's experience with diagnosis and treatment. While numerous studies have developed tools to assess quality of life, most focus on physical well-being aspects. The Stoma Quality of Life Scale (SQLS) Version II is a well-established tool specifically designed to assess the quality of life of colostomy patients. However, a validated Tamil version of this scale is currently unavailable. This study aims to translate the Stoma Quality of Life Scale Version II from English to Tamil and validate its use for Tamil-speaking colostomy patients. The Stoma Quality of Life Scale Version II was translated following the European Organization Research and Treatment of Cancer (EORTC) translation guidelines and underwent pilot testing on 30 patients diagnosed with colorectal cancer. They further underwent a debriefing interview regarding the comprehensibility and difficulty levels of the items. The forward translation revealed the difference in the language used by the two individual translators, including the meaning of the word and syntaxes, at the same time backward translation found out the differences in their perception of the items. The debriefing interview revealed that out of 21 items, four items needed clarification by 6.6% of the patients and 93.4% of the patients were able to comprehend and respond to the items without any clarification and support. The translated tool of the Stoma Quality of Life Scale had a more simplified administrative process, as it was self-administrative, less time consuming, and more comprehensible.

Carcinoma of the esophagus is the fourth common cancer in India, with the majority of cancers occurring at the mid and lower third of the esophagus. Studies done to evaluate the role of neoadjuvant chemoradiation and surgery did show a statistically significant improvement in disease-free survival (DFS) and overall survival (OS) with preoperative concurrent chemoradiation followed by surgery compared to surgery alone. The aim of this study is to analyze the oncological outcomes, survival rate, and factors that influence survival following esophagectomy in our institute. Patients with carcinoma esophagus who underwent esophagectomy in the Department of Surgical Oncology from the year 2015 to 2024 were included. The details of the patients, including clinical stage, histopathology details, type of surgery performed (VATS/transhiatal esophagectomy), neoadjuvant and adjuvant therapy administered, and survival status of the patients, were retrospectively collected via hospital medical records and follow-up records. Statistical analyses were calculated using the Statistical Package for the Social Sciences (SPSS) software version 25. Chi-square tests were used for categorical variables. Independent t-tests were used to compare means. Kaplan-Meier curves were used for survival analysis. In our institute, a total of 126 patients with carcinoma esophagus were operated on. Among the 126 patients, 82 patients (65%) received neoadjuvant chemoradiation followed by surgery, and 44 patients (35%) underwent primary surgery. The median overall and disease-free survival for the entire study population was 30 months and 28 months, respectively. Patients who received neoadjuvant chemoradiation had a higher median overall and disease-free survival of 35 and 32 months as against 25 and 22 months for those who underwent primary surgery, which was statistically significant (p value = 0.002). Patients receiving neoadjuvant chemoradiation show better survival outcomes when compared with patients undergoing upfront surgery for carcinoma of the esophagus. VATS-assisted esophagectomy had superior oncological outcomes when compared with transhiatal esophagectomy with respect to nodal harvest, less morbidity, and better survival rates.