Indian Journal of Surgical Oncology最新文献

Endometrial hyperplasia represents a spectrum of morphological and biological changes in the endometrial glands and stroma, ranging from an exaggerated physiological state to carcinoma. In recent years, numerous laboratory studies have evaluated the role of melatonin in regulating endometrial cell proliferation. Emerging evidence indicates an inhibitory role of melatonin administration in various gynecological cancers. Therefore, the present study aims to investigate melatonin's effect on the endometrium's histology in patients with endometrial proliferative disorders. This double-blind, randomized clinical trial was conducted at the Al-Zahra Hospital in Tabriz university of medicail scinsses. The patients with complaints of abnormal vaginal bleeding and with diagnosis of endometrial proliferative disorders or non-atypical hyperplasia were included .The patients were randomly assigned to control and intervention group. The control group received 80 mg Megestrol acetate daily, the intervention group received 80 mg Megestrol acetate daily plus 5 mg of melatonin before bedtime for three months. Both groups were homogenized regarding demographic information, including age, gravidity, parity, and body mass index. The patients were followed up for three months, and after completing of treatment, an endometrial biopsy was performed. The endometrial histology was compared between two groups after three months. Out of the 40 enrolled patients in the study, 37 were included in the final analysis. 18 out of 19 patients (94.7%) in the intervention group and 12 out of 18 patients (66.6%) in the control group had normal biopsy results after treatment . This difference was statistically significant (P<0.05). Adding melatonin to progestin for treatment of endometrial hyperplasia can enhance the treatment response in women with this condition and lead to a higher rate of treatment.

There is no data on the expression of PD-L1 in oral cavity cancers from the Indian population. Hence, this audit was done to estimate the incidence of PD-L1 expression in oral cavity cancers and detect factors affecting the same. Data of 340 cases of oral cavity cancer who were advised for PD-L1 gene expression testing were collected from the head and neck OPD of Tata Memorial Hospital from the year 2018 to 2023. These cases were evaluated for demographic details, i.e., age and gender, and also for factors such as performance status (PS) as per the Eastern Cooperative Oncology Group (ECOG) scale, subsite of oral tumor, histopathology, and grade. Descriptive statistics were used for analysis. Factors affecting PD-L1 gene expression were sorted using ordinal logistic regression analysis. In total, 340 patients were evaluated with a median age of 48 years (range, 17-79; interquartile range, 40-55), and PD-L1 expression was divided as scores and was observed that Tumor Proportion Score (TPS) 0% was seen in 34 patients (10.0%), TPS 1-5% was seen in 70 patients (20.6%), TPS 6-10% was seen in 29 patients (8.5%), TPS 11-20% was seen in 29 patients (8.5%), TPS 21-30% was seen in 33 patients (9.7%), TPS 31-50% was seen in 44 patients (12.9%), TPS 51-75% was seen in 47 patients (13.8%), and TPS > 75% was seen in 54 patients (15.9%). Univariate analysis was run to determine the distribution of TPS scores within each variable under age, gender, sample collection site, differentiation of tumor, and subsite of tumor. This is one of the first studies evaluating data on the expression of PDL-1 in oral cavity cancers in the Indian population and the factors affecting it. The data provides novel insights into many factors potentially affecting the expression of PDL-1 in oral cavity cancers and in the future, can be of help in developing treatment plans with various immunotherapies.

This study aims to evaluate postoperative PTH trends after parathyroidectomy and determine whether elevated PTH levels predict disease recurrence or reflect a benign physiological response. The present study is of descriptive epidemiological type. All patients diagnosed with primary hyperparathyroidism in (Vali-e-Asr Hospital of Qazvin Province) during the year 2017 underwent surgery. They were followed up for one year, and their parathyroid hormone and serum calcium levels were measured at the following times: one day after surgery, 1 month after surgery, 6 months after surgery, and one year after surgery, and recorded. Most participants were women (72.2%), and the average age of the sample was 50 ± 10, ranging from 32 to 79 years. The study results indicated a significant relation between temporal decline in parathyroid hormone and calcium levels in surgical procedures. There was no significant relationship between age, parathormone, and calcium during surgery. There was a significant relationship between increasing age and calcium level increases. As the level of parathormone increases, the level of calcium also increases, with an increase in both parathormone and calcium levels observed 6 months after the surgery. The increase in parathormone levels after surgery is a common finding, continuing up to 6 months postoperatively, but decreasing again without any correlation with disease recurrence. This increase in parathormone levels is not associated with the age and gender of the patient.

Axillary dissection and radiation to the axilla are known to cause significant morbidity especially in the form of lymphoedema, paraesthesia, and shoulder dysfunction. Our aim was to study our results of axillary surgery related to complications. Secondary objective was to find out the local recurrence. Records of detailed operation notes and radiotherapy of all patients who underwent surgery for breast cancer in a single unit were kept since January 2001 to December, 2020. Prospectively different parameters like the age, sex, extent of axillary dissection, the structures preserved during axillary nodal dissection, and short-term and long-term complications were recorded. The results were then analyzed to correlate the incidence of long- or short-term complications as mentioned above and also the local recurrence. A total of 1054 patients underwent surgeries for breast cancer during this period; 99% were females and the average age was 42 years. 75.5% underwent modified radical mastectomies (MRM), and the remaining 25% underwent oncoplastic breast surgeries (BCS) and toilet mastectomies. In 1006, patients who underwent level III axillary dissection and LD pedicle were preserved in 100% cases, nerve to serratus anterior in 989 cases (98.3%), medial pectoral vessels and nerve in 957 (95.1%), and intercostobrachial nerves in 872 cases (86.7%). Only 11 (1%) patients had local infection, 13 (1.31%) had seroma needing aspiration, and 57 (5.66%) had long-term paraesthesia in the upper ipsilateral arm and all were related to sacrifice of intercostobrachial nerves. None had long-term shoulder dysfunction. Minor lymphoedema was seen in 20 patients (1.83%), while major lymphoedema with more than 2-cm difference in the mid or wrist circumferences was seen in 5 patients (0.45%). Four of them had radiation in other Institutes which included the axilla. None of our patients had recurrence in the axilla. Management of axilla has been ever evolving. The morbidities arising from axillary dissection has always been a matter of concern and sentinel lymph node biopsy (SLNB) is becoming a standard of care in early breast cancer. However, in India, where we see mostly locally advanced disease, and the affordability and access to healthcare for many patients remain a challenge, optimal surgery is required to avoid axillary recurrence and at the same time minimize the morbidities. Our study has tried to address both and the results of our 20-year data is found to be encouraging.

Breast cancer represents a substantial global health challenge and stands as a predominant cancer among women in India. Globally, it ranks as the fifth leading cause of cancer-related deaths. The advent of molecular classification has revolutionized the approach to treating breast cancer. In this study, we aimed to assess the prevalence of various molecular subtypes within breast cancer patients in our state. It was a prospectively conducted study in a tertiary care cancer center over a period of 2 years from November 2020 to October 2022. A total of 1003 breast cancer patients which included both metastatic and non-metastatic cases who underwent treatment were evaluated. All patients had their molecular subtyping done by immunohistochemistry (IHC), and fluorescence in situ hybridization (FISH) testing was further performed in equivocal cases. The intrinsic classification of breast cancer endorsed by the St. Gallen Consensus Conference was used to subtype the cases. The results were presented in terms of means and standard deviations, while categorical data were represented as frequencies and proportions. Among the 1003 patients included in the study over 2 years, 999 were females and 4 males with a median age of 54 years. In total, 92.2% and 7.8% were non-metastatic and metastatic respectively. The most common molecular subtype was luminal B (53.3%) followed by TNBC (22.1%), luminal A (13.2%), and HER2-enriched (11.4%). Among the 912 operated cases, 572 (62.7%) and 340 (37.2%) underwent BCS and mastectomy respectively. ER score increases with an increase in age in contrast to PR score which decreases with age. Overall, HER2/neu receptor status was positive in 26.7% (268 out of 1003 patients) and has a positive correlation with increase in age. In our study, we have analyzed the distribution patterns of molecular subtypes in breast cancer within the Northern Kerala region. The findings of our study reveal a striking similarity between the observed patterns in Northern Kerala and those documented both regionally and globally. This convergence not only underscores the consistency of the molecular subtypes across diverse geographical areas but also emphasizes the significance of our research in contributing valuable insights to the broader understanding of breast cancer epidemiology.

Gastric cancer remains one of the most common cancers in the world. While there is an overall decrease in incidence, there has been a rise in proximal gastric cancers. This article reviews the subsite-specific epidemiology, treatment patterns, pathology, and survival outcomes of gastric cancer. A retrospective analysis of the data of 372 patients was done from a prospectively maintained computerized database from 1994 to 2022. Out of them, a total of 199 patients underwent curative resection. Based on the position of the tumour, gastric cancer was classified into proximal gastric cancer, cancer of the body of stomach, and distal gastric cancer. Gastric cancer is more common in males. Anorexia and weight loss were the most common symptoms. GOO seen in 21.9% patients of distal gastric cancers. Distal cancers remain the most common subtype in India. Most patients (90.4%) presented with T2 and T3 stage. Node positivity was most commonly seen with distal gastric cancers (67%). Highest recurrence rate was seen with cancers of the body. Proximal cancers showed the highest median OS (68 months). Distal gastric cancers at our centre commonly present at advanced stages with poor outcomes, while proximal cancers exhibit aggressive pathology and higher recurrence rates. Peritoneal and liver recurrences highlight the need for early detection and tailored treatments.

Oncoplastic breast surgery (OPBS) has advanced with local perforator flaps (LPFs), improving cosmetic outcomes in breast-conserving surgery (BCS). However, LPFs remain underutilized in low-resource settings. We evaluated the feasibility, adoption and outcomes of LPFs in a resource-limited setting. A retrospective study of 28 patients undergoing OPBS with LPF reconstruction was conducted at a single low-resource center. Flap selection was based on defect size, tumor location, and patient anatomy. Demographic and perioperative data, including operative time, complications, and adoption trends, were analyzed. All 28 procedures were completed without secondary reconstruction. Mean operative time was 115 ± 20 min, reducing by 13.5% over sequential cases, demonstrating a learning curve. Minor complications occurred in 10.7% of cases, with one flap loss. Cosmetic outcomes were satisfactory in 89.3% of patients. LPF adoption in OPBS cases increased from 12% in the first year to 33% by the third year, with a Total Adoption Score of 70.99%. LPF-based reconstruction is a feasible, reproducible technique for BCS in low-resource settings, with a clear institutional learning curve and increasing adoption.

This consensus on advanced epithelial ovarian cancer was focused on issues not covered by existing international guidelines, some country-specific issues, and general and technical aspects of cytoreductive surgery (CRS). The modified Delphi technique was employed with two rounds of voting. There were 47 close-ended questions on 7 key topics that were disseminated through the SurveyMonkey (www.surveymonkey.com) platform. Out of 54 invited surgical and gynecologic oncologists, 48 agreed to vote. A consensus was reached if any one option received > 70% votes (strong consensus-> 90%votes). The response rate was 100% in round 1 and 95.8% in round 2. A consensus was reached on 32/47(68.0%) questions, with strong consensus on 10/47 (21.2%). The panel recommended neoadjuvant chemotherapy (NACT) for patients with positive pleural cytology, and resection of regions involved prior to NACT for stage III-C and only resection of sites of residual disease for stage IV patients. For both primary and secondary CRS, using a combination of clinical and radiological features and validated predictive scores was recommended for patient selection. There was a strong consensus that hyperthermic intraperitoneal chemotherapy (HIPEC) should be added to interval CRS for high-grade serous and mucinous carcinomas, but no consensus on its use in stage IV-A disease. Visceral resections and lymphadenectomy were not recommended in absence of overt disease or suspicion of disease. The panel reached a consensus on many technical aspects of CRS and issues related to HIPEC. These recommendations should be a useful clinical guide for surgeons treating ovarian cancer. Some recommendations could change as new evidence comes in.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02300-0.