Indian Journal of Surgical Oncology最新文献

Renal papillary adenoma (RPA) is a rare benign tumor that is usually asymptomatic and incidentally detected. Although typically benign and of low malignant potential, close monitoring and further investigation is warranted due to the potential association with renal cell carcinoma and other associated conditions as per the present literature. We performed a clinicopathological evaluation of incidentally detected renal papillary adenomas to ascertain features having a prognostic impact along with the systematic review of literature. All cases of incidentally detected RPA of the kidney from January 2019 to December 2022 were assessed for size, site of adenomas, clinical features, associated conditions, clinical diagnosis, and a number of adenomas. Each feature was noted and correlated with the associated conditions of the patient and prognosis. We received a total of 62 nephrectomies, in the Department of Pathology, AIIMS Rishikesh, for non-functioning kidneys from January 2019 to December 2022, four cases exhibit incidentally detected renal papillary adenoma. Medical renal biopsies received during the period were 330 in number and only one case shows renal papillary adenoma along with IgA nephropathy and focal segmental glomerulosclerosis (FSGS) lesion. The association of both entities is unclear in the medical literature and is a rare finding. Two cases of chronic pyelonephritis demonstrate multiple adenomas of varying sizes and one was associated with hepatitis B virus infection. Our study outlines histomorphology spectrum of incidentally detected RPA and emphasizes its frequent occurrence in patient undergoing nephrectomies for non-functioning end-stage kidney diseases and rare association of IgA nephropathy. Limitation of the study was a small number of cases with follow-up.

Head and neck cancer is one of the most common cancers worldwide which exhibits a continuous rising trend of prevalence and incidence rates across the globe. Head and neck cancer is found to be more prevalent in developing nations like India where it is responsible for significant cancer-related mortality rate. We aim to analyze the prevalence, incidence, and mortality trends of head and neck cancers in India as per the latest Global Cancer Observatory (GLOBOCAN) 2022 estimates produced by the International Agency for Research on Cancer (IARC) and disseminated as Cancer Today on GLOBOCAN website. The GLOBOCAN 2022 database includes seven types of head and neck cancers, including the lip and oral cavity, hypopharynx, nasopharynx, oropharynx, salivary gland, larynx, and thyroid cancer. These categories are made according to the International Classification of Diseases Related Health Problems, 10th Revision (ICD-10) based on anatomical location of tumor. The data was extracted for the prevalence, incidence, and mortality rate. The incidence rate trend was analyzed for 15 years, from 2003 to 2017. The estimated rise in the incidence rate was predicted until 2050. The highest prevalence was reported for lip and oral cavity cancer which was 26.31, 17.07, and 6.4 for the 5 years, 3 years, and 1 year per 100,000 individuals respectively. The age-standardized rate (ASR) and crude incidence rate were highest for the lip and oral cavity cancers (9.91 and 10.22 respectively). The incidence rate of larynx and thyroid cancer remains stabilized over 15 years from year 2003 to 2017. The percent risk of rise of new cancer cases by the year 2050 is maximum for oropharynx cancer (103.9%). GLOBOCAN is one of most compressive global cancer databases which provides important insight regarding cancer across 185 countries. Head and neck cancer in India was found to impose a high prevalence, incidence, and mortality rate. Healthcare agencies need to derive an action plan to reduce the rising risk of head and neck cancer in India.

Unusual tumors and tumor-like lesions are rare in the stomach and occur with variable incidence. Such lesions have either epithelial or mesenchymal origin, and present with non-specific clinical features like abdominal pain, melena, vomiting, and have overlapping radiological features, and thus, mimic other gastric tumors which may have markedly different management and prognosis. At times, esophagogastroduodenoscopy (EGD), different imaging modalities, and even histopathology of endoscopic biopsy may be non-contributory owing to atypical presentation, rare occurrence and unfamiliarity of radiologists or pathologists with such rare lesions. Even repeated endoscopic biopsies may prove inconclusive and in such situations excision of the lesion with confidence and its further histopathological examination helps us to reach a definitive diagnosis. Here, we present a heterogeneous collection of such gastric lesions mainly to emphasize the importance of a thorough and meticulous histopathological examination and the familiarity of a pathologist with these lesions during the evaluation of all gastric lesions, which in the light of relevant clinical information, EGD findings and radiological impression can lead to a prompt and correct diagnosis.

To compare the progression-free survival (PFS) and overall survival(OS) among patients diagnosed with platinum-sensitive recurrent ovarian cancer (PSROC) and undergoing secondary cytoreduction with chemotherapy versus chemotherapy alone. We did a 1:1 propensity score-matched analysis (PSM) on retrospectively collected data of all patients with PSROC patients treated at our center from January 2014 to December 2020. Patients were categorized into chemotherapy with secondary cytoreductive surgery (SCH) and chemotherapy alone (CH). PSM was done with baseline characteristics. Cox proportional hazard model was used to compare survivals between the matched cohorts. We identified 96 patients (SCH, N = 29; CH, N = 67). After matching, there were 58 patients (29 in each group). SCH patients had better OS and PFS compared to CH in the matched cohort [median OS 40.27 versus 23.17 months (p = 0.002) and median PFS was 26.5 versus 8.6 months (p < 0.001)] respectively. In univariate and multivariate Cox regression analysis, treatment modality (SCH vs. CH alone) at recurrence was the only significant factor for both OS and PFS. Our series had no perioperative mortality, and the morbidity was manageable. In patients with PSROC, chemotherapy with secondary cytoreductive surgery resulted in better OS and PFS than chemotherapy alone, with acceptable perioperative morbidity and no perioperative mortality.

Surgical complications are graded using various systems, with the Clavien-Dindo classification (CDC) being the most widely used due to its simplicity and ease of replication. The Comprehensive Complication Index (CCI) was recently introduced to overcome the shortcomings of the CDC. This study aims to compare the Clavien-Dindo classification and the Comprehensive Complication Index in assessing post-operative complications. After elective surgery for Gastrointestinal malignancies, post-operative complications were recorded using the CDC and CCI scoring systems. CCI was calculated from free online software (https://www.cci-calculator.com). Using Pearson and Spearman correlations, both scores were correlated with the ICU stay and hospital stay. Between August 2021 and April 2023, 141 patients were included. The median number of complications per patient was 3 (range 1 to 10). The median CCI score was 39.3 (12.2 to 100). The median postoperative hospital stay was 8 days (range, 4-54 days). The median length of ICU stay was 1 day (range, 0-22 days). Using the Pearson and Spearman correlations, there was a strong correlation between both the CDC and CCI with the duration of hospital stay (correlation coefficient, 0.706 vs. 0.731, p < 0.001) and ICU stay (0.768 vs. 0.755, p < 0.001). The Comprehensive Complication Index and the Clavien-Dindo classification highly correlate with the length of hospital stay and ICU stay, with the CCI score having an edge in correlating better with hospital stay. Due to its dynamicity, the CCI score may be a better tool to depict postoperative complications in morbidity meetings and publishing literature.

The oral tongue is a common location for squamous cell carcinoma (SCC) and behaves more aggressively. Lymph node yield(LNY) is a robust independent prognostic factor in oral SCC. In this study, we attempt to determine the prognostic significance of LNY per neck node level for oral tongue SCC. This retrospective observational study includes 302 patients with oral tongue SCC who were operated in our unit between 2017 and 2022. Relevant data were collected, and patients followed up for at least 24 months. LNY per level was calculated and correlated with recurrence and overall survival. A total of 344 neck dissections were performed on 302 patients. On average, 36 nodes (36.05 ± 15.02) were harvested per neck dissection. The maximum yield was found in level IIa, 6.72 (6-10), irrespective of pathological node positivity. On multivariate analysis, a higher LNY at level IIa significantly correlated with recurrence, along with other factors. We found that LNY of 10 or more nodes from level II might be a more sensitive predictor of recurrence than overall LNY per neck dissection. This could be because level II nodes receive a majority of lymphatic drainage from the oral tongue. Total LNY may be impacted by yield at other levels and may lull the surgeon into a false sense of security, when clearance of the most crucial nodal basin at level II remains suboptimal.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02219-6.

Cytoreductive surgery (CRS) for peritoneal malignancies is conventional performed employing a large incision from the xiphisternum to the pubis. Recent publications have suggested a minimally invasive approach to achieve similar outcomes in patients with limited peritoneal cancer spread. This manuscript reports the results of a consensus exercise that aimed to provide recommendations on minimally invasive cytoreductive surgery (MI-CRS) for which evidence is limited. The consensus was carried out using the modified Delphi technique. There were 23 questions on two main topics: staging laparoscopy and minimal invasive cytoreductive surgery. A total of 56/62 invited surgeons agreed to vote on the consensus. A consensus was achieved if any option received > 70% of votes, and a strong consensus was set at > 90%. In rounds I and II both, 50/56 (89.28%) panellists voted. Overall, a consensus was achieved on 18/23 (78.2%) questions (strong consensus on 17.3%). The panel strongly recommended that MI-CRS should not be performed if there is incomplete evaluation during the staging laparoscopy. The panel considered PCI > 10, previous extensive abdominal surgery, large intraabdominal masses, gross diaphragmatic involvement and multi-focal mesenteric disease as contraindications to MI-CRS. There was no consensus obtained on the technique of HIPEC after MI-CRS and on performing MI-CRS in high-grade tumours and after neoadjuvant chemotherapy in advanced ovarian cancer. This consensus laid down recommendations for technical aspects of staging laparoscopy and patient selection and technical aspects of MI-CRS. The results should spur more collaborative studies across the world to address key questions related to MI-CRS.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02271-2.

Squamous cell carcinomas of head and neck region usually carry a poor prognosis despite being subjected to multimodality treatment. The recurrence rate in cancers of the oral cavity are almost 20-30% in early stage and approximately 50% in advanced stages. Salvage surgery carries the highest survival advantage in both recurrent and second primary cancers of the oral cavity. We present a retrospective analysis of prospectively collected dataset of a tertiary care centre of 40 patients which included 28 recurrent and 12 patients of second primary head and neck squamous cell carcinomas. The study was conducted to identify factors that are associated with a poor disease outcome of surgical salvage for recurrent and second primary HNSCC. Advanced tumour stage and higher WPOI score were found to be associated with poorer prognosis.

The last 25 years have seen considerable changes in cancer epidemiology in India. Numerous studies have shown increases in certain cancers, such as lifestyle and tobacco-related cancers, with decreases in other cancers, such as cervical cancer. Despite the development of the National Cancer Registry Program in 1964, cancer is not a notifiable disease in India, and there remains no comprehensive cancer registry with data relying on regional and hospital-based registries. This retrospective study aimed to elucidate the trends in cancer epidemiology in the West Bengal region over a period of 25 years (1996-2020). Our analysis includes retrospective data from the hospital electronic records of a tertiary cancer institution in Kolkata which serves patients from Kolkata as well as Eastern, North-Eastern India and Bangladesh. We collected data from 189,485 patients (of which 135,578 had malignant disease) who were diagnosed during this time. Data was visualised using Microsoft Excel and analysed using linear trend analyses and the Mann-Kendall test. We saw significant increases in breast cancers amongst females and oral cavity cancers amongst males, consistent with other studies across various regions of India. In contrast, we identified significant decreases in the frequency of cervical cancers amongst females and cancers of the ear, nose and throat regions amongst males. We report that the cancer epidemiology in West Bengal is generally following that of the rest of India. Our study has revealed important trends in cancer frequency in West Bengal and has illustrated important areas for targeting preventative and/or screening interventions.

Supplementary information: The online version contains supplementary material available at 10.1007/s13193-025-02252-5.