Indian Journal of Surgical Oncology最新文献

Anastomotic leakage (AL) is a major complications following Low Anterior Resection (LAR) for rectal cancer. Identifying risk factors is critical to improving surgical outcomes. This retrospective study analyzed 230 patients with rectal cancer who underwent LAR following neoadjuvant chemoradiotherapy (NCRT) between 2016 and 2024. Patient demographics, tumor characteristics, surgical factors, and postoperative outcomes were examined. Chi-square and t-tests identified significant variables, which were further analyzed using logistic regression. ROC curve analysis determined cutoff values, sensitivity, and specificity for significant predictors. Anastomotic leakage was observed in 18 patients (7.8%). BMI was significantly higher in the AL group (27.89 ± 3.69) compared to the non-AL group (25.67 ± 3.54, p = 0.012). Operative duration was also longer in patients with AL (243.69 ± 86.89 min vs. 192.37 ± 72.4 min, p = 0.005). Logistic regression identified BMI (OR: 1.164, 95% CI: 1.018-1.330, p = 0.027) and operative duration (OR: 1.006, 95% CI: 1.001-1.012, p = 0.018) as independent predictors of AL. ROC analysis showed a BMI cutoff of 27.77 (sensitivity 61.1%, specificity 75.9%) and an operative time cutoff of 175 min (sensitivity 88.9%, specificity 43.4%). Higher BMI and prolonged operative duration independently predict AL after LAR. Addressing these factors preoperatively may help reduce complications and improve patient outcomes.

This retrospective study was conducted to assess the clinicopathological and radiological features, management, and oncological outcome of endometrial stromal sarcoma (ESS). Data were collected from all cases of ESS treated at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) from 2012 to 2023. The clinical and radiological features and treatment offered were collected, and overall survival rates were analyzed. A total of 18 cases were collected, with 50% being high-grade and 50% being low-grade disease. The mean age was 48 years, with 44% being post-menopausal. The most common presentation was abnormal uterine bleeding. Ultrasound showed leiomyoma in 44.4% of cases and a heterogeneous mass in the endometrium in 22.2%. Pre-operatively, four patients had a diagnosis of endometrial stromal sarcoma. Five patients had disease recurrence; four were high-grade ESS, and one was low-grade ESS. Of the 18 patients, four succumbed to the disease. The median follow-up period (interquartile range IQR) was 24 months (3 to 108 months). The mean survival time was 89.7 months (CI 63.8-115.6; S.E ± 13.2), and the mean progression-free survival time was 75.9 months (CI 43.3-108.5; S.E ± 16.6). Thus, ESS can have a wide range of presentations and should always be suspected in women with symptomatic fibroid and mass in the endometrium, especially in the post-menopausal age group. The patient's age and tumor stage and grade are the most important prognostic factors affecting the overall survival time.

Rhabdomyosarcomas (RMS) form a major subset of pediatric sarcomas with an incidence of 4.5/million cases/year. Adult RMS is rare. Retroperitoneal (RP) RMS in adults is rarer with only a handful of cases reported to date. The management involves surgery with chemotherapy for resectable disease and definitive chemoradiotherapy for the unresectable. The outcome of adult RP RMS is worse than the pediatric counterparts. This image illustrates a locally advanced adult RP RMS treated with perioperative chemotherapy and multivisceral along with vascular resection to achieve a favorable outcome.

Leadership and mentorship are key drivers of growth in oncology, especially during the pivotal transition from senior resident to mid-level consultant. While these roles are essential for career development, they often come at a significant cost to physical and mental health, as well as personal and family life. Senior residents and newly minted consultants endure long hours, chronic stress, and emotional burnout. The culture in many oncology departments exacerbates these struggles, especially when mistakes are harshly reprimanded rather than used as learning tools. This review delves into the often-overlooked facets of leadership, mentorship, and the critical yet unmet need for guidance in navigating the mid-level consultant trajectory, emphasizing their pivotal role in fostering more sustainable and fulfilling careers.

Primary liver tumors vary in carcinogenesis. It is well known that these tumors have two carcinogenic pathways: small and large duct pathogenesis. Small duct pathogenesis is always present as mass-forming tumors. Large duct etiology tumors can be periductal infiltration or intraductal growth with mass-forming appearing in the late stage. Our objective is to analyze and compare the characteristics and outcomes of patients with mass-forming lesions in the liver based on their pathogenesis. A retrospective analysis was undertaken from January 2012 to December 2017. We analyzed the 222 medical records of all patients who had curative-intent hepatic resection for mass-forming, pathologically proven primary liver cancer. Analyses included clinical, pathological, and survival characteristics. Hepatocellular carcinoma (HCC) was the most prevalent tumor type (43.4%), followed by papillary cholangiocarcinoma (CCA) (27.6%), tubular CCA (22.6%), adenosquamous carcinoma (ASC) (4.1%), and small duct, mass-forming cholangiocarcinoma (SD-CCA) (2.3%). HCC and SD-CCA patients had a considerably greater survival rate than CCA and ASC patients. HCC, SD-CCA, papillary CCA, tubular CCA, and ASC had median survivals of 1373, 1180, 591, 447, and 205 days. Tumors in large duct pathogenesis are usually associated with increased rates of hilar invasion, lymph node involvement, and positive surgical margin. ASC is associated with a significantly poorer prognosis. Small duct pathogenesis tumors exhibit several shared characteristics and demonstrate a more favorable prognosis. Tumors in large duct pathogenesis are usually associated with increased rates of hilar invasion, lymph node involvement, and positive surgical margin. ASC is associated with a significantly poorer prognosis.

Meningiomas are among the most frequent primary brain tumors, so knowing the association of different factors with the imaging recurrence of meningiomas is important for post-surgical decision-making. We conducted a retrospective analysis in six high specialty hospitals in Mexico with 190 patients diagnosed with meningiomas and who underwent resection surgery from 2009 to 2019. A univariate and multivariate analysis was performed to identify different risk factors, a simple linear regression analysis for quantitative variables, and a comparison of means to identify the impact of the different factors with the months of survival free of tumor recurrence. A total of 190 patients were analyzed, with an overall recurrence rate of 38.9% (74 patients). Regarding risk factors, the onset of intracranial hypertension syndrome was associated with a higher risk of tumor recurrence at follow-up. The simple linear regression analysis found that the greater the intraoperative bleeding, the lower the survival rate of tumor recurrence. In the comparison analysis of means, the intracranial hypertension syndrome and the petroclival location significantly reduced the months of free survival of the tumor recurrence. We report that a clinical presentation such as intracranial hypertension syndrome increases the risk of recurrence in meningiomas up to eight times more and that the greater the intraoperative bleeding, the lower the survival free of recurrence.

We describe an image depicting the syndromic association of multiple cutaneous leiomyomas and uterine fibroids, which goes by the name of "Reed syndrome". This syndrome predisposes affected individuals to renal cell carcinomas. Close surveillance is necessary in them.

Dysphagia is a prevalent swallowing dysfunction in cancer patients. Due to its life-threatening complications, early diagnosis and management are essential. Improving the knowledge (K) and attitude (A) of the medical staff potentially affects their practice (P). Conducting KAP studies is one way to find gaps in delivering patient care. This study aimed to investigate the KAP of healthcare providers working with cancer patients to find the gaps and create a basis for educational policies to improve the quality of care in the future. This is a cross-sectional study in which 147 healthcare providers in the oncology wards were enrolled. KAP of the participants was assessed by a validated and reliable researcher-made questionnaire. The mean score of knowledge was 14.95 ± 2.41 out of 38. A few participants (2.7%) were able to recognize all the symptoms of dysphagia. Half of the participants wrote their recommendations to the patients. The most prevalent recommendations were using soft and pureed food (65.4%) and decreasing the volume of the food (34.6%). There was a positive correlation between the score of the knowledge and mentioning the symptoms for diagnosis (p-value = 0.007) and intervention recommendations (p-value = 0.019). The participants' knowledge was very limited. They relied only on obvious symptoms of dysphagia instead of relying on a multidimensional point of view on diagnosis. Improving knowledge through hands-on courses with a multidisciplinary point of view is recommended to improve the quality of care for patients.

Axillary dissection provides prognostic information and regional control and possibly improves overall survival. The usefulness of level III lymph node dissection is less well studied. The study aims to identify the rate of level III nodal positivity and factors that can predict its involvement. A retrospective analysis of 190 breast cancer patients (cT1-3, N0-1, M0) who underwent surgery (modified radical mastectomy or breast conservation surgery) between May 2017 and December 2020 at a tertiary care centre was done. Clinical and pathological details were obtained from the electronic medical record. The rate of level III nodal positivity in patients with pathologically positive level I/II lymph nodes was 23.15% (n = 22). Skip metastasis in level III without involvement in levels I and II was 0.52% (n = 1). There was a significant correlation between involvement of level I/II lymph nodes (p ≤ 0.001), lymphovascular invasion (p = 0.001), pathological tumour size (p = 0.015), extranodal extension in level 1/2 lymph nodes (p < 0.00001) and level III lymph node metastases. Level III lymph node dissection should be performed in all patients with metastases in level I/II axillary lymph nodes.