Indian Journal of Surgical Oncology最新文献

Introduction: Sternum plays a crucial role in chest stability and protection of vital organs. Sternal defects after major oncological resection pose significant challenge for reconstructive surgery. Traditional techniques using autologous tissue or synthetic material have limitations in achieving optimal functional and aesthetic outcomes. Three-dimensional (3D) printing technology offers a promising solution for personalized sternal reconstruction. This article presents a series of patient with complex sternal defects who underwent 3D-printed sternum reconstruction.

Methods: The article describes the preoperative planning process, surgical technique, and postoperative outcomes after radical resection of primary sternum tumour and reconstruction with 3D titanium implant.

Results: Four patients of primary sternum tumour managed by radical resection and customised 3D implant reconstruction were included. The median age was 33 years with male: female ratio of 3:1. R0 resection was achieved in all, first patient had non porous implant followed three porous implant reconstruction. No patient had postoperative wound or implant related complications. After median follow up of 21 month all patients were alive and disease free.

Conclusion: The 3D printed sternum reconstruction provides a customized, anatomically accurate solution with improved surgical precision and excellent patient satisfaction. Further studies are warranted to evaluate long-term outcomes and cost-effectiveness of this innovative approach.

Background: Functional recovery after tongue cancer surgery involves restoration of oral intake, speech intelligibility, and swallowing function. The Functional Oral Intake Scale (FOIS) is a simple, validated tool for grading oral intake, while the Performance Status Scale-Head and Neck (PSS-HN) measures patient-reported functional outcomes. Their relationship in postoperative tongue cancer patients is not well defined.

Methods: A retrospective analysis was conducted on postoperative tongue cancer patients with documented FOIS and PSS-HN scores. Correlations between FOIS and PSS-HN subscales-Speech Understandability, Eating in Public, and Normalcy of Diet-were assessed using Spearman's correlation coefficient. Missing data were handled using multiple imputation prior to analysis.

Results: A total of 100 patients were included. Higher FOIS scores were significantly associated with improved functional outcomes. FOIS showed a moderate correlation with Speech Understandability (ρ = 0.62, p < 0.001), a strong correlation with Eating in Public (ρ = 0.74, p < 0.001), and the strongest correlation with Normalcy of Diet (ρ = 0.82, p < 0.001).

Conclusion: FOIS is a robust marker of postoperative functional recovery in tongue cancer patients and correlates strongly with patient-reported speech and swallowing outcomes.

Background: Gallbladder adenocarcinoma has limited global prevalence but occurs more frequently in certain regions. The disease is often diagnosed at advanced stages, restricting therapeutic options and contributing to poor outcomes. The molecular mechanisms underlying its development remain largely undefined, complicating the discovery of targeted therapies. Microsatellite instability (MSI), resulting from defective DNA mismatch repair, plays a well-established role in several malignancies; however, its significance in gallbladder adenocarcinoma remains unclear. Characterizing MSI status may help identify patients eligible for novel therapeutic approaches. This study investigates the loss of DNA mismatch repair protein expression in gallbladder adenocarcinoma.

Methods: Samples diagnosed as gallbladder adenocarcinoma were assessed for the expression of four DNA mismatch repair proteins using immunohistochemistry. Antibodies against MLH1, MSH2, PMS2, and MSH6 were employed to evaluate protein expression status. The study included 109 cases, both prospective and retrospective. Cases were included if sufficient paraffin-embedded tissue and relevant clinical data were available. Protein expression results were analysed in relation to clinical parameters and tumor-infiltrating lymphocytes.

Results: The majority of patients were female. Radical cholecystectomy was the most common surgical procedure, while incidentally detected cases were typically managed with laparoscopic cholecystectomy. Most tumors demonstrated moderate differentiation. Immunohistochemistry revealed intact protein expression in 64 cases, whereas 45 cases showed loss of at least one mismatch repair protein. Loss of mismatch repair protein expression was significantly associated with the presence of tumor-infiltrating lymphocytes but not with other clinicopathological features.

Conclusion: Although still incompletely defined, MSI may represent a biologically and clinically relevant subset of gallbladder adenocarcinoma. Clarifying its role could help identify patients who may benefit from targeted or immunotherapy-based treatment strategies. Larger multicenter studies with standardized methodologies are warranted to establish the prevalence, prognostic value, and therapeutic implications of MSI in gallbladder adenocarcinoma.

Background: Colorectal Cancer (CRC) is generally considered a disease of older age; however, there is a rising trend among younger individuals worldwide. There is limited data regarding the demographic profile and clinicopathological aspects of young individuals in South India. This study aimed to evaluate the clinicopathological profile of young patients with CRC.

Methods: This prospective observational study was conducted in the Department of Surgical Oncology, Nizams Institute of Medical Sciences, Telangana, from January 2024 to March 2025. Patients aged less than 50 years were included in the analysis. Demographic details, clinical presentation, tumour marker levels, histopathological details were collected. Associations between age, gender, family history, tumour site, histology, grade, metastasis were analysed. Statistical analysis was performed using SPSS version 23.0 with p value 0.05 considered statistically significant.

Results: Among 163 Early Onset (EO-CRC), 71.46% belongs to 41-50 years age group, with a mean age of 42.46 years. Males constituted 64.4% of patients, and the majority were from Hyderabad district. Family history was observed in 8.5% of patients. The most common tumour location was the rectum (44.9%), followed by the ascending colon (25.3%). Colon cancer patients most commonly presented in stage IV (38.8%), while rectal cancer patients commonly presented in stage III (42.2%). The most common sites of metastasis were the peritoneum (15.3%) and liver (14.1%), followed by the lung (6.7%). A very weak, positive, non-significant correlation was observed between AJCC stage and tumour size and CEA levels. Signet ring (8.64%) and mucinous (7.4%) types were less common than adenocarcinoma. LVSI and PNI were present in 55% and 35% respectively. MSI-high tumours were observed in 18.57%. Higher burden of signet ring tumours was noted in patients aged < 30 years, while mucinous type were more common in the 31-40 years age group. No gender predilection for tumour site was observed; however, signet ring carcinoma was more common in females. Patients with a family history presented at earlier stages, with poorly differentiated carcinoma as the predominant histology. Mucinous tumours, poorly differentiated carcinomas and grade 3 tumours were more common in right colon.

Conclusion: Younger patients present with advanced stages and aggressive tumour variants, underscoring the importance of a high index of suspicion and increased awareness in Indian population.

Background: Breast cancer has surpassed lung cancer as the most diagnosed cancer globally. This retrospective audit, conducted in Eastern India, aimed to evaluate the clinicopathological profile and 5-year survival outcomes of 584 non-metastatic invasive breast cancer patients treated with curative intent between June 2016 and May 2023.

Methods: Clinical and pathological data were analyzed, and patients underwent various treatments, including neoadjuvant therapy, surgery, and adjuvant therapy. Hormone receptor and HER2/neu status were considered in the analysis.

Results: The majority of patients were postmenopausal (60.5%), with T2 tumors (52.2%), clinical node-positive disease (61.5%) and most commonly clinical stage at presentation was Stage IIA (52.7%). Hormone receptor positivity was observed in 61.5% of cases, and HER2/neu positivity in 38.4%. Neoadjuvant therapy was administered to 39.4% of patients. The 5-year disease-free survival was 68.1%, and overall survival was 78.8%. Recurrence, particularly distant recurrence (72%), was the primary cause of treatment failure. Factors influencing survival included clinical nodal positivity and presence of lymphovascular invasion. HER2/neu-positive patients had a 5-year DFS of 65.9%, while triple-negative disease patients had the lowest DFS at 63.5%.

Conclusion: This audit provides important insights into breast cancer management at a tertiary care center in Eastern India. Most patients presented with Stage II or Stage III disease, reflecting the persistent burden of locally advanced presentation in the Indian setting. Survival outcomes were comparable to those reported in other large Indian series. These findings emphasize the need for improved early detection and the role of continuous institutional audits in refining healthcare delivery and improving outcomes.

This study was undertaken to compare and report oncological outcomes of our technique of laparoscopic radical hysterectomy (lap RH) using myoma screw with open radical hysterectomy (RH) for early-stage cervical cancer. This was a retrospective analysis of a prospectively maintained database of early-stage cervical cancer patients undergoing open or lap RH. The clinico-pathological data in the form of age, FIGO (2009) stage, type of surgery, lymph node yield, number of positive lymph nodes, margin status, adjuvant radiation, time and pattern of recurrence and 5-year overall survival data were collected. Out of the 129 eligible patients, 92 underwent open and 37 lap RH. Both groups were comparable in terms of baseline clinico-pathological characteristics, except that the lap group had significantly more low FIGO (2009) stage patients. There was no significant difference in the lymph node yield, lymph node positivity or vaginal cut margin status. The need for adjuvant radiation was higher in the open group (54.4% vs. 8.1%, p < 0.001). Twenty-eight patients (30.4%) in the open group and 11 patients (29.7%) in the laparoscopic group developed recurrence (p = 0.7). There was no difference in the rate, pattern or time to recurrence. There were 22 deaths in the open and seven in the laparoscopic group. The 5-year survival probability for lap RH was 74.6% (95% CI 56.8 to 85.9%) and for open was 75.4% (95% CI 64.6 to 83.3%). Lap RH using myoma screw is an oncologically safe technique in carefully selected patients and can be offered to early-stage cervical cancer.

DGIST represents a small subset, accounting for 4-5% of all GIST. The intricacies of the duodenum's anatomy had led to a scarcity of comprehensive surgical guidelines for its management. Ours is a high-volume pancreaticobiliary unit, and we retrospectively evaluated the management and outcomes of patients with duodenal GIST to formulate an algorithm. We retrospectively analyzed the demographics, perioperative outcomes, and survival data of 25 patients who were operated for DGIST from 2008 to 2021 in the Department of Surgical Gastroenterology. Out of 25 patients, 23 patients (92%) underwent LR, whereas the other 2 patients (8%) underwent PD. The most common type of LR performed was segmental resection with reconstruction (72%). The most common location was in the second (40%, n = 10) part of the duodenum. The median tumor size of the entire cohort was 4 cm. The majority of the patients had negative surgical margin (R0) (PD, 100%; LR, 96%). The 10-year overall survival (OS) for LR and PD was 89.3% and 50% (p = 0.354), while the 10-year disease-free survival (DFS) was 89.7% and 50% (p = 0.217), respectively. A management algorithm was proposed based on our experience. DGIST is a rare entity for which the surgical algorithm is unclear. In experienced hands, morbid surgery (like Whipple's) can be avoided in most of the patients with modified duodenal resection even for large tumors with good oncological outcomes. Neoadjuvant TKI should be used whenever mandated to avoid multiorgan resections.

Cancer has become a significant health burden in India, with an estimated 1.41 million new cases and 0.91 million cancer-related deaths in 2022. The situation is expected to worsen, with projections indicating nearly double the number of new cases by 2050. Uttarakhand, a sub-Himalayan state with a diverse geography, faces unique challenges in cancer care due to its varied demographics, environmental factors, and limited healthcare infrastructure. This hospital-based study conducted at a tertiary care hospital in Uttarakhand between May 1, 2021, and June 30, 2024, aimed to analyze the cancer patterns and trends in the Garhwal region. Data were extracted from the hospital's cancer registry and analyzed for sociodemographic factors, cancer types, and staging at diagnosis. The study included 3600 cancer patients, with 55.2% males and 44.8% females. The most common cancers identified were lung (14.9%), gastrointestinal (14.7%), and head and neck cancers (13.4%). In women, the five most common cancer sites were breast, gallbladder, lung, ovaries, and cervix. In men, the most common sites were lung, urinary bladder, oral cavity, stomach, and colorectum. Most patients (83.3%) were diagnosed at advanced stages. Only 11.6% had received prior oncological treatment, while 20.4% were deemed unfit for treatment and were consequently advised to receive palliative care. This study highlights a significant burden of advanced-stage cancers in the Garhwal region of Uttarakhand. Strengthening early detection, public awareness, and screening programs is urgently needed to improve timely diagnosis and cancer outcomes in this population.

Accurate staging of gingivobuccal complex (GBC) cancers is critical for treatment planning and prognosis. Discrepancies between clinical T staging (cT) and pathological T staging (pT) may lead to over or undertreatment. This study examines these discrepancies to highlight their implications. A retrospective observational study of 469 patients with GBC cancers was conducted at a tertiary care center. Patients underwent clinical staging based on imaging and physical examination and pathological staging following surgical resection. The agreement between cT and pT stages was analyzed using Cohen's kappa coefficient. Concordance between cT and pT stages was 32.08%. Upstaging (pT > cT) occurred in 13.4% of cases, primarily due to extra nodal extension or nodal metastases, while 51.4% of cases were downstaged, often from cT4b to pT4a. Discrepancies arose from misjudgements of tumor size, depth of invasion, and involvement of structures like the masticator space, infratemporal fossa, and bone. Significant discrepancies between cT and pT staging in GBC cancers underscore the limitations of preoperative assessments. Integrating advanced imaging and tagging structures intraoperatively could improve staging accuracy, optimize treatment decisions, and enhance outcomes.