A retrospective clinicopathological study of 131 cases with endometrial cancers--is it possible to define the role of retroperitoneal lymphadenectomy in low-resource settings?

Efficacy of a Gender-Relevant Smoking Cessation Intervention Among Women in Brazil: Findings from a Group Randomized Controlled Trial

Background: There is scarcity of smoking cessation programs that take gender into account during its development, implementation, and evaluation. We evaluated the efficacy of a theory-based, culturally, and gender-relevant smoking cessation intervention delivered by Community Health Workers (CHWs) among Brazilian women that augments the smoking cessation program offered through the public health system (PHS). Materials and Methods: A total of 328 women current smokers (100% cigarette smokers) were recruited across 8 towns in a tobacco producing state in Brazil between 2014 and 2017. Four towns were randomly assigned to the intervention (12 home visits by a CHW and a scheduled appointment to attend the smoking cessation program at the PHS) and four towns to the control condition (scheduled appointment to attend the cessation program at the PHS). The primary outcome was self-reported 7-day smoked tobacco abstinence at 7-month follow-up with biochemical verification. Results: Retention at 7-month follow-up was 80.7% (intervention) and 85.1% (control). Using intention-to-treat analysis, abstinence at 7-month-follow-up was 20% in the intervention arm versus 11% in the control arm. Multivariable modeling showed that participants in the intervention arm had 1.88 times the odds of self-reported smoking cessation than control participants after adjustment for depressive symptomatology, self-efficacy, and having someone in the house who smokes. Besides the intervention, only self-efficacy remained significant in the full model as a predictor of cessation. Replication of these analyses using the objective measure of carbon monoxide at a cutoff score of 8 ppm yielded similar results. Conclusions: A theory-based, culturally, and gender-relevant intervention, delivered by CHWs, can successfully promote smoking cessation among women. Clinical Trial Registration No. NCT03845413.

Survival Outcomes in Patients with Thymoma after Thymectomy in an Indian Scenario

Thymomas are relatively slow growing with late presentation. Because of rarity and underreporting in India, there is an unmet need for evaluating the patient characteristics and assessing the factors affecting survival for standardizing the ideal modality of treatment in Indian population. A retrospective analysis of 96 patients with thymoma was done between 1998 and 2018. Patient characteristics, histopathological characteristics, operative outcomes, local recurrences, and survival outcomes were recorded. Survival analysis was done using Kaplan-Meier method, and statistical data were analyzed using SPSS version 25 (IBM). The incidence of thymoma was relatively high in 6th decade with no sex predilection. Common presenting symptoms were cough and dyspnea. Myasthenia gravis was noted in 30.2%, which resolved after thymectomy in 65.5% of patients. Most patients presented with Masaoka stages I and II, and predominant WHO histological types were B1 and AB. Complete resection was done in 69.8% cases, and local recurrence was noted in 15.6%. Median sternotomy was the most frequently used approach for thymectomy. The 5-year overall survival was 76%, with an excellent 5-year survival of 95% and 86% in stages I and II patients. Masaoka stage, WHO histologic type, completeness of surgery, and local recurrence did affect the survival significantly. Masaoka stages III and IV, histological type B3, incomplete resection during surgery, and presence of local recurrence did independently predict a worse overall survival.

Surgical and Oncological Outcomes in Locally Advanced Thymoma

This study aimed at reporting the surgical management of locally advanced thymoma (Masaoka stages III and IVA) and evaluating the factors predicting the survival. This is a retrospective analysis of patients operated for locally advanced thymoma from March 2012 to December 2019 in a thoracic surgery center in India. An analysis of all perioperative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Out of total 54 patients, 42 (77.8%) had stage III and 12 (22.2%) had stage IVA. Upfront surgery was done in 34 (63%) patients, and induction chemotherapy was given in 20 (37%) patients. Pericardium was the commonest structure resected (79.6%) followed by the lung (51.8%), phrenic nerve (48.1%), major vascular structures (40.7%), parietal pleura (22.2%), diaphragm (9.2%), and right atrial appendage (1.8%). Forty-seven (87%) cases had complete (R0) resection, and the remaining 7 (12.9%) cases had incomplete (R1/R2) resection. There were no perioperative deaths (< 90 days). The median follow-up was 58 months. Overall survival (OS) and disease-free survival (DFS) at 5 years were 77.8% and 75.9%. Higher age (> 60 years), incomplete surgical resection, type B histology, and "> 3" structures resected with tumor were the poor prognostic factors for survival. An aggressive surgical approach, by an experienced team of cardiac and thoracic surgeons, aimed at complete resection is vitally important and can achieve excellent surgical and oncological outcomes even in locally advanced thymomas.

The risk and pattern of pelvic and para aortic lymph nodal metastasis in patients with intermediate and high risk endometrial cancer

There is a continuous debate about the extent and prognostic value of retroperitoneal lymphadenectomy in endometrial cancer. Systematic pelvic and para-aortic lymphadenectomy in endometrial cancer provides a more accurate assessment of neoplastic spread and may help in better individualization of patients for adjuvant therapy. To evaluate the risk and pattern of retroperitoneal lymph nodes metastasis in patients with endometrial cancers having intermediate and high risk factors for nodal metastasis and recurrence. We conducted a prospective nonrandomized study of 62 cases of high risk endometrial cancers examined and treated at our regional cancer institute between the years 2008 and 2012. The inclusion criteria: The intermediate risk; all patients having grade 3 or undifferentiated adenocarcinomas with less than half MI and the grade 1, 2 tumors having more than half MI with tumor size >2 cm. The high risk group; all the patients having grade 3 or undifferentiated adenocarcinomas with more than half MI, the grade 1, 2 tumors with lymph vascular space invasion (LVSI) or cervical stromal invasion as depicted by pre-operative MRI. The type 2 histology uterine papillary serous, clear cell and squamous cell carcinomas. The patients staging was carried out according to the classification established by the FIGO for endometrial cancer in 2009. The Chi-square test was used to analyze the correlation between tumor grade, myometrial invasion, size of the lesion and lymph nodes metastasis and Fisher's correction done whenever the frequency distribution was less than five. The patients mean age was 58.3 (range 31 to 76 years). A total of 118 endometrial cancer patients were treated during the study period. The 56 (47.5 %) patients belonged to low risk and 62 (52.5 %) patients belonged to high risk endometrial cancers. The 52 of 62 cases were eligible for the analysis. The 10 patients' were excluded from further analysis as the post operative specimens final histopathologic examinations in nine cases revealed carcinosarcoma uterus and one case with yolk sac tumor of endometrium. The total 17(32.7 %) of 52 cases had retroperitoneal nodes metastasis; nine of 17 (52.9 %) in this group had both pelvic and para-aortic lymph nodal metastasis and one of 17 (5.9 %) had isolated para-aortic lymph nodal metastasis. The high grade tumors (grade 3) revealed 41.4 % pelvic and 20.7 % para-aortic lymph nodes metastasis and there was statistically significant higher nodal metastasis in both pelvic and para-aortic lymph nodes with increasing depth of myometrial invasion (P = 0.0119 and P = 0.0001) and increasing size of the lesion. (P = 0.04 and P = 0.0501). The intermediate and high risk endometrial cancer is associated with greater degree of lymph node metastasis. A complete surgical staging which involves extrafascial hysterectomy or a type 3 radical hysterectomy when there is a cervical involvement, along with bilateral salphingo-oophorectomy, pelvic, para-aortic lymphadenectomy and an omentectomy when indicated as in the present study, is a valuable modality of treatment in intermediate and high risk cases of endometrial cancers for determining the prognosis and appropriate categorization of these women for adjuvant therapy. It is also possible to achieve a complete surgical staging in these groups of women with acceptable morbidity when performed by a trained gynaecologic oncologist.