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Vinchurkar K, Kenwadkar R, Pattanshetti V, Aggarwal S, Gupta U, Ahmed I. Hybrid Minimally Invasive Esophagectomy for Carcinoma Oesophagus: Experience at Tertiary Care Centre in North Karnataka. Indian J Surg Oncol 2023; 14:398-404. [PMID: 37324303 PMCID: PMC10267028 DOI: 10.1007/s13193-023-01703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
Surgery remains the mainstay for curative treatment of carcinoma of midthoracic and lower thoracic oesophagus. In the twentieth century, open esophagectomy was the standard of care. In the twenty-first century, treatment for carcinoma oesophagus has revolutionized with incorporation of neoadjuvant treatment and application of various minimally invasive techniques for esophagectomy. At present, there is no consensus about the optimum position to perform minimally invasive esophagectomy (MIE). We share our experience of MIE with modification in the port position in this article.
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Affiliation(s)
- Kumar Vinchurkar
- Department of Surgical Oncology, JNMC, KAHER, Belagavi, Karnataka India
- KLES Dr Prabhakar Kore Hospital & MRC, Belagavi and KLES Belgaum Cancer Hospital, Belagavi, India
| | - Rahul Kenwadkar
- Department of General Surgery, JNMC, KAHER, Belagavi, Karnataka India
| | | | - Salil Aggarwal
- Department of General Surgery, JNMC, KAHER, Belagavi, Karnataka India
| | - Urbee Gupta
- Department of General Surgery, JNMC, KAHER, Belagavi, Karnataka India
| | - Imtiaz Ahmed
- Department of Radiation Oncology, KLES Belgaum Cancer Hospital, Belagavi, Karnataka India
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Nerli R, Kalloli M, Rangrez S, Ghagane SC, Vinchurkar K, Shreya S, Thakur ML. Diagnosis of Oral Cancers by Targeting VPAC Receptors: Preliminary Report. Asian Pac J Cancer Prev 2023; 24:1711-1715. [PMID: 37247292 PMCID: PMC10495900 DOI: 10.31557/apjcp.2023.24.5.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Oral cancer is a major health problem. The study of exfoliative cytology material helps in the differentiation of premalignant and malignant alterations of oral lesions. The objective of this study was to assess the feasibility of detecting oral cancer by targeting genomic VPAC (combined vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide) receptors expressed on malignant oral cancer cells. PATIENTS & METHODS All patients with suspected oral cavity cancers/lesions formed the study group. The samples from the oral cavity lesion or suspicious area were collected with a cytology brush. The harvested material was examined for malignant cells by 1. the standard PAP stain and 2. targeting the VPAC receptors on the cell surface using a fluorescent microscope. Similarly, malignant cells were identified from cells shed in oral gargles. RESULTS A total of 60 patients with oral lesions were included in the study. The histopathological diagnosis was squamous cell carcinoma in 30 of these. The VPAC receptor positivity both on the brush cytology staining as well oral gargle staining was more sensitive than the brush cytology PAP staining. The accuracy of the various techniques was as follows, brush cytology PAP staining at 86.67%, brush cytology VPAC staining at 91.67% and oral gargle VPAC staining at 95%. CONCLUSIONS This preliminary study validates our belief that malignant cells in the saliva can be identified by targeting the VPAC receptors. The test is simple, easy, non-invasive and reliable in the detection of oral cancers.
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Affiliation(s)
- Rajendra Nerli
- Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, India.
| | - Mahesh Kalloli
- Department of Surgical-Oncology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, India.
| | - Shadab Rangrez
- Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, India.
| | - Shridhar C Ghagane
- Department of Biotechnology, KAHER‟s Dr. Prabhakar Kore Basic Science Research Center, III Floor, V. K. Institute of Dental Sciences Campus, Nehru Nagar, Belagavi, India.
| | - Kumar Vinchurkar
- Department of Surgical-Oncology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, India.
| | - Shreya Shreya
- Urinary Biomarkers Research Centre, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, India.
| | - Madhukar L Thakur
- Departments of Urology, Radiology, Thomas Jefferson University, Philadelphia, PA, USA 6The Sidney Kimmel Cancer Centre, Thomas Jefferson University, Philadelphia, PA, USA.
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Ahmed I, Krishnamurthy S, Vinchurkar K. Prognosticating Gross Tumor Volume in Head-and-Neck Cancer - Redefining Gross Tumor Volume Beyond Contouring. J Med Phys 2023; 48:68-73. [PMID: 37342608 PMCID: PMC10277296 DOI: 10.4103/jmp.jmp_101_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose Precision radiotherapy (RT) requires accurate delineation of gross tumor volumes (GTVs) for targeted dose delivery. Volumetric measurement of this GTV can predict the treatment outcomes. This volume has been limited for mere contouring and its potential as the prognostic factor is less explored. Materials and Methods The data of 150 patients with oropharynx, hypopharynx, and larynx cancer undergoing curative intensity-modulated RT and weekly cisplatin between April 2015 and December 2019 were retrospectively evaluated. GTV-P (primary), GTV-N (nodal), and GTV-P+N were defined, and volumetric parameters were generated. Volume thresholds were defined as per the receiver operating characteristics, and the prognostic value of these tumor volumes (TVs) with respect to treatment outcomes was analyzed. Results All patients completed 70 Gy, median chemotherapy cycles were six. Mean GTV-P, GTV-N, and GTV-P+N were 44.5 cc, 13.4 cc, and 57.9 cc, respectively. Oropharynx constituted 45% of cases. Forty-nine percent had Stage III disease. Sixty-six percent had complete response (CR). As per the defined cutoff values, GTV-P <30cc, GTV-N <4 cc, and GTV-P+N <50 cc had better CR rates with P < 0.05 (82.6% vs. 51.9%; 74% vs. 58.4% and 81.5% vs. 47.8%, respectively). At median follow-up of 21.4 months, overall survival (OS) was 60% and median OS was 32.3 months. The median OS in patients with GTV-P <30 cc, GTV-N <4 cc, and GTV-P+N <50 cc was better with P < 0.05 (59.2 vs. 21.4; 59.2 vs. 22.2, and 59.2 vs. 19.8 months, respectively). Conclusion GTV should not just be limited for contouring but its role as an important prognostic factor has to be recognized.
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Affiliation(s)
- Imtiaz Ahmed
- Department of Radiation Oncology, JNMC and KLES, Dr. Prabhakar Kore Hospital and MRC, KAHER, Belgaum, Karnataka, India
| | - Sapna Krishnamurthy
- Department of Radiation Oncology, JNMC and KLES, Dr. Prabhakar Kore Hospital and MRC, KAHER, Belgaum, Karnataka, India
| | - Kumar Vinchurkar
- Department of Surgical Oncology, JNMC and KLES, Dr. Prabhakar Kore Hospital and MRC, KAHER, Belgaum, Karnataka, India
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Vinchurkar K, Gopinath KS. A Tribute to Dr. Sandeep Madhwapathy - an Entrepreneur-Built Belgaum Cancer Hospital to KLES Belgaum Cancer Hospital. Indian J Surg Oncol 2022; 13:113-114. [PMID: 36691517 PMCID: PMC9859972 DOI: 10.1007/s13193-022-01562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Kumar Vinchurkar
- Department of Surgical Oncology, J. N. Medical College, Belagavi, India
| | - K. S. Gopinath
- HCG Hospital and Bangalore Institute of Oncology, Bangalore, India
- Sri Devaraj Urs Medical College, Kolar, India
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Ahmed I, Krishnamurthy S, Bhise R, Vinchurkar K, Kalloli M. Concurrent Weekly Cisplatin and Simultaneous Integrated Boost-IMRT in Locally Advanced Head and Neck Squamous Cell Carcinoma-An Institutional Experience. South Asian J Cancer 2022; 11:235-242. [PMID: 36588613 PMCID: PMC9803551 DOI: 10.1055/s-0042-1743578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction Concurrent chemoradiation with weekly cisplatin in locally advanced head and neck squamous cell carcinoma (LA-HNSCC) is widely practiced in India. Radiation with simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) has the advantage of executing IMRT in single phase with better dose distribution. Material and Methods 150 patients with LA-HNSCC treated between April 2015 and December 2019 were retrospectively evaluated. All patients received 70Gy in 33 to 35 fractions with SIB-IMRT and concurrent weekly cisplatin at a dose of 40 mg/m 2 . Treatment compliance and toxicities were assessed. Overall survival (OS) was evaluated using Kaplan-Meier estimates; univariate and multivariate analysis of prognostic factors were also evaluated. Results Median age was 58.5 years. Forty-five percent had primary oropharyngeal cancer. Sixty-two percent had T3 disease, 41% had N2 disease, and 51% had stage IV disease. All patients received 70Gy dose of RT. Median chemotherapy cycles were six, 84.7% received 200 mg/m 2 . Acute grade 2 xerostomia was seen in 79%, grade 3 neutropenia, mucositis and pharyngitis were seen in 11, 15, and 21%, respectively. Complete response was seen in 66.6%. At median follow-up of 21.4 months (3-71) OS was 60% and median OS was 33.2 months. Estimated 2 and 3 year OS was 56 and 48%. On univariate analysis, absence of node, N0-N1, stage III, cisplatin use, dose per fraction 2.12Gy ,and complete response showed good OS ( p <0.05). On multivariate analysis dose per fraction 2.12Gy and complete response showed good OS ( p <0.05). Conclusion Definitive chemoradiation with weekly cisplatin and SIB-IMRT in LA-HNSCC is well tolerated with good clinical outcomes.
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Affiliation(s)
- Imtiaz Ahmed
- Department of Radiation Oncology, KLES Belgaum Cancer Hospital and KLES Dr Prabhakar Kore Hospital and MRC, Belgaum, India,Address for correspondence Imtiaz Ahmed, MD Department of Radiation Oncology, KLES Belgaum Cancer HospitalBelgaumIndia
| | - Sapna Krishnamurthy
- Department of Radiation Oncology, KLES Belgaum Cancer Hospital and KLES Dr Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Rohan Bhise
- Department of Medical Oncology, KLES Belgaum Cancer Hospital and KLES Dr Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Kumar Vinchurkar
- Department of Surgical Oncology, KLES Belgaum Cancer Hospital and KLES Dr Prabhakar Kore Hospital and MRC, Belgaum, India
| | - Mahesh Kalloli
- Department of Surgical Oncology, KLES Belgaum Cancer Hospital and KLES Dr Prabhakar Kore Hospital and MRC, Belgaum, India
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Nerli RB, Ghagane SC, Ram P, Shimikore SS, Vinchurkar K, Hiremath MB. Bladder Invasion in Patients with Advanced Colorectal Carcinoma. Indian J Surg Oncol 2018; 9:547-551. [PMID: 30538386 DOI: 10.1007/s13193-018-0788-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 07/13/2018] [Indexed: 11/24/2022] Open
Abstract
Involvement of the bladder by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. Extirpative procedures for advanced colorectal cancers can involve partial/total bladder resections. In patients without evidence of distant metastatic disease, a reasonable therapeutic effect can be expected when negative surgical margins are obtained. The decision to perform a bladder-sparing procedure or a total pelvic exenteration (TPE) will be based on the extent of the primary lesion as well as patient characteristics. In this study, we report our experience in the management of operable locally advanced colorectal carcinomas involving the urinary bladder. We retrospectively reviewed the hospital records of all patients with advanced colorectal cancer invading the urinary bladder. The age, gender, clinical presentation, physical examination findings, and imaging records were noted. Colonoscopy reports and images were noted and biopsy findings recorded. Similarly, cystoscopy findings and biopsy reports were noted and analyzed. Eight (88%) patients had a primary sigmoid tumor and one (11%) had primary rectal tumor. The clinical staging of the primary tumor was T3 in three (33%) and T4 in six (66%). A biopsy taken during cystoscopy confirmed the malignant lesion in all the nine patients. Four (44%) patients received neoadjuvant chemotherapy with 5-fluorouracil. Eight (88%) patients underwent bladder-sparing resection and the remaining one underwent total pelvic exenteration with ileal conduit for urinary drainage. The mean overall survival was 44 months. The wide spectrum of possible bladder involvement by colorectal cancer requires individual patient-specific and disease-specific approaches. En bloc bladder resection for adherent or invading colorectal cancers achieves good local control and prognosis. The potential for cure in completely excised, node-negative tumors is good. Bladder reconstruction is achievable in most patients.
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Affiliation(s)
- Rajendra B Nerli
- 1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Shridhar C Ghagane
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Prasanna Ram
- 1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - S S Shimikore
- 3Department of Surgery, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Kumar Vinchurkar
- 4Department of Surgical Oncology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Nehru Nagar, Belagavi, 590010 Karnataka India
| | - Murigendra B Hiremath
- 5Department of Biotechnology and Microbiology, Karnatak University, Dharwad, 580003 Karnataka India
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Vinchurkar K, Pattanshetti VM, Togale M, Hazare S, Gokak V. Outcome of Pancreaticoduodenectomy at Low-Volume Centre in Tier-II City of India. Indian J Surg Oncol 2018; 9:220-224. [PMID: 29887705 DOI: 10.1007/s13193-018-0744-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/28/2018] [Indexed: 01/08/2023] Open
Abstract
Currently, pancreaticoduodenectomy (PD) is considered a common and feasibly performed surgery for periampullary tumours, but it is still a high-risk surgical procedure with potential morbidity and mortality rates. Previously, it was emphasised for the need of high-volume centres to perform specialised surgery such as PD. The authors have made an attempt to know the relation between low-volume centre and outcomes of PD. The study was conducted in a Tier-II city referral hospital located in Karnataka, India. A total of 37 patients with suspected periampullary neoplasms underwent surgical exploration with curative intent over a period of 4 years, i.e. from May 2012 to May 2016. Out of 37 patients, 26 underwent PD, either classic Whipple resection (n = 01) or pylorus-preserving modification (n = 25). In 11 patients, resection was not possible, where biliary and gastric drainage procedures were done. All patients were treated by standardised post-operative care protocols for pancreatic resection used at our centre. We recorded the perioperative outcome along with demographics, indications for surgery, and pre- and intra-operative factors of PD. Post-operative pancreatic fistulae were evident in 4 patients. Two patients had hepaticojejunostomy leak. One patient had chyle leak. Three patients had infection at the surgical site. One patient had post-operative pneumonia leading to mortality. None of the patients had post-op haemorrhage. The surgeon volume and surgeon experience may have minimal contributing factor in post-operative morbidity, especially if there is availability of well-equipped ICU and imaging facilities, along with well-experienced personnel like oncosurgeon, anaesthesiologist, intensivist, radiologist, and nursing staff. There is a need of a multicentre study from Tier-II city hospitals/low-volume centres and high-volume centres to come with perioperative surgical outcomes following PD.
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Affiliation(s)
- Kumar Vinchurkar
- Consultant Surgical Oncology, KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, Karnataka India
| | - Vishwanath M Pattanshetti
- 2Department of General Surgery, J N Medical College, KLE University and KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, Karnataka 590010 India
| | - Manoj Togale
- 2Department of General Surgery, J N Medical College, KLE University and KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, Karnataka 590010 India
| | - Santosh Hazare
- 3Gastroenterology, J N Medical College, KLE University and KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, Karnataka India
| | - Varadraj Gokak
- 3Gastroenterology, J N Medical College, KLE University and KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, Karnataka India
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Ahmed I, Kotur S, Bhise R, Sahoo D, Vinchurkar K, Dashnamoorthy S. Concurrent weekly cisplatin and radiation in squamous cell carcinoma esophagus: A simplistic approach. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ahmed I, Kotur S, Sahoo D, Sougumarane D, Bhise R, Vinchurkar K, Kalloli M, Sanikoppa A. EP-1411: Chemo-IMRT in elderly head and neck cancer patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pattanshetti VM, Vinchurkar K, Pattanshetti SV. Solid pseudo papillary tumor of pancreas: Presenting as acute abdomen in a female child. Indian J Med Paediatr Oncol 2014; 35:184-6. [PMID: 25197185 PMCID: PMC4152640 DOI: 10.4103/0971-5851.139000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Solid pseudo papillary tumor (SPT) or Frantz's tumor is a slow-growing low-grade malignant tumor, commonly seen in young patients with a female predominance, which is commonly located in the body and tail of the pancreas. We report a case of SPT arising from the body of the pancreas in a 12-year-old girl who presented with acute abdomen and was treated successfully by local excision of the tumor with preservation of head of pancreas and spleen.
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Affiliation(s)
- Vishwanath M Pattanshetti
- Department of Surgery, J N Medical College and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
| | - Kumar Vinchurkar
- Department of Surgery (Oncosurgery), J N Medical College and KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
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Shrikhande SV, Barreto SG, Talole SD, Vinchurkar K, Annaiah S, Suradkar K, Mehta S, Goel M. D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy. World J Surg Oncol 2013; 11:31. [PMID: 23375104 PMCID: PMC3583696 DOI: 10.1186/1477-7819-11-31] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/18/2013] [Indexed: 12/14/2022] Open
Abstract
Background Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature. Methods Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperative outcomes and histopathological responses to NACT were analyzed. The data is presented and compared to a cohort of patients undergoing upfront surgery in the same time period. Results In this study, 139 patients (42 female and 97 male patients, median age 53 years) with gastric adenocarcinoma received NACT. Chemotherapy-related toxicity was noted in 32% of patients. Of the 139 patients, 129 underwent gastrectomy with D2 lymphadenectomy, with 12% morbidity and no mortality. Major pathological response of primary tumor was noted in 22 patients (17%). Of these 22 patients, lymph node metastases were noted in 12 patients. The median blood loss and lymph node yield was not significantly different to the 62 patients who underwent upfront surgery. Patients who underwent upfront surgery were older (58 vs. 52 years, P <0.02), had a higher number of distal cancers (63% vs. 82%, P <0.015) and a longer hospital stay (11 vs. 9 days, P <0.001). Conclusions Perioperative outcomes of gastrectomy with D2 lymphadenectomy for locally advanced, resectable gastric cancer were not influenced by NACT. The number of lymph nodes harvested was unaltered by NACT but, more pertinently, metastases to lymph nodes were noted even in patients with a major pathological response of the primary tumor. D2 lymphadenectomy should be performed in all patients irrespective of the degree of response to NACT.
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Affiliation(s)
- Shailesh V Shrikhande
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
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