1
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Midha N, Arjunan R, Althaf S, Chinduri S, Sugoor P. Total robotic anterior resection with intracorporeal anastomosis under fluorescence navigation - a video vignette. Colorectal Dis 2024; 26:817-818. [PMID: 38369961 DOI: 10.1111/codi.16902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Nishtha Midha
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Syed Althaf
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Srinivas Chinduri
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
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2
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Nishtha, Arjunan R, Althaf S, Srinivas C, Sugoor P. Kidwai technique of laparoscopic complete splenic flexure mobilization-A video vignette. Colorectal Dis 2024; 26:811-812. [PMID: 38326701 DOI: 10.1111/codi.16894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/01/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Nishtha
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Syed Althaf
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | | | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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3
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Jhunjhunwala A, Sugoor P, Arjunan R, Altshaf S, Chunduri S. Standardized robotic intersphincteric resection-A Video Vignette. Colorectal Dis 2024; 26:809-810. [PMID: 38326700 DOI: 10.1111/codi.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Affiliation(s)
| | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Syed Altshaf
- Kidwai Memorial Institute of Oncology, Bangalore, India
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4
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Bharadwaj G, Arjunan R, Althaf S, C S, Sugoor P. Robotic complete splenic flexure mobilization: a standardized step by step approach - a video vignette. Colorectal Dis 2024; 26:576-578. [PMID: 38297392 DOI: 10.1111/codi.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Guru Bharadwaj
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Srinivas C
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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5
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Nishtha, Arjunan R, Althaf S, Chinduri S, Sugoor P. Robotic complete mesocolic excision with central vascular ligation: Superior mesenteric vein (SMV) first approach. Colorectal Dis 2024; 26:205-207. [PMID: 38010164 DOI: 10.1111/codi.16806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Nishtha
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Syed Althaf
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | | | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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6
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Mathew J, Arjunan R, Dasappa A, Namachivayam A. ASO Visual Abstract: Prognostic Factors and Clinical Outcomes in Extraskeletal Ewing Sarcoma-A Cohort Study. Ann Surg Oncol 2023; 30:8673-8674. [PMID: 37491574 DOI: 10.1245/s10434-023-13939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Joseph Mathew
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ashwathappa Dasappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - ArunKumar Namachivayam
- Department of Biostatistics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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7
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Batra P, Narasannaiah AH, Reddy V, Subramaniyan V, K V M, R Y, Arjunan R, Althaf S, Chunduri S, Anwar AZ. Prognostic Value of Tumor Markers in Gastric Cancer: A Tertiary Cancer Centre Experience. Cureus 2023; 15:e42328. [PMID: 37614264 PMCID: PMC10443652 DOI: 10.7759/cureus.42328] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES Gastric cancer is a heterogeneous malignancy in terms of stage-wise prognosis. This study aimed at finding any prognostic significance of preoperative carcinoembryonic antigen (CEA) and cancer antigen (CA) 19-9 in resectable gastric cancer. METHODS A total of 57 patients at Kidwai Memorial Institute of Oncology, Bengaluru, India from January 2022 to March 2023 were included in this observational prospective study. Included patients had a resectable tumor at clinical staging. Patients were divided into two categories (raised and non-raised) based on serum tumor marker (CEA and CA 19-9) levels. Their relationship with clinicopathological features was studied. The association was studied using chi-square test, and p-value <0.05 was considered significant. RESULTS The mean age of the study group was 55.47 years with male predominance (63.2%, n=36). Raised CEA and CA 19-9 were seen in 15.8% (n=9) and 10.5% (n=6) patients, respectively, while both markers were raised in 5.3% (n=3). Raised CEA was found significantly associated with grade 3 adenocarcinoma stomach (OR 7.825, 95%CI: 1.374-44.562; p= 0.020) and intraoperative finding of inoperability due to occult intra-abdominal disease (p<0.05). CA 19-9 (pre- and post-operative levels) had no statistically significant association (p>0.05) with the grade of adenocarcinoma. CONCLUSION This study indicates a benefit in estimating CEA for the prediction of prognosis in gastric cancer. CEA levels have been found to predict chances of finding occult intra-abdominal metastasis in gastric cancer.
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Affiliation(s)
- Pratham Batra
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | | | - Venkatesh Reddy
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | | | - Manjunath K V
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | - Yeshwanth R
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | - Ravi Arjunan
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | - Syed Althaf
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | - Srinivas Chunduri
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
| | - Ali Z Anwar
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IND
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8
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Suresh GM, Yeshwanth R, Arjunan R, Ramachandra C, Altaf S. Who Needs Level III Lymph Node Dissection in Carcinoma Breast-Study from a Tertiary Care Center. Indian J Surg Oncol 2023; 14:324-330. [PMID: 37324309 PMCID: PMC10267033 DOI: 10.1007/s13193-020-01243-y] [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: 06/01/2019] [Accepted: 09/24/2020] [Indexed: 10/23/2022] Open
Abstract
In Indian females, breast cancer is the most common cancer with a late stage of presentation leading to one-third of patients undergoing modified radical mastectomy (MRM). Our study is undertaken to find out predictors of level III axillary lymph node metastasis in breast cancer and who needs complete axillary lymph node dissection (ALND). Retrospective study of 146 patients who undergone MRM or breast-conserving surgery (BCS) with complete ALND at Kidwai Memorial Institute of Oncology was done, and data was analyzed to find out the frequency of level III lymph nodes and the demographic relation and its relation to positive lymph nodes in level I + II. Positive metastatic level III lymph node was found in 6% of patients, with the median age of the patient in our study with level III positivity was 48.5 years with 63% pathological stage II with 88% perinodal spread (PNS)- and lymphovascular invasion (LVI)-positive. Involvement of level III lymph node was associated with gross disease in level I + II lymph node having more than four lymph node-positive and with pT3 stage or more which has higher chances of level III lymph node involvement. Level III lymph node involvement, though rare in early-stage breast cancer, is associated with larger clinical and pathological sizes (T3 or more), more than 4 lymph node-positive in level I + II and with PNS and LVI. Hence, based on these results, we recommend that for inpatient with more than 5-cm tumor size and those with the gross disease in axilla, complete ALND is recommended.
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Affiliation(s)
- Girish Mysore Suresh
- Department of surgical oncology, Kidwai Memorial Institute of Oncology (KMIO), Dr. MH Mariagowda road, Near Bangalore Dairy, Bengaluru, Karnataka 560029 India
| | - R. Yeshwanth
- Department of surgical oncology, Kidwai Memorial Institute of Oncology (KMIO), Dr. MH Mariagowda road, Near Bangalore Dairy, Bengaluru, Karnataka 560029 India
| | - Ravi Arjunan
- Department of surgical oncology, Kidwai Memorial Institute of Oncology (KMIO), Dr. MH Mariagowda road, Near Bangalore Dairy, Bengaluru, Karnataka 560029 India
| | - C. Ramachandra
- Department of surgical oncology, Kidwai Memorial Institute of Oncology (KMIO), Dr. MH Mariagowda road, Near Bangalore Dairy, Bengaluru, Karnataka 560029 India
| | - Syed Altaf
- Department of surgical oncology, Kidwai Memorial Institute of Oncology (KMIO), Dr. MH Mariagowda road, Near Bangalore Dairy, Bengaluru, Karnataka 560029 India
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9
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Halkud R, Krishnappa R, Chavan P, Siddappa KT, Shetty R, Pallavi VR, Rathod P, Shobha K, Sabitha KS. Outcomes of Cancer Surgery During the COVID-19 Pandemic: Preparedness to Practising Continuous Cancer Care. Indian J Surg Oncol 2023; 14:440-444. [PMID: 33100778 PMCID: PMC7569097 DOI: 10.1007/s13193-020-01250-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has placed unprecedented pressure on healthcare services. Deprioritisation of nonemergency clinical services and growing concerns of adverse outcomes of COVID-19 in cancer patients is having a deleterious impact across oncologic practice. We report cancer surgery outcomes taking into account the acuity of the COVID-19 situation. A prospectively maintained database of the Department of Surgical Oncology was analysed from 1st May to 30th June, 2020, to evaluate the perioperative outcomes, morbidity and mortality following major surgical procedures. A total of 359, preoperatively, tested negative for COVID-19 underwent surgery. Median age was 52 years with 26.7% (n = 96) above the age of 60 years. Sixty-one percent (n = 219) patients were American Society of Anaesthesiology grades II-III. As per surgical complexity grading, 36.8% (n = 132) cases were lower grades (I-III) and 63.2% (n = 227) were complex surgeries (IV-VI). 5.3% (n = 19) had ≥ grade III Clavien-Dindo complication, and the postoperative mortality rate was 0.27% (n = 1). Major complication rates in patients > 60 years were 9.3% in comparison to 4.1% in < 60 years (p = 0·63). The median hospital stay was 1-10 days across subspecialties. Postoperatively, repeat COVID 19 testing in 2 suspected patients were negative. Our study showed that after screening, triaging and prioritisation, asymptomatic cases may undergo cancer surgeries without increased morbidity during COVID-19 pandemic.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Rajshekar Halkud
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - R. Krishnappa
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Purushotham Chavan
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. T. Siddappa
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Rathan Shetty
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - V. R. Pallavi
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Praveen Rathod
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. Shobha
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. S. Sabitha
- Department of Oral Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
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10
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Mathew J, Arjunan R, Dasappa A, Namachivayam A. ASO Author Reflections: Extraskeletal Ewing Sarcoma-Outcomes and Prognosticators of a Rare Malignancy. Ann Surg Oncol 2023; 30:3095-3096. [PMID: 36695993 DOI: 10.1245/s10434-023-13134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Joseph Mathew
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Ashwathappa Dasappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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11
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Mathew J, Arjunan R, Dasappa A, Namachivayam A. Prognostic Factors and Clinical Outcomes in Extraskeletal Ewing Sarcoma: A Cohort Study. Ann Surg Oncol 2022; 30:3084-3094. [PMID: 36564656 DOI: 10.1245/s10434-022-12992-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Extraskeletal Ewing sarcoma (ESE) is a lesser-known, rarer counterpart of Ewing sarcoma of bone. This single-center study sought to evaluate the prognosticators and outcomes following multimodality therapy in patients with ESE. METHODS Forty-seven patients with ESE, treated between 2013 and 2018 with a standardized protocol and multimodality therapy using established doxorubicin-based regimens, were followed-up to assess outcomes. RESULTS Median age at diagnosis was 20 (range 7-56) years, and 57.4% were male. Median tumor size was 7 (range 2-21) cm. The symptom-duration ranged from 1 to 8 (median 4) months. Tumor-site was trunkal in 61.7%, extremity in 23.4%, and head and neck 14.9%. Of the 35 patients with nonmetastatic disease at presentation, 13 underwent upfront surgery. The rest received chemotherapy followed by local treatment, which was surgical in 15 and radiotherapy in 5. At median follow-up of 24 (range 5-98) months, 55.3% patients had experienced events, and 29.8% had died of progressive disease. Three-year event-free survival was 41.1%, and overall survival was 53%. On univariate analysis, trunkal location, upfront surgery, and positive surgical margins were associated with inferior EFS. Trunkal tumors and upfront surgery were also associated with poorer OS. On multivariate analysis, trunkal location and margin-positive resections retained statistical significance for adverse EFS. CONCLUSIONS Unless clearly resectable upfront, ESE should be downstaged with chemotherapy before local treatment. A margin-negative resection should be the objective when performing surgery. Definitive radiotherapy is an alternative in tumors not amenable for complete excision or when anticipated postoperative morbidity precludes radical surgery.
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Affiliation(s)
- Joseph Mathew
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Ashwathappa Dasappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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12
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Arjunan R, Dharanikota A, Chowdappa R, Althaf S, Dasappa A, Shetty NS. Impact of Level of Surgery on the Functional Outcomes in Patients with Lower Extremity Bone Tumors Undergoing Amputation Versus Limb Salvage Surgery. Indian J Surg Oncol 2022. [DOI: 10.1007/s13193-022-01627-2] [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: 11/29/2022] Open
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13
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Chowdappa R, Dharanikota A, Arjunan R, Althaf S, Premalata CS, Ranganath N. Operative Outcomes of Minimally Invasive Esophagectomy versus Open Esophagectomy for Resectable Esophageal Cancer. South Asian J Cancer 2022; 10:230-235. [PMID: 34984201 PMCID: PMC8719958 DOI: 10.1055/s-0041-1730085] [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: 11/23/2022] Open
Abstract
Background
There is a recent rise in the incidence of esophageal carcinoma in India. Surgical resection with or without neoadjuvant chemoradiation is the current treatment modality of choice. Postoperative complications, especially pulmonary complications, affect many patients who undergo open esophagectomy for esophageal cancer. Minimally invasive esophagectomy (MIE) could reduce the pulmonary complications and reduce the postoperative stay.
Methodology
We performed a retrospective analysis of prospectively collected data of 114 patients with esophageal cancer in the department of surgical oncology at a tertiary cancer center in South India between January 2019 and March 2020. We included patients with resectable cancer of middle or lower third of the esophagus, and gastroesophageal junction tumors (Siewert I). MIE was performed in 27 patients and 78 patients underwent open esophagectomy (OE). The primary outcome measured was postoperative complications of Clavien–Dindo grade II or higher within 30 days. Other outcomes measured include overall mortality within 30 days, intraoperative complications, operative duration and the length of hospital stay.
Results
A postoperative complication rate of 18.5% was noted in the MIE group, compared with 41% in the OE group (
p
= 0.034). Pulmonary complications were noted in 7.4% in the MIE group compared to 25.6% in the OE group (
p
= 0.044). Postoperative mortality rates, intraoperative complications, and other nonpulmonary postoperative complications were almost similar with MIE as with open esophagectomy. Although the median operative time was more in the MIE group (260 minutes vs. 180 minutes;
p
< 0.0001), the median length of hospital stay was shorter in patients undergoing MIE (9 days vs. 12 days;
p
= 0.0001).
Conclusions
We found that MIE resulted in lower incidence of postoperative complications, especially pulmonary complications. Although, MIE was associated with prolonged operative duration, it resulted in shorter hospital stay.
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Affiliation(s)
- Ramachandra Chowdappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Anvesh Dharanikota
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Chennagiri S Premalata
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Namrata Ranganath
- Department of Anesthesiology and Pain Relief, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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14
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Arjunan R, Karthik SDS, Chowdappa R, Althaf S, Srinivas C. Contemporary Surgical, Oncological, and Survival Outcomes of Pancreaticoduodenectomy for Periampullary Tumours: a 5-Year Experience from Tertiary Cancer Center. Indian J Surg Oncol 2021; 12:603-610. [PMID: 34658591 DOI: 10.1007/s13193-021-01385-7] [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: 03/02/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022] Open
Abstract
With advances in surgical management of pancreaticoduodenectomy (PD), mortality rate for PD has been reported to be less than 5%. Postoperative pancreatic fistula (POPF) remains a major complication and morbidity after PD with incidence of up to 40%. This is a retrospective analysis of patients who underwent PD in a tertiary cancer referral center in southern India. Data was collected for the patients operated during the period from Jan 2014 to Dec 2018. Surgicopathological, oncological, and survival outcomes were described. Of 76 patients presumed as operable, 16 were excluded and data analyzed for 60 patients. Forty-four percent underwent classical Whipple's PD and 56% pylorus-preserving PD. The most common postoperative complications were wound infection (25%); pneumonia (20%); clinically relevant POPF (13%); and delayed gastric emptying (19%). Thirty-day in-hospital mortality was 5%, 90-day mortality was 8.3%, and fistula-related mortality was 1.6%. Ampullary cancer was the most common histology. Three-year survival rate was 23.3% with a mean overall survival of 33.2 months with significantly better survival in the node negative than positive group (41.3 vs 20.5 months, P = 0.003) and significantly lower survival in pancreatic head cancer than other tumor histologies (16.6 vs 37.3 months, P = 0.002). Multivariate analysis has shown pancreatic head histology (HR = 2.38, 95% CI (1.08-5.26), P = 0.033) and nodal positivity (HR = 2.38, 95% CI (1.27-4.44), P = 0.007) as poor prognostic factors. Pancreaticoduodenectomy is a safe operation in experienced hands. Adhering to a meticulous adaptable reproducible anastomotic technique with standard perioperative management strategies significantly decreases the operative morbidity and mortality.
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Affiliation(s)
- Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, 560029 India
| | - S D S Karthik
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, 560029 India
| | - Ramachandra Chowdappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, 560029 India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, 560029 India
| | - Chunduri Srinivas
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, 560029 India
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15
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Gurawalia J, Arjunan R. Predicting clinical behaviour of breast phyllodes tumors: utility of Singapore nomogram. Breast 2021. [DOI: 10.1016/s0960-9776(21)00204-6] [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: 11/28/2022] Open
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16
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Patil V, Kumar H, Beesanna G, Abhishek M. Robotic Complete Mesocolic Excision with Central Vascular Ligation for Right Colon Cancer: Surgical Technique and Short-term Outcomes. Indian J Surg Oncol 2020; 11:674-683. [PMID: 33281407 PMCID: PMC7714811 DOI: 10.1007/s13193-020-01181-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Minimally invasive colorectal surgery has demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. PURPOSE The study aims to present technical details and short-term oncological outcomes of robotic-assisted complete mesocolic excision (CME) with central vascular ligation (CVL) for right colon cancer. METHODOLOGY Fifty-two consecutive patients affected by right colon cancer were operated between May 2016 and February 2020 with da Vinci Xi platform. Data regarding surgical and short-term oncological outcomes were systematically collected in a colorectal specific database for statistical analysis. RESULTS Thirty-seven (71.15%) and 15 (28.85%) patients underwent right and extended right hemicoletomy with an extracorporeal anastomosis. Median age was 55 years. Mean operative time was 182 ± 36 min. Mean blood loss was 110 ± 90 ml. Conversion rate was 3.84% (two cases). 78.84% (41 cases) were pT3 and mean number of harvested lymph nodes was 28 ± 4. 1/52 (1.92%) had a documented anastomotic leak requiring exploratory laparotomy and diversion proximal ileostomy. Surgery-related grade IIIa-IIIb Calvien Dindo morbidity were noted in 9.61% and 1.92%, respectively. CONCLUSION Robotic assistance allows performance of oncological adequate dissection of the right colon with radical lymphadenectomy as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Vijay Patil
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Harish Kumar
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - G. Beesanna
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - M. Abhishek
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
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Dharanikota A, Arjunan R, Chowdappa R, Althaf S. Survival Outcomes in Patients with Thymoma after Thymectomy in an Indian Scenario. Indian J Surg Oncol 2020; 11:785-790. [PMID: 33299290 DOI: 10.1007/s13193-020-01258-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/30/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
- Anvesh Dharanikota
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
| | - Ramachandra Chowdappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Marigowda Road, Bangalore, Karnataka India
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18
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Jonnada P, Arjunan R, Karjol U, Syed A, Chandranath A, Anwar A. 94P Prognostic influence of mean platelet volume on stage III rectal cancer patients: A tertiary cancer center study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.114] [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: 10/22/2022] Open
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19
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Dev K, Shivran N, Gurawalia J, Pandey A, Kumar S, Kurpad V, Nayak S, Arjunan R. Less Than 12 Lymph Nodes in The Surgical Specimen after Neo-Adjuvant Chemo-Radiotherapy in Rectal Cancer: Five Years Survival Analysis. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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20
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Gurawalia J, Arjunan R, Dev K, Kurpad V. Utility of Singapore Nomogram for Outcome Prediction in Breast Phyllodes Tumors: An Indian Cohort. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.095] [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] Open
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21
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Arjunan R, Ramamani TA, Ramachandra C, Swamyvelu K, Chunduri S, Althaf S, Usha A, Namrata R. Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer After Neoadjuvant Chemotherapy-an Indian Perspective. Indian J Surg Oncol 2020; 11:242-247. [PMID: 32523270 DOI: 10.1007/s13193-020-01035-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/20/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) alone in early breast cancer is an established standard of care. However, the same results have not been replicated in locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NACT). We aim to examine the feasibility of SLNB in LABC patients post NACT to determine identification rates (IR) and false negative rates (FNR). This was a single tertiary cancer center-based prospective study from February 2017 to November 2018. Forty-four patients with LABC (T3, T4 with N0 or N1) were studied and response after NACT was assessed. Only those patients who were N0 or who converted from N1 to N0 after NACT were included. Those patients who remained node positive after NACT directly proceeded with axillary dissection without SLNB and were excluded from the study. Demographic and clinical data is expressed in ratios and percentage and presented in table format. The median age at the time of study was 45.18 years. Most of the patients had T3 and above (97.7%) and N1 (86.3%) disease at the start of neoadjuvant therapy. The mean number of axillary lymph nodes dissected was 13.97. Dual method of sentinel lymph node mapping (methylene blue dye and radiolabeled colloid) was used in 26 (59.1%) patients. At least 1 SLN was identified in 86.4% patients with 100% identification in those patients in whom the dual method of SLN mapping was used. Median of 2 SLN was removed. Overall, false negative rate was 21.4%. FNR was high with the single method of SLN mapping (50% and 33.3% with methylene blue and radioactive colloid respectively) while it was considerably low when both were used simultaneously (11%). An average of 2 (range 0-4) SLN were identified and FNR were zero when 2 or more SLN were identified. Our study shows that SLNB in patients with LABC post NACT though viable cannot be recommended at present due to unacceptable high FNR. However, this should not dissuade us from exploring recurrence-free survival and overall survival associated with such IR and FNR albeit strictly under a clinical trial setting.
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Affiliation(s)
- Ravi Arjunan
- Department of Surgical Oncology, Kidwai Cancer Institute, Bangalore, India
| | | | | | | | - Srinivas Chunduri
- Department of Surgical Oncology, Kidwai Cancer Institute, Bangalore, India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Cancer Institute, Bangalore, India
| | - Amirtham Usha
- Department of Pathology, Kidwai Cancer Institute, Bangalore, India
| | - Ranganath Namrata
- Department of Anaesthesia and Pain Relief, Kidwai Cancer Institute, Bangalore, India
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22
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Suresh G, Arjunan R, Altaf S, Kumar V. Dilemma in primary hyperparathyroidism with multiple brown tumors. Formos J Surg 2020. [DOI: 10.4103/fjs.fjs_45_19] [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: 11/04/2022] Open
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23
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Girish S, Arjunan R, Ramachandra C, Altaf S. Mean Platelet Volume (MPV) is it a new prognostic marker in resectable carcinoma stomach? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.032] [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: 11/14/2022] Open
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24
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Suresh GM, Ramachandra C, Arjunan R, Halkud R. CLO19-049: Central Lymph Node Dissection in the Clinically Node-Negative (cN0) Papillary Thyroid Carcinoma: Is it Necessary? J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Surgery is the treatment of choice in papillary thyroid cancer (PTC), which is the most common thyroid malignancy and frequently has metastases in the central compartment lymph nodes (CLN). There is debate among surgeons whether removing normal-appearing lymph nodes in the central neck (prophylactic lymph node dissection) is better than removing only the abnormal-appearing lymph nodes. Herein, we review the potential utility of central compartment lymph nodal dissection (CLND) on surgical outcome and disease-free follow-up of PTC and 5-year survival of patients operated on at our center. Methods: A total of 246 patients from February 2009 to March 2012 who were treated for PTC in our Kidwai Cancer Institution was analyzed retrospectively. 135 patients who underwent total thyroidectomy and CLND were assigned to Group A, which was compared with 111 patients who received total thyroidectomy, without CLND, who were assigned to Group B by evaluation of postoperative complications (recurrent laryngeal nerve damage, hoarseness, hypocalcemia, and hemorrhage rates) and recurrence at the time of Iodine131 treatment and subsequently at 60 months follow-up. Results: In the present study, Mean DFS and OS did not differ in both groups. Male gender and age more than 45 years had statistically significant DFS but without any impact on OS. There was a significant postoperative complication in group A compared to group B (P≤.001), with a very minimal recurrence in the central neck. 4 patients (3.6%) had recurrences in CLN. Conclusion: Considering the significant postoperative complication, which outweighs benefit, we conclude that for cN0 PTC, routine CLND is not necessary.
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Affiliation(s)
| | | | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bengaluru, India
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25
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Chowdappa R, Tiwari AR, Arjunan R, Althaf S, Kumar RV, Chunduri S. Perioperative Mortality in Cancer Esophagus-a Case Control Study at a High-Volume Regional Cancer Center in South India. Indian J Surg Oncol 2018; 10:83-90. [PMID: 30948879 DOI: 10.1007/s13193-018-0825-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/14/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023] Open
Abstract
Surgery for esophageal cancers carries high rates of morbidity and mortality despite improvements in perioperative care especially with increasingly safe anesthesia and postoperative ICU care. A case control study was conducted on 713 patients operated for esophageal cancer over a period of 8 years (2009-2016). Multiple preoperative, intraoperative, and postoperative clinical and laboratory parameters were compared between patients who succumbed to the surgery, i.e., 30-day mortality, and those who did not. Of the preoperative parameters, age > 58.5 years (p = 0.01), history of dysphagia with significant weight loss (p = 0.028), diabetes (p = 0.002), ischemic cardiac disease (p = 0.0001), low FEV1 < 69.5% (p = 0.036), preoperative length of hospital stay > 6.94 days (p = 0.001), involvement of gastroesophageal junction (p = 0.04), and ASA score > 2 (p = 0.002) were significantly associated with perioperative mortality. Intraoperatively, blood loss (p = 0.003), intraoperative (p = 0.015) and postoperative (p = 0.0001) blood transfusion, splenectomy (p = 0.0001), and excessive intraoperative intravenous fluids (p = 0.003) were associated with mortality. Decreased postoperative day 1 serum albumin level < 2.38 mg/dl (p = 0.0001), increased ICU stay > 7.32 days (SD+/- = 6.28, p = 0.03), number of positive lymph nodes > 2.97 (SD+/- = 4.19, p = 0.013), conduit necrosis (p = 0.0001), recurrent laryngeal nerve palsy (p = 0.013), pulmonary venous thromboembolism (p = 0.0001), multiple organ dysfunction syndrome (p = 0.0001), LRTI (p = 0.0001), arrhythmia (p = 0.005), sepsis (p = 0.0001), and ARDS (p = 0.0001) were the postoperative complications that were significantly associated with mortality. Comprehensive patient care involving preoperative optimization, improved surgical skills, rigorous intraoperative fluid management, and dedicated intensive care units will continue to play a major role in further minimizing mortality and morbidity associated with esophageal cancer surgeries.
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Affiliation(s)
| | | | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Rekha V Kumar
- Department of Pathology, Kidwai Cancer Institute, Bengaluru, India
| | - Srinivas Chunduri
- Department of Surgical Oncology, Kidwai Cancer Institute, Bengaluru, India
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26
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Arjunan R, Kumar D, Kumar KVV, Premlatha CS. Breast Cancer with Synchronous Renal Cell Carcinoma: A Rare Presentation. J Clin Diagn Res 2016; 10:XD03-XD05. [PMID: 27891445 DOI: 10.7860/jcdr/2016/20362.8683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/14/2016] [Accepted: 07/08/2016] [Indexed: 01/30/2023]
Abstract
Primary cancer arising from multiple organs is a well known fact. Synchronous tumours have been most commonly associated with kidney cancer. Bladder, prostate, colorectal and lung cancer are the most common synchronous primaries with Renal Cell Carcinoma (RCC) identified till date. We found metachronous tumours of breast with RCC in literature search which included both metastatic tumours as well second primaries. Overall, 25 cases of metastatic breast tumours and eight cases of second primary in previously treated RCC have been reported in the literature. Here, we are reporting a case of synchronous presentation of carcinoma breast with RCC which is very rare because most of the multiple malignancies reported in the literature are metastatic tumours or metachronous breast malignancy with RCC.
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Affiliation(s)
- Ravi Arjunan
- Associate Professor, Department of Surgical Oncology, Kidwai Memlorial Institute of Oncology , Bangalore, Karnataka, India
| | - Durgesh Kumar
- Senior Resident, Department of Surgical Oncology, Kidwai Memlorial Institute of Oncology , Bangalore, Karnataka, India
| | - K V Veerendra Kumar
- Professor, Department of Surgical Oncology, Kidwai Memlorial Institute of Oncology , Bangalore, Karnataka, India
| | - C S Premlatha
- Associate Professor, Department of Pathology, Kidwai Memlorial Institute of Oncology , Bangalore, Karnataka, India
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Sumathi BG, Kumarswamy SR, Amritam U, Arjunan R. Shewanella algae: First case report of the fast emerging marine pathogen from squamous cell carcinoma patient in India. South Asian J Cancer 2014; 3:188-9. [PMID: 25136533 PMCID: PMC4134617 DOI: 10.4103/2278-330x.136819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- B G Sumathi
- Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - S R Kumarswamy
- Department of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Usha Amritam
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Ravi Arjunan
- Department of Onco Surgery, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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28
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Hebbar K A, K S, Deshmane VL, Kumar V, Arjunan R. Papillary carcinoma in median aberrant thyroid (ectopic) - case report. J Clin Diagn Res 2014; 8:QD01-3. [PMID: 25121039 DOI: 10.7860/jcdr/2014/7626.4463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/11/2013] [Accepted: 05/01/2014] [Indexed: 11/24/2022]
Abstract
Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed.
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Affiliation(s)
- Ashwin Hebbar K
- Assistant Professor, Department of General Surgery, Shimoga Institute of Medical Sciences , Shimoga, Karnataka, India
| | - Shashidhar K
- Associate Professor, Department of ENT, Karnataka Institute of Medical Sciences , Hubli, Karnataka, India
| | - Vijaya Laxmi Deshmane
- Professor and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology , Bangalore, Karnataka, India
| | - Veerendra Kumar
- Professor, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology , Bangalore, Karnataka, India
| | - Ravi Arjunan
- Associate Professor, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology , Bangalore, Karnataka, India
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Hebbar AK, Shashidhar K, S KM, Kumar V, Arjunan R. Breast as an unusual site of metastasis- series of 3 cases and review of literature. Indian J Surg Oncol 2014; 5:189-93. [PMID: 25419063 DOI: 10.1007/s13193-014-0333-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 05/06/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022] Open
Abstract
Background and objectives Metastasis to the breast from extra mammary sites is uncommon with an incidence ranging from 1.2 to 2 % in clinical reports. Approximately 300 cases of breast metastasis from extra mammary sites have been reported, mostly in small series or as a single case report. Gastrointestinal adenocarcinoma metastasising to the breast is also very rare and only 30 cases have been reported in the literature. Metastatic deposits within the breast may be difficult to distinguish from primary breast carcinoma. Radiological features and immunohistochemistry especially for steroid hormone receptors (ER/PR) and expression of gross cystic disease fluid protein (GCDFP) and presence of other immunohistochemistry protein factors in breast metastasis which are specific to primary site may be helpful in differentiating these two conditions. Materials and methods In this series of 3 cases of breast as an unusual site of metastasis, we present different cases of adenocarcinoma of stomach, sigmoid colon and kidney with metastasis to the breast and discuss the differential diagnosis and management plans. Conclusion In conclusion, secondary tumors to the breast are rare and thus differentiating primary tumors from metastatic breast carcinoma is important for rational and optimum therapy and avoidance of unnecessary radical surgery. Palpable breast lump without typical radiological signs of primary breast carcinoma in patients with known primary should be suspected of representing metastasis.
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Affiliation(s)
- Ashwin K Hebbar
- 39. "Krutika" 3rd Main, 2nd Cross Gururagavendra Nagar J.P. Nagar 7th Phase, Bangalore, Karnataka 560078 India ; Department of General Surgery, Shimoga Institute of Medical Sciences, Shimoga, Karnataka India
| | - K Shashidhar
- Department of ENT, Karnataka Institute of Medical Sciences, Hubli, Karnataka India
| | - Krishna Murthy S
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
| | - Veerendra Kumar
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka India
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