Breast Cancer (Poster)
EP 01
Title: Analysis Of Demographic Characteristics And Treatment Outcome Of Breast Cancer In A Tertiary Cancer Centre
Author:S. DEEPA MCh Postgraduate, PROF. SUBBIAH SHANMUGAM, R. RAJARAMAN MS, MCh, SUJAY SUSIKAR MS, MCh
Institution: Manipal Hospital, Bengaluru
Email: oncodeepa@gmail.com
Abstract
Introduction
Breast cancer is the most common cancer of women in India.As per WHO prediction, in 2015 there will be an estimated 1,55,000 new cases of breast cancer and about 76,000 women in India are expected to die of the disease.
Materials & Methods
The records of 1252 patients treated for carcinoma breast at Centre for oncology,Government Royapettah hospital between January 2002 and December 2014 were analysed.
Results
The median age was 49 years and 30.33% patients were premenopausal. Stage I, II, III and IV comprised of 6.2%, 36.8%, 42.3% and 14.7% respectively. 96% patients presented with lump breast. At a median follow-up of 60 months 313 (32.6%) out of 1068 patients who had non-metastatic diseasehad relapsed (Systemic 256, Loco-regional 57) and 204 patients (21.3%) had died. Five year DFS and OS were 67.4% and 78.7% respectively.
Conclusion
Breast cancer is a major health problem in India. Diagnosis at an advanced stage is a major concern. Education, awareness campaigns, better access to diagnostic resources, availability of higher standards of health care, use of breast self-examination, and screening mammography if implemented would go a long way towards increasing early diagnosis and improved survival.
EP 02
Title: Local Oncoplastic Reconstructive Surgery for Carcinoma Breast- Surgical and Oncological outcome (E-Poster)
Author: Dr.Nataraj Naidu R, Dr.SomashekharSp, Dr.Shabber S Zaveri, Dr.RajshekharJaka, Dr.Ashwin, Dr. Prasanna G, Dr.Rohit Kumar
Institution: KOLKATA, INDIA
Email: dr.natarajnaidu@gmail.com
Abstract
Background
Oncoplastic surgery refers to immediate or delayed breast reconstruction following partial mastectomy and involves both volume displacement and volume replacement techniques. The technique involves the transfer of adjacent breast parenchyma and skin to the area of the defect. It is dependent on random blood supply and does not involve creating a parenchymal tissue pedicle. The indications for cosmetically acceptable breast conserving surgery can be safely extended to tumours involving all the quadrants of the breast, thus expanding the armamentarium of Oncoplastic Surgery.
Our Study
Prospective non randomized study between January 2010- June2015. It included 110 patients with carcinoma breast with T1/T2 lesions in different quadrants. Acceptablecosmesis was achieved in 100% of patients. Margins were negative in all the patients. No patient has had regional or distant metastasis or has succumbed to the disease.
Conclusions
Reshaping of breasts after partial mastectomy involves essentially building a new smaller cone and adjusting the nipple areola complex (NAC) to the summit of the cone. Oncoplasty achieves all this over 30–45 min as compared to other autologous tissue reconstructions. It also has no donor site morbidities vis-à-vis LD/ TRAM.
Advantages of Oncoplasty
Make breast mound aesthetic, safe disease control, and Displace margins. It does not add volume or achieve complete symmetry
EP 03
Title: AXILLARY REVERSE MAPPING FOR BREAST CANCER- A FEASIBILITY STUDY IN INDIAN SCENARIO (E-Poster)
Author: Sanghamitra Jena*, Samir Bhattacharyya, Arnab Gupta
Institution: KOLKATA,INDIA
Email: docsalu@gmail.com
Abstract
Introduction
Axillary lymph node dissection (ALND) remains the gold standard for treatment of breast cancer patients. However, this operation is associated with significant morbidity, the most functionally debilitating is lymphedema.
Axillary reverse mapping (ARM ) helps in differentiating arm lymphatics from breast lymphatics. Based on the hypothesis that the lymphatic pathway of the arm is not involved by the metastasis of the primary breast cancer and after accurately identifying and preserving the arm lymphatics, lymphedema can be decreased without increasing local recurrence.
Considering the difference in patient characteristics in Indian set-up, where large number of patients present with clinically node positive axilla and SLNB is less commonly practiced, we tried to study the feasibility of ARM in Indian scenario.
Materials and Methods
All female patients of age 18–75 years with biopsy/ FNAC confirmed breast cancer, undergoing axillary lymph node dissection as part of their treatment were included in the study. ARM was performed with 1% methylene blue 30 min before ALND. Any blue lymphatic channels and/or blue lymph nodes were identified.Blue lymph nodes were dissected and sent separately for pathologic evaluationto detect any metastases.
Results
120 patients were included.
Lymph nodes were identified in 40 (33%) and lymphatics in 58 patients (48.33%).
In only 3 of 40 patients (7.5%) the lymph node was positive for malignant tumour cells. The tumour burden in both these patients was very high.
The identification rate of ARM nodes and lymphatics was lower in patients with higher clinical T, clinical N and clinical stage of the disease.
Conclusion
The identification rate of ARM lymphatics and nodes is low when only blue dye is used; a combination of two techniques may be a better alternative.
The technique appears to be relatively oncologically safe in patients with low tumour burden. However further studies will be required before this procedure can be universally applicable without compromising the oncologic safety.
EP 04
Management of the Phyllodes of the Breast – Our Institute Experience
Institute
Nizam’s Institute of Medical Sciences (NIMS),
Department of Surgical Oncology, Panjagutta, Hyderabad, Telangana 500,082
Authors
Prof G S N Raju, Dr. Rajshekhar,Dr. Jena, Dr. Rangnath, Dr. Ajit, Dr. Amogh
Presenter: Dr. Amogh Satchidanand Kale [Email: amoghskale@gmail.com | Ph: 040–23489186, Cell: 7207241000]
Abstract
Introduction
Phyllodes tumor of the breast account for <1% of all breast tumors. It can be benign,malignant or borderline; all three kinds tend to grow fast, requiring surgery with good surgical margins for tumor clearance to reduce local recurrence.
Materials and Methods
Medical records were reviewed of the patients with phyllodes tumor, who underwent surgery at NIMS in our department between January 2005 to December 2013. Patients age, tumor size, Histopathology report and recurrences were noted.
Results
Out of 32 cases studied most of the patients were between 35 and 45 years age group,tumor size was 2–5 cm in 13 patients, 5–10 cm in 10, >10 cm in 7 and <2 cm in 2 patients. Histopathology was reported as benign in 26 borderline in 5 and malignant in one patient. Wide Local Excision (WLE) was done in 28 patients with 1–2 cm margin out of which 24 had benign tumors, 3 borderline and one malignant tumor. Simple Mastectomy was done in 4 patients, 2 of them had borderline and 2 benign phyllodes tumors.None of them received any adjuvant treatment.All patients are doing well without recurrence with median follow up of 2 years.
We observed that, 7 patients had recurrence after initial excision of the tumors in the past. We had performed WLE in 4 and simple mastectomy in 3 patients for these recurrent tumors which were reported as benign phyllodes in 3 and borderline phyllodes in 4 patients.
Conclusions
Most of the phyllodes are benign or borderline, yet requires adequate marginal clearance to avoid recurrence.
EP 05
Title: Carcinoma breast in a 12 year old female (E-Poster).
Author: Prof.N.K.Jha, Dr. Amrisha Sharan*
Institution: 252, NEW AG CO-OPERATIVE COLONY,KADRU,RANCHI,INDIA
Email: amrishaneha@gmail.com
Abstracts
Introduction
Primary breast cancer is rare in children and adolescents. The incidence of breast cancer in women younger than 20 years is 1 in 1,000,000.Thirty-nine cases of primary breast cancer in pediatric patients have been published. Secretory adenocarcinoma is the most common primary breast cancer in children. Cases of medullary and inflammatory cancer have also been described in adolescents.The usual presentation is a large painless mass in the breast. Lack of sufficient data has led to controversy in management guidelines. Surgical excision is the goal of therapy. Radiotherapy and chemotherapy may be used after weighing the risk of subsequent cancers.
Case presentation
A 12 year old female presented to the surgery opd with complain of swelling and hardness in the right breast since two months andulcer over the breast since one month following incision and drainage for breast abscess. She had not attained menarche. There was no family history of breast cancer. On examination, in the right breast there was a 10cm x7cmhard, non tender lump fixed to the chest wall with an ulcer of size 4 × 4 cm in upper part. In the left breast a lump of size 1cm x1cm in upper inner quadrant, hard, non tender not fixed. Bilateral axillary lymph nodes and left cervical lymph nodes were enlarged. Biopsy from right breast ulcer reported an Invasive Carcinoma(NOS) of the breast. ER −/PR + Her2- on immunohistochemistry. All nodes showed metastasis. Left breast mass was suspicious for malignancy. A diagnosis of carcinoma breast was made which was infiltrating the chest wall and the patient was started on chemotherapy. The tumor regressed in size after 3 cycles and the patient is planned to undergo surgical excision.
Conclusion
Carcinoma breast is uncommon in children and to our knowledge this is the first case of invasive carcinoma breast with Progesterone receptor positivity reported. Surgical excision is planned in the month of August 2015.
EP 06
RECURRENT ANGIOSARCOMA BREAST- A RARE CAUSE OF KASSABACH MERRITT SYNDROME
Authors
Dr. Adithya Malolan P, Dr. Prashant Chowdary, Dr. Shiva Nandaswamy BS
Institution: F2, #16, 10th cross, 2nd main, NR Colony, HCG, Bangalore
Presenter: Dr. Adithya Malolan P. [Email: adithya.malolan@gmail.com Mobile: +91-9845147145]
Abstract
Introduction
Kassabach Merritt Syndrome is characterized by the association of a consumptive thrombohemorrhagic disorder and angioma occurring usually in children with large vascular lesions such as haemangiomata.
Mammary angiosarcomas are rare neoplasms, accounting for about 0.05% of all primary malignancies of the breast. They occur sporadically in young women and usually present as palpable masses. They are aggressive tumors of endovascular origin and are often immunopositive for CD31, CD34 and Factor-VIII.
Case Report
We present the case of a 38 year old lady, diagnosed with angiosarcoma breast, primarily treated with simple mastectomy and presented with recurrence after 4 months. Her clinical course was complicated by bleeding from the recurrence site with anemia and thrombocytopenia. She underwent subsequent wide local excision and has been started on adjuvant chemotherapy. It is presented along with a review of literature.
Conclusion
As rare histopathological diagnoses become more frequent in the breast, it is the responsibility of the treating surgeon to beware of their complications, many of which may surprise the untrained mind.
EP 07
EP 07
Title: MOLECULAR PROFILLING IN BREAST CARCINOMA: A FUTURE PERSPECTIVE (E-Poster) Author: Dr. Arnab Chakraborty
Institution: IPGME&R KOLKATA Email: drarnabchakraborty@gmail.com
Abstract
Introduction
Breast cancer is a heterogeneous disease, and by gene expression profiling has been shown to be classifiable into four major molecular subtypes:
luminal A(ER+,PR+,HER-2-),
luminal B(ER+,PR+,HER-2+),
Human epidermal growth factor receptor-2(HER-2+).
basal – like(ER-,PR-,HER-2-).
The choice of adjuvant therapy is based on menopausal status, tumor size, grade, lymph node involvement, hormone receptors status and HER-2/neu status.
Aim OF The Study
To study the relation between Molecular subtypes and lymph node status,NPI of patients diagnosed to have breast cancer.
Methodology
After Surgery we measured the expression of ER, PR and HER-2 in human breast carcinomas using immunohistochemistry and investigated with known tumor variables such as tumor size, grade, nodal status and NPI in single pathological laboratory.
The association between molecular subtypes and lymph node status was statistically significant (p < 0.001).
Her2 type came out to be the second most common subtype in indian scenario.
Higher NPI (poor prognosis) was associated with molecular subtypes (p < 0.001).
Luminal B was poor prognostic marker than Luminal A.
Our study HER-2 positive subtype had the worst overall survival compare to the other subtypes.
From this study we can concluded that molecular profilling significantly correlates with other prognostic factor. However, whether it can replace lymph node assessment or not, for that survival analysis with large sample size is contemplated.
Keywords
Breast CancerMolecular SubtypeLymph node involvementNottingham Prognostic Index Prognosis
EP 08
THE VICTORS - TELL TALES OF BREAST CANCER SURVIVORS FROM COMPREHENSIVE BREAST CLINIC AND BREAST SERVICES, IPGME
Authors: Dr. Shail Jalan [ Shail.Jalan@Gmail.Com ] | Dr. Diptendra Sarkar | Dr. SuvroGanguly
Institution: Comprehensive Breast Clinic & Breast Services, IPGMER and SSKM Hospital
Abstract
Introduction
Breast cancer is associated with three factors, fear, survival and womanhood. Many cultural programs have been held throughout the country to address the psychological and social aspect associated with breast cancer and its treatment.
Aim of the study
This study addresses the impact of these cultural programs on breast cancer survivors.
Methodology
A questionnaire was prepared and based on it, interviews were conducted and recorded, before and after the treatment.
Conclusion
The responses of the patients at the time of diagnosis differed. They underwent different but known modes of treatment subsequently. Before the cultural program psychological and behavioral responses were different for patients of various age groups and socioeconomic status. The cultural programs had a similar positive impact on all the patients.
EP 09
THE LADY WITH RAISED PROSTATE SPECIFIC ANTIGEN: DO WE NEED TO WORRY?
Authors: Dr. Milton Swarnakar, Dr. Soumen Das, Dr. Retina Paul, Dr. M. L. Saha
Institution: Room 624, PG hostel, sskm hospital,Kolkata, IPGME&R
Email: drmswarnakar@hotmail.com
Abstract
Background
rostate specific antigen (PSA) is generally considered a biological marker of prostate cancer although raised values may also be observed in benign prostatic diseases. PSA can be secreted in females from skeine’speriurethral gland but at low levels. This case - control study aimed at the evaluation of relation of PSA with different diseases in women.
Method
A total of 297 patients were included, 107 with breast cancer, 90 with benign breast disease (BBD) and 100 controls (patients attending our surgery department for non-breast diseases). PSA was measured in the serum of all and a statistical analysis was conducted.
Result
An association of raised PSA with breast diseases was observed. Total PSA was more sensitive for benign breast diseases, whereas breast cancer showed a predilection towards increase in free PSA. PSA decreased after surgery. Conclusion: PSA can be used as a diagnostic and prognostic marker of breast cancer in women, therefore helping secondary prevention of breast cancer.
EP 10
Title: EARLY PREDICTION THERAPY RESPONSE AND OUTCOMES IN BREAST CANCER PATIENTS USING STRAIN WAVE ELASTOGRAPHY (E-Poster)
Author: Dr. Amit Katyan
Institution: RZ-6, VAISHALI EXTENSION, DABRI PALAM ROAD. VARDHAMAN MAHAVIR MEDICAL COLLEGE AND SAFDARJUNG HOSPITAL
Email: amitkatyan@icloud.com
Abstract
Introduction
Ultrasound elastography is a new imaging technique that can be used to assess tissue stiffness. Reliable early assessment of breast cancer response to neoadjuvant therapy (NAT) would provide considerable benefit to patient care and ongoing research efforts.
Materials and Methods
We conducted a pilot study at VMMC and Safdarjung hospital, New Delhi in which the potential of ultrasound elastography was investigated in 20 patients of LABC.Women receiving NACT had the affected breast scanned before and at each cycle of chemotherapy. Changes in elastographic parameters related to tissue biomechanical properties were then determined and compared to clinical and pathologic tumor response after mastectomy.
Results
Patients who responded to therapy demonstrated a significant decrease (P < .05) in strain ratios and strain differences 4 weeks after treatment initiation compared to non-responding patients. Mean strain ratio and mean strain difference for responders was significantly lower in contrast to non responders.
Conclusion
Strain ratio using static ROIs was found to be the best predictor of treatment.
Translating and incorporating these techniques into the clinical setting will require close attention to statistical validation methods, standardization and reproducibility of technique.
Breast Free Paper
FP 01
Title: Sentinel Lymph Node Biopsy For Breast Cancer – A Preliminary Experience (Free Paper)
Author: Dr. Kirthiga R
Institution: Room 7, I floor, ladies PG Hostel, Kidwai memorial institute of oncology, Bangalore
Email: kirithigaramalingam@gmail.com
Abstract
Introduction
Sentinel lymph node biopsy(SLNB) is the standard recommended procedure for node negative early breast cancer patients. The combination of both isosulphan blue and the radioactive sulphur colloid gives the best result and is the standard procedure for SLNB. Isosulphan blue is costly and nuclear medicine facility is not widely available. An affordable, equally efficient alternative could be the use of methylene blue dye alone for doing SLNB.
Materials and Methods
Of the 56 node negative early breast cancer patients included in the study, 24 were subjected to the combination method of methylene blue and radioactive sulphur colloid and 32 to methylene blue only for carrying out SLNB. All the patients were subjected to axillary lymph node dissection (ALND) following SLNB. Median follow up of the patients were 2.3 years.
Results
Sentinel lymph nodes were identified in all the 56 patients. Five and 8 patients were SLNB positive in combination method and blue dye only method respectively. One patient from the combination method with a negative SLNB report was positive on ALND. All other results were concurrent. Sensitivity and specificity of the blue dye only method was100% and combination method was 83.3% and 100% respectively. On a median follow up of 2.3 years, none had axillary recurrence. However, 2 patients had recurrence at the breast scar site.
Conclusion
The results of methylene blue dye alone are comparable to the combination method for SLNB. When nuclear medicine facilitiesare not available, the use of blue dye alone could be justifiedto carry out SLNB to avoid ALND when not necessary.However, this needs validation by further studies in large numbers.
FP 02
Title: IMPACT OF SPECTRUM OF GENETIC MUTATION IN BREAST CARCINOMA Authors- Dr. Anirban Das, Prof. Diptendra K Sarkar, Dr. Suvro Ganguly. Comprehensive Breast Service & Breast Cancer Research Unit, (Free Paper)
Author: Dr. Anirban Das
Institution: 77/2/1A, Bade Raipur Road. Kolkata- 700,032, IPGMER / SSKM Hospital, Kolkata
Email: dr.anirban.9@gmail.com
Abstract
Introduction
Breast cancer is the most commonly occurring cancer among Indian women with a relative proportion ranging from 19.3% to 27.5% (ICMR). Mutations in the BRCA 1 and BRCA 2 genes profoundly increase the risk of developing breast and/ or ovarian cancer among women. Genetic predisposition for familial early-onset breast cancer accounts for approximately 5–10% of all breast cancers. They differ in their expression in various prognostic factors of breast cancers, particularly in tumour size, grade, axillary lymph node status, NPI, ER/PR status at the time of diagnosis. Our aim of the study is to identify the effects of genetic mutation over various CA breast prognostic factors.
Material & Methods
It is a prospective study among the patients admitted with diagnosis of female breast cancer (IDC) for surgery at S.S.K.M. Hospital, Kolkata from January’2014 to April’2015. The total number of CA breast patients indentified before surgery was 107. Detailed clinical history was taken from them including family history and they are subjected to Sandwich ELISA technique for identification of mutation like BRCA 1 and BRCA 2. After surgery with MRM, HPE & IHC reports were collected for information’s like tumour size, grade, axillary lymph nodal involvement, NPI and ER / PR status. The data are analysed to identify the effect of genetic mutation over disease prognostic factors.
Results
Ca breast patients with BRCA 1 mutation (n1 = 4), prevalence = 3.7%. Ca breast patients with BRCA 2 mutation (n2 = 15), prevalence = 14%. BRCA 1 mutation CA breast presents in majority with large tumour size (50%), high tumour grade (50%), high axillary lymph node metastasis (50%), mostly associated with triple negative on IHC (75%). BRCA 2 mutation CA breast presents in majority with moderate tumour size (53.33%), high tumour grade (60%), moderate to high axillary lymph node metastasis (46.67%), high NPI (60%), mostly associated with Luminal B type on IHC (46.67%).
Conclusions
Genetic mutation is responsible for causation of breast carcinoma in 3.7%–14% ca breast cases with majority with BRCA 2 mutation. BRCA 1 mutation associated tumour shows more aggressiveness in tumour size, grade, axillary lymph node involvement and NPI than BRCA 2. Most of the BRCA 1 mutation tumour shows Triple negative on IHC, whereas BRCA 2 shows Luminal B type. Hence, BRCA 1 mutation has grave prognosis.
FP 03
Title: CYSTOSARCOMA PHYLLODES: PATHOLOGICAL ENIGMA - A RETROSPECTIVE REVIEW OF 162 CASES (Free Paper)
Author: Dr. Kapil Dev
Institution: 307, PG HOSTEL, KMIO, BANGALORE, KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY, BANGALORE
Email: DR.kapil2010@gmail.com
Abstract
Introduction
Phyllodestumour(PT) is rare fibroepithelial neoplasm comprising <1% of all breast tumors. Clinical spectrum ranges from benign(B), borderline(BL) and locally recurrent to malignant(M) and metastatic type. We analyzedclinicopathological factors, compare treatment options and evaluate outcome in patients with phyllodes.
Material & Methods
We retrospectively reviewed 162 women with phyllodes. The surgical intervention varied from simple excision (lumpectomy)/ wide local excision (WLE) in benign cases to simple/modified radical or radical mastectomy (SM/MRM/RM) in malignant and recurrent tumours.
Results
Out of 162 patients B, BL and M were 95(58.64%), 29(18%) and 38(23.45%) respectively. Mean age, duration of lump and size was 38 ± 8years, 28 ± 10 months and 12 ± 5 cms respectively. Recurrence rate with B, BL and M was 15.78%, 41.37% and 55.26% respectively(p = 0.00001). As compared to WLE(22%), SM(23.8%) & MRM/RM(14.2%) recurrence was higher with lumpectomy (48.9%)(p = 0.004).Positive correlation found between recurrence rate with size of tumour(p = 0.008) and also number of recurrence with HPE (p = 0.047). No association between number of recurrences and size of tumour (p = 0.63).Malignant PT seen in 38(24%) and distant metastasis in 7(18%). Mean duration of follow-up was 42 months.
Conclusion
WLE with negative margins should be initial surgery for PT. The role of adjuvant radiotherapy and chemotherapy is uncertain.PT is pathological enigma. Till date no factors can accurately predict recurrence and outcome. PT is known for unpredictable behavior and high recurrence rates, hence long term follow up is advised.
FP 04
Title: TRIPLE NEGATIVE BREAST CANCER - A CLINICAL CHALLENGE
Institute
Nizams Institute of Medical Sciences, Department of Surgical Oncology, Panjagutta, Hyderabad, Telangana 500,082 Email: drpraju@yahoo.com, Phone: 04023489186, Cell: 09246339569
Authors
Prof. G. Suryanarayana Raju, Dr. Rajshekar Patil, Dr. S Jena, Dr. Ranganath, Dr. Ajit
Presenting Author: Dr. RajshekarS.Patil
Abstract
Introduction
Triple negative breast cancer (TNBC) is a special subgroup of breast cancer accounting for 15–25%, characterized by the clinic-pathological heterogenesity, aggressive course of the disease and limited treatment options making clinical management challenging.
Materials and Methods
We have reviewed our breast cancer patients who underwent curative surgery at Nizams Institute of Medical Sciences Hyderabad between Jan. 2005 and Dec. 2010.Clinicopathologic variables and outcomes were evaluated with patients followed till June 2015.
Results
In our study there were 65 TNBC patients (23.3%) out of 278 patients with known estrogen, progesterone and Her2neu receptor status. The mean age at presentation was 46 years with 50.6% patients premenopausal. 57.6% patients had tumour size between 2.1cm to 5cm (T2). The histological grade was III in 53.8% particularly in patients under the age 50 years (65.7%). 60% of the TNBC cases were lymphnodepositive.There were total 14 (21.5%) recurrences in TNBC group. 13/14 recurrent patients had chemotherapy and 8/14 had post operative radiotherapy. Distant metastasis occurred in 64.2% and loco regional in 21.4% as first site of recurrences. 35.6% of patients had spread to visceral organs as first site of metastasis compared to bone (28.5%). Most of the cases were grade 3 (9/14) and LN positive (11/14). Three patients died with recurrent disease.
Conclusions
TNBC tends to develop visceral metastases and aggressive clinical behaviour despite the curative surgery, chemotherapy and radiotherapy which necessitate further studies to define subtypes of TNBC in greater detail and to develop and assess specifically targeted therapies.
FP 05
Title: PROGNOSTIC SIGNIFICANCE OF HER-2/NEU AND ITS SURVIVAL OF BREAST CANCER PATIENTS ATTENDING AT COMPREHENSIVE BREAST CLINIC OF A SPECIALIZED INSTITUTE IN KOLKATA, EASTERN INDIA (Free Paper)
Author: Dr. Amit Kumar Das
Institution: VILL-ICHAPUR. P.O-MADHABPUR
Email: kamit2306@gmail.com
Abstract
Introduction
The worldwide incidence of breast cancer has increased rapidly in recent years. The scenario of Eastern India is also showing the same trend. It is necessary to study the usefulness of HER-2/neu as prognostic significance in breast cancer survival. But there have not been detailed studies in this respect with the breast cancer patients of Eastern India. Thus this study provides prognostic significance of HER-2/neu and its survival of breast cancer patients of Eastern India.
Materials and Methods
In this hospital based study 86 breast cancer patients attend at a Breast Clinic of a reputed institute of Eastern India and having invasive ductal carcinoma were observed for a period of 5 years after surgery. The association between 5 years observed survival and status of ER, PR and HER-2/neu of the patients was critically studied.
Results
There was statistically significant association between survival pattern for 5 years and with status of HER-2 /neu (p = 0.00001). Better survival pattern had been observed for the patients with HER-2/neu negative tumors 67(100%) compared to HER-2/neu positive tumors 7(36.8%).
Conclusion
There is strong interaction between survival and HER-2/neu expression of breast cancer patients. Thus the patients with HER-2/neu positive tumors need to be treated aggressively.
FP 06
Title: PER OPERATIVE PARAMETERS PREDICTING ‘ARM’ LYMPH NODE METASTASIS IN NODE POSITIVE OPERABLE (Free Paper)
Author: Dr. Hemant G N
Institution: NO. 19, 2ND MAIN ROAD, N R COLONY, ST. JOHN’S MEDICAL COLLEGE HOPITAL
Email: drhemanth.gn@gmail.com
Abstract
Introduction
Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the breast from that of the upper limb in the axillary lymph node basin. If lymphedema is caused by removing these lymphatics and nodes in the upper limb, the possibility of identifying these lymphatics and nodes would enable surgeons to preserve them, based on certain per operative parameters.
Materials and Methods
Sample size: 20
Study type: Prospective
Place of study: St. John’s Medical College Hospital, Bangalore
Time period: 1 year (July 2014 to July 2015 )
Inclusion criteria: Patients with biopsy proven, node positive (clinical &/or imaging) upfront operable breast cancers
Exclusion criteria: Post neoadjuvant chemotherapy, previous axillary surgery
Results
ARM node identification rate was 75% with average node size being between 1 and 2 cm. The most common location of the ARM node was lateral to the LD pedicle (8/19 nodes, 42.10%), none of them being malignant. Intra operative FNAC had a PPV of 92.8% for a benign node and 100% for a malignant node with a sensitivity of 100% for both benign and malignant nodes.
Conclusion
Location, consistency, and intraoperative FNAC of ARM node, put together, are reliable parameters to predict involvement of ARM node with metastasis, whereas, taken individually, they are not reliable.
FP 07
Title: Cyclin D1 be a useful prognostic marker in breast cancer patients (Free Paper)
Author: Dr. Chiranjit Mukherjee
Institution: I. P.G.M.E.& R. & SSKM Hospital, Kolkata
Email: Chiranjit1201@gmail.com
Abstract
Aims
Cyclin D1 regulates cell cycle & progression of cancer in breast and some other parts of human body. This study investigated the role of Cyclin D1 activity in human breast cancer with overexpression of ER, PR, HER-2/neu , as well as its role on Cyclin D1 expression of menopausal status , different stage , grade, tumor size, nodal status, NPI of breast carcinoma in Eastern India.
Methods
In this hospital based study 123 breast cancer patients attend at a Comprehensive Breast Service and Breast Cancer Research Unit, Eastern India and Cyclin D1 protein expression was measured from breast tumor tissue sample by Western Blot Technique. Cyclin D1 mRNA expression was measured by RT-PCR Technique. ER, PR and HER-2/neu were measured by immunohistochemistry methods.
Results
Cyclin D1 was significantly associated with small tumor size (≤2 cm), low grade tumors, ER positive, PR positive, HER-2/neu negative and low NPI value (NPI < 5.4) which were good prognostic marker in breast cancer.
Conclusions
Low levels of Cyclin D1 have poor prognosis in breast cancer patients. In our clinical practice, Patients with Cyclin D1 negative tumors need to be treated aggressively.
Keywords
Breast CancerCyclin D1Prognostic markerNottingham Prognostic Index (NPI)Immunohistochemistry (IHC)
BONE
EP 01
Title: Reconstruction of Elbow with Alloprosthesis Composite for Malignant Bone Tumour: A case Report (E-Poster)
Institution
Manipal Comprehensive Cancer Center, Manipal hospital, Bangalore
Authors:
Nataraj Naidu, DR.SRINIVAS CH, DR.SRIMANTH BS, DR.SOMASHEKHAR SP, DR.SHABBER S ZAVERI, DR.RAJSHEKHAR JAKA, DR.ASHWIN, DR PRASANNA G , DR.ROHIT KUMAR
Address for correspondence: Manipal Comprehensive Cancer Center, Manipal hospital
#98 HAL airport road, Rustam Bagh, Bangalore 560,017, Karnataka, India
Presenting Author: DR NATARAJ NAIDU R. [dr.natarajnaidu@gmail.com Cell: +91 9,886,328,394]
Abstract
Introduction & Purpose
A 50 year old lady from Mysore presented with history of swelling and pain in her right elbow for 2 years for which she had undergone 2 surgeries for a suspected sarcoma. The swelling had reappeared since 6 months. She had rest pain associated with restriction of elbow movements.
Material & Methods
X ray and MRI of the Elbow showed an expansile lytic lesion in the proximal Ulna with breach of the articular cartilage and extension into elbow joint. A true cut needle biopsy revealed diagnosis of Low grade recurrent Fibrosarcoma of the Proximal Ulna. Staging included CT Thorax which was negative for metastases. She underwent wide excision of elbow via medial approach, which was reconstructed with Alloprosthesis composite using proximal Ulna allograft and Custom made Total Elbow Megaprosthesis. The reconstruction was covered by LatissimusDorsi flap.
Results
Histopathology evaluation of excised specimen indicated intermediate grade malignant mesenchymal tumour suggestive of monophasic synovial sarcoma. Wound healing was satisfactory and flap had taken up well. Physiotherapy was initiated after 3 weeks. Ulnar nerve neuropraxia was noted which completely recovered by 6 months. At latest follow up of 3 years and 4 months, the patient is comfortable, able to perform daily activities of living with functional score (MSTS) of 26/30. There was no evidence of local recurrence or distant metastases.
Conclusion
This case highlights the unusual locally aggressive presentation of monophasic synovial sarcoma followed by adequate resection and approach to limb salvage in a recurrent soft tissue sarcoma scenario. Alloprosthesis composite is an innovative method of reconstruction to restore near normal function of elbow.
EP 02
Title: Chemoport placement using novel technique under local anesthesia: Our Experience (E-Poster)
Author: Dr.Nataraj Naidu R, Dr.SomashekharSp, Dr.Shabber S Zaveri, Dr.RajshekharJaka, Dr.Ashwin, Dr. Prasanna G, Dr.Rohit Kumar
Institution: Manipal Hospital, Bengaluru
Email: dr.natarajnaidu@gmail.com
Abstract
Background
Chemoports are intravenous access for chemotherapy. Most commonly used technique for chemoport insertion by most surgeons is Seldinger puncture technique. This utilizes blind puncturing of vein for catheter access and a separate incision for subcutaneous pocket for chamber. This technique carries risks of inadvertent arterial puncture, multiple vein punctures which leads to hematoma, pneumothorax, hemothorax, brachial plexus injuries and increased radiation exposure. These risks can be avoided by our novel technique of cephalic vein cut down.
Results
In total 1200 Patients from Jan. 2007- June 2015. Ninety 5 % of time we could access vein through this technique, 4–5% times we used seldinger technique. 0%pneumothorax and 0%subclavian vein injury.
Conclusions
Advantage is this can be done in local anesthesia. We use single incision for catheter and chamber placement. The cephalic vein is directly visualized and catheter placement done so no increased risks as of puncture technique. Less radiation exposure in our technique as we use only to confirm the position of the catheter with fluoroscopy. There is no need of post procedure CXR to detect pulmonary complications.
Short video explains the steps of chemoport insertion and advantages in short.
EP 03
Title: A Safe Approach To Tumor In Prestyloid Space: Trancervical Approach (E-Poster)
Author: Dr. Harish Kumar H.
Institution: D.NO.101, GANGOTHRI CASTLE APPARTMENT,14TH MAIN, 39TH A CROSS, JAYANAGAR,BENGALURU, kIDWAI MEMORIAL INSTITUTE OF ONCOLOGY
Email: harishkumarh1983@gmail.com
Abstract
Introduction
Masses in the prestyloid space are mostly benign, well defined, surrounded by fat, and unlike tumours of the poststyloid space, are generally not tethered to structures such as major nerves and vessels. They can therefore generally be removed by careful blunt dissection along the tumour capsule, avoiding tumour rupture, especially with pleomorphic adenomas.
Materials and Methods
Hereby we present a case ,wherein a 48 year old lady presenting with history of dysphagia since three weeks. On clinical examination, tonsillar fossa was pushed medially. CT Scan features were suggestive of tumor in presytloid region of parapharyngeal space, with surgical planes well maintained. Ultrasound guided fine needle aspiration cytology was suggestive of pleomorphic adenoma.Hence surgery was planned. Although many surgical approaches have been defined for parapharyngeal space tumors, transcervical approach is a safe and easily accessible approach specially for tumors in prestyloid region. Here we approached the tumor with transcervical route and once the space was entered, by blunt dissection, tumor was excised in total without damaging surrounding vital structures.
Conclusion
Hereby we conclude that any benign tumor in prestyloid space can be removed by transcervical approach without any major complications.
EP 04
Title: A Rare Case Report Of Chest Wall Periosteal Chondroma - A Rare Entity (E-Poster)
AuthorsDR.N.SELVARAJ Mch Postgraduate, PROF.DR.R.RAJARAMAN MS, Mch, PROF.S. SUBBIAH MS, Mch, DR.SUJAY SUSIKARMS, Mch,
Institution: C14 VASANTHAM APPARTMENTS, NO 6 MTH ROAD,
VILLIVAKKAM CHENNAI, SURGICAL ONCOLOGY GOVT KILPAUK MEDICAL COLLEGE
Email: drsels@yahoo.com
Abstract
Introduction
Chondroma of chest wall constitutes 15–20% of benign chest wall tumors,which peaks in the third and fourth decades. It usually occurs at costochondral junction anteriorly. It’s divided into Enchondroma and Periostealchondroma. Periosteal chondromas are frequently diagnosed in the second or third decades of life.
Objective
Periosteal chondromas account for less than 1% of all chondromas and 0.1% of all bone tumors. Periosteal chondromas common in the long tubular bones followed by short tubular bones of the hand. This case is being presented because of its rarity and atypical presentation.
Case History
A 17 year old male presented with recurrent chest wall swelling for 4 months. HPE report of previous excision biopsy was chondroma. Open biopsy done outsidewas reported as chondroma with atypia. He underwent excision of the swelling with resection of segment of 2nd and 1st rib and chest wall reconstruction with mesh and pectoralis major muscle at our department. Post-operative HPE was reported as benign chondroma.
Conclusion
The differentiation between a benign cartilage lesion and a low-grade chondrosarcoma can be extremely difficult both clinically and radiologically. Recurrence of an enchondroma may be a sign that the lesion is actually a low-grade chondrosarcoma. Chondroma offlat bones should be treated with wide local resection and histopathologic evaluation to rule out the possibility of chondrosarcoma, which is common at these sites.
EP 05
Title: Total humerus replacement for chondrosarcoma shaft humerus (E-Poster)
Author Dr. N Kannan, Dr. P Takkar, Dr. K Sahai, Dr. A Sharma
Institution: Dept Of Surg Onco MDTC, 4th floor, MH(CTC) Kondwa Road Pune,
Email: majkannan@gmail.com
Abstract
42 years male, presented with 02 years history of progressive circumferential swelling and pain in right arm. Examination revealed a firm circumferential swelling involving mid 1/3 of right arm. Skin over the swelling was uninvolved. MRI and CECT scan of the right arm revealed a 20cm mass epicentredin themid humerus with cortical thickening, altered marrow signal and internal calcifications, displacing the muscles and brachial vessels. Biopsy confirmed a periosteal chondrosarcoma. Bone scan and PET scan revealed a localized disease. Patient underwent wide resection of tumour and total humerus resection and replacement with a modular reconstruction system. Patient resumed normal activites within 6–8 weeks.
Cervix
FP 01
Title: Can Laparoscopic Radical Hysterectomy Be A Standard Surgical Modality In Stage Ib1-Iia Cervical Cancer? A Retrospective Analysis Of 224 Patients From A Single Center (Free Paper)
Author: Dr. Satish Pawar
Institution: Road no.14, Banjara hills, basavatarakam indoamerican cancer Institute
Email: satishoncology@gmail.com
Abstract
Objectives
To determine if total laparoscopic radical hysterectomy (TLRH) can be substitute for open radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1–IIA cervical cancer.
Methods
We retrospectively reviewed the medical records of early stage cervical cancer patients who underwent TLRH with laparoscopic pelvic lymphadenectomy (LPL) from APRIL 2010 to JUNE 2014.Analysis was done on 31MARCH 2015.
Results
There were 224patients who underwent TLRH with LPL 134 (59.8%) were in IB1, 49 (21.9%) were in IB2, 32(14.3%) was in IIA1, and 9(4%) were in IIA2 clinical stages. The median operating time, operative blood loss, post operative day(POD) of oral liquids starting, POD of flatus passage, days of hospital stay, the number of harvested pelvic lymph nodes were 3.30 h(range 2–5 h), 100ml(range 20–400 ml), 1 day(range 1–6), 2days(range 1–4), 6days(range 4–16), 10 nodes(range 0–29) respectively. There was no unplanned conversion to laparotomy. No perioperative mortality was present and grade 1–2 morbidity was seen in 23 patients (10.3%).
Out of 224 patients, recurrence was seen in 25 (recurrence percentage 11.1%). In a median follow-up of 24.5 months (range 0–56), 31 patients (13.9%) were lost to follow up. Out of remaining 193 patients (86.1%), 29 patients (15.2%) died&164 patients (84.8%) were alive for final analysis.Disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 84.9%, respectively.
Statistical analysis was done by using Graph pad software’s Fischer’s t test. Parametrial involvement (p = 0.0367), vaginal margin positivity (p = 0.0045)&Lymph node positivity (p = 0.0471) were significantly associated with DFS but not OS rates. Lymphovascular invasion, histological tumor type&grade of tumor were not significantly associated DFS or OS rates. Figo stage was significantly associated with both DFS (p = 0.0355) & OS (p = 0.0376) rates.
Conclusions
Total laparoscopic radical hysterectomy with pelvic lymphadenectomy is a safe and effective therapeutic procedure for management of early-stage cervical cancer in terms of survival with a far lower morbidity and better surgical outcomes than reported for the open approach. Our data suggest the need for larger prospective randomized trials which could support this approach as a new standard of care for stage IB1–IIA cervical cancer.
Colorectal
EP 01
Title: MULTI-ORGAN RESECTION AND MORBIDITY IN ADVANCED COLORECTAL CANCERS- AN ANALYSIS FROM A RURAL TERTIARY CANCER CENTRE (E-Poster)
Author: Dr. Faslu Rehman N. K
Institution: SENIOR RESIDENT IN SURGICAL ONCOLOGY MALABAR CANCER CENTRE MOOZHIKKARA PO, THALASSERY
Email: RAHMAN.FASLU@GMAIL.COM
Abstract
Objectives
To determine if total laparoscopic radical hysterectomy (TLRH) can be substitute for open radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1–IIA cervical cancer.
Methods
We retrospectively reviewed the medical records of early stage cervical cancer patients who underwent TLRH with laparoscopic pelvic lymphadenectomy (LPL) from APRIL 2010 to JUNE 2014.Analysis was done on 31MARCH 2015.
Results
There were 224patients who underwent TLRH with LPL 134 (59.8%) were in IB1, 49 (21.9%) were in IB2, 32(14.3%) was in IIA1, and 9(4%) were in IIA2 clinical stages. The median operating time, operative blood loss, post operative day(POD) of oral liquids starting, POD of flatus passage, days of hospital stay, the number of harvested pelvic lymph nodes were 3.30 h(range 2–5 h), 100ml(range 20–400 ml), 1 day(range 1–6), 2days(range 1–4), 6days(range 4–16), 10 nodes(range 0–29) respectively. There was no unplanned conversion to laparotomy. No perioperative mortality was present and grade 1–2 morbidity was seen in 23 patients (10.3%).
Out of 224 patients, recurrence was seen in 25 (recurrence percentage 11.1%). In a median follow-up of 24.5 months (range 0–56), 31 patients (13.9%) were lost to follow up. Out of remaining 193 patients (86.1%), 29 patients (15.2%) died&164 patients (84.8%) were alive for final analysis.Disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 84.9%, respectively.
Statistical analysis was done by using Graph pad software’s Fischer’s t test. Parametrial involvement (p = 0.0367), vaginal margin positivity (p = 0.0045)&Lymph node positivity (p = 0.0471) were significantly associated with DFS but not OS rates. Lymphovascular invasion, histological tumor type&grade of tumor were not significantly associated DFS or OS rates. Figo stage was significantly associated with both DFS (p = 0.0355) & OS (p = 0.0376) rates.
Conclusions
Total laparoscopic radical hysterectomy with pelvic lymphadenectomy is a safe and effective therapeutic procedure for management of early-stage cervical cancer in terms of survival with a far lower morbidity and better surgical outcomes than reported for the open approach. Our data suggest the need for larger prospective randomized trials which could support this approach as a new standard of care for stage IB1–IIA cervical cancer.
Esophagus
FP 01
Title: A COMPARISON BETWEEN MINIMALLY INVASIVE AND OPEN ESOPHAGECTOMYIN CANCER ESOPHAGUS (Free Paper)
Author: Dr. Vikash Sharma
Institution: 201, P.G. MENS HOSTEL, KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY, BANGALORE-560,029
Abstract
Introduction
Esophagectomy is the only curative treatment for esophageal cancer. It can be performed by both traditional open i.e., transhiatal esophagectomy, transthoracic esophagectomy or minimally invasive methods i.e., VATS esophagectomy, laproscopic transhiatal esophagectomy. Esophagectomy is associated with high morbidity and prolonged post operative recovery periods. Minimally invasive can improve post operative outcomes. We have compared the pos operative outcome of minimally invasive versus open esophagectomy at a regional cancer centre in south india in last two years.
Material and Methods
From June 2013 to May 2015, 17 patients who underwent minimally invasive esophagectomy are compared to 30 patients who underwent open esophagectomy. Statistical analysis is performed using stata 11 software.
Results
Minimally invasive as compared to open esophagectomy , took slightly longer operative time (188 mins vs 171 mins; p = 0.002), less blood loss (111 ml vs 241 ml; p < 0.05), shorter ICU stay (4 vs 6days; p < 0.05), shorter hospital stay (8 vs 11days; p < 0.05), less pulmonary and cardiac complications ( 1/17 vs 3/30 patients; p = 0.62), less anastomotis leak (2/17 vs 4/30 patients; p = 0.87), more lymph node yield(13 vs 11; p = 0.17),slightly higher R0 resection(15/17 vs 26/30 patients; p = 0.87).
Conclusion
Most important benefits of minimally invasive esophagectomy are Faster post operative recovery with less blood loss, less post operative pain medication requirement without any significantly longer operating time with less pulmonary and cardiac events. Very few studies have been published in India. This study shows that minimally invasive esophagectomy is safe alternative and has same oncologic outcome to open esophagectomy. Radomised trials are needed to establish the role.
Eye
EP 01
Title: MANAGEMENT OF EYE LID DEFECTS FOLLOWING SURGICAL RESECTION FOR EYELID TUMORS – OUR
INSTITUTION’S EXPERIENCE (E-Poster)
Author: Dr. G.Arulkumar, Prof S.Subbiah M.Ch., Prof R.Rajaraman.M.Ch, Dr.G.Gopu.M.Ch
Institution: plot 65, behind CTO colony, brindavan nagar, tambaram west, kilpauk medical college
Email: arulkumar_g@yahoo.co.in
Abstract
Introduction
Malignant tumors of eyelid are rare and affectolder age group. BCC is the most common tumor followed by squamous cell carcinoma &meibomian carcinoma. Surgical resection with margins is the mainstay ofmanagement in these tumors. Reconstruction of these defects pose challenges in terms of function and aesthetic.
Materials & Methods
A retrospective study of various eyelid tumors presented in our department between 2003 to2014. In patients who underwent surgery,eyelid defects were analysedwith respect to the size, site and type of reconstruction.
Results
13 patients were included in this study. Most common histology was basal cell carcinoma followed by meibomian carcinoma. Median age was 66 years. Two patients with xerodermapigmentosum presented at a younger age.Lateral canthus (zone 4) was the commonest site of involvement followed by upper eyelid (zone 1) and lower eye lid (zone2). Rhomboid flap was the commonest type of reconstruction used for zone 4 defect. Primary closure or local rotation flap was the commonest reconstruction for zone 2 defects. Zone 1 defects less than 25% were closed primarily.In a case with >75% defect of the zone 1 , eyelid switch flap was used for reconstruction.
Conclusion
Eyelid defects arising in different zones have different anatomical, functional and aesthetic consideration. Type of reconstruction depends on the site, thickness of the defect and percentage of lid loss. The Principles of the reconstructive ladder should be applied in eyelid reconstruction.
EP 02
Title: ORBITAL ALVEOLAR SOFT PART SARCOMA: A RARE CASE REPORT (E-Poster)
Author: Dr. R. Ch. Nagaraju Chavali
Institution: Indo American Cancer Hospital & Research, Hospital Basavatarakam
Email: rajumsmch@gmail.com
Abstract
Background
Alveolar soft part sarcoma is an intermediate grade malignant tumor which accounts for less than 1% of sarcomas and has predilection to head and neck region. It is relatively common in young age and orbital involvement is very uncommon.
Material and method
A 7 year young girl presented with history of left orbital swelling since three years. Biopsy was done three years back and reported as Rhabdomyosarcoma and treated with six cycles of vincristine, adriamycin, cyclophosphamide. Patient did not responded to chemotherapy and the swelling progressed. At present, patient has huge swelling with grossly enlarged left eyelids, intermittent bleeding and complete blindness. The lesion measures 8.6 × 7.5 cms with increased vascularity seen around the lesion & left side of neck on CECT. Further metastatic work up did not show any disease elsewhere.
Result
In view of nonfunctional and bleeding left eye, orbital exenteration was performed with preservation of eyelids. Bone all around the globe was remodeled and became vascular. Orbital apex area was free of tumour. To the surprise, histopathology reported as alveolar soft part sarcoma. Further adjuvant therapy has been advised.
Conclusion
Alveolar soft part sarcoma of the orbit is very uncommon tumor among the malignant diseases. There were around 30 cases have been reported in the literature. The present case is unique in its presentation of three years long duration without distant metastasis and with dysfunctional bleeding eye.
Gall Bladder
EP 01
Title: Effect of Chemotherapy in survival in patients of Carcinoma Gall bladder (E-Poster)
Author: Dr. Sudipta Saha
Institution: F-514,Pragati Vihar Hostel, Lodhi Road Delhi-110,003, LHMC Delhi
Email: sudipta2067@gmail.com
Abstract
Background
Carcinoma of gall bladder is 4th commonest cancer in females in Northern India. Incidence is 5.5/1,00,000 women. Surgery is only modality for cure. Majority of patients present in advanced inoperable stage where median survival is between 3 and 6 months.
Objective
To evaluate the role of chemotherapy in carcinoma gall in adjuvant setting or as palliative measure
Material and Methods
Retrospective evaluation of all the patients of carcinoma gallbladder who received chemotherapy in a single surgical unit in a tertiary hospital in north India from 2008 onwards.
Observation
Twenty seven patients of carcinoma gallbladder received chemotherapy (cisplatin and gemcitabin). All the patients were female and mean age was 54 years (SD- 10.4). Stage wise distribution was- Stage II - 5, Stage lllA - 5, Stage IIIB - 3, Stage IVA- 9 and Stage IVB- 5. Five patients of Stage II, four patients of Stage IIIA and one patient of Stage lllB underwent RO resection. In five patients palliative bypass was performed Long term survival was noted in one patient with stage II disease who is disease free 4 years after curative resection and adjuvant chemotherapy. In Stage IV A mean survival was 8.75 months (range 5 to 12 months). In Stage IV B mean survival was four months (range- 3 to 5 months).
Conclusion
Gemcitabin cisplatin combination chemotherapy may improve survival in Stage IV A carcinoma gallbladder.
EP 02
Title: Epidemiological study of Gallbladder cancer patients from North Indian Gangetic planes - A high volume centre’s experience (E-Poster)
Author: Dr. Sameer Gupta
Institution: Deptt. of Surgical Oncology, Shatabdi Hospital, King George’s Medical University, chowk, Lucknow-2
Email: SAMEERDR79@GMAIL.COM
Abstract
Introduction
Gall bladder carcinoma (GBC) is characterized by dismal prognosis owing to paucity of early signs and symptoms. North Indian Gangetic planes report one of the highest incidences of GBC in the world.Understanding the epidemiology of gallbladder cancer has and will continue to provide valuable insights into determining risk factors for GBC.
Material and Methods
Prospective study of all GBC patients reporting in our hospital over last 3 years to evaluate the epidemiological profile of GBC patients from our region.
Results
The peak incidence of GBC was in 31–50 years age group [58%]. Male to female ratio was 1:4.83, with mean age for females [Mean – 49.1 years] significantly lower than male counterpart [Mean - 54.9 years] (p value =0.000423). 84% of them consumed mustard oil (home made/loose packed) as predominant medium of cooking. 38% of patients consumed tobacco, 20% were smokers [all male patients] while 5% consmed alcohol. Majority of the patients of GBC in our study, were from low socioeconomic strata (68%) [Kuppuswamy class IV, V (lower class)].
GBC was more commonly observed in females with age of menarche <14 years [83%], age of 1st child birth <20 years [56%]. Females with >2 children had higher incidence [57%]. Gall stones were present in 390 out of 490 patients [80%]. Incidental GBC was detected in 158 out of 490 patients [32%] and most had undergone open cholecystectomy. Pain abdomen was the most common presenting complaint found in almost all patients of GBC [98%]. Significant proportion of the patients presented with distant metastasis (stage IVB) (52%). Most common histological subtype of GBC was adenocarcinoma (78%).
Conclusion
This data emphasizes high prevalence of GBC in northern India. Current data suggest that the epidemiology of GBC is constantly evolving, with much of this change caused by lifestyle, cultural, mixing of different ethnicities and dietary factors. Balanced diet, prevention of malnutrirtion/adulteration, tobacco prevention, early intervention for cholelithiasis – may help in decreasing the incidence of this dreaded disease. More structured studies need to be carried out to ascertain risk factors for GBC in our population subgroup.
FP 01
Title: Gallbladder Cancer: Redefining Indications for Radical Resection – Lessons learnt along the way: Experience from high volume centre (Free Paper)
Author: Sameer Gupta, Channabasappa Kori, Vijay Kumar, Sanjeev Misra, Naseem Akhtar
Institution: Deptt. of Surgical Oncology, Shatabdi Hospital, King George’s Medical University, chowk, Lucknow-2
Email: SAMEERDR79@GMAIL.COM
Abstract
Introduction
Gallbladder carcinoma (GBC) is characterized bydismal 5-year overall survival (5–10%). Early detection and R0 resection offers the only chance for cure, butunfortunately, is possible in only small proportion.This study was undertaken to assess the clinical profile and outcome of GBC patients amenable to definitive surgical resection and to evaluate the predictors of long term survival in these patients.
Material & Methods
A large, single center, retrospective study was conducted over five year period (2010–2014) to identify GBC patientsthat underwent radical/extended radical surgeries with curative intent. Their clinicopathological, surgical data and clinical outcome were recorded andanalyzed.
Results
Of the total 140 patients, 80% of patients (n = 112) underwent curative surgery while 20% patients (n = 28) were found inoperable due to metastatic disease.Mean age at diagnosis was 51.2 years (Range - 25-78 years).Co-existantgall stones were present in 75.7% (N = 106)patients. Incidental Gall bladder carcinoma was detected in 17% patients (N = 24).75% patients(n = 105) underwent radical cholecystectomy,16 patientsout of theseunderwent additional adjacent organ resection (with acceptable morbidity) while 5% patients underwent simple cholecystectomy. Node positive disease was seen in 33 patients (29%) with mean node yield of 5.7 (range is 3–27). Majority of the tumor were diagnosed in T3 stage (34.3%, n = 48). Extended resections improved survival in patients with T3/T4N+ disease. Loco-regional recurrence observed in 8 patients with mean duration to recurrence of 9 months.
About 40% of patients (n = 45) with curative resection (n = 112) received adjuvant chemotherapyon the basis of final pathologic staging (node positive/T3 and above). Average follow-up duration was 18 months (Range = 3–44 months). Mean Disease Specific Survival (D.S.S.) was 18.7 months (Range = 3–42 months).
Conclusion
R0 resection offers the only chance of cure in GBC. T3N + ve disease had better survival after extended procedures. In addition to the R0 surgical resection, factors such as tumor (T) stage,adjacentorgan infiltration, lymph node status, presence of lymphovascular invasion (LVI) and stage influenced the survival.Role of the adjuvant combination chemotherapy in adjuvant setting may offer survival benefit though it remains to be validated in prospective randomized studies.
Gastric
EP 01
Title: An interesting case of gastric volvulus with eventration of diaphragm - case report (E-Poster)
Dr. Suresh Venkatachalam (M.S. MCh. Prof. Chief Surgical Oncology)
Dr. Rajkumar (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Kathirvel Kumaran (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Balamurugan (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Niruban Chakravarthy G. (M.S. P.G.) - Presenter
Department of Surgical Oncology RCC
Coimbatore Medical College Hospital, Coimbatore
Institution: room no 87, CRRI MENS QUATERS, COIMBATORE MEDICAL COLLEGE HOSPITAL, regional cancer center, CMC-H, coimbatore
Email: NIRUBAN85@GMAIL.COM
Abstract
Introduction
Gastric volvulus of stomach a twisting of all or part of the stomach by more than 180 degrees with obstruction of the flow of material through the stomach. The incidence and prevalence of gastric volvulus are unknown. The condition is uncommon in adults younger than 50years.
28 year old female admitted with abdominal pain and features of peritonitis.
X-ray chest: air under diaphragm, Ryles tube passed , Patient taken up for laparotomy.
Findings
Dusky hue color of the stomach with perforation of 3*2 CMs in the lesser curvature of the stomach wall. Perforation closed B/L drain kept. Feeding jejunostomy done. 1st 4 days patient hemo-dynamically unstable and later on settled. FJ feed started on 6th day. Oral fluid were started on 11th pod. On 18th pod, whatever given intra orally came through the abdominal wound.
CT scan done
Eventration of diaphragm with gastric gangrene once again emergency laparotomy was attempted and findings were:
Gangrene of the entire stomach OGJ to pylorus
Pharyngostomy done through left side. FJ continued post OP. Patient discharged after 40 days. Patient re admitted and left colonic inter position done to restore the gut path way from the pharynx to the jejunum.
This case is presented for its rarity and management of how to restore the gut path way after complete excision of the stomach and importance of Post Operative care.
Gist
EP 01
Title: Imatinib Resistant Recurrent extraintestinal GIST – A case study (E-Poster)
Authors:
Dr. Suresh Venkatachalam (M.S. MCh. Prof. Chief Surgical Oncology)
Dr. Rajkumar (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Kathirvel Kumaran (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Balamurugan (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Vasanthraja T. G (M.S. P.G.)
Department of Surgical Oncology RCC
Coimbatore Medical College Hospital, Coimbatore
Institution: regional cancer center CMC-H, coimbatore
Email: vasanthraja.gunasekharan@gmail.com
Abstract
Introduction
Gastro Intestinal Stromal Tumors are mesenchymal tumors of GI tract arising from interstitial cell of Cajal. In the past it was consedered as the leomyosarcoma of GI tract, after 1983 it was redesignated as GIST.
Case Summary
A 35 yr./F had menorrhagia & underwent TAH with BSO for multiple fibroid uterus in Feb. 2014.
In Dec 2014- pt. had C/O vague abdominal pain. CT showed multiple omental mass. Laparotomy was done. Findings – multiple dark red coloured tumor all over the abdominal cavity. There was 2 big mass in the omentum. During the laparotomy all palpable and visible tumors were excised. The intra abdominal visera including the stomach, intestines, rectum and retroperitonium were normal. HPE – GIST ; with kit CD117 mutation +ve. It was considered as Extra Intestinal GIST - High Grade. Pt. was started on adjuvant T. Imatinib 400mg- OD.
In May 2015 pt. presented with abdominal mass and colicky abd. Pain. PET CT showed 3 masses in the abdomen one in the ascending colon and 2 in the pelvis. On clinical examination the abdominal mass was palpable. ; On P/V a firm mass was palpable in the lateral fornix. On P/R a huge mass palpable through the rectum with normal rectal mucosa. As pt. opted for surgery laparotomy was done. Findings – a pedunculated mass in the ascending colon ;few small nodules in the peritoneal cavity. Recto sigmoid was entirely involved with a mass of >10 cm. Sigmoid could not be separated from the tumour so sigmoid resection was done and descending colon and rectum were anestamosed. The mass in the recto vesical pouch was adherent to the bladder wall which was excised along with the dome of the bladder and bladder wall closed in two layers. Post operatively – uneventfull. Pt. now started on T.Sunitinib.
This case is presented for its rarity and proved to be Imatinib Resistant Recurrent extraintestinal GIST and it has recurred both in extra intestinal as well as in the rectum. We have started this pt. on T.Sunitinib a 2nd line adjuvant Tyrosine kinase inhibitor. The follow up of this pt. will be presented in the next ASI conference.
Groin
FP 01
Title: OUTCOMES OF GROIN DISSECTIONS – A SINGLE INSTITUTIONAL RETROSPECTIVE ANALYTICAL STUDY
Authors: Dr.PrasannaSrinivasa Rao H, Prof. R.RajaramanMCh, Prof.S.SubbiahMCh, Dr.G.GopuMCh
Institution: 11/6, Kambar Street, Mehta Nagar, Chennai-600,029, govt. Royapettah Hospital, Chennai
Email: drpsrh@gmail.com
Abstract
Introduction
Inguinal nodal metastasis is an important prognostic factor for survival in a patient with carcinoma penis, carcinoma vulva andcutaneous cancers of the lower limbs.The type of node dissection depends on the primary site.
Materials and Methods
Patients who underwent groin dissection at our department between 2004 and 2015 were studied.The type of groin dissection, the prevalence of inguinal and pelvic nodal secondaries, the primary disease, the method of inguinal wound closure, the morbidity of the procedure were all studied.
Results
A total of 129 groin dissectionswere done between 2004 and 2015, of which 56.6% were superficial inguinal dissections while 43.4% were ilioinguinal block dissections. Unilateral groin dissection was done in 30.2% while 69.8% had bilateral groin dissection.
The most common indications forgroin node dissection were carcinoma penis(42%) and carcinoma vulva(40%).The prevalence of inguinal and pelvic nodal metastases in carcinoma penis were58%(36/62) and 16% (9/56) respectively.There were no skip metastases to the pelvic nodes.Among patients with carcinoma vulva 45%had nodal disease.
Regarding closure of the groin wounds 53% were closed primarily, while tensor fascia lata flaps were used in the rest 47%. In primary closure 72.4% dissections had wound dehiscence as against 8.3% with flap closure. The most common long term morbidity noted was lymphedema(37%).
Conclusions
Nodal dissection in the groin is both therapeutic and an important prognosticator. Nevertheless, it is associated with significant immediate and delayed post operative morbidity, which could be minimised by choosing proper flap cover and good post operative physiotherapeutic techniques.
Head & Neck
FP 01
Title: HEAD AND NECK CANCER - DEMOGRAPHIC ANALYSIS OF 10 YEARS DATA FROM A TERTIARY CARE CENTRE (Free Paper)
Author: Prof. R.Rajaraman.M.Ch., Prof. S.Subbiah.M.Ch., Dr. S.Sujaysusikar.M.Ch.,
Institution: plot 65, behind CTO colony, brindavan nagar, tambaram west, kilpauk medical college
Email: arulkumar_g@yahoo.co.in
Abstract
Introduction
In India, head and neck cancers account for 25% and 10% of cancers in males and females respectively. By the year 2020, 19% of all cancers are expected to be HNC globally. Majority of global disease burden is in Asia, especially from India.
Materials and Methods
Demographic pattern of head and neck cancer from our hospital data between the period 2015 to 2010 was analysed. Distribution of head and neck cancer among malesand females with respect to the site of diseaseand age of diagnosis were analysed.
Results
Total of 1238 patients were included in this study. Most of them presented in the sixth decade.Buccal mucosa(35%) was the most common site of cancer followed by oral tongue(20%) and gingiva(8.2%). Nasopharynx(1.6%) and paranasal sinuses(2.3%)have the lowest incidence.Incidence is 1.5 times higher in males than females. Ca hypoharynx incidence is higher in females than males in the 4th decade. Buccal mucosa cancer shows an increased incidence in female than males in 6th decade.
Conclusion
Demographic patterns of head and neck cancer vary among different regions in India due to difference in lifestyle and habits. Pattern of incidence in differentage group and gender may throw light on emerging risk factors and changing trends in head and neck cancers. This knowledge can help in developing preventive strategy at community level and boosting infrastructure at tertiary level.
Jejunostomy
EP 01
Title: A Rare Complication of a Common Surgery: ejunoileal Intussusception after Feeding Jejunostomy (E-Poster)
Author: Dr. Suresh Venkatachalam (M.S. MCh. Prof. Chief Surgical Oncology)
Dr. Rajkumar (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Kathirvel Kumaran (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Balamurugan (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Vasanthraja T. G. (M.S. P.G.)- Presenting Author
Department of Surgical Oncology RCC
Coimbatore Medical College Hospital, Coimbatore
Institution: Regional Cancer Center, Dept. Of Surgical Oncology, Coimbatore Medical college
Email:
Abstract
Introduction
An intussusception is an invagination of a segment of the gastrointestinal tract into an adjacent one. Adult intussusception accounts for only 1%–5% of intestinal obstructions in adults. Almost 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point.
Jejunoileal intussusception is a rare complication of placing of the feeding jejunostomy tube. Only few case reports have been published about jejunoileal intussusception following feeding jejunostomy needing re-laparotomy.
Case Report
A 47 year old female diagnosed with squamous cell carcinoma of lower third of esophagus underwent an uneventful Transhiatal esophagectomy with Witzel’s type of feeding jejunostomy. Patient tolerated jejunostomy feeding and subsequently discharged on a normal diet. Twenty days later she presented with history of sudden onset colicky upper abdominal pain and vomiting, obstipation of one day duration. Her clinical examination revealed upper abdominal fullness. CECT showed features suggestive of small bowel obstruction with jejunoileal intussusception with feeding jejunostomy as the lead point. Feeding Jejunostomy was removed and the patient was observed nil orally, with nasogastric tube inserted, intravenous fluid, prokinetics and antacids. But her symptoms aggravated with severe abdominal pain, upper abdomen distension.
At laparotomy, jejunoileal intussusception with gangrenous changes was found at tip of the Feeding Jejunostomy site. Resection of the involved segment with end-to-end anastomosis was done. She had an uneventful recovery post operatively and was discharged from the hospital on 10th post operative day.
Conclusion
Jejunoileal intussusception is a very rare complication of feeding jejunostomy which needs vigilant clinical suspicion in a patient of persistent high obstructive GI symptoms. This report emphasizes that even a simple surgical procedure like feeding jejunostomy should be followed up as close as any other major surgical procedure, because these rare complication can significantly increases morbidity.
Reporting of rare complications for a common surgical procedure like feeding jejunostomy will certainly increases awareness among the surgeons, and thus improving the outcome of the patients.
Kidney
FP 01
Title: Comparing Outcomes Of Robot Assisted Nephron Sparing Surgery (Partial Nephrectomy ) And Laparoscopic Partial Nephrectomy For Localized Renal Tumors: Our Initial Experience (Free Paper)
Author: Dr. Nikhil Dharmadhikari ,Dr. T B Yuvaraja, , Dr. Nikhil Gulavani, Dr. Harshavardhana Rao , Dr. Abhinav Pednekar, Dr. Amit Patil, Dr. Kalyan Chakradhar, Dr. Mrunal Parab
Institution: 2nd floor, Centre for Cancer, Kokilaben dhirubhai ambani hospital, andheri (west) Mumbai
Email: nikhil_dharma7@yahoo.co.in
Abstract
Objective
Partial Nephrectomy is the standard treatment for localized renal cell cancer. We present our experience with robotic partial nephrectomy (RPN) compared the results with laparoscopic partial nephrectomy (LPN).
Materials and Methods
Fifity two transperitoneal and two retroperitoneal RPN have been performed since July 2012 on 51 patients and three were bilateral. The results were compared to 38 LPN done by same author (two bilateral tumor) on 37 patients. Mean age was 55 years (42–68) and 58 years (43–66), mean tumor size 4.7 cms (2.2–6.5) and 2.9 cms (1.8–4.4 cms) in RPN and LPN group respectively.
Results
Average size of tumor in RPN was larger compared to LPN (p = 0.05). Four in LPN were converted to open and none in RPN. Mean blood loss was 100 ml (50–140) and 220 ml (100–300) (p-0.05), mean warm ischemia time was 17 mts (12–22) and 24 mts (16–29) (p-0.04) in RPN and LPN respectively. One patient RPN and LPN group each had hematuria on 3rd and 5th day which was embolized. Surgical margins were negative in RPN, 2 patients of LPN had margin positive, one required re-resection,other nephrectomy. With mean follow-up of 14 months (2–25) none of patients with RPN had recurrence and 3 in LPN group had metastasis with follow-up of 28 months (8–36).
Conclusions
Robot-assisted partial nephrectomy is well tolerated with acceptable ischemia time, less blood loss and better margin status compared to pure laparoscopic approach. Our initial experience is encouraging but more number of cases is required to draw conclusions.
Limb
FP 01
Title: INITIAL EXPERIENCES WITH INTRAOPERATIVE EXTRACORPOREAL AUTOGENOUS IRRADIATED BONE GRAFTS FOR FUNCTIONAL LIMB SALVAGE SURGERY IN EXTREMITY OSTEOSARCOMA (Free Paper)
Author: Dr. Shamna Mohammad
Institution: MALABAR CANCER CENTRE KODIYERI THALASSERY
Email: DRSHAMNAJ@GMAIL.COM
Abstract
Introduction
Chemotherapy with limb salvage surgery is the latest treatment modality for osteosarcoma with good oncological safety and functional outcome. Irradiated autograft is a rather new method of reconstruction with no change in oncological safety. The aim of this study is to evaluate the functional and oncological outcome of limb salvage surgerywith extracorporeal autogenous irradiated bone grafts.
Materials and Methods
2 pediatric patients agedof 8 and 15 years with osteosarcoma of femur were treated with neoadjuvant chemotherapy afterpre-operative imaging and staging. The former had metastatic disease at presentation and the lesion was at lower end of femur with large soft tissue component. The other patient had diaphyseal tumor and nonmetastatic disease. After resection, extracorporeal high dose irradiation was done to the resected bone and it was used for reconstruction.For the 8 year old patient knee arthrodesis was done and he would have required free flap reconstruction for soft tissue reconstruction had endoprosthesisbeen used.
Results
Both patients had good locoregional control. The8 year old patient expired due to distant metastasis after 5 months and the other is alive after two years without disease with good functional outcome.
Conclusion
Extracorporeal irradiation and re-implantation is a useful, convenient and inexpensive technique in carefully selected patients.
liver
FP 01
Title: CURATIVE RESECTIONS FOR LARGE HILAR LIVER TUMORS: PUSHING THE BOUNDARIES (Free Paper)
Author: Dr. Adithya Malolan P, Dr. Basant Mahadevappa1, Dr. Adithya Malolan P2
Institution: F2, #16, 10th cross, 2nd main, NR Colony, HCG, Bangalore
Email: adithya.malolan@gmail.com
Abstract
Introduction
Neoplastic hilar obstruction to the liver outflow presents a unique challenge to the surgeon wherein, the balance between a curative and possibly larger resection has to beachieved against a more conservative local resection. These are often technically demanding and have thus far produced equivocal outcomes on both ends.
Methods
We review a case series of seven patients who presented to us with hilar obstruction. They underwent resection with curative intent. The focus of our review is on the technical nuances and the strategies we used, intra- and peri-operatively to make curative resections possible in these patients, who at first look, were deemed inoperable.
Results
Among the seven, six had hilar cholangiocarcinoma while the other patient, had a more benign biliary cystadenoma with associated ruptured hydatid disease. We did not encounter any thirty day mortality in our series. Two of our patients had to be re-explored for intra-abdominal complications. Among the seven, we encountered one death. The rest of the patients are still on follow up.
Conclusion
Hilar cholangiocarcinoma continues to be a rare and challenging tumor for the HPB surgeon to manage. Outlooks are currently changing as we try to resect bigger and more complicated hilar liver tumors with better results.
Lung
EP 01
Title: STUDY OF PROGNOSTIC ROLE OF P53 AND KI-67 IN ADENOCARCINOMA LUNG: A RETROSPECTIVE STUDY (E-Poster)
Author: Ashutosh Chauhan DNB ( Surg Onco)*, Anmol Chandele PhD#,Manomoy Ganguly MCh*
Institution: 463 , rama Apartments, Sector 11, Dwarka, army College Medical Sciences/Bas Hospital Delhi
Email: bolubonkey@rediffmail.com
Abstract
Background
To assess the prognostic role expression of p53 and Ki-67 in lung adenocarcinoma tissue.
Methods
Tumor samples from 96 patients who had undergone surgical resection for lung adenocarcinoma were retrospectively evaluated for p53 and Ki-67 expression by immunohistochemistry. Associations of clinical and pathologic variables with p53 and Ki-67 were determined using the χ(2) test. After excluding four patients lost to follow up 92 cases were evaluated for associations between p53, Ki-67, clinical and pathologic variables, and survival by using the Cox proportional hazards regression model and Kaplan-Meier method.
Results
In the 96 patients, p53 was positive in 68.0% (71/96, and Ki-67 showed high in 40.2% (42/96). Of these, poor tumor differentiation strongly was correlated with high level of Ki-67 expression (P = 0.032). The log-rank test revealed a significant association between Ki-67 and lower survival in all patients (χ(2) = 5.637; P = 0.018); however, the risk was limited to stage III cases (χ(2) = 5.939; P = 0.015). Unlike p53, patients with high level of Ki-67 expression showed lower 3-year actuarial survival than those without (log-rank test, χ(2) = 4.936; P = 0.026).
Conclusion
IHC expression of Ki-67 in lung adenocarcinoma tissue shows stronger association with poor tumor differentiation, and negatively affects patients’ survival in advanced-stage lung cancer; however, the role of p53 on patient outcome needs further study.
EP 02
Title: CARINAL SLEEVE RESECTION FOR BRONCHIAL GLOMUS TUMOUR (E-Poster)
Author: Kannan N, Takkar P, Venkatesh MD, Sharma RM, Sahai KK
Institution: Dept Of Surg Onco MDTC, 4th floor, MH(CTC) Kondwa Road Pune, Command Hospital Pune
Email: majkannan@gmail.com
Abstract
Introduction
Haemangiopericytoma or Glomus tumours are commonly seen in the nail bed. They present as small painful lesions in the nail bed. Occasional reports of non extremity locations are reported in literature. Bronchial or tracheal location is by far the rarest of them and only about 37cases are reported in literature. We present the case for its rarity of histology and complexity of the surgical procedure of sleeve resection of the left main bronchus.
Case Report
36 year old male presented with wheezing and an non resolving pneumonia. Evaluation revealed a mass lesion at the origin of the left main bronchus extending into the LMB for a length of 1.5 cm. There was nearly total occlusion of the LMB opening. Biopsy of this vascular lesion was reported as Glomus tumour.
CT evaluation revealed a 2 × 1.5 cm mass lesion at the LMB origin, occlusion of the LMB and extrabronchial spread. No nodal enlargement was noted. He was planned for a left Bronchial sleeve resection with cardiopulmonary bypass standby.
Left lung was mobilized with a throracoscope to allow advancement of the LMB into the right chest. Right thoracotomy was done and carina exposed. LMB was divided distal to the tumour and ventilation was re established by an ETT through the thoracotomy into the LMB while the carina was dissected and tumour excised with clear margins. LMB was now reimplated into the trachea with interrupted sutures and reinforced with an intercostals flap.
Discussion
Haemangiopericytoma or Glomus tumour is a tumour commonly seen in the nail bed region. Occasional reports from other sites are reported. Of all the trachea bronchial sites reported most of them are from the trachea or proximal bronchus. Excision of the lesion is the commonest and most preferred therapy. For lesion which do not cross the bronchial wall endoscopic laser excision is a reasonable and accepted therapy.
In this case the complexity of surgery was increased due to the location in the carina and involvement of the origin of the LMB. We opted to ventilate the left lung during the resection phase through a tube inserted into the LMB through the throracotomy instead of a cardiopulmonary bypass. This procedure is fraught with risks due to the work space being shared by the surgeon and anaesthesiologist calling for an excellent degree of understanding and coordination at the time of resection and reanastomosis.
The rarity of the location of this uncommon tumour is unique and involvement of the entire bronchial wall by invasion and its size makes it a malignant. Though no nodal deposits were present. The need for adjuvant therapy is undefined in malignant Glomus tumour.
FP 01
Title: CLINICOEPIDEMIOLOGICAL PROFILE OF LUNG CANCER PATIENTS – A SINGLE INSTITUTE STUDY OF OVER 600 PATIENTS (Free Paper)
Author: Dr. Abhijit Das1,Arvind Krishnamurthy1, R Swaminathan2
Institution: DEPARTMENT OF SURGICAL ONCOLOGY, CANCER INSTITUTE (WIA), 38 SARDAR PATEL ROAD, CHENNAI – 36
Email: drabhiidas@gmail.com
Abstract
Introduction
Lung Cancer is one of the leading cause of morbidity and mortality worldwide, accounting for more deaths than any other cancer. Lung cancer is most commonly attributed to smoking; a smaller proportion is attributed to occupational exposure. However, a significant number of patients presenting in recent days with lung cancer have no history of smoking.In particular, a high proportion of Asian women diagnosed with lung cancer are never-smokers. Robust data on the similar epidemiological trends in lung cancers from the Indian subcontinent is, however, lacking.
Aim
We propose to analyze the clinicoepidemiological profileof lung cancer patients in India.
Materials and Methods
Ours is a prospective study involving all consecutive lung cancer patients presenting in the outpatient department (approx 600 patients) with histologically proven diagnosis of lung cancer conducted over a period of one year. Their demographic details, smoking and occupational exposure history, residence details, histology and stage at presentation, causes in delay in treatment, and treatment particulars (anti tuberculosis treatment) were collected and analyzed.
Results
The median age of presentation of patients in our study was 52 years. Male to Female ratio was approximately 3:1. Nearly 50% had adenocarcinoma as the predominant histology and among all about 37% were nonsmokers. Adenocarcinoma was more prevalent among nonsmokers where as squamous cell carcinoma was prevalent among smokers. We found an equal distribution of the disease in both rural and urban areas. History of indoor air pollution from coal as a fuel for cooking purposes seems to be related to lung cancer among females in rural areas. Most patients were higher staged at the time of presentation.The most common cause of delay in treatment remains delayed presentation on the part of the patient followed by erroneous treatment with antitubercular drugs. Majority of the patients (52%) were offered palliative chemotherapy. Surgery accounted for less than 10% of the treatment modalities offered.
Conclusion
The epidemiology of lung cancer is changing in India. Our prospective of it as a smoker’s disease should change. From the study we see a large chunk of disease among non smokers and women. The reason for delay is seeking treatment in case of lung cancer needs to be answered. From the study we can conclude that because of the presentation being similar to tuberculosis and tuberculosis being considered a public health problem in India, we are missing on the diagnosis of lung cancer. Moreover the impact of smokeless tobacco and indoor air pollution as an etiological factor needs further investigations.
Mediastinal
FP 01
Title: Surgical treatment of Anterior Mediastinal tumours: Preliminary experience and results from tertiary care cancer institute (Free Paper)
Author: Sunil kumar, S V S Deo, N K Shukla, Vinay kumar
Institution: room no 426, MMRDH, AIIMS, Ansarinagar, 110,029
Email: jrvk85@gmail.com
Abstract
Aim
The purpose of this retrospective study was to analyse our experience with Anterior mediastinal tumours emphasizing the clinical presentations and surgical results.
Methods
We retrospectively analyzed prospectively maintained thoracic database from 2013 to 2015. Surgically explored anterior mediastinal mass patients included in the study.
Results
There were 16 cases of anterior mediastinal mass explored surgically contributing to 8% of all thoracic surgeries (excluding esophageal surgeries). Median age of presentation is 40 years [25 to 62 years] with a male predominance[M:F = 10:6]. Chief complaints were chest pain and cough. Computed tomography was done in all patients and pre operative biopsy / needle aspiration done for diagnosis in majority. Eleven patients were diagnosed to have thymoma with four patients hadmyasthenia gravis features , three cases of germ cell tumor , one case ofpoorly differentiated carcinoma and inflammatory myofibroblast tumor. Four patients received neoadjuvant chemotherapy [ two cases of germ cell tumor and two cases of locally advanced thymoma] and yielded a partial response. Median sternotomy done in 15 cases. Phrenic nerve, pericardium, pleura, lung , manubrium, superior vena cava and brachiocephalic vein were the surrounding structures involved. Histopathology showed majority to be thymoma 10 patients;followed by germ cell tumor – 3 patients [rare – seminoma in female], one each in adenomatous goiter of thyroid and inflammatory myofibroblast tumor.Six patients received adjuvant therapy and all myasthenia gravis patients showed symptomatic improvement.
Conclusions
Multimodality management with aggressive surgery results in better outcomes of anterior mediastinal mass.
Neck
EP 01
Title: Salvage Radical neck dissection in post chemoradiation advanced Secondaries neck - Case study (E-Poster)
Author: Dr.Anbusenthil M.S. (Post Graduate)
Dr.Rajkumar M.CH (onco)
Dr.Kathirvel Kumaran M.Ch (onco)
Dr.Balamurugan M.Ch (onco)
Dr. Suresh Venkatachalam M.Ch (onco)
Institution: 26 H, HAPPY HOMES APARTMENT, SUNDARESA IYER LAYOUT, TRICHY MAIN ROAD, COIMBATORE MEDICAL COLLEGE
Email: DR_ANBU@YAHOO.COM
Abstract
Introduction
The purpose of the salvage radical neck dissection(RND) in patients with N3 nodal disease undergoing radiation or chemoradiation is to maximize the probability of achieving regional control and to eliminate possible residual malignancy. There are reports of improved neck control rates in patients with N3 disease treated with radiotherapy followed by RND vs. radiotherapy alone.
Case Report
45 yr. old male smoker with left cervical nodal squamous cell carcinoma metastases of unknown origin(Tx N3 M0) was initially treated at a private hospital with 7 cycles of chemotherapy with Cisplatin and radiotherapy with 70 Gy to involved nodes and 50 Gy to uninvolved nodes and all mucosal sites and was recommended palliative chemotherapy for residual nodal disease. Patient presented to us with left residual cervical nodes in Levels II,III and IV (yc Tx N3 M0). CT scan showed infiltration of sternomastoid, internal jugular vein thrombosis and doubtful infiltration of carotid artery. Carotid Doppler showed good flow in the carotid artery. The case was discussed in our multidisciplinary tumour board and planned for salvage RND. Intra operatively, internal jugular vein was infiltrated and thrombosed, vagus nerve infiltrated which were resected. Left common carotid artery was encased by nodal disease and was dissected off the tumour and RND completed. Post operative period was uneventful and patient was discharged satisfactorily. HPE showed metastatic poorly differentiated carcinomatous deposits.
Conclusion
Salvage Neck dissection is definitely an option in advanced cases of Metastatic carcinoma Neck especially post Radiotherapy where the adjacent infiltration is doubtful.
EP 02
Title: Lymph nodal metastases with co-existent tuberculous lymphadenitis – A challenge in diagnosis, staging and management of cancers in high prevalence areas like India (E-Poster)
Author: Dr. Niruban Chakravarthy G. ,Dr. Suresh Venkatachalam (M.S. MCh. Prof. Chief Surgical Oncology)
Dr. Rajkumar (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Kathirvel Kumaran (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Balamurugan (M.S. MCh. Assistant Prof. Surgical Oncology)
Dr. Vinodhini C. (M.S. P.G.)
Institution: room no 87, CRRI MENS QUATERS, COIMBATORE MEDICAL COLLEGE HOSPITAL, regional cancer center, CMC-H, coimbatore
Email: NIRUBAN85@GMAIL.COM
Abstract
Introduction
India has the largest tuberculosis (TB) burden in the world with around 2.1 million cases diagnosed every year. Incidence of TB lymphadenitis in India is around 10–15%. It is an important differential diagnosis for enlarged lymph nodes (LN) in patients with suspected cancer. Co-existing TB lymphadenitis and malignancy in the same LN group presents a challenge in the diagnosis, staging and management of cancers. We present such a case scenario to highlight this challenge.
Case Report
A 40 year female presented with recurrent papillary thyroid cancer with multiple enlarged bilateral cervical LNs. She had history of contact with TB but had no pulmonary symptoms. Her sputum AFB stainswere negative and Chest X-Ray was normal. Mantoux skin test was positive. CT scan of neck showed a 4 cm recurrent thyroid nodule in the isthmus with bilateral cervical LNs with central necrosis. Iodine-131 scan showed uptake in thyroid bed but not in the LNs. FNACs of LNs were inconclusive. She underwent completion total thyroidectomy with bilateral functional neck dissections. HPE showed papillary carcinoma with metastatic deposits in 6 Level VI nodes and caseating TB granulomatosis in 19 nodes out of 49 nodes (pT3N1aM0 with TB). The patient received post operative Radio-Iodine ablation and is on anti- TB treatment (ATT).
Conclusions
Misdiagnosis and under staging can affect or delay adjuvant therapy in many cancer patients. Sputum AFB stain, Mantoux skin test, PCR and Imaging with Ultrasound, CT, PET, RAI scan, etc. and FNACs/Biopsies are helpful in differentiating TB and cancer but can be misleading and inconclusive when both coexist. The long ATT schedules and its impact on the patient’s immunity also interfere with cancer treatment. The treatment of malignancy can in turn affect the treatment of TB.
EP 03
Title: SURGICAL OPTIONS FOR RECONSTRUCTION OF DEFECTS IN POST WIDE EXCISION OF SCALP TUMORS (E-Poster)
Author: Dr. Harish Kumar H.
Institution: D.NO.101, GANGOTHRI CASTLE APPARTMENT,14TH MAIN, 39TH A CROSS, JAYANAGAR,BENGALURU, kIDWAI MEMORIAL INSTITUTE OF ONCOLOGY
Email: harishkumarh1983@gmail.com
Abstract
Scalp tumors may be primary or metastatic. Primary tumors of scalp may arise from epithelium, glandular elements, somatic tissue elements. Metastatic tumors can be from thyroid, vary, renal cell carcinomas etc. Surgical challenge depends not in excising the tumors, but in actual reconstruction of the defects. Defects smaller than 3 cm are amenable for orimary closure.3 to 6cm cm are covered by rotation flap or skin graft. Defect size more than 6 cm needs a freeflap. We hereby present a series of 5 cases ,where different surgical options of reconstructions were done based on size of the surgical defect. Histology of the cases were Dermatofibroarcoma protuberns, squamous cell carcinoma in a patient with xeroderma pigmentosum, matastases from peritoneal mesothelioma. Different reconstruction surgical methods attempted were primary closure, skin graft, pericranial flap and anerolateral thigh free flap. The free flap procedure is a good option in large area defects. With a free flap, we are not given back hairs, but a good quality tissue in pliability and quantity give the best aesthetic reconstruction. Wide varieties of flap types have been described in the literature, each with its advantages and disadvantage. With smaller defects, primary closure or rotation flap can be attempted. With larger defects, pericreanial flap with skin grafting or free flaps are the available options.
Oral
EP 01
Title: Lymph Node Ratio As A Risk Factor For Locoregional Recurrence After Surgical Resection In Squamous Cell Carcinomas Of Oral Cavity (E-Poster)
Author: Dr. Ghanish Panjwani
Institution: A/15, NOBA NAGAR PHA KHOJAI IMLI, PHULWARI SHARIF, PATNA, harishkumarh1983@gmail.com
Email: dr.ghanish@gmail.com
Introduction
Lymph node ratio (LNR)(ratio of positive nodes to total nodes harvested), has been shown to have prognostic importance in esophageal, colon and breast cancer. We aim to study the value of LNR as risk factor for locoregional recurrences in patients of squamous-cell cancers of oral cavity.
Material & Methods
This study included retrospective analysis of 106 patientsundergoing initial surgical resection of the primary site with neck dissectionat our institute between Jan.-2012 to Feb.- 2013 followed by adjuvant therapy as indicated.Patients were divided into two groups based on LN ratio < 0.1 or ≥0.1. Data was analysed for predetermeined demographic and pathological variableswith Graph-Pad-Prism(ver6.05).
Results
Of the total 106 patients included, 41(38.67%)cancers were gingivobuccal, 32(30.1%)were alveolus,21(19.81%)buccal-mucosa, 10(9.4%)tongue and 5(4.71%)were lip SCC. Most common were Grade1(60.33%),Grade2 were 33% and 6%were grade3. 58patients(54%) were node-negative while 33(31%)and 15(14.1%)were N1and N2 respectively. Mean LN positivity was 0.76.Patients were followed up for a mean 11.86 months during which 9(8.49%) patients developed LR recurrence, 2(1.88%) developed second-primary while 7(6.6%) had distant-metastasis.On univariate analysis histologic- grade, nodal-positivity, margin-status and LN-ratio ≥ 0.1 were each significantly associated with locoregional recurrences, while T stage, site of disease and depth of infiltration showed association with recurrence but not reaching statistical significance.
Conclusions
LN ratio should be one of the factors considered along side TNM, histologic grade, margin status,depth of infiltration while evaluating patients’ risk of locoregional recurrence and deciding appropriate adjuvant therapy.
EP 02
Title: RECONSRTUCTION AFTER MAJOR ORAL RESECTION: A RETROSPECTIVE ANALYSIS (E-Poster)
Author: Dr. Subhransu Jena, Prof. G. Suryanaryana Raju, Dr. S Jena, Dr. Ranganath, Dr. Rajshekar, Dr. Kanwerneet Singh
Institution: department of surgical oncology.nizams institute of medical sciences.panjagutta Hyderabad
Email: sjena678@gmail.com
Abstract
Introduction
Oral squamous cancers are the most common cancers in males in India, and form nearly 30% of all newly diagnosed cancers annually. Most patients present with locally advanced tumors which require multi modality therapy and extensive surgical resections. We analyzed the various epidemiological factors and describe the different methods of reconstruction used to treat our patients.
Aims
To assess the proportion of patients who requiring major resections and mandatory factors requiring microvascular tissue transfers.
Materials and Methods
A retrospective analysis of head and Neck cancer patients who were treated in our Institute between January 2008 to December 2012 was done. The demographic features, tumor characteristics and treatment modalities used were compiled. An analysis of the various reconstruction modalities was performed.
Results
A total of 279 patients underwent surgical resection of their oral cancers during the above study period. Of these, 108 patients (50%) needed primary closure, 62 patients needed a regional flap and 44 patients (21%) needed a microvascular tissue transfer. The free flaps commonly used were free radial artery forearm flap in 16 patients anterolateral thigh flap in 9 patients and free fibular flap in 19 patients. All these patients had Histopathological T3/ T4 disease, Grade III tumors and neck node positivity. Out of 279 patients only 39 were long term survivors inspite-of multimodality treatment and radical surgery.
Conclusions
Oral cancers usually present as locoregionally advanced tumors which require multimodality therapy and extensive surgical resections combined with adequate tissue reconstruction. To achieve good quality of life and survival.
EP 03
Title: CORRELATION BETWEEN ULTRASONOGRAPHIC THICKNESS OF PRIMARY TUMOR AND LYMPH NODE METASTASIS INEARLY CARCINOMA ORAL TONGUE
Author: Dr. Ahmed Syed Murtaza
Institution: Basavatarakam indoamerican cancer hospital , rd no 10 , banjara hills , Hyderabad - 500,034, telangan
Email: syedmurtazaahmed@gmail.com
Abstract
Back ground and objectives
A major determinant of the prognosis of oral carcinoma is the risk of cervical lymph node metastasis. Of the several factors evaluated for prediction of cervical metastasis, tumor thickness has shown to have a high degree of positive co-relation with cervical lymph node metastasis. Pre- operative accurate measure of tumor thickness and its validation would prove to be useful in determining treatment plan of patients having clinically negative neck nodes. Hence a study is being undertaken to determine role of preoperative ultrasonographic assessment of tumor thickness in early oral tongue squamous cell carcinoma.
Material and Methods
The prospective study included patients attending the department of Surgical Oncology, Basavatarakam IndoAmerican Cancer Hospital in between February 2014 to February 2015with histopathologically proven Squamous Cell Carcinoma of early oral tongue. Intraoral USG was done with 8 MHz frequency probe to objectively asses the tumour thickness pre operatively.All patients received elective neck dissections. The Pearson product moment correlation coefficient was used to calculate the significance of correlation between ultrasonographic thickness and histopathological thickness of the tumor.
Results
This study was conducted in 50 patients comparing the USG thickness and HPE thickness. Thickness was same in two patients , within 1 mmin 27(54%) pts.,and it was within 2 mm in remaining 21 pts. (21/50) 42%. When the two measures were compared there was a significant correlation between them. The Pearson product moment correlation coefficient was 0.9603 (P < 0.0024).
The preoperative USG tumour thickness was also evaluated vis a vis nodal involvement on HPE. Tumors in this series were divided into four groups, those with thickness of 1–4 mm, 5-10mm , 11-15mm and >15mm. In the 1–4 mm group there were 3 patients with positive lymph node metastasis (3/14) 21%, where as 47% Patients (17/36) with tumour thickness = > 5 mm had positive lymph nodes. The subgroups 5-10mm, 11-15mm and >15 mm had lymph node positivity of 6/23(26%), 7/9(77%) and 4/4( 100%) respectively. Lymph node positivity is not statistically significant for tumour thickness 1-4mm vs > = 5 mm (p value – 0.1183).
Conclusion
Preoperative assessment of the tumor thickness by ultrasonography is an accurate method to determinethe maximal thickness in early carcinoma oral tongue. USG assessment of the tumour thickness is non invasive, cost and time effective, and safe.
In early oral tongue cancer tumor thickness is considered a significant predictor of cervical nodal metastasis. However in contrast to other studies where a cutoff thickness of <4mm was found to be a significant predictor of lymph node negativity on univariate analysis , in our study there was no significant difference detected.
FP 01
Title: Patterns Of Failure In Patient With Carcinoma Of Tongue After Multimodality Treatment (Free Paper)
Author: Dr. Ankit Shah1, Dr. Preeti Jain2
Institution: C/O Advocate Narendra Prasad Singh “ Kanti Kutir” , Maa Anandmayee Colony, khoja Imli, Phulwarishari
MAHAVIR CANCER SANSTHAN
Email: ankitdr86@gmail.com
Abstract
Introduction
Carcinoma of tongue is one of the notorious cancer which is having high recurrence rate. Aim of this study is to assess the patterns of failure in patients of carcinoma of tongue and its predictive factors.
Material & Methods
101 consecutive patients of carcinoma of tongue diagnosed by incision biopsy and primarily operated from July 2005 to December 2013at the institute Mahavir Cancer Sansthanwere included in the study. Patients treated by any other modalities before surgery were excluded.Retrospective data analysis of patient’s records was done of various clinical factors & pathological factors. Data was analysed by Epi info version 3.5.3.
Results
101 patients underwent surgery. There were 22.77% of patients in each Stage I, II ,III and 30.69% in stage IV. It was 2 times more common in male ( M:F- ~2:1). 29 patients developed recurrences (Local or systemic) (Mean = 8.276 months). Out of them, 14 (48.27%) were developed local recurrence into the tongue,11(37.93%) were nodal in which 6 were ipsilateral (20.68%) & 5 were contralateral (17.24%) and 6 (20.68%) were developed systemic metastases. Bivariate analysis revealed that Tumor volume, Lymphnode positivity, close or involved surgical margin, Pathological stage and Delay ofcommencement of radiotherapy after 43 days of surgery were statistically significantly associated with recurrence.(p < 0.05).
Conclusion
Majority of recurrences in carcinoma of tongue occur locoregionally so surgery with optimal resection margin with timely commencement of adjuvant therapy are essential part to address the issue of high recurrence.
FP 03
Title: Tube dependency after total glossectomy and PMMC reconstruction - Is it a myth? (Free Paper)
Author: Dr. R. Ch. Nagaraju Chavali
Institution: Indo American Cancer Hospital & Research Institute, Road No:14,Banjnara Hills, Hospital Basavatarakam
Email: rajumsmch@gmail.com
Abstract
Background
Total glossectomy defects are managed with the reconstruction by free flap or pedicled flaps. There is a general notion that, total glossectomy with laryngeal preservation leads to high dependency of tracheostomy or/and feeding tube. The objective of this study is to analyze the tube dependency following total glossectomy with PMMC and laryngeal suspension.
Materials and Methods
This retrospective study included patients operated in the Department of Surgical Oncology – Head and Neck Services, between February 2013 to February 2015 with histologically proven advanced Squamous Cell Carcinoma of tongue. We analyzed the time to wean off tracheostomy and feeding tube in 56 patients who underwent total glossectomy with laryngeal preservation and PMMC reconstruction with laryngeal suspension.
Results
The median time for tracheostomy weaning is 10 days and nasogastric tube is 16 days. Minimum time to decanulate tracheostomy is 6 days and maximum 15 days. The minimum time for removal of nasogastric tube is 12 days, maximum is 42 days.
Conclusion
Pectoralis major myocutaneous flap with laryngeal suspension in total glossectomy is a viable option with minimal functional morbidity. Tracheostomy and feeding tube dependency is minimal as compared to the previous literature.
Ovarian
EP 01
Title: Role of laparoscopy in predicting surgical outcome in patients undergoing interval cytoreduction for advanced ovarian carcinoma (E-Poster)
Authors:
Dr. Than Singh Tomar, − 09,567,172,102, thansinghtomar111@gmail.com (presenting author)
Dr.RemaP , − 09847602033drremaanil@gmail.com( corresponding author)
Dr.SuchethaJ – 09,847,860,868, suchethajyothish@gmail.com
Dr.Iqbal Ahmed – 09,847,067,377, Iqbal ahamed@gmail.com
Abstract
Introduction
Epithelial ovarian cancersusually present at anadvanced stage.Cytoreductive surgery attaining optimal cytoreduction is the most important determinant of patient survival. Various imaging modalities including CT scan are being used to predict optimal resectabilitybefore surgery but the false negative rates are very high.Various models based on laparoscopy are found to be better in predicting operability. Faggoti et al. have developed a laparoscopic predictive index to assess operability using seven parameters.
The aim of this study is to assess the safety and efficacy of diagnostic laparoscopy indetecting inoperable disease in patients undergoing interval cytoreduction.
Primary outcome measured was thetest performance of laparoscopy based score developed by Fagotti et al. in our population.
Materials and Methods
This study is a non-randomized, single arm prospective trial.Patients undergoing interval cytoreduction for advanced ovarian cancer in the department of surgical oncology, RCCwere included. Patients underwent preoperative evaluation as perinstitute protocol including complete physical examination, CT scan, chest X-ray and CA −125 levels.During diagnostic laparoscopy seven parameters including omental involvement, peritoneal carcinamatosis, diaphragmatic carcinomatosis,mesenteric retraction, bowel infiltration, stomach infiltration and liver metastasis were assessed.
Results: Of the total 73 patients, 59(80.9%) patient achieved optimal cytoreduction and in 14(19.1%) patients OCR could not be achieved. Laparoscopy could successfully predict inoperability in 12(16.4%) patients and thus can avoid 85% of unsuccessful surgeries. Sensitivity, specificity, PPV and accuracy of laparoscopy was 85%, 100%, 100% and 97% respectively at cut off of 8 Faggoti’s score.
Conclusions
Laparoscopy is safe and effective in predicting inoperabilty inpatients undergoing interval cytoreduction.
FP 01
Title: Change in surgical complexity score (SCS) in ovarian cancer since adoption of R0 resection strategy (Free Paper)
Author: Thangjam D, Lucksom P G, Chakraborti B, Ghosh A, Bhaumik J, Mukhopadhyay A
Institution: tata medical Center , Major Arterial Road ,New Town Rajarhat
Email: dhanabir27@rediffmail.com
Abstract
Background
Complete cytoreduction (R0) improves survival in advanced ovarian cancer compared to optimal cytoreduction (< 1cm residual disease). In our institution, we instituted a change in practice since January 2015.
Aim
To compare the trend change in SCS (Aletti score) since adopting R0 resection for primary debulking surgery(PDS) and interval debulking surgery(IDS).
Methods: - Retrospective observational study. SCS was calculated from operation records obtained through hospital electronic database and compared between PDS and IDS at 6 monthly treatment periods(P1:Jan. - Jun 2014,P2:Jul-Dec 2014 and P3: Jan.-Jun 2015).
Result:87 cases were evaluated; 35 PDS and 52 IDS. There was an increasing trend for performing PDS -P1: PDS- 4 (20%), IDS- 17; P2: PDS- 12 (40%), IDS- 20; and P3: PDS- 19 (60%), IDS-15. Major resection procedures for PDS and IDS were: Diaphragm (40% vs. 20%), Pelvic peritoneum (51% vs. 50%), Abdominal Peritoneum (29% vs.27%) Rectosigmoidectomy anastomosis(23% vs.21%),Splenectomy (14% vs.13%), Small bowel(14% vs.7%),Total Colectomy(3 vs.0),lesser sac tumour(5 vs.0 ),porta hepatistumor(3 vs. 0), Distal pancreatectomy( 1 vs. 0 ).There was an increasing trend for SCS in PDS; Mean SCS for PDS vs IDS was as follows: P1 (4.3 vs5.35),P2 ( 4.6 vs 6.48)and P3 ( 11.08 vs 5.9), which may reflect selection bias for PDS prior to 2015.
Conclusion
There is increase in surgical complexity with R0 resection and PDS. Detailedprospective recording with regular audit of practice and outcome should be mandatory.
Parotid
EP 01
Title: Giant Carcinoma Ex Pleomorphic Adenoma Of Parotid- A Case Report (E-Poster)
Author: Dr. Kirthiga R
Institution: Room 7, I floor, ladies PG Hostel, Kidwai memorial institute of oncology, Bangalore
Email: kirithigaramalingam@gmail.com
Abstract
Introduction
Carcinoma ex pleomorphic adenoma (CXPA) is defined as carcinoma arising from primary or recurrent benign pleomorphic adenoma. It’s incidence is 3.6–4% of all salivary gland neoplasms. This is a case report of gaintmyoepithelialCXPA- a rare subtype of parotid gland carcinoma, one of very few reported in literature.
Case presentation
A 35 years old male presented with26 × 21 cms multi-lobulated, hard, fixed, ulcerated left sided neck mass with history ofpre-existing swelling below the angle of left jaw since 10 years with rapid increase in size for past 6 months. FNA revealed spindle cell neoplasm, likely to be malignant. Metastatic work-up was negative.
The patient underwent wide local excision + parotidectomy + left modified radical neck dissection as the lesion was found to arise from the lower part of parotid. Immunohistochemistry revealed MyoepithelialCXPA (positive for S100, CD10 and CK).Pathological staging was pT4aN0M0.Post operative radiotherapy of 45 Gray given for 5 weeks as the deep margin was focally positive.
Discussion
The typical clinical presentation of CXPA arising from a benign pleomorphic adenoma is long standing swelling in the region of parotid for 10 to 15 years with sudden onset of rapid growth ranging from 3 to 6 months.Myoepithelial carcinoma is one of the rare subtypes of CXPA. Surgery is the primary modality of treatment in CXPA with adjuvant radiation therapy used for poor prognostic factors.
Conclusion
CXPA of parotid though a rare malignancy of head and neck should be considered in the differential diagnosis. Careful history taking, detailed clinical examination with correlation of cytology, IHC and imaging features guide in appropriate diagnosis and management of such cases.
Reconstruction
EP 01
Title: SOLITARY GINGIVAL METASTASES IN FIBULAR EWING’S SARCOMA (E-Poster)
Author: Dr. Kapil Dev
Institution: 307, PG HOSTEL, KMIO, BANGALORE, KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY, BANGALORE
Email: DR.kapil2010@gmail.com
Abstract
Metastatic tumours of oral soft tissue are very rare, but it is a major morbidity in a cancer patient. It is reported are only 1–8% among all oral cancers. Gingiva is the most common site among oral cavity soft tissue for metastases. Here, a11-year old male child of Ewing sarcoma of fibula metastasized to lower gingiva. He was diagnosed with fine needle aspiration cytology with cytogenetics from left pathological fracture of fibula. Metastatic workup was normal. Patient received neoadjuvant chemotherapy followed by fibulectomyand than completed chemotherapy. He was remained asymptomatic for 4 years and than presented with a soft tender swelling over lower gums, which free from bone and rapidly progressive.
FNAC shown small round cells suggestive of metstaticewing sarcoma to gingival. He received radiotherapy 30Gy in 10 fractions and it reduced by half in size within 1 week and progressively sloughed out.
Earlier in English literature, only single case was reported so it a very rare case.Although, its early recognition and local treatment by radiotherapy helps in improving QOL but it is a poor prognostic sign.
Rectal Cancer
EP 01
Title: Assessment Of Utility Of “ Triple Test” As Indicator Of Anastomotic Integrity In Rectal Cancer Pat (E-Poster)
Author: Dr. Nitish Ranjan Acharya
Institution: Department of Surgical Oncology, RCC, Trivandrum, rEGIONAL CANCER CENTRE, TRIVANDRUM
Email: drnitishra05@gmail.com
Abstract
Introduction
Neoadjuvant therapy amongst other factors is considered as a risk factor for leak following low and ultra low anterior resection for rectal cancer patients. Faecaldiversion significantly reduces the leak rates. Aim of the study was to assess the utility of the triple test, namely a negative air leak test, complete integrity of the surgical doughnuts and an intact anastomosis felt on digital rectal examination, in foregoing faecal diversion in rectal cancer patients undergoing low and ultra low anterior resection ( post CTRT).
Materials and Methods
The study period was from August 2009 to August 2014 (60 months). The study includes rectal cancer( post CTRT) patients not undergone diverting stoma following low or ultra low anterior resection. Decision of foregoing stoma was made on basis of triple test. The patients who satisfied the criteria did not undergo a stoma. Patients were followed for anastomotic leak. Correlation of patient and the procedure related factors with the anastomotic leak was also done.
Results
The study included 200 patients. 14 patients developed anastomotic dehiscence. No perioperative mortality. Age more than 50 years and end-to-end anastomosis were found to be significantly associated with leak.
Conclusion
No reason to recommend routine faecal diversion in these patients. ‘TRIPLE TEST’, can be used to decide on requirement of faecal diversion. Age more than 50 years and end-to-end anastomosis were found to be significantly associated with anastomotic leak and routine faecal diversion can be considered in these cases.
EP 02
Title: RADICAL TREATMENT OF RECTAL CANCER IN ELDERLY IS FEASIBLE THAN FEARED: RESULTS FROM A TERTIARY CARE CENTRE (E-Poster)
Author: Dr. Rajesh
Institution: RCC MEDICAL COLLEGE CAMP
Email: rajeshsurg@gmail.com
Abstract
Introduction
The thought of subjecting an elderly patient diagnosed with rectal cancer to protocol based NeoadjuvantChemoradiation (NACTRT), surgery and adjuvant chemotherapy is sought with fear due to multiple comorbidities and impaired functional status associated with the age.Hence, many a times the treatment is compromised and it is a fact that they are underrepresented in most of clinical studies. This study is aimed at analyzing the perioperative and oncological outcomes after protocol based curative intent treatment of rectal cancer in the elderly, defined as those with age more than 70 years. .
Patients & Methods
Analysis of Medical records of rectal cancer patients ≥70 years of age who were curatively treated at Regional Cancer Centre (RCC), Thiruvanathapuram from 2008 to 2012 was done.
Results
In five years period, a total of 339 rectal cancers were treated with curative intent at RCC, of which 75 patients were ≥70 years of age. More than half of the patients had multiple comorbidities. Majority of the cases were locally advanced. All locally advanced cases (62%) underwent NACTRT protocol and they tolerated Radiotherapy (RT) without modification (50.4 Gy). Curative Anterior resection was performed in two thirds ; with covering stoma in four; of which three remained permanent. Three patients (4%) died within 30 days due to leak, sepsis and cardiopulmonary causes. Two colostomies were performed for delayed leaks. 60% received adjuvant chemotherapy, of them 24% needed dose reduction or stoppage of chemotherapy. The median survival was 28 months. The 3 year Disease Free Survival (DFS) and Overall (OS) were 83.9% & 80.3% respectively. There were 11 distant recurrences including one locoregional recurrence.
Conclusion
Curative Surgical Resection after chemoradiation and adjuvant therapy is much feasible than feared in elderly patients despite multiple comorbidities.
FP 01
Title: Prevalence And Predictors Of Apical Lymph Node Involvement In Locally Advanced Rectal Cancers In The Era Of Combined Modality Therapy: Prospective Study (Free Paper)
Author: Dr. Rajesh
Institution: RCC MEDICAL COLLEGE CAMP
Email: rajeshsurg@gmail.com
Abstract
Introduction
Lymph node status is a major prognostic factor for survival in patients with rectal cancer. The incidence of metastatic nodes at the origin of Inferior Meseneteric Artery (Apical nodes) has been reported to be relatively low in several studies, ranging from 0.3 to 8.6%. In this era of standardized Total Mesorectal Excision and Neoadjuvant cheomoradiotherapy there is a need to study the rationality for apical nodal retrieval and its oncological safety.
Materials and Methods
With the primary aim of finding the incidence of apical lymph node involvement in locally advanced rectal cancer (stages II & III) taken up for surgery after neoadjuvant chemo radiotherapy, the study was undertaken in Department of Surgical Oncology at Regional Cancer Centre. During surgery apical nodes were sampled and sent separately for pathology.
Results
From Nov 2013 to Jun 2015, apical node was sampled in 112 cases. Of these pathological identification rate of lymph nodal tissue was 52% (58/112). Twocases hadpositive apical nodes 3.4% (2/58). First one had pathological complete response in the specimen but at apical node and the next had p T3N2 with ECS, PNI positive and close CRM. Three cases had prolonged bladder drainage.
Conclusion
Although the sterilizing effect of chemoradiotherapy appears to be effective and does not routinely warrant routine apical node dissection in locally advanced carcinoma rectum.
STS
EP 01
Title: A Rare Case Of Soft Tissue Sarcoma Of Extremity Presenting With Tumor Thrombus In Femoral Vein (E-Poster)
Author: Dr. A. N. Gurumoorthy , Prof. Dr. R. Rajaraman M.Ch, Prof. Dr. S. Subbiah. M.Ch.andDr.SujaySusikar M.Ch
Institution: new no 11/ old no 6/ cumber st, mehtha nagar, chennai 29, dept. of Surgical Oncology, Govt Royapettah hospital ,chennai
Email: guruh2607@gmail.com
Abstract
Background
The annual international incidence rate of soft tissue sarcoma (STS) ranges between 1.4 and 5.0 cases per 100,000. 41% are located in the extremities.Though haematogenous metastatic spread is common in STS, presentation of STS with tumor invading into adjacent major vessel as tumor thrombus influencing treatment is a rarity.
Objective
The objective of this paper is to report a patient with STS of extremity presenting with intra venous tumor thrombus. To our knowledge presentation of STS with venous tumor thrombus from primary has not been previously reported in literature.
Case History
A 54 year old male with swelling left thigh was evaluated with MRI which revealed heterogeneoushyperintense mass lesion involving vastus medialis, semitendinosus and sartorius, displacing Superficial Femoral vessels laterally, with suspicious short segment encasement of Superficial Femoral Artery. Preoperative biopsy –malignant spindle cell neoplasm of neural origin.Wide local excision was planned.During surgery, a part of tumor was found extending as a thrombus into Femoral vein through a tributary. A segment of Femoral vein was resected for clearance and end to end anastamosis done. Post operative HPE: High grade MPNST; Margins free. Intra vascular tumor thrombus seen without vessel wall invasion.
Conclusion
MPNST is an aggressive type of sarcoma commonly involving lower extremity and retroperitoneum. Our patient with MPNST of lower extremity had a rare clinical presentation of tumor thrombus which could not be detected preoperatively. Venous extension of tumor thrombus from STS is a rarity. No prior similar case report has been published in literature.
EP 02
Title: CASE REPORT - RARE CASE OF CHONDROMYXOID FIBROMA OF HAND (E-Poster)
Author: Dr. Bharanidharan,Prof.R.RajaramanMCh, Prof.S.SubbiahMCh,Dr.SujaySusikarMCh
Institution: 28/1 vellala street, purasawalkam, Chennai, kilpauk medical college
Email: bharani828@gmail.com
Abstract
Chondromyxoid fibroma is a rare benign tumour classically occurring in the metaphyseal region of the long bones surrounding the knee and in other long bones, the pelvis, and ribs. The small bones of the hand are very rarely involved. The tumour is considered a physeal plate remnant and may involve the epiphysis, diaphysis, or both, along with its metaphyseal origin. It may cause cortical expansion and destruction, but consistently respects the periosteal boundary. We report a case of chondromyxoid fibroma involving the first metacarpal of left hand that was treated by excision and iliac bone allograft.
A 21 year old male presented with history of pain and recurrent swelling of left thumb of one year duration. He had earlier been treated for similar complaints with curettage and bone graft a year back. Histopathology was reported as chondromyxoid fibroma. Radiograph and MRI of the hand revealed osteolytic lesion of the first metacarpal of size 3.2*2.5 cm, eroding the distal articular surface.
Excision of the first metacarpal was done with replacement by iliac crest bone graft, fixed by mini plate and screws proximally, and K-wire distally. Post-operative histopathological examination confirmed chondromyxoid fibroma.
Thymus
EP 01
Title: Mucoepidermoid Carcinoma of the Thymus: A Case Report (E-Poster)
Author: Kannan N*, Singh VP**
Institution: DEPARTMENT OF SURGICAL ONCOLGY ARMY HOSPITAL (R&R), DELHI CANTT, NEW DELHI
Email: vpsafmc@gmail.com
Abstract
Mucoepidermoid carcinoma of the thymus is an extremely rare malignant mediastinal neoplasm, and to our knowledge, only 13 cases have been reported. We report a case of mucoepidermoid carcinoma of the thymus that was seen in a 37-yr.-old man with right chest pain and non productive cough. Chest CT scan showed a huge, cystic mass having a focal solid portion with direct invasion of the adjacent anterior chest wall and pericardium in the anterior mediastinum. Mucoepidermoid carcinoma of the thymus should be included in the differential diagnosis for masses of the anterior mediastinum associated with extensive cystic changes, although the carcinoma is exceedingly rare.
Keywords
Mediastinal NeoplasmsThymus NeoplasmsCarcinomaMucoepidermoid
EP 02
Title: ThoracoscopicThymectomy For Myasthenia Gravis The Way Ahead (E-Poster)
Author: Dr. Pradeep Jaiswal
Institution: DEPARTMENT OF ONCOSURGERY LEVEL − 2 ARMY HOSPITAL RR DELHI CANTT −110,010, ARMY HOSPITAL RR
Email: DRJAISWALPRADEEP@YAHOO.CO.IN
Abstract
Introduction
Myasthenia gravis(MG) is an autoimmune disease characterised by weakness and fatigability after repetitive exercise. The prevalence of MG is estimated to be about 2–7/10,000 population. Thymus is abnormal in about 75% of patients with 65% showing hyperplasia and only 10–25% showing thymoma. Conversely about 30–60% of patients with Tymoma have MG. The mainstay of therapy for majority of patients is medical management. However a subset of population can benefit with surgical intervention in the form of Thymectomy. An ideal patient for surgical therapy is young patient with short duration of severely debilitating symptoms and is poorly controlled on medication. The expected outcome is 85% improvement in symptoms with 35% patients showing drug free remission.
Material and Methods
There has being considerable debate over the approach and extent of thymectomy. However at present Trans-sternal excision of all anterior Mediastinal fat and thymus is considered the Gold Standard. In recent years Vedio Assisted ThoracoscopicThymectomy has been promoted as the surgical procedure of choice in view of less postoperative pain, shorter hospital stay, superior cosmesis and non-inferior outcome as compared to open procedures. In our institute we performed 15 VATS Thymectomy over a period of 3 years from 2012 to 2015. All patients were diagnosed cases of MG with poor response with medical management. 5 patients of 15 had a well defined lesion in the anterior mediastinum. Preoperatively all were optimised using Plasmapheresis and IVIG. The surgery was carried out under general anaesthesis with single lung ventilation. The patient was placed supine with ports placed at 3rd, 5th and 7th Intercoastal spaces. In 12 patients the approach was through Rt chest wall while in 3 through Lt side. The resection included removal of all anterior Mediastinal fat: inferiorly till pericardium, Laterally between the two phrenic nerves and till visualisation of contralateral pleura and superiorly till the subclavian vessels with pulling down the superior cornu of the thymus.
Results
Out of 15 cases taken up for thoracoscopicthymectomy we could complete the procedure in 14 Patients. One patient has to converted due to encasement of phrenic nerve. The average duration of surgery was 120 min.Average blood loss was 42 ml. The hospital stay in acute surgical ward only 4.5 days. One patient had postoperative Myasthenic crisis and was in acute care for 60 days. We had one mortality due to acute coronary syndrome in the immediate post-operative period. The requirement of analgesia was considerably reduced with 3 days of intravenous analgesia required on an average. 12/15 patients had Class 2 response and 2 patients had Class 3 response over a period of 3 months post operatively.
Conclusion
Thoracoscopicthymectomy is a viable and equivalent option to trans sternal thymectomy in patients with myasthenia with thymoma and is associate with less morbidity and shorter hospital stay.
Thyroid
EP 01
Title: A Rare Case Report Of Papillary Carcinoma Arising In Thyroglossal Cyst (E-Poster)
Author: DR. S. DEEPA MCh postgraduate, PROF. DR. R. RAJARAMAN MS.MCAh, PROF. DR. SUBBIAH SHUNMUGAM MS, MCh , DR. G. ANITHA MS, MCh,
Institution: KILPAUK MEDICAL COLLEGE
Email: oncodeepa@gmail.com
Abstract
Introduction
Thyroglossalcyst is found in approximately 7% of the population, originating from the persistent tract formed during migration of the rudimentary thyroid gland. Malignant changes in thyroglossalcyst are very rare, occurring in less than 1% of cases.The papillary adenocarcinoma accounts for 75–85% of all tumors of the thyroglossalcyst.
Objective
Only 215 cases have been reported so far in literature.This case is being presented because of its rarity.
Case History
A 41- year old male presented with asymptomatic swelling in upper midline of neck for 1month duration.Patient was evaluated with an USG neck which showed a 3 cm cystic swelling with solid components below the hyoid bone FNAC of which was reported as papillary carcinoma, with a normal thyroid gland.Excision of thyroglossal cyst and tract with central part of hyoid bone was done. Postoperative histopathological examination revealed athyroglossal cyst with papillary carcinomatous foci in cyst wall about 0.5 cm. Since the thyroid gland was normal and tumor size <1 cm, we preferred not to do a thyroidectomy. Patient is on suppressive dose of Thyroxin. He is on follow up with us for the past 8 months.
Conclusion
Currently there is no definitive management guideline for the treatment of papillary carcinoma in thyroglossalcyst. High risk characteristics for which total thyroidectomy is indicated include age above 45 years,H/O radiation exposure,tumor in thyroid on radiological evaluation,tumor size >1 cm,cyst wall invasion and positive margins. Such a recommendation is based only on case reports. Long term follow-up is mandatory because of the risk ofmetachronouspapillary cancer in the thyroid gland.
EP 02
Title: SAFETY OF COMPLETION THYROIDECTOMY FOR INITIALLY MISDIAGNOSED THYROID CANCER (E-Poster)
Author: Dr. Yugandhar Reddy
Institution: BASAVATARAKAM,ROAD NO-14,BANJARA HILLS,HYDERABAD,TELENGANA ,INDIA, INDO-AMERICAN CANCER HOSPItal
Email: yugandhar.jan16@gmail.com
Abstract
Background
Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total or near-total thyroidectomy. Whether thyroid re-operations are associated with an increased complication risk is controversial.
Objective: A retrospective analysis was done for the patients undergoing completion thyroidectomy for cancer of thyroid who underwent surgery elsewhere for solitary nodule.The incidence of residual tumor and or residual thyroid tissue and surgical complication rates in patients after reoperation were analyzed in this study.
Material And Methods:A total of 53 patients who underwent thyroid surgery for solitary nodule as initial surgery elsewhere and referred to our institute for completion thyroidectomy when the histopathology revealed malignancy, were studied.
Results:There were 53 patients, 44females and 9 males.Their mean age was 34 ± 11.8years (range 19 to 65 years). After initial surgery, the histopathology revealed papillary carcinoma in 46 patients (87%), follicular carcinoma in 6 (11%), medullary cell carcinoma in 1(2%). Thirteen out of 53 patients had recurrent laryngeal nerve palsy after initial surgery (24.5%). After completion thyroidectomy, 17 of the 53 patients revealed malignancy in the remaining thyroid specimen (32%), papillary carcinoma in 16 patients (30%), follicular in one (2%). One or more parathyroid glands was identified and preserved in 52 patients (98%). No patient had additional recurrent nerve injury at the second surgery. The mean serum calcium value preoperatively was 8.98 ± 0.39 and post-surgery serum calcium 8.74 ± 1.15. Mean follow up was 18 months. Transient hypoparathroidism occurred in 3 patients (6.2%). Permanent and symptomatic hypoparathyroidism occurred in eight patients(16.6%). Five patients were lost to follow up. Five of the patients with permanent hypoparathyroidism had undergone bilateral central compartment dissection.
Conclusions
Completion thyroidectomy is a safe and appropriate option in the management of well differentiated thyroid cancer. It removes disease and or thyroid tissue from the thyroid bed on both sides including isthmus. Revision surgery carries a low risk of recurrent laryngeal nerve damage, but a higher risk of permanent hypoparathyroidism especially in patients who have undergone central compartment dissection.
Trachea
EP 01
Title: RARE CASE REPORT OF MALIGNANT PERIPHERAL NERVE SHEATH TUMOR OF TRACHEA (E-Poster).Author: Dr. Yugandhar Reddy
Institution: BASAVATARAKAM,INDO-AMERICAN CANCER HOSPITAL,ROAD NO-14,BANJARA HILLS,HYDERABAD,TELENGANA ,INDIA, INDO-AMERICAN CANCER HOSPITAL
Email: yugandhar.jan16@gmail.com
Abstract
Background
Malignant peripheral nerve sheath tumor (MPNST) is a rare entity and most cases originate in peripheral nerve root trunks in the extremities; MPNST rarely occurs in the head and neck. MPNST of trachea is not reported in literature till now.
Material and method
A 33 year old male patient presented with history of treatment for bronchial asthma for the last 6 months. Patient was evaluated for the severe breathlessness with CT scan suggestive of complete luminal obstruction in the second and third tracheal ring by mass lesion.
Result
Emergency Tracheostomy was performed for acute obstruction. On Microlaryngotracheoscopy, a fleshy pedunculated growth observed which was arising from the left side of the second and third tracheal rings and obliterating the entire tracheal lumen. Intraluminal complete excision was done and histopathology reported as MPNST. Hence open tracheal re-resection was done for the margins.
Conclusion
Malignant peripheral nerve sheath tumor of the cervical trachea is not described in the available (Pubmed, Medscape) in the literature. The present case is unique in its presentation with complete tracheal luminal obstruction.
FP 01
Title: Repair of Tracheal injury during Trans Hiatal Oesophagectomy - our experience (Free Paper)
Author: Dr.Anbusenthil M.S. (Post Graduate)
Dr.Rajkumar M.CH (Onco)
Dr.Kathirvel Kumaran M.Ch (Onco)
Dr.Balamurugan M.Ch (Onco)
Dr. Suresh Venkatachalam M.Ch (Onco)
Institution: 26 H, HAPPY HOMES APARTMENT, SUNDARESA IYER LAYOUT, TRICHY MAIN ROAD
Email: DR_ANBU@YAHOO.COM
Abstract
Introduction
Tracheal injury is a known complication during esophagectomies(4–10% of all tracheal injuries). The incidence is higher in Transhiatal Esophagectomy (THE-0.67% ) than in Transthoracic Esophagectomy (TTE-0.4%). Immediate identification and repair of tracheal injury is the key in reducing further morbidity and mortality. We report our experience of tracheal injury during THE recently.
Case Report
58 year male with squamous cell Carcinoma of Oesophagus T2N1M0 from 30 to 38 cm underwent THE after evaluation. During mediastinal blunt dissection of Esophagus, there was a sudden gush of air through the hiatus in the diaphragm below and the neck wound above. A 2 cm tracheal rent was identified 3 cm proximal to the carina. The patient was stabilised, double lumen endotracheal tube placed, gastric conduit pulled to the neck through the mediastinum and abdominal part of the surgery completed. The patient was put on left lateral position and thorocotomy done through the right 4th intercostal space, Lungs deflated, tracheal leak identified and repaired with 1–0 vicryl sutures. Stomach conduit was used to buttress the tracheal repair. The patient was then put again in supine position and neck anastomosis was completed. The patient was on ventilatory support for one day. The post operative period was uneventful, oral diet was started on day 7 and patient was discharged on day 10.
Conclusion
Immediate Identification, Proper repair and good post operative management are key to successful management of tracheal injuries during esophagectomies.