Kennystroud8020

Locoregional recurrences from breast cancer represent a heterogeneous group of disease that poses a therapeutic challenge and needs a multidisciplinary team management. The incidence of local recurrence after breast conservation surgery ranges from 10 to 22% and 5-15% after mastectomy at 10-year follow-up. Management of locoregional recurrence depends on tumor biology, stage at presentation, and prior local and systemic therapy. With improvements in diagnostic, pathological, and surgical techniques, radiation and systemic therapy approach, outcomes in these patients have improved. In this review, we discuss the risk factors, prognostic factors, surgical and reconstruction options, re-irradiation, and role of systemic therapy to define a reasonable treatment approach without compromising oncologic safety and achieve good cosmetic and survival outcomes.With advances in surgical management of pancreaticoduodenectomy (PD), mortality rate for PD has been reported to be less than 5%. Postoperative pancreatic fistula (POPF) remains a major complication and morbidity after PD with incidence of up to 40%. This is a retrospective analysis of patients who underwent PD in a tertiary cancer referral center in southern India. Data was collected for the patients operated during the period from Jan 2014 to Dec 2018. Surgicopathological, oncological, and survival outcomes were described. Of 76 patients presumed as operable, 16 were excluded and data analyzed for 60 patients. Forty-four percent underwent classical Whipple's PD and 56% pylorus-preserving PD. The most common postoperative complications were wound infection (25%); pneumonia (20%); clinically relevant POPF (13%); and delayed gastric emptying (19%). Thirty-day in-hospital mortality was 5%, 90-day mortality was 8.3%, and fistula-related mortality was 1.6%. Ampullary cancer was the most common histology. Three-year survival rate was 23.3% with a mean overall survival of 33.2 months with significantly better survival in the node negative than positive group (41.3 vs 20.5 months, P = 0.003) and significantly lower survival in pancreatic head cancer than other tumor histologies (16.6 vs 37.3 months, P = 0.002). Multivariate analysis has shown pancreatic head histology (HR = 2.38, 95% CI (1.08-5.26), P = 0.033) and nodal positivity (HR = 2.38, 95% CI (1.27-4.44), P = 0.007) as poor prognostic factors. Pancreaticoduodenectomy is a safe operation in experienced hands. Adhering to a meticulous adaptable reproducible anastomotic technique with standard perioperative management strategies significantly decreases the operative morbidity and mortality.Only a few countries of the world have a population more than Bihar, but due to the lack of a cancer registry, authentic research, and publications, data regarding the clinicopathological characteristics of breast cancer patients from this state are scarce. The present study was aimed to report the clinicopathological characteristics of breast cancer patients at a tertiary care center in Bihar, India. This is a retrospective review of a prospectively maintained database of patients of breast cancer treated between January-2018 and March-2020. One hundred fifteen patients with breast carcinoma were included of which 112 (97.4%) were women. The mean age was 47.28 ± 11.62 years and 54.5% of women were postmenopausal. Most patients had a clinical stage of II or III (44.5% each) while 8.7% of patients had stage IV disease. Invasive ductal carcinoma no special type (IDC-NST) was the most common histology (85.2%). The majority of tumors were grade II (55.6%), lymphovascular invasion was seen in 45.6%, and perineural invasion in 18.4%. Estrogen receptor was found in 41.8%, progesterone receptor was positive in 47.3%, and human epidermal growth factor receptor-2 (HER-2/Neu) overexpression was observed in 39.8%. Triple-negative breast cancer was found in 26.2% of patients. The majority underwent mastectomy (71.3%) while breast conservation was done in 26%. All except one patient underwent axillary lymph node dissection for axillary staging. 43.5% patients received neoadjuvant chemotherapy, 52.9% received adjuvant chemotherapy, while 3.5% patients received palliative chemotherapy. The clinicopathological profile of breast cancer patients from Bihar is similar to that reported from other parts of India except for a lower rate of distant metastasis.The aim of this meta-analysis was to compare short-term outcomes of laparoscopic and open gastrectomy for gastric cancer. EMBASE, MEDLINE, PubMed, and the Cochrane Database were searched for randomized control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30-day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2 gastrectomies, lymph node retrieval, operative time, wound complications, and intraabdominal complications. Systemic review and meta-analysis were done according to MOOSE and PRISMA guidelines. Eleven RCTs consisting of 4614 patients were included in the study. A total of 2452 patients were there in laparoscopic gastrectomy group while 2162 patients were included in open gastrectomy group. Morbidity was significantly low in laparoscopic group (p = 0.003). There was no significant difference in mortality between the two groups (P = 0.75). There were fewer wound complications in laparoscopic group and no difference intra-abdominal complications in both groups. Blood loss was significantly lesser in laparoscopic group (p  less then  0.001). Hospital stay was similar in both groups (p = 0.30). Operative time was significantly higher in laparoscopic group (p  less then  0.001). Laparoscopic group patients had a lesser number of lymph node retrieval compared to open group (p = 0.002). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies (p = 0.64). Laparoscopic gastrectomies were associated with lesser wound-related complications without decreasing hospital stay with a smaller number of lymph nodes retrieval.Uterine leiomyosarcoma is a rare female reproductive system tumor which is difficult to distinguish from uterine leiomyoma preoperatively. Manual and power morcellation are used to remove the large uterus through the vagina or small abdominal incision. Worse outcome with use of power morcellation is now clear but impact of manual morcellation on survival outcome not established till date. The objective of the present study was to find impact of tumor spillage and to evaluate influencing factors for oncological outcome and prognosis in uterine leiomyosarcoma patients. This is a single-institutional retrospective cohort study including all uterine leiomyosarcoma patients from January 2005 to December 2017. Role of intraoperative tumor spillage and other influencing factors on oncological outcome were assessed. Thirty-three patients with median follow-up period of 49.7 months were evaluated. Stage 1 and absence of tumor spill had significant association with prolonged progression-free survival. Stage 1 uterine leiomyosarcoma (56.8 vs 6.8 months, p =   15 months (68.5 vs 12.2 months, p =   less then  0.001) were favourable prognostic factors to predict better survival outcome but unable to establish significance on multivariate analysis. Survival plot did not reach median limit for stage I uterine leiomyosarcoma patients with preoperative suspicion. Age, site of recurrence and mitotic index had no significant association with better survival in the present study. Stage I disease and absence of tumor spillage during surgery improved progression-free survival but did not affect overall survival. Progression-free survival more than 15 months can predict better overall survival.

Androgen deprivation therapy (ADT) is a well-established treatment for metastatic hormone-sensitive prostate cancer (mHSPC). It includes either bilateral orchiectomy or medical castration in form of luteinizing hormone-releasing hormone (LHRH) agonist or antagonist. We conducted this study to compare surgical and medical castration in terms of time to progression (TTP) to castration resistant prostate cancer.

Patients with mHSPC underwent either bilateral orchidectomy or medical castration by either LHRH agonist or by antagonist from November 2016 to May 2018 in our institution. Initial PSA and baseline imaging either magnetic resonance imaging (MRI) or positron emission tomography-computed tomography (PET CT) finding were recorded. Serum PSA, testosterone, and FSH were repeated every 3months till 1year. All enrolled patients were followed up with a bone scan/MRI/ PET CT at 6months and 12months. End point of study was progression of disease and death of patient.

Mean nadir PSA (ng/ml) after treatment was 4.7 and 9.8 in surgical and medical group respectively, whereas mean time to the nadir PSA was 8.7 and 8.8 respectively with no statistically significant difference. Mean TTP was 13.9months in bilateral orchidectomy group and 13.8months in medical castration group (chi-square 0.003,

value 0.958).

There was no significant difference in time to progression between bilateral orchidectomy and medical castration. Considering nadir PSA level, better quality of life, patient compliance, reduced hospital visit, and decrease in cost of treatment, bilateral orchidectomy may be a better treatment option especially in developing countries.

There was no significant difference in time to progression between bilateral orchidectomy and medical castration. Considering nadir PSA level, better quality of life, patient compliance, reduced hospital visit, and decrease in cost of treatment, bilateral orchidectomy may be a better treatment option especially in developing countries.Inguinal lymph nodal dissection is notoriously associated with high morbidity. Various risk factors and technical modifications have been described in the past to overcome complications like lymphedema, wound breakdown, and infection which adversely affect the postoperative outcome and quality of life of the patient. This is a retrospective observational study from 1 January 2016 to 31 December 2019 of patients who underwent inguinal/ilio-inguinal block dissection for malignancy. Lymphedema was the most frequent morbidity seen (24%). The mean hospital stay of patients following surgery was 9.7 days (range 4 to 28 days). The inguinal drain was removed on a mean of 17.7 days (range 4 to 21 days), while mean iliac drain removal time was 11.7 days (range 4 to 21 days).Biliary drainage before pancreaticoduodenectomy was introduced to decrease morbidity from obstructive jaundice. Recent retrospective and randomised data show that preoperative biliary drainage (PBD) increases perioperative infectious complications. Most patients presenting to our tertiary care centre have undergone drainage procedures prior to surgical consultation. We analysed the impact of PBD, specifically endoscopic stent placement, on the postoperative outcome of pancreaticoduodenectomy at our centre. A cohort of 87 patients undergoing pancreaticoduodenectomy from 2012 to 2016 was identified. Data was collected retrospectively and a comparative analysis of stented and nonstented patients was done. Ipatasertib Comparison of the 23 stented patients was done with 23 nonstented patients after matching them for age, sex and bilirubin levels. Median total bilirubin level in stented patients was 10.2 mg/dl versus 7.7 mg/dl in nonstented patients. The infectious complication rate in the stented group was 39.1% versus 12.7% in the nonstented group (P value  less then  0.