Nonreferral of Possible Soft Tissue Sarcomas in Adults: A Dangerous Omission in Policy

Introduction. The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment.Patients and methods. We reviewed all our nonmetastatic extremity-STS patients with a minimum follow-up of 2 years. We compared three patient groups: those referred directly to our centre (group A), those referred after an inadequate initial excision (group B), and patients with local recurrence (group C).Results. The study included 174 patients. Disease-free survival was 73%, 76%, and 28% in groups A, B, and C, respectively (P<.001). Depth, size, and histologic grade influenced the outcome in groups A and B, but not in C.Conclusion. Initial wide surgical treatment is the main factor that determines local control, being even more important than the known intrinsic prognostic factors of tumour size, depth, and histologic grade. The influence on outcome of initial wide local excision (WLE), which is made possible by referral to a specialist centre, is paramount.

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Management of phyllodes tumour of breast: 5 year experience at Madina Teaching Hospital, Faisalabad.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.01.5576 ◽

2021 ◽

Vol 28 (01) ◽

pp. 9-15

Author(s):

Saira Saleem ◽

Aysha Rehman ◽

Farhan Javed ◽

Irshad Ahmad

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Local Recurrence ◽

Distant Metastasis ◽

Tumour Size ◽

Oncological Outcome ◽

Phyllodes Tumour ◽

Different Types ◽

Group A ◽

Group B

Objectives: To determine the oncological outcome of different types of phyllodes tumour (PT) and to analyze the impact of radiotherapy on outcome. Study Design: Experimental study. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: April 2015 to April 2020. Material & Methods: Female patients diagnosed as phyllodes tumour of breast were included and classified into benign, borderline and malignant PT according to WHO criteria. Borderline and malignant PT were further divided into 2 groups; Group A (Surgery alone) and Group B (Surgery + Radiotherapy). Oncological outcome based on local recurrence, distant metastasis and overall survival rate among different types of phyllodes tumour and those patients who received or not received radiotherapy was assessed. Results: In 5 years, 29 patients of phyllodes tumour were studied. 15 (51.7%) patients had benign, 8 (27.6%) malignant and 6 (20.7%) borderline tumour. Mean age of our patients was 39.5 years (range: 25-55 years).The disease free survival rate was 82.8% (100% for benign, 83.4% for borderline and 50% for malignant PT). Malignant histotype and tumour size >6cm were significantly associated with recurrence (p<0.05). In Group A, 4 patients developed local recurrence and 2 of them developed distant metastasis; while in group B only 1 patients developed local recurrence (p=0.2, OR=0.147). Overall survival rate was 93.1%. It was 100% for radiotherapy group compared to 88% for non irradiated patients. Conclusion: Malignant phyllodes tumour and large tumour size is associated with worse prognosis. Post operative radiotherapy is associated with improved local recurrence, distant metastasis and overall survival.

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Neo-adjuvant chemotherapy followed by surgery versus definitive chemo radiation as treatment for localized carcinoma cervix

10.1055/s-0039-1685273 ◽

2016 ◽

Author(s):

S. Singh ◽

V. Goel ◽

V. Talwar ◽

S. Raina ◽

S. Mitra ◽

...

Keyword(s):

Overall Survival ◽

Radical Surgery ◽

Locally Advanced ◽

Disease Free Survival ◽

Free Survival ◽

Common Cancer ◽

Group A ◽

Group B ◽

Disease Free

Background: Cervical cancer is ranked as the most common cancer in Indian women, second most common cancer worldwide and the leading cause of death in the developing countries. In the developing countries majority of the patients are diagnosed at locally advanced stages. The standard treatment of locally advanced cervical cancer is concomitant chemoradiation (CTRT) using platinum based chemotherapy. However, some randomized studies have shown improved results for patients receiving neoadjuvant chemotherapy (NACT) followed by surgical resection in comparison to patient receiving radiation alone. The present study was designed to compare response to the treatment and survival of and NACT followed by radical surgery (RS) with CTRT in the patients of uterine cervix of a tertiary cancer care centre. Patients and Methods: Retrospective study was performed in locally advanced/advance stage patients of cervix UTERI registered in the institute between years 2009 to 2013. Patients were included in the two groups, group A consists of 89 patients who have received NACT + RS and 67 patients in group B who have received CTRT. Clinical records were reviewed with particular reference to presenting complaint, clinical stage, response to the therapy, disease free survival and overall survival. Statistical analysis was done using SPSS version 22. Results: In the neoadjuvant group (group A) (n=89) the median age of patients was 53 years (range 31-80 years), most of the patients (70%) were presented with complaint of postmenopausal bleeding. Of the total patients, 69 (77.5%) underwent to radical surgery and 5 (8.5%) received radiotherapy after NACT. From 69 patients, who had undergone to surgery, 54 (78.3%) had also received radiation. The overall response to induction chemotherapy was 84%. In the chemo radiation group (group B) (n=65) median age was 56 years (33-75 years). Vaginal bleeding (34%) followed by postmenopausal bleeding (32%) was major presenting complaint in this group. Overall response to the complete treatment was 91%. The median follow up time was 14.3 months in group A and 12.2 months in group B. The disease free survival for NACT group was 32 months (95% CI 26.8-36.5) whereas for CTRT group it was 28 months (95% CI 23.5-33) with 12 and 13 recurrences per group (p = .226). In NACT group overall survival was 46.2 months (95% CI 44-48.3) and for CTRT group it was 38.3 months (95%CI 36.6-40) with 3 and 2 deaths per group (p=.883). Conclusion: Present study shows comparable results, with no difference in survival between both the groups. However, NACT + RS group had showed better disease free and overall survival than another group. Further studies should be performed with larger number of patients and longer duration of follow up.

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Preoperative Tru-Cut biopsy (POB) for the diagnosis of retroperitoneal soft tissue sarcomas (RPS) and risk of local recurrence (LR) compared to primary surgery of the tumor.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.10583 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 10583-10583

Author(s):

Paola Boccone ◽

Lorenzo D'Ambrosio ◽

Danilo Galizia ◽

Erica Palesandro ◽

Sandra Aliberti ◽

...

Keyword(s):

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Complete Information ◽

Surgical Removal ◽

Exact Test ◽

Primary Surgery ◽

Increased Risk ◽

Group A ◽

Needle Track

10583 Background: Regardless optimal surgery LR is still a major challenge in RPS affecting 60% of the patients (pts). To improve these results pre-operative radiotherapy +/- chemotherapy are under investigation. This strategy requires to perform a POB. The surgical removal of the whole needle track is mandatory for limb sarcomas, but it can hardly ever be achieved in RPS. We explored whether POB did increase the risk of LR in terms of tumor cell seeding (along the needle track) or in the tumor mass area. Methods: We scanned our prospectively (01/2000 to 12/2010) collected RPS database including 176 pts. Complete information (records, CT scans, biopsy-track, follow up data) were available and retrospectively examined in 100 pts. Pts were divided into: group A (POB), group B (direct surgery). The 7 year probability of disease free survival (DFS) was estimated for each pt (ASCO 2012 abs 10000). T student test and Fisher's exact test were used to compare the estimated DFS and the incidence of LR in the 2 groups, respectively. Kaplan-Meier method was used to estimate DFS and overall survival (OS). Results: In 51 male, 49 female, median age 58 years (22-81) RPS histotype distribution was: lipo 43, leio 28, pleomorphic 9 and other 20. RPS grades were: G1 29%, G2 32%, G3 39%. POB was performed in 25 pts (25%) without major complications. The baseline probability of 7 year DFS was 0.43 and 0.51 (p= .24) for group A and B, respectively. After a median follow up of 71 mos, LR was 8% and 23% (p> .05) for group A and B, respectively. No relapse along the needle track was detected. As expected, liposarcoma was associated with a higher rate of LR (Odds Ratio 5.6 CI 95% 2-13). Median DFS, local DFS and OS were 24, 88 and 71 months, respectively. Conclusions: With the limit of the retrospective nature of our data, we didn’t find any increased risk of LR for POB in RPS. Although surgery is still the standard therapy in RPS, knowledge of histotype and differential diagnosis might encourage to consider inclusion of pts into pre-operative clinical trials and to avoid surgery for other retroperitoneal tumors (e.g. lymphomas, germinal cell tumors, IgG4-related sclerosing disease).

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Preoperative radiotherapy combined with simultaneous chemotherapy with capecitabine plus oxaliplatin versus surgery alone: A single-centered, phase II study in patients with mid/low rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.609 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 609-609

Author(s):

Fulong Wang ◽

Zhen-Hai Lu ◽

Zhizhong PAN ◽

Yuan-Hong Gao ◽

Gong Chen ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Preoperative Radiotherapy ◽

Group A ◽

Group B ◽

Anal Preservation ◽

Preservation Rate

609 Background: Though total mesorectal excision (TME) has proved to effectively decrease local recurrence rate of mid/low rectal cancer, the efficacy of preoperative radiotherapy in Asian patients remains unclear. The present study aimed to compare the efficacy of TME alone versus TME after preoperative radiotherapy and simultaneous chemotherapy with capecitabine plus oxaliplatin in Chinese patients with stage II and III mid/low rectal adenocarcinoma. Methods: Patients (n=192) aged between 18 and 70 years enrolled from March 23, 2008 to August 2, 2012 were randomly divided into two groups. Group A (n=97) received preoperative radiotherapy and simultaneous chemotherapy [46-50 GY/23-25 with oxaliplatin 100 mg/m2 (D1) and capecitabine 1,000 mg/m2 (bid, D1-15), repeated since D22], which was followed by TME; while patients in group B (n=95) underwent TME alone. While disease free survival (DFS) was the primary endpoint; the following were evaluated as secondary endpoints: pathological response rate, pathologic complete response (PCR) rate, anal preservation rate, local recurrence rate, distant metastasis rate, acute toxic effects, and late toxic effects. Results: Excluding the drop outs, 90 and 94 patients were analyzed in group A and B, respectively. The median follow-up time was 29 (range: 0 to 59) months. PCR was achieved for 32 patients (35.6%). The median survival time and overall survival (OS) rate in group A were 24 months and 92.5% (95% CI: 88.3-96.7), respectively; while the same were 34 months and 88.7% (95% CI: 84.8-92.6) in group B. The median DFS time was 22 and 31 months in group A and B, respectively; and the overall DFS was 86.1% (95% CI: 81.6-90.6%) and 80.6% (95% CI: 74.8-85.4%) in both groups. No significant differences were observed between groups in OS rate (p=0.323), overall DFS, (p=0.612), and anal preservation rate (p=0.849). Conclusions: Preoperative radiotherapy combined with chemotherapy of capecitabine plus oxaliplatin could result in higher PCR rate. However, studies with long follow up and large sample are recommended to demonstrate the efficacy of this treatment strategy over TME alone. Clinical trial information: ChiCTR-TRC-00000122.

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Clinical Significance of Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels Before Surgery and During Postoperative Follow-Up in Colorectal Cancer

International Surgery ◽

10.9738/intsurg-d-17-00026.1 ◽

2018 ◽

Vol 103 (7-8) ◽

pp. 322-330

Author(s):

Harunobu Sato ◽

Yoshikazu Koide ◽

Miho Shiota ◽

Hiroshi Takahashi ◽

Zenichi Morise ◽

...

Keyword(s):

Colorectal Cancer ◽

Carcinoembryonic Antigen ◽

Disease Free Survival ◽

Carbohydrate Antigen ◽

Preoperative Serum ◽

Serum Carcinoembryonic Antigen ◽

Group A ◽

Serum Cea ◽

Group B

Objective: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common colorectal cancer markers. We aimed to identify the appropriate clinical conditions for measuring serum CEA and CA19-9 levels before surgery and during follow-up. Methods: This study included 1275 colorectal cancer patients who were divided into 3 groups according to preoperative CEA levels (group A, ≤5 ng/mL; group B, >5–≤11 ng/mL; group C, >11 ng/mL). Each group was subdivided into 2 groups according to preoperative CA19-9 levels (cutoff level: ≤37 U/mL). Recurrence and survival rates were analyzed. Results: Recurrence rate, disease-free survival after curative surgery, and prognosis were significantly worse in group A and B patients with high CA19-9 levels. At recurrence, CEA levels showed a greater increase in group B and C patients; CA19-9 levels increased in group A patients with high CA19-9 levels. At recurrence, high serum CA19-9 levels were observed in group A patients with high preoperative serum CA19-9 levels, even if the serum CEA level did not increase. Preoperative CA19-9 levels could predict recurrence and prognosis in groups A and B. Conclusion: Periodic CA19-9 determination is useful for monitoring recurrence among group A patients with high CA19-9 levels.

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What Factors Influence the Outcome of Surgically Treated Soft Tissue Sarcomas of the Hand and Wrist?

Hand ◽

10.1177/1558944716672197 ◽

2016 ◽

Vol 12 (5) ◽

pp. 493-500 ◽

Cited By ~ 4

Author(s):

Matthew T. Houdek ◽

Brian E. Walczak ◽

Benjamin K. Wilke ◽

Sanjeev Kakar ◽

Peter S. Rose ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Disease Status ◽

Distant Metastases ◽

Factors Affecting ◽

Disease Free

Background: Soft tissue sarcomas (STS) of the hand are exceedingly rare. The aim of this study was to review our institution’s experience with STS of the hand to identify factors affecting outcomes and survivorship. Methods: We retrospectively reviewed the records of 46 hand STS treated with definitive surgery at our institution between 1992 and 2013. Pertinent demographics as well as information regarding the surgical procedure, and disease status at latest follow-up were reviewed. Mean age at diagnosis was 38 years with a mean follow-up of 5 years. Results: The most common tumor subtypes were epithelioid (n = 10) and synovial sarcoma (n = 8). Sixty-one percent were superficial in location. Thirty-three patients had had a nononcologic resection prior to definitive surgical treatment at our institution. Ultimately, negative margins were obtained in all cases. Local recurrence was observed in 5 patients and distant metastases in 14 patients. Tumor sizes ≥2 cm, American Joint Committee on Cancer (AJCC) grade, and depth of the tumor were found to adversely affect the outcome in terms of disease-free and overall survival. Reexcision of an inadvertently excised tumor at an outside institution did not adversely affect the outcome. The 10-year overall and disease-free survival was 72% and 63%. Conclusions: Local recurrence after a wide excision was observed infrequently; however, distant disease was relatively common. Tumors with a size ≥2 cm were associated with a worse disease-free and overall survival, highlighting the aggressive nature of these tumors.

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Prakash versus figure of eight technique in sternal closure in CABG patients

International Surgery Journal ◽

10.18203/2349-2902.isj20190476 ◽

2019 ◽

Vol 6 (3) ◽

pp. 828

Author(s):

Mohammad M. Elsaify ◽

Hatem M. Soltan ◽

Rafik F. Soliman ◽

Mohamed Gamal Hagag

Keyword(s):

Median Sternotomy ◽

Sternal Dehiscence ◽

Sternal Closure ◽

Group A ◽

Patient Groups ◽

Sternal Wound Infections ◽

Group B ◽

Cabg Patients ◽

Suitable Technique

Background: Median sternotomy was recommended in 1957 by Julian for complete exposure of the heart. Despite the high importance of correct sternotomy, proper sternal closure is vital to ensure fewer post-operative complications. The sternum can be closed by wires and other methods. Sternal closure using the most suitable technique can dramatically reduce the risk of development of such complications.Methods: It is a prospective randomized comparative study of two patient groups, each included 30 patients, diagnosed of ischemic heart disease and underwent CABG. Group A with the patients’ sterna closed by figure of eight method and group B with multi-twist (Prakash) technique. Both groups were compared regarding postoperative pain and complications as superficial and deep sternal wound infections (SSWI, DSWI), wire removal and rewiring within six months of follow up.Results: The mean of minimum post sternotomy pain in group A patients was 24.50±11.7, whereas in patients of group B, it was 27±10.1. Only two patients (group A) suffered sternal dehiscence within six months follow up. The incidence of SSWI and DSWI among both groups was almost similar with only two patient of group A needed wire removal and one of them required rewiring.Conclusions: The multi-twist sternal closure provides better sternal stability after CABG especially in patients who are vulnerable to sternal dehiscence.

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Absorbable suture material in carotid surgery

VASA ◽

10.1024/0301-1526/a000468 ◽

2015 ◽

Vol 44 (6) ◽

pp. 451-457 ◽

Cited By ~ 4

Author(s):

Vincenzo Gasbarro ◽

Luca Traina ◽

Francesco Mascoli ◽

Vincenzo Coscia ◽

Gianluca Buffone ◽

...

Keyword(s):

Suture Material ◽

Absorbable Suture ◽

Paediatric Surgery ◽

Carotid Surgery ◽

Suture Materials ◽

Absorbable Suture Material ◽

Absorbable Sutures ◽

Group A ◽

Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

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Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190201111332 ◽

2019 ◽

Vol 14 (2) ◽

pp. 141-146

Author(s):

Simone Zanella ◽

Enrico Lauro ◽

Francesco Franceschi ◽

Francesco Buccelletti ◽

Annalisa Potenza ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

The Elderly ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v1i1.3631 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Praveenkumar H. Bagali ◽

A. S. Prashanth

Keyword(s):

Medical Science ◽

Frozen Shoulder ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Animal Kingdom ◽

Shoulder Joints ◽

Group A ◽

Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

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