HER2 Positive Gastric and Gastroesophageal Adenocarcinoma: A Tertiary Center Experience in (NICRH) Bangladesh

Background: Gastric cancer is the fourth commonest cancer worldwide. It is also recognized as the second commonest cause of cancer related death in the global perspective. Although the incidence of gastric cancer has gradually decreased over the last half of the century, it varies among the different part of the world and different ethnic group. Mortality from gastric cancer extremely high, and it is second only to lung cancer. Gastric cancer occurs more frequently in men than in women. Aim of the study: Aim of the study was to find the clinic-profile outcome HER2 Positive Gastric and Gastroesophageal Adenocarcinoma.Methods:This cross sectional study was conducted in the Department of Surgical Oncology of National Institute of Cancer, Research and Hospital, Mohakhali, Dhaka. The study period was from March, 2014 to April, 2015. A total of 80 patients were included for the study. After receiving the gastrectomy specimen, it was fixed in 10% formaldehyde. Data were compiled and necessary statistical analysis were carried out using computer based software package for social science (SPSS 16.1). Ethical clearance was taken from the ethical committee of NICRH.Results:The highest patients were from 61-70 years’ age group and the lowest were from 71-80 years. The mean age of the patients was 59.71 (±10.19) years. The female to male ratio in this study was 1: 2.48. 66 (82.5%) patients were presented with anemia which was followed by 39 (48.75%) cases with dehydration. Most of the tumors were located in the distal part of the stomach (11.67%). Regarding staging 79(12.65%) patients were in the advanced stage of the disease. The correlation between HER2 overexpression and TNM staging has been tabulated below where it is shown that only Nodal (N) staging has the significant correlation with the HER2 overexpression.Conclusion:It is already mentioned that, in early history of immunohistochemistry, HER2 overexpression in case of carcinoma stomach was highly varied in different studies (from 9-92%). But recently, it was found around 9-32%, in several studies all over the world. It is necessary to conduct further studies with larger samples and long term follow-up in order to draw definite conclusions regarding the role of HER2/neu overexpression.

Risk-Adjusted Mortality Rates as a Quality Proxy Outperform Volume in Surgical Oncology—A New Perspective on Hospital Centralization Using National Population-Based Data

PURPOSE Despite a long-known association between annual hospital volume and outcome, little progress has been made in shifting high-risk surgery to safer hospitals. This study investigates whether the risk-standardized mortality rate (RSMR) could serve as a stronger proxy for surgical quality than volume. METHODS We included all patients who underwent complex oncologic surgeries in Germany between 2010 and 2018 for any of five major cancer types, splitting the data into training (2010-2015) and validation sets (2016-2018). For each surgical group, we calculated annual volume and RSMR quintiles in the training set and applied these thresholds to the validation set. We studied the overlap between the two systems, modeled a market exit of low-performing hospitals, and compared effectiveness and efficiency of volume- and RSMR-based rankings. We compared travel distance or time that would be required to reallocate patients to the nearest hospital with low-mortality ranking for the specific procedure. RESULTS Between 2016 and 2018, 158,079 patients were treated in 974 hospitals. At least 50% of high-volume hospitals were not ranked in the low-mortality group according to RSMR grouping. In an RSMR centralization model, an average of 32 patients undergoing complex oncologic surgery would need to relocate to a low-mortality hospital to save one life, whereas 47 would need to relocate to a high-volume hospital. Mean difference in travel times between the nearest hospital to the hospital that performed surgery ranged from 10 minutes for colorectal cancer to 24 minutes for pancreatic cancer. Centralization on the basis of RSMR compared with volume would ensure lower median travel times for all cancer types, and these times would be lower than those observed. CONCLUSION RSMR is a promising proxy for measuring surgical quality. It outperforms volume in effectiveness, efficiency, and hospital availability for patients.

Urgent Breast-Related Consults Seen by Acute Care Surgery at a Safety Net Hospital

Background Classically, urgent breast consults are seen by Breast Surgery or Surgical Oncology (BS/SO). At our safety net hospital, Acute Care Surgery (ACS) performs all urgent surgical consultations, including initial assessment of breast consults with coordinated BS/SO follow-up. The objective was to determine safety of ACS initial assessment of acute breast pathology. Methods All urgent breast-related consultations were included (2016-2019). Demographics, consult indications, and investigations/interventions were captured. Outcomes were compared between patients assessed by ACS versus both ACS and BS/SO at presentation. Results 234 patients met study criteria, with median age 39 years. Patients were primarily Hispanic (82%) women (96%). Most were not seen by BS/SO at presentation (69%), although BS/SO assessment was more frequent among patients ultimately diagnosed with cancer (8% vs 1%, P = .012). No patient had delay >90 days to core biopsy from presentation. Outcomes including time to cancer diagnosis (14 vs 8 days, P = .143) and outpatient BS/SO assessment (16 vs 13 days, P = .528); loss to follow-up (25% vs 21%, P = .414); and ED recidivism (24% vs 18%, P = .274) were comparable between patients seen by ACS versus ACS/BS/SO at index presentation. Conclusion Urgent breast consults at our safety net hospital typically underwent initial assessment by ACS with outpatient evaluation by BS/SO. Time to follow-up and cancer diagnosis, loss to follow-up, and ED recidivism were similar after index presentation assessment by ACS versus ACS and BS/SO. In a resource-limited environment, urgent breast consults can be safely managed in the acute setting by ACS with coordinated outpatient BS/SO follow-up.

Thyroid Cancer In Children: A Multicenter International Study Highlighting Clinical Features And Surgical Outcomes Of Primary And Secondary Tumors

Background: Thyroid gland malignancy is rare in pediatrics (0.7% of tumors); only 1.8% are observed in patients < 20 yrs with a higher prevalence recorded in females and adolescents. Risk factors include genetic syndromes - MEN disorders, autoimmune disease and ionizing radiation exposure. Radiotherapy is also linked with increased risk of secondary thyroid cancers. The present study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors. Methods: Institutional data was collected on pediatric patients with thyroid cancer during 2000 - 2020 from 8 International Surgical Oncology centers. Statistical analysis was performed using GraphPad Prism. Results: Of 255 cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI] 0.7466-5.132, p 0.2323), had bilateral glandular location (OR 2.847, 95% CI 0.6835-12.68, p 0.2648) and proved metastatic at 1st diagnosis (OR 1.259, 95% CI 0.3267-5.696 p>0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI 0.4579-5.57, p 0.4525) and surgical morbidity (OR 2.042, 95% CI 0.7917-5.221, p 0.1614) including hypoparathyroidism and recurrent laryngeal nerve injury. Overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident with primary vs. secondary tumors (Chi square 0.7307, p 0.39026). Conclusions: This multicenter study demonstrates excellent survival for pediatric thyroid malignancy. Secondary tumors exhibit greater disease relapse (15.8% vs 10.5%) and a higher incidence of surgical related complications (36.8% vs 22.2%).

Early Experience of Oncological Reconstructive Surgery at Dharmais National Cancer Center

Background: Oncological reconstructive surgery is a new paradigm in which it combines oncologic principles with reconstruction techniques. This study aims to present patients’ characteristics who had undergone oncological reconstructive surgery at the Department of Surgical Oncology, Dharmais National Cancer Center. Methods: This descriptive study identified patients’ characteristics who underwent oncological reconstructive surgery, their cancer types, and their therapies. All data were obtained from surgery registration and medical records from January 2019 to January 2020. Data were then presented in number and percentage.Results: A total of 174 patients had undergone oncological reconstructive surgery within one year. The mean age of all patients was 48.2 ± 16.7 years old. Most patients were female (72.1%), with breast cancer making up most cases (43.7%). Most of the participants also underwent mastectomy (42.1%), which was later followed by various reconstruction types. Sixty patients received free tissue transfer with microsurgery (34.4%), of which head and neck cancer constituted most cases. In addition, the most common donor site for the free flap was the Anterolateral Thigh (41.7%). Of all 174 patients, 75.2% presented with locally advanced cancer, and 17.8% had metastatic cancer. Within one year of follow-up, the survival rate was 87.4%, while local recurrence was 3%. Conclusions: The oncological reconstructive surgery approach plays a therapeutic and reconstructive role, and such might be the preferred method of choice for patients presenting with advanced-stage cancer

Surgical Management of Locally Advanced Breast Cancer: Recommendations of the Brazilian Society of Surgical Oncology

The Brazilian Society of Oncological Surgery organized a group of oncological surgeons to discuss surgical aspects associated with locally advanced breast carcinoma. This article reviews the indications, the different surgeries (especially those associated with thoracoabdominal or myocutaneous flaps), and associated complications. It discusses special conditions such as invasion of the chest wall and interscapular thoracic disarticulation. It makes recommendations based on the literature regarding clinical findings, tumor conditions, response to neoadjuvant therapy, choice of flaps in surgery, and tumor biology.