Predictors of recurrence of peritoneal carcinomatosis among patients with colorectal cancer following cytoreductive surgery alone versus cytoreductive surgery plus HIPEC

Background: Peritoneal carcinomatosis (PC) is a lethal regional progression in patients with colorectal cancer (CRC). Treatment with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) achieves better local control than systemic palliative chemotherapy. Objectives: To assess the efficacy on the prognosis of CRS and HIPEC compared with CRS only and to identify possible clinicopathological factors associated with the recurrence of PC. Methods: The present retrospective study included all colorectal carcinoma cases with PC subjected to CRS with or without HIPC from January 2009 to June 2018 at the National Cancer Institute (NCI), Cairo University, Cairo, Egypt. The outcome is evaluated in terms of recurrence-free survival (RFS) and its predictors. Results: Out of the 61 patients, 45 patients (73.8%) underwent CRS plus HIPEC, and 16 (26.2%) underwent CRS alone. The 1-year RFS was 55.7%, with a median of 12 months. The risk factors for recurrence identified in the univariate analysis were T4 primary tumor, high-grade, positive lymphovascular invasion (LVI), positive extracapsular nodal spread, and patients treated with CRS only, without HIPEC. In the multivariate analysis, the independent risk factors for recurrence were high grade and patients treated with CRS only. Conclusion: T4 primary tumor, high grade, positive LVI, and positive extracapsular nodal spread seemed to be important predictors of recurrence following the treatment of PC. Our study also demonstrated that the addition of HIPEC to CRS improved the RFS. (AU)

Anterior versus conventional surgical approach for hepatic resection of large hepatocellular carcinoma

Hepatic resection of a large HCC represents a surgical challenge. In patients with large HCC in the right liver, the conventional technique for hepatectomy, i.e., mobilization of the right liver from the retro peritoneum and anterior surface of the inferior vena cava may be difficult because of the tumor volume and local adhesions. Likewise, even if the mobilization can be accomplished, the forceful manipulation of the liver can result in tumor rupture and dissemination of malignant disease. To report the efficacy of using the anterior approach versus the conventional approach, in surgical resection for large hepatocellular carcinoma [HCC] in terms of surgical and long-term outcomes. This was a retrospective study of 126 consecutive patients who underwent hepatic resection with curative intent for large right HCC >/=7 cm between 2000 and 2006. The 36 patients who had anterior approach were compared with the remaining 90 patients who had conventional approach. The median follow-up periods after hepatectomy was 36 months [range, 6 to 132 months]. Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis. There was no significant difference between the 2 groups as regard clinical, laboratory and pathological parameters apart from gender. The operative results had shown a comparable proportion of patients experienced massive operative blood loss and postoperative complications in the 2 groups. The AA group had a lower recurrence rate [P = 0015], better disease-free survival [DFS] [P = 0001] and overall survival than the CA group. Our study identified that the anterior approach is a prognostic factor of both overall survival and disease-free survival for large HCC >/=7cm. The anterior approach is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the conventional approach

Selective variants for postoncological oro-mandibular reconstruction

Squamous cell carcinoma of the head and neck is a challenging disease to both surgeons and radiation oncologists due to proximity of many important anatomical structures. Reconstructive methods follow the principle of what is removed should be either repaired or replaced. Thus reconstruction of oromandibular defects after resection of tumors allows surgeons to resects tumors without fear of reconstruction of large defects. The aim of this study is to evaluate the aesthetic and functional outcome after reconstruction of oromandibular defects by selective variants of flap and to evaluate different techniques of these flaps in reconstruction of oro-mandibular defects after tumors resection by either free microvascular flaps or local and regional flaps as regard indication, reliability, donor sites morbidity, complications. The study involves a total of 41 patients with oro-mandibular tumors whose need reconstructions flaps after tumor resection and they admitted to National Cancer Institute [NCI] and South Egypt Cancer Institute [SECI], Egypt, during the period from January 2009 till January 2011.The reconstruction either immediate in 38 patients [92.7%] or delayed reconstruction after tumor resection within 1-3 years by free flaps after previous tumor resection in 3 patients [7.3%].The flaps used for reconstruction was grouped in two groups, group I include 21 patients who reconstructed by local and regional flap and group II include 20 patients who reconstructed by free flaps. The 41 patients enrolled in this study were 23 males [56%] and 18 females [44%]. The male: female ratio was 1:3. The age range of the enrolled patients was 13-80 years with average age of [53.4 +/- 12.9 years] in group I and [32.9+ 14 years] in group lithe mean age 53.4 years in group I and 32.9 years in group II. In group I most common presentation is lower alveolar margin ulcerative lesion [28.6%] then malignant tongue ulcer but in group II most patients [10 patients] presented with jaw swelling that represent 50% of cases of that group. The commonest histopathology of the operated patients was squamous cell carcinoma which presented in 24 patients [58.5%], 16 in group I and 8 in group II. Local complications were recorded in 16 patients [39%] [12 in group I and 4 in group II], of them 2 patients [4.9%] with total flap loss and one patient died from cardiopulmonary arrest. The overall success rate was 95% in both groups. postoperative functional and cosmetic assessment for 38 patients in both groups [both groups regarding pain 57.9% of patients had no pain with p value = 1.000 [>0.05], as regard to speech 47.3% in group I and 57.9% in group II have normal speech with p value 0.648 [>0.05], as regard to swallowing was 63.1% in group I and 84.2% in group II of patients can swallow normally with p value = 0.141 [>0.05], As regard cosmetic appearance 47.4% in group land 26.3% in group II of patients have no change in the appearance with p value = 0.379 [>0.05]. Regional flap as PMMF that cover a bridging titanium plate and other flap as submental, deltopectoral and nasolabial flaps are a reliable and effective method for reconstruction of oro-mandibular defect and allow improvement of pain and restoration of speech, chewing, swallowing, and aesthetic contour of face but Free tissue transfer is the preferred method of reconstructing large oromandibular defects and central defects

Comparison of pancreatic remnant reconstruction methods after pancreatoduodenectomy

Surgery remains the main-stay therapy for periampullary carcinoma [PC] and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased the survival. We evaluate the safety and feasibility of 3 reconstruction methods of pancreatic remnant after Pancreatoduodenectomy [PD] such as Telescoping, Duct-to-mucosa pancreaticojejunostomy or pancreaticogastrortomy. This is Comparative prospective study of reconstruction methods of pancreatic remnant after PD was conducted on periampullary carcinoma patients admitted to South Egypt Cancer Institute from Nov.2008 to July 2012. Forty -one patients with periampullary carcinoma consisted of 23 men and 18 women with age ranged between 17-70 years, with a median age of 56 years. Characteristics of patients in the three groups were compared with Chi-square test. A variable was analysed with the Logistic Regression test. Survival rate was analyzed by use Kaplan-Meier test. P-value < 0.05 was considered statistically significant. 9 patients underwent duct-to-mucosa PJ, 17 patients Telescoping of pancreas into the jejunum and 15 patients PG, 30 stenting of pancreatic duct. There was a significant difference between 3 variable methods of reconstruction in leakage rate, operative time, technical difficulty and between stenting and non stenting pancreatic duct. Duct-to-mucosa PJ was least leakage rate, least post operative complication but associated with the longer reconstructive time and same resection time and it was the somewhat difficult. Duct-t-mucosa-PJ safe, least leakage, least blood loss; however PG is associated with more functional deterioration

A Pilot Study For Evaluating Egyptian Health Websites: Technical And Ethical Perspectives.

Background: The growing popularity of the Internet has made it easier and faster to find health information. Much of this information is valuable; however, the Internet also allows rapid and widespread distribution of false and misleading information. Aim of the work: To evaluate some of the Egyptian health websites from the Technical and Ethical perspectives and to compare the reliability of the different types of Egyptian health websites. Materials and Methods: This is a descriptive study. Search engines (eg. Google.com and Yahoo.com) were thoroughly searched for Egyptian health websites. Some of these websites were not accessible. Out of thirty two health websites, thirteen internet health websites were randomly selected and evaluated twice in this study. They were classified into 4 categories, official, professional, educational and private. The tool used in this study was a questionnaire developed by the research team depending on EHealth code of ethics, 2000 and international technical guidelines. The questionnaire consists of two main categories (technical and ethical). The technical evaluation includes (authority, objectivity, coverage, currency, design, privacy and security). The ethical evaluation includes (quality of information, informed consent and professionalism). A score for the questionnaire was developed by the research team to assess the websites. All statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 11.0. Comparisons between ethical and technical categories were done using the student’s t-test and ANOVA test for continuous variables and Pearson’s Chi square test for categorical variables. Results: On evaluating the quality of information of the health websites, it is noticed that in 92.3% of the sample, medical care is provided by professionals and their information based on scientific studies. Around forty six percent (46.2%) of the health websites do not mention the date of publication, date of recent update and the source of the information. Concerning the professionalism, 100% of the sample obeys laws and regulation in identifying themselves and mentioning the limitation of online consultation. 76.95% of the sample states clearly the purpose of the health website. Only 38.5% of them were recently updated. Privacy policy evaluation shows that 33.3% mentions if the system prevents unauthorized access to personal data while only 16.7% states how the user's personal data is stored and for how long. There is a statistically a significant change (p<0.05) on comparing the quality of information between the different types of websites. Both of the official and professional websites are better than educational and private websites. Conclusion: Some of the Egyptian health websites are reliable and up-to-date; some are not. Most of them are technically satisfactory. Evaluation of the health websites faces difficulties due to continuous updating. Recommendations: we should teach the health seekers to trust what they see or read on the Internet only if they can validate the source of the information and the authors and contributors should always be identified. It is necessary to establish mechanisms of Accreditation of Egyptian Health Websites. E-Health Ethics Training is very essential for the health professionals.

Near total laryngectomy: a versatile approach for voice restoration in advanced T3 and T4 laryngeal cancer: functional results and survival

Creation of a tunneled mucosal shunt between the trachea and pharynx that is controlled by remaining intrinsic laryngeal musculature with its nerve supply is an acceptable voice restoration procedure for advanced T3 and T4 laryngeal cancer. Such a tunnel will allow unilateral direction of air from lung to pharynx during phonation and will prevent aspiration since deglutition is a vagal mediated response which will induce contraction of tubed laryngeal musculature preventing aspiration. We previously reported our preliminary experience with the technique and we adopted the voice restoration approach based on the concept of the near total laryngectomy thereafter, Forty five patients with histologically proven squamous cell carcinoma of the larynx were included in this study [between January 1998 and February 2001]. They were 42 males and 3 females with a mean age of 52.6 years. Criteria for selection were a normal vocal process and arytenoid cartilage on the opposite side of the lesion as evidenced by endoscopy and CT scan with no major subglottic extension. In two patients supraglottic laryngectomy was carried out and in four other patients, complete tumor extirpation necessitated total laryngectomy. Accordingly, near total Iaryngectomy was carried out in the remaining 39 patients. Following a near total laryngectomy, where all laryngeal mucosa and cartilages are resected sparing the contralateral arytenoid cartilage with the overlying mucosa and surrounding musculature, the shunt was created by tubing the remaining mucosa with augmentation by pyriform sinus mucosa if necessary. The resulting tube was fashioned over 14 FG catheter for diameter control only and the remaining muscles were sutured over the tube. A permanent tracheostomy was established. Voice training was started postoperatively following resumption of oral feeding. Only one patient died in the immediate postoperative period due to massive myocardial infarction. One patient developed reactionary hemorrhage that was explored and controlled. Minor salivary fistula developed in nine patients [23.1%] and all were managed conservatively, none required intervention. Two patients [7.6%] had a retracted tracheostomy that required refashioning. Thirteen patients [33.3%] suffered transient aspiration that resolved spontaneously, none required intervention. Six patients developed recurrent disease [15.8%]. The overall two year disease free survival was 76%. None of the cases developed laryngeal mucosal recurrences, Intelligible speech was achieved in 31 patients [81.6%]. In the seven patients with shunt failure, insertion of a one way valve was successful in five patients in restoring a good quality voice. Near total laryngectomy is an oncologically safe procedure with acceptable complications that are well tolerated. It represents an ideal solution for patients with advanced T3 and T4 laryngeal cancer. Voice quality is very good and it does not require further management as is the ease with prosthetic voice shunt valves

Lag time in diagnosis of head and neck malignancies

Delay in diagnosis of head and neck cancer was studied in a series of 832 cases of head and neck malignancies. Lag time was calculated as the interval between the onset of symptoms and the definite diagnosis of malignancy. The mean lag time of all head neck malignant tumors was 8.9 weeks. The type of tumors affected lag time by virtue of its site, clinical course and rate of growth. Laryngeal tumors constituting 40% of the series had a mean lag time of 8.5 weeks. Thyroid tumors [33% of the cases] had a mean lag time of 11 weeks. Maxillary tumors showed the longest values with a mean of 12.3 weeks. Salivary and oral cavity neoplasms displayed the shortest values with a mean lag time of 4.4 and 5.7 weeks, respectively