ABSTRACT
Background: The objective of the study was to study morbidity and mortality patterns in patients with carcinoma oesophagus who underwent minimally invasive esophagectomy (MIE) in a tertiary centre for oncology in South India.Methods: This was a retrospective observational study of 20 patients with carcinoma esophagus who underwent minimally invasive esophagectomy in center for oncology, Government Royapettah Hospital. Medical records of all these patients treated from September 2016 to August 2019 were collected from medical records department and details regarding the type of lesion, site of the lesion, preoperative chemoradiotherapy, type of surgery performed and post-operative complications were analyzed.Results: Out of 20 patients who underwent minimally invasive esophagectomy 13 were female and 7 were male. Among these 18 had squamous cell carcinoma, 2 had adenocarcinoma. Thirteen patients had lesion in middle third oesophagus and 7 patients had lesion in lower third oesophagus. Nineteen patients underwent surgery after chemoradiation and one patient underwent upfront surgery. Twelve patients underwent thoracolaparoscopic esophagectomy and 8 patients underwent trans hiatal esophagectomy. Perioperative complications were seen in 8 patients of whom pulmonary complications seen in 6 were most common. Anastomotic leaks occurred in 4 patients of which 2 patients were reoperated. One patient died within 30 days of surgery. Voice change and ECG abnormalities occurred in 2 patients each.Conclusions: Minimally invasive esophagectomy is safe and associated with comparable morbidity. Though the initial learning curve is steep, it helps in faster recovery of the patient. Also, the peri-operative outcome tends to improve with experience.
ABSTRACT
Background: Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. Awareness of such variations will decrease intraoperative dilemma and complications. In this article, we have presented our experience in congenital anomalies and anatomical aberrations in head and neck malignancies. We have reviewed the literature and discussed relevant embryology and their clinical significance. Methods: All patients with head and neck malignancies operated at our institution in the past three years, who had congenital anomalies and anatomical aberrations detected during preoperative evaluation or intraoperatively were included in this study. Results: Seven types of congenital anomalies were encountered, with most common anomaly being the aberrations in the pattern of facial nerve branches (47.6%). Thyroglossal cyst and non-recurrent laryngeal nerves were the next common anomalies noted (14.2%). Preoperative suspicion and diagnosis were evident in three patients. Conclusion: Though rare, congenital anomalies may pose significant challenges to the surgeon. Since most of them are noticed intraoperatively, a thorough knowledge of anatomy and its variation will help prevent injury to these structures. When promptly recognized and appropriately dealt, congenital anomalies do not produce surgical morbidity.
ABSTRACT
Background: The aim of this prospective study is to correlate radiological and intraoperative nodal characterization with pathological examination of pelvic and para-aortic nodes in operable epithelial ovarian cancer. Methods: The patients with epithelial ovarian cancer who had surgical cytoreduction were included in the study. These patients were subjected to radiological assessment of the abdomen with CT scan for nodal deposits in the para-aortic and pelvic region and it was followed by surgical cytoreduction. Intraoperatively, the nodes were palpated before, and after nodal basin, facial planes were dissected. After nodal dissection, the lymph nodes were grossed and sampled clinically as significant and insignificant and placed in separate jars. These nodes were pathologically assessed. Pathologically positive nodes were correlated with radiological, intraoperative and grossing findings. Results: Of the 27 patients, mean age was 45.6±10.9 years. Nine patients underwent upfront surgery, 18 patients underwent interval cytoreduction. A significant correlation was obtained (P Value <0.001) with grossing after surgery with the final histopathological report. The probable chance of identifying significant lymph nodes obtained in final pathological report from grossing after surgery in para-aortic nodes, right pelvic nodes, left pelvic nodes, right common iliac nodes and left common iliac nodes were 55%, 50%, 67.7%, 81.25% and 61.53% were positive for deposits and for insignificant lymph nodes obtained in final pathological report from grossing after surgery were 83.3%, 86.3%, 89.1%, 79% and 92% respectively were negative for deposits. Conclusion: Grossing after surgical dissection of the lymph nodes best correlates with final histopathology. CT scan findings for lymph nodal status in epithelial ovarian cancer does not correlate with final pathology.