Surgical Outcomes, Risk Factors, and Patterns of Recurrence in Endometrial Cancer

Introduction: Endometrial cancer (EC), being the third most common gynecologic cancer, is now increasing in prevalenceamong the developed countries. The morbidity and mortality rates are rising gradually in spite of available advancing treatmentmodalities. This study aims to brief on the patterns and risk factors of recurrence and surgical outcomes of EC.Aim: This study aims to study the patterns of recurrence and surgical outcomes of EC based on surgical and adjuvant therapy.Materials and Methods: The study was conducted among 60 women with EC in a tertiary care center. Disease staging wasdone by 2009 FIGO criteria. Post-operative adjuvant therapy in the form of pelvic radiation or vaginal radiation was offeredalong with chemotherapy to appropriate patients. The risk factors, surgical outcomes, and prognostic factors were studied byradiological imaging and blood parameters.Results: The mean age of the occurrence of EC was 51.22 years and abnormal uterine bleeding was the common presentingsymptom. About 86.6% of the patients underwent total abdominal hysterectomy and 52 of 60 patients required bilateral salpingooophorectomy (BSO). Pelvic lymph node dissection was done in 47 cases (61.6%) and 10 cases (16.6%) needed para-aorticnode dissection. Laparoscopic vaginal hysterectomy with BSO was done in one patient due to associated comorbidity. Onepatient needed only vaginal hysterectomy due to early-stage disease. The complication rate in this series was found to be 15%(9/60 cases). Two recurrences and one reported death were noticed.Conclusion: EC is common in postmenopausal women and comprehensive surgery, adjuvant radiotherapy and chemotherapycan help in reducing disease recurrence. Open surgery and minimally invasive surgery both have more or less equal outcomes.

Clinical Significance of Neck Dissection in Post-radiotherapy Clinically Negative N0 Neck in Advanced T3/T4 Oral Malignancies

Introduction: Optimal therapy for patients with metastatic neck disease remains controversial. Neck dissection followingradiotherapy has, traditionally, been used to improve locoregional control.Aim: The aim of the study was to study the neck dissection in post-RT clinically negative neck (cN0) in advanced T3/T4 oralmalignancies.Materials and Methods: In this retrospective study, cases of oral squamous cell carcinoma were included from 2014 to 2018.The study includes 16 patients with a cN0. Patients with advanced T stage (T3/T4), the presence of lymphovascular invasion,the presence of perineural invasion, positive surgical margins, lymph node involvement, extracapsular nodal extension, andbone involvement were received post-operative radiotherapy (PORT).Results: A total of 16 cases were included in the study, the PORT was given to six patients where three of them were pN+and three were pN0 but had adverse features of primary tumors that mandate PORT. The regional recurrence had occurredin 1 case which was pN+.Conclusion: Tumor recurrence was not influenced statistically with the use of PORT in the cN0.

​Histomorphological Spectrum of Pancreatic Carcinoma – A Retrospective Study

Introduction: Pancreatic cancer is dominated by exocrine pancreatic cancer. The most common histological type isadenocarcinoma in 95% of cases. Surgery remains the only curative treatment. However, only 20% of pancreatic cancers arejudged to be operable at the time of diagnosis.Aim: The aim of this study was to comprehensively analyze the histopathological spectrum of pancreatic lesions.Materials and Methods: This retrospective study was conducted in all pancreatic lesion cases. The specimens were examinedexternally and then opened as per the conventional method after overnight fixation in 10% formalin.Results: A total of 26 (52%) biopsy samples were obtained, 4 (8%) cyst excision, 11 (22%) partial pancreatectomy, and9 (18%) Whipple’s procedure specimen. Mean tumor size was 2.64 cm range 0.6–13 cm. Of the various gross morphologicaltypes seen, the most common was polypoid. Malignant lesions were 16 (32%) cases of adenocarcinoma, 6 (12%) cases of theneuroendocrine tumor, and 4 (8%) cases of solid pseudopapillary tumor of the pancreas.Conclusion: Histopathology is mandatory in many of the lesions which present as cystic and solid masses. It also aids inavoiding unwanted radical surgeries in patients which will increase the morbidity and mortality.

Role of Axillary Reverse Mapping in Breast Cancer to Decrease Complications

Introduction: The concept of axillary reverse mapping (ARM) is to map this part of upper limb drainage. If lymphedema ofthe upper extremity is caused by removing lymphatics and nodes situated in the axilla, theoretically the ability to map theselymphatics would enable surgeons to preserve them.Aim: The aim of the study was to study the effect of ARM technique on the incidence of seroma and lymphedema after modifiedradical mastectomy (MRM).Materials and Methods: A prospective, randomized, and controlled study over 40 female patients who underwent MRM. Patientswere divided and randomized into study and control groups, 20 patients for each. In the study group, the ARM procedure wasdone by injecting 2.5 ml of methylene blue dye intradermally and subcutaneously in the upper inner ipsilateral arm along themedial intramuscular groove before axillary lymph node dissection. Operative and post-operative results were recorded.Results: ARM procedure and successful visualization of arm lymphatics were achieved in 17 patients (85%). Statistically,there was no significant difference between the two groups regarding patient and tumor characteristics, operative time anda number of excised lymph nodes. There was significant difference favoring the ARM group in decreasing the incidence ofseroma, lymphedema and time passed till remove drains.Conclusion: ARM procedure facilitated arm lymphatics visualization. It is an easy non-time-consuming procedure. It resulted in asignificant reduction in the incidence of seroma and lymphedema, with a considerable reduction in the overall complications rate.

Therapeutic Significance of Comprehensive Lymphadenectomy in Early-stage Clear Cell Carcinoma of Ovary

Aim: This study aims to study the therapeutic significance of full lymphadenectomy in early-stage ovarian clear cell carcinoma.Methods: This prospective study was conducted in the patients with early-stage epithelial cell carcinoma. The followingprocedures were performed: Bilateral salpingo-oophorectomy and hysterectomy (if not previously performed), washing, randommultiple peritoneal biopsies, omentectomy, and systematic pelvic and para-aortic lymphadenectomy.Results: A total of 96 of 107 women with epithelial cell carcinoma were suitable for analysis. Endometrioid (35.5%), serous(22.4%), and clear cell (7.5%) cancers represented in the histological types. 12.5% rate of lymph node metastases in apparentepithelial cell carcinoma after lymph node assessment, no cases reported in clear cell carcinoma.Conclusion: The present results suggest that some patients with selected early-stage clear cell carcinoma may benefit fromfull lymphadenectomy