ABSTRACT
Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase the chance of recurrence in the follow up period.
ABSTRACT
Background: Gastrointestinal (GI) cancers are responsible for more deaths from cancer than any other cancers. These patients are at risk for disease-related malnutrition which has been linked to an increase in post operative complications. Despite research, guidelines for preoperative nutritional assessment are lacking. The study was aimed to assess the nutritional status of patients in gastrointestinal malignancy, impact of nutritional supplementation and its impact on outcome of surgery.Methods: This cross-sectional study was conducted on patients of gastrointestinal malignancy attending Dept. of Surgery, Dr. D.Y. Patil Medical College, and Hospital, Pimpri, Pune. Institute Ethics Committee clearance was obtained before starting the study. 45 newly diagnosed patients of gastrointestinal malignancy were included in the study after informed consent.Results: At the start of this study 26.66% were well nourished, 35.55% moderately nourished, and 37.77% poorly nourished. At 6 weeks after supplementation 60 % were well nourished, 24.4 % moderately nourished, and 7 % poorly nourished. Surgical site infection (SSI) occurred in 7 patients of which 57.14% were poorly nourished, 28.57 % were moderately nourished. Anastomotic leak occurred in 3 patients of which 66.66% patients were poorly nourished. Average number of days of hospital stay for well nourished patients was 6.23 and for poorly nourished patients 14.14.Conclusions: Malnutrition is a concern in gastrointestinal malignancies. Delay in surgery upto 6 weeks is permissible to enhance patients’ nutritional status. Proper nutritional supplementation significantly improves nutritional status. Complications like SSI and anastomotic leak; hospital stay are significantly reduced after improvement in nutritional status.