Initial experience in a cancer hospital in Nepal with sentinel lymph node mapping and biopsy for evaluation of axillary lymph node status in palpable invasive breast cancer.

To evaluate the performance and feasibility of sentinel lymph node biopsy in early breast cancer patients using patent blue dye. From March 2004, we are consecutively enrolling breast cancer patients with tumor size less than 5 cm with no clinically palpable axillary lymph nodes in this feasibility study. So far, 21 patients underwent sentinel lymph node biopsy using 1.0% patent blue dye injection around the tumor followed by axillary dissection. Sentinel lymph node biopsy was compared with axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes. Age of patients ranged form 32-67 years old with mean age of 46.72 years. Fifty seven percent of patients were postmenopausal. Patients with T1 lesions were 8 and T2 were 13. The sentinel lymph node/s were successfully identified in 20 out of 21 patients (95.0%). The number of sentinel lymph nodes ranged from 1 to 5 (average 2.0) and non-sentinel nodes ranged from 5-22 (average 12.0). Infiltrating ductal carcinoma was diagnosed in 15 patients, DCIS with early invasion in 4 patients, invasive lobular carcinoma in 1 and medullary carcinoma in 1 patient. Of the 20 patients in whom sentinel lymph nodes were successfully identified, nodes were positive in 35.0% (7/20) of patients. All the positive nodes were detected in group with T2 lesions. SLNs were the only positive nodes in 2 patients. There were no false negative patients, yielding an accuracy of 100.0%. Lymphatic mapping using patent blue dye alone is technically feasible for patients with small (T1 or T2) palpable breast tumors. The sentinel node can be reliably identified in the majority of these patients, and its histology reflects that of the axilla with a high degree of accuracy. This method is very useful in economically backward countries as it involves less expensive material.

Gastric trichobezoar presenting as gastric outlet obstruction--a case report.

Trichobezoars are impactions of swallowed hairs in the stomach and occasionally in the intestine. They occur in emotionally disturbed, depressed, or mentally retarded patients who have trichotillomania and trichophagia. Removal of gastric trichobezoar by open surgery (gastrotomy) is a standard approach. Psychiatric follow-up is needed to diminish the recurrence of trichotillomania and trichophagia. Here, we report a case of large gastric trichobezoar presenting as gastric outlet obstruction in a 13-years-old girl. She was treated with open surgical extraction of the bezoar and behavioral therapy.

Retrospective study of chest wall tumors at a cancer hospital in Nepal.

Primary and metastatic tumors of both soft tissues and bony skeleton, and primary tumors of adjacent organs invading the chest wall constitute chest wall tumors. A retrospective review of all the patients with chest wall tumors was done at BP Koirala Memorial Cancer Hospital (BPKMCH). Primary tumors of breast were excluded. Surgical treatment consisted of wide local excision (WLE). Chest wall reconstruction, if needed, was achieved by a muscular flap +/- prolene mesh +/- omental transposition. Thirty one patients were treated in the period from October 1999 to October 2003. Age of the patients varied from 3 years to 72 years (mean age--38 years). Presenting complaint was mass in 96.8% and pain in 48.4% cases. The mass was 5 cm or less in 34.4%, from 5 to 10 cm in 32.3%, and more than 10 cm in 32.3% cases. The lesions were located in sternal region, anterior, lateral, posterior, and vertebral chest wall in 6.5%, 32.3%, 41.9%, 16.1% and 3.2% respectively. WLE was done in 29 cases. Chest wall reconstruction using both muscular flaps and prolene mesh (15x15 cm) was done in 8 cases. In three of them, where concomitant wedge resection of the lung was done, omental transposition was added. In rest of the cases, primary closure, muscular/myocutaneous flap or skin grafting was done. Minor complications were observed in 31.0% cases, which were managed conservatively. Two patients received adjuvant radiotherapy and four patients--adjuvant chemotherapy. There were no postoperative deaths. The rate of malignancy was 48.4%.

Omentoplasty versus no omentoplasty for esophagogastrostomy after surgery for cancer of cardia and esophagus.

BACKGROUND: The standard of care of patients with cancer of cardia and esophagus still remains surgery in early stage. One of the most feared complications after such procedure is anastomotic leak. AIM: We present our experience with omental wrapping of anastomosis (omentoplasty) to decrease the anastomotic leak. SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: An analysis of 50 consecutive patients, who underwent surgical resection for cancer of cardia and esophagus at BPKMCH, is done. For cancer of esophagus, a 10 cm proximal tumor free margin and for lesions of cardia, at least 5 cm margin was achieved. A 5 cm distal tumor free margin was achieved in each case. A subset of patients was considered for omentoplasty after completion of anastomosis. RESULTS: There were 29 male and 21 female with a mean age of 56.3 years. The average postoperative stay was 13.14 days. The stomach was the organ of substitute in 48 and jejunum in 2 cases. Omentoplasty was done in 37 cases, whereas in 13 cases, no omental wrapping was done. The rate of anastomotic leak was 6%. There was no leak from anastomosis placed at chest, whereas three cases of leak was observed in the anastomosis at the level of neck (P=.013). Overall, there was no leak in omentoplasty group, whereas there were three cases with leak in the group without omentoplasty (P=0.003). CONCLUSION: Omentoplasty should be considered in every case after surgical resection for cancer of cardia and esophagus.