ABSTRACT
Introduction: Minimal Access Surgery (MAS) has shown better peri-operative outcomes with equivalent oncological outcomes in gastrointestinal and thoracic oncology. Open CRS (O-CRS) procedure accompanies inevitable and significant surgical morbidity in patients. The aim of the review article is to compare outcomes of M-CRS and HIPEC/EPIC with open procedure in peritoneal surface malignancies. Content: Comprehensive search of databases was done and total 2,807 articles were found (2793-PubMed and 14-Cochrane review). PRISMA flow chart was prepared and 14 articles were selected. Meta-analysis was performed according to PRISMA guidelines using random-effects model (DerSimonian Laird) and fixed effect model. Publication bias was tested with Funnel plot and Egger's regression test. Quality of studies was assessed by Newcastle-Ottawa scale. Summary and Outlook: Patients in both groups [total (732), M-CRS(319), O-CRS(413)] were similar in demographic characteristics. Peri-operative outcomes were significantly better in M-CRS group in terms of blood loss SMD=-2.379, p<0.001 (95â¯% CI -2.952 to -1.805), blood transfusion RR=0.598, p=0.011 (95â¯% CI 0.402 to 0.889), bowel recovery SMD=-0.843, p=0.01 (95â¯% CI -1.487 to -0.2), hospital stay SMD=-2.348, p<0.001 (95â¯% CI -3.178 to -1.519) and total morbidity RR=0.538, p<0.001 (95â¯% CI 0.395 to 0.731). Duration of surgery SMD=-0.0643 (95â¯% CI -0.993 to 0.865, p=0.892) and CC0 score RR=1.064 (95â¯% CI 0.992 to 1.140, p=0.083) had no significant difference. Limited studies which evaluated survival showed similar outcomes. This meta-analysis shows that M-CRS and HIPEC/EPIC is feasible and has better peri-operative outcomes compared to open procedure in patients with limited peritoneal carcinoma index (PCI) peritoneal surface malignancies. Survival outcomes were not calculated. Further studies are warranted in this regard.
ABSTRACT
Brown Tumour or Osteitis fibrous cystic or Von-Recklinghausen disease of bone is a non-malignant condition due to abnormal metabolism of bones in hyperparathyroidism. Although pathognomonic of hyperparathyroidism, brown tumours are rare and only case reports are found in literature. We report a case of brown tumour of mandible with recurrent episodes of bleeding. A 46 year old male patient presented in emergency with bleeding from ulceroproliferative mass from left floor of mouth. After control of bleeding, radiological, laboratory and histopathological investigations were done that led to the diagnosis of brown tumour of mandible in the presence of parathyroid adenoma of left lower parathyroid gland. Left upper and lower parthyroidectomy was done with segmental resection of mandible with mass and titanium plating. Brown tumour of facial bones is a rare entity. Very rarely it can reach enormous sizes to cause bleeding. Although parathyroidectomy and correction of parathormone levels cause regression of small tumours, large brown tumours with complications should be managed with surgical resection and reconstruction.
ABSTRACT
Lip and oral cavity SCC account for 2nd highest incidence of cancers and 3rd most common cause of mortality from cancer in India. Reconstruction of defects of central arch invading cancers results in poor cosmetic and functional outcomes if free flaps are not used. 30 patients with Oral SCC in the age group 20-75 years requiring central arch segmental mandibulectomy were included. Reconstruction was done with pedicled bipaddled PMMC flap with 'AJ's orbicularis oris stitch' using Fiber wire. Patients were divided into 4 groups according to extent of lip and skin loss post excision of primary tumour. Patients were evaluated with subjective scores for drooling, oral competence and cosmesis. There were 4, 12, 9 and 5 patients in Group A, B, C and D respectively. Mean subjective scores using our technique for drooling, oral competence and cosmesis were 3.75/4,3.75/4 and 3.5/4 for group A, 3.45/4, 3.36/4 and 3.09/4 for group B, 2.8/4, 2.6/4 and 2.3/4 for group C defects and 2.5/4, 3/4 and 2.5/4 for group D defects respectively. Over all scores for all patients were 3.2/4, 3.14/4 and 2.84/4 for drooling, oral competence and cosmesis. This simple, quick and inexpensive technique of reconstruction of central mandibular arch defects can drastically improve cosmetic and functional outcomes in a resource restrained set up. However, long term results and comparison studies are required for standardisation of the technique.
ABSTRACT
Malignant melanoma is an aggressive malignancy of melanocytes which is usually found on sun exposed areas of the body. A rare variant of this disease with no etiological association is the mucosal malignant melanoma found on all mucosal surfaces of the body including the oral cavity, respiratory mucosa and anorectal region. In the head and neck region, this disease is almost always diagnosed at an advanced stage and requires a very high index of suspicion for diagnosis. It is more commonly found in females than males.Indians are more prone to this disease as compared to Caucasians.Due to the obscure location within the oral and nasal cavity, it is clinically found at an advanced stage and requires surgical resection with adequate margins for complete eradication. This may be achieved either endoscopically in the nasal cavity or with wide local resection in the oral cavity. this in certain cases may not be feasible due to vicinity of vital structures. In such cases, adjuvant radiotherapy helps in the local control of disease. Histopathological evaluation of the specimen helps to determine aggressive biology of tumor with factors such as presence of ulceration, nodular morphology and perineural invasion being high risk features for development of local and regional recurrence. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04001-y.
