Correction to: An Initial Experience of Shoulder Resections and Reconstruction for Bone Tumours from a Cancer Centre in North-East India.

[This corrects the article DOI: 10.1007/s13193-021-01292-x.].

An Initial Experience of Shoulder Resections and Reconstruction for Bone Tumours from a Cancer Centre in North-East India.

Advances in surgery and multidisciplinary approach have made limb salvage surgery feasible in most patients with tumours around the shoulder joint. Although resection and reconstruction options are complex, good outcomes can be achieved when performed at a specialised centre. The data of patients with bone tumours who underwent proximal humeral resection and reconstruction in a single cancer centre were prospectively analysed. Comparison between biological and non-biological reconstruction was done in seven patients of which three patients underwent biological reconstruction and four patients had non-biological reconstruction. Measurement data were presented as mean ± standard deviation. The mean values were compared using independent t test. Kaplan-Meier method was used to evaluate survival with log rank test for comparison among groups. A p value less than 0.05 was considered statistically significant at 95% confidence interval. There were six males and two female patients. Mean follow-up duration was 17.3 months. The mean age of patients was 24.7 ± 16.3 years. The mean functional score for biological reconstruction was 26.3 ± 1.16 and for non-biological reconstruction was 24.5 ± 1.3 with a p value of 0.1. Overall survival of patients with biological reconstruction was 75% and non-biological reconstruction was 100% with a p value of 0.3. Recurrence-free survival for biological reconstruction and non-biological reconstruction was 75% and 100%, respectively, with p value of 0.3. Limb salvage surgery in a dedicated cancer centre is a feasible option for most tumours around the shoulder joint. Biological and non-biological reconstructions both produced acceptable functional outcomes in our patients.

Feasibility and Outcomes of Multivisceral Resection in Locally Advanced Colorectal Cancer: Experience of a Tertiary Cancer Center in North-East India

Purpose: Locally advanced colorectal cancer may require an en bloc resection of surrounding organs or structures to achieve complete tumor removal. This decision must weigh the risk of complications of multivisceral resection against the potential survival benefit. The purpose of this study is to review a single-center experience of feasibility of en bloc multivisceral resections for locally advanced colorectal carcinoma and to examine the effect of surgical experience on immediate outcome and rate of R0 resections. Methods: This is a study of 27 patients who underwent multivisceral resection for locally advanced colorectal carcinoma which was performed at our institute from January 2016 to December 2019. Among the 27 patients aged between 21 and 76 years (mean age, 48.67±7.3 years), 13 were males and 14 were females. Overall 18 patients had primary colon carcinoma and 9 had primary rectal carcinoma. All rectal cancer patients received neoadjuvant chemoradiation. All patients underwent surgery with curative intent. All patients underwent open surgery of which 66.7% underwent colectomy, 14.8% underwent anterior resection, 11.1% underwent Miles procedure, and 7.4% underwent pelvic exenteration. Results: The mean operative time was 268.14±72.2 minutes and the median amount of blood units transfused was 2.07 units. The mean hospital stay was 13.67±3.4 days. Histologically, 44.4% of patients had well-differentiated adenocarcinoma and 55.6% had moderately differentiated adenocarcinoma. The final histopathological examinatio n revealed malignant infiltration of the adjacent organs in 19/27 patients (70.4%). Pathological complete response was seen in 2 patients. R0 resection rate achieved was 96.3%. Lymph node metastasis was seen in 66.7% of patients with colon cancer and 11.1% with rectal cancer with overall mean number of harvested lymph nodes being 12.44±3.01. Postoperative complications were identified in 7 patients (25.9%), while mortality was seen in 2 (7.4%). Conclusion: Multivisceral resection for advanced colorectal cancer invading into the adjacent organ may be performed with acceptable morbidity and mortality.

A study of outcomes, technical safety, and feasibility of D-2 lymphadenectomy in gastric cancer.

BACKGROUND AND AIM: Lymph node dissection in gastric cancer had been controversial, but recent data have led us to the conclusion that D-2 dissection should be the standard of care for potentially curable advanced gastric carcinoma. In this study, we present our single-institution experience of D-2 lymph node dissection. METHODS: From January 2013 to September 2018, 115 patients of gastric cancer were treated with D-2 gastrectomy, 91 of whom met the criteria for study analysis. Data were statistically described as frequencies and percentages where appropriate. Survival curves were plotted using the Kaplan-Meier method, and Cox regression was used to assess the risk among groups. A P value <0.05 was considered to be statistically significant at 95% confidence interval. RESULTS: The majority of patients (86.8%) had Clavien-Dindo grade I postoperative surgical complications; 90-day mortality was seen in five (5.5%) patients. Patients with stages I, II, and III had survival rates of 100%, 71.4%; 53.2%, 44.4%; and 27.8%, 28.1%, respectively, for ages <55 and >55 years. Overall recurrence free survival rates were 26 and 28% for <55 years and >55 years, respectively, with a P value of 0.570. On multivariate analysis, positive distal margin and multivisceral resection had a statistically significant hazard ratio. CONCLUSIONS: This retrospective study conducted in our institute on patients with gastric cancer undergoing D-2 lymphadenectomy has shown that the addition of D-2 lymph node dissection, when performed at high-volume centers, have acceptable morbidity and mortality rates. This can be seen from our grades of postoperative surgical complications, 90-day mortality, and overall 5-year survival.

Radical Gastrectomy: Still the Gold Standard Treatment for Gastric Cancer-Our Experience from a Tertiary Care Center from Northeast India.

Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is the cornerstone of treatment and offers the only chance for cure. This study was conducted to assess the outcomes of all resectable gastric cancers that presented to our tertiary cancer center in Northeast India. All patients undergoing upfront surgery for gastric cancer with curative intention between 2012 and 2017 were included in the study. A total of 116 patients who underwent upfront radical gastrectomy were included in the study. Males (58.6%) were more common than females (41.4%). Mean age at presentation was 56.12 years (range 26-89). The most common mode of presentation was pain abdomen (53.8%). The most common location of tumor was the distal part (81%) followed by the proximal part (10.3%). The most commonly done procedure was distal radical gastrectomy (56.9%) followed by subtotal gastrectomy (32.8%). Median number of lymph nodes isolated was 14. Fifty-four patients received adjuvant chemotherapy while 32 patients received adjuvant chemoradiation (CTRT). At a median follow-up of 14 months (range, 2-78 months), overall 5-year survival was 23.75% (mean survival 33.77 months, median survival 24 months). The 5-year survival for stages I-III was 100%, 26.25%, and 11.25%, respectively (P < 0.001). Though perioperative chemotherapy has a role in gastric cancer, it is not the substitute for radical D2 gastrectomy which is still the gold standard treatment especially in high-volume centers.

A Study of Hormonal Receptors in Esophageal Carcinoma: Northeast Indian Tertiary Cancer Center Study.

Background Esophageal cancers, both squamous cell and adenocarcinoma, have poor outcomes with high morbidity and mortality. Our hospital-based registry for the year 2017 to 2018 showed that esophageal cancer constituted 22.7% of annual caseload. Most of our patients present in advanced stages. The aim of this article was to study the role of hormonal receptors in patients with esophageal cancer. Methods This is a single-institution, prospective, observational study in patients with esophageal carcinoma. Hormonal receptors (estrogen receptor [ER]-α and progesterone receptors) were studied in tumor tissue. Of 160 patients, receptor status was analyzed in 133 patients. Chi-square test was used for the correlation of categorical variables. The value of p < 0.05 was considered as statistically significant. Results A total of 133 patients was taken into the study of which 96 were males and 37 were females. The mean age of patients was 52 years. Carcinoma esophagus was predominantly seen in males. Estrogen and progesterone receptors were positive in 9.02 and 4.51% of the study population, respectively. Patients with hormonal receptor positivity presented with poor functional status, higher grades of dysphagia, higher stage, and most of the tumors were poorly differentiated with statistically significant p -values. Conclusion Despite recent advances in various fields of oncology, outcomes of esophageal carcinoma have not improved significantly. Hence, a study of new pathways of pathogenesis in carcinogenesis of esophageal carcinoma is essential. Few recent evidences including our study shows that the hormonal milieu is responsible in the pathogenesis of carcinoma esophagus. The utilization of this data and future study of the role of hormonal therapy might lead to improved outcomes in patients with carcinoma esophagus.

Reverse sural flap - A feasible option for oncological defects of the lower extremity, ankle, and foot: Our experience from Northeast India.

BACKGROUND: Soft-tissue management around the lower third of the leg and foot presents a challenge to the surgeon. To achieve local control of tumor, additional surgical margins are required, thus creating large soft-tissue defects. The reverse sural artery flap (RSAF) is a popular option for many of these defects. MATERIALS AND METHODS: This is a retrospective study of 26 patients who underwent resection of tumor around the lower leg, ankle, and foot, and reconstruction with RSAF was performed at our institute from 2012 to 2018. RESULTS: Among the 26 studied patients, aged between 22 and 71 (mean age: 50.8) years, 5 were female and rest were male. The most common site of involvement by tumor was heel (42.3%), followed by sole (26.9%). The most common histopathological diagnosis was melanoma (61.5%), followed by squamous cell carcinoma (26.9%) and soft-tissue sarcoma (11.5%). CONCLUSION: The distally based sural flap is a reliable flap for the coverage of soft-tissue defects following oncological defects of the distal lower extremity and foot.

Primary Ovarian Carcinoma with Rectal Metastasis-a Rare Presentation (a Case Report).

Rectal metastasis from primary ovarian cancer is a rare condition. In this case report, we present a case of 45-year-old female presented with chief complaint of pain abdomen and vomiting and with on and off history of per rectal bleeding. On examination, patient was pallor, hemoglobin level of 5.5 for which she was admitted. On per rectal examination, there was circumferential rectal growth around 7 cm from anal verge. Imaging was suggestive of ovarian lesion with rectal growth. Biopsy and immunohistochemistry of rectal growth was suggestive of metastatic well-differentiated papillary adenocarcinoma probably of ovarian origin. In view of its rare presentation, we want to report this case.