Retrospective study of ovarian malignancy managed in surgical unit at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

OBJECTIVE: To determine the oncological outcome and pattern of ovarian tumours in patients who underwent surgical management. METHODS: The retrospective, descriptive hospital-based study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of all patients who underwent surgical intervention for ovarian cancer between January 2010 and December 2015. Data was retrieved from the hospital database and analysed using SPSS 20. RESULTS: Of the 236 patients, 203(86%) had undergone open surgery, while 33(14%) had had laparoscopic surgery. Neo-adjuvant chemotherapy was given in 60(25.42%) cases and adjuvant chemotherapy in 102(43.22%). Epithelial ovarian cancer in 201(85.16%) cases was the most common tumour type. Mortality was recorded in 36(15.5%) cases, while 41(19.9%) were lost to follow-up. CONCLUSIONS: Ovarian tumours were found to be difficult to treat and were associated with frequent recurrence.

Is it necessary to measure hepatic venous pressure gradient before liver resection in cirrhotic patients? A single center audit.

OBJECTIVE: To determine whether routine preoperative hepatic venous pressure gradient measurements are necessary in child's-A cirrhotic patients undergoing liver resection for hepatocellular carcinoma, and to assess immediate post-operative liver dysfunction and 30-day mortality in such cases. METHODS: The 3-year audit was done at Shuakat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 1, 2015, to December 31, 2017, of all Child's class "A" patients with hepatocellular carcinoma without any clinical signs of portal hypertension who had preoperative hepatic venous pressure gradient measurements done. A proforma was used to collect the required data from patient files. Data was analysed using SPSS 21. RESULTS: Of the 20 patients, 11(55%) were males. The overall mean age was 60.6±7.4 years. Only 2(10%) patients had raised hepatic venous pressure gradient. Of the total, 14(70%) patients underwent surgery. Mean duration of surgery was 222±82.5 minutes and mean hospital stay was 6.8±3.2 days. None of the patients had deranged prothrombin-time or bilirubin on postoperative day 5. CONCLUSIONS: The incidence of subclinical portal hypertension was very low. Hepatic venous pressure gradient measurement can be avoided in early stage hepatocellular carcinoma for child's A cirrhotic patients undergoing liver resection.

Prophylactic Antibiotics for Reducing Central Line-associated Blood Stream Infection in Children with Totally Implantable Venous Access Devices.

OBJECTIVE: To analyse the need of prophylactic antibiotic before the insertion of totally implantable venous access devices (TIVADs) in terms of preventing central line-associated blood stream infection (CLABSI) in early postoperative period in pediatric oncology patients. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore from January 2005 to June 2016. METHODOLOGY: A total of 645 consecutive children with malignancy, who were implanted with TIVAD, were included in the study. The data were collected retrospectively and divided into two groups on the basis of prophylactic antibiotic administration (Group A) received the antibiotic; and Group B did not receive the antibiotic. Both the groups were compared in terms of positive central blood cultures in the absence of any other clinical source of infection during the early postoperative period of 30 days. RESULTS: The overall infection rate was 12.54% (35 out of 279) in Group B (did not receive prophylactic antibiotic) and 11.68% (41 out of 351) in Group A (received prophylactic antibiotic) without any significant difference (p = 0.741). CONCLUSION: There was no advantage of the use of prophylactic antibiotic before TIVAD insertion in preventing early postoperative CLABSI.

Prognostic significance of pre- and post-operative serum carcinoembryonic antigen levels in patients presented with rectal carcinoma; an experience from Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore.

OBJECTIVE: To explore the importance of serum carcinoembryonic antigen level as a tumour marker in rectal carcinoma. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of patients with rectal carcinoma from January 1996 to December 2015. Serum carcinoembryonic antigen levels were analysed using immulite@2000 system analyser. On the basis of serum carcinoembryonic antigen levels, data of patients was divided into four groups. Group A had normal serum levels both before and after surgical resection; Group B had normal levels pre-surgery but post-surgery levels were raised; Group C had raised levels pre-surgery that went down to normal post-surgery; and Group D had raised levels both before and after surgery. SPSS 23 was used for data analysis. RESULTS: Of the 401 patients, 267(66.6%) were males, and 204(50.9%) were aged <50 years. Group A had 267(66.6%) patients, Group B 26(6.5%), Group C 79(`9.7) and Group D had 29(7.2%) patients. Stage III disease was the most common 343(85.5%) and it was true across the groups. Overall recurrence was in 141(35.2%) patients. Group D had the highest recurrence rate 26(89.7%), while Group C had the lowest 18(22.8%). CONCLUSIONS: Fluctuating levels of carcinoembryonic antigen affected post-operative outcome.

Risk factors and patterns of recurrence after curative resection in Gastroesophageal Junction Adenocarcinoma.

OBJECTIVES: We looked at risk factors and patterns of recurrence following surgical treatment of Gastro-Oesophageal Junction carcinoma (GOJC). METHODS: Electronic medical records of patients with GOJC undergoing resection with curative intent between Jan 2009 and June 2017 at Shaukat Khanum Memorial Cancer Hospital were reviewed. GOJ cancer was classified as per Siewert classification. Clinical and operative details were studied and data was analysed using SPSS 20. RESULTS: During the study period, we identified 78 patients with GOJ adenocarcinoma (38 patients with GOJ Type-I, 16 with Type-II tumors and 24 patients with GOJ Type-III tumors). Median age was 56 years ± 1.1. Male to female distribution was 72 versus 28%. Carbo-Pacli /5-FU based XRT verses Magic protocol (p<0.015) and advanced pathological T.-stage (p-value<0.032) were found to be statistically significant risk factors for recurrence. After a median follow up of 17.8 months+/- 1.5, 20 patients developed recurrence of which five had local recurrence, three had regional recurrence, eight had distant metastases and four had both local and distant metastases. CONCLUSION: The incidence of recurrence following curative resection of GOJC is 25%. Type of neoadjuvant treatment, waiting time for surgery and advanced T-stage are a risk factor for recurrence.

Risk factors effecting development of metachronous liver metastasis in rectal cancer patients after curative surgical resection. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore experience.

OBJECTIVE: To determine risk factors affecting development of metachronous liver metastasis in rectal cancer patients after curative surgical resection. METHODS: The retrospective cohort study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of patients with histologically proven rectal carcinoma admitted to the department of surgical oncology from January 2005 to December 2015. Clinical data of all patients, including age, gender, clinical presentation, clinical and pathological tumour-nodes-metastasis classification, neoadjuvant chemo-radiotherapy, surgery, adjuvant chemotherapy, pre- and postoperative carcinoembryonic antigen levels, histopathological findings and tumour recurrence were analysed. SPSS 23 was used for data analysis.. RESULTS: Of the 434 patients, 26(6%) developed liver metastasis. Of them, 18(69%) were male and 16(61.5%) were aged below 50 years. On clinical staging, 2(7.7%) patients had stage II disease, 22(84.6%) had stage III, and 2(7.7%) patients had stage IV disease. At last follow-up, 2(7.7%) patients were alive without disease, 7(27%) had expired, while 17(65.4%) were alive with disease.. CONCLUSIONS: Tumour depth, lymph node metastasis, postoperative carcinoembryonic antigen levels, complete tumour response on histopathology were found to beresponsible for metachronous liver metastases in rectal cancer patients following curative resection.

Risk Factors For Chyle Leak After Esophagectomy.

BACKGROUND: Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagectomy with poorly understood risk factors. It has a high morbidity due to loss of fluids, electrolytes, and other nutrients, loss of lymphocytes and immune dysfunction. METHODS: Retrospective chart review of adult patients who underwent esophagectomy between 2009 and 2016 was performed. Cases with chyle leak were identified according to a set criteria. Clinical features, operative findings and postoperative variables were recorded and predictors of chyle leak were analyzed. RESULTS: During the study period, a total of 193 adult patients underwent esophagectomy of which 186 received neo adjuvant chemotherapy. The mean age was 53 years with 118 males and 74 females. Type of procedure performed was 3-stage esophagectomy in 98, Transhiatal esophagectomy in 79 and Ivor-Lewis esophagectomy in 15 patients. Chyle leak was identified in 9 (4.6%) patients. There was no significant association of chyle leak with age, gender, co-morbid, level of tumor, Neoadjuvant therapy and Type of esophagectomy. Chest drain output on postoperative day 5 was significantly predictive of chyle leak (p-value<0.05). Drain output more than 1000 on day 4 was highly suggestive of chyle leak (p-value<0.05). Day on which chest drain was removed was also found to be significantly related to chyle leak (p-value <0.05). CONCLUSIONS: No significant preoperative risk factors were identified for chyle leak. High chest drain output on postoperative day 5 and drain output more than 1000 on day 4 are significant predictors of chyle leak.