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1.
Colorectal Dis ; 25(9): 1896-1909, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37563772

RESUMO

AIM: Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. METHOD: A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. RESULTS: Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. CONCLUSION: This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.


Assuntos
Neoplasias Retais , Reto , Humanos , Consenso , Técnica Delphi , Reto/patologia , Canal Anal , Neoplasias Retais/patologia , Diafragma da Pelve , Resultado do Tratamento
2.
Ann Coloproctol ; 2023 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-36751014

RESUMO

Intersphincteric resection (ISR) with coloanal anastomosis is an oncologically safe anus-preserving technique for very low-lying rectal cancers. Most studies focused on oncological and functional outcomes of ISR with very few evaluating long-term postoperative anorectal complications. Full-thickness prolapse of the neorectum is a relatively rare complication. This report presents the case of a 70-year-old woman presenting with full-thickness prolapse of the side limb of the side-to-end coloanal anastomosis occurring 2 weeks after the stoma closure and 2 months after a robotic partial ISR performed with the Da Vinci single-port platform (Intuitive Surgical System Inc.). The anastomosis was revised through resection of the side limb and conversion of the side-to-end anastomosis into an end-to-end handsewn anastomosis with interrupted stitches. This study describes the first case of full-thickness prolapse of the side limb of the side-to-end handsewn coloanal anastomosis following ISR. Moreover, a revision of all reported cases of post-ISR full-thickness and mucosal prolapse was performed.

4.
HPB (Oxford) ; 24(9): 1511-1518, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35379594

RESUMO

BACKGROUND: Cholangiocarcinomas (CCA) are rare tumours originating from bile duct. Due to their asymptomatic nature they are usually diagnosed when the disease is advanced. Little data exists with respect to their incidence and treatment outcomes in low and middle income countries. METHOD: A retrospective analysis of a prospectively maintained database of all patients with perihilar (pCCA) and intrahepatic (iCCA) CCA registered between January 2012 and December 2018 was performed. RESULTS: A total of 760 patients, 427 (56.2%) diagnosed with pCCA and 333 (43.8%) of iCCA were included. Patients with localised, locally advanced and metastatic disease in pCCA were 45.5%, 25.9%, 8.5% and that in iCCA were 22.1%, 10.1% and 67.7% respectively. Only 141 (43.9%, 57 - iCCA, 84 -pCCA) of the total 321 patients started on some definitive cancer directed therapy could complete the intended treatment. The overall curative resection rate for all patients of iCCA was 14.5% whereas for patients of pCCA it was only 10.5%. CONCLUSION: More than half of CCA patients are not able to complete their intended treatment, being worse for pCCA as compared to iCCA. Early referral and centralisation of treatment for this complex disease might be the way forward to achieve optimal outcomes.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/epidemiologia , Colangiocarcinoma/cirurgia , Humanos , Estudos Retrospectivos , Centros de Atenção Terciária
5.
Indian J Cancer ; 57(3): 334-336, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675441

RESUMO

Extraintestinal gastrointestinal stromal tumors (EGISTs) are mesenchymal tumor with no connection to tubular gastrointestinal system. They commonly arise from omentum and mesentry. Retroperitoneum is a rare primary site. We herein report a case of a 33 year old woman who underwent upfront surgery for primary retroperitoneal gastrointestinal stromal tumor and is now disease-free on adjuvant Imatinib.


Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Adulto , Feminino , Tumores do Estroma Gastrointestinal/terapia , Humanos , Neoplasias Retroperitoneais/terapia
6.
J Surg Oncol ; 119(7): 958-963, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30802316

RESUMO

BACKGROUND: The objective was to elucidate the operative technique of robotic radical cholecystectomy (RRC) and to compare the early outcomes of RRC with open radical cholecystectomy (ORC) for gallbladder cancer (GBC). METHODS: Patients who underwent RRC for suspected or incidental GBC between July 2015 and August 2018 were analyzed. Patients who underwent ORC during the same period and fulfilled the study criteria formed the control group. RESULTS: During the study period, 27 patients who underwent RRC formed the study group (group A) and 70 matched patients who underwent ORC formed the control group (group B). Median surgical time was higher in group A (295 vs 200 minutes, P < 0.001). However, median blood loss (200 vs 600 mL, P < 0.001), postoperative hospital stay (4 vs 5 days, P = 0.046) and postoperative morbidity (1 vs 15 patients, P = 0.035) were lower in group A. Median lymph node yield was 10 (range = 2-21) for group A and 9 (range = 2-25) for group B, and was comparable (P = 0.408). During a median follow up of 9 (1-46) months, two patients in group A developed recurrence (no port site recurrence). CONCLUSION: RRC is safe and feasible and the short-term results are compared with ORC.


Assuntos
Colecistectomia/métodos , Neoplasias da Vesícula Biliar/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
J Gastrointest Cancer ; 50(2): 298-303, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29435905

RESUMO

PURPOSE: Published literature on gall bladder neuroendocrine tumors (GB NETs) is limited with none reporting the role of multimodal therapy. METHODS: Patients with histologically confirmed GB NETs treated at Tata Memorial Hospital, Mumbai, from January 2010 to June 2017 were analyzed. Staging was done by contrast-enhanced computed tomography (CECT) of abdomen and chest or a positron emission topography (PET) scan. Tumor marker (CA19-9) was measured. WHO-2017 guideline was used to classify GB NETs. GB NETs were categorized as early disease (ED) (T1, T2, N0, i.e., stages I and II); locally advanced disease (LAD) (T3, T4, or N+, i.e., stage III); and metastatic disease (MD). Response to treatment was assessed with RECIST1.1 criteria. RESULTS: Twenty-five patients of GB NETs were identified; 19 with neuroendocrine carcinomas (NECs) and 6 with mixed adenoneuroendocrine carcinomas (MANECs). Two patients (8%) presented with ED, 9 (36%) with LAD, and 14 (56%) had MD. Those with ED underwent open revision radical cholecystectomy. Both received adjuvant chemotherapy (ACT) with six cycles of carboplatin-etoposide and were disease-free at 3 months of follow-up. Of the nine patients with LAD, six received three cycles of neoadjuvant chemotherapy (NACT) (carboplatin-etoposide) and three operated upfront. All six patients showed partial response to NACT and five underwent open radical cholecystectomy with R0 resection. All patients operated after NACT received three cycles of ACT. Their median follow-up was 7 months (range 3-22 months). Three patients with LAD developed metastasis after median disease-free survival of 5 months. The median survival in patients with MD was 12 (range 6-23) months. CONCLUSIONS: In carefully selected patients of GB NECs, downsizing with NACT facilitates radical resection with negative margins.


Assuntos
Carcinoma Neuroendócrino/terapia , Neoplasias da Vesícula Biliar/terapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/uso terapêutico , Carcinoma Neuroendócrino/patologia , Quimioterapia Adjuvante , Colecistectomia , Estudos de Coortes , Terapia Combinada , Etoposídeo/uso terapêutico , Feminino , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Resultado do Tratamento
8.
Chin Clin Oncol ; 7(5): 51, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30395718

RESUMO

Fibrolamellar hepatocellular carcinoma (FLHCC) is a primary liver tumor. It is a pathologically distinct variety of hepatocellular carcinoma (HCC). The term 'fibrolamellar' is derived from the presence of thick fibrous collagen bands surrounding the tumor cells. It is a relatively rare tumor of unknown biology. It has a distinctive predilection for adolescents and young adults with no underlying liver disease or cirrhosis. FLHCC patients have higher incidence of lymph node involvement than conventional HCC patients probably owing to larger median tumor size at presentation. Most cases present at an advanced stage at the time of initial diagnosis, however, curative intent treatment options can still be offered to up to 70% of patients. Surgery (resection/liver transplantation) is the current mainstay of treatment and remains the only potentially curative option. As recurrences are common, alternative therapies are under investigation. FLHCCs have traditionally been considered less chemo-responsive than their conventional HCC counterparts, but in advanced cases multimodality treatments can be effective. Compared to stage-matched non-cirrhotic patients with HCC, patients with FLHCC do not have a favourable prognosis and do not respond differently to treatment. The survival advantage observed in FLHCC over conventional HCC is most likely due to younger age at presentation and absence of cirrhosis.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Biomarcadores Tumorais/metabolismo , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patologia , Estadiamento de Neoplasias , Prognóstico
9.
Indian J Med Paediatr Oncol ; 35(1): 106-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25006298

RESUMO

Renal cell carcinoma (RCC) has the propensity to metastasize to any organ in the body. Tongue metastases from RCC is very rare with most of them being metachronous in nature. We present a rare case where patient presented with a tongue lesion leading to a diagnosis of RCC. Surgery is the preferred modality of treatment for tongue metastases.

10.
J Minim Access Surg ; 8(3): 97-8, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22837598

RESUMO

Hepatoduodenal ligament cysts are rare. These may be confused with hepatic cysts even on advanced investigative modalities like Computerized tomography scanning or Magnetic Resonance Imaging. Diagnosis is often an intraoperative surprise. Laparoscopic treatment of such hepatoduodenal cysts is not described in available medical literature. We report one such case treated laparoscopically.

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