A leap towards changing gender dynamics in oncology leadership - An ESSO-EYSAC initiative.

Despite the importance of diversity for the success and survival of biological and social systems, women are underrepresented in leadership positions, particularly in the medical field. Data from seven internationally renowned academic associations in surgical, medical, and radiation oncology show that women's representation in leadership roles is only 11%, with no individual society exceeding 20%. Possible justifications for the underrepresentation of women include unconscious biases and societal norms. Fortunately, a notable development in the form of an increased number of women attaining leadership positions in many major professional societies has emerged over recent times, thereby reflecting a positive transformation in the direction of gender equality. The authors recommend organizational interventions such as mentorship, leadership development programs, and national-level initiatives with global collaboration. The oncology community must promote a culture of cooperation and gender equality to ensure equitable opportunities for women in all aspects of life, including professional hierarchy.

Current practice in assessment and management of malnutrition in surgical oncology practice - An ESSO-EYSAC snapshot analysis.

INTRODUCTION: Malnutrition is common in patients suffering from malignant diseases and has a major impact on patient outcomes. Prevention and early detection are crucial for effective treatment. This study aimed to investigate current international practice in the assessment and management of malnutrition in surgical oncology departments. MATERIAL AND METHODS: The survey was designed by European Society of Surgical Oncology (ESSO) and ESSO Young Surgeons and Alumni Club (EYSAC) Research Academy as an online questionnaire with 41 questions addressing three main areas: participant demographics, malnutrition assessment, and perioperative nutritional standards. The survey was distributed from October to November 2021 via emails, social media and the ESSO website to surgical networks focussing on surgical oncologists. Results were collected and analysed by an independent team. RESULTS: A total of 156 participants from 39 different countries answered the survey, reflecting a response rate of 1.4%. Surgeons reported treating a mean of 22.4 patients per month. 38% of all patients treated in surgical oncology departments were routinely screened for malnutrition. 52% of patients were perceived as being at risk for malnutrition. The most used screening tool was the "Malnutrition Universal Screening Tool" (MUST). 68% of participants agreed that the surgeon is responsible for assessing preoperative nutritional status. 49% of patients were routinely seen by dieticians. In cases of severe malnutrition, 56% considered postponing the operation. CONCLUSIONS: The reported rate of malnutrition screening by surgical oncologists is lower than expected (38%). This indicates a need for improved awareness of malnutrition in surgical oncology, and nutritional screening.

Role of Sentinel Lymph Node Drainage Mapping for Localization of Contralateral Lymph Node Metastasis in Locally Advanced Oral Squamous Cell Carcinoma - A Prospective Pilot Study.

Aim/Background: Sentinel lymph node biopsy (SLNB) has become the standard of care for nodal staging in early-stage oral squamous cell carcinoma (OSCC) as an alternative to elective neck dissection. However, the role of sentinel lymph node (SLN) and lymphatic drainage mapping with image-guided surgery has not been studied in locally advanced OSCC. Therefore, this study was undertaken to evaluate the role of lymphatic drainage mapping in the identification of contralateral cervical lymph node metastasis in locally advanced OSCC (Stage III-IVb). Materials and Methods: We have prospectively analyzed treatment-naïve patients of locally advanced, lateralized OSCC (n = 20). All patients underwent SLN imaging using peritumoral injection 0.5-1.0 mCi of 99 mTc-Sulfur colloid (Filtered) and intraoperative identification of contralateral neck nodes using a handheld gamma probe (Crystal Photonics). Results: A total of 20 patients (18 males and 2 females) with a median age of 52.5 (33-70 years) were included. Ipsilateral SLN was localized in 18 (90%) patients. Bilateral cervical nodes were visualized only in 7 (35%) patients on lymphoscintigraphy (LSG). Out of the seven patients, 5 patients underwent bilateral neck dissection and 2 patients had unilateral neck dissection with LSG-guided exploration of contralateral cervical node and intraoperative frozen section examination. Six out of these seven patients had one or other risk factor for contralateral metastasis (patients had either primary in the tongue, involvement of floor of mouth, or tumor thickness >3.75 mm). On postoperative HPE, only 1/20 (5%) patient showed metastasis in the contralateral cervical lymph node. Conclusion: Correct identification of metastatic disease in contralateral neck directly influences clinical management, as it can reduce contralateral neck failure rate and limit the morbidity associated with unnecessary contralateral neck dissection, and it is also crucial in radiotherapy planning in locally advanced OSCC. In the current study, lymphatic drainage mapping showed a metastatic rate of 5% in the contralateral neck nodes in locally advanced, lateralized OSCC. However, the role of SLNB and lymphatic drainage mapping in this subgroup of OSCC needs to be studied in larger population to validate these findings.

Revisiting the Anatomical Landmark-Guided Central Venous Access Device Insertion: A Retrospective Cohort Study.

BACKGROUND: Ultrasound (USG) guidance is superior to blind and open cut-down techniques for accurate puncture of the internal jugular vein (IJV) or subclavian vein, but it increases the cost and duration of the procedure. Here, we report our experience with the reliability and consistency of anatomic landmark-guided technique for Central Venous Access Device (CVAD) insertion in a low-resource setting. MATERIAL AND METHODS: A retrospective analysis of the prospectively maintained database of patients undergoing CVAD insertion through one of the jugular veins was performed. Central venous access was achieved using a standardized anatomic insertion landmark (apex of Sedillot's triangle). Ultrasonography (USG) and/or fluoroscopy assistance was taken as and when required. RESULTS: Over 12 months (October 2021 to September 2022), a total of 208 patients underwent CVAD insertion. Central venous access was successfully achieved using anatomic landmark-guided technique in all but 14 patients (6.7%), in whom USG guidance or C-arm was used. Eleven out of 14 patients who needed guidance for CVAD insertion had body mass index (BMI) of more than 25, one had thyromegaly while the remaining two had an arterial puncture during cannulation. CVAD insertion-related complications included deep vein thrombosis (DVT) in five, extravasation of chemotherapeutic agent in one, spontaneous extrusion related to a fall in one, and persistent withdrawal-related occlusion in seven patients. CONCLUSION: Anatomical landmark-guided technique of CVAD insertion is safe and reliable, and can reduce the need for USG/C-arm in 93% of the patients.

Radiological tumor thickness as a clinical predictor of pathological depth of invasion in oral squamous cell carcinoma: a retrospective analysis.

PURPOSE: Inclusion of depth of invasion (DOI) in the recent AJCC/UICC TNM staging for oral cancer has incorporated the concept of tumor third dimension and its prognostic importance. However, there is no uniform consensus about measuring DOI at clinical setting at present. For more practical reasons, radiological tumor thickness (rTT) is a simple and practical measurement which can be used as a clinical predictor of pDOI. METHODS: We compared rTT and pathological DOI (pDOI) of 179 patients with OSCC who underwent curative surgery from April 2018 to April 2020 at AIIMS Rishikesh, India. Spearman correlation was used to determine correlation between rTT and pDOI. ROC curve was used to determine inter-group cutoff values. RESULTS: Overall, rTT showed a strong correlation with pDOI (rho = 0.74; 95% CI 0.667-0.8; p < 0.001). The inter-group cutoff value for rTT were 8 mm (Sn 89.1%; Sp 53.2%) between Group A (pDOI ≤ 5 mm) and B (pDOI > 5 mm, ≤ 10 mm), and 14 mm (Sn 89.5%; Sp 78.3%) between Group B and C (pDOI > 10 mm), respectively. CONCLUSIONS: rTT is a clinical predictor of pDOI in OSCC, and may be considered as a surrogate of DOI in the clinical setting.

Assessing the Prevalent Myths and Misconceptions Among Caregivers of Patients With Cancer: A Cross-Sectional Study.

Introduction Certain popular ideas about how cancer starts and spreads, though scientifically wrong, can seem to make sense, especially when those ideas are rooted in old theories. The present study was conducted to assess the prevalence of myths and misconceptions among caregivers of patients with cancer. Materials and methods A hospital-based survey in a tertiary teaching hospital in a sub-Himalayan region of North India was conducted where caregivers (aged 18-70 years) were administered questionaries containing 10 close-ended questions. The study was conducted in small batches of 20-25 participants. The questionnaire was analyzed, and a healthcare worker discussed it with the participants and clarified their myths. Results A total of 400 participants were included in the study. The median age of the participants was 45 years (IQR 35-59). The majority of the participants were males (85%, n=340). The prevalent myths among the caregivers were the following: (a) cancer is always very painful (45.5%), (b) the cause of cancers is some sin/harm done to others (26%), (c) cancer results from some form of injuries (22.8%), and (d) cancer spreads from one person to another (20.8%). Over 90% of the participants (347/378) informed that post-survey counselling was effective in ameliorating their myths. Conclusion The present study highlights the widespread cancer myths and misconceptions among the caregivers of patients with cancer. Therefore, the need of the hour is to eliminate them to avoid any unnecessary treatment delays and strengthen the emotional and social support system for patients with cancer.

Otological Assessment in Head Injury Patients: A Prospective Study and Review of Literature.

Head injuries constitute a tragic problem invariably in under-developed, developed and developing countries. The concomitant otological injuries often go unnoticed. The purpose of this study was to assess the various otological manifestations following head injuries. Prospective study with review of literature using PubMed database was done. All the patients were evaluated for their presenting symptoms and signs. Audiological investigations including PTA (Pure tone audiometry), OAE (Otoacoustic emission), Impedance-Audiometry and BERA were done. HRCT temporal bone was advised in cases of suspicion. Relevant literature was reviewed to calculate the pooled prevalence rates. Random-effects model to synthesize overall effects was used. Heterogeneity was evaluated with the I2 statistic. Of 53 patients enrolled in the study, RTA was the most common mode of injury. The audiometric findings showed SNHL, CHL and mixed HL in 34, 20 and 18% of patients respectively. HRCT showed Longitudinal fracture (n = 17; 53.12%); isolated mastoid bone fracture (n = 9; 28.12%), transverse (n = 3; 9.37%) and isolated EAC fracture in (n = 3; 9.37%) patients. The pooled prevalence (n = 1106 patients) of SNHL, CHL, Mixed HL and Normal hearing were-35% (95%CI, 18-55%; I2 = 95.20%; P < 0.00), 24% (95%CI, 16-33%; I2 = 80.01%; P < 0.00), 15%(95%CI, 9-23%; I2 = 79.64%; P < 0.00) and 30% (95%CI, 3-66%; I2 = 98.71%; P < 0.00) respectively. The pooled prevalence (n = 4191 patients) of longitudinal, Transverse, mixed and other fractures were-44% (95%CI, 3-66%;I2 = 99.48%; P < 0.00), 9% (95% CI, 4-16%; I2 = 95.95%; P < 0.00), 4% (95%CI, 1-8%; I2 = 94.13%; P < 0.00) and 1% (95%CI, 0-4%; I2 = 90.37%; P < 0.00) respectively. In patients with head injury coordination between the trauma-surgeon, neurosurgeon and otologist is must to improve the long-term outcomes.

Analysis of the Role of Selective Neck Dissection in Clinically Node-Positive T3/T4 Oral Cancers.

INTRODUCTION: The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging. Contemporary studies support the feasibility of SND in selected node-positive oral cancers with early primaries. Nevertheless, the suitability of SND in clinically node-positive (cN+) oral cancers with advanced primaries (T3/T4) is unknown. AIM: This study explores if patients with cN+ advanced primaries were suitable candidates for SND by spotting the involved lymph node distribution in various stations of the neck. Secondary objectives were to check if predictive clinicopathological factors for metastases to the neck in general also apply for lymph node metastases to levels IV and V. METHODS: The present retrospective study analysed the distribution of pathologically involved lymph nodes in 134 patients and explored the interrelation of various predictive factors and cervical metastases overall and those specific to levels IV and V. RESULTS: Level V was involved in 6.7% (6/83) of T4 and none of the T3 primaries. Depth of invasion (DOI), perineural invasion (PNI), and skin invasion were statistically significant predictors for nodal metastases in general on multivariate analysis. CONCLUSION: Our analysis supports the option of considering SND, sparing level V in patients with cN+ oral cancers in a subset with T3 primary and nodal stage N2 and below.

Risk Benefit Analysis of Routine Thymectomy for Differentiated Thyroid Cancers: A Systematic Review.

Background Central compartment lymph node dissection (CLND) is a part of the surgical management of differentiated thyroid cancer (DTC). Therapeutic CLND is done to address clinically significant central compartment nodes in patients with DTC, while prophylactic CLND is performed in the presence of high-risk features in the absence of clinically significant neck nodes. Removal of thymus-unilateral or bilateral-during CLND to achieve complete clearance of level VI and VII lymph node stations and address thymic metastasis is debatable. Objective The present systematic review was conducted to summarize the evidence, delineating the role of thymectomy during CLND in patients with DTC. Methods Electronic databases of PubMed, Embase, and Cochrane were searched from their inception to July 2020 using keywords-thyroid neoplasms or tumors, thyroidectomy, and thymectomy-to identify the articles describing the role of thymectomy during CLND in DTC. A pooled analysis of surgicopathological outcomes was performed using metaprop command in STATA software version 16. Result A total of three studies and 347 patients-total thyroidectomy (TT) with bilateral thymectomy in 154, TT with unilateral thymectomy in 166, and TT alone in 27 patients with DTC-were included in the systematic review. The pooled frequency of thymic metastasis was a mere 2% in patients undergoing either unilateral or bilateral thymectomy. The routine addition of thymectomy does not result in better lymph node clearance. Unilateral and bilateral thymectomy were associated with high chances of transient hypocalcemia (12.0% and 56.1%, respectively). Conclusion Routine thymectomy is not warranted during CLND, considering minimal oncological benefit and high risk of postoperative hypocalcemia.

Technical Considerations and Outcome Analysis of Using Extended Bipaddle Pectoralis Major Myocutaneous Flaps for Reconstructions of Large and Complex Oral Cavity Defects: Expanding the Horizons.

Reconstruction of large and complex defects arising from resection of advanced oral cancers requires free flaps or multi-staged reconstructions using a combination of pedicled flaps. Bipaddle (pectoralis major myocutaneous (PMMC) flap is a good alternative for reconstruction of such defects, especially in low-middle-income countries (LMIC). However, care should be taken while expanding its limits to avoid unnecessary morbidity. We discuss technical considerations while extending the PMMC flap design beyond the usual boundaries and analyse surgical and quality of life (QOL) outcomes in our patients with large (≥ 10 cm) oral cavity defects while using extended bipaddle PMMC flaps. We retrospectively analysed the results of 72 oral cancer patients with large buccoalveolar defects with at least one dimension ≥ 10 cm who underwent single-stage reconstruction using extended bipaddle PMMC flaps between January 2018 and December 2019. Total flap loss was seen in one patient and partial loss in 10 (13.8%) patients, while 18 (25.1%) patients had major complications (Clavien-Dindo grade III). Discharge from hospital was delayed beyond a mean of 6 days in 15 (20.8%) patients and the start of adjuvant treatment was delayed in 5 patients (6.9%). On univariate analysis, age > 50 years, female gender, the largest dimension and flap area were significant factors increasing morbidity. The QOL outcomes were acceptable. The satisfactory results from our series reaffirm that extended bipaddle PMMC flaps are a viable alternate option for such reconstructive challenges in resource-limited centres. However, age, gender, the defect dimensions and flap area should be taken into consideration while using this flap. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13193-021-01345-1.