Morbidity and mortality in minimally invasive esophagectomy: where do we stand

Background: The objective of the study was to study morbidity and mortality patterns in patients with carcinoma oesophagus who underwent minimally invasive esophagectomy (MIE) in a tertiary centre for oncology in South India.Methods: This was a retrospective observational study of 20 patients with carcinoma esophagus who underwent minimally invasive esophagectomy in center for oncology, Government Royapettah Hospital. Medical records of all these patients treated from September 2016 to August 2019 were collected from medical records department and details regarding the type of lesion, site of the lesion, preoperative chemoradiotherapy, type of surgery performed and post-operative complications were analyzed.Results: Out of 20 patients who underwent minimally invasive esophagectomy 13 were female and 7 were male. Among these 18 had squamous cell carcinoma, 2 had adenocarcinoma. Thirteen patients had lesion in middle third oesophagus and 7 patients had lesion in lower third oesophagus. Nineteen patients underwent surgery after chemoradiation and one patient underwent upfront surgery. Twelve patients underwent thoracolaparoscopic esophagectomy and 8 patients underwent trans hiatal esophagectomy. Perioperative complications were seen in 8 patients of whom pulmonary complications seen in 6 were most common. Anastomotic leaks occurred in 4 patients of which 2 patients were reoperated. One patient died within 30 days of surgery. Voice change and ECG abnormalities occurred in 2 patients each.Conclusions: Minimally invasive esophagectomy is safe and associated with comparable morbidity. Though the initial learning curve is steep, it helps in faster recovery of the patient. Also, the peri-operative outcome tends to improve with experience.

Fabrication and in- vitro permeation studies of indomethacin-ficus carica fruit mucilage patches.

The main objective of the present study was to develop matrix-moderated transdermal systems of Indomethacin using various proportions of Ficus carica fruit mucilage. Physical evaluation was performed such as moisture content, moisture uptake, tensile strength, flatness and folding endurance. In-vitro permeation studies were performed in a Keshary-Chien diffusion cell. The matrix-type transdermal systems were prepared using Indomethacin with Ficus carica fruit mucilage by the solvent evaporation technique. The interactions between Indomethacin and Ficus carica fruit mucilage were performed. The transdermal patches were subjected to various physicochemical parameters viz., mechanical properties, permeation studies and skin irritation studies. The prepared patches possessed satisfactory pre-formulary and formulary characteristics. In vitro permeation studies were performed using a Keshary-Chien diffusion cell across hairless Albino rat skin. The non-ionic surfactants Span 80, Glycerin, Propylene glycol in the formulation played a role as permeability enhancer. The patches were seemingly free of potentially hazardous skin irritation. The experimental results shows that the release of drug from the patch delayed in controlled manner as the proportion of Ficus carica increased. It was concluded that Indomethacin can be developed as a transdermal patches with Ficus carica fruit mucilage.