Does the Nightmare of Distressing Complications of Groin Dissection Over with "River Flow" Incision? - Experience of 240 Dissections from Tertiary Referral Oncology Centre, India.

OBJECTIVE: Groin dissection has been a nightmare for many surgeons due to its higher morbidity especially flap necrosis. Various modifications in incisions have been described in the literature to reduce the complications but with variable outcomes. By our novel "River Flow" incision technique, we have significantly reduced the procedure related complications without compromising onco surgical principles. METHODS: A prospective longitudinal clinical observational study was designed after Institutional Ethical Committee clearance, aiming to minimize the rate of complications, especially flap necrosis. All patients who underwent unilateral/bilateral ilio-inguinal block dissection (IIBD) from January 2014 to December 2021 were included in the study. The "River Flow" incision was made and standard ilio-inguinal block dissection was performed. Flap viability, seroma formation, lymphedema, infection, etc. were observed and noted during hospitalization and on followup. Clavien- Dindo classification was used to grade the postoperative complications. We have taken our historical data of 235 groin dissections as a control and compared them with the results of the present study. It is one of the largest studies on groin dissection so far. RESULTS: A total of 138 patients underwent 240 groin dissections. The most common diagnosis was carcinoma penis (44.9%) followed by carcinoma vulva (22.4%). Overall, the outcome of all groin dissections showed no postoperative mortality. None of the patients had complete flap necrosis. But in our historical data, the flap necrosis rate was 38%. The most common complication observed was seroma formation in 13.7% of cases followed by surgical site infection (6.52%). All the complications were managed conservatively. The postoperative stay of the patients was also significantly less. The median hospital stay was 3 days. CONCLUSION: "River Flow" incision technique is a simple but effective novel surgical technique for therapeutic ILND for any surgical setup without the learning curve. It can avoid flap necrosis, and decrease morbidity significantly without compromising the onco surgical principle of standard groin dissection. KEY WORDS: Groin dissection, skin necrosis, river flow incision.

Pattern of Care in Real-World Scenario on Advanced Epithelial Ovarian Cancer in a Tertiary Referral Oncology Centre in India - ISPSM Collaborative Study.

The treatment of advanced epithelial ovarian cancer (EOC) has evolved over time. With advent of platinum-based chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC), there is a paradigm shift in the patterns of care with improved survival. In this study, we analysed our advanced EOC patients aiming to gain insights into the pattern of care. An ambispective study of 250 patients of advanced EOC was done from our prospectively maintained computerised database in the Department of Surgical Oncology, tertiary care referral centre from 2013 to 2020. We analysed the demographic profile, treatment patterns, and perioperative outcomes. In this study, there were 83.6% stage III and 16.4% stage IVA. There were 62 (24.8%) upfront and 112 (44.8%) in interval settings. There was a higher number of patients receiving neo-adjuvant chemotherapy. One hundred twenty-six (50.4%) underwent cytoreductive surgery (CRS) only and 124 (49.6%) underwent CRS and HIPEC. CC-0 was achieved in 84.4% and CC-1 in 15.6% patients. HIPEC programme was started in 2013. With advent of RCTs in HIPEC, there was a substantial increase in the number of patients receiving HIPEC from 2015 (n = 10), 2017 (n = 20) to 2019 (n = 41). We offer secondary CRS in a limited subset of patients, n = 76 (30.4%). There was 24.8% early and 8.4% late postop complications. We have median follow-up of 50 months with attrition rate of 4%. With practice changing updates, the treatment of advanced EOC has been evolving over time. Though the primary CRS followed by systemic therapy is the standard to date, there is change in pattern of care with neo-adjuvant chemotherapy followed by interval CRS and HIPEC because of various RCTs. The addition of HIPEC has acceptable morbidity and mortality. There is a definite learning curve and the team has to evolve as a whole. In a tertiary care referral centre from LMIC, good patient selection, logistics, and implementing recent advances will definitely add to improved survival.

Can EPIC Be a Low-Cost Alternative to HIPEC in Advanced Epithelial Ovarian Cancer in Resource-Constraint Settings? Experience from Tertiary Care Oncology Center.

Management of advanced ovarian cancer underwent a paradigm shift with advent of cytoreductive surgery and intraperitoneal chemotherapy. Hyperthermic intraperitoneal chemotherapy requires complex machinery and costly disposables, and increased operative time. Early postoperative intraperitoneal chemotherapy is a relatively less resource-intensive alternative way of intraperitoneal drug delivery. We started our HIPEC programme in 2013. In select cases, we offer EPIC. This study is an audit of outcomes to look into the feasibility of EPIC as alternative to HIPEC. We performed analysis of prospectively maintained database in the Department of Surgical oncology from January 2019 to June 2022. We had 15 patients who underwent CRS + EPIC and 84 CRS+ HIPEC. We did a propensity-matched analysis for demographics, baseline data and PCI and compared 15 CRS + EPIC with 15 CRS + HIPEC patients. We compared the perioperative outcomes-morbidity, mortality, length of ICU and hospital stay. Procedure time was significantly higher in the HIPEC compared to EPIC as HIPEC is an intraoperative procedure. Patients were admitted to intensive care unit (ICU) after surgery for a longer mean duration in HIPEC arm (1.4 + 0.7 days) compared to EPIC arm (1.2 + 0.41 days). Patients in HIPEC arm had a significantly shorter hospital stay (mean 7.93 vs. 9.93 days. Four patients in EPIC arm had Clavien-Dindo grade 3 and 4 morbidity compared to 1 patient in HIPEC arm. Hematological toxicity was more common in EPIC group. CRS with EPIC can be explored as an alternative to HIPEC in centres lacking facilities and expertise for HIPEC.