RESUMEN
Pelvic exenteration is a surgery done to achieve margin negative resection in locally advanced rectal cancer infiltrating pelvic organs anterior to it. A retrospective observational study of patients undergoing pelvic exenteration for locally advanced rectal cancer was done at a single surgical unit of a tertiary care cancer centre. The period of study was from 1st January 2019 to 30th June 2021. A total of twelve patients underwent pelvic exenteration for locally advanced rectal cancer during the study period. The median duration of surgery was 310 min (range 250 to 380 min). The median duration of hospital stay was 14 days (range 12 to 30 days). Seven patients had documented postoperative complications, either major or minor, with a complication rate of 58.3%. Three patients required re-admission for complications. Two patients had COVID19 infection in the postoperative period but had uneventful recovery. Margin negative resection (R0) was achieved in eight patients (66.67%). Pelvic exenteration for locally advanced rectal cancer is a definitive surgery associated with a high morbidity rate. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-022-01529-3.
RESUMEN
Solid tumours around the foot are rare and include soft tissue sarcomas, skin and bone malignancies. Extended soft tissue defects due to oncological resection result in the loss of shock-absorbing and friction resistant tissue, which leads to altered walking patterns and pain. Replacement of plantar tissue requires soft tissue resistant to weight, pressure and shear stress. The other important desired goal of foot reconstruction is short wound healing time in order to allow adjuvant therapy at stipulated time. This is a retrospective study from March 2016 to October 2019. A total of twenty-one (n = 21) patients were operated for foot malignancies during this period in our institute and the resulting defects were reconstructed using various methods. Different reconstructive surgeries were performed depending on tumour size, location and general health status of patients. The length of hospitalization and the presence of local postoperative complications were assessed. Functional outcomes were measured in terms of MSTS score. Average age of the series is 53.1 years. Sixty-six percent of the patients (n = 14) presented with tumour at the weight bearing areas and 33% patients (n = 7) at the non-weight bearing areas of the foot. Fifty-seven percent of patients (n = 12) presented with malignant melanoma of foot, squamous cell carcinoma was seen in 33% (n = 7) patients and 4% patients (n = 1 each) presented as osteosarcoma and malignant peripheral nerve sheath tumour respectively. The mean MSTS score in patients with weight bearing areas (location) is statistically significant (p = 0.031). There is a significant correlation between the surgical complications and follow up MSTS score (p = 0.046) which signifies that flap related complications result in lower MSTS score. The mean MSTS score was 22.71/30. Complications were observed in three cases which included partial flap necrosis, graft loss and foot stiffness. Simple skin grafts to local flaps maybe a viable option in a limited resource setting based on the location of defect. Free tissue transfer is the ideal choice in case of weight bearing areas to achieve acceptable outcomes.
RESUMEN
Reconstructions of the maxillary defect after tumor resection are challenging surgeries. Maxillary reconstructions are done using obturators, locoregional flaps and free tissue transfers. Free flap options available for maxillary reconstruction are radial forearm, anterolateral thigh free flap, free fibular osteocutaneous flap, rectus abdominis myocutaneous flap, scapular, and iliac crest osteomyocutanous free flap etc. This is a single institutional observational study conducted at a tertiary cancer centre in North East India from May 2018 to April 2019. All the reconstructions are done with free tissue transfer. Post-operative outcome was assessed with University of Washington Quality of Life Questionnaire (UW-QOL v4.1). Data was collected from patient records and hospital online reporting system. All data were analysed using SPSS (statistical package for social sciences) version 21. Brown's classification was used to classify maxillary defects in this study. A p value ≤ 0.05 was considered statistically significant. In our study, we included fourteen patients (n = 14), of which anterolateral thigh free flap was used for reconstruction in thirteen cases and in one case free fibular osteocutaneous flap was done. Mean age is 33.36 ± 14 years; there was two flap failure. Flap failure is associated with a statistically significant low swallowing and appearance score (p value is 0.036 for both). The orbital exenteration is associated with low appearance score but it is not statistically significant (p value 0.70), probably due to small sample size in the series. Our early experience of free tissue transfer in maxillary reconstruction is satisfactory in terms of quality of life of the patient as well as the oncological outcome. With positive initial experience in maxillary reconstruction with free flaps large study population will be considered in near future.
RESUMEN
Inguinal lymph nodal dissection is notoriously associated with high morbidity. Various risk factors and technical modifications have been described in the past to overcome complications like lymphedema, wound breakdown, and infection which adversely affect the postoperative outcome and quality of life of the patient. This is a retrospective observational study from 1 January 2016 to 31 December 2019 of patients who underwent inguinal/ilio-inguinal block dissection for malignancy. Lymphedema was the most frequent morbidity seen (24%). The mean hospital stay of patients following surgery was 9.7 days (range 4 to 28 days). The inguinal drain was removed on a mean of 17.7 days (range 4 to 21 days), while mean iliac drain removal time was 11.7 days (range 4 to 21 days).
