Mean Lymph Node Yield Research Articles

SP3.6 - Do non-colorectal surgeons produce an inferior lymph node yield in emergency colorectal cancer resections?

Abstract Introduction Lymph node yield is a surrogate indicator of adequate resection and yields of 20 or more have been shown to be associated with better survival outcomes. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in lymph node yield between colorectal and non-colorectal surgeons in the context of emergency Hartmann's procedures performed for malignancy. Methods A retrospective study was conducted at a 3-site Trust in South East England between 2012 and 2022. Theatre and Info flex Cancer records were used to obtain patients who had undergone a Hartmann's procedure for malignancy and their operating surgeon. The histology reports were then reviewed and statistical analysis was undertaken. Results 346 patients were included in the study, in a 197:149 male-to-female ratio. The mean age was 73 (28-92 IQR). Histology confirmed malignancy in all the study participants. 11% (38/346) of the operations were conducted by non-colorectal surgeons (UGI, Breast, and Endocrine). The mean lymph node yield for the non-colorectal surgeons was 28 (24-33 IQR). The mean lymph node yield for colorectal surgeons was 29 (26-34 IQR). There was no statistical difference between the lymph node yield between colorectal and non-colorectal surgeons (p=0.671) Conclusion The study concluded that adequate oncological colonic resections could be conducted safely by non-colorectal surgeons in emergency settings.

Laparoscopic versus open pancreaticoduodenectomy: Long-term outcome from a tertiary care centre.

Laparoscopic Whipple's pancreaticoduodenectomy (WPD) is one of the most advanced minimally invasive procedures. In recent years, with advancements in minimally invasive surgery, laparoscopic WPD has been increasingly adopted as a safe and feasible technique. This study aims to compare the short-term and long-term outcomes of laparoscopic WPD to open WPD in resectable ampullary, periampullary and head of pancreas malignancies. A retrospective analysis of a prospectively maintained database of patients who underwent WPD from January 2015 to January 2021 at the department of surgical gastroenterology in a tertiary care medical college hospital was conducted. Patient demographics and pre-operative details, intraoperative parameters (operating time and blood loss), post-operative length of hospital stay, median intensive care unit (ICU) stay, time to resume oral diet, post-operative complications, interventional procedures, mortality, 3-year survival, 3 year recurrence-free survival and overall survival were analysed. Forty-two patients underwent WPD during our study period; 14 patients underwent laparoscopic WPD and 28 patients underwent open WPD. None required conversion. The majority of the patients had periampullary carcinoma in both the groups. Laparoscopic WPD showed a trend towards shorter ICU stays, hospital stays and surgical site infections (SSIs) compared to open WPD. The median operating time was significantly longer in the laparoscopic WPD group (380 min) compared to the open group (285 min). However, median blood loss was significantly lower in the laparoscopic group (250 mL vs. 300 mL). The pancreas-specific post-operative complications like delayed gastric emptying, post-operative pancreatic fistula or post-operative pancreatic haemorrhage did not differ significantly between the groups. All patients had R0 resection and the mean lymph node yield was comparable between the two groups (14.92 vs. 13.42). The reoperation rate or mortality rate did not show any statistical significance between the two groups. The overall survival was 46 months in the open group and 48 months in the laparoscopic group. Three-year survival was 74.1% in the open WPD group and 69.2% in the laparoscopic group. Three-year recurrence-free survival was 55.5% in the open group and 69.23% in the laparoscopic group. Laparoscopic WPD appears to be safe and feasible, with similar short-term and long-term survival outcomes. With a trend favouring laparoscopic WPD in terms of blood loss, hospital and ICU stay and post-operative SSIs, it should be offered to selected patients when the expertise is available.

Contemporary Role of Open Left Thoracoabdominal Approach in Esophageal Malignancy Treatment.

Despite the widespread use of minimally invasive techniques, open left thoracoabdominal esophagectomy (LTE) can offer excellent visualization and adaptability. The current study aimed to present and evaluate the outcomes related to an open LTE in esophageal malignancy treatment. A retrospective cohort analysis of data collected from two institutions was performed, including patients with distal esophageal or junctional tumors who underwent open LTE between November 2018 and December 2023. Twenty-two patients were included (16 males; mean age 62.8 years). Postoperative complications occurred in eight patients (36%), with pulmonary complications being the most prevalent (seven patients; 32%). One patient experienced a clinical anastomotic leak. No reoperations or escalation to a higher level of care were required. In-hospital and 30-day mortality were zero. Tumor cells were found at the surgical margins in six patients (27%). The mean lymph node yield was 27. During the follow-up period, there were nine deaths and 11 cases of disease recurrence. Isolated locoregional recurrence was seen in five patients (23%). The one-year and two-year overall survival rates were 79% and 47%, respectively. In selected cases, open LTE remains a valid and safe operation with acceptable morbidity and oncological efficacy.

Robotic Neck Dissection in Head and Neck Cancer via Modified BABA Technique.

Neck dissection forms an important component in the surgical management of head and neck cancers. By using the conventional techniques of neck dissection, a conspicuous scar is inevitable for the patients. The development of robotic assisted neck dissection provides for a scar-free neck along with good oncological and functional outcomes. A prospective observational study was conducted in our institute from 2020 March to 2022 March, where robotic-assisted neck dissections performed via the modified bilateral axillo-breast insufflation technique. Eighty-two patients underwent robotic neck dissections in our institute. Notably, 79 patients were treatment-naïve. The average docking time was 12 min and console time was 160 ± 15 min. The mean lymph node yield was 28.2. The average post-operative stay was 5.6 days. The average follow-up was noted to be 6.4 months. The mean cosmetic satisfaction score in our patients was 4.45. Only one patient presented with nodal recurrence, who was identified as a defaulter for adjuvant treatment. Robotic neck dissection gives similar functional and oncological outcomes as compared with conventional neck dissection. Patients had excellent cosmetic satisfaction following the procedure. The limitations of these techniques include high cost of procedure and longer operating time. This is a level IV evidence study. Although good oncological, functional, and cosmetic outcomes have been attained in robotic assisted neck dissection, further randomized controlled studies need to be conducted to justify the added costs, cosmetic advantage, and the time taken. IV Laryngoscope, 134:4045-4051, 2024.

Demographic characteristics and short-term outcomes of laparoscopic colon cancer surgeries at a newly developed cancer center in Peshawar, Pakistan.

In Pakistan, colon cancer ranks fourth in incidence, exhibiting survival rates of 90% to 14%, contingent on TNM staging and early detection. This research focuses on the demographic involvement and short-term outcomes of elective colon cancer resections at a newly established tertiary care cancer center utilizing laparoscopic procedures. A retrospective analysis of elective laparoscopic colorectal resections at Shaukat Khanum Memorial Cancer Institute and Research Centre, Peshawar, from April 2021 to February 2022 was conducted. Out of 157 cases, 79 had colon cancer. Criteria included patients >18 years old with positive biopsies; consent non-providers were excluded. Statistical analysis employed descriptive statistics and cross-tabulations using SPSS-22. The study encompassed biopsy-confirmed colon cancers in patients >18 years. 157 colorectal cases were performed, including 79 colon cancers. The sample comprised 61 males (77.2%) and 18 females (22.7%), mean age 42 years. Most patients (33%) were in the 36-45 age group. Majority were from KPK (69.6%), followed by Afghanistan (24%). Tumors were predominantly in the ascending colon (30.3%). Most were moderately differentiated (70.8%). Mean lymph node yield was 19.0, with 1.2% requiring open laparotomy. Post-discharge, one readmission occurred within 30 days. Mortality within 90 days was 2%, attributed to aspiration pneumonia and chemotherapy-related effects. Elective laparoscopic colonic surgery exhibits safety and efficacy in treating colon cancer. The study provides evidence of minimal morbidity and mortality, low readmission rates, and absence of anastomotic leaks. Hence, elective laparoscopic colonic surgery should be favored due to fewer post-operative complications and superior short-term outcomes. Larger studies on colon cancer are imperative for enhanced healthcare delivery.

Open or robotic? Radical cystectomies for patients with non-metastatic bladder cancer: A systematic review and meta-analysis.

This systematic review and meta-analysis will review randomized control trials for localized bladder cancer, evaluating surgical and pathologic outcomes of ORC versus RARC. Randomized studies evaluating adults with non-metastatic bladder cancer who underwent a radical cystectomy. Randomized trials were selected for final review. Data was extracted and analyzed with Revman 5 software. The primary outcome was complication rates within 90 days. Secondary outcomes included postoperative quality of life, estimated intraoperative blood loss, and other perioperative outcomes. Continuous variables were reported using mean difference with 95% confidence intervals, and dichotomous variables were reported using risk difference with 95% confidence intervals with RARC as the experimental group and ORC as the reference group. Of 134 articles screened, six unique randomized studies were selected. For Grade I-II complications, the risk ratio (RR) was 0.92 (95% CI [0.79,1.08], p = 0.33), and for Grade III-V complications, RR 0.93 (95% CI [0.73,1.18], p = 0.59). RARC resulted in decreased blood loss (95% CI [-438.08, -158.44], p < 0.00001) and longer operative time (95% CI [55.23, 133.13], p < 0.00001). Quality of life using the EORTC-QLQ-30 global health score at 3 months post-op appeared to favor RARC with a mean difference of 4.46 points (95% CI [1.78, 7.15], p = 0.001). Pathologic outcomes neither statistically nor clinically favored one modality, as there was no significant difference between mean lymph node yield (p = 0.49), positive lymph nodes (p = 1.00), and positive surgical margins (p = 0.85) between the surgical modalities. Although one surgical modality is not overtly superior, the choice may be decided by mitigating individual operative risk factors like intraoperative blood loss, operative time, post-operative quality of life, as well as institutional costs and learning curve among surgeons.

Short-Term Outcomes of First 100 Laparoscopic Colorectal Surgeries at a Newly Developed Surgical Setup at Peshawar.

The incidence of colorectal cancer (CRC) has risen steadily, necessitating innovative strategies for diagnosis and treatment. Minimally invasive surgery, exemplified by laparoscopic techniques, has emerged as a transformative approach in colorectal surgical practices. Laparoscopy offers advantages such as improved aesthetic outcomes, reduced post-operative pain, early patient mobilization, and shorter hospital stays. This study aims to present the short-term surgical outcomes of the first 100 elective laparoscopic CRC resections performed at a newly established tertiary care cancer center in Peshawar, Pakistan. Data were prospectively collected for CRC resections performed between April 2021 and February 2022. The study included patients above 18 years of age with biopsy-proven CRC. Surgical procedures were performed by two dedicated colorectal surgeons trained in minimally invasive surgery. Patient demographics, pre-operative factors, intraoperative parameters, and post-operative outcomes were systematically recorded and analyzed. Among the 100 cases included in the study, laparoscopic colorectal surgeries were successfully performed without any conversions to open surgery. The mean age of the study population was 52.5 years, with a male-to-female ratio of 2:1. The majority of cases were colon (48%) and anorectal cancers (52%). The mean lymph node yield was 18.29 (range 6-49). Only one patient required a re-look laparoscopy for a pelvic hematoma, and overall mortality was reported at 1%. Laparoscopic colorectal surgery is a safe and effective treatment option for elective colorectal operations with minimal post-operative complications and favorable short-term outcomes.

Complete Primary Pathological Response Following Neoadjuvant Treatment and Radical Resection for Pancreatic Ductal Adenocarcinoma.

Neoadjuvant treatment (NAT) for borderline (BD) or locally advanced (LA) primary pancreatic cancer (PDAC) is now a widely adopted approach. We present a case series of patients who have achieved a complete pathological response of the primary tumour on final histology following neoadjuvant chemotherapy +/- chemoradiation and radical surgery. Patients who underwent radical pancreatic resection following neoadjuvant treatment between March 2006 and March 2023 at a single institution were identified by retrospective case note review of a prospectively maintained database. Ten patients were identified to have a complete primary pathological response (ypT0) on postoperative histology. Before treatment, five patients were considered BD and five were LA according to National Comprehensive Cancer Network guidelines. All patients underwent staging Computed Tomography (CT) and nine underwent 18Fluorodeoxyglucose Positron Emission Tomography (18FDG-PET/CT) imaging, with a mean maximum standardized uptake value (SUVmax) of the primary lesion at 6.14 ± 1.98 units. All patients received neoadjuvant chemotherapy, and eight received further chemoradiotherapy prior to resection. Mean pre- and post-neoadjuvant treatment serum Ca19-9 was 148.0 ± 146.3 IU/L and 18.0 ± 18.7 IU/L, respectively (p = 0.01). The mean duration of NAT was 5.6 ± 1.7 months. The mean time from completion of NAT to surgery was 13.1 ± 8.3 weeks. The mean lymph node yield was 21.1 ± 10.4 nodes, with one patient found to have 1 lymph node involved. All resections were reported to be R0. The mean length of stay was 11.8 ± 6.2 days. At the time of analysis, one death was reported at 35 months postoperatively. Two cases of recurrence were reported at 16 months (surgical bed) and 33 months (pulmonary). All other patients remain alive and under active surveillance. The current overall survival is 26.6 ± 20.7 months and counting. Complete primary pathological response is uncommon but possible following neoadjuvant treatment in patients with PDAC. Further work to identify the common denominator within this unique cohort may lead to advances in the therapeutic approach and offer hope for patients diagnosed with borderline or locally advanced pancreatic ductal adenocarcinoma.

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach - long-term institutional analysis ten years after surgery.

This study aimed to introduce a new modified en-bloc resection method and evaluate its feasibility and safety in endoscopic thyroid surgery via bilateral areolar approach (BAA). Papillary thyroid carcinoma (PTC) patients who underwent lobectomy and ipsilateral central node dissection (CND) via the BAA approach were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated, including operative duration, lymph node yield (LNY), surgical complications, recurrence rate, and metastasis rate, over a ten-year follow-up period. Simultaneous lobectomy and CND were performed in the modified en-bloc group, whereas lobectomy was performed first, followed by CND in the conventional group. The study included 108 patients in the modified en-bloc group and 213 in the conventional group. There were no significant differences in gender, age, tumor locations, tumor dominant nodule size, or the incidence of concomitant Hashimoto thyroiditis when comparing clinicopathologic characteristics. The comparison of operative duration (P = 0.14), blood loss (P = 0.13), postoperative hospital stay (P = 0.58), incidence of transient vocal cord paralysis (P = 0.90) and hypocalcemia (P = 0.60) did not show any differences. The mean LNY achieved in the central compartment of the modified en-bloc group (7.5 ± 4.5) was significantly higher than that in the conventional group (5.6 ± 3.6). Two patients in the modified en-bloc group and two in the conventional group experienced metastasis after surgery during the ten-year follow-up (1.8% vs. 0.9%, P = 0.60). The learning curve analysis showed a significant decrease in operative duration after the 25-35th cases for modified en-bloc resection. The modified en-bloc resection method in endoscopic thyroid surgery via BAA is a technically feasible and safe procedure with excellent cosmetic outcomes for selective PTC patients.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer.

To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Redo Pelvic Surgery and Combined Metastectomy for Locally Recurrent Rectal Cancer with Known Oligometastatic Disease: A Multicentre Review.

Historically, surgical resection for patients with locally recurrent rectal cancer (LRRC) had been reserved for those without metastatic disease. 'Selective' patients with limited oligometastatic disease (OMD) (involving the liver and/or lung) are now increasingly being considered for resection, with favourable five-year survival rates. A retrospective analysis of consecutive patients undergoing multi-visceral pelvic resection of LRRC with their oligometastatic disease between 1 January 2015 and 31 August 2021 across four centres worldwide was performed. The data collected included disease characteristics, neoadjuvant therapy details, perioperative and oncological outcomes. Fourteen participants with a mean age of 59 years were included. There was a female preponderance (n = 9). Nine patients had liver metastases, four had lung metastases and one had both lung and liver disease. The mean number of metastatic tumours was 1.5 +/- 0.85. R0 margins were obtained in 71.4% (n = 10) and 100% (n = 14) of pelvic exenteration and oligometastatic disease surgeries, respectively. Mean lymph node yield was 11.6 +/- 6.9 nodes, with positive nodes being found in 28.6% (n = 4) of cases. A single major morbidity was reported, with no perioperative deaths. At follow-up, the median disease-free survival and overall survival were 12.3 months (IQR 4.5-17.5 months) and 25.9 months (IQR 6.2-39.7 months), respectively. Performing radical multi-visceral surgery for LRRC and distant oligometastatic disease appears to be feasible in appropriately selected patients that underwent good perioperative counselling.

Lymph node assessment technique matters in radical cystectomy for bladder cancer.

For patients undergoing radical cystectomy with pelvic lymph node dissection for urothelial cancer, a lymph node count of at least 16 is associated with improved cancer-specific and overall survival. Lymph node yield is presumed to relate directly to extent of dissection and surgical quality, however limited studies have reviewed the impact of the pathological assessment process of lymph nodes on lymph node yield. A retrospective assessment of 139 patients who had radical cystectomy for urothelial cancer between March 2015 and July 2021 from Fiona Stanley Hospital (Perth, Australia) by a single surgeon was assessed. A change in pathological assessment process from assessment of only palpable lymph nodes to microscopic assessment of the entire submitted specimens occurred in August 2018. Patients were divided into two groups accordingly and other relevant demographic and pathological data was recorded. The impact of pathological processing technique on lymph node yield was assessed using the Student T test and logistical regression was used to assess the impact of other demographic variables. The mean lymph node yield was 16.2 nodes (IQR 12-23) in 54 patients in the pre-process change group compared to 22.4 nodes (IQR 15-28.4) in 85 patients in the post-process change group (P< 0.0001). 53.7% had 16 or more nodes in the pre-process change group compared to 71.3% in the post-process change group (P= 0.04). Age, BMI, and gender were not significant predictors of lymph node yield. The current study demonstrates that the microscopic assessment of all lymph node tissue detects significantly more lymph nodes than only examining palpably abnormal tissue. Pathologic assessment protocols should be standardized to this technique to ensure the utility of lymph node yield as a quality metric.

Operative and Pathological Factors in Right-Sided Colon Cancers: How Can We Improve the Outcomes?

Though the tumour-node-metastasis staging classification is the standard approach to risk stratification in patients with colorectal cancer, several other important variables including the presence of extramural venous invasion (EMVI), the tumour mismatch repair status, as well as surgical technique and its influence on lymph node yieldall have an impact on long-term survival. This study aims to review both the impact of the type of operation on lymph node yield: complete mesocolic excision (CME) versus right hemicolectomy, and the impact of EMVI and microsatellite instability in predicting overall survival in patients undergoing a right hemicolectomy for colon cancer. Data of all patients who underwent an elective or emergency right hemicolectomy with curative intent for colon cancer between January 2013 and June 2022 (inclusive) was collected for this single-centre retrospective study. Kaplan-Meier survival curves were calculated using the Statistical Package for the Social Sciences (SPSS version 28, IBM Corp., Armonk, NY) software, and the log-rank (Mantel-Cox) test was used to compare survival distribution between different groups. A total of 421 patients underwent a right hemicolectomy for colon cancer with curative intent during the study period. EMVI was present in 173 (41%) tumours. Survival analysis showed significantly reduced cancer-related survival in patients with EMVI-positive tumours (p < 0.001), with five-year survival rates of 70% in EMVI-positive groups versus 96% in EMVI-negative groups. Subgroup analysis showed a significant difference in survival between node-positive and node-negative tumours in cancers found to have EMVI (p < 0.001). Mean lymph node yield was significantly higher in the CME group versus the standard right hemicolectomy group (p < 0.001). We found no significant difference in survival between patients with microsatellite instability-high (MSI-H) tumours and microsatellite stable (MSS) tumours (p = 0.432). Consideration of tumour biology and adopting the optimum surgical technique are factors that may influence long-term survival in patients with colorectal cancer. Extramural venous invasion is an important prognostic indicator of adverse outcomes in patients with right-sided colon cancer. Our study demonstrates a reduction in survival in patients with EMVI-positive tumours when undertaking subgroup analysis by the presence or absence of nodal disease. Further research needs to be undertaken to compare the relative efficacy of neoadjuvant versus adjuvant chemotherapy in right-sided cancers known to be EMVI-positiveas some patients will fail to have adjuvant chemotherapy due to postoperative complications, thereby delaying recovery and missing the optimum window for treatment.

Implementation of minimally invasive Ivor Lewis esophagectomy: learning curve of a single high-volume center.

Open esophagectomy is considered to be the main surgical procedure in the world for esophageal cancer treatment. Implementing a new surgical technique is associated with learning curve morbidity. The objective of this study is to determine the learning curve based on anastomotic leakage (AL) after implementing minimally invasive Ivor Lewis esophagectomy (MI-ILE) in January 2015. All 257 patients who underwent MI-ILE in a single high-volume center between January 2015 and December 2020 were retrospectively included in this study. The learning curve was evaluated using the standard CUSUM analysis with an expected AL rate of 11%. Secondary outcome parameters were postoperative complications, textbook outcome, and lymph node yield divided by the year of operation. Hierarchical binary logistic regression analysis was used to check for potential confounding variables. The CUSUM analysis showed a learning curve of 179 cases. The mean AL rate decreased from 33.3% in 2015 to 9.5% in 2020 (P = 0.007). There was an increase in the mean lymph node yield from 21 in 2018 to 28 in 2019 (P < 0.001) and textbook outcome from 37.3% in 2015 to 66.7% in 2020 (P = 0.005). A newly implemented MI-ILE has a learning curve of 179 patients based on a reference AL rate of 11% using the CUSUM method. Whether future generation surgeons will show similar learning curve numbers, implicating continuous development of different introduction programs of new techniques, will have to be the focus of future research.

Impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery: A retrospective study and meta-analysis of data from 11,082 participants.

BackgroundThe COVID-19 pandemic is affecting the care of patients with colorectal cancer worldwide, resulting in the postponement of many colorectal cancer surgeries. However, the effectiveness and safety of performing colorectal cancer surgery during the COVID-19 pandemic is unknown. This study evaluated the impact of the COVID−19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery.MethodsWe retrospectively identified patients undergoing colorectal cancer surgery in January 21, 2019, to April 1, 2019, vs. January 21, 2020, to April 1, 2020. Data regarding perioperative outcomes (postoperative complications, conversion rate, duration of surgery, intraoperative blood loss, transfusion, reoperation, intensive care, histological examination, morbidity, and length of hospital stay) were retrieved and compared between the two cohorts. A meta-analysis of 14 studies was also conducted to assess the impact of the COVID−19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery.ResultsThe sample included 68 patients who underwent surgery in 2020 and 136 patients who underwent surgery in 2019. No patient was converted from laparoscopy to laparotomy or required reoperation. R0 resection was completed in all patients in both groups. There was no significant difference in postoperative complications (p = 0.508), duration of surgery (p = 0.519), intraoperative blood loss (p = 0.148), transfusion (0.217), intensive care (p = 0.379), mean lymph node yield (p = 0.205), vascular positivity rate (p = 0.273), nerve invasion rate (p = 0.713), anastomosis leak rate (p = 1), morbidity (p = 0.478), and length of hospital stay (p = 0.623) between the two groups. The meta-analysis also showed no significant difference in short-term outcomes between the two groups.ConclusionsOur study shows that the COVID-19 pandemic has not led to a deterioration in the surgical outcomes of colorectal cancer surgery or reduction in the quality of cancer removal. Therefore, we do not recommend postponing elective colorectal cancer surgery during the COVID-19 pandemic.

Hepatic Artery Anomalies and Its Impact in Patients Undergoing Pancreaticoduodenectmy. A Comparative Study from Kashmir Valley

Background: Pancreaticoduodenectomy provides the only opportunity to cure resectable and borderline pancreatic ductal adenocarcinoma. This is linked to a high rate of morbidity and mortality, especially when combined with hepatic artery anomalies. The goal of this study was to analyse the spectrum and impact of hepatic artery anomalies on intraoperative and postoperative variables, and oncologic outcomes in patients undergoing pancreaticoduodenectomy. Materials and Methods: All patients with resectable periampullary or pancreatic head tumours who underwent pancreaticoduodenectmy (PD) were included. Patients were divided into two groups using computer-generated random numbers; Group A included patients who had pancreaticoduodenectmy (PD) with normal hepatic artery anatomy and Group B included patients with aberrant hepatic artery anatomy. The data was collected and analysed using SPSS 22. Results: Among the 238 patients who met the inclusion criteria, 177(74.36%) participants were included in Group A (Normal hepatic artery anatomy) and 61 (25.36%) in Group B (Aberrant hepatic artery anatomy). The mean age of patients in Group A was 51.3 ± 8.63 years while it was 50.6 ± 8.09 years in Group B. The difference in gender, BMI, pre-operative haemoglobin, bilirubin and albumin between two groups was statistically insignificant (P value &gt;0.05). The difference in mean operative time of Group A 230.9(168–390) minutes and Group B 319.6(200–620) minutes was statistically significant (p-value &lt;0.001). The mean blood loss in Group A (511.5 120.18 ml) was significantly lower than in Group B (623.6 127.06 ml) (P ≤ 0.001). There were no significant differences between the two groups in terms of post-operative pancreatic fistula, delayed gastric emptying, wound infection, atelectasis, hospital stay, peri-operative mortality, positive resection margins, and mean lymph node yield. Conclusion: Patients with hepatic artery anomalies who undergo pancreaticoduodenectomy have significantly more operative blood loss. This could be due to the procedure’s complexity and lengthy operative time. There were no differences between the two groups in terms of postoperative morbidity, oncological outcome, or mortality.

Increasing Use of PET-CT, Neoadjuvant Treatment, Minimally Invasive Approach and Surgical Radicality in Esophageal Cancer Surgery are Associated with Improved Short- and Long-term Outcomes in Real-World Setting

BackgroundGuideline adherence has improved outcomes in several cancers. Our aim was to evaluate whether the rate of PET-CT, neoadjuvant treatment, minimally invasive approach, and surgical radicality, suggested also by recent guidelines, would improve short- and long-term operative outcomes in esophageal cancer in real-world setting. MethodsThis retrospective study in two Finnish Hospitals between 2010 and 2020 included 296 esophageal cancer patients. Grouping factors based on four factors with annual cut-offs by center were 90% rate in PET-CT-based staging, 70% in neoadjuvant therapy usage, 80% in minimally invasive approach, and 20 in annual mean lymph node yield. If none of factors were reached, all patients operated in that year were classified into group 1. With one to three cut-offs reached, grouping was into group 2. If all annual cut-offs were reached, patients were classified into group 3. Primary end points were major complication rate and overall 1-, 3-, and 5-year survival. ResultsMajor complication rate decreased significantly from 38.2% in group 1 (p < 0.001) and 34.2% in group 2 (p < 0.001) to 10.2% in group 3. Overall 1-, 3-, and 5-year survival rates between groups 1–3 were 77.9% vs. 80.3% vs. 94.2% (p = 0.004), 51.5% vs. 51.1% vs. 67.3% (p = 0.022), and 44.1% vs. 47.4% vs. 55.5% (p = 0.065), respectively. Adjusted 5-year overall mortality was reduced significantly in group 3 compared to group 1 (HR 0.46, 95% CI 0.28–0.75). ConclusionThis study suggests that increasing rate of PET-CT, neoadjuvant treatment, minimally invasive surgery, and surgical radicality improves short- and long-term outcomes in operated esophageal cancer patients.

Assessing the histopathology reports of colorectal carcinoma surgery: An audit of three years with emphasis on lymph node yield.

A comprehensive histopathology report of colorectal carcinoma surgery is important in cancer staging and planning adjuvant treatment. Our aim was to review histopathology reports of operated specimens of colorectal carcinoma in our institution between 2013 and 2015 to assess different histological parameters, including lymph node yield, and to evaluate compliance to minimum data sets. After approval by the institutional review board (IRB), we analyzed 1230 histopathology reports of colorectal carcinoma between 2013 and 2015. Various gross and microscopic findings (along with age, sex) were noted, for example, specimen type, tumor site, resection margins including circumferential resection margin (CRM), lymphovascular invasion, perineural invasion, pTNM stage, lymph node yield, etc. Out of 1230 patients, 826 (67.15%) were men and 404 (32.85%) were women. The overall mean age was 52 (range: 18 - 90) years. There were 787 surgeries for rectal cancers. All reports commented on the type of specimen, tumor size (mean = 4.38 cm), proximal, and distal margins. Lymphovascular invasion (LVI) and the pT stage were mentioned in 98.06% and 99.84%, respectively. The overall mean lymph node yield was 18.38 (median = 15, range = 0-130 lymph nodes). A statistically significant difference in lymph node yield was detected between rectal and colonic cancer patients (14.79 and 27.26); post neoadjuvant therapy (NACT) cases, and NACT naive cases (13.51 and 25.11); and high tumor stage and low tumor stage disease (20.60 and 15.22). Not commenting on extramural vascular emboli, tumor budding, and CRM in non-rectal cancer cases were the lacunae. Our compliance with minimal data sets is satisfactory. The overall mean lymph node yield was 18.38 (median = 15). Extramural vascular emboli, tumor budding need to be captured.

Minimal invasive approaches in lymph node management of carcinoma of penis: A review.

Introduction:Inguinal lymph node dissection (ILND) is an integral part in the management of carcinoma penis. The concerns about the postoperative morbidity associated with open ILND led to modification in the template of dissection and adoption of minimally invasive techniques such as video endoscopic inguinal lymphadenectomy (VEIL) and robotic-assisted VEIL (R-VEIL). In this review, we aim to describe the techniques, case selection, perioperative outcomes, and oncological outcomes of VEIL and R-VEIL and to compare it with open ILND.Methods:Databases of PubMed, Embase, and Google Scholar were searched to identify the articles for VEIL and R-VEIL. Using PRISMA guidelines, literature search yielded 3783 articles, of which 32 full-text articles relevant to the topic were selected and reviewed, after consensus from authors.Results:After the first description of VEIL, various modifications in port placements and approaches were described. Several studies have shown, VEIL and R VEIL are safe and feasible in both node-negative and node-positive Ca penis patients. Compared to open ILND, VEIL had fewer wound infections and skin necrosis, minimal blood loss, shorter mean hospital stays, and reduced duration of drain kept. There is no difference in mean lymph node yield and recurrence rates between open ILND, VEIL, R-VEIL.Conclusion:VEIL and R-VEIL are safe and have comparable oncological outcomes with open ILND.

Outcomes of post-chemotherapy robot-assisted retroperitoneal lymph node dissection in testicular cancer: multi-institutional study.

To evaluate the perioperative and oncological outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND). We retrospectively reported the perioperative and oncological outcomes of all the patients with testicular cancer who underwent PC-RARPLND at three tertiary teaching centers. Descriptive statistical measures were used to report demographic, clinical, intraoperative, postoperative and oncological outcomes. There were 43 consecutive patients who underwent PC-RARPLND at the participating institutions. Mean patient age was 29.2years (± 8.2), BMI was 26.6kg/m2 (± 6.2). The mean size of retroperitoneal mass was 4.1cm (± 3.5). Full bilateral template dissection was performed in 38 (88.3%) patients. Nerve sparing was attempted in 19 (44.1%) patients. Mean operative time was 374min (± 132) and estimated blood loss was 292ml (± 445.6). The mean postoperative LOS was 2.8days (± 5.9). There was a total of 12 complications in 10 patients (Clavien grade I = 5, II = 3, III = 3 and IV = 1). Postoperative pathology demonstrated 24 patients (55%) with necrosis/fibrosis, 16 (37%) with teratoma and 3 (7%) with viable tumor. Mean lymph node (LN) yield was 26.5 LNs (SD ± 16.1). Patients were followed for a mean of 30.7months (± 24.7). No deaths were documented during follow-up and 2 pulmonary recurrences were identified. Antegrade ejaculation was preserved in 70.6% of patient who underwent nerve sparing. Limitations included retrospective nature and limited follow up. PC-RAPLND is safe and technically reproducible. It provides improved morbidity and less convalescence.