Surgical Oncology Research Articles

Canine preclinical safety evaluation of a multimodal nanoparticle agent (Nanotrast-CF800) for image-guided cancer surgery.

Surgical oncology often requires the use of contrast-enhanced cross-sectional imaging preoperatively to characterize solitary tumours and identify sentinel lymph nodes. Intraoperative optical guidance can effectively aid tissue-sparing tumour excision and locate sentinel lymph nodes. Nanotrast-CF800 (CF800) is a novel dual-modality contrast agent, which co-encapsulates iohexol and indocyanine green (ICG) within a liposomal nanoparticle. It was developed for preoperative and intraoperative imaging of solitary tumours and sentinel lymph node mapping and its efficacy has been demonstrated in preclinical animal models (Zheng et al. 2015). The objective of this study is to evaluate the safety profile of CF800 following intravenous administration in healthy dogs. Six research dogs were randomized into two groups. Group 1 received a low dose (1 mL/kg) and group 2 received a high dose (5 mL/kg). Dogs were placed under general anesthesia and a continuous rate infusion of CF800 was administered based on group allocation. Physiologic parameters including heart rate, respiratory rate, direct arterial blood pressure, cardiac output, and temperature were measured at set time points. Plasma concentrations of iohexol, ICG, and histamine were measured at set time points. Dogs underwent whole body computed tomography scans pre-injection, 2-, and 7-days post-injection (p.i.). Contrast enhancement was measured in select organ systems and great vessels at each time point. There were no significant changes in physiologic parameters following IV infusion of CF800 in all dogs. Plasma iohexol and ICG concentrations peaked at 1 day p.i., while histamine concentrations peaked at 30 minutes p.i. Significant contrast enhancement was noted within the liver, heart, aorta, and caudal vena cava on day 2 p.i., which was significantly different compared to baseline. Prolonged contrast retention within the liver was identified. Intravenous administration of CF800 was safe to use in healthy dogs with no significant systemic adverse effects.

Survival Analysis of Patients with Bladder Cancer after Radical Cystectomy

Abstract: One of the most commonly used surgical operations among patients with bladder cancer (BC) is radical cystectomy (RC), which includes the removal of the entire bladder along with the surrounding lymph nodes and other nearby organs that are affected by malignant neoplasms. During this operation, the most important stage that has a direct impact on the further quality of life of the patient is the choice of the method of uroderivation (UD). Patients and Methods: Have been reviewed retrospectively the clinical records of 586 patients who had BC RC at the Oncourological Department of the Sverdlovsk Regional Oncological Dispensary (SROD) between December 2001 and May 2021 after RC with three methods of UD: external urine removal, internal urine removal, intestinal reservoir. Results: The direct dependence of the presence and severity of some complications after RC on the method of urine removal chosen by the oncologist surgeon were determined. The analysis of survival curves was carried out, as well as the 5- and 10-year survival rate of patients of the SROD after RC. According to the results of the analysis, it was found that the worst survival was observed in patients with external urine diversion, the best survival was found in patients with internal urine diversion (p < 0.05). Conclusions: Urinary diversion is definitely an important stage in the performance of such a surgical intervention as RC. The study revealed statistically significant differences between patient survival curves (p < 0.05) plotted for different groups of urinary diversion and differences between the medians of several types of survival for the groups considered (p < 0.05).

Introduction to Indian clinical practice consensus guidelines for the management of squamous cell carcinoma the head-and-neck: Update 2022

Head-and-neck cancer (HNC), a malignant tumor of the upper aerodigestive tract, is the sixth most common cancer worldwide. In India, around 30-40% of all cancers are HNCs. Even though there are global guidelines and recommendations for the management of HNCs, these may not be appropriate for the Indian scenario. In order to discuss current practices, and latest developments, and to come to a consensus on management strategies for different anatomical subsites of HNCs for Indian patients, a group of experts (medical, surgical, and radiation oncologists, and dentists) came together. A review of literature from medical databases (PubMed, Google Scholar) was conducted to provide the best possible evidence, which was reviewed by experts in 2019 when the first consensus guidelines were developed. These guidelines were published in the Indian Journal of Cancer in February 2020. To update these guidelines regularly, the experts reconvened on July 27, 2022, and updated the recommendations for all subsites based on the recent evidence.

Core needle biopsy of breast tumours: comparison of diagnostic performance between surgery and radiology services at a national cancer centre in Latin America.

Breast pathology is a very common reason for medical attention. Tissue diagnosis is usually obtained with core needle biopsy which could be performed by breast surgeons or interventional radiologists. Our aim was to assess the comparison of diagnostic performance between the two services. A retrospective, descriptive and cross-sectional study was carried out on patients who had breast pathology at Instituto Nacional de Enfermedades Neoplasicas in 2019. Descriptive analyses, sensitivity and specificity were calculated using the R program version 4.2.3. From 1,082 patients with breast tumours who underwent core needle biopsy (CNB) during 2019, 782 cases were included. Breast surgeons performed 462 CNBs and radiologists performed 320 CNBs. The 87.5% were palpable tumours and 525 breast carcinomas were identified in the final pathology. The diagnostic performance showed that the sensitivity and specificity were greater than 95% and 98%, respectively. The waiting time in both showed that >95% underwent a CNB before 2 months. The breast surgery service performed the majority of the biopsies in less than 1 week since the indication of the execution of the CNB compared to the radiology service (90% versus 36%). Both hospital services, breast surgery and radiology, are efficient in determining an accurate diagnosis using CNB. However, the breast surgery service performs CNB in a shorter time interval. Breast surgical oncologists are encouraged to perform CNB if there are understaffed radiology services to expedite the diagnosis and treatment of breast cancer patients.

Current level of shared decision-making in hepatobiliary surgical oncology (SAPACHA)

Current level of shared decision-making in hepatobiliary surgical oncology (SAPACHA)

Investigation of symptom management and functional state of women who underwent breast cancer surgery.

The aim of this study was to investigate the symptom management and the functional status of women who underwent surgery for breast cancer. This cross-sectional descriptive study was conducted in a university hospital surgical oncology clinic. This study was conducted on 80 patients who had undergone breast cancer surgery in the last 5 years in a surgical oncology clinic of a university hospital. Study data were collected using the patient identification form, Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer, and Functional Living Index-Cancer. The data were analyzed with the SPSS program. The mean total score of Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer was found to be 157.28±36.86, and the mean total score of the Functional Living Index-Cancer was found to be 103.79±18.77. When the correlation between the Functional Living Index-Cancer and Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer scales used in the study was examined, it was determined that there was a positive statistically significant correlation (p<0.05) between the subscale and scale total scores. As a result of the study, it was determined that the self-efficacy and functional status of the patients were poor. Their functional status was also determined to be improved as the symptom self-efficacy levels increased.

Survival Analysis of Triple Negative Breast Cancer Patients Based on Ki-67 Protein Expression in Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar

Aim: To prove that 2-year mortality of triple-negative breast cancer (TNBC) patients with protein Ki-67 expression ≥ 40% is higher than patients with protein Ki-67 expression &lt; 40% in Prof. dr. I.G.N.G. Ngoerah General Hospital Denpasar. Methods: This was a bidirectional cohort study with survival analysis. The end of follow-up was the mortality state (survived or deceased) of patients observed for 24 months (2 years) since the patient was diagnosed with TNBC. This study was conducted in the Surgical Oncology Department, Prof. dr. I.G.N.G. Ngoerah General Hospital Denpasar from January 2018 until January 2022. The sample was recruited by a consecutive sampling method. The Kaplan-Meier curve and log-rank test determined overall survival (OS) and its difference between the Ki-67 expression group. Multivariate analysis using Cox regression was also conducted. Results: 58 TNBC patients were included in this study. At the end of the study, 31 patients survived, with an OS of 53.4%. The mean OS time was 19 months (95%CI = 17.12-20.88). The two-year OS of TNBC patients with Ki-67 ≥ 40% group was 37.5%; meanwhile, in Ki-67 expression &lt; 40% was 88.9%. It was statistically significant (p = 0.001). Multivariate analysis revealed that Ki-67 ≥ 40% expression was a significant and independent predictor factor for a high 2-year mortality rate (adjusted HR = 9.140; p = 0.008). Tumor-resection history also had a significant result in multivariate analysis (p &lt; 0.05). Conclusion: TNBC patients with Ki-67 ≥ 40% have a higher 2-year mortality rate than patients with Ki-67 expression &lt; 40%.

The AANS/CNS Section on Tumors: a summary of 40 years of advocacy to advance the care of patients with brain and spine tumors.

The AANS/CNS Section on Tumors was founded 40 years ago in 1984 to assist in the education of neurosurgeons interested in neuro-oncology, and serves as a resource for other national organizations regarding the clinical treatment of nervous system tumors. The Section on Tumors was the first national physicians' professional organization dedicated to the study and treatment of patients with brain and spine tumors. Over the past 40 years, the Section on Tumors has built solid foundations, including establishing the tumor section satellite meetings, founding the Journal of Neuro-Oncology (the first medical journal dedicated to brain and spine surgical oncology), advancing surgical neuro-oncology education and research, promoting neurosurgical involvement in neuro-oncology clinical trials, and advocating for patients with brain and spine tumors. This review provides a synopsis of the Section on Tumors' history, its challenges, and its opportunities, drawing on the section's archives and input from the 17 section chairs who led it during its first 40 years.

Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience.

Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS. We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods. A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines. Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.

Assessment of Oncosurgical and Functional Outcomes in Patients undergoing Glossectomy for Advanced Carcinoma Tongue: A Cross-sectional Study at a Tertiary Cancer Care Centre in Northern India

Introduction: Tongue carcinoma presents a global oncological challenge due to its aggressive nature and late-stage diagnosis. Glossectomy, a key surgical procedure for advanced cases, significantly affects both cancer control and essential functions such as speech and swallowing. Aim: To analyse the impact of different glossectomy types on oncological and functional outcomes in patients with advanced carcinoma of the tongue. Materials and Methods: A cross-sectional study was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Uttarakhand, India over a one-year period from September 1, 2022, to August 31, 2023. The study included 47 patients with squamous cell carcinoma of the oral and posterior tongue who underwent glossectomy. Oncological outcomes (mortality and hospital stay) and functional outcomes (swallowing, speech, dysphagia, and Quality of Life (QoL)) were assessed. The questionnaires used were the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30), EORTC questionnaire for the assessment of QoL in head and neck cancer patients (EORTC QLQ-H&amp;N35), M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Follow-up was conducted at the 6th week to assess changes in the functional aspects compared to the baseline scores. Data were entered into Microsoft Excel, and the analysis was performed using Statistical Packages for Social Sciences (SPSS) software version 25.0. The data were analysed using the Wilcoxon Signed Rank test. A p-value of &lt;0.05 was considered statistically significant. Results: The study comprised 37 (78.72%) males and 10 (21.28%) females, with a mean age of 47.77±12.6 years. Preoperative staging indicated that 22 (46.81%) patients had T2N0 stage, 16 (34.04%) patients had T3, and 9 (19.15%) patients had T4a disease. Among the patients, 14 (29.79%) underwent partial glossectomy, 27 (57.45%) underwent hemiglossectomy, and 3 (6.38%) underwent subtotal glossectomy, and 3 (6.38%) underwent total glossectomy. The mean duration of hospital stay was 10.09±2.87 days. There were no instances of mortality or tumour recurrence at the 6th week. Regarding the functional outcomes, compared to baseline, at the 6th week, there was a significant decrease in EORTC QLQ-H&amp;N35 median scores from 6.94 to 1.73 (p=0.005), but no significant change in the mean EORTC QLQ-C30 (90±8.22 versus (vs) 89.72±8.52, p=0.368), mean MDADI (4.51±1.2 vs 4.43±1.19, p=0.585), and mean SHI (15.81±25.76 vs 13.43±26.19, p=0.052). Conclusion: It can be inferred that glossectomy for advanced carcinoma of the tongue leads to a significant improvement in symptoms; however, the overall Quality of Life (QoL) and functions of the tongue such as swallowing and speech remain comparable to pre-surgery levels.

Persistent luminescence nanoparticles with high intensity for colorectal cancer surgery navigation and precision resection.

Surgical resection remains the main treatment for malignant tumors. Image-guided surgery aims to remove tumor tissue completely while preserving normal tissue, thereby reducing tumor recurrence rates and injury. However, challenges like tissue autofluorescence, limited probe penetration and low contrast restrict its use. Near-infrared (NIR) persistent luminescent nanoparticles (PLNPs) provide a solution by emitting persistent luminescence (PersL) even after excitation ceases, thus circumventing autofluorescence and enabling deep tumor imaging. In this study, we prepared nano-sized (140 nm hydrodynamic size) Cr3+ doped zinc gallogermanate (ZGC) using a removable template method and modified it with folate acid to obtain ZGC-FA, which exhibits NIR (695 nm) PersL with a signal-to-noise ratio of 23.9 in vivo. We utilized a colon cancer model that selectively expressed luciferase for the first time to validate the guiding efficacy of ZGC-FA in precision surgical resection. Post-intraperitoneal injection at 50 minutes, the PersL closely matched the tumor boundaries, achieving an overlap rate of approximately 98%. Complete tumor resection was achieved under PersL guidance, with only 2.3% of healthy tissue removed. This research underscores the potential of ZGC-FA in the field of surgical oncology. The precision of the ZGC-FA guided surgical approach holds promise to enhance surgical outcomes and facilitate postoperative recovery in patients.

Implementation of pharmacy-led preoperative medication reconciliation in surgical oncology patients

BackgroundPharmacy-led medication history collection and reconciliation have demonstrated decreased medication errors, increased patient safety, and improved cost-savings. However, literature lacks documented efforts to implement such services in the preoperative space, where having accurate medication lists following complex procedures with high postoperative admission rates is critical. ObjectivesThe purpose of this study was to describe the implementation of a telephonic pharmacy student and pharmacist-led preoperative medication reconciliation program. Practice descriptionThe service was piloted using third- and fourth-year pharmacy students to conduct telephonic medication histories for urologic surgical oncology patients. Weekly reports identified eligible patients with scheduled procedures within 2 weeks’ time. Using standardized methods for patient communication and documentation, students authored telephone encounter notes that were reviewed and signed by pharmacist preceptors. Pharmacist preceptors also reconciled home medication lists based on students’ findings. Practice innovationA standardized preoperative medication reconciliation process was developed and implemented utilizing third- and fourth-year pharmacy students. Resulting notes were available for surgical staff on the day of patients’ procedures and upon potential postoperative admission. Evaluation methodsA retrospective chart review was conducted to evaluate successfully documented medication histories collected by pharmacy students within the pharmacy-led preoperative medication reconciliation program. ResultsForty-six medication reconciliation notes were identified between August 2021 and February 2022, and 39 met inclusion criteria. Amongst the 177 medication additions, deletions, and edits, deletions were the most common, and 95% of patients had at least 1 medication discrepancy identified. A total of 33 medication classes were represented by the identified discrepancies, and each encounter took an average of 33 minutes to complete. ConclusionPreoperative medication reconciliation services can be successfully accomplished through a telephonic pharmacy student and pharmacist-led workflow. Accurate medication histories aid in minimizing medication errors and increasing patient safety.

Recent Trends and Scope of Nanotechnology in Orthopaedic Surgery: A Narrative Review

Orthopaedic implants osseointegrate better using nanophase materials because they mimic the natural trabecular bone structure better. Additionally, prostheses with nanophase coatings can lessen bacterial adherence compared to prostheses with traditional surfaces. Improved osseointegration and infection prevention may be possible with nano-coated joint replacement implants. Other potential applications with strong in-vitro findings include rapidly integrating fillers for osteochondral flaws, antitumour seleniumcoated endoprostheses, along with potent targeted Drug Delivery Systems (DDSs) for infection prevention and treatment of chronic overuse injuries. It is significant to focus on the use of nanotechnology in artificial joint replacement prostheses, drug delivery utilising nanotechnology, surgical oncology of the skeleton using nanotechnology, bone cell function using nanotechnology, applications in orthopaedic surgery, and, finally, the use of nanotechnology and its potential new fields of study for human welfare. Before nanophase devices are approved for clinical use, significant progress must be made in comprehending the potential health concerns associated with their creation, implantation, and usage habits. However, they have a lot of potential and will probably be helpful to all of us in the future. Nanotechnology is a fast-advancing area, and its applications in orthopaedic surgery are continually expanding. This review article enables academics, clinicians, and other stakeholders to stay up-to-date on the most recent advancements, innovations, and achievements in the integration of nanotechnology into orthopaedic operations. The article also focuses on the challenges of applying nanotechnology in orthopaedics, such as biocompatibility issues, regulatory hurdles, and financial considerations. Simultaneously, it can discuss potential avenues for further research, collaboration, and progress in overcoming these challenges. Discussing the practical applications and clinical consequences of nanotechnology in orthopaedic surgery is crucial. The evaluation can explore on how these improvements will affect patient outcomes, surgical techniques, and overall healthcare practices.

Surgical Margin Definition and Assessment in Head and Neck Oncology: A Cross-Sectional Survey of Canadian Head and Neck Surgeons.

Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method. To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment. A 24-question cross-sectional survey was sent via email through the Canadian Society of Otolaryngology-Head & Neck Surgery (CSOHNS), and responses were gathered from December 19, 2023, to March 12, 2024. Responses were aggregated and reported using descriptive statistics. The survey was conducted in Canada among self-reported staff head and neck oncology surgeons with membership in the CSOHNS. A total of 36 staff head and neck oncology surgeons responded from across Canada. The most common (58.3%) definition of a negative surgical margin for oral cavity HNSCC was ">5 mm formalin fixed paraffin embedded distance." To obtain surgical margins, surgeons were split with 44.1% using only a tumor bed approach and 32.4% using only a specimen-driven approach. A dedicated head and neck pathologist is always available more commonly for final pathological assessment (63.6%) versus intraoperative frozen section assessment (15.5%). Finally, most surgeons reported having a synoptic standardized reporting system for annotating margin status (78.8%). The results of this survey provide a current-state analysis of head and neck surgeons across Canada and set the stage for future efforts to be directed toward standardizing the collection method and reporting criteria for surgical margins in HNSCC.

Breast Cancer in Young African Women: Unique Challenges and Perspectives

Abstract Breast cancer (BC) in young women is difficult to treat, especially in Africa. This review discusses the gaps and frustrations clinicians face in South Africa and the broader sub-Saharan region. It provides a snapshot of the literature concerning young BC patients and their unique challenges, including age, ancestry, barriers to care, fertility and ovarian preservation options, access to genetic testing and counseling, clinician knowledge and attitudes and specific molecular subtypes. In addition, the review includes insights from specialist oncology surgeons working in the South African public and private healthcare sectors and calls for advocacy. There is an urgent need for multilayered systemic change in the care of young BC patients in sub-Saharan Africa to address the tragic reality of clinicians being unable to offer them the care they deserve.

Management of Nodular Nasal Basal Cell Carcinoma with Wide Excision, Transpositional Median Forehead Flap, Forehead Split Thickness Skin Graft: Case Report

Introduction: Basal cell carcinoma (BCC) is the most common skin type cancer with an incidence rate of around 75-80%. The most common location is in the head and neck area around 70-80% and followed by other body parts around 25% consist of the penis, vulva or perianal area and 5% on the skin. BCC occurs more frequently in light-skinned individuals compared to dark-skinned individuals. The incidence rate is relatively lower in Asians, blacks ethnic, and Hispanics.&#x0D; Case Presentation: A 66 years-old woman complained of scabs on the right side of her nose which had become increasingly widespread for the past 2 years. The wound was initially the size of a mole and was scratched until it spread until the patient was hospitalized. Physical examination showed a wound in the nasal area measuring 4 x 5 x 1 cm, irregular wound edges, cartilaginous wound base with necrotic tissue and pus. The first biopsy examination showed poorly differentiated basal cell carcinoma. The patient was treated with Nasal Reconstruction surgery consisting of wide excision was performed by surgical oncologist, transpositional median forehead Flap and forehead Split Thickness Skin Graft were performed by reconstructive plastic surgeon.&#x0D; Discussion: The diagnosis of BCC in this patient was based on regarding history taking, physical examination and histopathological examination. However, for defects with a diameter of more than 1.5 to 2 cm, generally recommended using axial pattern flaps such as forehead flaps, nasolabial flaps and dorsal nose flaps. In this case, the patient was treated with wide excision followed by nasal reconstruction with a transpositional forehead flap and forehead split thickness skin graft.&#x0D; Conclusion: Nevertheless, regional flaps remain the recommended procedure for nasal reconstruction after wide excision of the tumor. Accurate analysis of the damage combined with evaluation of the patient's clinical condition is necessary to select the best surgical technique. Thorough knowledge of regional vascular anatomy and a comprehensive multidisciplinary approach are important first steps for proper treatment of nasal skin cancer, so that the procedure for wide excision of nasal basal cell carcinoma followed by nasal reconstruction with transpositional forehead flap and split thickness skin graft, can provide satisfactory result.

Role of Endoscopic Ultrasound in the Management of Pancreatic Cancer.

Pancreatic cancer is one of the common causes of cancer-associated mortality with a dismal overall prognosis which has remained virtually unchanged over decades. In the present era, the management of patients with pancreatic cancer involves a multi-disciplinary team of radiologists, gastroenterologists, surgical oncologists, medical oncologists, radiation oncologists and other specialists. The advancement of interventional endoscopy has made a significant impact in the management of pancreatic cancers. Since the inception of endoscopic ultrasound, it has evolved over the last few decades in the management of pancreatic malignancies and its role in staging and tissue acquisition is well established. There is an emerging role of endoscopic ultrasound in the treatment and palliation of unresectable pancreatic cancer. The aim of this article is to review the role of endoscopic ultrasound in diagnostic and therapeutic interventions in the current era.

Breast cancer burden and its implications on the Nigerian Patient

The fact that breast cancer is the commonest female cancer worldwide is no longer news. The more intriguing information, however, is the increasing incidence of the disease in African populations that previously had low incidence rates. The rising incidence of breast cancer in Africa has been attributed to many factors acting synergistically including increasing life expectancy, decreasing fertility, lifestyle changes and environmental factors. Moreover, the peculiar epidemiological, demographic and clinical characteristics of the disease make it a matter of grave public concern. Added to these are the persisting challenges of treatment delays, inadequate management modalities, cost of care, and poor survival indices. In addition to discussing these issues, this presentation focuses on the social, economic and psychological burden of breast cancer on Nigerian women. Findings from a mixed method study on the social, economic, psychological impacts and quality of life of breast cancer at the surgical oncology division, University College Hospital, Ibadan, Nigeria revealed that most patients were artisans and petty traders, presented late, and were low-income earners. The average cost of care per patient amounted to US$11,600, of which 39% was spent on chemotherapy and 32% on quantifiable losses. The main sources of funding of care were family members and spouses supporting an assertion in a publication that ‘breast cancer in Nigeria is a family disease’. The psychological morbidities they experienced included loss of self-esteem, depression and sexual dis-satisfaction. Late presentation was significantly associated with worse self-esteem and quality of life parameters. Nine out of ten would rather not attend social functions because of their appearance. Depression was worsened by an unsupportive spouse while many experienced a lack of spousal advances post-diagnosis. However, married women had higher emotional function and a significantly better quality of life, while breast padding as camouflage post- mastectomy significantly enhanced their QoL and body image perception.

Initial Experience of Laparoscopic Distal Pancreatic Resections: A Single Institution Study with Fifteen Consecutive Cases

Objective: To review the initial experience of outcomes of a consecutive series of laparoscopic distal pancreatic resections are performed at a dedicated cancer hospital. Study Design: Case series. Place and Duration of Study: Department of Surgical Oncology at Tertiary Care Hospital, from Mar 2013 to Feb 2021. Methodology: A retrospective review of consecutive series of patients in which distal laparoscopic pancreatic resections were performed. Data was collected through the Hospital information system (HIS), an electronic hospital database. All patients were discussed in a multidisciplinary team prior to surgery. Results: Fifteen patients, including 4(26.6%) males with a mean age of 49.27±15.2, were planned for laparoscopic distal pancreatectomy. Pathologically, 12(80%) tumours were malignant, while three were benign. The procedure was converted to open in 3 patients. The mean operating time was 4.6±0.57 hours, with an estimated blood loss of around 183±28. 8mls.Mean hospital stay was 5.3±1.5 days. One patient developed a Grade A pancreatic fistula. Recurrence in the liver occurred in two patients, which was managed by systemic adjuvant therapy. However, one of them died later on because of sepsis. Conclusion: A laparoscopic distal pancreatectomy is a safe approach for distal pancreatic tumours, with minimal complications and fast recovery in appropriate cases.

Comparative evaluation of different types of gastric conduits used for single-stage reconstruction during oesophageal cancer esophagectomy. Review

In the treatment of local and local‑regional oesophageal cancer, esophagectomy takes centre stage. It is a complex procedure with a high rate of postoperative complications. There are different methods for oesophageal reconstruction, including colon interposition, supercharged jejunal interposition, and gastric pull‑up. Each has both advantages and disadvantages. However, a gastric graft is the preferred option due to the less traumatic nature of the operation. Currently, there are different methods for forming a gastric graft. Gastric conduits are classified based on their shape and can be categorised as whole‑stomach, sub‑total stomach, or gastric tube. Previous research on the functional characteristics of gastric conduits revealed that the most effective solution is a typical gastric tube. Due to its width (3—6 cm), the gastric tube limits its impact on lung movement within the pleural cavity, hence decreasing the incidence of postoperative respiratory complications (e.g., pneumonia). Pulmonary complications and anastomotic leaks are the main contributing causes of postoperative morbidity and mortality after esophagectomy. Other complications include technical and functional issues, as well as delayed problems such as anastomotic strictures and disease recurrence. However, the rate of complications remains between 20 and 80%, prompting oncologic surgeons to develop new methods for gastric conduit formation. Over the past 5 years, innovative methods using a special‑shaped gastric tube have been suggested. They appear to decrease the incidence of postoperative complications and enhance nutritional outcomes. This study aimed to evaluate the advantages of using special‑shaped gastric tubes in clinical practice as opposed to whole‑stomach and typical gastric tubes.