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Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat. Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic. Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A—March 23, 2020–May 22, 2020) and pre-COVID time period (group B—January 1 to January 31, 2020). Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study. Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.

The pandemic of COVID-19 across the globe triggered national lockdowns hampering normal working for all the essential services including healthcare. In order to reduce transmission and safety of patients and healthcare workers, the elective surgeries have been differed. The visits to the hospitals for follow-ups and consultations received temporary halt. However, we cannot halt the treatment for cancer patients who may or may not be COVID-19 positives. These are emergencies and should be treated ASAP. Conducting emergency surgeries during pandemic like COVID-19 is challenge for surgeons and the entire hospital infrastructure. The available information about COVID-19 and its propensity of contamination through droplets and aerosol need some modifications for conducting surgeries successfully without contaminating the hospital buildings, protecting healthcare teams and the patient. With these objectives, some modifications in the operating theater including surgical techniques for minimal access, laparoscopy, and robotic surgery are proposed in this review article. This review article also discusses the safety measures to be followed for the suspected or confirmed COVID-19 patient and the guidelines and recommendations for healthcare teams while treating these patients. Although there is little evidence of viral transmission through laparoscopic or open approaches, modifications to surgical practice such as the use of safe smoke evacuation and minimizing energy device used to reduce the risk of exposure to aerosolized particles to healthcare team are proposed in this review article.

Despite minimally invasive neck dissection (MIND) being popular technique, there is a paucity of literature emphasizing its safety and efficacy. In this meta-analysis, we compared the efficacy and safety of MIND over CND techniques in treating oral/head and neck cancer. We systematically searched PubMed, MEDLINE, Embase, from database inception to January, 2019 for the relevant studies comparing MIND and CND. Two independent reviewers performed quality check and data were extracted for primary outcomes to assess length of hospital stay, duration of surgery, intraoperative blood loss and retrieved lymph nodes. Drainage volume and duration, length of incision, satisfaction of scar and safety were the secondary outcomes. We analyzed the outcomes using standard mean differences (SMDs) and the relative risk that were pooled using random effect meta-analysis. Out of 144 studies, 17 met the final inclusion criteria. MIND technique has shown better overall efficacy with outcomes compared to CND except with duration of surgery (SMD 1.82, 95% CI 0.47-3.17). Lesser hospital stay, better nodal yield and less intra-operative blood loss was observed with MIND over CND. Duration and volume of wound drainage was comparably less in MIND with smaller length of incision. Postoperative complications were less and tolerable with MIND approach with superior cosmetic outcomes. MIND via endoscopic or robotic approach is safe and efficacious with equitable oncological outcomes in terms of lymph nodes yield compared to CND, but it requires longer surgery duration.

Background: Video endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive technique that gives superior surgical outcomes than open inguinal lymphadenectomy (IL) for treating lymph node ...

To evaluate the feasibility and safety of robotic-assisted breast-axillo insufflation thyroidectomy (RABIT) for differentiated thyroid cancer. In this retrospective case series, patients with differentiated thyroid carcinoma were enrolled in our hospital from January 2018 to December 2018. All patients underwent indirect laryngoscopy to assess the status of vocal cord preoperatively. RABIT was performed with five separate breast-axillo incisions. All the procedures were performed using da Vinci Xi Robotic Surgical System, a single docking method using CO2 insufflation. Twelve patients completed RABIT, in which one case needed conversion to open thyroidectomy. The mean age was 30.25 ± 7 with male to female ratio being 1:1. Preoperative diagnosis showed papillary carcinoma (n = 9) and follicular neoplasm (n = 3). The mean operative time for RABIT was 140 ± 50.45 min and average blood loss during surgery was 22.92 ± 9 mL. Mean hospital stay was 4.42 ± 1.08 days. Final pathology confirmed classical papillary thyroid carcinoma (n = 10; 83.3%) and follicular variant of papillary carcinoma (n = 2; 16.7%). None of the cases reported injury or paralysis to the recurrent laryngeal nerves. RABIT is a safe and feasible approach for thyroidectomy. It has several advantages in that it provides similar symmetrical view to conventional open surgery and enables to maintain specimen integrity and use of assistant port permits better handling of the gland. Additionally, the largest operating angles with this technique prevent collision between the robotic arms and provide excellent cosmetic satisfaction due to very small, five separate breast-axillo incisions.

Primary giant cell tumour (GCT) originating from the sternum is rare. We report a case of painless slow growing sternal GCT in a 28-year-old man. Computed tomography showed a destructive lesion of the sternal body. Total sternectomy and reconstruction with polypropylene mesh and methyl methacrylate were performed. The tumour was 16 × 13 × 12 cm in size, and the histopathological examination confirmed GCT. Surgical resection of sternal GCT and appropriate reconstruction are important to minimize local recurrence and maintain good functional and aesthetic outcome.

Neck dissection leaves behind an aesthetically unacceptable scar over front of the neck. Various techniques, both endoscopic and robotic, have been tried to avoid this scar. Though comparatively more cases of robotic surgery are reported than endoscopic neck dissection, the cost and availability of robot precludes many patients from getting the benefit of minimally invasive neck dissection (MIND). We performed minimally invasive neck dissection for two carefully selected patients with early oral cancer and cN0. We used standard endoscopic equipment and ubiquitously available laparoscopic ports. We used gas insufflation to create the working space. Our results show that MIND is feasible and oncologically safe. The scars produced are aesthetically better than that of conventional open neck dissection. This procedure leaves no scars in the anterior aspect of the neck. This technique can be replicated at any center with endoscopic equipments without need for purchasing specialised retractors or a robot.

Single nucleotide polymorphisms (SNPs) in the 3′-UTR region are emerging cis-regulatory factors associated with the occurrences of several human diseases. SH3GL2, which is located at chromosome 9p21-22, is associated with hyperplastic/mildly dysplastic lesions of the head and neck and has a long 3′-UTR with multiple SNPs. The aim of the present study was to determine the susceptible allele(s) in the 3′-UTR SNPs of SH3GL2 in head and neck squamous cell carcinoma (HNSCC). First, we screened the genotypes of all SNPs located in the 3′-UTR of SH3GL2 in 110 controls and 147 cases in Indian populations by sequencing. A SNP (rs1049430:>G/T) that showed only heterozygosity was further confirmed by genotyping with an Illumina GoldenGate platform in 530 controls and 764 cases. Genotype-specific survival analysis of the HNSCC patients was performed. In addition, genotype-specific mRNA stability, isoform expression and protein expression were analyzed. SNP rs1049430 was not associated with disease occurrence, but it was associated with poor patient outcome. The G allele was associated with decreased SH3GL2 mRNA stability, differential splicing and low protein expression. Thus, our data demonstrate that the presence of the susceptible G allele in SNP rs1049430 is associated with the inactivation of SH3GL2 and could be used as a prognostic marker of HNSCC.

Sarcomatoid carcinomas are biphasic tumours, which occur at any site in the human body. It rarely affects the penis, with only 38 cases being reported in literature. It may be considered as a variant of squamous cell carcinoma or a dedifferentiated tumour. We report a 60-year old gentleman who presented with a swelling in the glans penis. He underwent a partial penectomy. Histopathology revealed sarcomatoid carcinoma of the penis, which was confirmed by immunohistochemistry. The rarity of this clinical entity makes its diagnosis difficult.

Kidney is considered to be the fifth most common site of metastases of esophageal carcinoma. Most of the metastatic renal tumors are bilateral, but a unilateral renal metastasis is extremely rare. There are only ten cases of unilateral renal metastases after curative treatment reported in literature. Herein is reported, a case of solitary, unilateral renal metastasis in a case of carcinoma esophagus after definitive chemoradiation treatment.

The number of lymph node retrieved in the surgical specimen is important for tumor staging and has paramount impact on prognosis in colorectal cancer and imitates the adequacy of lymph node surgical clearance. The paucity of lymph node yields in patients undergoing resection after preoperative chemo radiotherapy (CRT) in rectal cancer has seen. Lower total number of lymph nodes in the total mesoractal excision (TME) specimen after CRT, could a marker of better tumor response.We retrospectively reviewed the prospectively managed data of patients underwent excision for rectal cancer, who treated by neoadjuvant radiotherapy with or without chemotherapy in locally advanced rectal cancer. From 2010 to 2014, 364 patients underwent rectal cancer surgery, of which ninety-one treated with neoadjuvant treatment. Standard surgical and pathological protocols were followed. Patients were categorized into two groups based on the number of total harvested lymph nodes with group 1, having 12 or more nodes harvested, and group 2 including patients who had12 lymph nodes harvested. The total number of lymph nodes retrieved from the surgical specimen was correlated with grade of tumor regression with neoadjuvant treatment.Out of 91 patients, 38 patients (42%) had less than 12 lymph nodes examined in specimen. The difference in median number of lymph nodes was observed significantly as 9 (range, 2-11) versus 16 (range, 12-32), in group 2 and 1, respectively (P0.01). Patients with fewer lymph node group were comparable with respect to age, BMI, pre-operative staging, neoadjuvant treatment. Pathological complete response in tumor pCR was seen with significantly higher rate (40%Retrieval of fewer than 12 lymph nodes in surgical specimen of rectal cancer who had received neo-adjuvant radiotherapy with or without chemotherapy should be considered as a good indicator of tumor response with better local disease control, and a good prognostic factor, rather than as a pointer of poor diligence of the surgical and pathological assessment.

The print quality in digital printer like Epson Sty lus Pro 7900 is influenced by the various printing parameters and among these dot shape, screen resolution and paper are considered t o be the major. The study conducted here was to eva luate the print quality in terms of the maximum number of color that it can re produce on two different printing substrates at dif ferent dot shapes and resolutions by maintaining other printing parameter s constant. Linearization and profiling of the Eps on stylus Pro 7900 printer for all these combinations were completed using IT8.7-3 CMYK standard test target using Harlequin RIP V8.3 software. Then the color gamut volumes are analyzed using Taguchi’s Design oexperiments in Mini Tab software. This is done to evaluate the significant parameter that has a major influence on the color g amut. From the result obtained in the project it wa s concluded that change in the dot shapes and resolutions have less influence on t he color gamut than the substrate’s surface propert y. The glossy effect of the Epson proofing commercial 187 GSM paper has shown a signi ficant change in the color gamut in comparison with the other paper properties and printing attributes. There are diffe rent paper substrates available which are mainly ma de for use in ink jet printer and since these digital devices are widely used for pro ofing and by photographers, it is better to take si milar type of study to know the print quality on different paper substrates and mak ing a profile for each paper is a must for achievin g a consistent print in more economic way.

Objective: Robot-assisted neck dissection requires a larger wound, is expensive and requires specialised equipment which is not easily available. We have developed an inexpensive minimally invasive neck dissection (MIND) procedure using simple endoscopic instruments in the past. This study was conducted to evaluate the safety, efficacy and reproducibility of the technique. Materials and Methods: From January 2013 to December 2016, we performed MIND on 45 patients with oral cancer using the standard endoscopic equipment. CO2 gas insufflation was used to create the working space. Intra-operative data, post-operative data and pathological characteristics were evaluated and overall survival (OS) and disease-free survival (DFS) Kaplan–Meier curves were compared using the Log-Rank test. Results: Median operative time was 130 (80–190) min with a mean blood loss of 63 (20–150) ml. Major intra-operative complications were not observed. The median number of nodes retrieved was 14 (range: 7–38). Three patients with a positive lymph node were advised to undergo adjuvant radiotherapy. After consultation, 12 out of 13 tongue cancer patients with a tumour depth >3 mm underwent adjuvant radiotherapy. Mean follow-up period was 31.5 (95% confidence interval [CI] 27.9–35.1) months and 27.8 (95% CI 23.6–32.1) months for OS and DFS, respectively. Four (8.9%) deaths and 8 (17.8%) recurrences were observed. The 3-year OS and DFS was 91.1% and 82.2%, respectively. Conclusion: MIND is aesthetically better than conventional procedures for oral cancer patients due to its safety, efficacy and reproducibility at any centre using the standard laparoscopic equipment.

Polyorchidism is a rare congenital anomaly. Approximately 100 cases have been published to date. We report a case of triorchidism in a 20-year-old man who presented to us with inguinal hernia. There is more than 30% incidence of histological abnormalities in polyorchid testes and 4-7% present with malignancy. The management of polyorchidism is controversial. Some authors prefer conservative approach to increase the chances of spermatogenesis and others suggest excision to prevent malignancy. In our case, a biopsy of the testes was performed and was found to be normal. This patient was placed on follow-up with regular self examination, six monthly clinical examination and yearly scrotal sonogram.

Internal jugular vein duplication (IJVD) is a rare phenomenon. Twenty-one such instances in 18 individuals have been reported to date. We report an intra-operative case of unilateral IJVD in a 32-year-old male, who was operated for cancer of gingivobuccal sulcus. We have reviewed the published literature and have proposed a classification scheme in order to make future reporting systematic. The condition has been classified into type A, B and C based on their morphology. About 75 % of the reported cases are of Type A. Type C is the most complex of all the duplications. Though IJVD is physiologically inconsequential, it has clinical implications. Percutaneous catheterisation of the vein could be hazardous in all cases, but more so in type B and C duplications. As with any anomaly, the risk of accidental injury increases during surgical procedures. It is important to document findings of this anomaly in order to understand its anatomy and implications in a better way.

Invasion of thyroid gland (TG) by laryngeal cancer is rare. However, ipsilateral hemithyroidectomy is routinely performed during total laryngectomy (TL) for laryngeal cancers. Even hemithyroidectomies are associated with hypothyroidism in 23–63% and hypoparathyroidism in 25–52%. Most of the studies on laryngectomy have advised thyroidectomy for T3 and T4 lesion, transglottic growth, subglottic disease or extension and involvement of anterior commissure. The role of tumour differentiation in TG invasion is unknown. The cases with TG invasion have been reported to have poorer prognosis. This is a retrospective study of 45 patients undergoing thyroidectomy along with TL. Of these, five had TG invasion. Extra-laryngeal soft tissue involvement [RR 1.89 (1.02, 4.24)] and transglottic growths [RR 1.18 (1.02, 1.36)] had a significant association with TG invasion. The mode of spread, contiguous or non-contiguous, depended on tumour differentiation. Well differentiated cancers had propensity for contiguous spread and moderately differentiated cancers for non-contiguous spread (p = 0.05). The 5 years survival of T4a cases was 30%. The difference in survival between TG invasion (p = 0.618), cartilage invasion (p = 0.111) and soft tissue infiltration (p = 0.474) was statistically insignificant. Anatomically direct TG invasion can only occur through extralaryngeal soft tissue which is includes cricopharyngeus and cricothyroid muscles. We recommend thyroidectomy only when these muscles are involved by the tumour in case of well differentiated cancers. The probability of TG invasion increases with transglottic growths with subglottic extension more than 10 mm. We recommend ipsilateral hemithyroidectomy in less differentiated cancers as they have propensity for non-contiguous spread.

Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%.This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region.Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n = 148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n = 148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively.The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India.

Background: Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years. Methods: From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients. Results: There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group. Conclusions: The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option. doi:10.4021/wjon2010.02.191w

The worldwide incidence of colorectal cancer has increased rapidly in the past few decades and dietary habits have been implicated in the cause. Though the Indian diet varies substantially from western diet, there have not been detailed studies on any association.This is hospital based case control study enrolling 108 cases and 324 controls, all hailing from the Malabar region of Kerala, India. The subjects were interviewed using food frequency questionnaires for commonly consumed dietary items in the region.A strong association was found between colorectal cancer and tapioca (OR= 2.7 p= 0.001), beef (OR= 4.25, p= 0.000) and pungent spices (OR= 9.62, p= 0.018). Fruits and vegetables a showed strong inverse association (OR= 0.15 p= 0.002). Fish consumption on a daily basis showed a 25% reduction in risk on univariate analysis. Heavy consumption of sugar (OR= 2.80) and tobacco use (OR= 8.79) showed significant high risk.There is strong evidence from our study that intake of beef, refined carbohydrates and tobacco can promote colorectal cancer. Our study has also thrown light on some of the other commonly consumed items, like tapioca and spices, which have positive associations. These are commonly consumed in Malabar region of Kerala. A cohort study is now needed to confirm our findings.