Morbidity and Outcome of Pelvic Exenteration in Locally Advanced Pelvic Malignancies

Pelvic exenteration is a technically demanding surgical procedure performed for locally advanced cancers in the pelvis. Aim of the present study was to analyze morbidity, failure pattern and survival after pelvic exenteration during a period of 15 years in a dedicated cancer centre in South India. Retrospective analysis of case records of 50 patients who underwent pelvic exenteration from 1996 to 2011 in the Department of Surgical Oncology, Government Royapettah Hospital Chennai. Forty-six patients were females and 4 were males with a mean age of 48.3 years (range 21–72). Twenty six patients had cervical cancer,14 had rectal cancer, 3 had bladder cancer,2 had endometrial cancer, 2 had vaginal cancer, 1 had uterine sarcoma, 1 had anal cancer and 1 had ovarian cancer. The postoperative morbidity was 50%. 7 patients (14%) developed recurrence of which 5 had local and 2 had distant recurrence. The estimated 5 year overall survival for all patients in our series was 53.5% and for the patients with Ca rectum and Ca cervix was 60.6% and 40.1% respectively. Adjacent organ invasion had a significant impact over survival. Pelvic exenteration provides a curative form of treatment for carefully selected locally advanced cancer in the pelvis and it can be done safely with acceptable complications in centers experienced in multivisceral resections

Recurrence Patterns and Management Options in Aggressive Fibromatosis

Aggressive fibromatosis is a rare neoplasm arising from musculoaponeurotic structures. Our aim is to share our experience with this rare tumor in our institute and to discuss the more perplexing recurrence patterns and the management options. This is a retrospective study of the disease, treated in our institute for the past fourteen years. A total of 36 patients were analyzed. The demographic pattern of the disease, various treatment modalities offered and their outcome along with patterns of recurrence were studied. Our study showed a demographic pattern mostly similar to the rest of the world. But the pattern of recurrence and the multicentric and the non-random pattern of presentation observed in our study showed some difference from the other studies. We suggest surgery as the primary modality with radiation reserved for select patients with margin positivity, inoperable tumors, and multiple tumors. Since the disease has a long natural history a wait and watch policy can be observed for giving adjuvant RT. There is need for prospective multi-institutional RCTs to shed light on the unknown facts about this disease

Approach to Carcinoma Cervix with Pelvic Kidney

To study the management of carcinoma cervix when the patient has an associated pelvic kidney. The simultaneous occurrence of carcinoma cervix and pelvic kidney is rare. It is an interesting scenario where surgery is technically challenging and radiation is difficult since the pelvic kidney lies within the field of radiation. In our department, we treated three cases of cervical carcinoma with pelvic kidney. First case was FIGO IIB treated with external beam radiotherapy followed by radical hysterectomy; second case stage IB1 treated with radical hysterectomy, third case was referred to us after panhysterectomy with carcinoma detected in postoperative histopathological report, and she was treated with external beam radiotherapy. We made an online database search and found few case reports of gynecological malignancies associated with pelvic kidney and reviewed their management. All the three patients are alive and disease free in the last follow up. None of the patients developed uremia. The pelvic kidney of the patients treated with radiotherapy has shrunken in size. Surgery is preferred over radiotherapy in early stages of carcinoma cervix with pelvic kidney to avoid radiation-induced damage to pelvic kidney

Defining the T status in breast cancer: Where do we stand?

Background: Tumor size in breast cancer is a key factor for staging, prognosticating, and deciding the choice of treatment. Currently, there are no standard rules for measuring the T status in breast cancer. The purpose of this study was to determine an accurate method to evaluate the T status by various parameters compared with the actual size in fresh specimens. Materials and Methods: This prospective study was conducted on 134 breast cancer patients scheduled to undergo a modified radical mastectomy. The paired t-test was used for analyses. Results: Using a paired t-test, the differences in tumor size as measured by physical examination (P ≤ 0.001) and in the formalin-fixed specimen (P ≤ 0.001) when compared with the postoperative fresh specimen were highly significant. These differences indicated that the physical examination and formalin-fixed specimen measurements were inaccurate in estimating tumor size. Tumor size, as measured by a mammogram and ultrasonogram when compared with the referenced P= 0.077 and 0.149, respectively, showed that the ultrasonogram is the most accurate method of determining tumor size in vivo. The mean percentage decrease in size of the formalin-fixed specimen was 7.8, which was significant enough to downstage two patients from T2 to T1 and seven patients from T3 to T2. Conclusion: An ultrasonogram is the most accurate way of defining tumor size in vivo as measured in postoperative fresh specimens. Tumor shrinkage with formalin fixation may give a false T status

Primary malignancy of seminal vesicle: A rare entity

We report a rare case of seminal vesicle malignancy (primitive neuro ectodermal tumor) in a 40-year-old male patient. He was treated with enbloc resection of the tumor and ureteric reimplantation. In view of the rarity of this entity, management of these tumors should be individualized

Treatment Outcome of Carcinoma Vulva Ten-Year Experience from a Tertiary Cancer Centre in South India

Background. Carcinoma vulva is a rare disease accounting for 1.3% of all gynaecological malignancies. The present study is a 10-year retrospective review of our experience of the surgical options, morbidity, failure pattern, and survival for invasive carcinoma vulva. Materials and Methods. Retrospective analysis of case records of 39 patients who underwent surgery for invasive vulval cancer between 2004 and 2013 in the Department of Surgical Oncology at the Government Royapettah Hospital, Chennai. Results. The median age was 55 years. Radical vulvectomy was the preferred surgery. 31 patients underwent lymphadenectomy. Seroma formation and groin skin necrosis were the most common postoperative complications. With a median follow-up of 32 months, 8 patients (20.5%) developed recurrence (systemic = 1, regional = 4, and local = 3). The estimated 5-year disease-free survival (DFS) was 65.4% and the overall survival (OS) was 85.1%. On univariate analysis, stage and lymph node involvement significantly affected OS. Nodal involvement with extracapsular spread (ECS) significantly affected both DFS and OS. Conclusion. The treatment of carcinoma vulva should be individualized with multidisciplinary cooperation. The paucity of data, especially from India, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence