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Sinukumar S, Kammar P, Ray M, Shaikh S, Patel A, Rajan F, Srinivasan A, Damodaran D, Mehta S, Mahajan V, Deo SVS, Bhatt A. Long-Term Survival in Patients Treated by Cytoreductive Surgery with or Without HIPEC for Peritoneal Surface Malignancies-A report from the Indian HIPEC Registry. Indian J Surg Oncol 2023; 14:198-208. [PMID: 37359912 PMCID: PMC10284732 DOI: 10.1007/s13193-023-01727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/24/2023] [Indexed: 03/28/2023] Open
Abstract
A previous report from the Indian HIPEC registry showed acceptable early survival and morbidity in patients undergoing cytoreductive surgery (CRS) + / - hyperthermic intraperitoneal chemotherapy (HIPEC). The goal of this retrospective study was to evaluate the long-term outcomes in these patients. Three hundred seventy-four patients treated from December 2010 to December 2016 and enrolled in the Indian HIPEC registry were included. All patients had completed 5 years from the date of surgery. The 1-, 3-, 5- and 7-year progression-free (PFS) and overall survival (OS) and factors affecting these were evaluated. The histology was epithelial ovarian cancer in 209 (46.5%), pseudomyxoma peritonei (PMP) in 65 (17.3%) and colorectal cancer in 46 (12.9%) patients. The peritoneal cancer index (PCI) was ≥ 15 in 160 (42.8%). A completeness of cytoreduction (CC) score of 0/1 resection was obtained in 83% (CC-0-65%; CC-1-18%). HIPEC was performed in 59.2%. At a median, follow-up of 77 months (6-120 months), 243 (64.9%) patients developed recurrence, and 236 (63%) died of any cause; 138 (36.9%) were lost to follow-up. The median OS was 56 months (95% CI 53.42-61.07), and the median PFS was 28 months (95% CI 37.5-44.4). The 1-, 3-, 5- and 7-year OS was 97.6%, 63%, 37.7% and 24% respectively. The 1-, 3-, 5- and 7-year PFS was 84.8%, 36.5%, 27.3% and 22% respectively. The use of HIPEC (p = 0.03) and PMP of appendiceal origin (p = 0.01) was independent predictors of a longer OS. CRS + / - /HIPEC may achieve long-term survival in patients with PM from different primary sites in the Indian scenario. More prospective studies are needed to confirm these findings and identify factors influencing long-term survival. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01727-7.
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Affiliation(s)
| | - Praveen Kammar
- Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Mukurdipi Ray
- Dept. of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sakina Shaikh
- Dept. of Surgical Oncology, Zydus Hospital, Thaltej, Ahmedabad, 380054 India
| | - Ankita Patel
- Dept. of Surgical Oncology, Zydus Hospital, Thaltej, Ahmedabad, 380054 India
| | - Firoz Rajan
- Dept. of Surgical Oncology, Kovai Medical Centre, Coimbatore, India
| | | | | | - Sanket Mehta
- Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Vikas Mahajan
- Dept. of Surgical Oncology, Apollo Hospital, Chennai, India
| | | | - Aditi Bhatt
- Dept. of Surgical Oncology, Zydus Hospital, Thaltej, Ahmedabad, 380054 India
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Mercier F, Passot G, Bonnot PE, Cashin P, Ceelen W, Decullier E, Villeneuve L, Walter T, Levine EA, Glehen O, Baik SH, Baratti D, Bhatt A, De Hingh I, De Simone M, Dubé P, Edwards RP, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman MP, Hsieh MC, Kecmanovic D, Lee KW, Lehmann K, Liu Y, Mehta S, Morris DL, O’Dwyer S, Orsenigo E, Pande PK, Park EJ, Pingpank JF, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Tentes AAK, Teo M, Yarema R, Younan R, Zaveri SS, Zeh HJ, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Ferron G, Kianmanesh R, Dico RL, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F. An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 2022; 46:1336-1343. [PMID: 35286418 DOI: 10.1007/s00268-022-06498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry. METHODS A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed. RESULTS The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications. CONCLUSION CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.
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Affiliation(s)
- Frederic Mercier
- Department of Surgical Oncology, CHU Montreal, University of Montreal, 1000 St-Denis, Montreal, QC, H2X 0C1, Canada. .,The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
| | - Guillaume Passot
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | | | - Peter Cashin
- Department of Surgery, Akademiska Sjukhuset, Uppsala University Hospital, Uppasala, Sweden
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Gent University Hospital, Ghent, Belgium
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Laurent Villeneuve
- EMR 37-38, Lyon 1 University, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Thomas Walter
- Department of Gastroenterology and Oncology, Hospices Civils de Lyon, Edouard Herriot Hospital University of Lyon, Lyon, France
| | - Edward A Levine
- Section of Surgical Oncology, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Olivier Glehen
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
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Lurvink R, Villeneuve L, Govaerts K, de Hingh I, Moran B, Deraco M, Van der Speeten K, Glehen O, Kepenekian V, Kusamura S, Alyami MS, André T, Barrios-Sanchez P, Baumgartner JM, Bhatt A, Ben-Yaacov A, Bertulli R, Braess J, Burger JW, Cascales-Campos P, Cashin P, Cecil, P T, Ceelen WP, Creemers GJ, Cortes-Guiral D, Dayal S, De Simone M, Di Bartolomeo M, Dube P, Flatmark K, Foster JM, Goere D, Gonzales-Bayon L, Heriot A, Hewett PJ, Hsieh MC, Hubner M, Kok N, Larsen SG, Lehmann K, Li Y, Loggie BW, Lutton N, Ly J, Lynch C, Lyra M, Mehta S, Mohamed F, Morris DL, Nissan A, Nowacki MS, Pande PK, Park EJ, Peron J, Perry DJ, Pietrantonio F, Piso P, Pocard M, Quadros C, Rajan F, Rau B, Reymond MA, Thuss-Patience P, Sardi A, Sideris L, Sinn M, Sokmen S, Somashekhar SP, Spiliotis JD, Sugarbaker PH, Syk I, Tentes AA, Teo M, Turaga KK, Valle M, Verwaal VJ, Wilson MS, Yarema RR, Yonemura Y, Yu Y. The Delphi and GRADE methodology used in the PSOGI 2018 consensus statement on Pseudomyxoma Peritonei and Peritoneal Mesothelioma. European Journal of Surgical Oncology 2021; 47:4-10. [PMID: 30954350 DOI: 10.1016/j.ejso.2019.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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Sinukumar S, Rajan F, Mehta S, Damodaran D, Zaveri S, Kammar P, Bhatt A. A comparison of outcomes following total and selective peritonectomy performed at the time of interval cytoreductive surgery for advanced serous epithelial ovarian, fallopian tube and primary peritoneal cancer - A study by INDEPSO. Eur J Surg Oncol 2021; 47:75-81. [PMID: 30857879 DOI: 10.1016/j.ejso.2019.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare clinical outcomes following total and selective peritonectomy performed during interval cytoreductive surgery (CRS) for stage IIIC/IVA serous epithelial ovarian cancer. METHODS In this retrospective study, extent of peritonectomy was classified as total parietal peritonectomy (TPP) which comprised of removal of the entire parietal peritoneum and the greater and lesser omenta or selective parietal peritonectomy (SPP) that included 1/>1 of parietal peritonectomies performed to resect sites of residual disease. A comparison of patient and disease characteristics, morbidity, mortality and survival outcomes between the two groups was made. RESULTS From January 2013 to December 2017, 79 patients underwent CRS (TPP-30, SPP-49) with or without intraperitoneal chemotherapy (IPC). The median PCI was 14 for TPP and 8 for SPP. The 90-day grade 3-4 morbidity (23.3% for TPP, 14.2% for SPP, p = 0.58) the 90-day mortality was similar (p = 0.58). The median disease free survival (DFS) was 37 months for SPP and 33 months for TPP (p = 0.47) and median overall survival (OS) not reached for both. The 3-year OS was 95% for TPP and 70.8% for SPP (p = 0.06). The only independent predictor of OS was grade 3-4 morbidity (p = 0.01) and not TPP (p = 0.09). Microscopic residual disease was seen in 23.3% with normal looking peritoneum in TPP group. CONCLUSIONS TPP was not associated with increased morbidity compared to SPP. There was a trend towards a longer OS in the TPP group and the finding of residual disease in 'normal looking' peritoneum' warrants prospective evaluation of the benefit of TPP in this setting.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/mortality
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/surgery
- Cytoreduction Surgical Procedures
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Fallopian Tube Neoplasms/surgery
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Peritoneal Neoplasms/surgery
- Postoperative Complications
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Pune, India
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Center, Coimbatore, India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR Cancer Centre and Research Institute, Calicut, India
| | | | - Praveen Kammar
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India.
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Kushvaha S, Mehta S, Rajan F, R S, Renganathan R. All the lumps are primarily not from breast-report of a metastatic breast lump in a cervical cancer survivor. Breast J 2020; 26:1622-1624. [PMID: 32383230 DOI: 10.1111/tbj.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Firoz Rajan
- Kovai Medical Center & Hospital, Coimbatore, India
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Bhatt A, Sinukumar S, Rajan F, Damodaran D, Ray M, Zaveri S, Kammar P, Mehta S. Impact of Radicality Versus Timing of Surgery in Patients with Advanced Ovarian Cancer (Stage III C) Undergoing CRS and HIPEC-a Retrospective Study by INDEPSO. Indian J Surg Oncol 2019; 10:57-64. [PMID: 30886495 DOI: 10.1007/s13193-019-00875-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023] Open
Abstract
HIPEC in addition to interval CRS has shown a survival benefit of 12 months compared to CRS alone. However, there are many controversial issues pertaining to CRS itself which should be addressed first. To compare NACT and primary CRS approaches when CRS is categorized according to the extent of resection. To evaluate the feasibility of performing HIPEC at these two time points. A retrospective analysis of patients with stage III C ovarian cancer undergoing primary and interval CRS + HIPEC was performed. The surgical approach for interval CRS was classified as (1) resection of sites of residual disease alone or (2) resection of sites involved before NACT. The morphological response was divided into different categories, and surgeons had to state what they consider residual disease and what they do not. From January 2013 to December 2017, 54 patients were included (18-primary; 36-interval). Median PCI 11 vs 6.5 (p = 0.07); CC-0 was obtained in 77.7%. Three surgeons resected previously involved sites; three sites of residual disease only. All surgeons resected areas of scarring. Twenty percent patients had residual disease in "normal-looking" peritoneum. Morbidity (p = 0.09), median OS (p = 0.71), and median DFS (p = 0.54) were similar in the two groups. Early recurrence occurred in 50% with resection of residual disease alone compared to 16.6% when previous disease sites were resected (p = 0.07). Interval CRS should be performed to resect sites involved prior to NACT and not just sites of residual disease. HIPEC can be performed in both primary/interval settings with acceptable morbidity.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Zydus hospital road, SG highway, Thaltej, Ahmedabad, 380054 India
| | - Snita Sinukumar
- 2Department of Surgical Oncology, Jehangir hospital, Pune, India
| | - Firoz Rajan
- 3Department of Surgical Oncology, Kovai Medical center, Coimbatore, India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR Cancer Centre and Research Institute, Calicut, India
| | - Mukurdipi Ray
- 5Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shabber Zaveri
- 6Department of Surgical Oncology, Manipal Hospitals, Bangalore, India
| | - Praveen Kammar
- 7Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Sanket Mehta
- 7Department of Surgical Oncology, Saifee Hospital, Mumbai, India
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Muthusamy R, Mehta S, Rajan F, P. S. S. Dedifferentiated Liposarcoma of the Retroperitoneum With Hyperleukocytosis as Paraneoplastic Syndrome: A Rare Presentation. MAMC J Med Sci 2019. [DOI: 10.4103/mamcjms.mamcjms_8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bhatt A, Mehta SS, Zaveri S, Rajan F, Ray M, Sethna K, Katdare N, Patel MD, Kammar P, Prabhu R, Sinukumar S, Mishra S, Rangarajan B, Rangole A, Damodaran D, Penumadu P, Ganesh M, Peedicayil A, Raj H, Seshadri R. Treading the beaten path with old and new obstacles: a report from the Indian HIPEC registry. Int J Hyperthermia 2018; 35:361-369. [PMID: 30300029 DOI: 10.1080/02656736.2018.1503345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Indian HIPEC registry is a self-funded registry instituted by a group of Indian surgeons for patients with peritoneal metastases (PM) undergoing surgical treatment. This work was performed to • Evaluate outcomes of cytoreductive surgery ± HIPEC in patients enrolled in the registry. • Identify operational problems. METHODS A retrospective analysis of patients enrolled in the registry from March 2016 to September 2017 was performed. An online survey was performed to study the surgeons' attitudes and existing practices pertaining to the registry and identify operational problems. RESULTS During the study period, 332 patients were enrolled in 8 participating centres. The common indication was ovarian cancer for three centres and pseudomyxoma peritonei for three others. The median PCI ranged from 3 to 23. A CC-0/1 resection was obtained in 94.7%. There was no significant difference in the morbidity (p = .25) and mortality (p = .19) rates between different centres. There was a high rate of failure-to-rescue (19.3%) patients with complications and the survival in patients with colorectal PM was inferior. A lack of dedicated personnel for data collection and entry was the main reason for only 10/43 surgeons contributing data. The other problem was the lack of complete electronic medical record systems at all centres. CONCLUSIONS These results validate existing practices and identify country-specific problems that need to be addressed. Despite operational problems, the registry is an invaluable tool for audit and research. It shows the feasibility of fruitful collaboration between surgeons in the absence of any regulatory body or funding for the project.
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Affiliation(s)
- Aditi Bhatt
- a Department of Surgical Oncology , Fortis Hospital , Bangalore , India
| | - Sanket S Mehta
- b Department of Peritoneal surface oncology , Saifee Hospital , Mumbai , India
| | - Shabber Zaveri
- c Department of Surgical Oncology , Manipal Hospital , Bangalore , India
| | - Firoz Rajan
- d Department of Surgical Oncology , Kovai Medical Center , Coimbatore , India
| | - Mukurdipi Ray
- e Department of Surgical Oncology , All India Institute of Medical Sciences , New Delhi , India
| | - Kayomarz Sethna
- f Department of Surgery , Lokmanya Tilak Municipal medical college and general hospital , Mumbai , India
| | - Ninad Katdare
- g Department of Surgical Oncology , SL Raheja hospital , Mumbai , India
| | - Mahesh D Patel
- h Department of Surgical Oncology , Zydus Hospital , Ahmedabad , India
| | - Praveen Kammar
- i Department of Surgical Oncology , Global hospitals , Hyderabad , India
| | - Robin Prabhu
- a Department of Surgical Oncology , Fortis Hospital , Bangalore , India
| | - Snita Sinukumar
- j Department of Surgical oncology , Jehangir Hospital , Pune , India
| | - Suniti Mishra
- k Department of Pathology , Fortis Hospital , Bangalore , India
| | - Bharath Rangarajan
- l Department of Medical oncology , Kovai Medical center , Coimbatore , India
| | - Ashvin Rangole
- m Department of Surgical oncology , CHL, CBCC cancer center , Indore , India
| | - Dileep Damodaran
- n Department of Surgical oncology , MVR cancer center and research Institute , Calicut , India
| | - Prasanth Penumadu
- o Department of Surgical oncology , Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Mandakulutur Ganesh
- p Department of Surgical Oncology , Vaidehi Institute of Medical sciences , Bangalore , India
| | - Abraham Peedicayil
- q Department of Gynecologic Oncology , Christian Medical College , Vellore , India
| | - Hemant Raj
- r Department of Surgical Oncology , Cancer Institute (WIA) , Chennai , India
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Amblard I, Mercier F, Bartlett D, Ahrendt S, Lee K, Zeh H, Levine E, Baratti D, Deraco M, Piso P, Morris D, Rau B, Tentes A, Tuech JJ, Quenet F, Akaishi E, Pocard M, Yonemura Y, Lorimier G, Delroeux D, Villeneuve L, Glehen O, Passot G, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Kianmanesh R, Lo Dico R, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F, Ahrendt S, Akaishi E, Baik S, Baratti D, Bhatt A, Cachin P, Ceelen W, De Hingh I, De Simone M, Dubé P, Edwards R, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman M, Hsieh MC, Kecmanovic D, Lee K, Lehmann K, Liu Y, Mehta S, Morris D, O'Dwyer S, Orsevigo E, Pande P, Park E, Pingpank J, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Sugarbaker P, Tentes A, Teo M, Yarema R, Younan R, Zaveri S, Zeh H. Cytoreductive surgery and HIPEC improve survival compared to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups. Eur J Surg Oncol 2018; 44:1378-1383. [PMID: 30131104 DOI: 10.1016/j.ejso.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022] Open
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Bhatt A, Mehta S, Pande P, Rajan F, Rangole A, Saklani A, Sethna K, Singh S, Zaveri S, Gopinath KS. Setting up of the Indian HIPEC Registry: A Registry for Indian Patients with Peritoneal Surface Malignancies. Indian J Surg Oncol 2017; 8:527-532. [PMID: 29203985 DOI: 10.1007/s13193-017-0693-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
There are various registries for patients with peritoneal metastases (PM) that aid pooling of data and generate evidence that dictates current clinical practice. This manuscript describes the setting up of the Indian HIPEC registry that was set up with a similar goal by a group of Indian surgeons. This is a registry for patients with PM treated with CRS and HIPEC in India. It also acts as a database for storing treatment-related information. Patients with PM from colorectal ovarian, gastric, appendiceal tumors, and other rare peritoneal tumors/metastases from rare tumors are enrolled in the registry. A coordinator updates the disease status of patients on a yearly basis. A private organization maintains the database. A non-disclosure agreement is signed between the company and each surgeon contributing to the registry to maintain confidentiality. For enrolling patients, securing institutional permission depends on the requirement of each institute; patient consent is mandatory. Data entry can be prospective or retrospective. To propose and conduct a study, the approval of a scientific committee linked to the registry is required. The Indian HIPEC registry is a practical database for Indian surgeons. There is no regulatory body that mandates collection and publication of scientific data in India. The onus is on each surgeon to capture valuable information pertaining to these common and rare diseases that could contribute to the existing scientific knowledge and guide the treatment of these patients in the future. The next challenge will be to enter data into the registry.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Fortis Hospital, 154/9 Bannerghatta road, Opposite IIM-B, Bangalore, 560076 India
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Bhatt A, Mehta S, Seshadri RA, Sethna K, Zaveri S, Rajan F, Mahajan V, Singh S, Raj EH, Sugarbaker PH. The Initial Indian Experience with Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases. Indian J Surg Oncol 2016; 7:160-5. [PMID: 27065706 DOI: 10.1007/s13193-016-0500-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022] Open
Abstract
Worldwide, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for nearly 3 decades to treat peritoneal metastases (PM), improve quality of life, and prolong survival substantially in selected patients. In India, the use of the combined modality of treatment dates back a decade with majority of the efforts taking place within the last 5 years. The first PSOGI workshop (India) held in April 2015, at Bangalore, India offered an opportunity for Indian surgeons performing CRS and HIPEC to share their experience. To study the methodologies of CRS and HIPEC (hospital set up, equipment, training and surgical background) as well as the outcomes in terms of perioperative morbidity and mortality and short and long term survival of patients treated in India, Indian surgeons who had treated at least 10 patients with this combined modality were invited to present their experience. Data collection was retrospective. Analysis of the pooled data was carried out. Eight surgeons treated 384 patients with CRS and HIPEC over a period of 10 years. The commonest primary sites were ovary (as first line therapy n = 124), followed by appendix, including pseudomyxoma peritonei (n = 99), colorectum (n = 77), recurrent ovary (as second line therapy, n = 33), stomach (n = 15), primary peritoneal cancer (n = 10), peritoneal mesothelioma (n = 9) and rare tumors in 17 patients. The weighted mean PCI for all 384 patients was 18.25. 349/384 patients (90.88 %) had a complete cytoreduction (completeness of cytoreduction score of CC-0/1). Grade 3-5 complications developed in 108 patients (27.34 %) and 30 day mortality occurred in 28 (7.29 %) patients. This study showed that CRS and HIPEC can be performed with an acceptable morbidity and mortality in Indian patients. Most of the surgeons are on the learning curve and further improvement in these outcomes is expected over a period of time. Pooling of data related to both common and rare peritoneal cancers would be useful in knowing the disease behavior, response to treatment and outcomes in Indian patients. The 2015 PSOGI meeting provided a unique platform for data presentation with feedback from international experts in the field of peritoneal surface oncology. Future meetings are planned to expand the evaluation of Indian data and progress.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Fortis Hospital, 154/9 Bannerghatta road, Opposite IIM-Bangalore, Bangalore, -560076 India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | | | - Kayomarz Sethna
- Department of General Sugery, Sion Hospital Mumbai, Mumbai, India
| | - Shabber Zaveri
- Department of Surgical Oncology, Manipal Hospital, Bangalore, India
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Centre, Coimbatore, India
| | - Vikas Mahajan
- Department of Surgical Oncology, Apollo Hospital, Chennai, India
| | - Shivendra Singh
- Department of GI Oncology, Rajiv Gandhi Cancer Centre, New Delhi, India
| | - E Hemanth Raj
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Paul H Sugarbaker
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
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Kamaleshwaran K, Rajan F, Mohanan V, Shinto A. Intraosseous malignant peripheral nerve sheath tumor of distal femur detected with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging. J Mahatma Gandhi Inst Med Sci 2016. [DOI: 10.4103/0971-9903.189533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kamaleshwaran K, Natarajan S, Rajan F, Mohanan V, Shinto A. Image findings of rare case of gestational breast cancer diagnosed in a lactating women with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography. J Mahatma Gandhi Inst Med Sci 2016. [DOI: 10.4103/0971-9903.178110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kamaleshwaran KK, Rajan F, Mohanan V, Shinto AS. Rare case of axillary lymph node metastasis in papillary thyroid carcinoma detected using Iodine-131 whole-body scintigraphy and single-photon emission computed tomography/computed tomography. Indian J Nucl Med 2015; 30:168-70. [PMID: 25829741 PMCID: PMC4379682 DOI: 10.4103/0972-3919.152985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Differentiated thyroid cancer is, usually, associated with an excellent prognosis and indolent course. Distant metastases are rare events at the onset of thyroid cancer. Among these presentations, metastasis to the axillary lymph nodes is even more unusual. Only few cases of papillary carcinoma with axillary nodal metastasis were previously reported in the literature. We present a 38-year-old female who underwent Iodine-131 whole-body scintigraphy, after total thyroidectomy and bilateral neck lymph node dissection for papillary carcinoma of thyroid, showed intense uptake in the remnant thyroid, lung metastasis, left cervical and left axillary lymph nodes. Excision of left axillary lymph nodes confirmed metastatic papillary carcinoma.
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Affiliation(s)
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Vyshak Mohanan
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
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Kamaleshwaran KK, Rajan F, Asokumar P, Mohanan V, Shinto AS. Mediastinal ectopic benign colloid goitre detected using iodine-131 whole body scintigraphy and single-photon emission computed tomography-computed tomography. Indian J Nucl Med 2015; 30:180-2. [PMID: 25829745 PMCID: PMC4379686 DOI: 10.4103/0972-3919.152989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ectopic thyroid tissue primarily occurs along the course of the embryologic migration of the thyroid gland. Mediastinal thyroid may be differentiated into primary and secondary form. Primary mediastinal goiters are quite rare, occurring in <1% of all goiters. We present findings of 29-year-old female, case of papillary carcinoma of the thyroid who underwent iodine-131 whole body scintigraphy after total thyroidectomy showed a primary mediastinal mass lesion along with residual thyroid. She underwent mediastinal mass excision through sternotomy and biopsy confirmed as ectopic nodular colloid goiter with no malignancy.
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Affiliation(s)
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | | | - Vyshak Mohanan
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
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Kamaleshwaran KK, Rajan F, Mehta S, Mohanan V, Shinto AS. Multiple pulmonary sclerosing hemangiomas (pneumocytoma) mimicking lung metastasis detected in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2014; 29:168-70. [PMID: 25210285 PMCID: PMC4157193 DOI: 10.4103/0972-3919.136578] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pulmonary sclerosing hemangioma (PSH), or the alternative name of “sclerosing pneumocytoma,” is a rare benign neoplasm. PSH is often asymptomatic and presents as a solitary or multiple pulmonary nodules on radiologic imaging studies. Few articles have been reported to describe the fluorodeoxyglucose positron emission tomography (FDG PET) findings about PSH. The authors describe an interesting but uncommonly encountered cause of false positive FDG PET scan in the thorax in a 25-year-old woman, a known case of arteriovenous malformation of oral cavity who underwent embolization and presented with incidental detection of bilateral lung nodules. She is asymptomatic and is on follow-up.
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Affiliation(s)
- Koramadai Karuppusamy Kamaleshwaran
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Firoz Rajan
- Department of Surgical Oncology, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Sangita Mehta
- Department of Pathology, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Vyshakh Mohanan
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
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Rennie CA, Chowdhury S, Khan J, Rajan F, Jordan K, Lamb RJ, Vivian AJ. The prevalence and associated features of posterior embryotoxon in the general ophthalmic clinic. Eye (Lond) 2005; 19:396-9. [PMID: 15309023 DOI: 10.1038/sj.eye.6701508] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To estimate the prevalence of posterior embryotoxon (PE) in the general ophthalmic clinic and to identify any features of PE that suggest that it is pathological rather than physiological. METHODS Over 700 consecutive patients of all ages were examined with the slit lamp during their routine eye clinic appointment. Patients with posterior embryotoxon were invited to return for full ocular examination including keratometry, corneal topography, and gonioscopy. RESULTS In all, 49 out of 723 patients were found to have PE. This gives a prevalence of 6.8% with an age range of 18 months to 95 years. There was a higher prevalence in the younger age group of 22.5% (age range 18 months to 20 years) compared to 5.9% in the older age range (21-95 years). A total of 29 patients with PE returned for further examination. Six patients had glaucoma (two with Axenfeld's syndrome and one with aniridia), and one had ocular hypertension. In all, 20 patients had bilateral PE on slit-lamp examination, which increased to 24 with gonioscopy. The majority of the PE was seen temporally (97.9%) and limited to a few clock hours. Gonioscopy showed that eight patients with PE had associated inferior pigmentation of schwalbes line. CONCLUSION This large series found the prevalence of PE the general ophthalmic clinic to be 6.8%. Its presence should prompt careful anterior segment examination, including gonioscopy, to identify any associated abnormalities that may carry a risk of glaucoma. Children should also be assessed for any associated systemic or genetic abnormality.
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Affiliation(s)
- C A Rennie
- Department of Ophthalmology, West Suffolk Hospital, Bury St Edmunds, Suffolk IP33 2QZ, UK
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