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Midha N, Arjunan R, Althaf S, Chinduri S, Sugoor P. Total robotic anterior resection with intracorporeal anastomosis under fluorescence navigation - a video vignette. Colorectal Dis 2024; 26:817-818. [PMID: 38369961 DOI: 10.1111/codi.16902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Nishtha Midha
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Syed Althaf
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Srinivas Chinduri
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
| | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology Ringgold Standard Institution, Bangalore, India
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Nishtha, Arjunan R, Althaf S, Srinivas C, Sugoor P. Kidwai technique of laparoscopic complete splenic flexure mobilization-A video vignette. Colorectal Dis 2024; 26:811-812. [PMID: 38326701 DOI: 10.1111/codi.16894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/01/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Nishtha
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Syed Althaf
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | | | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Jhunjhunwala A, Sugoor P, Arjunan R, Altshaf S, Chunduri S. Standardized robotic intersphincteric resection-A Video Vignette. Colorectal Dis 2024; 26:809-810. [PMID: 38326700 DOI: 10.1111/codi.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Affiliation(s)
| | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Syed Altshaf
- Kidwai Memorial Institute of Oncology, Bangalore, India
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Midha N, Althaf S, Sugoor P. Fluorescence-Guided Selective Autonomic Nerve Preserving Robotic Total Mesorectal Excision: Redefining Technology and Techniques. Dis Colon Rectum 2024:00003453-990000000-00610. [PMID: 38498776 DOI: 10.1097/dcr.0000000000003236] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Nishtha Midha
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Bharadwaj G, Arjunan R, Althaf S, C S, Sugoor P. Robotic complete splenic flexure mobilization: a standardized step by step approach - a video vignette. Colorectal Dis 2024; 26:576-578. [PMID: 38297392 DOI: 10.1111/codi.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Guru Bharadwaj
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Syed Althaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Srinivas C
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Nishtha, Arjunan R, Althaf S, Chinduri S, Sugoor P. Robotic complete mesocolic excision with central vascular ligation: Superior mesenteric vein (SMV) first approach. Colorectal Dis 2024; 26:205-207. [PMID: 38010164 DOI: 10.1111/codi.16806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Nishtha
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ravi Arjunan
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Syed Althaf
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | | | - Pavan Sugoor
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Halkud R, Krishnappa R, Chavan P, Siddappa KT, Shetty R, Pallavi VR, Rathod P, Shobha K, Sabitha KS. Outcomes of Cancer Surgery During the COVID-19 Pandemic: Preparedness to Practising Continuous Cancer Care. Indian J Surg Oncol 2023; 14:440-444. [PMID: 33100778 PMCID: PMC7569097 DOI: 10.1007/s13193-020-01250-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has placed unprecedented pressure on healthcare services. Deprioritisation of nonemergency clinical services and growing concerns of adverse outcomes of COVID-19 in cancer patients is having a deleterious impact across oncologic practice. We report cancer surgery outcomes taking into account the acuity of the COVID-19 situation. A prospectively maintained database of the Department of Surgical Oncology was analysed from 1st May to 30th June, 2020, to evaluate the perioperative outcomes, morbidity and mortality following major surgical procedures. A total of 359, preoperatively, tested negative for COVID-19 underwent surgery. Median age was 52 years with 26.7% (n = 96) above the age of 60 years. Sixty-one percent (n = 219) patients were American Society of Anaesthesiology grades II-III. As per surgical complexity grading, 36.8% (n = 132) cases were lower grades (I-III) and 63.2% (n = 227) were complex surgeries (IV-VI). 5.3% (n = 19) had ≥ grade III Clavien-Dindo complication, and the postoperative mortality rate was 0.27% (n = 1). Major complication rates in patients > 60 years were 9.3% in comparison to 4.1% in < 60 years (p = 0·63). The median hospital stay was 1-10 days across subspecialties. Postoperatively, repeat COVID 19 testing in 2 suspected patients were negative. Our study showed that after screening, triaging and prioritisation, asymptomatic cases may undergo cancer surgeries without increased morbidity during COVID-19 pandemic.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Rajshekar Halkud
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - R. Krishnappa
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Purushotham Chavan
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. T. Siddappa
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Rathan Shetty
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - V. R. Pallavi
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - Praveen Rathod
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. Shobha
- Department of Gynec-oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
| | - K. S. Sabitha
- Department of Oral Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, 560029 India
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Somashekhar SP, Saklani A, Dixit J, Kothari J, Nayak S, Sudheer OV, Dabas S, Goud J, Munikrishnan V, Sugoor P, Penumadu P, Ramachandra C, Mehendale S, Dahiya A. Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer. Front Oncol 2022; 12:1002530. [PMID: 36267970 PMCID: PMC9577482 DOI: 10.3389/fonc.2022.1002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There are standard treatment guidelines for the surgical management of rectal cancer, that are advocated by recognized physician societies. But, owing to disparities in access and affordability of various treatment options, there remains an unmet need for personalizing these international guidelines to Indian settings. Methods Clinical Robotic Surgery Association (CRSA) set up the Indian rectal cancer expert group, with a pre-defined selection criterion and comprised of the leading surgical oncologists and gastrointestinal surgeons managing rectal cancer in India. Following the constitution of the expert Group, members identified three areas of focus and 12 clinical questions. A thorough review of the literature was performed, and the evidence was graded as per the levels of evidence by Oxford Centre for Evidence-Based Medicine. The consensus was built using the modified Delphi methodology of consensus development. A consensus statement was accepted only if ≥75% of the experts were in agreement. Results Using the results of the review of the literature and experts’ opinions; the expert group members drafted and agreed on the final consensus statements, and these were classified as “strong or weak”, based on the GRADE framework. Conclusion The expert group adapted international guidelines for the surgical management of localized and locally advanced rectal cancer to Indian settings. It will be vital to disseminate these to the wider surgical oncologists and gastrointestinal surgeons’ community in India.
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Affiliation(s)
- S. P. Somashekhar
- Department of Surgical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
- *Correspondence: S. P. Somashekhar,
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jagannath Dixit
- Department of GI Surgery, HCG Hospital, Bengaluru, Karnataka, India
| | - Jagdish Kothari
- Department of Surgical Oncology HCG Hospital, Ahmedabad, Gujarat, India
| | - Sandeep Nayak
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - O. V. Sudheer
- Department of GI Surgery and Surgical Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - Surender Dabas
- Department of Surgical Oncology, BL Kapur-Max Superspeciality Hospital, Delhi, India
| | - Jagadishwar Goud
- Department of Surgical Oncology, AOI Hospital, Hyderabad, Telangana, India
| | | | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - C. Ramachandra
- Director and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Shilpa Mehendale
- Director and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Akhil Dahiya
- Department of Clinical and Medical Affairs, Intuitive Surgical, California, CA, United States
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Desouza AL, Kazi M, Verma K, Sugoor P, Mahendra BK, Saklani AP. Local recurrence with intersphincteric resection in adverse histology rectal cancers. A retrospective study with competing risk analysis. ANZ J Surg 2021; 91:2475-2481. [PMID: 34427027 DOI: 10.1111/ans.17155] [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: 06/17/2021] [Revised: 07/16/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The safety of inter-sphincteric resection (ISR) for low rectal cancer with adverse histologic subtypes has been incompletely studied. The present study aims at determining the risk of local recurrence with this procedure in poorly differentiated and signet ring cell (PDSR) adenocarcinoma. METHODS Retrospective analysis from a single tertiary cancer centre of non-metastatic primary rectal cancer <6 cm from the anal verge that underwent ISR. Competing risk analysis and sub-distribution hazard ratios for local recurrence free survivals were calculated to determine factors that influenced local recurrence with the competing risk of death from any cause to overcome the exceeding risk of distant metastasis associated with adverse histologic types. RESULTS One hundred forty-two patients underwent ISR and 22.6% has PDSR histology. At a median follow up of 61 months, 15.6% of the PDSR cohort developed local recurrence (five patients) compared to 11.7% in the non-PDSR group. PDSR histology influenced overall and disease free survival but not local recurrence on cox regression. On competing risk analysis, only ypT stage ≥3 predicted worse local recurrence free survival and not histology. CONCLUSIONS The presence of PDSR histology did not increase the risk of local recurrence after ISR in this retrospective competing risk analysis.
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Affiliation(s)
- Ashwin L Desouza
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Kamlesh Verma
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Pavan Sugoor
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Balu K Mahendra
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Avanish P Saklani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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Kumar NA, Sasi SP, Shinde RS, Verma K, Sugoor P, Desouza A, Engineer R, Saklani A. Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer. JSLS 2021; 24:JSLS.2020.00026. [PMID: 32714002 PMCID: PMC7347395 DOI: 10.4293/jsls.2020.00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/18/2022] Open
Abstract
Background: Minimally invasive surgery (MIS) for pelvic exenteration is not a well-established technique. The aim was to assess the safety and feasibility of MIS for pelvic exenteration in locally advanced primary colorectal cancer and to compare the perioperative outcomes with open surgery. Methods: This is a retrospective analysis of patients, who had undergone pelvic exenteration for primary colorectal adenocarcinoma from May 2013 to July 2018. The short-term outcomes like perioperative details and histopathological characteristics were compared between the two groups. Results: MIS was performed in 23 patients and open pelvic exenteration was carried out in 72 patients. The mean operative time was significantly more in the MIS group (640 vs. 432 min, p = 0.00). The intraoperative blood loss (900 vs. 1550 ml, p = 0.00) and the requirement for blood transfusion (170 vs. 250 ml, p = 0.03) was significantly less in the MIS group. The overall morbidity (60% vs. 49%, p = 0.306) was comparable between the two groups. The median length of hospital stay in the MIS group was 11 d, compared to 12 d in the open surgery group, (p = 0.634). The rate of R0 resection (87% vs. 89%, p = 0.668) was comparable between the two groups. Conclusion: MIS is feasible and safe for total pelvic exenteration and posterior exenteration in carefully selected locally advanced primary colorectal cancer, when performed by an experienced surgical team in high volume centers. An R0 resection with adequate margin can be achieved with good perioperative outcomes in MIS. Long-term oncological outcomes would require further follow up to confirm.
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Affiliation(s)
- Naveena An Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education
| | - Sajith P Sasi
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajesh S Shinde
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kamlesh Verma
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pavan Sugoor
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwin Desouza
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Reena Engineer
- Department Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Avanish Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Patil V, Kumar H, Beesanna G, Abhishek M. Robotic Complete Mesocolic Excision with Central Vascular Ligation for Right Colon Cancer: Surgical Technique and Short-term Outcomes. Indian J Surg Oncol 2020; 11:674-683. [PMID: 33281407 PMCID: PMC7714811 DOI: 10.1007/s13193-020-01181-9] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Minimally invasive colorectal surgery has demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. PURPOSE The study aims to present technical details and short-term oncological outcomes of robotic-assisted complete mesocolic excision (CME) with central vascular ligation (CVL) for right colon cancer. METHODOLOGY Fifty-two consecutive patients affected by right colon cancer were operated between May 2016 and February 2020 with da Vinci Xi platform. Data regarding surgical and short-term oncological outcomes were systematically collected in a colorectal specific database for statistical analysis. RESULTS Thirty-seven (71.15%) and 15 (28.85%) patients underwent right and extended right hemicoletomy with an extracorporeal anastomosis. Median age was 55 years. Mean operative time was 182 ± 36 min. Mean blood loss was 110 ± 90 ml. Conversion rate was 3.84% (two cases). 78.84% (41 cases) were pT3 and mean number of harvested lymph nodes was 28 ± 4. 1/52 (1.92%) had a documented anastomotic leak requiring exploratory laparotomy and diversion proximal ileostomy. Surgery-related grade IIIa-IIIb Calvien Dindo morbidity were noted in 9.61% and 1.92%, respectively. CONCLUSION Robotic assistance allows performance of oncological adequate dissection of the right colon with radical lymphadenectomy as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Vijay Patil
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Harish Kumar
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - G. Beesanna
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - M. Abhishek
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
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12
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Desouza A, Sugoor P, Sasi S, Rohila J, Saklani A. Robotic intersphincteric resection with right seminal vesicle excision via a right vascular approach using the Da Vinci Xi robotic system - a video vignette. Colorectal Dis 2019; 21:492-493. [PMID: 30687990 DOI: 10.1111/codi.14570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 01/12/2023]
Affiliation(s)
- A Desouza
- Division of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Mumbai, India
| | - P Sugoor
- Division of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Mumbai, India
| | - S Sasi
- Division of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Mumbai, India
| | - J Rohila
- Division of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Mumbai, India
| | - A Saklani
- Division of Gastrointestinal and HPB Surgery, Tata Memorial Centre, Mumbai, India
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13
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Pokharkar A, Kammar P, D'souza A, Bhamre R, Sugoor P, Saklani A. Laparoscopic Pelvic Exenteration for Locally Advanced Rectal Cancer, Technique and Short-Term Outcomes. J Laparoendosc Adv Surg Tech A 2018; 28:1489-1494. [DOI: 10.1089/lap.2018.0147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Praveen Kammar
- Colorectal Services, Tata Memorial Hospital, Mumbai, India
| | - Ashwin D'souza
- Colorectal Services, Tata Memorial Hospital, Mumbai, India
| | - Rahul Bhamre
- Colorectal Services, Tata Memorial Hospital, Mumbai, India
| | - Pavan Sugoor
- Colorectal Services, Tata Memorial Hospital, Mumbai, India
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14
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Saklani A, Sugoor P, Bhandare M, Jatal S, Desouza A, Ostwal V. Chemo-Radiation After Upfront Rectal Resections-a Clinical Dilemma. Indian J Surg Oncol 2018; 9:495-500. [PMID: 30538378 PMCID: PMC6265169 DOI: 10.1007/s13193-018-0805-z] [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: 12/20/2017] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
Abstract
To compare the impact of adjuvant chemo-radiotherapy (ACRT) versus adjuvant chemotherapy (ACT) alone on recurrence and survival in patients with stage II and III rectal adenocarcinoma undergoing upfront curative resection. Prospective observational review of colorectal database at Tata Memorial Hospital from July 2010 to March 2015 identified 84 patients who underwent upfront curative resection for stage II or III rectal cancer. None of the patient received preoperative chemo-radiation. Of these, adjuvant chemo-radiotherapy was administered to 29 patients (ACRT group) and 55 patients received CAPEOX/FOLFOX-based adjuvant chemotherapy (ACT group) alone. At a median follow-up of 20 months, there were 10 recurrences (3 local recurrence) in the ACRT group and 15 (2 local recurrence) in ACT group. The estimated disease-free survival at 3 years in the ACRT group was 62.7% and in ACT group was 49.7% (p = 0.417) with an estimated 3-year overall survival of 74 and 78% in the ACRT and ACT group, respectively (p = 0.241). Subgroup analysis was performed after risk stratifying prognostic features (pT4, pN2, poor differentiation, involved resection margin). Our study does not show any benefit of ACRT over ACT on local control, disease-free and overall survival after upfront rectal cancer resection for low-risk stage II-III. In the subgroup analysis, local recurrence did not occur in patients who did not have poor prognostic features irrespective whether they received ACRT or ACT. Adjuvant chemo-radiation can be avoided in low-risk stage II-III rectal cancer after upfront resection.
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Affiliation(s)
- A. Saklani
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - P. Sugoor
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - M. Bhandare
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - S. Jatal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - A. Desouza
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - V. Ostwal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
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15
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Kammar P, Verma K, Sugoor P, Saklani A. Complete robotic lateral pelvic node dissection using the da Vinci Xi platform in rectal cancer - a video vignette. Colorectal Dis 2018; 20:1053-1054. [PMID: 30194908 DOI: 10.1111/codi.14412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Kammar
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - K Verma
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - P Sugoor
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - A Saklani
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
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16
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Sugoor P, Verma K, Chaturvedi A, Kannan S, Desouza A, Ostwal V, Engineer R, Saklani A. Robotic versus laparoscopic sphincter-preserving total mesorectal excision: A propensity case-matched analysis. Int J Med Robot 2018; 15:e1965. [PMID: 30318725 DOI: 10.1002/rcs.1965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/23/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Robotic total mesorectal excision (R-TME) is expected to have advantages over laparoscopic total mesorectal excision (L-TME). The aim is to compare the short-term outcomes between initial cases of L-TME and RTME. MATERIALS AND METHODS Among a total of 168 patients assigned to receive either R-TME (n = 84) or L-TME (n = 84), short term outcomes were compared between the groups by 1:1 propensity score matching of eight variables. RESULTS The inter-sphincteric resection rate (42.9% vs. 25%; P = 0.006) and operative time (372.4 ± 102.8 vs. 301 ± 53.6, P = 0.000) were significantly greater in R-TME. The conversion rate, blood loss, and length of hospital stay were similar. The anastomotic leak rate and major surgical complications rates were significantly higher in L-TME (9.5% vs. 1.2%; P = 0.016) and (13.1% vs. 4.8%; P = 0.034) respectively. CONCLUSION The oncologic quality and short-term outcomes in the two groups were comparable; however, anastomotic leak rates and major complications were significantly lower in R-TME. For experienced laparoscopic surgeons, robotic sphincter-saving TME is associated with lower morbidity when compared with laparoscopic approach.
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Affiliation(s)
- Pavan Sugoor
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kamlesh Verma
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Aditi Chaturvedi
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sadhana Kannan
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ashwin Desouza
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vikas Ostwal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Reena Engineer
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Avanish Saklani
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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Saklani A, Sugoor P, Chaturvedi A, Bhamre R, Jatal S, Ostwal V, Engineer R. Clinical Utility of Staging Laparoscopy for Advanced Obstructing Rectal Adenocarcinoma: Emerging Tool. Indian J Surg Oncol 2018; 9:488-494. [PMID: 30538377 DOI: 10.1007/s13193-018-0803-1] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
The multimodal treatment for advanced rectal adenocarcinoma mandates accurate preoperative staging with contrast-enhanced computed tomography (CECT) of the thorax, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Unlike gastric cancer, the role of staging laparoscopy (SL) in advanced colorectal cancer has not been evaluated. This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of near or complete obstructing advanced RC. Medical records of 34% (94/274) who underwent SL with diversion stoma (DS) were analyzed. In the absence of ascites, extensive peritoneal deposits, and unresectable liver metastases on SL, a curative treatment was offered, which entailed neoadjuvant chemoradiation (NACTRT), whereas the cohort of patients with extensive peritoneal disease received palliative therapy. Of the 94 patients with advanced RC, conventional imaging studies staged 73.5% (69/94) cohort as non-metastatic locally advanced and 26.5% (25/94) had potentially resectable metastatic RC. Pre-therapeutic SL upstaged the disease by 26% (18/69) and 8% (2/25) in locally advanced and potentially resectable metastatic RC cohorts, respectively. Treatment decision changed in 21.2% (20/94) of the patients, and midline laparotomy was thus avoided. In our observational study, SL was found to be a safe and effective staging modality in RC; it detected occult peritoneal disease and prevented midline laparotomy in 21.2% of the cohort, which was of value to determine treatment strategy in patients with advanced RC before initiating NACTRT. SL and laparoscopic-assisted de-functioning stoma were associated with minimal morbidity and led to early initiation of NACTRT.
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Affiliation(s)
- Avanish Saklani
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - P Sugoor
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - A Chaturvedi
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - R Bhamre
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - S Jatal
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - V Ostwal
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India.,2Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R Engineer
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
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Kammar P, Bakshi G, Verma K, Sugoor P, Saklani A. Robotic total pelvic exenteration for locally advanced rectal cancer - a video vignette. Colorectal Dis 2018; 20:731. [PMID: 29777600 DOI: 10.1111/codi.14256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/02/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Kammar
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - G Bakshi
- Department of Urooncology, Tata Memorial Center, Mumbai, India
| | - K Verma
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - P Sugoor
- Colorectal Division, GI Services, Tata Memorial Center, Mumbai, India
| | - A Saklani
- Department of Surgical Oncology, Colorectal Division, GI services, Tata Memorial Center, E Borges Road, Parel, Mumbai, 400012, India
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Sugoor P, Gupta A, Patkar S, Rekhi B, Goel M. Sporadic Retroperitoneal Fibrosis: a Gentle Giant. Indian J Surg Oncol 2018; 9:71-73. [PMID: 29563740 DOI: 10.1007/s13193-017-0710-x] [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: 08/02/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022] Open
Abstract
Fibromatosis covers a broad spectrum of benign fibrous tissue proliferation and is characterized by slow growing, locally infiltrative growth pattern with a high propensity for local recurrence. We report on a case of multicentric fibromatosis originating from the retroperitoneal space and submandibular triangle, in an 18-year-old lady. Computed tomography revealed a retroperitoneal abdominopelvic tumor extending from the left sub-diaphragmatic space to the pelvic inlet which had enveloped the solid viscera in the left upper quadrant with a displaced celiac axis. She also had a recurrent resectable fibromatosis in left submandibular gland. Histopathological evaluation revealed fibromatosis. Preoperatively, Vinblastin-, Methotrexate-, Tamoxifen-based systemic chemotherapy was offered for 12 weeks in an attempt to downsize the mass. An en bloc complete resection of tumor with multi-visceral resection was performed to achieve negative margins and since then, the patient has remained asymptomatic without any signs of tumor recurrence during the 12th month follow-up visit. Complete resection with negative margins is the treatment of choice and majority of the lesions are amenable for surgical resections. Adjuvant therapy using non-steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for un-resectable or recurrent cases.
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Affiliation(s)
- Pavan Sugoor
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Amit Gupta
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Shraddha Patkar
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Bharat Rekhi
- 2Department of Pathology, Tata Memorial Center, Mumbai, Maharashtra 400012 India
| | - Mahesh Goel
- 1Department of Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra 400012 India.,3Gastrointestinal and HPB Surgery, Department of Surgical Oncology, Tata Memorial Center, Parel, Mumbai, 400012 India
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Bhamre R, Shinde R, Pokharkar A, Sugoor P, Saklani A. Robotic transabdominal intersphincteric resection and coloanal anastomosis with the da Vinci Xi System - a video vignette. Colorectal Dis 2018; 20:164-165. [PMID: 29165878 DOI: 10.1111/codi.13963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/03/2017] [Indexed: 01/19/2023]
Affiliation(s)
- R Bhamre
- Department of Surgery, Tata Memorial Hospital, Mumbai, India
| | - R Shinde
- Department of Surgery, Tata Memorial Hospital, Mumbai, India
| | - A Pokharkar
- Department of Surgery, Tata Memorial Hospital, Mumbai, India
| | - P Sugoor
- Department of Surgery, Tata Memorial Hospital, Mumbai, India
| | - A Saklani
- Department of Surgery, Tata Memorial Hospital, Mumbai, India
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21
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Sugoor P, Shah S, Dusane R, Desouza A, Goel M, Shrikhande SV. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg 2016; 401:687-97. [PMID: 27143021 DOI: 10.1007/s00423-016-1422-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 04/17/2015] [Accepted: 03/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The appropriate extent of gastric resection for patients with proximal third gastric cancer is controversial. This study addresses whether the choice of surgical strategy (proximal gastrectomy [PG] versus total gastrectomy [TG]) influences the outcomes for proximal third gastric adenocarcinoma. MATERIALS AND METHODS Review of prospective database at Tata Memorial Hospital from January 2010 to December 2012 identified 343 patients diagnosed and treated for gastric cancer. Of these, 75 underwent curative resections with D2 lymphadenectomy for proximal third gastric adenocarcinoma, which entailed proximal gastrectomy in 43 and total gastrectomy in 32 patients, depending on the epicenter of the primary and its relation with the mid-body of the stomach. Morbidity, lymph node yield, resection margins, patterns of recurrence, and survival were compared between these two groups. RESULTS 41/75 tumors were pT3 (23 cases [53.4 %] in the PG and 18 cases [56.3 %] in the TG group). Thirty-six patients [83.7 %] in PG and 29 patients [90.6 %] in TG group received neoadjuvant chemotherapy (NACT). There were no significant differences with regard to median blood loss, general complication rates and length of hospitalization between the two groups. The lymph node yield was comparable between the two procedures [PG = 14; TG = 15]. Positive proximal resection margin rates were comparable between the two groups [PG = 4.7 %; TG = 9.4 %], and there was no statistical difference observed in the distal resection margin positivity rates [PG = 4.7 %; TG = 3.1 %]. Regarding the patterns of recurrence, local recurrence in PG was 4.7 % and there was no local recurrence in the TG group (p = 0.08). Distant recurrence rates was dominant in TG [PG = 30.2 % versus TG = 53.1 %]. The overall 2-year survival following PG and TG was 73.8 and 49.9 %, respectively, and not statistically different (p = 0.10). CONCLUSIONS The extent of resection for proximal third gastric cancer does not influence the clinical outcome. PG and TG have similar survival rates. Both procedures can be accomplished safely. Therefore, PG should be an alternative to TG, even in locally advanced proximal gastric cancers treated by NACT, provided that the tumor size and location permit preservation of adequate remnant of stomach without compromising oncological resection margins. Future QOL studies would further lend credence to the concept of PG for proximal third gastric cancer.
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Affiliation(s)
- Pavan Sugoor
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Sanket Shah
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Rohit Dusane
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Ashwin Desouza
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Mahesh Goel
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Shailesh V Shrikhande
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India.
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Shankar R, Qureshi SS, Sugoor P, Kembhavi S, Yadav PS, Mukta R. Colossal squamous cell carcinoma of the face in a child with Xeroderma Pigmentosum. J Indian Assoc Pediatr Surg 2014; 19:185-6. [PMID: 25197203 PMCID: PMC4155642 DOI: 10.4103/0971-9261.136485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Raghu Shankar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India ; Department of Division of Pediatric Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sajid S Qureshi
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India ; Department of Division of Pediatric Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Pavan Sugoor
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prabha S Yadav
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India ; Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ramadwar Mukta
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
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