Ibrahim Fakhr | Cairo University (original) (raw)

Papers by Ibrahim Fakhr

Research paper thumbnail of P0050 Survival of children with rhabdomyosarcoma: Experience of the National Cancer Institute Egypt

European Journal of Cancer, May 1, 2014

Background: Survival rates of paediatric rhabdomyosarcoma have improved tremendously during the p... more Background: Survival rates of paediatric rhabdomyosarcoma have improved tremendously during the past decade by the development of risk stratification. This approach has favoured tailoring of treatment using multi-therapeutic modalities. Methods: Patients were given upfront surgical resection followed by systemic chemotherapy using the vincristine/actinomycin-D/ cyclophosphamide (VAC) regimen, with subsequent further local control by surgery or radiotherapy, or both, according to risk stratification into low, intermediate, and high risk groups. Findings: The study included 40 patients; their median age was 3.5 years (range: 8 months to 17 years), 28 were boys and 12 were girls. 2-year overall survival (OS) and event-free survival (EFS) were 87% and 45% respectively. After univariate analysis, OS was 100% for a complete response versus 92% for only partial response (p = 0.03). OS was 94% if there were no distant metastasis versus 66% if metastasis was present (p = 0.024). On the other hand, EFS was 88% for complete response versus 46% for partial response (p < 0.001), and was 80% if upfront surgery was done versus 33% if only simple biopsy was taken (p = 0.03). Local radiotherapy versus no radiotherapy was highly associated with EFS, with a difference of 75% versus 0%, respectively (p < 0.001). Interpretation: Complete response and extent of disease are two important factors influencing survival in childhood rhabdomyosarcoma. Both local control measures, surgical resection and radiation therapy, and treatment response are important variables predicting EFS. The poor outcome of patients with metastatic disease necessitates further therapeutic approaches to improve survival.

Research paper thumbnail of P009 Neobladder long term follow up

European Urology Supplements, Nov 1, 2013

Introduction & Objectives: The major shortcoming of standard routine pretreatment assessment of l... more Introduction & Objectives: The major shortcoming of standard routine pretreatment assessment of lymph node (LN) status following radical cystectomy (RC) is the lack of accuracy. The objective of the study was to assess whether pretreatment clinical parameters in combination with computed tomography (CT) can improve the prediction of lymph node metastasis in patients with bladder cancer (BC) treated with RC and pelvic limph node disection (PLND). Material & Methods: In a single-centre retrospective study, demographic and clinicopathological information of 213 patients with BC undergoing RC was reviewed. The following clinicopathological data were analysed: demographic, initial transurethral resection (grade, stage, multiplicity of tumours, lymphovascular invasion), hydronephrosis, abdominal and pelvic CT radiography (size of the tumor, tumor base width, size and number of LN), and presence of lymph node disease on final pathology. Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of positive LN. Various measures for the assessment of risk prediction models were determined such as: model fit, predictive ability (the area under the receiver operating characteristic [ROC] curve [AUC] and integrated discrimination improvement [IDI]) and clinical utility (net reclassification improvement [NRI]). Results: The median (range) number of removed lymph nodes was 13 (2-25) and 109 (51.2%) of patients undergoing PLND had positive lymph nodes on pathological examination. In a multivariable analysis, two risk factors most strongly associated with LN metastasis: status LN on CT [odds ratio (OR)=3.0], and hydronephrosis (OR=2.5). The resultant total possible score ranged from 0 to 22, with a cutoff value of >5 points. AUC was 0.818 (0.762-0.873), and IDI was 0.057, showing good discriminatory ability. The calibration was R 2 =0.82. NRI was 0.392, showing clinical utility. Conclusions: The pre-cystectomy model improved the prediction of lymph node status in patients with BC. Our model represented a user-friendly staging aid, but a large multi-center study should be performed before widespread implementation.

Research paper thumbnail of P0058 Preserving fertility in stage 1a ovarian carcinoma

European Journal of Cancer, May 1, 2014

Background: Adenocarcinoma of the colon is a common cancer and the annual incidence is increasing... more Background: Adenocarcinoma of the colon is a common cancer and the annual incidence is increasing. Treatment is essentially surgical, combined with adjuvant chemotherapy in advanced cases. Methods: This is a retrospective study of 100 patients with non-metastatic colon adenocarcinoma, treated at the gastroenterology and oncology centre in Ibn Rushd Hospital, Casablanca, over a period of 5 years from January, 2006, to January, 2010. Diagnosis was made after a histological study of biopsies taken during colonoscopy. Findings: One hundred patients were diagnosed with non-metastatic colon adenocarcinoma. The sex ratio was 3:2 (M:F), the average age was 52 years, and approximately 50% of patients were diagnosed after a period of 7 months from the appearance of their first symptoms of rectal bleeding events, melena, and dysentery syndrome. Histologically, non-metastatic colon adenocarcinoma is well-differentiated in 80% of cases. All patients were operated on. The distribution of patients by stage was: 61% classified as stage II, 30% stage III, and 9% stage I. Adjuvant chemotherapy FUFOL, FOLFOX IV, or capecitabine was given in 85% of patients and monitoring without adjuvant therapy in 15%. The immediate follow-up after completion of chemotherapy showed complete remission in 95% of patients and 5% were in disease progression. After a mean follow-up of 30 months, 71% were in remission. 18% had a local or metastatic recurrence treated by second line chemotherapy (FOLFIRI or XELIRI), with remission seen in three patients, stable disease in seven patients, and treatment failure in eight patients. Interpretation: The multidisciplinary approach to all stages of the process requires the involvement of various disciplines to give the patient the best quality of care.

Research paper thumbnail of Breast cancer laterality among Egyptian patients and its association with treatments and survival

Journal of the Egyptian National Cancer Institute, 2013

Background and aim: Breast cancers (BCs) involve the left side (LS) more than the right side (RS)... more Background and aim: Breast cancers (BCs) involve the left side (LS) more than the right side (RS). Among the Egyptians, neither BC laterality nor its association with demographic factors, tumor locations, treatments and outcomes were previously reported. Patients and methods: Laterality was analyzed among 5459 BCs from the Gharbiah populationbased cancer registry covering >5% of the Egyptian population. Cox proportional model was used to assess the independent effect of stage, ER, and laterality on overall survival (OS). Results: In Egypt, BCs involve LS more than RS with LS-to-RS ratio (LRR) of 1.16. LS predominance was evident among men and women and both younger (<45 years) and older patients. HER2 over-expression and ductal cancers were significantly more in RSBCs while lobular cancers were significantly more in LSBCs. There were no significant differences in localization within the breast between LSBCs and RSBCs (p = 0.51). LS predominance was noticed across all subgroups except in patients with HER2 positive tumors (LRR = 0.63; p = 0.02). OS was significantly better in stage II and ER positive tumors than stage III and ER negative tumors. Despite OS of LSBCs being generally lower than RSBCs, this was not statistically significant. The significant impact of stage on OS was lost in LSBCs. Conclusions: Among Egyptian patients, the left breast is at greater risk of cancer than the right one. Despite right-sided tumors seemed more aggressive, Left-sided ones tend to confer worse survival than right-sided tumors.

Research paper thumbnail of When would we advocate a total thyroidectomy in cases of hypopharyngeal carcinoma?

Journal of the Egyptian National Cancer Institute, 2014

Research paper thumbnail of Assessment of the Proliferative Marker Ki-67 and p53 Protein Expression in HBV- and HCV-related Hepatocellular Carcinoma Cases in Egypt

Chronic HBV and HCV infections are the major risk factors for the development of HCC through a mu... more Chronic HBV and HCV infections are the major risk factors for the development of HCC through a multistep pathway that involves viral and non-viral dependent pathophysiological steps. Hepatic expression of the nuclear proliferative marker ki-67 and the p53 oncoprotein were found to be associated with poor outcome. So, the present study was done to evaluate the changes in expression of Ki-67 and p53 oncoprotein, and to determine p53 gene mutation in HBV/HCV-related HCC Egyptian patients. Eight HBV-and 22 HCV-positive HCC cases have been examined for the presence of p53 mutation by immunohistochemistry (IHC) and single-strand conformation polymorphism (SSCP), followed by direct DNA sequencing. HCV were genotyped by LiPA-II. Our results have shown that the proliferative marker ki-67 LI and p53 were highly expressed and significantly related to tumor grade in the Egyptian HCC cases (p<0.05). Also, p53 mutation was found in 16 HCC cases by IHC and in 14 HCC cases by SSCP, only 11 patie...

Research paper thumbnail of Pelvic Exentration and Composite Sacral Resection in the Surgical Treatment of Locally Recurrent Rectal Cancer

Background: The incidence of rectal cancer recurrence after surgery is 5-45%. Extended Pelvic res... more Background: The incidence of rectal cancer recurrence after surgery is 5-45%. Extended Pelvic resection such as pelvic exentration and abdominosacral composite resection which entails En-bloc resection of the tumor and adjacent involved organs provide the only true possible curative option for patients with locally recurrent rectal cancer. The Aim of this Study: Is to evaluate the surgical and oncological outcome of such treatment. Patients and Methods: Between 2006 and 2012 a consecutive series of 40 patients with locally recurrent rectal cancer underwent abdominosacral resection (ASR) in 18 patients, total pelvic exentration with sacral resection in 10 patients and pelvic exentration in 12 patients. Patients with sacral resection were 28, with the level of sacral division at S2-3 interface in 10 patients, at S3-4 in 15 patients and S4-5 in 3 patients. Results: Forty patients, male to female ratio 1.7:1, mean age 45 years (range 25-65Y) underwent extended pelvic resection in the fo...

Research paper thumbnail of Laparoscopic Gastrectomy for Gastric Cancer: Early Experience

The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric ... more The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric cancer and to explore the possibility, safety, usefullness of laparoscopy and its role in the management of patients with gastric malignancies. Nine patients with mean age 49.1± 9.4 years (range 34-62 years) presented for laparoscopic gastrectomy. Six patients presented with gastric adenocarcinoma, two patients with gastrointestinal stromal tumor (GIST) and one case of gastric lymphoma were operated upon with laparoscopy in the National Cancer Institute (2003-2007). The study group consisted of seven patients as two (22%) patients were found to be metastatic at laparoscopic exploration.. The mean operative time was 225.7± 29.9 minutes (range190-270), with no intra-operative complications. Postoperative periods to starting oral feeding, and discharge were 6.8±1.4 days (range 5-9 days) and 10.7±3.9 days (range 7-18 days) respectively. There was no post-operative mortality and only one case...

Research paper thumbnail of Delayed Cystectomy for T 1 G 3 Transitional Cell Carcinoma ( TCC ) of the Urinary Bladder , NCI Retrospective Case Series

Aim: We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome re... more Aim: We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regarding recurrence, progression and survival in patients with T1G3 urinary bladder transitional cell carcinoma. Patients and Methods: In a retrospective study, between January 2001 and December 2007, all 34 patients with T1G3 bladder transitional cell carcinoma (TCC), after complete transurethral resection (TURBT), received intravesical BCG as adjuvant therapy. A conservative approach was adopted, whereby those with superficial recurrences were eligible to TURBT, with delayed cystectomy for progression to muscle invasion. Overall, recurrence, and progression-free survival were analyzed. Results: Thirty-three patients were included, 29 were males and 4 were females. The mean age was 61 years (range 35-89 years). Final analysis was made at median follow-up of 15 months (Range of 3-68 months, mean 18 months) for survival. Eleven (33.3%) patients had multifocal tumors. Associated schistosomi...

Research paper thumbnail of Gastrointestinal stromal tumor (GIST)'s surgical treatment, NCI experience

PURPOSE To review the clinical presentation, surgical management, and prognostic factors for gast... more PURPOSE To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors. PATIENTS AND METHODS A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months. RESULTS Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4%), palpable mass (33.3%) and abdominal pain (24.3%). The stomach was the most common site of origin of the disease (39.4%), followed by the colorectal region (24.2%). Tumors were high grade in 63.6% of patients and low-grade in 36.4% of patients. Complete resection of all gross disease was accomplished in 26 patients ...

Research paper thumbnail of Cytoreductive surgery for advanced epithelial tumors of the ovary: technical considerations and outcome

Journal of the Egyptian National Cancer Institute, 2005

PURPOSE To study the role of cytoreductive surgery in the management of advanced epithelial tumor... more PURPOSE To study the role of cytoreductive surgery in the management of advanced epithelial tumors of the ovary and its effect on survival. PATIENTS AND METHODS A prospective study of fifty eight female patients presenting with stage III and VI epithelial ovarian tumors attending the National Cancer Institute, Cairo University during the period from January 2003 to of December 2004. All patients were evaluated clinically, radiologically (including plain chest-X-ray and abdomino-pelvic ultrasound and/or CT), laboratory work up and CA-125. Abdominal exploration under general anesthesia with intent of maximum surgical cytoreduction was performed for all patients. Patients were followed up during the period of the study by history and physical examination, CA-125 measurement and abdomino-pelvic ultrasound or CT. RESULTS Our study included 58 female patients with advanced epithelial tumors of the ovary. Their age ranged from 18 to 73 years with a mean age of 49 years. Pathological distri...

Research paper thumbnail of The role of surgical management in pediatric germ cell tumors (GCTs), NCI case series

Journal of the Egyptian National Cancer Institute, Mar 1, 2008

To review the experience of a tertiary referral center in pediatric germ cell tumors (GCTs) in th... more To review the experience of a tertiary referral center in pediatric germ cell tumors (GCTs) in the last 8 years and to investigate the impact of surgery and site of disease on prognosis. We retrospectively analyzed the cases of pediatric germ cell tumors at National Cancer Institute over an 8 years period. Data concerning diagnosis, surgery and medical decisions were reviewed and analyzed for all patients. A total of 34 children with (GCTS) were found, with a mean age, at presentation, of 6.7 years and a follow-up period ranging from 3-52 months. One patient with benign GCT was excluded during analysis of the results. Among the 34 patients, there were 14 males and 20 females with mean age of 6.7 years (range: 9 months-15 years), with male to female ratio 1:1.4. All patients were symptomatic at presentation, most commonly with abdominal swelling (18 patients; 52.9%). Anatomic distribution of GCTs according to sex organ involvement was either gonadal in 21 patients (61.8%) or extragonadal in 13 patients (38.2%). All patients had surgery either in the form of curative resection or biopsy after formal exploration and evidence of irresectability. No significant surgical morbidity or mortality were encountered in our patients. Yolk sac tumor and malignant teratoma were the commonest histologic subtypes in our series. Metastatic disease was encountered in nine out of 33 patients (27.2%). Adjuvant chemotherapy was administered in 28 out of 33 patients (84.8%), following surgery, including all patients with extragonadal disease. Our patients were followed-up to 52 months. Twenty-two patients (66.7%) had no recurrence while two patients (6.1%) died from disease. Pelvic extragonadal site was the worst site regarding resectability. Complete surgical resection showed better disease free survival, while those with irresectable disease had comparable overall survival while none could be rendered disease free with chemotherapy. The initial surgical approach to malignant GCTs at all sites should be complete resection when possible; the morbidity of extensive surgical resection should be weighed carefully against the good tumor control with chemotherapy. Surgical staging does not preclude preservation of fertility, which should always be considered in this young age. The site of primary disease plays a role in the prognosis of pediatric germ cell tumors with the extragonadal pelvic tumors being the worst regarding resectability. Good tumor response can be achieved with surgery and chemotherapy even for advanced stage and metastatic disease.

Research paper thumbnail of Gastrointestinal Stromal Tumor (GIST)'s Surgical Treatment, NCI Experience

Journal of the Egyptian National Cancer Institute, Jul 1, 2005

To review the clinical presentation, surgical management, and prognostic factors for gastrointest... more To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors. A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months. Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4%), palpable mass (33.3%) and abdominal pain (24.3%). The stomach was the most common site of origin of the disease (39.4%), followed by the colorectal region (24.2%). Tumors were high grade in 63.6% of patients and low-grade in 36.4% of patients. Complete resection of all gross disease was accomplished in 26 patients (78.7%), among whom, multiple adjacent organ resection was required in 6 patients (22.2 %) and metastatic disease was identified in the liver in 3 patients at the time of exploratory surgery of these one could be resected. Immunohistochemical staining for CD117 was positive in 88.9% of patients. The median follow-up period was 20 months (range, 14-35 months). The overall median survival in this study was 25 months, and the cumulative survival at 30 months was 46.9%. Unfavorable prognostic factors were incomplete resection and, high-grade histological features (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). None of the patients received adjuvant or palliative chemotherapy. Twenty six patients (78.8%) are alive free of disease. Of the 7 patients with incomplete resections or biopsy only; 4 patients (12.1%) are alive with disease and 3 patients died. Surgical resection, including en bloc resection of locally advanced tumors, remains the only curative treatment. Overall survival is significantly affected by high-grade tumors and positive resection margin.

Research paper thumbnail of Incidence, Risk Factors and Management of Pharyngeal Fistulae Following Total Laryngectomy, NCI Case Series

Pharyngocutaneous fistula is a common and troublesome postoperative complication after total lary... more Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this study was to determine the incidence, predisposing factors, and outcome of post laryngectomy pharyngo-cutaneous fistula in patients operated on in our department and to describe the management of such complication. The medical records of 100 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 2000 and 2008 were studied. All patients had similar preoperative and postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, clinical stage, and pathological grade. A pharyngocutaneous fistula was observed in 25% of the patients within a mean time of 9.6 days from surgery. Spontaneous clo...

Research paper thumbnail of The Impact of Two & Three Dimensions Transvaginal Ultrasonography and Color Doppler on the Surgical Management of Endometrial Carcinoma

The purpose of this study was to evaluate the accuracy of Two and Three Dimensions Trans-Vaginal ... more The purpose of this study was to evaluate the accuracy of Two and Three Dimensions Trans-Vaginal Ultrasound (2D & 3D-TVUS) in the preoperative assessment of the depth of myometrial invasion in endometrial carcinoma and to compare them with the histopathologic findings in these patients. The study combined color Doppler to examine its usefulness in predicting tumor myoinvasion. Twenty-seven patients with endometrial carcinoma were prospectively evaluated with 2D, 3D-TVUS and Color Doppler to assess the depth of myometrial invasion. Intraoperative gross visual inspection was also performed. (The data were analyzed twice; myometrial invasion defined once as absent, less than 50% or 50% or greater and the second time as less than 50% or 50% or greater). Imaging findings, gross visual inspection and the final histologic results were compared and correlated. The accuracy in assigning the correct International Federation of Gynecology & Obstetrics (FIGO) stage for 2D, 3D-TVUS and Gross Vis...

Research paper thumbnail of Sphincter saving and abdomino-perineal resections following neoadjuvant chemoradiation in locally advanced low rectal cancer

Journal of the Egyptian National Cancer Institute, 2015

The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients... more The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients with low rectal cancer to have sphincter preservation. To compare the oncologic and functional outcome in patients with locally advanced low rectal cancer treated by neoadjuvant chemoradiation followed by sphincter saving resection (SSR) against those who underwent abdomino-perineal resection (APR). A total of 111 patients with low rectal cancer were included in the study. Sixty-one consented patients who prospectively underwent SSR, from Jan 2008 to Jan 2013, and a retrospective group, formed of 50 patients, selected from cases seen at NCI, with comparable demographic, clinical and pathologic criteria, who underwent APR from Jan 2003 to Jan 2008. All lesions were <5cm from anal verge. All 111 patients received preoperative chemoradiation and total mesorectal excision. All tumors were located at a median of 3.6cm (range 2.5-4.5cm) for the SSR group, and 3.5cm (range 2.5-4.6cm) for th...

Research paper thumbnail of Outcome of different oncoplastic surgical (OPs) techniques for centrally located breast cancer (CLBC)

Journal of the Egyptian National Cancer Institute, 2014

Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance bet... more Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance between good cosmetic outcome and limited risk of locoregional recurrence, by enabling proper resection margins. To present multiple techniques of partial breast reconstruction following the resection of centrally located breast cancer (CLBC) resection. From January 2011 to August 2014, 21 patients underwent central quadrantectomy for carcinoma of the central region of the breast. Excisions included the nipple/areola complex, in most of the cases, down to the pectoralis fascia with a wide safety margin, and proper axillary management. Oncoplastic approaches included latissimus dorsi flap, inferior pedicle flap, Melon slice, Grisotti and round block techniques. Mean age of patients was 49.5±10.61 years. Tumor size ranged from 1.5 to 4.5 cm. Postoperative pathology revealed a tumor mean safety margin of 2.5±0.83 cm, with positive axillary lymph nodes in 15 (75.0%) patients. Nineteen (95.0%) p...

Research paper thumbnail of Cytoreductive Surgery for Advanced Epithelial Tumors of the Ovary: Technical Considerations and Outcome

Journal of the Egyptian …, 2005

Purpose: To study the role of cytoreductive surgery in the management of advanced epithelial tumo... more Purpose: To study the role of cytoreductive surgery in the management of advanced epithelial tumors of the ovary and its effect on survival. Patients and Methods: A prospective study of fifty eight female patients presenting with stage III and VI epithelial ovarian tumors attending ...

Research paper thumbnail of Delayed Cystectomy for T1G3 Transitional Cell Carcinoma (TCC) of the Urinary Bladder, NCI Retrospective Case Series

nci.cu.edu.eg

We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regardi... more We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regarding recurrence, progression and survival in patients with T1G3 urinary bladder transitional cell carcinoma. In a retrospective study, between January 2001 and December 2007, all 34 patients with T1G3 bladder transitional cell carcinoma (TCC), after complete transurethral resection (TURBT), received intravesical BCG as adjuvant therapy. A conservative approach was adopted, whereby those with superficial recurrences were eligible to TURBT, with delayed cystectomy for progression to muscle invasion. Overall, recurrence, and progression-free survival were analyzed. Thirty-three patients were included, 29 were males and 4 were females. The mean age was 61 years (range 35-89 years). Final analysis was made at median follow-up of 15 months (Range of 3-68 months, mean 18 months) for survival. Eleven (33.3%) patients had multifocal tumors. Associated schistosomiasis was present in 12 (36.6%) patients. Twenty-two (66.67%) patients showed recurrence. Eleven out of these 22 (50.0%) patients progressed to muscle invasion and underwent radical cystectomy. Ten out of 34 (30.3%) patients received postcystectomy radiotherapy. Two (20.0%) of them, were staged as TNM stage II, 6 (60.0%) as TNM stage III and 2 (20.0%) patients were TNM stage IV. Eight (72.7%) of these 11 patients had post-cystectomy radiotherapy alone; while the 2 (6.0%) other patients with stage IV had adjuvant concomitant Cisplatin and Gemcitabine chemotherapy. Five (14%) patients of those cystectomy patients died of TCC. Three (60%) patients died from metastatic disease (to lung, liver and bone), one patient died from advanced locoregional disease and another patient died from postoperative complications. Among those patients who received radiotherapy alone, 62.5% are alive. Although, we report a biologically more aggressive behavior of T1G3 than that reported by some authors, for this conservative approach, the overall survival (OS) was (84.4%) and the recurrence-free survival (RFS) was (41.3%), at 18 months; which are comparable to those reported in the literature for the delayed cystectomy approach. Adjuvant intravesical therapy with BCG with repeated cystoscopies, and delayed radical cystectomy until progression to the invasive disease carries a significant risk of mortality from invasive disease. This treatment policy may be acceptable for T1G3 bladder TCC, without concomitant carcinoma in situ (CIS), who don&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t recur after intravesical BCG, however, patients who progress to invasive disease may skip stage II disease and present with stage III or IV, with consequent poor survival. Therefore, due to the aggressive biologic behavior of T1G3 cancer, a determination of a cutoff number for recurrence(s) or better evaluation parameters are needed, to proceed with cystectomy without awaiting muscle invasion. Superficial bladder cancer - T1G3 TCC - Delayed cystectomy - BCG.

Research paper thumbnail of Laparoscopic Gastrectomy for Gastric Cancer: Early Experience

The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric ... more The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric cancer and to explore the possibility, safety, usefullness of laparoscopy and its role in the management of patients with gastric malignancies. Nine patients with mean age 49.1± 9.4 years (range 34-62 years) presented for laparoscopic gastrectomy. Six patients presented with gastric adenocarcinoma, two patients with gastrointestinal stromal tumor (GIST) and one case of gastric lymphoma were operated upon with laparoscopy in the National Cancer Institute (2003-2007). The study group consisted of seven patients as two (22%) patients were found to be metastatic at laparoscopic exploration.. The mean operative time was 225.7± 29.9 minutes (range190-270), with no intra-operative complications. Postoperative periods to starting oral feeding, and discharge were 6.8±1.4 days (range 5-9 days) and 10.7±3.9 days (range 7-18 days) respectively. There was no post-operative mortality and only one case...

Research paper thumbnail of P0050 Survival of children with rhabdomyosarcoma: Experience of the National Cancer Institute Egypt

European Journal of Cancer, May 1, 2014

Background: Survival rates of paediatric rhabdomyosarcoma have improved tremendously during the p... more Background: Survival rates of paediatric rhabdomyosarcoma have improved tremendously during the past decade by the development of risk stratification. This approach has favoured tailoring of treatment using multi-therapeutic modalities. Methods: Patients were given upfront surgical resection followed by systemic chemotherapy using the vincristine/actinomycin-D/ cyclophosphamide (VAC) regimen, with subsequent further local control by surgery or radiotherapy, or both, according to risk stratification into low, intermediate, and high risk groups. Findings: The study included 40 patients; their median age was 3.5 years (range: 8 months to 17 years), 28 were boys and 12 were girls. 2-year overall survival (OS) and event-free survival (EFS) were 87% and 45% respectively. After univariate analysis, OS was 100% for a complete response versus 92% for only partial response (p = 0.03). OS was 94% if there were no distant metastasis versus 66% if metastasis was present (p = 0.024). On the other hand, EFS was 88% for complete response versus 46% for partial response (p < 0.001), and was 80% if upfront surgery was done versus 33% if only simple biopsy was taken (p = 0.03). Local radiotherapy versus no radiotherapy was highly associated with EFS, with a difference of 75% versus 0%, respectively (p < 0.001). Interpretation: Complete response and extent of disease are two important factors influencing survival in childhood rhabdomyosarcoma. Both local control measures, surgical resection and radiation therapy, and treatment response are important variables predicting EFS. The poor outcome of patients with metastatic disease necessitates further therapeutic approaches to improve survival.

Research paper thumbnail of P009 Neobladder long term follow up

European Urology Supplements, Nov 1, 2013

Introduction & Objectives: The major shortcoming of standard routine pretreatment assessment of l... more Introduction & Objectives: The major shortcoming of standard routine pretreatment assessment of lymph node (LN) status following radical cystectomy (RC) is the lack of accuracy. The objective of the study was to assess whether pretreatment clinical parameters in combination with computed tomography (CT) can improve the prediction of lymph node metastasis in patients with bladder cancer (BC) treated with RC and pelvic limph node disection (PLND). Material & Methods: In a single-centre retrospective study, demographic and clinicopathological information of 213 patients with BC undergoing RC was reviewed. The following clinicopathological data were analysed: demographic, initial transurethral resection (grade, stage, multiplicity of tumours, lymphovascular invasion), hydronephrosis, abdominal and pelvic CT radiography (size of the tumor, tumor base width, size and number of LN), and presence of lymph node disease on final pathology. Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of positive LN. Various measures for the assessment of risk prediction models were determined such as: model fit, predictive ability (the area under the receiver operating characteristic [ROC] curve [AUC] and integrated discrimination improvement [IDI]) and clinical utility (net reclassification improvement [NRI]). Results: The median (range) number of removed lymph nodes was 13 (2-25) and 109 (51.2%) of patients undergoing PLND had positive lymph nodes on pathological examination. In a multivariable analysis, two risk factors most strongly associated with LN metastasis: status LN on CT [odds ratio (OR)=3.0], and hydronephrosis (OR=2.5). The resultant total possible score ranged from 0 to 22, with a cutoff value of >5 points. AUC was 0.818 (0.762-0.873), and IDI was 0.057, showing good discriminatory ability. The calibration was R 2 =0.82. NRI was 0.392, showing clinical utility. Conclusions: The pre-cystectomy model improved the prediction of lymph node status in patients with BC. Our model represented a user-friendly staging aid, but a large multi-center study should be performed before widespread implementation.

Research paper thumbnail of P0058 Preserving fertility in stage 1a ovarian carcinoma

European Journal of Cancer, May 1, 2014

Background: Adenocarcinoma of the colon is a common cancer and the annual incidence is increasing... more Background: Adenocarcinoma of the colon is a common cancer and the annual incidence is increasing. Treatment is essentially surgical, combined with adjuvant chemotherapy in advanced cases. Methods: This is a retrospective study of 100 patients with non-metastatic colon adenocarcinoma, treated at the gastroenterology and oncology centre in Ibn Rushd Hospital, Casablanca, over a period of 5 years from January, 2006, to January, 2010. Diagnosis was made after a histological study of biopsies taken during colonoscopy. Findings: One hundred patients were diagnosed with non-metastatic colon adenocarcinoma. The sex ratio was 3:2 (M:F), the average age was 52 years, and approximately 50% of patients were diagnosed after a period of 7 months from the appearance of their first symptoms of rectal bleeding events, melena, and dysentery syndrome. Histologically, non-metastatic colon adenocarcinoma is well-differentiated in 80% of cases. All patients were operated on. The distribution of patients by stage was: 61% classified as stage II, 30% stage III, and 9% stage I. Adjuvant chemotherapy FUFOL, FOLFOX IV, or capecitabine was given in 85% of patients and monitoring without adjuvant therapy in 15%. The immediate follow-up after completion of chemotherapy showed complete remission in 95% of patients and 5% were in disease progression. After a mean follow-up of 30 months, 71% were in remission. 18% had a local or metastatic recurrence treated by second line chemotherapy (FOLFIRI or XELIRI), with remission seen in three patients, stable disease in seven patients, and treatment failure in eight patients. Interpretation: The multidisciplinary approach to all stages of the process requires the involvement of various disciplines to give the patient the best quality of care.

Research paper thumbnail of Breast cancer laterality among Egyptian patients and its association with treatments and survival

Journal of the Egyptian National Cancer Institute, 2013

Background and aim: Breast cancers (BCs) involve the left side (LS) more than the right side (RS)... more Background and aim: Breast cancers (BCs) involve the left side (LS) more than the right side (RS). Among the Egyptians, neither BC laterality nor its association with demographic factors, tumor locations, treatments and outcomes were previously reported. Patients and methods: Laterality was analyzed among 5459 BCs from the Gharbiah populationbased cancer registry covering >5% of the Egyptian population. Cox proportional model was used to assess the independent effect of stage, ER, and laterality on overall survival (OS). Results: In Egypt, BCs involve LS more than RS with LS-to-RS ratio (LRR) of 1.16. LS predominance was evident among men and women and both younger (<45 years) and older patients. HER2 over-expression and ductal cancers were significantly more in RSBCs while lobular cancers were significantly more in LSBCs. There were no significant differences in localization within the breast between LSBCs and RSBCs (p = 0.51). LS predominance was noticed across all subgroups except in patients with HER2 positive tumors (LRR = 0.63; p = 0.02). OS was significantly better in stage II and ER positive tumors than stage III and ER negative tumors. Despite OS of LSBCs being generally lower than RSBCs, this was not statistically significant. The significant impact of stage on OS was lost in LSBCs. Conclusions: Among Egyptian patients, the left breast is at greater risk of cancer than the right one. Despite right-sided tumors seemed more aggressive, Left-sided ones tend to confer worse survival than right-sided tumors.

Research paper thumbnail of When would we advocate a total thyroidectomy in cases of hypopharyngeal carcinoma?

Journal of the Egyptian National Cancer Institute, 2014

Research paper thumbnail of Assessment of the Proliferative Marker Ki-67 and p53 Protein Expression in HBV- and HCV-related Hepatocellular Carcinoma Cases in Egypt

Chronic HBV and HCV infections are the major risk factors for the development of HCC through a mu... more Chronic HBV and HCV infections are the major risk factors for the development of HCC through a multistep pathway that involves viral and non-viral dependent pathophysiological steps. Hepatic expression of the nuclear proliferative marker ki-67 and the p53 oncoprotein were found to be associated with poor outcome. So, the present study was done to evaluate the changes in expression of Ki-67 and p53 oncoprotein, and to determine p53 gene mutation in HBV/HCV-related HCC Egyptian patients. Eight HBV-and 22 HCV-positive HCC cases have been examined for the presence of p53 mutation by immunohistochemistry (IHC) and single-strand conformation polymorphism (SSCP), followed by direct DNA sequencing. HCV were genotyped by LiPA-II. Our results have shown that the proliferative marker ki-67 LI and p53 were highly expressed and significantly related to tumor grade in the Egyptian HCC cases (p<0.05). Also, p53 mutation was found in 16 HCC cases by IHC and in 14 HCC cases by SSCP, only 11 patie...

Research paper thumbnail of Pelvic Exentration and Composite Sacral Resection in the Surgical Treatment of Locally Recurrent Rectal Cancer

Background: The incidence of rectal cancer recurrence after surgery is 5-45%. Extended Pelvic res... more Background: The incidence of rectal cancer recurrence after surgery is 5-45%. Extended Pelvic resection such as pelvic exentration and abdominosacral composite resection which entails En-bloc resection of the tumor and adjacent involved organs provide the only true possible curative option for patients with locally recurrent rectal cancer. The Aim of this Study: Is to evaluate the surgical and oncological outcome of such treatment. Patients and Methods: Between 2006 and 2012 a consecutive series of 40 patients with locally recurrent rectal cancer underwent abdominosacral resection (ASR) in 18 patients, total pelvic exentration with sacral resection in 10 patients and pelvic exentration in 12 patients. Patients with sacral resection were 28, with the level of sacral division at S2-3 interface in 10 patients, at S3-4 in 15 patients and S4-5 in 3 patients. Results: Forty patients, male to female ratio 1.7:1, mean age 45 years (range 25-65Y) underwent extended pelvic resection in the fo...

Research paper thumbnail of Laparoscopic Gastrectomy for Gastric Cancer: Early Experience

The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric ... more The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric cancer and to explore the possibility, safety, usefullness of laparoscopy and its role in the management of patients with gastric malignancies. Nine patients with mean age 49.1± 9.4 years (range 34-62 years) presented for laparoscopic gastrectomy. Six patients presented with gastric adenocarcinoma, two patients with gastrointestinal stromal tumor (GIST) and one case of gastric lymphoma were operated upon with laparoscopy in the National Cancer Institute (2003-2007). The study group consisted of seven patients as two (22%) patients were found to be metastatic at laparoscopic exploration.. The mean operative time was 225.7± 29.9 minutes (range190-270), with no intra-operative complications. Postoperative periods to starting oral feeding, and discharge were 6.8±1.4 days (range 5-9 days) and 10.7±3.9 days (range 7-18 days) respectively. There was no post-operative mortality and only one case...

Research paper thumbnail of Delayed Cystectomy for T 1 G 3 Transitional Cell Carcinoma ( TCC ) of the Urinary Bladder , NCI Retrospective Case Series

Aim: We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome re... more Aim: We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regarding recurrence, progression and survival in patients with T1G3 urinary bladder transitional cell carcinoma. Patients and Methods: In a retrospective study, between January 2001 and December 2007, all 34 patients with T1G3 bladder transitional cell carcinoma (TCC), after complete transurethral resection (TURBT), received intravesical BCG as adjuvant therapy. A conservative approach was adopted, whereby those with superficial recurrences were eligible to TURBT, with delayed cystectomy for progression to muscle invasion. Overall, recurrence, and progression-free survival were analyzed. Results: Thirty-three patients were included, 29 were males and 4 were females. The mean age was 61 years (range 35-89 years). Final analysis was made at median follow-up of 15 months (Range of 3-68 months, mean 18 months) for survival. Eleven (33.3%) patients had multifocal tumors. Associated schistosomi...

Research paper thumbnail of Gastrointestinal stromal tumor (GIST)'s surgical treatment, NCI experience

PURPOSE To review the clinical presentation, surgical management, and prognostic factors for gast... more PURPOSE To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors. PATIENTS AND METHODS A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months. RESULTS Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4%), palpable mass (33.3%) and abdominal pain (24.3%). The stomach was the most common site of origin of the disease (39.4%), followed by the colorectal region (24.2%). Tumors were high grade in 63.6% of patients and low-grade in 36.4% of patients. Complete resection of all gross disease was accomplished in 26 patients ...

Research paper thumbnail of Cytoreductive surgery for advanced epithelial tumors of the ovary: technical considerations and outcome

Journal of the Egyptian National Cancer Institute, 2005

PURPOSE To study the role of cytoreductive surgery in the management of advanced epithelial tumor... more PURPOSE To study the role of cytoreductive surgery in the management of advanced epithelial tumors of the ovary and its effect on survival. PATIENTS AND METHODS A prospective study of fifty eight female patients presenting with stage III and VI epithelial ovarian tumors attending the National Cancer Institute, Cairo University during the period from January 2003 to of December 2004. All patients were evaluated clinically, radiologically (including plain chest-X-ray and abdomino-pelvic ultrasound and/or CT), laboratory work up and CA-125. Abdominal exploration under general anesthesia with intent of maximum surgical cytoreduction was performed for all patients. Patients were followed up during the period of the study by history and physical examination, CA-125 measurement and abdomino-pelvic ultrasound or CT. RESULTS Our study included 58 female patients with advanced epithelial tumors of the ovary. Their age ranged from 18 to 73 years with a mean age of 49 years. Pathological distri...

Research paper thumbnail of The role of surgical management in pediatric germ cell tumors (GCTs), NCI case series

Journal of the Egyptian National Cancer Institute, Mar 1, 2008

To review the experience of a tertiary referral center in pediatric germ cell tumors (GCTs) in th... more To review the experience of a tertiary referral center in pediatric germ cell tumors (GCTs) in the last 8 years and to investigate the impact of surgery and site of disease on prognosis. We retrospectively analyzed the cases of pediatric germ cell tumors at National Cancer Institute over an 8 years period. Data concerning diagnosis, surgery and medical decisions were reviewed and analyzed for all patients. A total of 34 children with (GCTS) were found, with a mean age, at presentation, of 6.7 years and a follow-up period ranging from 3-52 months. One patient with benign GCT was excluded during analysis of the results. Among the 34 patients, there were 14 males and 20 females with mean age of 6.7 years (range: 9 months-15 years), with male to female ratio 1:1.4. All patients were symptomatic at presentation, most commonly with abdominal swelling (18 patients; 52.9%). Anatomic distribution of GCTs according to sex organ involvement was either gonadal in 21 patients (61.8%) or extragonadal in 13 patients (38.2%). All patients had surgery either in the form of curative resection or biopsy after formal exploration and evidence of irresectability. No significant surgical morbidity or mortality were encountered in our patients. Yolk sac tumor and malignant teratoma were the commonest histologic subtypes in our series. Metastatic disease was encountered in nine out of 33 patients (27.2%). Adjuvant chemotherapy was administered in 28 out of 33 patients (84.8%), following surgery, including all patients with extragonadal disease. Our patients were followed-up to 52 months. Twenty-two patients (66.7%) had no recurrence while two patients (6.1%) died from disease. Pelvic extragonadal site was the worst site regarding resectability. Complete surgical resection showed better disease free survival, while those with irresectable disease had comparable overall survival while none could be rendered disease free with chemotherapy. The initial surgical approach to malignant GCTs at all sites should be complete resection when possible; the morbidity of extensive surgical resection should be weighed carefully against the good tumor control with chemotherapy. Surgical staging does not preclude preservation of fertility, which should always be considered in this young age. The site of primary disease plays a role in the prognosis of pediatric germ cell tumors with the extragonadal pelvic tumors being the worst regarding resectability. Good tumor response can be achieved with surgery and chemotherapy even for advanced stage and metastatic disease.

Research paper thumbnail of Gastrointestinal Stromal Tumor (GIST)'s Surgical Treatment, NCI Experience

Journal of the Egyptian National Cancer Institute, Jul 1, 2005

To review the clinical presentation, surgical management, and prognostic factors for gastrointest... more To review the clinical presentation, surgical management, and prognostic factors for gastrointestinal stromal tumors. A prospective study which was carried out between January 2002 and March 2004 on thirty-three patients with gastrointestinal stromal tumor (GIST) at the National Cancer Institute, Cairo University. All patients were evaluated preoperatively and underwent exploratory laparotomy with a curative intent, they were followed up for period ranging between 14-35 months. Among the 33 patients there were 17 males and 16 females. The mean age of patients was 52.8 years. Clinical findings included gastrointestinal bleeding (42.4%), palpable mass (33.3%) and abdominal pain (24.3%). The stomach was the most common site of origin of the disease (39.4%), followed by the colorectal region (24.2%). Tumors were high grade in 63.6% of patients and low-grade in 36.4% of patients. Complete resection of all gross disease was accomplished in 26 patients (78.7%), among whom, multiple adjacent organ resection was required in 6 patients (22.2 %) and metastatic disease was identified in the liver in 3 patients at the time of exploratory surgery of these one could be resected. Immunohistochemical staining for CD117 was positive in 88.9% of patients. The median follow-up period was 20 months (range, 14-35 months). The overall median survival in this study was 25 months, and the cumulative survival at 30 months was 46.9%. Unfavorable prognostic factors were incomplete resection and, high-grade histological features (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). None of the patients received adjuvant or palliative chemotherapy. Twenty six patients (78.8%) are alive free of disease. Of the 7 patients with incomplete resections or biopsy only; 4 patients (12.1%) are alive with disease and 3 patients died. Surgical resection, including en bloc resection of locally advanced tumors, remains the only curative treatment. Overall survival is significantly affected by high-grade tumors and positive resection margin.

Research paper thumbnail of Incidence, Risk Factors and Management of Pharyngeal Fistulae Following Total Laryngectomy, NCI Case Series

Pharyngocutaneous fistula is a common and troublesome postoperative complication after total lary... more Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this study was to determine the incidence, predisposing factors, and outcome of post laryngectomy pharyngo-cutaneous fistula in patients operated on in our department and to describe the management of such complication. The medical records of 100 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 2000 and 2008 were studied. All patients had similar preoperative and postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, clinical stage, and pathological grade. A pharyngocutaneous fistula was observed in 25% of the patients within a mean time of 9.6 days from surgery. Spontaneous clo...

Research paper thumbnail of The Impact of Two & Three Dimensions Transvaginal Ultrasonography and Color Doppler on the Surgical Management of Endometrial Carcinoma

The purpose of this study was to evaluate the accuracy of Two and Three Dimensions Trans-Vaginal ... more The purpose of this study was to evaluate the accuracy of Two and Three Dimensions Trans-Vaginal Ultrasound (2D & 3D-TVUS) in the preoperative assessment of the depth of myometrial invasion in endometrial carcinoma and to compare them with the histopathologic findings in these patients. The study combined color Doppler to examine its usefulness in predicting tumor myoinvasion. Twenty-seven patients with endometrial carcinoma were prospectively evaluated with 2D, 3D-TVUS and Color Doppler to assess the depth of myometrial invasion. Intraoperative gross visual inspection was also performed. (The data were analyzed twice; myometrial invasion defined once as absent, less than 50% or 50% or greater and the second time as less than 50% or 50% or greater). Imaging findings, gross visual inspection and the final histologic results were compared and correlated. The accuracy in assigning the correct International Federation of Gynecology & Obstetrics (FIGO) stage for 2D, 3D-TVUS and Gross Vis...

Research paper thumbnail of Sphincter saving and abdomino-perineal resections following neoadjuvant chemoradiation in locally advanced low rectal cancer

Journal of the Egyptian National Cancer Institute, 2015

The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients... more The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients with low rectal cancer to have sphincter preservation. To compare the oncologic and functional outcome in patients with locally advanced low rectal cancer treated by neoadjuvant chemoradiation followed by sphincter saving resection (SSR) against those who underwent abdomino-perineal resection (APR). A total of 111 patients with low rectal cancer were included in the study. Sixty-one consented patients who prospectively underwent SSR, from Jan 2008 to Jan 2013, and a retrospective group, formed of 50 patients, selected from cases seen at NCI, with comparable demographic, clinical and pathologic criteria, who underwent APR from Jan 2003 to Jan 2008. All lesions were <5cm from anal verge. All 111 patients received preoperative chemoradiation and total mesorectal excision. All tumors were located at a median of 3.6cm (range 2.5-4.5cm) for the SSR group, and 3.5cm (range 2.5-4.6cm) for th...

Research paper thumbnail of Outcome of different oncoplastic surgical (OPs) techniques for centrally located breast cancer (CLBC)

Journal of the Egyptian National Cancer Institute, 2014

Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance bet... more Oncoplastic breast surgery is a standard treatment of early breast cancer, offering a balance between good cosmetic outcome and limited risk of locoregional recurrence, by enabling proper resection margins. To present multiple techniques of partial breast reconstruction following the resection of centrally located breast cancer (CLBC) resection. From January 2011 to August 2014, 21 patients underwent central quadrantectomy for carcinoma of the central region of the breast. Excisions included the nipple/areola complex, in most of the cases, down to the pectoralis fascia with a wide safety margin, and proper axillary management. Oncoplastic approaches included latissimus dorsi flap, inferior pedicle flap, Melon slice, Grisotti and round block techniques. Mean age of patients was 49.5±10.61 years. Tumor size ranged from 1.5 to 4.5 cm. Postoperative pathology revealed a tumor mean safety margin of 2.5±0.83 cm, with positive axillary lymph nodes in 15 (75.0%) patients. Nineteen (95.0%) p...

Research paper thumbnail of Cytoreductive Surgery for Advanced Epithelial Tumors of the Ovary: Technical Considerations and Outcome

Journal of the Egyptian …, 2005

Purpose: To study the role of cytoreductive surgery in the management of advanced epithelial tumo... more Purpose: To study the role of cytoreductive surgery in the management of advanced epithelial tumors of the ovary and its effect on survival. Patients and Methods: A prospective study of fifty eight female patients presenting with stage III and VI epithelial ovarian tumors attending ...

Research paper thumbnail of Delayed Cystectomy for T1G3 Transitional Cell Carcinoma (TCC) of the Urinary Bladder, NCI Retrospective Case Series

nci.cu.edu.eg

We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regardi... more We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regarding recurrence, progression and survival in patients with T1G3 urinary bladder transitional cell carcinoma. In a retrospective study, between January 2001 and December 2007, all 34 patients with T1G3 bladder transitional cell carcinoma (TCC), after complete transurethral resection (TURBT), received intravesical BCG as adjuvant therapy. A conservative approach was adopted, whereby those with superficial recurrences were eligible to TURBT, with delayed cystectomy for progression to muscle invasion. Overall, recurrence, and progression-free survival were analyzed. Thirty-three patients were included, 29 were males and 4 were females. The mean age was 61 years (range 35-89 years). Final analysis was made at median follow-up of 15 months (Range of 3-68 months, mean 18 months) for survival. Eleven (33.3%) patients had multifocal tumors. Associated schistosomiasis was present in 12 (36.6%) patients. Twenty-two (66.67%) patients showed recurrence. Eleven out of these 22 (50.0%) patients progressed to muscle invasion and underwent radical cystectomy. Ten out of 34 (30.3%) patients received postcystectomy radiotherapy. Two (20.0%) of them, were staged as TNM stage II, 6 (60.0%) as TNM stage III and 2 (20.0%) patients were TNM stage IV. Eight (72.7%) of these 11 patients had post-cystectomy radiotherapy alone; while the 2 (6.0%) other patients with stage IV had adjuvant concomitant Cisplatin and Gemcitabine chemotherapy. Five (14%) patients of those cystectomy patients died of TCC. Three (60%) patients died from metastatic disease (to lung, liver and bone), one patient died from advanced locoregional disease and another patient died from postoperative complications. Among those patients who received radiotherapy alone, 62.5% are alive. Although, we report a biologically more aggressive behavior of T1G3 than that reported by some authors, for this conservative approach, the overall survival (OS) was (84.4%) and the recurrence-free survival (RFS) was (41.3%), at 18 months; which are comparable to those reported in the literature for the delayed cystectomy approach. Adjuvant intravesical therapy with BCG with repeated cystoscopies, and delayed radical cystectomy until progression to the invasive disease carries a significant risk of mortality from invasive disease. This treatment policy may be acceptable for T1G3 bladder TCC, without concomitant carcinoma in situ (CIS), who don&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t recur after intravesical BCG, however, patients who progress to invasive disease may skip stage II disease and present with stage III or IV, with consequent poor survival. Therefore, due to the aggressive biologic behavior of T1G3 cancer, a determination of a cutoff number for recurrence(s) or better evaluation parameters are needed, to proceed with cystectomy without awaiting muscle invasion. Superficial bladder cancer - T1G3 TCC - Delayed cystectomy - BCG.

Research paper thumbnail of Laparoscopic Gastrectomy for Gastric Cancer: Early Experience

The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric ... more The aim of this work is to describe our early experience in laparoscopic gastrectomy for gastric cancer and to explore the possibility, safety, usefullness of laparoscopy and its role in the management of patients with gastric malignancies. Nine patients with mean age 49.1± 9.4 years (range 34-62 years) presented for laparoscopic gastrectomy. Six patients presented with gastric adenocarcinoma, two patients with gastrointestinal stromal tumor (GIST) and one case of gastric lymphoma were operated upon with laparoscopy in the National Cancer Institute (2003-2007). The study group consisted of seven patients as two (22%) patients were found to be metastatic at laparoscopic exploration.. The mean operative time was 225.7± 29.9 minutes (range190-270), with no intra-operative complications. Postoperative periods to starting oral feeding, and discharge were 6.8±1.4 days (range 5-9 days) and 10.7±3.9 days (range 7-18 days) respectively. There was no post-operative mortality and only one case...