Omar Hamdy - Academia.edu (original) (raw)

Papers by Omar Hamdy

Revista Española de Patología, Apr 1, 2023

Purpose. To investigate the impact of the nomenclature change to ''noninvasive follicular thyroid... more Purpose. To investigate the impact of the nomenclature change to ''noninvasive follicular thyroid neoplasm with papillary-like nuclear features'' (NIFTP) on reported malignancy rates following thyroidectomy. Methods. Retrospective cohort study of patients with thyroid nodules sampled preoperatively with fine-needle aspiration (FNA) and subsequently removed at one tertiarycare hospital from 4/2016 to 2/2017. Surgical procedure, anatomic pathology, thyroid cytopathology classification, and demographic characteristics were recorded. Results. Thyroidectomy was performed in 353 patients. Twenty-six patients (7.3%) had NIFTP on anatomic pathology. Preoperative FNA demonstrated atypia of undetermined significance (AUS/Bethesda III) in 13 (50%), suspicious for malignancy (SUS/Bethesda V) in 6 (23%), suspicious for follicular neoplasm (SFN/Bethesda IV) in 4 (15%), benign/Bethesda I in 2 (8%), and malignant/Bethesda VI in 1 (4%). Invasive malignancy rates across cytologic categories changed as follows: benign (n = 74) from 4 to 1%, AUS (n = 85) from 33 to 18% (p \ 0.05), SFN (n = 58) from 29 to 22%, SUS (n = 33) from 91 to 73% (p \ 0.05), and malignant (n = 99) from 99 to 98%. Overall decrease in invasive malignancy was 7.3% for the entire population and 13.1% for indeterminate preoperative FNA cytology (Bethesda III-V). Among 26 NIFTP patients, 17 had thyroid lobectomy (TL) and 9

Indian Journal of Surgical Oncology, Jun 16, 2022

Journal of Stomatology, Oral and Maxillofacial Surgery, Apr 1, 2022

INTRODUCTION Submandibular sialadenectomy is a part of the classic technique of neck dissection f... more INTRODUCTION Submandibular sialadenectomy is a part of the classic technique of neck dissection for oral cavity cancers. However, its removal is associated with a reduction in the salivary outflow in many cases, as well as, some uncommon complications such as lingual and hypoglossal nerve injuries. Assessment of the necessity of such maneuvers should be addressed. PATIENTS AND METHODS The data of 105 patients with tongue cancer who underwent neck dissection in the Oncology Center, Mansoura University from January 2008 to March 2019 were reviewed and analyzed retrospectively. RESULTS In all the included patients, whether showing pathologic positive or negative lymph nodes, none showed capsular or parenchymal submandibular gland metastasis except for one patient who should direct infiltration of the gland by the primary tumor. CONCLUSION Submandibular sialadenectomy may not be indicated as a part of neck dissection in tongue cancer patients. Further research should be conducted to focus on the effect of its preservation on disease-free and overall survival.

Endometrial cancer, Oct 1, 2022

the sentinel lymph node 6. vNOTES hysterectomy 7. Closure of the incisions Results The approach h... more the sentinel lymph node 6. vNOTES hysterectomy 7. Closure of the incisions Results The approach has performed for three patients with endometrial cancer until today. No complication was detected. All of them discharged postoperative day 1. Blood loss were under 50 ml. One of these patients was at stage IIIC1 treated with chemoradiotherapy, and the other two were at stage IA endometrioid type were under observation. No recurrence was found. Conclusion VNOTES sentinel lymph node dissection may be an alternative approach of treatment for patients with endometrial cancer.

Current Medicine Research and Practice, Sep 1, 2017

Extra-pulmonary small cell carcinoma is a rare primary tumor of the urinary bladder. Herein, we r... more Extra-pulmonary small cell carcinoma is a rare primary tumor of the urinary bladder. Herein, we report a 52 years-old male with a primary small cell carcinoma of the urinary bladder, who presented with recurrent attacks of hematuria. Identification of this tumor entity and its aggressive treatment is recommended.

Breast disease, Apr 12, 2023

The Lancet Diabetes & Endocrinology

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from no... more Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78•6%] female patients and 4922 [21•4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1•4 [IQR 0•6-3•4]) compared with the prepandemic phase (2•0 [0•9-3•7]; p<0•0001) and pandemic decrease phase (2•3 [1•0-5•0]; p<0•0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased

Mansoura Medical Journal

In the last 20 years, axillary surgery for breast cancer has changed dramatically. In clinically ... more In the last 20 years, axillary surgery for breast cancer has changed dramatically. In clinically node-positive patients, ALND is the conventional procedure. With the development of efficient neo-adjuvant chemotherapy (NACT), there is a shift toward less aggressive operation in patients who have clinical signs of excellent response and disease shrinkage. Therefore, SLN biopsy (SLNB), which offers an accurate, less morbid staging procedure that prevents complications of ALND has become the standard technique in node negative early breast cancer. In these patients, However, there has been a reluctance to perform (SLNB) after completion of NACT in patients with histologically proven axillary metastases because of false-negative rates (FNRs) greater than 10%. To deal with this problem, a new and promising technique called targeted axillary dissection (TAD) has been developed for determining axillary status in postneoadjuvant chemotherapy (NACT) node-positive breast cancer patients. It includes removal of the SLN as well as the pathologically proven positive nodes which have to be marked before starting the NACT. TAD can be considered a practical, reproducible, and valid method for ruling out metastatic axillary involvement in patients with breast cancer who have had a favourable response to NACT

Current Gynecologic Oncology

Background: Surgery has been considered the cornerstone in the management of endometrial cancer, ... more Background: Surgery has been considered the cornerstone in the management of endometrial cancer, especially in its early stages. The use of minimally invasive surgeries in patients with endometrial cancers has been widely adopted worldwide. In this study, we discuss the outcomes of type I endometrial cancer patients who underwent laparoscopic hysterectomy at our center. Results: The patients were categorized into two groups: open surgery group (59 patients) and laparoscopy group (60 patients). There was no significant difference between both groups as regards the epidemiologic and clinicopathologic parameters. There was no statistical difference between the two groups in the FIGO stage (International Federation of Gynecology and Obstetrics). Operative time was significantly longer in the laparoscopy group compared to the open surgery group (p < 0.0001). No significant difference was found between both groups as regards the type of operation and blood loss. The rate of intraoperat...

Indian Journal of Gynecologic Oncology, 2021

Endometrial cancer is a common gynecologic malignancy that usually presents at an early stage, an... more Endometrial cancer is a common gynecologic malignancy that usually presents at an early stage, and the need for lymphadenectomy in those patients is still debatable. In addition, it occurs in old comorbid patients. So performing unnecessary lymphadenectomy in patients with low risk of lymphatic metastases should be omitted to avoid related short- and long-term postoperative complications. We used intraoperative frozen section for 62 patients with low- and intermediate-risk stage I endometrial cancer to evaluate the tumor histologic type, grade, depth of myometrial invasion, extension to the cervix, and ESMO risk group. According to the results of frozen section, lymphadenectomy and surgical staging were tailored. Intraoperative frozen section guided us to perform lymphadenectomy for 13 patients and omitting the procedure in 49 patients. Out of 62 patients, 55 were treated adequately, 5 patients were undertreated and needed surgical restaging procedure, and 2 patients were over-treated by unnecessary lymphadenectomy. The adequacy of frozen section in guiding lymphadenectomy was 88.7%. Intraoperative frozen section is a useful strategy to guide and tailor surgical staging in early endometrial cancer.

Ovarian cancer, 2021

recommends patients with baseline bodyweight <77 kg or baseline platelet count <150×10 3 /ml to i... more recommends patients with baseline bodyweight <77 kg or baseline platelet count <150×10 3 /ml to initiate niraparib at 200 mg and all other patients, at 300 mg. ISD was adopted in NORA (NCT03705156), the published pivotal study in Chinese patients, who generally have lower body weights than Western patients. While niraparib demonstrated acceptable safety in NORA, dose reduction remained essential and occurred in 59.9% of patients. This post hoc analysis aims to characterise the major TEAEs necessitating dose modification in NORA, to inform TEAE management in Chinese patients receiving niraparib. Methodology In NORA, adults with PSROC and complete/partial response to most recent platinum-containing chemotherapy were randomised 2:1 to niraparib or placebo MT of 28-day cycles. Primary endpoint was progression-free survival (PFS). First 16 patients started treatment at 300 mg, before ISD was implemented. Dose interruption £28 days and dose reduction were permitted. Niraparib-treated patients with stabilised dosing at Cycle 4 were analysed, with descriptive statistics summarising TEAEs and descriptive PFS analysis by dose levels at the beginning of Cycle 4. Result(s)* During Month 1/2, platelet count decrease caused dose interruption and reduction in 32.8%/36.2% and 22.0%/ 23.6% of patients, respectively; neutrophil count decrease caused dose interruption and reduction in 9.0%/12.1% and 8.5%/9.2% of patients, respectively. These percentages decreased from Month 3 and remained low through Months 4-6 (figure 1). Anaemia-related dose interruption/reduction occurred in £10% of patients. Most patients' stabilised doses at Cycle 4 were 100 mg (n=74) or 200 mg (n=78). These two groups had comparable baseline characteristics and showed similar PFS (figure 2) from Cycle 4 onward through 12 months, regardless of germline BRCA mutation status.

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

The Annals of The Royal College of Surgeons of England, 2021

Introduction Thyroid cancer is increasing in incidence globally due either to early detection (ov... more Introduction Thyroid cancer is increasing in incidence globally due either to early detection (overestimation) or true increment. A recent debate concerns multinodular goitre (MNG) or toxic goitres which have classically been considered at a lower risk for cancer. Methods In this study, we enrolled retrospectively all patients with nodular goitre treated at our tertiary hospital and analysed their data with the aim of detecting the rate of cancer among different types of nodular goitre. We also studied predictors of incidental malignancy among thyroidectomies. Results A predilection for solitary thyroid nodules (STNs) was found in women of younger age, with STNs tending to be larger in comparison with MNG in the same age group. However, both types of nodules were at equal risk of harbouring malignancy. Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda scores were the only dependent predictors of malignancy within thyroid nodules. Conclusion The authors recommend manag...

Surgical Science, 2018

Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement... more Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemotherapy. In this study, we will examine accuracy and feasibility of using Sentinel lymph node biopsy in predicting axillary lymph node status in breast cancer patients after neoadjuvant chemotherapy. Methods: 45 female patients with resectable, nonmetastatic breast carcinoma cases who received neoadjuvant chemotherapy were enrolled in this study according to the routine Mansoura Oncology Center-guidelines of management of breast cancer. Methylene blue dye used for detection of Sentinel lymph node. Results: Successful Sentinel lymph node detection was 82.2%. Skin involvement (T4 disease) were linked to a low identification (P = 0.005). False negative rate equals 11/27 = (40.7%).With advancement of the stage of the tumor, the incidence of false negative results increases significantly (p = 0.012) with 95% confidence interval; 1.2-5.4. Conclusion: Sentinel lymph node should be adopted to be the standard method for axillary staging with T1-3 tumors after receiving neoadjuvant chemotherapy, in T4 patients, it is associated with low detection rate & high false negative rate making it doubtful technique for axillary staging.

Cancers

Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leadi... more Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists’ proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augm...

Breast Disease

BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an in... more BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS: This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS: The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕− 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients’ age, marital status,...

The Annals of The Royal College of Surgeons of England

A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomi... more A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.

Revista Española de Patología, Apr 1, 2023

Purpose. To investigate the impact of the nomenclature change to ''noninvasive follicular thyroid... more Purpose. To investigate the impact of the nomenclature change to ''noninvasive follicular thyroid neoplasm with papillary-like nuclear features'' (NIFTP) on reported malignancy rates following thyroidectomy. Methods. Retrospective cohort study of patients with thyroid nodules sampled preoperatively with fine-needle aspiration (FNA) and subsequently removed at one tertiarycare hospital from 4/2016 to 2/2017. Surgical procedure, anatomic pathology, thyroid cytopathology classification, and demographic characteristics were recorded. Results. Thyroidectomy was performed in 353 patients. Twenty-six patients (7.3%) had NIFTP on anatomic pathology. Preoperative FNA demonstrated atypia of undetermined significance (AUS/Bethesda III) in 13 (50%), suspicious for malignancy (SUS/Bethesda V) in 6 (23%), suspicious for follicular neoplasm (SFN/Bethesda IV) in 4 (15%), benign/Bethesda I in 2 (8%), and malignant/Bethesda VI in 1 (4%). Invasive malignancy rates across cytologic categories changed as follows: benign (n = 74) from 4 to 1%, AUS (n = 85) from 33 to 18% (p \ 0.05), SFN (n = 58) from 29 to 22%, SUS (n = 33) from 91 to 73% (p \ 0.05), and malignant (n = 99) from 99 to 98%. Overall decrease in invasive malignancy was 7.3% for the entire population and 13.1% for indeterminate preoperative FNA cytology (Bethesda III-V). Among 26 NIFTP patients, 17 had thyroid lobectomy (TL) and 9

Indian Journal of Surgical Oncology, Jun 16, 2022

Journal of Stomatology, Oral and Maxillofacial Surgery, Apr 1, 2022

INTRODUCTION Submandibular sialadenectomy is a part of the classic technique of neck dissection f... more INTRODUCTION Submandibular sialadenectomy is a part of the classic technique of neck dissection for oral cavity cancers. However, its removal is associated with a reduction in the salivary outflow in many cases, as well as, some uncommon complications such as lingual and hypoglossal nerve injuries. Assessment of the necessity of such maneuvers should be addressed. PATIENTS AND METHODS The data of 105 patients with tongue cancer who underwent neck dissection in the Oncology Center, Mansoura University from January 2008 to March 2019 were reviewed and analyzed retrospectively. RESULTS In all the included patients, whether showing pathologic positive or negative lymph nodes, none showed capsular or parenchymal submandibular gland metastasis except for one patient who should direct infiltration of the gland by the primary tumor. CONCLUSION Submandibular sialadenectomy may not be indicated as a part of neck dissection in tongue cancer patients. Further research should be conducted to focus on the effect of its preservation on disease-free and overall survival.

Endometrial cancer, Oct 1, 2022

the sentinel lymph node 6. vNOTES hysterectomy 7. Closure of the incisions Results The approach h... more the sentinel lymph node 6. vNOTES hysterectomy 7. Closure of the incisions Results The approach has performed for three patients with endometrial cancer until today. No complication was detected. All of them discharged postoperative day 1. Blood loss were under 50 ml. One of these patients was at stage IIIC1 treated with chemoradiotherapy, and the other two were at stage IA endometrioid type were under observation. No recurrence was found. Conclusion VNOTES sentinel lymph node dissection may be an alternative approach of treatment for patients with endometrial cancer.

Current Medicine Research and Practice, Sep 1, 2017

Extra-pulmonary small cell carcinoma is a rare primary tumor of the urinary bladder. Herein, we r... more Extra-pulmonary small cell carcinoma is a rare primary tumor of the urinary bladder. Herein, we report a 52 years-old male with a primary small cell carcinoma of the urinary bladder, who presented with recurrent attacks of hematuria. Identification of this tumor entity and its aggressive treatment is recommended.

Breast disease, Apr 12, 2023

The Lancet Diabetes & Endocrinology

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from no... more Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78•6%] female patients and 4922 [21•4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1•4 [IQR 0•6-3•4]) compared with the prepandemic phase (2•0 [0•9-3•7]; p<0•0001) and pandemic decrease phase (2•3 [1•0-5•0]; p<0•0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased

Mansoura Medical Journal

In the last 20 years, axillary surgery for breast cancer has changed dramatically. In clinically ... more In the last 20 years, axillary surgery for breast cancer has changed dramatically. In clinically node-positive patients, ALND is the conventional procedure. With the development of efficient neo-adjuvant chemotherapy (NACT), there is a shift toward less aggressive operation in patients who have clinical signs of excellent response and disease shrinkage. Therefore, SLN biopsy (SLNB), which offers an accurate, less morbid staging procedure that prevents complications of ALND has become the standard technique in node negative early breast cancer. In these patients, However, there has been a reluctance to perform (SLNB) after completion of NACT in patients with histologically proven axillary metastases because of false-negative rates (FNRs) greater than 10%. To deal with this problem, a new and promising technique called targeted axillary dissection (TAD) has been developed for determining axillary status in postneoadjuvant chemotherapy (NACT) node-positive breast cancer patients. It includes removal of the SLN as well as the pathologically proven positive nodes which have to be marked before starting the NACT. TAD can be considered a practical, reproducible, and valid method for ruling out metastatic axillary involvement in patients with breast cancer who have had a favourable response to NACT

Current Gynecologic Oncology

Background: Surgery has been considered the cornerstone in the management of endometrial cancer, ... more Background: Surgery has been considered the cornerstone in the management of endometrial cancer, especially in its early stages. The use of minimally invasive surgeries in patients with endometrial cancers has been widely adopted worldwide. In this study, we discuss the outcomes of type I endometrial cancer patients who underwent laparoscopic hysterectomy at our center. Results: The patients were categorized into two groups: open surgery group (59 patients) and laparoscopy group (60 patients). There was no significant difference between both groups as regards the epidemiologic and clinicopathologic parameters. There was no statistical difference between the two groups in the FIGO stage (International Federation of Gynecology and Obstetrics). Operative time was significantly longer in the laparoscopy group compared to the open surgery group (p < 0.0001). No significant difference was found between both groups as regards the type of operation and blood loss. The rate of intraoperat...

Indian Journal of Gynecologic Oncology, 2021

Endometrial cancer is a common gynecologic malignancy that usually presents at an early stage, an... more Endometrial cancer is a common gynecologic malignancy that usually presents at an early stage, and the need for lymphadenectomy in those patients is still debatable. In addition, it occurs in old comorbid patients. So performing unnecessary lymphadenectomy in patients with low risk of lymphatic metastases should be omitted to avoid related short- and long-term postoperative complications. We used intraoperative frozen section for 62 patients with low- and intermediate-risk stage I endometrial cancer to evaluate the tumor histologic type, grade, depth of myometrial invasion, extension to the cervix, and ESMO risk group. According to the results of frozen section, lymphadenectomy and surgical staging were tailored. Intraoperative frozen section guided us to perform lymphadenectomy for 13 patients and omitting the procedure in 49 patients. Out of 62 patients, 55 were treated adequately, 5 patients were undertreated and needed surgical restaging procedure, and 2 patients were over-treated by unnecessary lymphadenectomy. The adequacy of frozen section in guiding lymphadenectomy was 88.7%. Intraoperative frozen section is a useful strategy to guide and tailor surgical staging in early endometrial cancer.

Ovarian cancer, 2021

recommends patients with baseline bodyweight <77 kg or baseline platelet count <150×10 3 /ml to i... more recommends patients with baseline bodyweight <77 kg or baseline platelet count <150×10 3 /ml to initiate niraparib at 200 mg and all other patients, at 300 mg. ISD was adopted in NORA (NCT03705156), the published pivotal study in Chinese patients, who generally have lower body weights than Western patients. While niraparib demonstrated acceptable safety in NORA, dose reduction remained essential and occurred in 59.9% of patients. This post hoc analysis aims to characterise the major TEAEs necessitating dose modification in NORA, to inform TEAE management in Chinese patients receiving niraparib. Methodology In NORA, adults with PSROC and complete/partial response to most recent platinum-containing chemotherapy were randomised 2:1 to niraparib or placebo MT of 28-day cycles. Primary endpoint was progression-free survival (PFS). First 16 patients started treatment at 300 mg, before ISD was implemented. Dose interruption £28 days and dose reduction were permitted. Niraparib-treated patients with stabilised dosing at Cycle 4 were analysed, with descriptive statistics summarising TEAEs and descriptive PFS analysis by dose levels at the beginning of Cycle 4. Result(s)* During Month 1/2, platelet count decrease caused dose interruption and reduction in 32.8%/36.2% and 22.0%/ 23.6% of patients, respectively; neutrophil count decrease caused dose interruption and reduction in 9.0%/12.1% and 8.5%/9.2% of patients, respectively. These percentages decreased from Month 3 and remained low through Months 4-6 (figure 1). Anaemia-related dose interruption/reduction occurred in £10% of patients. Most patients' stabilised doses at Cycle 4 were 100 mg (n=74) or 200 mg (n=78). These two groups had comparable baseline characteristics and showed similar PFS (figure 2) from Cycle 4 onward through 12 months, regardless of germline BRCA mutation status.

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

The Annals of The Royal College of Surgeons of England, 2021

Introduction Thyroid cancer is increasing in incidence globally due either to early detection (ov... more Introduction Thyroid cancer is increasing in incidence globally due either to early detection (overestimation) or true increment. A recent debate concerns multinodular goitre (MNG) or toxic goitres which have classically been considered at a lower risk for cancer. Methods In this study, we enrolled retrospectively all patients with nodular goitre treated at our tertiary hospital and analysed their data with the aim of detecting the rate of cancer among different types of nodular goitre. We also studied predictors of incidental malignancy among thyroidectomies. Results A predilection for solitary thyroid nodules (STNs) was found in women of younger age, with STNs tending to be larger in comparison with MNG in the same age group. However, both types of nodules were at equal risk of harbouring malignancy. Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda scores were the only dependent predictors of malignancy within thyroid nodules. Conclusion The authors recommend manag...

Surgical Science, 2018

Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement... more Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemotherapy. In this study, we will examine accuracy and feasibility of using Sentinel lymph node biopsy in predicting axillary lymph node status in breast cancer patients after neoadjuvant chemotherapy. Methods: 45 female patients with resectable, nonmetastatic breast carcinoma cases who received neoadjuvant chemotherapy were enrolled in this study according to the routine Mansoura Oncology Center-guidelines of management of breast cancer. Methylene blue dye used for detection of Sentinel lymph node. Results: Successful Sentinel lymph node detection was 82.2%. Skin involvement (T4 disease) were linked to a low identification (P = 0.005). False negative rate equals 11/27 = (40.7%).With advancement of the stage of the tumor, the incidence of false negative results increases significantly (p = 0.012) with 95% confidence interval; 1.2-5.4. Conclusion: Sentinel lymph node should be adopted to be the standard method for axillary staging with T1-3 tumors after receiving neoadjuvant chemotherapy, in T4 patients, it is associated with low detection rate & high false negative rate making it doubtful technique for axillary staging.

Cancers

Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leadi... more Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists’ proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augm...

Breast Disease

BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an in... more BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS: This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS: The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕− 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients’ age, marital status,...

The Annals of The Royal College of Surgeons of England

A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomi... more A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.