Joydeep Purkayastha - Academia.edu (original) (raw)

Papers by Joydeep Purkayastha

Indian Journal of Surgical Oncology, 2021

In this study, we aimed to compare the surgical volume and outcomes between this COVID-19 period ... more In this study, we aimed to compare the surgical volume and outcomes between this COVID-19 period and data from non-COVID-19 period of last year. A retrospective observational study was done in one single surgical unit of a dedicated oncology center in a peripheral location in India. The comparison was done between patients undergoing major cancer surgery during the COVID-19 pandemic period of 1st April to 30th June 2020, when a nationwide lockdown was in force, to a comparable period of last year. Statistical analysis was done using SPSS software 20.0. A total of 72 patients underwent major cancer surgery during this period, with surgery for breast cancer (n = 26) being the major sub-site operated. This was a significant decrease from the total 209 major cancer surgeries performed during a similar period of last year (2019) (p < 0.05). There were several reasons for the decrease in surgical numbers, including the difficulty in travel and accommodation during the lockdown period. The mean distance of patient's residence from the treating hospital was 45.7 km (range 4 to 165 km). Public transport was in a limbo and interstate travel was restrictive with mandatory quarantine rules in effect. Morbidity associated with major surgeries was observed to be significantly less during the COVID-19 period compared to the pre-COVID-19 times (8.3% vs 17.2% with a p value of < 0.05), which can probably be attributed to the lesser number of complex surgical procedures being performed. There was no significant difference between the total mortality percentages (2.8% vs 3.8%). A total of 156 PPE kits were used (3-4/per patient) throughout the in-hospital care of the surgical patients included in this study. In the midst of a pandemic, the delivery of surgical cancer care is an essential service and although the surgical volume is significantly hampered due to various reasons, the outcomes are largely unaffected.

Breast Cancer Research, 2005

Introduction Prognostic and predictive factors play important roles in the treatment of breast ca... more Introduction Prognostic and predictive factors play important roles in the treatment of breast cancer. Genome-wide monitoring of gene expression using DNA microarrays makes it possible to study thousands of genes in a tumour sample in a single experiment. By looking for an association between the gene expression pattern and tumour behaviour, it should be possible to identify new prognostic and predictive factors. Method We used gene expression profiling using two different microarray platforms: one containing 25,000 oligonucleotide probes and one containing 18,000 cDNA probes. To obtain prognostic gene expression profiles, we isolated RNA from tumours from a series of 295 patients younger than 53 years presenting with stage I and II breast cancer treated at our institute between 1984 and 1993. The expression of 25,000 genes was assessed, and using various statistical approaches correlation of gene expression with distant metastasis-free probability and overall survival was assessed [1-3]. In addition, we started studies to obtain gene expression profiles predicting response to specific chemotherapy regimens. Within a single-institution, randomized phase II trial, patients with locally advanced breast cancer received six courses of either AC (n = 24) or AD (n = 24) containing neoadjuvant chemotherapy. Gene expression profiles for 18,000 genes were generated from core needle biopsies obtained before treatment and correlated with the response of the primary tumour to the chemotherapy administered [4]. Additionally, pretreatment gene expression profiles were compared with those in tumours remaining after chemotherapy. Results We previously identified a 70-gene expression profile associated with increased risk for developing distant metastases within 5 years [1,2]. More recently, we studied a Wound Signature in these same tumors [3]. By combining the 70-gene expression profile to subdivide the tumours into 'good prognosis' and 'poor prognosis' tumours, and the Wound signature to subdivide tumours into 'activated' and 'quiescent' tumours, subgroups of patients with markedly different prognosis can be identified. Additional gene expression signatures are being tested in this series of tumours to arrive at an optimal prognostic classifier and to obtain improved insight into breast cancer biology. In the study to identify predictive profiles, 10 (20%) of the 48 patients showed (near) pathological complete remission of the primary tumour after treatment [4]. No gene expression pattern correlating with response could be identified for all patients, or for the AC or AD treated groups separately. Conclusion Various gene expression profiles in breast cancer are associated with the propensity of the tumour to develop distant metastases. Gene expression profile predicting the response of primary breast carcinomas to AC or AD based neoadjuvant chemotherapy are most likely to be very subtle and cannot be detected when small series of patients are studied. Genetic tests derived from gene expression profiling studies are likely to become useful as prognostic and predictive tests to guide clinical decision making in the treatment of primary breast cancer. S2 Gene expression profiles and molecular classification to predict distant metastasis and tamoxifen-resistant breast cancer

Clinical Anatomy, 2004

A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatom... more A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatomical variations in the termination of the thoracic duct may occur, rendering it susceptible to injury. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.5-50%. Herein such a case of postmastectomy chylous fistula and its management are discussed. A 56-year-old postmenopausal woman with invasive duct carcinoma of the left breast underwent modified radical mastectomy with complete axillary clearance (Level I, II, III nodes). The operative procedure was uneventful. On the commencement of a normal diet, however, the patient started exuding milky fluid from the axillary drain and analysis of the fluid revealed biochemical features compatible with chyle. After 2 weeks of failed conservative management, the axilla was re-explored. A continuous flow of clear fluid was observed originating from a single major lymphatic trunk inferior to the axillary vein in the region of the former Level II nodes. The leak was controlled by the application of multiple mass ligatures using 2-0 silk suture. A part of the pectoralis major muscle was rotated and sutured over the area of the leak as additional reinforcement. Suturing a muscle flap over the leak has been described previously and functions theoretically by causing fibrosis. The chylous fistula in the present case was managed successfully with mass ligatures and muscle flap reinforcement.

South Asian Journal of Cancer, 2019

Background: Soft-tissue management around the lower third of the leg and foot presents a challeng... more Background: Soft-tissue management around the lower third of the leg and foot presents a challenge to the surgeon. To achieve local control of tumor, additional surgical margins are required, thus creating large soft-tissue defects. The reverse sural artery flap (RSAF) is a popular option for many of these defects. Materials and Methods: This is a retrospective study of 26 patients who underwent resection of tumor around the lower leg, ankle, and foot, and reconstruction with RSAF was performed at our institute from 2012 to 2018. Results: Among the 26 studied patients, aged between 22 and 71 (mean age: 50.8) years, 5 were female and rest were male. The most common site of involvement by tumor was heel (42.3%), followed by sole (26.9%). The most common histopathological diagnosis was melanoma (61.5%), followed by squamous cell carcinoma (26.9%) and soft-tissue sarcoma (11.5%). Conclusion: The distally based sural flap is a reliable flap for the coverage of soft-tissue defects followi...

Indian Journal of Surgical Oncology

Apocrine adenocarcinoma is an uncommon cutaneous malignant neoplasm arising in the area of high a... more Apocrine adenocarcinoma is an uncommon cutaneous malignant neoplasm arising in the area of high apocrine density. It has male sex predilection, and average age of presentation is 58 years [1]. It is most commonly found in axilla followed by anogenital area, nipple, scalp, face, trunk, acral sites, wrist, fingertip, and lip [2]. They can arise rarely from Moll’s gland of eyelid. Clinically, they present as a slow growing, painless lesion giving a picture of benign entity, which can enlarge rapidly and become tender over time, red to violaceous in color, single/multiple with skin ulceration [3]. It can arise de novo or in presence of benign hyperplastic or adenomatous component [4].

Indian Journal of Surgical Oncology, 2021

Inguinal lymph nodal dissection is notoriously associated with high morbidity. Various risk facto... more Inguinal lymph nodal dissection is notoriously associated with high morbidity. Various risk factors and technical modifications have been described in the past to overcome complications like lymphedema, wound breakdown, and infection which adversely affect the postoperative outcome and quality of life of the patient. This is a retrospective observational study from 1 January 2016 to 31 December 2019 of patients who underwent inguinal/ilio-inguinal block dissection for malignancy. Lymphedema was the most frequent morbidity seen (24%). The mean hospital stay of patients following surgery was 9.7 days (range 4 to 28 days). The inguinal drain was removed on a mean of 17.7 days (range 4 to 21 days), while mean iliac drain removal time was 11.7 days (range 4 to 21 days).

South Asian Journal of Cancer, 2021

Background Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tu... more Background Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tumor. SLN biopsy can be done in lieu of a formal lymphadenectomy in selected clinically node-negative cancers and minimizes morbidity compared with the latter. Methods This prospective study was done in patients with operable clinically node-negative breast cancer, penile cancer, and malignant melanoma of extremities in a cancer center of North-east India from January 2019 to December 2019. All the patients underwent formal lymph nodal dissection after the SLN biopsy. Besides intraoperative frozen section study of the sentinel node(s), all the specimens, including the sentinel node(s), were subjected to paraffin section histopathology. Results SLN was identified successfully in 96% of patients. Mean number of sentinel node(s) dissected was 2.3. Study of SLN biopsy with methylene blue dye for staging was done with 100% sensitivity and 95.3% specificity. The SLN procedure was able to negati...

International Journal of Science and Research (IJSR), 2020

Introduction: Oncoplastic surgery merges the principles of oncology and plastic surgery. Methods:... more Introduction: Oncoplastic surgery merges the principles of oncology and plastic surgery. Methods: A prospective single centre study was done on patients with carcinoma breast for a one year period from 1 st January to 31 st December 2019. Various parameters were noted over time and the results were analyzed using simple statistical methods. Results: Of 248 patients who underwent surgery for carcinoma breast, 64 patients had breast conservation surgery (BCS). The oncoplastic techniques performed were breast tissue advancement flap (Type 1 Oncoplasty) in 49(76.56%), Grisotti flap 2(3%), Benelli technique 3(4.68%) and latissimus dorsi flap 10 (15.62%). The median age of patients was 46.5 years. The median size of tumor was 3.5 cm. At median follow up for 4.4 months (range 1-12 months) patient satisfaction results were excellent based on subjective assessment. Based on an objective assessment according to Harvard Scale, results were excellent in 37(58%), good 17(26.3%), fair 7(10.5%) and poor 3(5.2%). The choice of technique was dependent on achievement of safety margins, breast volume and its ptotic degree. Conclusion: Use of oncoplastic techniques provides rewarding cosmetic results.

South Asian Journal of Cancer, 2020

Background and Aim Carcinoma of the stomach is one of the leading causes of mortality worldwide. ... more Background and Aim Carcinoma of the stomach is one of the leading causes of mortality worldwide. Surgery for gastric cancer in the form of total or distal gastrectomy is definitive treatment. Feeding jejunostomy (FJ) though improves postoperative nutritional status and outcome, it is not devoid of its complications. In this study, we present the outcomes of nasojejunal (NJ) feeding and FJ and complications associated with them. Materials and Methods It is both retrospective and prospective observational study in patients with gastric cancer undergoing surgery. Patients were divided into two groups: those who underwent FJ and those who underwent NJ route of feeding placed intraoperatively. Results A total of 279 patients of gastric cancer who underwent surgery were taken into study, of which, 165 were male and 114 females. FJ was done in 42 and NJ in 237 patients, respectively. Gastrectomy + NJ was done in 128 patients, gastrectomy + FJ in 27 patients, gastrojejunostomy + NJ in 109 p...

JGH Open, 2020

Background and Aim: Lymph node dissection in gastric cancer had been controversial, but recent da... more Background and Aim: Lymph node dissection in gastric cancer had been controversial, but recent data have led us to the conclusion that D-2 dissection should be the standard of care for potentially curable advanced gastric carcinoma. In this study, we present our single-institution experience of D-2 lymph node dissection. Methods: From January 2013 to September 2018, 115 patients of gastric cancer were treated with D-2 gastrectomy, 91 of whom met the criteria for study analysis. Data were statistically described as frequencies and percentages where appropriate. Survival curves were plotted using the Kaplan-Meier method, and Cox regression was used to assess the risk among groups. A P value <0.05 was considered to be statistically significant at 95% confidence interval. Results: The majority of patients (86.8%) had Clavien-Dindo grade I postoperative surgical complications; 90-day mortality was seen in five (5.5%) patients. Patients with stages I, II, and III had survival rates of 100%, 71.4%; 53.2%, 44.4%; and 27.8%, 28.1%, respectively, for ages <55 and >55 years. Overall recurrence free survival rates were 26 and 28% for <55 years and >55 years, respectively, with a P value of 0.570. On multivariate analysis, positive distal margin and multivisceral resection had a statistically significant hazard ratio. Conclusions: This retrospective study conducted in our institute on patients with gastric cancer undergoing D-2 lymphadenectomy has shown that the addition of D-2 lymph node dissection, when performed at high-volume centers, have acceptable morbidity and mortality rates. This can be seen from our grades of postoperative surgical complications, 90-day mortality, and overall 5-year survival.

International Journal of Molecular & Immuno Oncology, 2020

Objectives: Esophageal cancer both squamous cell (SCC) and adenocarcinoma have poor outcomes with... more Objectives: Esophageal cancer both squamous cell (SCC) and adenocarcinoma have poor outcomes with high morbidity and mortality. Our hospital-based registry for the year 2017–2018 showed that esophageal cancer constituted 22.7% of the annual caseload. The main objective of this study was to determine the presence of HER-2 receptors in patients with esophageal carcinoma in our region. Material and Methods: From September 2018 to September 2019, data regarding the expression of HER-2 receptors was analyzed in 133 patients of esophageal carcinoma. Data were statistically described as frequencies (number of cases) and percentages where appropriate. Chi-square and Fischer’s exact test was used to find out the association between categorical variables. A P < 0.05 was considered as statistical significant at 95% confidence interval. The statistical analysis was performed using SSPS software version 17.0. Results: A total of 133 patients were taken into study. The majority of patients wer...

Annals of Coloproctology, 2020

Purpose: Locally advanced colorectal cancer may require an en bloc resection of surrounding organ... more Purpose: Locally advanced colorectal cancer may require an en bloc resection of surrounding organs or structures to achieve complete tumor removal. This decision must weigh the risk of complications of multivisceral resection against the potential survival benefit. The purpose of this study is to review a single-center experience of feasibility of en bloc multivisceral resections for locally advanced colorectal carcinoma and to examine the effect of surgical experience on immediate outcome and rate of R0 resections. Methods: This is a study of 27 patients who underwent multivisceral resection for locally advanced colorectal carcinoma which was performed at our institute from January 2016 to December 2019. Among the 27 patients aged between 21 and 76 years (mean age, 48.67 ± 7.3 years), 13 were males and 14 were females. Overall 18 patients had primary colon carcinoma and 9 had primary rectal carcinoma. All rectal cancer patients received neoadjuvant chemoradiation. All patients underwent surgery with curative intent. All patients underwent open surgery of which 66.7% underwent colectomy, 14.8% underwent anterior resection, 11.1% underwent Miles procedure, and 7.4% underwent pelvic exenteration. Results: The mean operative time was 268.14 ± 72.2 minutes and the median amount of blood units transfused was 2.07 units. The mean hospital stay was 13.67 ± 3.4 days. Histologically, 44.4% of patients had well-differentiated adenocarcinoma and 55.6% had moderately differentiated adenocarcinoma. The final histopathological examinatio n revealed malignant infiltration of the adjacent organs in 19/27 patients (70.4%). Pathological complete response was seen in 2 patients. R0 resection rate achieved was 96.3%. Lymph node metastasis was seen in 66.7% of patients with colon cancer and 11.1% with rectal cancer with overall mean number of harvested lymph nodes being 12.44 ± 3.01. Postoperative complications were identified in 7 patients (25.9%), while mortality was seen in 2 (7.4%). Conclusion: Multivisceral resection for advanced colorectal cancer invading into the adjacent organ may be performed with acceptable morbidity and mortality.

International Surgery Journal, 2019

Background: Breast cancer is one of the most common malignancy among women but it is not common i... more Background: Breast cancer is one of the most common malignancy among women but it is not common in men. Male breast cancer (MBC) is a rare disease and accounts for ∼1% of all cancers in men. There is lack of data related to MBC. The objective was to study the clinic-pathological characteristics and outcome of MBC patients at this institute.Methods: It is a retrospective study. Author analyzed clinico-pathological factors, management and follow up details of all patients with MBC from 2012 to 2018 at the cancer centre.Results: Total 20 patients were included in the study. No risk factor identified in any patient. The median age at diagnosis was 57.5 years. Most common location was central quadrant. Most common stage at presentation was stage 3. Fifteen patients underwent upfront surgery while neoadjuvant chemotherapy was given to two patients. One patient had complete pathological response (cPR). The median follow up was 24 months (4-60 months). Three patients developed local recurre...

Indian Journal of Surgical Oncology, 2019

Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is th... more Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is the cornerstone of treatment and offers the only chance for cure. This study was conducted to assess the outcomes of all resectable gastric cancers that presented to our tertiary cancer center in Northeast India. All patients undergoing upfront surgery for gastric cancer with curative intention between 2012 and 2017 were included in the study. A total of 116 patients who underwent upfront radical gastrectomy were included in the study. Males (58.6%) were more common than females (41.4%). Mean age at presentation was 56.12 years (range 26-89). The most common mode of presentation was pain abdomen (53.8%). The most common location of tumor was the distal part (81%) followed by the proximal part (10.3%). The most commonly done procedure was distal radical gastrectomy (56.9%) followed by subtotal gastrectomy (32.8%). Median number of lymph nodes isolated was 14. Fifty-four patients received adjuvant chemotherapy while 32 patients received adjuvant chemoradiation (CTRT). At a median follow-up of 14 months (range, 2-78 months), overall 5-year survival was 23.75% (mean survival 33.77 months, median survival 24 months). The 5-year survival for stages I-III was 100%, 26.25%, and 11.25%, respectively (P < 0.001). Though perioperative chemotherapy has a role in gastric cancer, it is not the substitute for radical D2 gastrectomy which is still the gold standard treatment especially in high-volume centers.

Clinical Cancer Investigation Journal, 2019

Aim: This study aims to identify the frequency of bacteriobilia, commonly isolated bacteria and t... more Aim: This study aims to identify the frequency of bacteriobilia, commonly isolated bacteria and their antibiotic susceptibility pattern from cancer patients with periampullary carcinoma attending a regional cancer center in the North-East India. Materials and Methods: This was a retrospective 1-year study of patients with obstructive jaundice due to periampullary carcinoma treated between January 2018 and December 2018. Intraoperative bile samples were obtained for microbiological analysis after transection of the common bile duct. Bile specimens were transported to the microbiology laboratory, and processing was done according to the standard protocol used in our clinical microbiology laboratory. Results: Intraoperative bile samples were obtained from 27 patients, and in 21 (77.77%) patients, it was culture positive. Stenting was done in 10 (37.07%) patients, and in those who underwent stenting, microbial contamination of bile was increased significantly (80%) compared to 61.90% in those without stenting. Organisms isolated were Escherichia coli 9 (42.85%), Klebsiella pneumonia 7 (33.33%), Pseudomonas 3 (14.28%), and Enterococcus cloacae 2 (9.52%). Carbapenamase producing E. coli(n = 1) and K. pneumonia (n = 1) was isolated from the two stented patient and one was vancomycin-resistant enterococcus (n = 1). Conclusion: Patients who underwent stenting for periampullary carcinoma had a significant risk for acquiring infection with multidrug-resistant bacteria.

Indian Journal of Surgical Oncology, 2019

Rectal metastasis from primary ovarian cancer is a rare condition. In this case report, we presen... more Rectal metastasis from primary ovarian cancer is a rare condition. In this case report, we present a case of 45-year-old female presented with chief complaint of pain abdomen and vomiting and with on and off history of per rectal bleeding. On examination, patient was pallor, hemoglobin level of 5.5 for which she was admitted. On per rectal examination, there was circumferential rectal growth around 7 cm from anal verge. Imaging was suggestive of ovarian lesion with rectal growth. Biopsy and immunohistochemistry of rectal growth was suggestive of metastatic well-differentiated papillary adenocarcinoma probably of ovarian origin. In view of its rare presentation, we want to report this case.

International Surgery Journal, 2019

Retroperitoneal liposarcoma is a rare malignant disease with a high rate of recurrence. Retroperi... more Retroperitoneal liposarcoma is a rare malignant disease with a high rate of recurrence. Retroperitoneal liposarcoma is usually asymptomatic until the liposarcoma is large enough to compress the surrounding organs and usually presented with compressive symptoms. Main modality of the treatment is surgery both in primary and recurrence cases. Even with complete removal of the liposarcoma, local recurrence rate is very high. Till now, there is currently no evidence that chemotherapy or radiotherapy improve survival rates. Successful complete resection of recurrent retroperitoneal liposarcoma is the sole chance of cure and may increase the 5-year survival rate. In recurrent case, it is challenging for the operating surgeon because of the altered anatomy, adherent to adjacent organs and large vessels and the huge size of the recurrent tumour. The aim of the present study is to report a giant recurrent retroperitoneal liposarcoma and its challenging surgical management.

The majority of breast cancer patients in India present with advanced disease, in whom radical su... more The majority of breast cancer patients in India present with advanced disease, in whom radical surgical extirpation produces large defects that may not be suitable for primary closure. The primary aim in such cases is to achieve an adequate soft tissue cover expeditiously. Various methods have been tried in the past, however, there is no consensus regarding the method of choice in such situations. A retrospective analysis of the breast cancer database of a single surgical unit was done to find out an ideal surgical option in an Indian setting. Forty-five (12.8 %) out of 350 locally advanced breast cancer patients undergoing mastectomy required additional surgical procedures for soft tissue cover. Thoraco-abdominal (TA) flap was utilized for cover in 26 (7.4 %) patients. For patients undergoing TA flap repair, the mean operating time was 35 min, blood loss was 40 ml and hospital stay was 5 days. Only 1 out of 26 patients had a major wound problem, 23 patients received postoperative r...

World Journal of Gastroenterology, 2007

were most significantly downregulated. CONCLUSION: Several genes that showed alterations in our s... more were most significantly downregulated. CONCLUSION: Several genes that showed alterations in our study have also been reported from a high incidence area of esophageal cancer in China. This indicates that molecular profiles of esophageal cancer in these two different geographic locations are highly consistent.

Indian Journal of Surgical Oncology, 2021

In this study, we aimed to compare the surgical volume and outcomes between this COVID-19 period ... more In this study, we aimed to compare the surgical volume and outcomes between this COVID-19 period and data from non-COVID-19 period of last year. A retrospective observational study was done in one single surgical unit of a dedicated oncology center in a peripheral location in India. The comparison was done between patients undergoing major cancer surgery during the COVID-19 pandemic period of 1st April to 30th June 2020, when a nationwide lockdown was in force, to a comparable period of last year. Statistical analysis was done using SPSS software 20.0. A total of 72 patients underwent major cancer surgery during this period, with surgery for breast cancer (n = 26) being the major sub-site operated. This was a significant decrease from the total 209 major cancer surgeries performed during a similar period of last year (2019) (p < 0.05). There were several reasons for the decrease in surgical numbers, including the difficulty in travel and accommodation during the lockdown period. The mean distance of patient's residence from the treating hospital was 45.7 km (range 4 to 165 km). Public transport was in a limbo and interstate travel was restrictive with mandatory quarantine rules in effect. Morbidity associated with major surgeries was observed to be significantly less during the COVID-19 period compared to the pre-COVID-19 times (8.3% vs 17.2% with a p value of < 0.05), which can probably be attributed to the lesser number of complex surgical procedures being performed. There was no significant difference between the total mortality percentages (2.8% vs 3.8%). A total of 156 PPE kits were used (3-4/per patient) throughout the in-hospital care of the surgical patients included in this study. In the midst of a pandemic, the delivery of surgical cancer care is an essential service and although the surgical volume is significantly hampered due to various reasons, the outcomes are largely unaffected.

Breast Cancer Research, 2005

Introduction Prognostic and predictive factors play important roles in the treatment of breast ca... more Introduction Prognostic and predictive factors play important roles in the treatment of breast cancer. Genome-wide monitoring of gene expression using DNA microarrays makes it possible to study thousands of genes in a tumour sample in a single experiment. By looking for an association between the gene expression pattern and tumour behaviour, it should be possible to identify new prognostic and predictive factors. Method We used gene expression profiling using two different microarray platforms: one containing 25,000 oligonucleotide probes and one containing 18,000 cDNA probes. To obtain prognostic gene expression profiles, we isolated RNA from tumours from a series of 295 patients younger than 53 years presenting with stage I and II breast cancer treated at our institute between 1984 and 1993. The expression of 25,000 genes was assessed, and using various statistical approaches correlation of gene expression with distant metastasis-free probability and overall survival was assessed [1-3]. In addition, we started studies to obtain gene expression profiles predicting response to specific chemotherapy regimens. Within a single-institution, randomized phase II trial, patients with locally advanced breast cancer received six courses of either AC (n = 24) or AD (n = 24) containing neoadjuvant chemotherapy. Gene expression profiles for 18,000 genes were generated from core needle biopsies obtained before treatment and correlated with the response of the primary tumour to the chemotherapy administered [4]. Additionally, pretreatment gene expression profiles were compared with those in tumours remaining after chemotherapy. Results We previously identified a 70-gene expression profile associated with increased risk for developing distant metastases within 5 years [1,2]. More recently, we studied a Wound Signature in these same tumors [3]. By combining the 70-gene expression profile to subdivide the tumours into 'good prognosis' and 'poor prognosis' tumours, and the Wound signature to subdivide tumours into 'activated' and 'quiescent' tumours, subgroups of patients with markedly different prognosis can be identified. Additional gene expression signatures are being tested in this series of tumours to arrive at an optimal prognostic classifier and to obtain improved insight into breast cancer biology. In the study to identify predictive profiles, 10 (20%) of the 48 patients showed (near) pathological complete remission of the primary tumour after treatment [4]. No gene expression pattern correlating with response could be identified for all patients, or for the AC or AD treated groups separately. Conclusion Various gene expression profiles in breast cancer are associated with the propensity of the tumour to develop distant metastases. Gene expression profile predicting the response of primary breast carcinomas to AC or AD based neoadjuvant chemotherapy are most likely to be very subtle and cannot be detected when small series of patients are studied. Genetic tests derived from gene expression profiling studies are likely to become useful as prognostic and predictive tests to guide clinical decision making in the treatment of primary breast cancer. S2 Gene expression profiles and molecular classification to predict distant metastasis and tamoxifen-resistant breast cancer

Clinical Anatomy, 2004

A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatom... more A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatomical variations in the termination of the thoracic duct may occur, rendering it susceptible to injury. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.5-50%. Herein such a case of postmastectomy chylous fistula and its management are discussed. A 56-year-old postmenopausal woman with invasive duct carcinoma of the left breast underwent modified radical mastectomy with complete axillary clearance (Level I, II, III nodes). The operative procedure was uneventful. On the commencement of a normal diet, however, the patient started exuding milky fluid from the axillary drain and analysis of the fluid revealed biochemical features compatible with chyle. After 2 weeks of failed conservative management, the axilla was re-explored. A continuous flow of clear fluid was observed originating from a single major lymphatic trunk inferior to the axillary vein in the region of the former Level II nodes. The leak was controlled by the application of multiple mass ligatures using 2-0 silk suture. A part of the pectoralis major muscle was rotated and sutured over the area of the leak as additional reinforcement. Suturing a muscle flap over the leak has been described previously and functions theoretically by causing fibrosis. The chylous fistula in the present case was managed successfully with mass ligatures and muscle flap reinforcement.

South Asian Journal of Cancer, 2019

Background: Soft-tissue management around the lower third of the leg and foot presents a challeng... more Background: Soft-tissue management around the lower third of the leg and foot presents a challenge to the surgeon. To achieve local control of tumor, additional surgical margins are required, thus creating large soft-tissue defects. The reverse sural artery flap (RSAF) is a popular option for many of these defects. Materials and Methods: This is a retrospective study of 26 patients who underwent resection of tumor around the lower leg, ankle, and foot, and reconstruction with RSAF was performed at our institute from 2012 to 2018. Results: Among the 26 studied patients, aged between 22 and 71 (mean age: 50.8) years, 5 were female and rest were male. The most common site of involvement by tumor was heel (42.3%), followed by sole (26.9%). The most common histopathological diagnosis was melanoma (61.5%), followed by squamous cell carcinoma (26.9%) and soft-tissue sarcoma (11.5%). Conclusion: The distally based sural flap is a reliable flap for the coverage of soft-tissue defects followi...

Indian Journal of Surgical Oncology

Apocrine adenocarcinoma is an uncommon cutaneous malignant neoplasm arising in the area of high a... more Apocrine adenocarcinoma is an uncommon cutaneous malignant neoplasm arising in the area of high apocrine density. It has male sex predilection, and average age of presentation is 58 years [1]. It is most commonly found in axilla followed by anogenital area, nipple, scalp, face, trunk, acral sites, wrist, fingertip, and lip [2]. They can arise rarely from Moll’s gland of eyelid. Clinically, they present as a slow growing, painless lesion giving a picture of benign entity, which can enlarge rapidly and become tender over time, red to violaceous in color, single/multiple with skin ulceration [3]. It can arise de novo or in presence of benign hyperplastic or adenomatous component [4].

Indian Journal of Surgical Oncology, 2021

Inguinal lymph nodal dissection is notoriously associated with high morbidity. Various risk facto... more Inguinal lymph nodal dissection is notoriously associated with high morbidity. Various risk factors and technical modifications have been described in the past to overcome complications like lymphedema, wound breakdown, and infection which adversely affect the postoperative outcome and quality of life of the patient. This is a retrospective observational study from 1 January 2016 to 31 December 2019 of patients who underwent inguinal/ilio-inguinal block dissection for malignancy. Lymphedema was the most frequent morbidity seen (24%). The mean hospital stay of patients following surgery was 9.7 days (range 4 to 28 days). The inguinal drain was removed on a mean of 17.7 days (range 4 to 21 days), while mean iliac drain removal time was 11.7 days (range 4 to 21 days).

South Asian Journal of Cancer, 2021

Background Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tu... more Background Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tumor. SLN biopsy can be done in lieu of a formal lymphadenectomy in selected clinically node-negative cancers and minimizes morbidity compared with the latter. Methods This prospective study was done in patients with operable clinically node-negative breast cancer, penile cancer, and malignant melanoma of extremities in a cancer center of North-east India from January 2019 to December 2019. All the patients underwent formal lymph nodal dissection after the SLN biopsy. Besides intraoperative frozen section study of the sentinel node(s), all the specimens, including the sentinel node(s), were subjected to paraffin section histopathology. Results SLN was identified successfully in 96% of patients. Mean number of sentinel node(s) dissected was 2.3. Study of SLN biopsy with methylene blue dye for staging was done with 100% sensitivity and 95.3% specificity. The SLN procedure was able to negati...

International Journal of Science and Research (IJSR), 2020

Introduction: Oncoplastic surgery merges the principles of oncology and plastic surgery. Methods:... more Introduction: Oncoplastic surgery merges the principles of oncology and plastic surgery. Methods: A prospective single centre study was done on patients with carcinoma breast for a one year period from 1 st January to 31 st December 2019. Various parameters were noted over time and the results were analyzed using simple statistical methods. Results: Of 248 patients who underwent surgery for carcinoma breast, 64 patients had breast conservation surgery (BCS). The oncoplastic techniques performed were breast tissue advancement flap (Type 1 Oncoplasty) in 49(76.56%), Grisotti flap 2(3%), Benelli technique 3(4.68%) and latissimus dorsi flap 10 (15.62%). The median age of patients was 46.5 years. The median size of tumor was 3.5 cm. At median follow up for 4.4 months (range 1-12 months) patient satisfaction results were excellent based on subjective assessment. Based on an objective assessment according to Harvard Scale, results were excellent in 37(58%), good 17(26.3%), fair 7(10.5%) and poor 3(5.2%). The choice of technique was dependent on achievement of safety margins, breast volume and its ptotic degree. Conclusion: Use of oncoplastic techniques provides rewarding cosmetic results.

South Asian Journal of Cancer, 2020

Background and Aim Carcinoma of the stomach is one of the leading causes of mortality worldwide. ... more Background and Aim Carcinoma of the stomach is one of the leading causes of mortality worldwide. Surgery for gastric cancer in the form of total or distal gastrectomy is definitive treatment. Feeding jejunostomy (FJ) though improves postoperative nutritional status and outcome, it is not devoid of its complications. In this study, we present the outcomes of nasojejunal (NJ) feeding and FJ and complications associated with them. Materials and Methods It is both retrospective and prospective observational study in patients with gastric cancer undergoing surgery. Patients were divided into two groups: those who underwent FJ and those who underwent NJ route of feeding placed intraoperatively. Results A total of 279 patients of gastric cancer who underwent surgery were taken into study, of which, 165 were male and 114 females. FJ was done in 42 and NJ in 237 patients, respectively. Gastrectomy + NJ was done in 128 patients, gastrectomy + FJ in 27 patients, gastrojejunostomy + NJ in 109 p...

JGH Open, 2020

Background and Aim: Lymph node dissection in gastric cancer had been controversial, but recent da... more Background and Aim: Lymph node dissection in gastric cancer had been controversial, but recent data have led us to the conclusion that D-2 dissection should be the standard of care for potentially curable advanced gastric carcinoma. In this study, we present our single-institution experience of D-2 lymph node dissection. Methods: From January 2013 to September 2018, 115 patients of gastric cancer were treated with D-2 gastrectomy, 91 of whom met the criteria for study analysis. Data were statistically described as frequencies and percentages where appropriate. Survival curves were plotted using the Kaplan-Meier method, and Cox regression was used to assess the risk among groups. A P value <0.05 was considered to be statistically significant at 95% confidence interval. Results: The majority of patients (86.8%) had Clavien-Dindo grade I postoperative surgical complications; 90-day mortality was seen in five (5.5%) patients. Patients with stages I, II, and III had survival rates of 100%, 71.4%; 53.2%, 44.4%; and 27.8%, 28.1%, respectively, for ages <55 and >55 years. Overall recurrence free survival rates were 26 and 28% for <55 years and >55 years, respectively, with a P value of 0.570. On multivariate analysis, positive distal margin and multivisceral resection had a statistically significant hazard ratio. Conclusions: This retrospective study conducted in our institute on patients with gastric cancer undergoing D-2 lymphadenectomy has shown that the addition of D-2 lymph node dissection, when performed at high-volume centers, have acceptable morbidity and mortality rates. This can be seen from our grades of postoperative surgical complications, 90-day mortality, and overall 5-year survival.

International Journal of Molecular & Immuno Oncology, 2020

Objectives: Esophageal cancer both squamous cell (SCC) and adenocarcinoma have poor outcomes with... more Objectives: Esophageal cancer both squamous cell (SCC) and adenocarcinoma have poor outcomes with high morbidity and mortality. Our hospital-based registry for the year 2017–2018 showed that esophageal cancer constituted 22.7% of the annual caseload. The main objective of this study was to determine the presence of HER-2 receptors in patients with esophageal carcinoma in our region. Material and Methods: From September 2018 to September 2019, data regarding the expression of HER-2 receptors was analyzed in 133 patients of esophageal carcinoma. Data were statistically described as frequencies (number of cases) and percentages where appropriate. Chi-square and Fischer’s exact test was used to find out the association between categorical variables. A P < 0.05 was considered as statistical significant at 95% confidence interval. The statistical analysis was performed using SSPS software version 17.0. Results: A total of 133 patients were taken into study. The majority of patients wer...

Annals of Coloproctology, 2020

Purpose: Locally advanced colorectal cancer may require an en bloc resection of surrounding organ... more Purpose: Locally advanced colorectal cancer may require an en bloc resection of surrounding organs or structures to achieve complete tumor removal. This decision must weigh the risk of complications of multivisceral resection against the potential survival benefit. The purpose of this study is to review a single-center experience of feasibility of en bloc multivisceral resections for locally advanced colorectal carcinoma and to examine the effect of surgical experience on immediate outcome and rate of R0 resections. Methods: This is a study of 27 patients who underwent multivisceral resection for locally advanced colorectal carcinoma which was performed at our institute from January 2016 to December 2019. Among the 27 patients aged between 21 and 76 years (mean age, 48.67 ± 7.3 years), 13 were males and 14 were females. Overall 18 patients had primary colon carcinoma and 9 had primary rectal carcinoma. All rectal cancer patients received neoadjuvant chemoradiation. All patients underwent surgery with curative intent. All patients underwent open surgery of which 66.7% underwent colectomy, 14.8% underwent anterior resection, 11.1% underwent Miles procedure, and 7.4% underwent pelvic exenteration. Results: The mean operative time was 268.14 ± 72.2 minutes and the median amount of blood units transfused was 2.07 units. The mean hospital stay was 13.67 ± 3.4 days. Histologically, 44.4% of patients had well-differentiated adenocarcinoma and 55.6% had moderately differentiated adenocarcinoma. The final histopathological examinatio n revealed malignant infiltration of the adjacent organs in 19/27 patients (70.4%). Pathological complete response was seen in 2 patients. R0 resection rate achieved was 96.3%. Lymph node metastasis was seen in 66.7% of patients with colon cancer and 11.1% with rectal cancer with overall mean number of harvested lymph nodes being 12.44 ± 3.01. Postoperative complications were identified in 7 patients (25.9%), while mortality was seen in 2 (7.4%). Conclusion: Multivisceral resection for advanced colorectal cancer invading into the adjacent organ may be performed with acceptable morbidity and mortality.

International Surgery Journal, 2019

Background: Breast cancer is one of the most common malignancy among women but it is not common i... more Background: Breast cancer is one of the most common malignancy among women but it is not common in men. Male breast cancer (MBC) is a rare disease and accounts for ∼1% of all cancers in men. There is lack of data related to MBC. The objective was to study the clinic-pathological characteristics and outcome of MBC patients at this institute.Methods: It is a retrospective study. Author analyzed clinico-pathological factors, management and follow up details of all patients with MBC from 2012 to 2018 at the cancer centre.Results: Total 20 patients were included in the study. No risk factor identified in any patient. The median age at diagnosis was 57.5 years. Most common location was central quadrant. Most common stage at presentation was stage 3. Fifteen patients underwent upfront surgery while neoadjuvant chemotherapy was given to two patients. One patient had complete pathological response (cPR). The median follow up was 24 months (4-60 months). Three patients developed local recurre...

Indian Journal of Surgical Oncology, 2019

Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is th... more Gastric cancer (GC) is common in the northeast and southern parts of India. Radical surgery is the cornerstone of treatment and offers the only chance for cure. This study was conducted to assess the outcomes of all resectable gastric cancers that presented to our tertiary cancer center in Northeast India. All patients undergoing upfront surgery for gastric cancer with curative intention between 2012 and 2017 were included in the study. A total of 116 patients who underwent upfront radical gastrectomy were included in the study. Males (58.6%) were more common than females (41.4%). Mean age at presentation was 56.12 years (range 26-89). The most common mode of presentation was pain abdomen (53.8%). The most common location of tumor was the distal part (81%) followed by the proximal part (10.3%). The most commonly done procedure was distal radical gastrectomy (56.9%) followed by subtotal gastrectomy (32.8%). Median number of lymph nodes isolated was 14. Fifty-four patients received adjuvant chemotherapy while 32 patients received adjuvant chemoradiation (CTRT). At a median follow-up of 14 months (range, 2-78 months), overall 5-year survival was 23.75% (mean survival 33.77 months, median survival 24 months). The 5-year survival for stages I-III was 100%, 26.25%, and 11.25%, respectively (P < 0.001). Though perioperative chemotherapy has a role in gastric cancer, it is not the substitute for radical D2 gastrectomy which is still the gold standard treatment especially in high-volume centers.

Clinical Cancer Investigation Journal, 2019

Aim: This study aims to identify the frequency of bacteriobilia, commonly isolated bacteria and t... more Aim: This study aims to identify the frequency of bacteriobilia, commonly isolated bacteria and their antibiotic susceptibility pattern from cancer patients with periampullary carcinoma attending a regional cancer center in the North-East India. Materials and Methods: This was a retrospective 1-year study of patients with obstructive jaundice due to periampullary carcinoma treated between January 2018 and December 2018. Intraoperative bile samples were obtained for microbiological analysis after transection of the common bile duct. Bile specimens were transported to the microbiology laboratory, and processing was done according to the standard protocol used in our clinical microbiology laboratory. Results: Intraoperative bile samples were obtained from 27 patients, and in 21 (77.77%) patients, it was culture positive. Stenting was done in 10 (37.07%) patients, and in those who underwent stenting, microbial contamination of bile was increased significantly (80%) compared to 61.90% in those without stenting. Organisms isolated were Escherichia coli 9 (42.85%), Klebsiella pneumonia 7 (33.33%), Pseudomonas 3 (14.28%), and Enterococcus cloacae 2 (9.52%). Carbapenamase producing E. coli(n = 1) and K. pneumonia (n = 1) was isolated from the two stented patient and one was vancomycin-resistant enterococcus (n = 1). Conclusion: Patients who underwent stenting for periampullary carcinoma had a significant risk for acquiring infection with multidrug-resistant bacteria.

Indian Journal of Surgical Oncology, 2019

Rectal metastasis from primary ovarian cancer is a rare condition. In this case report, we presen... more Rectal metastasis from primary ovarian cancer is a rare condition. In this case report, we present a case of 45-year-old female presented with chief complaint of pain abdomen and vomiting and with on and off history of per rectal bleeding. On examination, patient was pallor, hemoglobin level of 5.5 for which she was admitted. On per rectal examination, there was circumferential rectal growth around 7 cm from anal verge. Imaging was suggestive of ovarian lesion with rectal growth. Biopsy and immunohistochemistry of rectal growth was suggestive of metastatic well-differentiated papillary adenocarcinoma probably of ovarian origin. In view of its rare presentation, we want to report this case.

International Surgery Journal, 2019

Retroperitoneal liposarcoma is a rare malignant disease with a high rate of recurrence. Retroperi... more Retroperitoneal liposarcoma is a rare malignant disease with a high rate of recurrence. Retroperitoneal liposarcoma is usually asymptomatic until the liposarcoma is large enough to compress the surrounding organs and usually presented with compressive symptoms. Main modality of the treatment is surgery both in primary and recurrence cases. Even with complete removal of the liposarcoma, local recurrence rate is very high. Till now, there is currently no evidence that chemotherapy or radiotherapy improve survival rates. Successful complete resection of recurrent retroperitoneal liposarcoma is the sole chance of cure and may increase the 5-year survival rate. In recurrent case, it is challenging for the operating surgeon because of the altered anatomy, adherent to adjacent organs and large vessels and the huge size of the recurrent tumour. The aim of the present study is to report a giant recurrent retroperitoneal liposarcoma and its challenging surgical management.

The majority of breast cancer patients in India present with advanced disease, in whom radical su... more The majority of breast cancer patients in India present with advanced disease, in whom radical surgical extirpation produces large defects that may not be suitable for primary closure. The primary aim in such cases is to achieve an adequate soft tissue cover expeditiously. Various methods have been tried in the past, however, there is no consensus regarding the method of choice in such situations. A retrospective analysis of the breast cancer database of a single surgical unit was done to find out an ideal surgical option in an Indian setting. Forty-five (12.8 %) out of 350 locally advanced breast cancer patients undergoing mastectomy required additional surgical procedures for soft tissue cover. Thoraco-abdominal (TA) flap was utilized for cover in 26 (7.4 %) patients. For patients undergoing TA flap repair, the mean operating time was 35 min, blood loss was 40 ml and hospital stay was 5 days. Only 1 out of 26 patients had a major wound problem, 23 patients received postoperative r...

World Journal of Gastroenterology, 2007

were most significantly downregulated. CONCLUSION: Several genes that showed alterations in our s... more were most significantly downregulated. CONCLUSION: Several genes that showed alterations in our study have also been reported from a high incidence area of esophageal cancer in China. This indicates that molecular profiles of esophageal cancer in these two different geographic locations are highly consistent.