Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy, an Update From the International PSOGI Registry.

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal surface malignancies, traditionally performed via laparotomy. Recent advancements in laparoscopic approaches (L-CRS + HIPEC) have shown promising results in selected patients.

Methods: The PSOGI registry, established in November 2019, collects data from specialized centers performing L-CRS + HIPEC.

Impact of Previous Abdominal Surgery and Timing of Peritoneal Metastases on Accuracy of Imaging in Predicting the Surgical PCI: A Report From the PRECINCT Study.

Background And Aim: In this report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, a correlation was performed between the radiological PCI (peritoneal cancer index; rPCI) and surgical PCI (sPCI). The impact of timing of peritoneal malignancy (PM) and previous abdominal surgery was also studied.

Methods: The rPCI and sPCI were considered the 'same' if they differed by ≤ 3 points.

Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience.

Purpose: The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022-2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.

Outcomes of underwater endoscopic mucosal resection for colorectal polyps-Insights from western India.

Introduction: Underwater endoscopic mucosal resection (uEMR) represents an alternative to conventional EMR for resection of sessile colorectal polyps. We aimed at assessing the efficacy and safety of uEMR for sessile colorectal polyps.

Methods: A retrospective analysis of endoscopy database was done for patients who underwent uEMR for sessile colorectal polyps more than 10 mm in size without any features of sub-mucosal invasion from two tertiary care centres in western India between January 2021 and June 2023.

Utility of Microvascular Reconstruction in Gastrointestinal Cancer Surgery During Complex Resections and Emergency Salvage.

Major gastrointestinal surgical resections and subsequent reconstruction can occasionally need arterial or venous resection, can encounter variant anatomy, or may lead to injury to vessels. These can lead to arterial and/or venous insufficiency of viscera like the stomach, liver, colon, or spleen. Left unaddressed, these can lead to, partial or total, organ ischemia or necrosis.

Flow-Through Radial Artery Forearm Flap for Tongue Revascularization After Excision of Base of Tongue Malignancies.

Tongue cancers are common in the spectrum of oral malignancies. In base of tongue cancers, tumour excision might lead to injury of ipsilateral or both lingual arteries, leading to ischemia of residual, native tongue. Free radial artery forearm flap is commonly used for tongue reconstruction.

Long-Term Outcomes of Recurrent Laryngeal Nerve Repair/Reconstruction in Oncological Settings.

Vocal cord paralysis results from involvement of the recurrent laryngeal nerve (RLN), either before the surgery or following excision. Coaptation of the resected edges utilising microsurgical techniques is the most promising therapeutic strategy available for RLN excision. The RLN can be repaired by direct epineural coaptation or using nerve grafts adhering to recommended microsurgical techniques.

Identification of Wandering Masses and Tumor Heterogeneity on Ga-DOTATATE and F-FDG PET/CT in Metastatic Grade II Neuroendocrine Tumor with Increased Somatostatin Receptor Expression After Combined Chemotherapy and PRRT.

Neuroendocrine tumors (NETs) may manifest as large masses in the abdominopelvic region that exhibit mobility and shifting, potentially leading to diagnostic uncertainty both before and after treatment. A meticulous analysis of PET/CT scans is advantageous in accurately identifying the precise location of large abdominopelvic masses. Tumor heterogeneity may be present in NETs with large abdominopelvic masses and may be easily identified on dual-tracer (Ga-DOTATATE and F-FDG) PET/CT scans.

Gross Evaluation of Breast Carcinomas Post-Neoadjuvant Chemotherapy Without Radio-opaque Clip Insertion.

Context.—: Gross evaluation of post-neoadjuvant chemotherapy breast carcinoma is challenging when the primary tumor is not localized before therapy with a radio-opaque wire/clip, a situation common in resource-constrained settings.

Objective.

The Indian Society of Critical Care Medicine Position Statement on the Management of Sepsis in Resource-limited Settings.

Unlabelled: Sepsis poses a significant global health challenge in low- and middle-income countries (LMICs). Several aspects of sepsis management recommended in international guidelines are often difficult or impossible to implement in resource-limited settings (RLS) due to issues related to cost, infrastructure, or lack of trained healthcare workers. The Indian Society of Critical Care Medicine (ISCCM) drafted a position statement for the management of sepsis in RLS focusing on India, facilitated by a task force of 18 intensivists using a Delphi process, to achieve consensus on various aspects of sepsis management which are challenging to implement in RLS.

Guidelines for Antibiotics Prescription in Critically Ill Patients.

Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.

Think Globally, Adapt Locally: The ISCCM Guidelines and Position Statements.

Myatra SN, Peter JV, Juneja D, Kulkarni AP. Think Globally, Adapt Locally: The ISCCM Guidelines and Position Statements. Indian J Crit Care Med 2024;28(S2):S1-S3.

ISCCM Position Statement for Improving Gender Balance in Critical Care Medicine.

Unlabelled: Gender disparity in Critical Care Medicine (CCM) persists globally, with women being underrepresented. Female Intensivists remain a minority, facing challenges in academic and leadership positions at the workplace and within academic societies. The Indian Society of Critical Care Medicine (ISCCM) recognized the need for addressing issues related to gender parity and constituted its first Diversity Equity and Inclusion (DEI) Committee in 2023.

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with biliary tract cancer.

The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with biliary tract cancer (BTC), published in late 2022 were adapted in December 2023, according to established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with BTC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with BTC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and the Taiwan Oncology Society (TOS). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different regions of Asia.

Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis.

Background: Endoscopic treatment of refractory pancreatic duct (PD) strictures includes the placement of multiple plastic stents. Recent studies have shown the benefit of fully covered self-expandable metal stents (FCSEMS). This systematic review analyzes the efficacy and safety of FCSEMS in PD strictures.

Phase III randomized trial comparing neoadjuvant paclitaxel plus platinum with 5-fluorouracil plus platinum in esophageal or gastroesophageal junction squamous cell carcinoma.

Background: Standard neoadjuvant chemotherapy for locally advanced esophageal or gastroesophageal junction squamous cancer, 5-fluorouracil plus platinum, is toxic and logistically challenging; alternative regimens are needed.

Methods: This was a phase III randomized open-label noninferiority trial at Tata Memorial Center, India, in resectable locally advanced esophageal or gastroesophageal junction squamous cancer. Patients were randomly assigned 1:1 to 3 cycles of 3-weekly platinum (cisplatin 75 mg/m2 or carboplatin area under the curve 6) with paclitaxel 175 mg/m2 (day 1) or 5-fluorouracil 1000 mg/m2 continuous infusion (days 1-4), followed by surgery.

Robotic radical thymectomy-right-sided approach for a thymoma.

The utilization of a radical robotic thymectomy, with clearance of the mediastinal tissue between the two phrenic nerves for a thymoma, is well established. The complex mediastinal anatomy, limited space and the location of the heart introduce a distinctive challenge, particularly when adopting a right-sided approach to identify and dissect along the left phrenic nerve. We present our technique for performing a robotic radical thymectomy from a right-sided approach, tailored for a localized thymoma.

Acute kidney injury after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy - A systematic review.

The use of nephrotoxic chemotherapeutic agents during hyperthermic intraperitoneal chemotherapy (HIPEC), carries the risk of postoperative acute kidney injury (AKI). The available evidence on this subject is sparse with variability in the reported incidence of AKI. In this systematic review, the aim was to analyse the incidence, risk factors, and preventive measures for AKI after cytoreductive surgery and HIPEC.

Magnetic Resonance Imaging Features of Sporadic Optic Chiasmatic-Hypothalamic Gliomas and Correlation with Histopathology and BRAF Gene Alterations.

Objective: Sporadic optic chiasmatic-hypothalamic gliomas (OCHGs), though histologically low-grade tumors, manifest as aggressive neoplasms radiologically, leading to difficulty in diagnosis. Molecular alterations of the BRAF gene are detectable in a majority of sporadic OCHGs. The purpose of our study was to elucidate the characteristic imaging features of sporadic OCHGs and to investigate whether imaging phenotypes could potentially correlate with specific BRAF gene alterations associated with these tumors.

Dose estimation in patients from different protocols of 18F-FDG PET/CT studies and analysis of optimization strategies.

This study aimed to evaluate the dose in different protocols of 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) procedure. The retrospective study involves 207 patients with confirmed malignancies who underwent PET/CT. Effective dose (E) from PET was estimated based on injected activity and dose coefficient as per International Commission on Radiation Protection (ICRP) 128.

Structural Quality Indicators in Radiation Oncology: Insights and Implications.

Aims: Over the past two decades, significant progress has been made in the development of quality indicators (QIs) within the field of radiotherapy (RT). However, most of the literature has predominantly focused on process and outcome-related QIs, with limited attention given to structural QIs. This review aims to address this gap by providing insights into structural QIs in RT and examining the complexities and considerations involved in establishing universal standards for these indicators across RT facilities globally.

Direct radiolabeling of Folate with Tc-99m using QbD approach: A step closer to folate based diagnostic agent.

The aim of the presented work was to develop folate based radiolabeled compound intended to be used as diagnostic aid for the various folate-receptor overexpressing cancers eg. breast cancer, brain tumors, lung cancer etc. Folate was directly radiolabeled with Tc-99m using Quality-by-Design and encapsulated in micellar nanocarriers.

Postoperative Complications Result in Poor Oncological Outcomes: What Is the Evidence?

The majority of patients with solid tumors undergo a curative resection of their tumor burden. However, the reported rate of postoperative complications varies widely, ranging from 10% to 70%. This narrative review aims to determine the impact of postoperative complications on recurrence and overall survival rates following elective cancer surgeries, thereby providing valuable insights into perioperative cancer care.