Purpose: Purpose of the present study is to report our technique of the use of percutaneous endos... more Purpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer. Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group. Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-specific complications. The rate of ...
BACKGROUND Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagec... more BACKGROUND Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagectomy with poorly understood risk factors. It has a high morbidity due to loss of fluids, electrolytes, and other nutrients, loss of lymphocytes and immune dysfunction. METHODS Retrospective chart review of adult patients who underwent esophagectomy between 2009 and 2016 was performed. Cases with chyle leak were identified according to a set criteria. Clinical features, operative findings and postoperative variables were recorded and predictors of chyle leak were analyzed. RESULTS During the study period, a total of 193 adult patients underwent esophagectomy of which 186 received neo adjuvant chemotherapy. The mean age was 53 years with 118 males and 74 females. Type of procedure performed was 3-stage esophagectomy in 98, Transhiatal esophagectomy in 79 and Ivor-Lewis esophagectomy in 15 patients. Chyle leak was identified in 9 (4.6%) patients. There was no significant association of chyl...
Objectives: We looked at risk factors and patterns of recurrence following surgical treatment of ... more Objectives: We looked at risk factors and patterns of recurrence following surgical treatment of Gastro-Oesophageal Junction carcinoma (GOJC). Methods: Electronic medical records of patients with GOJC undergoing resection with curative intent between Jan 2009 and June 2017 at Shaukat Khanum Memorial Cancer Hospital were reviewed. GOJ cancer was classified as per Siewert classification. Clinical and operative details were studied and data was analysed using SPSS 20. Results: During the study period, we identified 78 patients with GOJ adenocarcinoma (38 patients with GOJ Type-I, 16 with Type-II tumors and 24 patients with GOJ Type-III tumors). Median age was 56 years ± 1.1. Male to female distribution was 72 versus 28%. Carbo-Pacli /5-FU based XRT verses Magic protocol (p<0.015) and advanced pathological T.-stage (p-value<0.032) were found to be statistically significant risk factors for recurrence. After a median follow up of 17.8 months+/- 1.5, 20 patients developed recurrence...
Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatme... more Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual's PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14-5.11), and 3.48 for micro-multifocal PTMC (CI ...
There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our... more There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer. The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute. All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Cl...
Purpose: Purpose of the present study is to report our technique of the use of percutaneous endos... more Purpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer.Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group.Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-speci c complications. The rate of pro...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To conduct a meta-analysis of reported evidence on surgical management for symptomatic ... more OBJECTIVE To conduct a meta-analysis of reported evidence on surgical management for symptomatic giant liver hemangiomas. METHODOLOGY A systematic literature search was conducted to identify studies on adult patient surgeries for symptomatic giant liver hemangiomas from January 2009 to July 2015. The primary outcome measures included postoperative symptom resolution, mortality, complications, and blood transfusions. Quality of life after surgery was taken as a secondary outcome. Meta-analysis was performed using a random-effect model with comprehensive meta-analysis software. RESULTS Fourteen studies with 1,557 patients were included. There were only two mortalities. Overall event rate for minor and major complications was low as 0.15 and 0.14, respectively, with a high symptom resolution rate of 0.69 (95%, CI 0.64-0.73). Pooled analysis for blood transfusion stayed insignificant due to high calculated heterogeneity across studies. Quality of life results after surgery are reported ...
Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal canc... more Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal cancer. The aim of this retrospective study is to analyze the oncologic adequacy of these two procedures at our Centre. Out of 1252 registered esophageal cancer patients at our institute from 2006 to 2015, 206 patients who underwent a surgical resection with curative intent and a complete medical record were retrospectively evaluated thru hospital medical record system (HIS). Patients were allocated into the conventional open OE, and minimally invasive MIE and Hybrid esophagectomy groups. Primary outcomes are tumor recurrence and disease-free survival over a minimum follow-up of 1 year along with assessment of adequacy of pathological specimen in terms of lymph nodes harvested and clear longitudinal &amp;amp;lt;1 cm and circumferential (≥1 mm) resection margins for patients with post-neo-adjuvant residual disease. Secondary endpoint is to look for trends in the adequacy of oncologic clearance in each group over the study period. Overall, there was no statistically significant difference (p &amp;amp;gt; 0.05) between groups (OE vs. MIE vs. Hybrid) for median number of lymph nodes retrieved (13 vs.14 vs.15), resection margin positive disease (55.8 vs. 35.7 vs. 44 % of patients with any residual disease N = 103,50 %), or tumor recurrence (45.2 vs. 37.3 vs. 25 %). Disease-free survival over a mean follow-up of 2.3 years was higher in the conventional group (13.8 months vs. 9.7MIE and 11.8hybrid) without any statistical significance. Learning curve for MIE to achieve a comparable mean lymph nodes harvest to OE was 1 year, while pathological complete resection stayed persistently better with minimally invasive approach. Minimally invasive esophagectomy is found to be oncologically adequate and gives results matching their conventional analogue with an increasing experience.
Purpose: Purpose of the present study is to report our technique of the use of percutaneous endos... more Purpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer. Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group. Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-specific complications. The rate of ...
BACKGROUND Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagec... more BACKGROUND Chylothorax is an uncommon (3-8% risk) but potentially fatal complication of esophagectomy with poorly understood risk factors. It has a high morbidity due to loss of fluids, electrolytes, and other nutrients, loss of lymphocytes and immune dysfunction. METHODS Retrospective chart review of adult patients who underwent esophagectomy between 2009 and 2016 was performed. Cases with chyle leak were identified according to a set criteria. Clinical features, operative findings and postoperative variables were recorded and predictors of chyle leak were analyzed. RESULTS During the study period, a total of 193 adult patients underwent esophagectomy of which 186 received neo adjuvant chemotherapy. The mean age was 53 years with 118 males and 74 females. Type of procedure performed was 3-stage esophagectomy in 98, Transhiatal esophagectomy in 79 and Ivor-Lewis esophagectomy in 15 patients. Chyle leak was identified in 9 (4.6%) patients. There was no significant association of chyl...
Objectives: We looked at risk factors and patterns of recurrence following surgical treatment of ... more Objectives: We looked at risk factors and patterns of recurrence following surgical treatment of Gastro-Oesophageal Junction carcinoma (GOJC). Methods: Electronic medical records of patients with GOJC undergoing resection with curative intent between Jan 2009 and June 2017 at Shaukat Khanum Memorial Cancer Hospital were reviewed. GOJ cancer was classified as per Siewert classification. Clinical and operative details were studied and data was analysed using SPSS 20. Results: During the study period, we identified 78 patients with GOJ adenocarcinoma (38 patients with GOJ Type-I, 16 with Type-II tumors and 24 patients with GOJ Type-III tumors). Median age was 56 years ± 1.1. Male to female distribution was 72 versus 28%. Carbo-Pacli /5-FU based XRT verses Magic protocol (p<0.015) and advanced pathological T.-stage (p-value<0.032) were found to be statistically significant risk factors for recurrence. After a median follow up of 17.8 months+/- 1.5, 20 patients developed recurrence...
Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatme... more Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual's PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14-5.11), and 3.48 for micro-multifocal PTMC (CI ...
There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our... more There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer. The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute. All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Cl...
Purpose: Purpose of the present study is to report our technique of the use of percutaneous endos... more Purpose: Purpose of the present study is to report our technique of the use of percutaneous endoscopic gastrostomy (PEG) site excision biopsy wound, for specimen retrieval and gastric conduit formation, in minimally invasive oesophagectomy for oesophageal cancer.Methods: It is a retrospective comparative study where we present data of our 100 resectable oesophageal cancer patients who underwent postneoadjuvant minimally invasive oesophagectomy from January 2012 to September 2015. All of the patients had an initial staging endoscopic ultrasound with PEG placement. The prestudy (conventional) approach, i.e., laparoscopic gastric conduit formation along with specimen pull up from the cervical/thoracic wound is compared to the present (Study) group.Results: The two groups were similar for basic demographic variables, tumour stage, morphology and nutritional status. The primary endpoints were an operative time in minutes and any additional procedure-speci c complications. The rate of pro...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To conduct a meta-analysis of reported evidence on surgical management for symptomatic ... more OBJECTIVE To conduct a meta-analysis of reported evidence on surgical management for symptomatic giant liver hemangiomas. METHODOLOGY A systematic literature search was conducted to identify studies on adult patient surgeries for symptomatic giant liver hemangiomas from January 2009 to July 2015. The primary outcome measures included postoperative symptom resolution, mortality, complications, and blood transfusions. Quality of life after surgery was taken as a secondary outcome. Meta-analysis was performed using a random-effect model with comprehensive meta-analysis software. RESULTS Fourteen studies with 1,557 patients were included. There were only two mortalities. Overall event rate for minor and major complications was low as 0.15 and 0.14, respectively, with a high symptom resolution rate of 0.69 (95%, CI 0.64-0.73). Pooled analysis for blood transfusion stayed insignificant due to high calculated heterogeneity across studies. Quality of life results after surgery are reported ...
Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal canc... more Minimally invasive esophagectomy is becoming the routine procedure for resectable esophageal cancer. The aim of this retrospective study is to analyze the oncologic adequacy of these two procedures at our Centre. Out of 1252 registered esophageal cancer patients at our institute from 2006 to 2015, 206 patients who underwent a surgical resection with curative intent and a complete medical record were retrospectively evaluated thru hospital medical record system (HIS). Patients were allocated into the conventional open OE, and minimally invasive MIE and Hybrid esophagectomy groups. Primary outcomes are tumor recurrence and disease-free survival over a minimum follow-up of 1 year along with assessment of adequacy of pathological specimen in terms of lymph nodes harvested and clear longitudinal &amp;amp;lt;1 cm and circumferential (≥1 mm) resection margins for patients with post-neo-adjuvant residual disease. Secondary endpoint is to look for trends in the adequacy of oncologic clearance in each group over the study period. Overall, there was no statistically significant difference (p &amp;amp;gt; 0.05) between groups (OE vs. MIE vs. Hybrid) for median number of lymph nodes retrieved (13 vs.14 vs.15), resection margin positive disease (55.8 vs. 35.7 vs. 44 % of patients with any residual disease N = 103,50 %), or tumor recurrence (45.2 vs. 37.3 vs. 25 %). Disease-free survival over a mean follow-up of 2.3 years was higher in the conventional group (13.8 months vs. 9.7MIE and 11.8hybrid) without any statistical significance. Learning curve for MIE to achieve a comparable mean lymph nodes harvest to OE was 1 year, while pathological complete resection stayed persistently better with minimally invasive approach. Minimally invasive esophagectomy is found to be oncologically adequate and gives results matching their conventional analogue with an increasing experience.
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