Bøger af M. D. Ray

In our study, we compared the immediate surgical outcomes of HIPEC and EPIC in patients with Ovarian cancer spread to the peritoneal cavity undergoing cytoreductive surgery. This comparison can help in feasibility assessment for future prospective trials comparing the outcomes of both modalities and establishing and standardizing protocols for both the interventions. This study also helps in placing EPIC in the treatment algorithm of peritoneal surface malignancy patients if HIPEC cannot be done due to resource constraints or patient factors and along with this comparison we audited our peritoneal surface malignancies data.

The most common type of ovarian cancer is epithelial ovarian cancer (EOC) worldwide. The current standard treatment consists of complete Cytoreductive surgery with platinum-based chemotherapy. HIPEC with Cisplatin is delivered after CRS at 410-430 C and it has become the advanced treatment modality with survival benefit. The tumor and the surrounding microenvironment (TME) are closely related and interact constantly. Tumors can influence the microenvironment by releasing extracellular signals, promoting tumor angiogenesis, and inducing peripheral immune tolerance, while the immune cells in the microenvironment can affect the growth and evolution of cancerous cells. Immunotherapy and cancer-directed vaccines represent promising future strategies for managing solid malignancies. Ovarian cancer is immunogenic. Most of the studies on the OC micro-environment are from the Western population. Cancer-testis antigen (CTA) is a potential target candidate for immunotherapy due to its expression in immune-privileged sites. In addition, CT45, a notable CTA, has been proposed to be expressed in advanced-stage epithelial ovarian cancer and influences chemo-responsiveness of the tumor.

Peritoneal metastasis from appendiceal, colorectal, ovarian, gastric and peritoneal cancer itself presents with an aggressive biology and clinical behavior. The majority of patients develop peritoneal carcinomatosis (PC) relatively early in the disease. The prognosis of the patients of ovarian cancer and colorectal cancer with PC has been shown to improve significantly after the cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy (CRS+HIPEC). Available literature suggests that serious postoperative complications not only affect patient recovery but may also delay the adjuvant treatment leading to early recurrence after CRS and HIPEC in various peritoneal surface malignancies which may also affect the survival of the patient. Thus, early recognition and appropriate management of commonly encountered perioperative complications is necessary in order to minimize the impact of treatment related morbidity on survival and to improve the quality of life.The present study focuses mainly on peri-operative complications and their management after CRS+HIPEC in various peritoneal surface malignancies.

Ovarian carcinoma is generally diagnosed at an advanced stage. Any gross peritoneal disease outside pelvis more than 2 cm in size is staged as FIGO stage IIIc. It encompasses a spectrum of disease from solitary tumor deposit anywhere in abdomen to diffuse peritoneal metastases resulting in a frozen abdomen. The prognosis of the patients across this spectrum vary widely. Therefore, there is a need to validate a score which can precisely prognosticate a patient with advanced ovarian carcinoma.The aim of surgery is to achieve optimal cytoreduction i.e. CCS 0/1. PCI is known to have a correlation with CCS. However, PCI is calculated intraoperatively and therefore it cannot be used to predict optimal cytoreduction before conducting surgery itself. Contrast enhanced CT (CECT) scan is done at most centers before CRS. Multiple models have been evaluated to predict optimality of cytoreduction based on radiological and clinical factors.These studies have ascertained that CT-PCI grossly underestimates the lesion size in individual region as well as the overall score. We strive to examine this in the Indian population in our study.

Quality assurance is defined as ¿Complete set of systematic actions that are required to achieve a treatment result that meets a certain standard¿. To achieve this standard, there is a need to formulate a minimum standard of care, define an acceptable level of variation in treatment outcome and identify factors which are crucial to achieve this standard. The ultimate goal is to improve treatment outcome.Quality assurance measures at this institute include well defined Protocol based patient Pathways, standardization of Surgical Procedure steps, Prospective Computerized Clinical Database creation, Audit of database, Morbidity & Mortality audit, and residents are actively involved in all process of patient care. This study was aiming to find out the quality indicators of such major oncological surgeries at this center which were assessed from the day of admission to the day of discharge of these patients and also the direct cost incurred to the patients during the admission out of their pocket for surgical expenses.

Ovarian cancer (OC) is the most lethal gynecological cancer worldwide. Complete cytoreduction with platinum based chemotherapy is the standard of care. Despite this, many patients recur predominantly in the peritoneal cavity. With advent of HIPEC, 5-yr survival has improved significantly. PCI is a major determinant for survival. Surgical PCI as advocated by Paul Sugarbaker provides a systematic and region wise assessment of disease. One of the indications for Neo-adjuvant chemotherapy is high PCI especially bulky upper abdomen disease including the sub diaphragmatic region and pleural effusion with high lymph nodal burden. No single imaging modality predicts the PCI accurately. This study was done to compare two imaging modalities namely CECT and PET-CT for calculating pre-op PCI and to compare with surgical PCI at the time of operation. Also, region wise concordance between imaging modalities and surgical PCI was done. If predicted PCI is high and involving critical locations that particular group of patients can be avoided unnecessary exploration and patient can be planned for neoadjuvant chemotherapy.

Esophageal cancer is unique among the gastrointestinal tract malignancies because it embodies two distinct histopathological types, squamous cell carcinoma and adenocarcinoma. Incidence is increasing gradually worldwide. Although it seems appropriate to individualize the treatment of these tumours, often they are managed as a single entity. Unfortunately, present-day therapeutic interventions have had little impact on survival, as evidenced by the equivalence of incidence and mortality rates. A more thorough understanding of the initiating events, the molecular biologic basis, and treatment successes and failures will hopefully dawn a new era of therapy effectively targeting both adenocarcinoma and squamous cell carcinoma of the esophagus. The treatment of carcinoma esophagus includes surgery, chemotherapy, radiotherapy or a combination of these techniques; however, despite multitudes of clinical trials and retrospective reviews, standard treatment protocols are yet to be formulated. This Study is one such effort to formulate or standardize a protocol for the treatment of carcinoma esophagus.

The book covers the basic concept of surgical and oncosurgical disciplines as a whole, as well as the management of surgical patients from pre-op preparation to discharge, i.e., all the basics needed for a successful outcome for oncosurgical patients. It covers surgical safety, the consumer protection act, medico-legal aspects, the importance of documentation, research and publications, and managing complications. The respective chapters cover pre-operative, intra-operative, and ICU management of cancer patients, based on a multi-disciplinary approach. Additionally, they highlight recent advances in surgical oncology and so-called incurable cancers. Edited and written by an interdisciplinary team of experts in oncology and palliative care, the book is intended as a clinically useful guide to the overlapping topics of pain management in cancer patients and the treatment of cancer in patients with multiple co-morbidities like cardiovascular, respiratory disease, hypertension and diabetes mellitus. Given its scope, it will benefit multi-disciplinary oncologists, pain, palliative and intensive care experts, as well as students of surgical disciplines, from MBBS, MS and DNB, to MRCS, MCh and FRCS.