Ashish Jakhetiya
All India Institute of Medical Sciences
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Publication
Featured researches published by Ashish Jakhetiya.
World Journal of Gastrointestinal Surgery | 2016
Ashish Jakhetiya; Pankaj Kumar Garg; Gaurav Prakash; Jyoti Sharma; Rambha Pandey; Durgatosh Pandey
Gastrointestinal stromal tumours (GISTs) are mesenchymal neoplasms originating in the gastrointestinal tract, usually in the stomach or the small intestine, and rarely elsewhere in the abdomen. The malignant potential of GISTs is variable ranging from small lesions with a benign behaviour to fatal sarcomas. The majority of the tumours stain positively for the CD-117 (KIT) and discovered on GIST-1 (DOG-1 or anoctamin 1) expression, and they are characterized by the presence of a driver kinase-activating mutation in either KIT or platelet-derived growth factor receptor α. Although surgery is the primary modality of treatment, almost half of the patients have disease recurrence following surgery, which highlights the need for an effective adjuvant therapy. Traditionally, GISTs are considered chemotherapy and radiotherapy resistant. With the advent of targeted therapy (tyrosine kinase inhibitors), there has been a paradigm shift in the management of GISTs in the last decade. We present a comprehensive review of targeted therapy in the management of GISTs.
World Journal of Gastroenterology | 2016
Pankaj Kumar Garg; Jyoti Sharma; Ashish Jakhetiya; Aakanksha Goel; Manish Kumar Gaur
Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer (T2 or greater or node positive); however, a high rate of disease recurrence (systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment (preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy (radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.
wjm | 2016
Pankaj Kumar Garg; Saurabh Kumar Singh; Gaurav Prakash; Ashish Jakhetiya; Durgatosh Pandey
Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell carcinoma and small cell carcinoma are the main histological subtypes and constitutes around 85% and 15% of all lung cancer respectively. Multimodality treatment plays a key role in the successful management of lung cancer depending upon the histological subtype, stage of disease, and performance status. Imaging modalities play an important role in the diagnosis and accurate staging of the disease, in assessing the response to neoadjuvant therapy, and in the follow-up of the patients. Last decade has witnessed voluminous upsurge in the use of positron emission tomography-computed tomography (PET-CT); role of PET-CT has widened exponentially in the management of lung cancer. The present article reviews the role of 18-fluoro-deoxyglucose PET-CT in the management of non small cell lung cancer with emphasis on staging of the disease and the assessment of response to neoadjuvant therapy based on available literature.
World Journal of Gastrointestinal Surgery | 2016
Pankaj Kumar Garg; Ashish Jakhetiya; Jyoti Sharma; Mukur Dipi Ray; Durgatosh Pandey
The stomach is the sixth most common cause of cancer worldwide. Surgery is an important component of the multi-modality treatment of the gastric cancer. The extent of lymphadenectomy has been a controversial issue in the surgical management of gastric cancer. The East-Asian surgeons believe that quality-controlled extended lymphadenectomy resulting in better loco-regional control leads to survival benefit in the gastric cancer; contrary to that, many western surgeons believe that extended lymphadenectomy adds to only postoperative morbidity and mortality without significantly enhancing the overall survival. We present a comprehensive review of the lymphadenectomy in the gastric cancer based on the previously published randomized controlled trials.
Case Reports | 2017
Ashish Jakhetiya; Nootan Kumar Shukla; Dillip K Muduly; Shashank Sharad Kale
Extraskeletal orbital mesenchymal chondrosarcoma (MC) is an extremely rare and highly aggressive tumour. It has characteristic radiological features and pathognomic histological biphasic pattern. Radical resection with negative margins is the mainstay of treatment; role of adjuvant chemotherapy and radiotherapy is yet not well defined. We report a rare case of 18-year-old man who was diagnosed to have orbital MC. He presented with locally advanced disease with no vision in the affected eye. He underwent right orbital exenteration; a transcranial intradural approach was used to divide the optic nerve, and the temporalis muscle flap was utilised to fill the exenterated orbit. Though optic nerve involvement is rare in orbital MCs, a transcranial approach may be used effectively to avoid traction on optic chiasma and ensure margin-free resection in case of optic nerve involvement up to orbital apex. Unfortunately, prognosis remains dismal in MCs despite treatment.
wjm | 2016
Mukur Dipi Ray; Pankaj Kumar Garg; Ashish Jakhetiya; Sunil Kumar; Durgatosh Pandey
Ilio-inguinal lymph node dissection (IILD) is a commonly performed surgical procedure for a number of malignant conditions involving mainly the male and female genitalia, and the skin; however the postoperative morbidity of IILD, due to high frequency of flap necrosis, wound infection and seroma formation, has always been a major concern for the surgeons. The aim of the study is to highlight a modified skin bridge technique of IILD using two parallel curvilinear incisions to minimize postoperative skin flap necrosis. This technique was successfully employed in 38 IILD during May 2012 to November 2013. None of the patient had flap necrosis. Two patients developed seroma while another two patients had superficial surgical site infection; they were managed conservatively. Modified skin bridge technique for IILD is an effective method to minimize flap necrosis without compromising the oncological safety.
Indian Journal of Surgical Oncology | 2016
Ashish Jakhetiya; Nootan Kumar Shukla; Sv Suryanarayana Deo; Pankaj Kumar Garg; Sanjay Thulkar
The aim of the study was to determine the incidence of postoperative deep vein thrombosis (DVT) in Indian patients undergoing surgery for thoracic and abdomino-pelvic malignancies.A prospective observational study was conducted in a tertiary care cancer centre in North India. Two hundred and fifty consecutive patients who underwent curative surgery for thoracic and abdomino-pelvic malignancies during the period March 2014 to March 2015 were enrolled in the study. Perioperative pharmacological antithrombotic prophylaxis was not prescribed to any of the patient as per the institutional protocol. All the patients underwent colour duplex ultrasound of the bilateral lower limbs – preoperatively to determine the baseline status, and on 7th and 28th day postoperatively to look for presence of DVT. None of the patient in the study cohort showed clinical or radiological evidence of lower limb deep vein thrombosis. Our study suggests very low incidence of deep vein thrombosis in Indian patients undergoing surgery for thoracic and abdomino-pelvic malignancy.
Hepatobiliary surgery and nutrition | 2015
Durgatosh Pandey; Pankaj Kumar Garg; Ashish Jakhetiya; Jyoti Sharma; Sh Chandrashekhara
A 63-year-old lady underwent classical pancreaticoduodenectomy with regional lymphadenectomy for periampullary cancer. Preoperative contrast-enhanced computed tomography (CECT) of abdomen revealed dilated common bile duct which showed abrupt cut-off at ampulla. CECT also revealed replaced right hepatic artery arising from the left gastric artery (Panels A-C). During surgery, gastroduodenal artery was test-clamped to confirm pulsations in the hepatic artery before being ligated. On third postoperative day, she was found to have altered sensorium. Liver function tests showed bilirubin of 10.9 mg%; however, liver transaminases were markedly elevated (AST of 2,095 U/L and ALT of 1,243 U/L)—prothrombin time was also elevated [international normalized ratio (INR) =2.2]. Postoperative CECT of abdomen and pelvis revealed thrombosis of celiac artery trunk resulting in marked liver and spleen necrosis. Distal right hepatic artery was reformed by the collaterals; it explains relative sparing of right lobe of liver (Panels D-F).
South Asian Journal of Cancer | 2017
Ashish Jakhetiya; Pankaj Kumar Garg; Rambha Pandey; Palaniappan Ramanathan; Sunil Kumar; Debojit Nath; Durgatosh Pandey
Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.
The Journal of community and supportive oncology | 2016
Mukur Dipi Ray; Bharat Khurse; Tapan Chauhan; Ashish Jakhetiya; Pankaj Kumar Garg
G rowing teratoma syndrome (GTS) is a rare condition seen in patients with germ-cell tumors (GCT) who present with enlarging masses during or after appropriate chemotherapy with normalized serum markers. Three defining criteria for GTS are: a persistently growing tumor mass or evolving new mass during or after chemotherapy, normalization of tumor markers, and presence of only mature teratoma in the resected specimen on the final histopathological examination. Growing teratomas lack the metastatic potential; however, their relentless local growth causes compression and infiltration of adjacent organs, which produces symptoms. These tumors may attain huge size with passage of time if they are left untreated. Surgery is the only potentially curative option for GTS as these growing teratomas are chemotherapy and radiotherapy resistant. Here we report a case of GTS in a 30-year-old woman for 2 reasons: first, to report one of the largest-known growing teratomas – it weighed 17.2 kg (38 lb) after resection; and second, to emphasize that complete surgical excision should be the aim of surgery, which may include multivisceral resection. No patient should be deemed unresectable unless surgical exploration has been undertaken at a high-volume center, which has expert surgical and anesthetic facilities.