Deepak Jha

Locally Advanced Sebaceous Cell Carcinoma (T3) of Eyelid: Incidence and Pattern of Nodal Metastases and Combined Modality Management Approach

Background: Sebaceous carcinoma (SbCC) is a rare malignancy that often mimics benign conditions. Lymphatic involvement, large T3 tumors herald a dismal survival for patients. We present our series of 13 cases of locally advanced SbCC of the eyelid treated at a surgical oncology unit and describe the clinical profile, patterns of nodal spread and recurrence pattern in this subset of SbCC. Methods: A retrospective analysis of case records was carried out for patients presenting with orbital tumors between January 1997 and April 2010 in the department of Surgical Oncology, AIIMS, New Delhi, India. All patients underwent orbital exenteration and superficial parotidectomy with neck dissection was added to patients with clinically significant lymphadenopathy. All patients who underwent OE after 2002 were advised radiotherapy as adjuvant therapy. The end point was development of recurrence or end of two year follow up period which ever occurred earlier. Results: Thirteen patients underwent orbital exenteration. Eleven patients had clinically palpable lymphadenopathy. Ten patients (76.9%) had pathologically confirmed metastatic nodes. Parotid lymph node involvement was present in all patients (100%); two of these ten patients also had level II b cervical lymph node involvement. Recurrence was observed in seven patients (53.8%). All recurrences were loco-regional only and no systemic metastases was seen. There were only two recurrences in the group that received PORT. Conclusions: Eyelid SbCC is a loco-regionally aggressive malignancy and adequate disease control can be achieved with combined modality approach of radical surgery followed by post operative radiotherapy.

Pulmonary metastasectomy: Review of experience at a tertiary cancer care center

BACKGROUND Thirty to 40% of all extra thoracic cancers lead to secondary pulmonary lesions and approximately 20% of these cases feature metastases that are confined to the lungs. There is benefit of pulmonary metastasectomy in a select subset of patients. AIMS The goal of this study was to evaluate the patient profile, treatment patterns, and outcomes following surgical treatment of lung metastasis and to identify prognostic factors for long-term survival. MATERIALS AND METHODS Retrospective analysis of a prospectively maintained computerized database at a tertiary cancer care centre was done. 36 patients underwent curative resection for isolated pulmonary metastasis from January 1999 to December 2009. All metastasis were detected by non-contrast CT scan of the chest. Lung function tests were performed in all patients. Posterolateral thoracotomy was performed for resection of pulmonary metastasis by lung sparing procedures. A routine protocol of complete resection of all visible and palpable lung metastasis with a margin of 0.5 to 10 mm was followed in all patients. Staged thoracotomy was done for bilateral metastases. All palpable nodules were resected by wedge resection except in one case where pneumonectomy was done to achieve R0 resection. All patients underwent complete resection. CONCLUSIONS Disease-free interval of more than 1 year along with less than 2 malignant nodules in patients with non-visceral pulmonary metastasis are variables identified in the present study which have enabled pulmonary metastasectomy to be offered as a safe therapeutic lifeline to patients.

Role of Loco-regional Surgery in metastatic breast cancer

Approximately 3-10% of patients of breast cancer present with metastatic disease. Traditionally the treatment of these patients has been systemic only with local therapy in form of surgery or RT offered only to palliate local complications like ulceration or haemorrhage, etc. We review and analyse the current literature on surgical removal of primary breast tumor in metastatic disease. Data for this review was compiled by searching the PubMed database. Though current evidence is not strong enough to recommend surgical removal in all MBC patients, there seems a subset of MBC patients who, when carefully selected, have a survival benefit from surgical removal of primary tumor. A carefully structured RCT with large number of patients and long follow up is needed.

Frugal Malleable Microdissectors and Arachnoid Knives for Microneurosurgery

BACKGROUND Similar to most of the other medical and surgical fields, neurosurgery has changed drastically in recent decades, especially in instrumentation and equipment. Safety, scope of treating initially considered nontreatable neurosurgical conditions, and prognosis of most neurosurgical procedures have improved significantly. Newer instruments and equipments are being introduced exponentially, leading to tremendous cost escalation of neurosurgical treatment. However, equitable distribution of neurosurgical services in society is far from reality. We need to look back and learn from our teachers and forefathers of neurosurgery their innovative ways to accomplish difficult procedures without advanced tools and techniques. Microneurosurgery is considered a highly skilled technique, and instruments used for it are delicate, precise, and costlier than similar instruments for macroneurosurgery. TECHNIQUE AND CONCLUSION Frugal innovative techniques and tools are presented for making stainless steel wire and plate microdissectors that are effective for microneurosurgical procedures and can be helpful for neurosurgeons working in resource-poor settings.