This study retrospectively analyzed 54 patients with retroperitoneal soft tissue sarcoma treated at Shaukat Khanum Cancer Hospital over 5 years. The most common histology was well-differentiated liposarcoma (74%). The median age was 43 years and most patients presented with abdominal pain and mass. The 5-year overall survival rate was 74% and disease-free survival was 14 months. Factors associated with improved outcomes included negative resection margins and neoadjuvant therapy. This study provides valuable local data on treatment and outcomes of retroperitoneal soft tissue sarcoma in Pakistan.
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
Minimal invasive Surgery in Management of colorectal cancerpiyushpatwa
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Minimally invasive liver surgery now allows almost all liver resection operations to be performed safely. The advent of robotic surgery has allowed further development of these surgeries. In this field, any artifice that can further benefit the surgeon in performing these particular hepatic resections is certainly desired. Indocyanine green has shown to be extremely useful in verifying the anatomy of the liver and biliary tract, in the discovery of small tumor nodules located in the more peripheral areas of the liver and in the intraoperative definition of liver segmentation.
Management of renal cell carcinoma - presented at Asian Oncology Summit 2013Siewhong Ho
Dr Ho lectured at the Asian Oncology Summit 2013 in Bangkok on the surgical opinion on management of renal cell carcinoma. He presented to a varied audience of medical oncologist, radiation oncologist, urologists, researchers, para clinical staff and nurses. The most interesting aspect of the lecture was on the role of urologists in management of Stage 4 kidney cancer in the era of 'targeted therapy'. The role of cytoreductive nephrectomy was reviewed potential future developments in this area was discussed
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Minimally invasive liver surgery now allows almost all liver resection operations to be performed safely. The advent of robotic surgery has allowed further development of these surgeries. In this field, any artifice that can further benefit the surgeon in performing these particular hepatic resections is certainly desired. Indocyanine green has shown to be extremely useful in verifying the anatomy of the liver and biliary tract, in the discovery of small tumor nodules located in the more peripheral areas of the liver and in the intraoperative definition of liver segmentation.
Management of renal cell carcinoma - presented at Asian Oncology Summit 2013Siewhong Ho
Dr Ho lectured at the Asian Oncology Summit 2013 in Bangkok on the surgical opinion on management of renal cell carcinoma. He presented to a varied audience of medical oncologist, radiation oncologist, urologists, researchers, para clinical staff and nurses. The most interesting aspect of the lecture was on the role of urologists in management of Stage 4 kidney cancer in the era of 'targeted therapy'. The role of cytoreductive nephrectomy was reviewed potential future developments in this area was discussed
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
The aim of this study was to investigate the role of diffusion imaging in the evaluation of response to neoadjuvant
breast cancer treatment by correlating apparent diffusion coefficient (ADC) value changes with pathological response.
From June 2007 to June 2009, all consecutive patients with histopathologically confirmed breast cancer undergoing neoadjuvant
chemotherapy were enrolled. All patients underwent magnetic resonance imaging (MRI) (including diffusion
sequence) before and after neoadjuvant treatment. The ADC values obtained using two different methods of region of interest
(ROI) placement before and after treatment were compared with MRI response (assessed using RECIST 1.1 criteria)
and pathological response (assessed using Mandard’s classification).
Fifty-one women (mean age 48.41 years) were included in this study. Morphological MRI (RECIST classification) well evaluated
the responder status after chemotherapy (TRG class; area-under-the-curve 0.865). Mean pretreatment ADC values
obtained with the two different methods of ROI placement were 1.11 and 1.02 · 10)3 mm2 ⁄ seconds. Mean post-treatment
ADC values were 1.40 and 1.35 · 10)3 mm2 ⁄ seconds, respectively. A significant inverse correlation between mean ADC
increase and Mandard’s classifications was observed for both the methods of ADC measurements. Diagnostic performance
analysis revealed that the single ROI method has a superior diagnostic accuracy compared with the multiple ROIs method
(accuracy: 82% versus 74%). The coupling of the diffusion imaging with the established morphological MRI provides superior
evaluation of response to neoadjuvant chemotherapy treatment in breast cancer patients compared with morphological
MRI alone. There is a potential in the future to optimize patient therapy on the basis of ADC value changes. Additional
works are needed to determine whether these preliminary observed changes in tumor diffusion are a universal response to
tumor cell death, and to more fully delineate the ability of ADC value changes in early recognizing responder from
nonresponder patients.
Bridging the STEM gender gap through cultural inclusion and educational opportunity, this opportunity was granted to a selected set of women from UB to showcase their research.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Επιλεκτική Ανασκόπηση Βιβλιογραφίας 2017-2019
Consensus, Recommendations, Guidelines
Prospective randomized trials
Meta analysis
Systematic review
Advances in Surgery 2018
Up to date 2019
Similar to Retroperitoneal Soft-Tissue Sarcoma: Retrospective Study at Shaukat Khanum Cancer Hospital (20)
Experiential Learning through the lens of Communities of Practice (CoP) theoryJibran Mohsin
Individual Presentation on "Experiential Learning through the lens of Communities of Practice (CoP) theory"
Advanced Level Course on Teaching and Learning 1
Master of Health Professions Education
Department for Educational Development
The Aga Khan University
Tuesday, February 07, 2023
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGYJibran Mohsin
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGY (Advanced Level Course on Curriculum Development in Health Professions Education, Department for Educational Development, The Aga Khan University)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
4. Introduction
____________________________
• Retroperitoneal sarcomas (RPS): rare neoplasms, 0.2% of adult cancers and 1-
2% of all solid malignancies.
• Average annual incidence: 0.3-0.4% per 100, 000 population (or 2.7 cases per
million).
• Accounts for only 10-20% of soft tissue sarcomas.
• Peak incidence: 5
th
decade of life, although no age is immune.
• 50-70 histological subtypes
_________________________________________________________________
1. Porter GA, Baxter NN, Pisters P. Retroperitoneal sarcoma: A population-based analysis of epidemiology, surgery, and radiotherapy. Cancer 106 (2006): 1610-1616.
2. Mettlin C, Priore R, Rao U. Results of the national soft tissue sarcoma registry. J Surg Oncol 19 (1982): 224-227.
3. McGrath P. Retroperitoneal sarcomas. Semin Surg Oncol 10 (1994): 364-368.
4. Daugaard S. Current soft tissue sarcoma classification. Eur J Cancer 40 (2004): 543- 548.
5. Coindre JM, Mariani O, Chibon F, et al. Most malignant fibrous histiocytomas developed in the retroperitoneum are dedifferentiated liposarcomas: a review of 25 cases initially diagnosed as
malignant fibrous histiocytomas. Mod Pathol 16 (2003): 256- 262.
6. Tseng WW, Seo HJ, Pollock RE, et al. Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma. J Surg Oncol 117 (2018): 7-11.
5. Introduction
____________________________
• Diagnosis of RPS: usually challenging and often delayed (non-specific
symptoms and clinically detected only when large size)
• Major cause of morbidity: local spread > distant metastasis (in contrast to
peripheral soft tissue sarcoma).
• Increasing recognition of subtype-guided management
• Surgery can be challenging, and adequate oncological resection must
be weighed against anticipated postoperative morbidity.
______________________________________________________________
1. van Dalus T, van Geel AN, van Coevorden F, et al. Dutch soft tissue sarcoma group. Soft tissue carcinoma in the retroperitoneum: an often-neglected diagnosis. Eur J Surg Oncol 27 (2001): 74-
79.
2. Papanicolaou N, Yoder IC, Lee MJ. Primary retroperitoneal neoplasms: How close can we come in making the correct diagnosis. Urol Radiol 14 (1992): 221-228.
3. Singer S, Corson JM, Demetri GD, et al. Prognostic factors predictive of survival for truncal and retroperitoneal soft tissue sarcoma. Ann Surg 221 (1995): 185-195.
4. Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): A report on 1007 patients from the Multi-institutional
Collaborative RPS Working Group. Ann Surg 263 (2016): 1002- 1009.
6. Introduction
____________________________
• Treatment at cancer-dedicated centers by multidisciplinary expertise
including experienced surgical oncologists is recommended.
• Preoperative evaluation must include CT/MRI CAP: to assess local
extension, distant metastasis, and plan surgery accordingly.
• Multivisceral resection is often required (Nephrectomy in 28 to 55% and
colectomy in 58% cases)
[4]
• Often multi-specialty involvement is needed.
_________________________________________________________________
7. Introduction
____________________________
• Image-guided percutaneous core needle biopsy: minimal risk (< 2 %) of
tumor seedling.
• Wide local excision with adequate margins, preferably outside the
pseudo capsule remains the cornerstone of the treatment of
nonmetastatic RPS.
• Extended or compartmental resection of adjacent uninvolved organs:
multivisceral involvement
• Palliative resection: Symptomatic, in the very selected group of patients.
_________________________________________________________________
1. Van Houdt WJ, Schrijver AM, CohenHallaleh RB, et al. Needle tract seeding following core biopsies in retroperitoneal sarcoma. Eur J Surg Oncol 43 (2017): 1740- 1745.
2. Gronchi A, Miceli R, Allard MA, et al. Personalizing the approach to retroperitoneal soft tissue sarcoma: Histology-specific patterns of failure and postrelapse outcome after primary extended resection. Ann Surg Oncol 22 (2015): 1447-1454.
3. Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol 27 (2009): 24- 30.
4. Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: A multivariate analysis of surgical factors associated with local control. J Clin Oncol 27 (2009): 31-37.
5. Pisters PW. Resection of some but not all clinically uninvolved adjacent viscera as part of surgery for retroperitoneal soft tissue sarcomas. J Clin Oncol 27 (2009): 6-8.
6. Gronchi A, Pollock R. Surgery in retroperitoneal soft tissue sarcoma: A call for a consensus between Europe and North America. Ann Surg Oncol 18 (2011): 2107- 2110.
7. Crago AM. Extended surgical resection and histology in retroperitoneal sarcoma. Ann Surg Oncol 22 (2015): 1401-1403.
8. Yeh JJ, Singer S, Brennan MF. Effectiveness of palliative procedures for intra-abdominal sarcomas. Ann Surg Oncol 12 (2005): 1084- 1089.
8. Introduction
____________________________
• Neo-adjuvant therapy: well-selected stage II, and III patients.
• Adjuvant treatment: as per histopathological status.
• In nutshell, the cornerstone of management is R0 resection.
__________________________________________________________
1. Nussbaum DP, Rushing CN, Lane WO, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: A case-control, propensity scorematched analysis of a
nationwide clinical oncology database. Lancet Oncol 17 (2016): 966-975.
2. Meric F, Milas M, Hunt KK, et al. Impact of neoadjuvant chemotherapy on postoperative morbidity in soft tissue sarcomas. J Clin Oncol 18 (2000): 3378-3383.
3. Almond LM, Gronchi A, Strauss D, et al. Neoadjuvant and adjuvant strategies in retroperitoneal sarcoma. Eur J Surg Oncol 44 (2018): 571-579. .
9. Introduction
____________________________
• Most of the published work on RPS is from the west.
• There is a dearth of published data from the subcontinent, especially Pakistan.
• This retrospective review helped in assessing the natural history and 5-year
follow-up of RPS patients in the local population and determining the factors
affecting survival in the Pakistani cohort of patients.
__________________________________________________________
10. Methods and Materials
____________________________
• Retrospective descriptive study (Department of Surgical Oncology, SKMCH&RC, Lahore)
• Non-probability consecutive sampling technique (total cases 54)
• Inclusion:
• Age: 18-70 years
• Clinical or operative diagnosis of retroperitoneal soft tissue sarcoma confirmed on the
histopathological specimen;
• irrespective of gender, duration, or type of symptoms
• Surgery from January 2011 to December 2015 and were followed for 5 years (December
2020).
• Exclusion:
• Retroperitoneal mass due to etiologies other than sarcomas such as lymphoma, metastatic
testicular cancer with para-aortic nodal mass, renal, pancreatic, adrenal, or vertebral/spine
masses.
_____________________________________________________________
11. Methods and Materials
____________________________
• Ethical approval from the Institutional Review Board (IRB) (Ex-22-04-20-03) taken
• Recruited from the Hospital Information System (HIS) of the hospital.
• Data collected:
• Preoperative (age, gender, geographic origin, preoperative biopsy, preoperative
imaging and MDT recommendations).
• Surgical plan (simple versus extensive/compartmental resection, blood loss,
operative time, any intraoperative or postoperative complication(s), length of hospital
or ICU stay.
• Whether neoadjuvant or adjuvant therapy was given or not,
_________________________________________________________
12. Methods and Materials
____________________________
• Data collected:
• Recurrence (local or distant),
• Median disease-free survival (DFS) and overall 5-year survival (OS)
• Histopathology reports indicating types of sarcomas and margins
• Descriptive statistics
• Continuous variables (median and interquartile range– IQR)
• Categorical variables (frequencies and percentages)
____________________________________________________
13. Results
____________________________
TABLE NO.1 DEMOGRAPHICS AND CLINICAL PRESENTATION
PARAMETERS
Age (years), Median (IQR) 43 (30-60)
Gender, n (%)
Male 31 (57)
Female 23 (43)
Co morbidities, n (%) None 40 (74)
Diabetes mellitus 8 (15)
Hypertension 9 (17)
Geographic origin, n (%) KPK 30 (56)
Afghanistan 15 (28)
Punjab 9 (16)
Presentation, n (%) Abdominal pain 50 (93)
Abdominal mass 45 (83)
Duration of symptoms (months), Median (IQR) 7 (3-10)
Size of tumor (cm), Median (IQR) 17 (10-26)
14. Results
____________________________
• Preoperative management:
• CT CAP (all cases): no systemic metastases in 87 % cases.
• Preoperative biopsy done in 83 % cases (rest underwent surgery due to
complications by mass effect or invasion)
• MDT discussion
• 55 % cases underwent neoadjuvant therapy (Doxorubicin and Ifosfamide
and/or radiotherapy). Rest underwent adjuvant therapy.
________________________________________________________________
20. Discussion
____________________________
_________________________________________________
Parameters Comparison Current Study Literature review
Gender distribution Male proportion slightly high 57 % 47 % [1] - 52 % [2]
Median age at presentation Younger 43 years 60 years [1]
Mass at presentation More frequent 83 % 43 % [3]
Median size at presentation Larger 17 cm 14 cm [4]
1. Porter GA, Baxter NN, Pisters P. Retroperitoneal sarcoma: A population-based analysis of epidemiology, surgery, and radiotherapy. Cancer 106 (2006): 1610-1616.
2. Mettlin C, Priore R, Rao U. Results of the national soft tissue sarcoma registry. J Surg Oncol 19 (1982): 224-227.
3. van Dalus T, van Geel AN, van Coevorden F, et al. Dutch soft tissue sarcoma group. Soft tissue carcinoma in the retroperitoneum: an often-neglected diagnosis. Eur J Surg Oncol 27 (2001): 74-79
4. Tseng WW, Wang SC, Eichler CM, et al. Complete and safe resection of challenging retroperitoneal tumors: Anticipation of multiorgan and major vascular resection and use of adjunct procedures. World J Surg
Oncol 9 (2011): 143.
21. Discussion
____________________________
_________________________________________________
Parameters Comparison Current Study Literature review
Median operative time Less 180 minutes 316 minutes [1]
Median intraoperative blood loss Less 250 ml 500 ml [1]
Median Hospital stay Comparable 6 days 7 days [1]
R0 resection Less 89 % 95 % [1]
Nephrectomy Less 15 % 42 % [2]
Colectomy Less 13 % 30 % [2]
1. Tseng WW, Wang SC, Eichler CM, et al. Complete and safe resection of challenging retroperitoneal tumors: Anticipation of multi-organ and major vascular resection and use of adjunct procedures. World J
Surg Oncol 9 (2011): 143.
2. Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: A multivariate analysis of surgical factors associated with local control. J Clin Oncol 27 (2009): 31-37.
.
22. Discussion
____________________________
_________________________________________________
Parameters Comparison Current Study Literature review
Most common variant – well differentiated liposarcoma Higher 74 % 55 % [1]
Overall survival (well differentiated liposarcoma) Comparable 92 % 95 % [2]
Overall survival (undifferentiated liposarcoma) Comparable 20 % 25 % [2]
Overall survival (Leiomyosarcoma) Low 25 % 43 % [2]
Survival difference of compartmental versus Non
compartmental
Same No difference [2]
1. Tseng WW, Wang SC, Eichler CM, et al. Complete and safe resection of challenging retroperitoneal tumors: Anticipation of multi-organ and major vascular resection and use of adjunct procedures. World J Surg Oncol 9 (2011): 143.
2. Feig BW, Ching CD. The MD Anderson Surgical Oncology Handbook. 6th Edn. Philadelphia; Wolters Kluwer. Chapter 5; Soft-Tissue and Bone Sarcoma (2019): 233-266.
23. Discussion
____________________________
_________________________________________________
Parameters Comparison Current Study Literature review
Recurrence rate Slightly less 52 % 66 % [1]
Local recurrence – Well differentiated
liposarcoma
Comparable 45 % 30 % - 60 % [1]
Distant recurrence - Leiomyosarcoma Comparable 75 % 60 % [1]
Margin positivity (recurrence) Same 100 % 33 % vs 66 % [1]
18 months vs103 months [1]
Compartmental vs Non compartmental
(recurrence)
Same 36 % vs 58 % 28 % vs 48 % [1]
3.29 times less [1]
1. Feig BW, Ching CD. The MD Anderson Surgical Oncology Handbook. 6th Edn. Philadelphia; Wolters Kluwer. Chapter 5; Soft-Tissue and Bone Sarcoma (2019): 233-266.
24. Discussion
____________________________
_________________________________________________
Parameters Comparison Current Study Literature review
Neoadjuvant therapy (recurrence) Same 27 % vs 83 % 60 % local control [1]
46 % vs 89 % [1]
Although standard resection in comparison to compartmental resection affects the recurrence rate but
has no effect on the overall survival rate.
Secondly, neoadjuvant therapy in the form of chemotherapy and radiotherapy has proven benefit on the
recurrence rate.
1. Feig BW, Ching CD. The MD Anderson Surgical Oncology Handbook. 6th Edn. Philadelphia; Wolters Kluwer. Chapter 5; Soft-Tissue and Bone Sarcoma (2019): 233-266.
26. Conclusion
____________________________
• In the Pakistani cohort of patients. retroperitoneal soft-tissue sarcoma was more
commonly seen in males at the median age of 43 years.
• Common presentations were abdominal pain and mass.
• Well-differentiated liposarcoma was the most common histological variant.
• The overall 5-year survival was 74% that was affected by histological variant and
grade.
• Recurrence was affected by histological variant and grade, margin positivity, and
use of neoadjuvant therapy.
_________________________________________________________________________________