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  1. EDITORIAL
  2. Hemato Lymphoid
  3. Bone & Soft Tissue
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Public reporting of healthcare data – Need of the hour in India

RA Badwe

Director, Tata Memorial Centre, Dr E Borges Road, Parel, Mumbai, Maharashtra, India 

In recent years, healthcare and its management have evolved a lot. There is greater stress upon the quality of care provided, outcomes, and patient satisfaction. The quality of care can be assessed by various methods such as appraisals, external peer reviews, and audits. Clinical audits have become part of normal hospital functioning in North America, the United Kingdom, and in several countries in Europe. As a part of an audit, the quality, outcomes, and complications of a procedure or surgery or the care provided are compared with the standard of care. Such a standard is generally as per the accepted international or implementable national guidelines. Many a times, guidelines may not exist or even if they do they may not be applicable in that particular setting due to differential demographic profile and healthcare facilities available. In such a case, locally accepted standards may be used for comparison. By doing such audits, we come to know whether best clinical practices are being followed and whether ideal patient care is being provided. This can help in assessing the shortcomings and working toward fulfilling them. It can even highlight deficit areas from resource allocation viewpoint and help healthcare managers in taking corrective actions.

We should not forget that patients are at the center of our healthcare system. Patients and patient welfare organizations should form part of the team assessing the healthcare. They need to be aware of the various healthcare options available, expected results, and complications. This means going public with the healthcare data. Public reporting of data may occur at different levels. There may be release of data having national figures which may help in sensitizing the public to different causes of healthcare problems and their effects – like that of tobacco in causing cancer, and so on. These can be used by the government for healthcare education and for controlling epidemics. Besides this, there may be release of hospital-based or individual doctor-based data. Such a data may be about patient satisfaction and quality of healthcare. These may help other patients in forming opinions, decision-making, and also help healthcare managers and doctors in improving healthcare facilities to suit the patient's needs. More debatable is the release of data about a hospital or an individual doctor's procedure or treatment-related outcomes, morbidity, and mortality. 

Public release of such a data has been practiced in the United States and United Kingdom. It is believed to increase public accountability, facilitate consumer choice and decision-making, and motivate healthcare providers to improve their services. As expected, release of such information is controversial. By making data public, the quality of healthcare is expected to improve by two methods. First, the hospital and the healthcare provider (doctor) will be motivated to perform better and provide superior patient care at competitive rates/prices. They will be forced to look into their shortcomings and correct them. Second, the patients will have the option of comparing treatment from different places based on their quality and costs.[1] Reviews have been conducted to assess the impact of public reporting of performance data. They have shown inconsistent results. A systematic review showed that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.[2] A Cochrane review was conducted to determine the effectiveness of the public release of performance data in changing the behavior of healthcare consumers, professionals, and organizations. They concluded that there is no consistent evidence that the public release of performance data changes consumer behavior or improves care. Evidence that the public release of performance data may have an impact on the behavior of healthcare professionals or organizations is lacking.[3] One of the study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than 2 months after each public release.[4] Contrary to these, a review demonstrated that publication of such results had a positive impact on performances of the hospitals leading to improvement in quality of healthcare.[5] 

Public disclosure of information has been criticized for being backward looking and unable to predict future performances. Doctors may fear that data may not be risk stratified or may not be considered with respect to relevant coexisting factors. It may lead to manipulation of data, undue focus on the aspect being studied and reported, and neglect of others.[6] Some studies have shown that consumers or patients may not try to search for such an information and even when available to them may not understand it fully.[7],[8] It may also lead to operating or treating less risky patients as was reported after the results of coronary artery bypass surgery in New York were publicized.[9] Though this was ruled out by other study groups which showed that publication of results of bypass surgery had actually improved the outcomes.[10] Irrespective of these, public reporting of healthcare data is essential. Such information is published by various agencies such as National Committee for Quality Assurance in the United Kingdom and the Centre for Medicare and Medicaid Services in the United States. 

The aim of all the healthcare professionals is the same, to improve patient-related outcomes. In this regard, the field of oncology provides its own challenges and advantages. There are generally widely accepted staging systems and treatment protocols. Outcomes and complications can be compared according to the treatment modality used and the staging of the disease. Publicizing such results will demonstrate that the hospital or the doctor is providing standard of care. It will be a source of motivation to perform better and will also give an opportunity to work upon the shortfalls. It will also be reassuring for the patient that his or her care is of acceptable standards. 

References

  • Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Med Care 2003;41 (1 Suppl):I-30-8. Back to cited text no. 1
  • Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: The evidence that publishing patient care performance data improves quality of care. Ann Int Med 2008;148:111-23. Back to cited text no. 2
  • Ketelaar NA, Faber MJ, Flottorp S, Rygh LH, Deane KH, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev 2011:CD004538. doi: 10.1002/14651858.CD004538.pub2. Back to cited text no. 3
  • Romano PS, Hong Zhou MPH. Do well-publicized risk adjusted outcomes reports affect hospital volume? Med Care 2004;42:367-77. Back to cited text no. 4
  • Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data: What do we expect to gain? A review of the evidence. JAMA 2000;283:1866-74. Back to cited text no. 5
  • Marshall MN, Shekelle PG, Leatherman S, Brook RH. Public disclosure of performance data: Learning from the US experience. Qual Health Care 2000;9:53-7. Back to cited text no. 6
  • Schneider EC, Epstein AM. Use of public performance reports. JAMA 1998;279:1638-42. Back to cited text no. 7
  • Marshall M, Hiscock J, Sibbald B. Attitudes to the public release of comparative information on the quality of general practice care: Qualitative study. BMJ 2002;325:1278. Back to cited text no. 8
  • Hannan EL, Kilburn H, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 1994;271:761-6. Back to cited text no. 9
  • Peterson ED, Delong ER, Jollis JG, Muhlbaier LH, Mark DB. The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly. J Am Coll Cardiol 1998;32:993-9. Back to cited text no. 10

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Long term clinical outcomes of adult hematolymphoid malignancies treated at Tata Memorial Hospital: An institutional audit

Khattry N, Laskar S, Sengar M, Rangarajan V, Shet T, Subramanian P G, Epari S, Bagal B, Goda JS, Agarwal A, Jain H, Tembhare P, Patkar N, Khanna N, Punatar S, Gokarn A, Shetty D, Jain H, Bonda A, Gota V, Hasan S, Kode J, Dutt S, Kulkarni S, Shetty N, Sable N, Deodhar J, Jadhav S, Pawaskar P, Mathew l, Menon H, Nair R, Kannan S, Chiplunkar S, Gujral S.

Abstract

There is paucity of data from India about the outcomes of patients with various hematological malignancies. Since its formation in 2009, the adult hematolymphoid disease management group of the Tata Memorial Centre is dedicated to the treatment of hematological malignancies alone. In this report, we present the outcomes of patients treated at our centre over a 5 year period for various haematological malignancies in both transplant and non-transplant setting. Methods: This is a retrospective analysis of all patients registered in adult hematolymphoid disease management group between 1st January 2010 to 31st December 2014. Patients not treated at our centre were excluded from survival analysis. The cutoff date for survival analysis was 31st January 2016. Results: Overall, 1869, 3633 and 544 patients with acute leukemias, various lymphomas and myeloma respectively were registered at our centre from 1st January 2010 to 31st December 2014. Of these, 1178 (63%), 3091 (85%) and 454 (83%) respectively received treatment at our centre. The cumulative probability of 5 year overall survival for patients with acute leukemias, Hodgkin's lymphoma, non-Hodgkin lymphoma and myeloma treated at our centre is 40%, 85%, 78% and 40% respectively. Four hundred and fifteen stem cell transplants were done between 14th November 2007 to 31st December 2014 with 46% being allogeneic and 54% being autologous. The 5 year overall survival of patients with allogenic and autologous transplant was 52% and 63% respectively. Conclusions: This is the largest single centre data on outcomes of various haematological malignancies from India. This real world data identifies areas which need further attention to improve outcomes.

Keywords:
 Hematological malignancies, hematolymphoid disease management group, outcomes

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Clinicoepidemiological profiles, clinical practices, and the impact of holistic care interventions on outcomes of pediatric hematolymphoid malignancies - A 7-year audit of the pediatric hematolymphoid disease management group at Tata Memorial Hospital

Narula G, Prasad M, Jatia S, Subramanian PG, Patkar N, Tembhare P, Shetty D, Khanna N, Laskar S, Shet T, Epari S, Kembhavi S, Shah S, Qureshi S, Gujral S, Banavali SD.

Abstract

The Pediatric Hematolymphoid Disease Management Group (PHL-DMG) at a tertiary cancer care hospital developed extensive patient support programs to improve retention and outcomes while focusing on protocols adapted to meet patient needs. An audit of measures and outcomes was done for a 7-year period from January 2010 to December 2016. MATERIALS AND METHODS: DMG protocols and patient support activities over the study period were documented and audited. Data was retrieved from internal databases and records. Measures taken and their impact were assessed by descriptive analytical tools. Survival outcomes were calculated using Kaplan–Meier method on SPSS v. 24™ software. RESULTS: Holistic patient support measures were undertaken through a charitable foundation entirely under pediatric oncology. Activities included infrastructure growth, socioeconomic support, provision of accommodation, nutrition, education, and multiple blood component donation drives. Patient registrations increased from 502 in 2009 to 874 in 2016, with the steepest rise in acute lymphoblastic leukemia (ALL) – 330 (2009) to 547 (2016). Treatment refusal and abandonment rates decreased from 32% to 3.4% over the same period, and male to female ratio decreased from 2.56 to 2.28:1. Early mortality in acute myeloid leukemia (AML) fell within 2 years from 26.7% in 2009 to 7%. Five-year overall survival (OS) was 69.5% for all patients registered in 2010, whereas disease-specific 5-year OS was ALL 67.1%, AML 49.3%, chronic myeloid leukemia 100%, Hodgkin lymphoma 90.4%, and non-Hodgkin lymphoma 74.2%. CONCLUSIONS: Holistic patient support-specific activities and adapted protocols made a measurable impact on patient outcomes. High survival outcomes of patients have been achieved despite relatively few receiving salvage therapies or stem cell transplant.

Keywords:
 Hematolymphoid malignancies, outcome audits, pediatrics

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Analysis of bone and soft-tissue sarcomas registered during the year 2012 at Tata Memorial Hospital, Mumbai, with clinical outcomes.

Bajpai J, Khanna N, Vora T, Gulia A, Laskar S, Puri A, Sanduptla B, Chinnaswamy G, Nayak P, Juvekar SL, Janu A, Desai S, Ghosh J, Purandare N, Ramadwar M, Rangarajan V, Rekhi B.

Abstract

Primary bone and soft tissue sarcomas are rare, but diagnostically and therapeutically challenging group of tumors, requiring multidisciplinary management. There are limited documented studies from multidisciplinary teams , in the form of comprehensive analysis of these tumors, from our country. This study is an analysis of cases of osteosarcomas, Ewing sarcomas (ESs), chondrosarcomas (CSs), and soft-tissue sarcomas (STSs), registered at our institution during 2012. Methods: Clinical details, including outcomes of cases of bone and STSs, during the year 2012, were retrieved from the medical records of our institution and were further analyzed. Results: Ninety-five high-grade, extremity-based, treatment-naïve cases of osteosarcomas were treated with a novel, dose-dense, nonhigh-dose methotrexate-based OGS-12 protocol. Good histopathologic response (necrosis ≥90%) was achieved in 59% nonmetastatic and 56% metastatic patients. At a median follow-up of 48 months, the estimated 5-year event-free survival and overall survival (OS) were 67% and 78%, respectively. In the metastatic cohort at a median follow-up of 51 months, the 5-year estimated progression-free survival was 24% and OS was 26%. Among 87 (73.2%) nonmetastatic and 32 (26.8%) metastatic, analyzable cases of ES, at a median follow-up of 40 months, the disease-free survival (DFS) and OS in the nonmetastatic group were 62% and 83%; in the metastatic group, they were 37.5% and 65.6%, respectively. Among 40 cases of CSs (33 nonmetastatic and 7 metastatic), 21 had limb salvage surgery while 5 had amputation. Microscopically, 90.4% were Grade II CSs. Five-year OS and DFS were 84.6% and 71%, respectively. Among 189 high-grade, extremity-based STSs (89% nonmetastatic), synovial sarcoma was the most common subtype (31%). Eighty-five percent had limb preservation surgery; a majority were offered adjuvant radiation with or without chemotherapy. At a median follow-up of 51 (1–63) months, 3-year local control, DFS, and OS were 81%, 48%, and 64%, respectively. Conclusions: The novel OGS 12 and Ewing Family of Tumors 2001 protocols have shown comparable outcomes to international standards in cases of osteosarcoma and ES, respectively, and merit wider applications, especially in low- and middle-income countries (LMICs). Outcomes in STS and CSs were also comparable and underscore the importance of a multidisciplinary approach for the management of sarcomas in LMICS.

Keywords:
Ewing sarcoma, management, multidisciplinary approach, osteosarcoma, soft-tissue sarcoma

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Breast cancer in a tertiary cancer center in India - An audit, with outcome analysis

Nair N, Shet T, Parmar V, Havaldar R, Gupta S, Budrukkar A, Sarin R, Thakur M, Desai S, Yadav P, jalali R, Gulia S, Wadasadawala T, Gosh J, Bajpai J, Kembhavi S, Patil A, Joshi S, Popat P, Rangarajan V, Shah S, Vanmali V, Siddiqui S, Mittra I, Badwe R.

Abstract

Background: Survival studies may serve as benchmarks to develop cancer-related policies and estimate baseline survival rates in a given patient population. Materials and Methods: We carried out a retrospective audit of cases managed in 2009 and now report the disease-free survival (DFS) in early breast cancer (EBC) and locally advanced breast cancer (LABC) in patients registered at a tertiary cancer center in India. Results: The study included 2192 patients with breast cancer with ages ranging from 18 years to 94 years with a median of 50 years. Of these, 888 (40.5%) were EBCs Stage I and II, 833 (38%) were LABCs (Stage III), and 471 (21.5%) were de novo metastatic or relapsed cancers at presentation. The 5-year DFS in the women with EBC was 85.5% and in LABC, it was 67.7%, P < 0.001. The factors adversely affecting DFS in EBC were node metastasis (P < 0.001), higher metastatic nodes (P < 0.001), hormone receptor negativity (P = 0.001), and human epidermal growth factor receptor 2 (Her2neu) positivity (P = 0.033). In the multivariate Cox regression analysis in EBC, node-positive status (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.51–3.45, P < 0.001) and hormone receptor negative tumors (HR 1.96, 95% CI 1.30–2.94, P = 0.001) significantly affected DFS in EBC. The factors adversely affecting DFS in LABC in the univariate analysis were node metastasis (P < 0.001), increasing numbers of nodes (P < 0.001), presence of lymphovascular emboli (LVE) (P < 0.01), mastectomy (P < 0.001), and Her2neu positivity (P = 0.03). In the multivariate Cox regression analysis, node positivity (HR 2.96, 95% CI 2.04–4.29, P < 0.0001), presence of LVE (HR 1.47, 95% CI 1.06–2.04, P = 0.023), and mastectomy (HR 1.49, 95% CI 1.06–2.10, P = 0.023) adversely impacted DFS in LABC. Conclusions: The survival rates in this study are equal to the documented global rates; nodal disease burden emerged as the most important prognostic factor. In addition, in EBCs, a lack of hormone receptor expression and in LABC, Her2neu overexpression appear to worsen the outcome.

Keywords:
Breast cancer, India, survival

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Radical gastrectomy for gastric cancer at Tata Memorial Hospital

Manish S. Bhandare, Naveena Kumar AN, Swati Batra, Vikram Chaudhari, Shailesh V Shrikh

Abstract

AIM: Tata Memorial Hospital is one of the high-volume tertiary care referral centers for gastric cancer (GC) in India. We aimed to analyze the outcomes after surgery for GC. PATIENTS AND METHODS: Data were collected from the prospective database maintained by the Gastrointestinal and Hepato-Pancreato-Biliary Division of the Department of Surgical Oncology at Tata Memorial Hospital, Mumbai, Maharashtra, India. All consecutive patients who underwent curative resection for adenocarcinoma of the stomach from January 2010 to December 2015 were included. RESULTS: A total of 580 patients underwent curative resection for adenocarcinoma of the stomach in the above mentioned time span. Distal tumors were more common and the tumor epicenter was at the distal body/antrum in 435 (75%) patients. One hundred eighty-two (31.3%) patients underwent upfront surgery and 398 patients (68.6%) were operated after receiving neoadjuvant chemotherapy. Surgical procedures included 371 distal/subtotal gastrectomies, 78 proximal, and 131 total gastrectomies. Overall median blood loss was 500 mL and intraoperative blood transfusion was required only in 10.5%. Median hospital stay was 8 days (range, 3–44). Postoperative major morbidity (Clavein–Dindo grade III/IV) was 8.9% and mortality was 1.5%. Median lymph node yield was 18 (range, 2–76). When perioperative outcomes were compared in the initial half of the study period (Period 1, 2010–2012) versus the later half (Period 2, 2013–2015), the median lymph node yield was found to be better in the later half (17 vs. 19) along with reduction in the median hospital stay (16 vs. 11 days). At a median follow-up of 36 months (range, 3–225 months), overall 5-year survival was 51.9%. The disease-free survival at 5 years was 46.9%. CONCLUSION: Results from our study indicate that, with increasing hospital volumes, the median lymph node yield after D2 gastrectomy improves and the median hospital stay is reduced. Surgery for GCs in high-volume centers might result in improved perioperative outcomes.

Keywords:
D2 lymphadenectomy, gastric cancer, gastrectomy

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Locally advanced cervical cancer: A study of 5-year outcomes

Chopra S, Gupta M, Mathew A, Mahantshetty U, Engineer R, Lavanya G, Gupta S, Ghosh J, Thakur M, Deodhar K, Menon S, Rekhi B, Bajpai J, Gulia S, Maheshwari A, Kerkar R, Shylasree T S, Shrivastava S K.

Abstract

Background: Cervical cancer is the second most common cancer among Indian women. This present retrospective study was conducted to report patient outcomes with locally advanced cervical cancer treated in the year 2010. Materials and Methods: Case records of cervical cancer patients registered from January 1, 2010, to December 31, 2010 were retrieved. A total of 1200 patients were registered, of which 583 received either definitive or adjuvant radiotherapy (RT). Of these, 345 patients who received complete treatment at our hospital were included for outcome analysis. Descriptive statistics were used to summarize patient- and treatment-related variables, and Kaplan–Meier analysis was performed for survival analysis. Results: The median age was 56 years (range: 33–90). Squamous carcinoma was the most common histology (91.4%) and the majority were FIGO Stage III (45.4%). Median follow-up of the cohort was 44 months (1–85 months). The 5-year disease-free survival (DFS) across stages was 50%. Most important predictor of DFS was FIGO staging (Stage II vs. Stage III: 62% vs. 45%) and use of concurrent chemoradiotherapy (CTRT) l (RT vs. CTRT: 32% vs. 57%, respectively). Patients aged >70 years had a significantly poor DFS at 5 years; however, did not have any effect on survival. Grade 3 or more late toxicity was seen in only 5% of the patients. Conclusion: Five-year DFS of 62% and 45% of Stage II and III patients treated under routine care represents comparable stage-matched results to the rest of the world, respectively.

Keywords:
Cervical cancer, chemoradiotherapy, outcomes

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Outcomes of advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy

Maheshwari A, Kumar N, Gupta S, Rekhi B, Shylasree T S, Dusane R, Bajpai J, Ghosh J, Gulia S, Deodhar K, Menon S, Popat P, Sable N, Thakur M, Kerkar R.

Abstract

Background: Ovarian cancer is the fourth most common cancer in Indian women. Majority of these are epithelial ovarian cancers (EOCs), most of which present in advanced stage. Women with poor performance status and/or those unlikely to achieve optimal debulking at upfront surgery, benefit from neoadjuvant chemotherapy (NACT) followed by interval cytoreduction, with lesser surgical morbidity and equal survival rates as compared to primary cytoreduction. Methodology: This was a retrospective analysis of patients with advanced ovarian cancer, treated with NACT followed by interval debulking surgery at Tata Memorial Hospital from January 2014 to December 2014. Results: Epithelial cancers constituted 84.4% (n = 406) of all cases of ovarian malignancies. Of these, overwhelming majority (84.3%, n = 342) were in the advanced stage. Sixty percent of all EOC patients received NACT. The mean baseline serum CA-125 level in women treated with NACT was 4294.7 U/ml (range, 11–151,200 U/ml). The median number of NACT cycles (paclitaxel + carboplatin) was 3. Optimal cytoreduction was achieved in 81.5% cases. The rates of Grade 3 or 4 intraoperative and postoperative complications were 4% each. The median postoperative stay was 5 days and the median time between surgery and adjuvant chemotherapy was 20 days. The median progression-free survival (PFS) was 15.15 months (95% confidence interval [CI]: 12.95–17.34), and the median overall survival (OS) was 34.73 months. Multivariate analysis revealed that optimal cytoreduction (hazard ratio [HR] = 2.04 [95% CI: 1.15–3.62]; P = 0.015) and number of NACT cycles (3 vs. >3; HR = 1.51 [95% CI: 1.06–2.16]; P = 0.022) were significantly associated with PFS, and optimal cytoreduction (HR = 3.21 [95% CI: 1.53–6.73]; P = 0.002) and ECOG status (0–1 vs. ≥2; HR = 2.64 [95% CI: 1.25–5.55]; P = 0.011) with OS. Conclusions: High rates of optimal cytoreduction were achieved at interval cytoreductive surgery after NACT, with acceptable surgical morbidity, early start of adjuvant chemotherapy, and survival outcomes comparable to international standards.

Keywords:
Advanced ovarian cancer, neoadjuvant chemotherapy

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Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India.

Nair D, Singhvi H, Mair M, Qayyumi B, Deshmukh A, Pantvaidya G, Nair S, Chaturvedi P, Laskar SG, Prabhash K, DCruz A.

Abstract

BACKGROUND: Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes. AIM: The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes. SETTINGS AND DESIGN: This was a retrospective analysis of prospectively collected data in a tertiary cancer center. MATERIALS AND METHODS: This study included 850 surgically treated oral cancer cases between January and December 2012. STATISTICAL ANALYSIS: We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression. RESULTS: The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula. CONCLUSION: The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment.

Keywords:
Complications, oral cancers, outcomes, surgery

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Total laryngectomy: Surgical morbidity and outcomes – A case series

Pantvaidya GH, Raina S, Mondal A, Deshmukh A, Nair D, Pai P, Chaturvedi P, D'Cruz A.

Abstract

BACKGROUND: Total laryngectomy (TL) is a well-established procedure for laryngeal and hypopharyngeal cancers. There is an increasing number of TLs done after organ preservation strategies. AIM: The aim of this study was to report 30-day morbidity and survival outcomes in patients undergoing TL at a tertiary referral center. SETTING AND DESIGN: This was a retrospective review of a prospective database of TL patients operated during 2012–2013. MATERIALS AND METHODS: Patient demographics and other data were captured from the database. Surgical

complications were graded as per Clavien–Dindo grading system and were also divided into major and minor as per predecided criteria. Recurrence and survival data were computed using Kaplan–Meier survival curves. RESULTS: A total of 169 patients underwent TL during the study period. About 34% of the patients had received prior radiation therapy. Around 18% of the patients had major complications with a pharyngocutaneous fistula rate of 22.4%. Ninety percent of these were managed conservatively. Though used in a small subset, microvascular reconstruction had the least complication rates. The 3-year disease-free survival and overall survival were 66% and 72%, respectively. There was no difference in survival between per primum and salvage surgery cohorts. CONCLUSION: TL is a safe and oncologically sound procedure in patients with laryngeal and hypopharyngeal cancers. A large proportion of patients still undergo TL as a de novo procedure. This denotes that patients still present with locally advanced cancers which are not amenable to organ preservation.

Keywords:
Laryngectomy, morbidity, outcomes, pharyngocutaneous fistula, salvage laryngectomy

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Surgical outcomes of thyroid cancer patients in a tertiary cancer center in India.

Deshmukh A, Gangiti K, Pantvaidya G, Nair D, Basu S, Chaukar D, Pai P, Nair S, Hawaldar R, Dusane R, Chaturvedi P, D'Cruz A.

Abstract

Background: Surgery is the mainstay in the management of thyroid cancer. Surgical outcomes need to be tempered against the excellent prognosis of the disease. Aims: This study aims to study the surgical outcomes including the 30-day morbidity and 5-year survival of thyroid cancer patients. Settings and Design: Retrospective analysis of a prospectively maintained surgical database in a tertiary cancer center in India. Materials and Methods: We analyzed 221 surgically treated patients in the year 2012. Statistical Analysis: Used IBM SPSS 24.0 (Armonk, NY) with p < 0.05. Results: The median age was 40 years with predominantly papillary thyroid carcinoma (55%). Localized disease in 47% of cases, locoregional disease in 42.5% and distant metastasis in 10.2% of cases at presentation was noted. Treatment naïve patients were 71% and revision surgeries were done in 29% patients. Extended thyroidectomy constituted 11% of the surgeries. Temporary hypocalcemia was seen in 30.8% of patients, 5% requiring intravenous calcium supplementation. Vocal cord palsy as per nerve at risk and chyle leak were seen in 4.5% and 3.1%, respectively. Aggressive histology, extended thyroidectomy, and inadvertent parathyroidectomy were significant factors associated with complications. Five year estimated overall survival with median follow-up of 50 months was 98%, and event-free survival was 84.8%. Advanced age, distant metastasis at presentation and aggressive histology connoted poor outcomes. Conclusion: Thyroid cancer, irrespective of the extent of disease, has good prognosis. Aggressive histology, the extent of thyroid surgery, distant metastasis and age are important factors, which should be factored in the algorithm of thyroid cancer management.

Keywords:
Complication, surgery, survival, thyroid cancer

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Surgical morbidities and outcomes of major salivary gland neoplasms treated at a tertiary cancer center.

Shivakumar Thiagarajan, Khuzema Fathehi, Deepa Nair, Anuja Deshmukh, Gouri Pantvaidya, Devendra Aravind Chaukar, Anil Keith D'Cruz

Abstract

Background and Objectives: Salivary gland neoplasms are relatively uncommon. They have a wide variety of histopathological types with diverse biological behavior. It involves all the major and minor salivary glands in the head and neck. This article focuses on the various types of major salivary gland tumors treated at a tertiary cancer center along with their surgical morbidities and outcomes. Materials and Methods: Data of all the salivary gland neoplasms operated in the head and neck services between January 2012 and December 2013 were retrieved from a prospectively collected database. The clinical, demographic data and types of surgeries along with the morbidities were collated from the database and the details regarding the follow-up were collected from the electronic medical record. Results: Out of 235. cases registered, 107. patients were treated at our institute. The parotid gland was most commonly involved; majority were malignant lesions. Sixty-two patients were treatment naive at presentation. Majority presented with advanced disease. Superficial parotidectomy was the most common surgery performed and neck dissection was done in 27. patients. Facial nerve palsy was the most common complication following surgery. (16%). Sixty patients received adjuvant treatment. All patients on follow-up were alive at their last visit, with 10. patients having recurrence. Factors influencing the disease-free survival were extracapsular spread, tumor grade, and perineural invasion. Conclusion: The postoperative morbidities and outcomes for major salivary gland neoplasms in our series were acceptable and comparable to the results available in the literature. Appropriate treatment of the salivary gland neoplasm will yield good outcomes with acceptable morbidity.

Keywords:
Major salivary gland, morbidity, neoplasm, outcomes, surgical

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Demographic profile, clinicopathological spectrum, and treatment outcomes of primary central nervous system tumors: Retrospective audit from an academic neuro-oncology unit.

Gupta T, Epari S, Moiyadi A, Shetty P, Goda JS, Krishnatry R, Chinnaswamy G, Vora T, Menon H, Patil V, Sahay A, Bano N, Jalali R.

Abstract

Primary tumors of the central nervous system are relatively uncommon, comprising only 1%–2% of all neoplasms. However, they constitute the second most common type of malignancy in children (after leukemia) and the leading cause of cancer-related morbidity and mortality in children and young adults worldwide. Globally, there is substantial variability with nearly five-fold difference in incidence between various parts of the world. Brain tumors are quite heterogeneous with regard to histology, biological behavior, and prognosis mandating multidisciplinary therapeutic decision-making. This retrospective audit of all consecutive patients registered in a single calendar year (2013) in the neuro-oncology disease management group at Tata Memorial Centre is reflective of the ground reality and fair representation of outcomes in routine neuro-oncologic practice.

Keywords:
Audit, brain tumors, epidemiology, neuro-oncology, outcomes

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A cross-sectional study of the distribution of pediatric solid tumors at an Indian tertiary cancer center

Qureshi SS, Bhagat MG, Kembhavi SA, Chinnaswamy G, Vora T, Prasad M, Laskar S, Khanna N, Ramadwar MR, Shah S, Salins N, Talole S.

Abstract

Context: Pediatric solid tumors include a heterogeneous group of tumors, and the burden of these tumors, especially from resource-challenged countries, is not well described. AIMS: The aim of this study was to describe the distribution of solid tumors in children and the treatment outcome of Wilms tumor and hepatoblastoma. Patients and Methods: All patients under 15 years of age with histologically confirmed tumors presenting at a tertiary cancer center from January 2012 to December 2016 were identified from the hospital database. Patients with lymphomas, bone, and central nervous tumors were excluded. The demographic profile including age, sex distribution, and the treatment received were recorded for all patients. Results: The mean age of the eligible 1944 patients was 5.7 years with majority (57.3%) in the 0–4 years age group. The male-to-female ratio was 1.4:1 with a male predominance in all tumors except germ cell tumors. Soft tissue tumors were the most common tumors followed by neuroblastoma and renal tumors, whereas liver tumors formed only 6.7% of all tumors. Seventy percent of the patients received treatment completely or partially at our institute, whereas 18.3% had no cancer-directed treatment. The 3-year overall survival of patients with Wilms tumor and hepatoblastoma was 85.4 and 78.5%, respectively. Conclusions: Extracranial and extraosseous pediatric solid tumors include a wide range of tumors with a predilection for male sex and children below 4 years of age. Soft tissue tumors, neuroblastoma, and renal tumors are the most common; the outcomes of Wilms tumor and hepatoblastoma are favorable.

Keywords:
Cancer, cancer epidemiology, childhood, developing countries, pediatric, solid tumors, tumor registries

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Kidney cancer demographics and outcome data from 2013 at a tertiary cancer hospital in India

Joshi A, Anand A, Prabhash K, Noronha V, Shrirangwar S, Bakshi G, Pal M, Murthy V, Krishnatry R, Desai S, Menon S, Patil D, Kulkarni S, Sable N, Popat P, Agrawal A, Rangarajan V, Prakash G.

Abstract

The stage at diagnosis of renal cell cancer (RCC) in developed countries is lower due to increased utilization of routine health checkups by patients compared to developed countries. This study aims to determine the sociodemographic and clinical distribution of RCC in patients presenting to Tata Memorial Hospital (TMH). SUBJECTS AND METHODS: We performed a retrospective audit of all patients presenting to TMH with a diagnosis of RCC. Data were retrieved from our electronic medical record system from January 1, 2013 to December 31, 2013. The survival analysis was done by Kaplan–Meir analysis method of estimating survival. Log-rank test of comparison was applied to estimate the difference in the survival among the different stages of renal cancer. RESULTS: Of the 35,197 new registered patients at TMH, 338 were diagnosed with RCC. Most patients were in the 50–60 years age group, with 56.6 years being the median age at presentation. Among patients treated at TMH, 84 underwent surgery and tyrosine kinase inhibitor was given in 55 (16%) patients. The patients' characteristics, clinical characteristics of RCC, treatment modalities offered, and survival of patients treated for RCC are presented in this paper. CONCLUSION: In the absence of robust Indian data on RCC, this audit provides baseline information on epidemiology, stage at presentation, and outcomes of RCC at our center compared with the West.

Keywords:
Indian data, kidney cancer, renal cell carcinoma, Tata Memorial Hospital

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