Rectal cancer surgery can be extremely challenging in the confines of a bony pelvis with adjoining vital structures. The male pelvis and obesity add to these challenges. Robotic systems provide surgeons with enhanced dexterity, precision, and visualization, making them particularly suitable for Rectal cancer surgeries. The major challenge with a robotic platform is additional per patient cost for using the robotic system, instruments and maintenance. To address this, we have standardized three important aspects of Rectal surgery. Firstly, through sub specialization of the surgeon in Rectal surgery, secondly standardization of the Robotic TME technique and thirdly by taking steps to reduce associated costs without compromising patient outcomes. The aim of this retrospective study was to assess if we can improve surgical outcomes while achieving cost efficiency in Robotic Rectal Cancer surgery. The early surgical outcomes like anastomotic leak, surgical site infection, readmission, re-exploration, margin positivity, and length of stay are comparable (sometimes even better) in our study as compared to the robotic group of ACS-NSQIP(American College of Surgeons National Surgical Quality Improvement Program) study. Additionally, our average cost of INR 450,315 (5122.10) is significantly lower than the national range of INR 500, 000 to INR 1,000,000 ( 5687.2 to 11374.4) for Robotic Rectal Cancer surgery. This study demonstrates that by adopting subspecialisation, standardising technique and implementing cost saving measures we can deliver favourable outcomes in Rectal cancer surgery and, do so cost effectively. This in turn opens the opportunity for wide spread use of Robotic Rectal Cancer surgery.
To develop a novel methodology for planning target volume (PTV) margin determination by analysing minimum coverage probabilities of virtual clinical target volumes (CTV) with reduced-margins, using accumulated doses in an offline adaptive radiotherapy (ART) framework. Treatment plans from 11 brain tumour patients with varying histologies, geometries, and volumes were analysed. Virtual CTVs (CTV-v0 to CTV-v3) were generated by isotropically contracting the clinical PTV (PTV-c) by 0–3 mm in 1 mm increments, with corresponding virtual PTVs assigned equal margins. For each treatment fraction, dose distributions were recalculated on setup-corrected daily megavoltage CT (MVCT) images using the clinically approved sinogram. A total of 303 fractions were assessed using two coverage thresholds: V98
BACKGROUND:The usage of antimicrobials is commonly associated with the emergence of resistant phenotypes in microorganisms. Health care facilities are required to measure antimicrobial consumption and monitor consumption trends to promote its rationale use. The aim of this study is to estimate the antimicrobial consumption in the hospital using the defined daily dose (DDD) methodology and to determine the percentage of antibiotics consumed as per the Access, Watch, and Reserve classification. METHODS:This retrospective observational study was conducted at Apollo Proton Cancer Centre, Chennai over a period of 1 year from January 2023 to December 2023. All inpatients admitted to the multidisciplinary critical care unit, surgical intensive care units, and wards were included in the study. Antimicrobial stewardship data collected by the clinical pharmacist were reviewed retrospectively. The calculation of antibiotic consumption was done using the DDD/1,000 patient-days formula, and the average of it was estimated using Microsoft Excel 2022 edition. RESULTS:A total of 5,029 inpatients were included in the study. The average antimicrobial consumption for the high-end antibiotics, restricted antifungals, and other antibiotics was found to be 637.9, 87.6, and 559.2, respectively. The most commonly consumed antibiotic was meropenem (51.4%) followed by cefoperazone-sulbactam (34.7%), piperacillin-tazobactam (34.2%), and teicoplanin (15.2%). CONCLUSION:In this study, the utilization of Watch (73%) group antibiotics was more than that of the Access (18%) group and Reserve (9%) antibiotics. These findings suggest an urgent need for strengthening the existing antimicrobial stewardship program in the health care setting to improve the antibiotic metrics.
PurposeMaxillary cancers extending to the deep craniofacial spaces represent one of the most challenging scenarios in head and neck oncology. Integrating compartmental surgery principles with combined endoscopic–open approaches may optimize deep-margin control, a key determinant of oncologic radicality.MethodsA retrospective analysis included 34 patients treated between 2019 and 2025 at four referral centers using combined compartmental maxillary resection (CCMR). Procedures were assigned to CCMR types 1–3 according to the compartmental resection performed; preoperative imaging, including assessment of posterior deep spaces and the infratemporal fossa (ITF), informed template selection.ResultsITF infiltration was absent in 38.2% of cases, partial in 35.3%, and extensive in 26.5%. Resection types were CCMR type 1 in 32.4%, type 2 in 38.2%, and type 3 in 29.4%. Negative margins were achieved in 79.4%; posterior and medial margin control remained reliable even with partial or extensive ITF involvement. Median follow-up was 21 months. Local control rates at one and three years were 81.9% and 75.1%, respectively.ConclusionCCMR appears to be a feasible and anatomically standardized surgical strategy for selected maxillary cancers arising from the oral cavity or maxillary sinus with deep craniofacial extension. By integrating compartmental resection principles with combined endoscopic–open approaches, this technique may support margin-oriented surgical planning and reliable control of deep posterior and medial margins, including in cases with ITF involvement. Further studies with longer follow-up are needed to define its oncologic impact.
BACKGROUND:Children with Ewing sarcoma (ES) and rhabdomyosarcoma (RMS) across Asia, the Middle East and Africa often require cross-border referral for advanced radiotherapy, risking a disruption of multimodality care. We evaluated whether a structured referral network could deliver advanced radiotherapy while preserving treatment continuity. METHODS:This retrospective single-centre study included 54 consecutive children (27 ES, 27 RMS) treated in India between 2019 and 2025, referred from 13 countries and 11 Indian states. Primary endpoints were radiotherapy completion, treatment interruptions, chemotherapy continuity, treatment abandonment and follow-up retention. Survival outcomes were secondary endpoints. RESULTS:Median age was 7 years (range, 1-18), and 87% received proton beam therapy. All patients completed planned radiotherapy; interruptions occurred in only three patients, all ≤4 days. There was no treatment abandonment, and loss to follow-up was 2%. Planned chemotherapy was completed in all patients, with shared delivery between referring and treating centres in 80%. Median time from chemotherapy initiation to radiotherapy was 23.3 weeks for ES and 17.7 weeks for RMS. Among patients receiving definitive radiotherapy, treatment began within 15 weeks of chemotherapy start in 72% of ES and 88% of RMS patients. After radiotherapy, 63% resumed chemotherapy within 14 days and 78% within 21 days. Three-year overall survival and progression-free survival were 89.7% and 55.0% for ES (100% and 66.4% in localised disease) and 82.5% and 69.7% for RMS (90.0% and 74.2% in localised disease). CONCLUSIONS:In a single-centre cohort of children referred across state and national borders, a structured referral network enabled the delivery of advanced radiotherapy while preserving multimodality treatment continuity. Although survival outcomes are descriptive and derived from a selected cohort, this model may inform access strategies in regions without local advanced radiotherapy capability.
