Positive peritoneal lavage cytology (PLC) in non-metastatic colon cancer is a marker for a higher likelihood of future peritoneal recurrence and poorer survival. Any association between PLC and the tumour site (laterality), stage, and other pathological variables is debated. Our study aimed to find any relationship between the positive PLC, laterality, stage and other pathological parameters in resectable non-metastatic colon cancer. We performed a prospective, observational study on all consecutive patients with stage I–III adenocarcinoma of the colon undergoing upfront curative resection at our centre from March 2021 to February 2023. Patients previously treated with chemotherapy, previous abdominal surgery, colon cancer as a second primary, intraperitoneal tumour rupture, and ascites were excluded from the study. PLC was performed using pre-standardised surgical and pathological methods determined by the research team. Among the 119 eligible patients, positive PLC was found in 15 (23.08

Background: Our main objective was to assess the impact of the coronavirus disease 2019 (COVID-19) on cancer services and cancer patients in terms of disease severity, morbidity and mortality. Secondary objectives were to characterize cancer type, affected age groups, gender, comorbidities, infectivity, and to identify cancer treatment delay and its complications after COVID-19 infection. Methods: A retrospective analysis of electronic health records of polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected cancer patients from April 2020 to March 2021 was done. The following parameters were investigated upon—new and follow-up cases during the pandemic and its preceding years (2018–2019, 2019–2020), age, sex, type of cancer, comorbidities, presentation, symptomatology and treatment for COVID-19, time to recovery, complications, delay in treatment and survival outcome. Statistical analysis using chi-square testing was done on the above variables. Results: There was a 50.49% reduction in the number of new and follow-up cases as compared to that of the previous years. Seventy-four out of 310 (23.87%) COVID-19 positive cancer patients were aged in their sixth decade with the commonest type being hematological malignancies. A proportion of 84.8% (n=263) patients were asymptomatic. Univariate analysis was statistically significant for mortality with regard to age ≥60 years (P=0.034), type of malignancy (P=0.000178), hypertension (P=0.0028), symptomatology of COVID-19 infection (P=0.0016), site of treatment and oxygen/intervention (P<0.0001). There was an average delay in treatment time of 5 to 6 weeks. Multivariate analysis showed that gastrointestinal (GI) and hepato-pancreato-biliary (HPB) malignancies and oxygen requirement (>2 L/min) were responsible for the 20.65% mortality rate. Conclusions: The pandemic significantly affected the care of cancer patients with decreased cases, late presentation, delayed treatment with potentially worse mortality outcome. Although they have decreased immunity, majority were asymptomatic. Most of the fatalities were in the GI and HPB malignancies.

Background: Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. Aims and objectives: This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast. Methodology: A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery—either mastectomy or lumpectomy—and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence. Results: We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15–70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05). Conclusion: Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy.

Causes of delay in presentation of breast cancer has been categorised into ‘Primary Delay’ (delay by the patient or her family); ‘Secondary Delay’ (delay by the doctors in the first contact — family physician or quacks/alternative medicine practitioners); ‘Tertiary Delay’ (delay in the system in a specialist breast care unit e.g. waiting list, delayed reporting, doctors on leave, strikes); and ‘Quaternary Delay’ (e.g. patient hopping from one competent breast cancer specialist to another or mid-course attrition to alternative treatments). In India, many patients have blind belief and high attrition towards the quacks and alternative medicine practitioners. Our study was to assess whether these ‘Secondary and Quaternary Delays’, particularly the attrition towards the alternative non-modern medical practitioners, have any effect on the delayed presentation and advancement of the overall anatomical staging among the breast cancer patients. We performed a retrospective observational study, based on ‘Triple Assessment’ and pre-structured Questionnaire. All pathologically confirmed female breast cancer patients admitted from 02/2017 to 08/2018 in the department of General Surgery in our Institute were included. Male breast cancer, histopathologically unconfirmed/inconclusive breast lumps, patients with previous breast surgery/radiotherapy/chemotherapy were excluded. Data from 267 patients was analysed. The mean age at presentation of breast cancer was 47.54 years. The average delay between the onset of the first symptom and the histological diagnosis was 13.76 ± SD 13.08 months. About half (50.2%) of our patients visited the non-modern medical practitioners at least once during their disease. The mean delay in diagnosis was significantly higher (p < 0.0001) among them. The average ‘Secondary Delay’ was significantly higher among those who visited the non-modern medical practitioners (9.7 ± SD 9.38 months). The average delay between the visit to the first doctor and the histological diagnosis was also significantly higher among them (18.35 ± 14 months). Patients with attrition to non-modern medical practitioners also were diagnosed in higher cT stages: cT4a (66.67%, 2 of 3) and cT4b (60%, 33 of 55). Most (56.9%) of stage IIIB patients visited the non-modern medical practitioners before their diagnosis. Patients who visited the non-modern medical practitioners had significantly more delay in the diagnosis of breast cancer. The ‘Secondary and Quaternary Delays’ form the major portion in the overall delay and lead to advancement of the anatomical staging of the disease. Creating public awareness, proper training and ‘continued medical education’ for primary care physicians, and the AYUSH practitioners are required. Further population-based studies are advised.

IntroductionPrimary adenocarcinoma of appendix is a rarely diagnosed malignancy accounting for less than 6% of appendiceal neoplastic lesions and less than 0.5% of all gastrointestinal malignancies. It is mostly diagnosed as an incidental finding after appendicectomy.Case summaryAn 81 year old male patient presented with bleeding per rectum in a background of previous rectal polyp, hypertension, diabetes and hypothyroidism. CECT of whole abdomen findings revealed thickening at the appendix and base of the caecum. Colonoscopy showed a sessile polypoid growth at appendicular orifice, at the base of the caecum. Laparoscopy confirmed the clinical suspicion of appendicular carcinoma and laparoscopy assisted radical right hemicolectomy was performed. Final histopathology revealed well differentiated adenocarcinoma of the appendix with no lymph node involvement (pT3N0M0).DiscussionPatients with primary adenocarcinoma of the appendix present with features similar to acute appendicitis whereas anaemia or fresh bleeding per rectum is a rare presentation. Surgery is the mainstay of treatment, the extent of which will depend upon the stage. Tumours staged as T1 may be managed by appendicectomy alone provided the base is free and there are no lymphadenopathies. T2 or above require right hemicolectomy as chances of lymph node metastasis are high. Nodal involvement warrants the need for adjuvant chemotherapy. Distant metastasis to the peritoneum or liver and lungs is very rare.ConclusionWhile investigating unexplained anaemia or bleeding per rectum, full colonoscopic examination up to the appendicular orifice is important and if required, should be combined with CT scan of abdomen, to clinch the rare but possible and potentially curable diagnosis of appendicular carcinoma.

IntroductionOsteosarcoma of the maxilla is recorded as the least common of all bone malignancies. It exhibits a clinical behavior and natural history distinct from their counterparts of the trunk and extremities. Transformation from a chronic pyogenic abscess of the maxilla is even more unusual.Case summaryA 70 year old lady presented to our hospital with a hard, fixed and tender bony swelling in her left cheek. She had initially presented to a different hospital with a similar presentation which was excised after imaging and post excision was found to be a chronic pyogenic abscess. The swelling reappeared within one year and on re-excision was found to be a low grade paraosteal osteosarcoma of the hard palate. CECT and PET-CT work-up at our hospital showed a left maxillary sinus growth with prominent neck lymph nodes along with mediastinal lymphadenopathy and pulmonary metastasis. Final histopathology revealed ulcerated stratified squamous epithelium mucosa overlying a lesion suggestive of osteosarcoma.DiscussionComplete surgical excision with negative margins continues to be the mainstay of treatment, but osteosarcomas of maxillofacial region pose difficulties in obtaining tumour free margins because of their complex anatomy around the cranium. Surgery may be complemented by radiotherapy with or without chemotherapy. Small size of the tumour and low-grade histology have been assumed to reflect a better prognosis.ConclusionOsteosarcoma of maxillofacial region has variable appearance clinically as well as radiologically posing a diagnostic challenge for clinicians. Any chronic abscess or recurrent cheek swelling thus necessitates further suspicion and requires a full work-up to rule out this high risk malignancy.

Background: Presence of haematoma, serous fluid, and dead space in a wound increase the risk of infection as they act as a culture media. Multiple options had been mentioned to reduce these risks. We tried to assess the incidence of SSI following placement of closed suction drains following elective surgeries. Methods: A prospective observational study was conducted in the Department of General Surgery, IPGMER & SSKM Hospital, Kolkata from January 2016 to June 2017. Patients who were given a subcutaneous suction drain after an elective general surgical procedure were included in the study. Patients unwilling to take part in the study, patients from paediatric age group, on steroids, with Class 4 wounds and those underwent Laparoscopic Surgery were excluded. Outcome was measured in the form of presence or absence of SSI and data was analysed. Results: No statistically significant decrease of incidence of SSI was found in terms of different age, sex, socio-economic status, duration of hospital stays, smoking or alcoholism. Increased incidence of SSI was detected among Diabetics even after using closed suction drainage. Conclusion: Placement of closed suction drain did not significantly reduce incidence of SSI following elective general surgical procedures.

Background: To improve patient safety and prevent complications, WHO introduced surgical safety checklist (WHO SSC). However, the actual effect of WHO SSC on patient morbidity, particularly surgical site infections (SSI), and mortality on post-operative patients is one of the least studied area. Our study was to measure the effects surgical safety checklists have in reducing morbidities and complications, particularly surgical site infections, post-operative length of stay and mortality resulting from the surgical procedures. Methods: A prospective observational comparative study was conducted among all patients who underwent elective general surgical procedures from 01st July 2015 to 30th June 2016 in the Main OT Complex (OT1 and OT2), Indoor Surgical Wards and higher dependency units (ITU & CCU) of IPGMER & SSKM Hospital, Kolkata, after applying proper exclusion criteria. Pre-implementation (before implementation of WHO Surgical Safety Checklist) data was collected for first 6 months, then WHO Surgical Safety Checklist was implemented over next 6 months. Pre and post-implementation cohorts were compared and analysed. Results: Total 382 patients (187 Control group and 195 implementation group) were included. Both groups matched regarding age, sex, type of surgery, type of anaesthesia, post-operative length of stay. However, incidence of SSI significantly decreased (30.48% to 16.41%, p value 0.002, <0.05, statistically significant). Overall complication rate, unplanned return to operating room (OR) also decreased though the results were statistically not significant. Conclusion: Implementation of WHO SSC decreases morbidity related to SSI significantly. Further studies are required to assess the effects on mortality and unplanned return to OR.

Background: Identification and protection of Facial Nerve is of prime importance during surgery of parotid glands. Several techniques are available in literature to identify and preserve FN. We present here a case series with dissection of FN in a novel technique during parotidectomy which has significantly lowered the morbidity due to injury of the FN. Methods: All data, from all the patients who underwent Parotidectomy in our unit (conducted or supervised by a single surgeon) in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, between March 2014 to March 2019, using our novel technique for identification and protection of FN, was retrospectively analysed. Outcome measurement was expressed in terms of type of surgery, duration, estimated blood loss, any intra-operative or post-operative complications, length of hospital stay, duration of drain in place, Histopathological (HPE) reports, size of the tumour, margin and lymph node status, Facial Nerve weakness and other complications. Results: Total 13 patients underwent Parotidectomy (Total or Superficial) following our technique of identifying and protecting Facial Nerve (FN). Four of them had temporary FN paresis in immediate post-op period. None of the patients had FN paresis on follow-up at 1 year. Conclusion: The novel technique described in our study for identification and protection of FN is a promising technique for Parotid Surgery.

In a cranium of a male cadaver styloid processes have been found to be unusually long with different lengths. Elongation of styloid process involvethe entire 'Stylohyoid complex/chain', though not rare as reported in earlier literatures, but the osseomorphological and radiological analysis of present case brings out a unique variety as its described in the article.