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Preoperative therapy in locally advanced esophageal cancer

World Journal of Gastroenterology 2016年第39期22卷 8750-8759页

作者： Pankaj Kumar Garg Jyoti Sharma ashish jakhetiya Aakanksha Goel Manish Kumar Gaur Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital University of Delhi Department of Surgical Oncology Sawai Man Singh Medical College Department of Surgical Oncology Dr BRA Institute Rotary Cancer Hospital All India Institute of Medical Sciences

Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.

关键词： Esophageal cancer Preoperative therapy Multimodality treatment Chemotherapy Radiotherapy Chemoradiotherapy

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Lymphadenectomy in gastric cancer: Contentious issues

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World Journal of Gastrointestinal Surgery 2016年第4期8卷 294-300页

作者： Pankaj Kumar Garg ashish jakhetiya Jyoti Sharma Mukur Dipi Ray Durgatosh Pandey Department of Surgical Oncology Dr BRA Institute Rotary Cancer Hospital All India Institute of Medical Sciences Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital

The stomach is the sixth most common cause of cancer worldwide. Surgery is an important component of the multi-modality treatment of the gastric cancer. The extent of lymphadenectomy has been a controversial issue in the surgical management of gastric cancer. The East-Asian surgeons believe that quality-controlled extended lymphadenectomy resulting in better locoregional control leads to survival benefit in the gastric cancer; contrary to that, many western surgeons believe that extended lymphadenectomy adds to only postoperative morbidity and mortality without significantly enhancing the overall survival. We present a comprehensive review of the lymphadenectomy in the gastric cancer based on the previously published randomized controlled trials.

关键词： Gastric neoplasms Lymphadenectomy Gastrectomy Survival Disease recurrence

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Role of positron emission tomography-computed tomography in non-small cell lung cancer

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World Journal of Methodology 2016年第1期6卷 105-111页

作者： Pankaj Kumar Garg Saurabh Kumar Singh Gaurav Prakash ashish jakhetiya Durgatosh Pandey Department of Surgery University College of Medical Sciences and Guru Teg Bahadur HospitalUniversity of Delhi Department of Surgical Oncology Dr BRA Institute Rotary Cancer HospitalAll India Institute of Medical Sciences Department of Pulmonary Medicine Gajra Raja Medical College and Jaya Arogya Group of Hospitals Clinical Hematology and Bone Marrow Trans- plant unit Department of Internal MedicinePost-Graduate Institute of Medical Education and Research

Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell carcinoma and small cell carcinoma are the main histological subtypes and constitutes around 85% and 15% of all lung cancer respectively. Multimodality treatment plays a key role in the successful management of lung cancer depending upon the histological subtype, stage of disease, and performance status. Imaging modalities play an important role in the diagnosis and accurate staging of the disease, in assessing the response to neoadjuvant therapy, and in the follow-up of the patients. Last decade has witnessed voluminous upsurge in the use of positron emission tomography-computed tomography(PET-CT); role of PET-CT has widened exponentially in the management of lung cancer. The present article reviews the role of 18-fluoro-deoxyglucose PET-CT in the management of non small cell lung cancer with emphasis on staging of the disease and the assessment of response to neoadjuvant therapy based on available literature.

关键词： Positron emission tomography Diagnostic imaging Neoplasm staging Carcinoma Non-small-cell lung cancer Lung neoplasms

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Targeted therapy of gastrointestinal stromal tumours

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World Journal of Gastrointestinal Surgery 2016年第5期8卷 345-352页

作者： ashish jakhetiya Pankaj Kumar Garg Gaurav Prakash Jyoti Sharma Rambha Pandey Durgatosh Pandey Department of Surgical Oncology Dr BRA Institute Rotary Cancer HospitalAll India Institute of Medical Sciences Department of Surgery University College of Medical Sciences and Guru Teg Bahadur HospitalUniversity of Delhi Clinical Hematology and Bone Marrow Transplant Unit Department of Internal MedicinePost-Graduate Institute of Medical Education and Research Department of Radiation Oncology Dr BRA Institute Rotary Cancer HospitalAll India Institute of Medical Sciences

Gastrointestinal stromal tumours(GISTs) are mesen-chymal neoplasms originating in the gastrointestinal tract, usually in the stomach or the small intestine, and rarely elsewhere in the abdomen. The malignant potential of GISTs is variable ranging from small lesions with a benign behaviour to fatal sarcomas. The majo-rity of the tumours stain positively for the CD-117(KIT) and discovered on GIST-1(DOG-1 or anoctamin 1) expression, and they are characterized by the presence of a driver kinase-activating mutation in either KIT or platelet-derived growth factor receptor α. Although surgery is the primary modality of treatment, almost half of the patients have disease recurrence following surgery, which highlights the need for an effective adjuvant therapy. Traditionally, GISTs are considered chemotherapy and radiotherapy resistant. With the advent of targeted therapy(tyrosine kinase inhibitors), there has been a paradigm shift in the management of GISTs in the last decade. We present a comprehensive review of targeted therapy in the management of GISTs.

关键词： Gastrointestinal tumors Molecular targeted therapy Protein kinase inhibitors Imatinib Survival

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Modified skin bridge technique for ilio-inguinal lymph node dissection:A forgotten technique revisited

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World Journal of Methodology 2016年第3期6卷 7-9页

作者： Mukur Dipi Ray Pankaj K Garg ashish jakhetiya Sunil Kumar Durgatosh Pandey Department of Surgical Oncology Dr BRA Institute Rotary Cancer Hospital All India Institute of Medical Sciences Department of Surgery University College of Medical Sciences and Guru Teg Bahadur Hospital University of Delhi

Ilio-inguinal lymph node dissection(IILD) is a commonly performed surgical procedure for a number of malignant conditions involving mainly the male and female genitalia, and the skin; however the postoperative morbidity of IILD, due to high frequency of flap necrosis, wound infection and seroma formation, has always been a major concern for the surgeons. The aim of the study is to highlight a modified skin bridge technique of IILD using two parallel curvilinear incisions to minimize postoperative skin flap necrosis. This technique was successfully employed in 38 IILD during May 2012 to November 2013. None of the patient had flap necrosis. Two patients developed seroma while another two patients had superficial surgical site infection; they were managed conservatively. Modified skin bridge technique for IILD is an effective method to minimize flap necrosis without compromising the oncological safety.

关键词： Skin bridge technique Wound infection Ilio-inguinal lymphadenectomy Flap necrosis

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