Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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Geriatric population is estimated to be 12.4% of population in India by the year 2026. As the population continues to age, the number of surgical interventions in the elderly (≥65yr) also continues to rise.Two important principles that makes the elderly more vulnerable is that first aging is associated with a progressive loss of functional reserve in multiple organ systems and secondly the extent and onset of these changes are highly variable on an individual basis. This article reviews the perianesthetic considerations for geriatric population emphasizing the need for utmost care and concern in the following three categories: preoperative evaluation and considerations, intra-operative management, and postoperative concerns. Due to the increased incidence of adverse events in geriatric population a meticulous risk stratification of these patients undergoing various surgical procedures preoperatively may help guide decisions on adequate perioperative management as well as reduce untoward complications.

Ameloblastic carcinoma is an extremely rare malignancy arising from odontogenic epithelium. The present work aimed to report clinical, histopathological, surgical and treatment-related details of four patients identified in our hospital database. We also present the disease behavior on follow-up of these patients. All patients underwent an adequate initial assessment and were treated with curative intent. The study population has a median follow-up of 68.5 months with no disease-related mortality. Literature suggests ameloblastic carcinoma to be chemo resistant and radio resistant. Surgical resection with wide margins is the standard of care. We also present a case of solitary lung lesion identified on follow-up imaging and addressed surgically. As surgery is the mainstay treatment in ameloblastic carcinoma, pulmonary metastasectomy is a valid tool in treating patients with isolated metastases.

Anticancer immunity modulation is the current standpoint of research and has revolutionized the standard of care of platinum refractory recurrent/metastatic head and neck carcinoma of squamous cell origin (R/M HNSCC). Checkpoint inhibitors are targeted at PD-1/ PD-L1 axis, which is involved in the genesis, maintenance and progression of HNSCC. Head and neck cancer has an immunosuppressive character and a high inflammatory response component in the tumor microenvironment. The clinical settings in which these agents are highly useful are in study all around the globe. We discuss the current up to date clinical trial results and the future prospective of cancer immunotherapy in the field of HNSCC.

Ageing is a natural biological property of all living beings. There is an estimated 120 crore population around the world currently over the age of 65 years, it is also estimated that half of the world's population would be in geriatric group by year 2050. Developed nations have about 30% of their population in geriatric age group. In India 10% of population belong to geriatric age, even though it comparatively low with other nations the numbers are huge due to population size. Special senses such as hearing and smell are impaired along with ageing body. Other otorhinolaryngological problems are also common due to degenerative changes in head and neck region. Cosmetic problems are a concern too due to the ever increasing zeal for youthfulness in modern society. We review some of the common problems faced in the elderly.

Inverted papilloma of sinonasal system is a benign tumour comprising of 0.5% to 4% of all nasal tumours having locally aggressive features. Recurrence is common and can cause bone destruction. Clinically, the most common presentation is unilateral nasal obstruction. Isolated frontal sinus inverted papilloma maybe hidden for long time without any symptoms. Case Report : A 55 yr old man with recurrent sinonasal polyposis who underwent endonasal surgery on multiple occasions presented to us with complaints of unilateral nasal obstruction, anosmia, fronto-temporal headache since 9 years which aggravated during past 6 months . Following admission CT -Para Nasal Sinuses showed sinonasal polyposis involving bilateral frontal , right maxillary sinuses with hyperdense lesions in frontal sinuses and multiple sinus wall erosions with exposure of dura. Patient was planned for Functional Endoscopic Sinus Surgery and osteoplastic flap without frontal sinus obliteration after adequate premedication. Intra-operatively frozen section revealed inverted papilloma histopathologically. Complete clearance of tumour was achieved via osteoplastic approach. Conclusion : In our case complete excision of the mass was very important because recurrence after surgery is between 25% -35% for inverted papillomas. There are difficulties in handling papillomas of the frontal sinus. Despite advances in endoscopic sinus surgery these may require open surgical approach to the frontal sinus. So, osteoplastic flap approach provides a safe and effective way to deal with these pathologies.