Background: Living donor renal transplant with grafts having complex vascular anatomy is technically difficult with higher complications. We herein present our experience of complex vascular anatomy living donor renal grafts as compared to grafts with simple vascular anatomy. Methods:The is a retrospective comparative analysis of a prospectively maintained database of all the patients undergoing live related renal allograft transplant from January 2015 till Dec 2019. All adult transplants with graft with complex vascular anatomy were included and deceased donor and pediatric transplants were excluded.Results: There were 422 eligible transplant patients out of which 92 (21.8%) patients had grafts with complex vascular anatomy and 330 (78.2%) patients had single renal artery and vein. There were no major intra-operative complications. Warm ischemia time and operating time were significantly less in single artery group (p < 0.001). There was no difference in terms of urine output, fall in serum creatinine levels, delayed graft function (4.2% vs. 4.3%), primary graft non function (1% vs. 0.6%), urine leak (2.1% vs. 3%) and hospital stay. Conclusion:Renal transplant with grafts with multiple renal vessels have equivalent outcomes as compared to simple vascular anatomy. Complex vascular anatomy living donor transplants should be done in high volume centers by experienced surgeons.
AimTo study expression of VEGF and D II40 in breast cancer and correlate with lymph nodal metastasis.Materials & MethodsFormalin fixed paraffin embedded blocks of breast cancer were retrieved and 4 mu thick sections obtained& stained with routine ‘H&E’. Sections were cut on APES (3‐Triethoxysilylpropylamine) coated slides & immunohistochemistry (IHC) was performed using Streptavidin Biotin Peroxidase technique using monoclonal antibodies against VEGF and DII 40 on coated sections of cases & controls. IHC stains were reviewed in conjunction with H&E. Intensity of VEGF expression & its distribution in the tumour were observed under high power magnification & semi‐quantitatively analyzed. Brown granules in the cytoplasm/membrane of the cells were considered as +ve for VEGF expression when the proportion of immunoreactive cells was ≥5%. ; 5–25% staining, weakly +ve (+) 26–50% staining,+ve (++); >50% staining, strongly +ve (+++). For statistical analysis, samples with 0/+ staining considered in low expression group, while ++/+++ expression were considered as high expression. For DII40 well demarcated vessels showing positivity in endothelial cells were counted per 10 hpf after selecting hot spots at scanner view. For statistical analysis, 0 was considered as no expression and 1/10HPF was considered as high expression.Results48 tissue specimens were included in the study. High VEGF expression (Fig 1) was seen 33/43 patients (76.74%%; 95% CI 61.37%–88.24%) and high DII 40 expression (Fig 2) in 30/44 (68.18%; 95% CI 52.42%–81.39%). Variation in expression of VEGF and DII 40 in relation to each other is given in figure 1. Of the 33 patients with high VEGF expression, DII 40 was expressed in 26 of them (78.79%). There is a strong association between VEGF expression and DII 40 expression (p<0.01). The scatter diagram of VEGF and DII 40 expression showed a significant trend (Figure 3 ) indicating that as VEGF expression increases so does the DII 40 expression. The variance explained by VEGF level in the variance of DII 40 as measured by the correlation (R2) was 0.1265 (p=0.02). When VEGF expression was compared with LN status, low expression of VEGF was found in 38.47 % (5/13) of SLN positive and 16.67 % (5/30) of negative senitnel node patients. High expression of VEGF was in 61.53% of positive patients as compared to 83.33% of negative sentinel node patients. Results of VEGF expression and sentinel node status revealed no statistically significant relation between expression of VEGF and LN involvement. No D II 40 expression of was found in 38.46% (5/13) % of LN +ve patients as compared to 29.03% (9/31) in node negative. High D II 40 expression was found 61.54% LN+ve patients and 70.97% of snode negative. Results of DII 40 expression and LN status revealed no statistically significant relation between expression of DII 40 and node involvement. When the expression of VEGF and D II 40 was compared with tumour characteristics there was no statistically significant relation with tumour size, tumour type, grade, ER/PR staus and Her2neu status.ConclusionsLympahngiogenesis marker (VEGF) expression is high in most tumours and there is significant association between lymph vessels detection as studied by D II 40 expression and lymphangiogenesis marker expression as studied VEGF expresssion. However, no association was found between expression of VEGF and D II 40 with neither sentinel / non‐sentinel nodal status nor any of the primary tumour characteristics.Support or Funding InformationnoneThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Oncoplastic breast surgery (OPBS) is offered to patients with early breast cancer. Local (LR) recurrence following OPBS reported only in case series till date. There is no RCT comparing the incidence of local recurrence (LR) following conventional BCS & OPBS. Aim: Evaluation of incidence of LR & cosmesis following conventional BCS & OPBS Methods: After obtaining IRB approval, over a 2 year period, 94 consenting Women with breast tumors ≤ 4cm were randomised to BCS (group 1: 47 patients) or OPBS (group 2: 47 patients). Patients with no suspicious axillary nodes underwent SLNB & those with nodal metastasis underwent ALND. All surgeries were performed under general anaesthesia. Patients in group 1 underwent ‘standard’ wide local excision with 1 cm tumor free margin following which wound was closed with absorbable sub cuticular sutures. Patients in group 2 underwent level 1 or level 2 oncoplastic breast surgery using volume displacement techniques wherein breast parenchymal plates were mobilized on either sides from underlying pectoral fascia and overlying skin. The cut edges were approximated by absorbable interrupted sutures so as to obliterate the cavity following which skin was closed with absorbable sub cuticular sutures. Cavity margins were marked with titanium clips to facilitate planning of radiotherapy. All patients were discharged on postoperative day 1 & were followed up as per standard protocol. At follow up patients were assessed for surgical site infection, seroma etc. Cosmetic & aesthetic outcome were evaluated by patient herself, a female nurse & surgeon 3 & 6 months after surgery. Aesthetic score was assessed individually using the predetermined criteria viz. shape with brasserie, shape without brasserie, symmetry to the opposite breast, mobility, consistency, position of inframammary fold & NAC and overall appearance. All patients received whole breast RT with boost to cavity site followed by systemic treatment. Statistical Analysis: Qualitative & quantitative data was expressed as frequency , mean +SD, and median (min-max). Categorical & continuous variables were compared among the groups by chi-square, Fischer exact test, independent t test or Wilcoxon rank sum test . P value <0.05 was considered as significant. Results: Mean age of patients was 48.78 years (range 23-76 years SD: 12.29). Tumor size ranged from 1-4 cm ( mean: 2.9 cm; median 3 cm in group 1 & mean 3.14 cm; median 3 cm in group 2). Primary tumor was T1 in 17 (18 %) & T2 in 77 (82%). Node status was N0 in 79 (81%) patients and N1 in 15 (19%). 66 (69.6%) tumors were ER and PR +ve, 21 (22.3%) were triple negative and 8 (8.5%) were Her2 neu positive. 91 (93.61%) were invasive carcinoma and 3 (6.39%) were DCIS. Seven patients (7.4%) received NACT. 79 (81.4%) underwent SLNB and rest underwent ALND. Patient & tumor characteristics were similar in both groups. Local Recurrence: At a mean follow up of 28.02±8.82 ( range 13-47) months, 5 patients (5.3%) developed LR ( 1 in group 1 (2.1%) and 4 in group 2 (8.5%). However, this difference was not statistically significant. Three (3.19%) of these patients ( 1 in group 1 and 2 in group 2) developed systemic metastasis and died. Patients’ satisfaction with surgery and comfort with brassiere were significantly higher in group 2. However, there was no difference in sexual and social life among the two groups. Shape of the breast with & without brassiere, and over all appearance were rated to be significantly better in group 2 by both the surgeon and nurse. Conclusions: Contrary to published literature, in this RCT, LRR following OPBS is slightly higher as compared to conventional BCS. But the difference is not statistically significant. Larger trials with longer follow up are needed to confirm this observation. Cosmetic satisfaction and aesthetic outcome were significantly better with OPBS Citation Format: Seenu V, Devprakash Choudhary, Shivangi Saha, Srineil Vuthaluru, Anurag Srivastava. Local recurrence and aesthetic outcome following conventional breast conserving surgery and oncoplastic breast surgery: A randomized controlled trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-47.
Introduction: Need for any form of surgery for axillary lymph nodes in breast cancer with clinical and radiologically negative axilla is being increasingly questioned. Randomized controlled trials are underway to answer this question. This study was undertaken to evaluate the results of sentinel node lymph biopsy (SLNB) in patients with normal preoperative axillary ultrasound (AUS) after obtaining institution ethics committee approval. Materials and Methods: All patients of operable breast cancer seen in the Breast Cancer Clinic at Sultan Qaboos University Hospital, underwent routine preoperative AUS as part of staging work up. In patients with suspicious lymph nodes, fine needle aspiration cytology (FNAC) was performed. Patients with clinical and radiologically normal axilla underwent BCS/ mastectomy with SLNB (Group 1), while patients with positive lymph nodes underwent neoadjuvant chemotherapy (NACT) and repeat AUS after completion of chemotherapy. Patients who were reported to have normal AUS post NACT underwent SLNB (Group 2). Negative Predictive Value (NPV) and probability of positive SLN when AUS was normal were calculated for the entire cohort, group 1 and group 2. A comparison of NPV between two groups was performed at a 5% level of significance (MedCalc 12.7, 2013). Results: Between 2016-2018, 165 patients with normal AUS underwent SLNB. One hundred and thirteen of these patients underwent ‘upfront’ SLNB, while 52 patients had received NACT and then underwent SLNB. Mean age of patients was 49.33 years (range: 32-74 years ) and was similar in both groups. Mean number of lymph nodes obtained was 4.7 (range 2-8) in group 1 and 4.69 (range 2-6) in group 2. Mean number of positive lymph nodes was 1.69 in group 1 and 2.4 in group 2. Out of 165 patients with normal AUS, 51 patients had metastasis in SLNs. Twenty nine of 113 patients in group 1 showed metastasis in SLNs while 22 out 52 patients in group 2 showed metastasis. NPV for AUS for the whole group was 69.1% (95% CI=62.0%-76.2%), and for group 1 & 2 were 74.3% (95%CI=66.2%-82.4%) and 57.6% (95% CI=44.2%-71.0%), respectively. A significant higher NPV was found in group 1 than in group 2 (χ2=3.873, p=0.049). Thus, the probability of positive SLN even when AUS was normal was 0.31 for whole group, 0.25 for group 1 and 0.42 for group 2. Conclusion: Probability of metastasis in SLN when AUS with or without FNAC is normal is more than 20%. Thus there is need for better preoperative imaging of axilla in patients of breast cancer with clinically and radiologically negative axilla before abandoning SLNB altogether. Citation Format: AlJarrah Adil, Seenu V, Badriya Al Qassabi, Hajar Nasser Alsaadi, Safa Abdullah Al-abadi, Srineil Vuthaluru, Moon-Fai Chan, Radiya Al Ajmi. Can sentinel lymph node biopsy be avoided in patients of breast cancer with normal preoperative ultrasound of axilla [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-40.
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