Neoadjuvant chemotherapy in gastric cancer can treat micro metastatic disease and can increase the resectability rate. The trial was to compare early outcomes after primary surgery versus neoadjuvant chemotherapy followed by surgery in gastric adenocarcinoma. The primary aim of the study was to compare resectability and R0 resection rates in upfront surgery v/s chemotherapy followed by surgery arm. A secondary aim was to see if neoadjuvant chemotherapy is well tolerated or not by comparing postoperative morbidity and mortality. The study consisted of 60 consecutive patients of carcinoma stomach randomized into primary surgery and neoadjuvant chemotherapy followed by surgery arms. Morbidity, pathological status, and mortality data were collected and analyzed. Mean operating time in primary surgery arm was 290 ± 46.5 min, while in NACTarm, it was 316.7 ± 56.6 min, respectively. When postop complications were compared between the arms, it was not significant. Comparing the histopathological report of two groups, there was no significant difference between differentiated, T stage, mean lymph node harvest, R0 resection, PNI, and LVI. Neoadjuvant chemotherapy showed a trend towards improving in the R0 resection rate. There is no increase in postoperative morbidity and mortality with neoadjuvant chemotherapy.
Seckel syndrome (SS) is a rare, autosomal recessive syndrome; characterized by severe intrauterine and postnatal growth retardation, microcephaly, mental retardation, and typical facial appearance with beaklike protrusion of the midface (bird headed). In addition to the characteristic craniofacial dysmorphism and skeletal defects, abnormalities have been described in the cardiovascular, hematopoietic, endocrine, gastrointestinal, and central nervous systems. Usually such patients have poor psychomotor development. This case report presents an 8-year-old child with SS born to parents, exposed in Bhopal gas disaster.
Patients with anorectal malignant melanoma (ARMM) have a poor prognosis. Optimal surgical treatment is not defined. The aim of the study was to define the surgical treatment for ARMM, to compare the overall survival (OS) of abdomino-perineal resection (APR) and wide local excision (WLE) and to study various prognostic factors. Thirty patients of ARMM were managed, 20 with locoregional disease, 10 metastatic. Of the 20 patients with locoregional disease, 15 underwent APR and 5 WLE. The 1-, 2-, 3-, and 4-year overall survival rates (by Kaplan-Meier survival analysis) in the APR group were 67, 40, 40, and 32%, and in WLE group were 100, 100, 67, and 67% respectively. Median survival for APR and WLE groups were 13 and 36 months and were not significant (p 0.48). Node-negative patients had better survival than node positive in the APR group (56 vs. 13 months) (p 0.017). Patients with tumor size < 2cm, lymphovascular invasion and perineural invasion negative, and margin-negative and with superficial infiltration had a trend toward better survival than their counterparts. WLE gives an equivalent oncological outcome and can be offered for patients with smaller ARMM and APR for locally advanced, larger tumors or as a salvage following recurrence after WLE.
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