Clinical Examination and Ultrasonography as Predictors of Lateral Neck Lymph Nodes Metastasis in Primary Well Differentiated Thyroid Cancer

Background: Lateral neck dissection is risky and should be performed only as a therapeutic intervention for known disease. Aim of the Study: This study aims at finding predictors which help in selecting patients who have high risk of lymph node metastasis. Methods: All the patients with well differentiated thyroid cancer underwent thyroidectomy with lateral lymph nodes (LNs) dissection with available pathology report and sufficient data have been included in the study. Results: Sixty nine patients have been included in this study. In multivariate analysis, the most reliable and significant factors for detecting L.N. involvement were the clinical picture and the U/S appearance of the Neck with P value of (0.008) and (0.001) respectively. Conclusion: Clinical and U/S examinations are the most independent and reliable factors to detect lateral neck lymph nodes involvement.

In Frail Elderly Patients, Low-Dose Gemcitabine over 6-Hour Infusion Is Equally Effective and Less Toxic Than the Standard Gemcitabine Protocol for Advanced Pancreatic Adenocarcinoma: A Randomized Phase II Trial

Background:?Treatment of frail elderly patients with pancreatic cancer is still a major problem due to intolerance to standard chemotherapy doses. Aim:?This study aims to compare the low-dose gemcitabine over 6 hours (LD6H) to the standard gemcitabine protocol in terms of clinical benefit, survival, and safety in the frail elderly patients with advanced pancreatic adenocarcinoma. Methods:?Patients enrolled in this trial were randomly assigned by in a 1:1 fashion via closed envelope method to either receive gemcitabine of 1000 mg/m2?over 30-minute infusion on days 1, 8, and 15 of every 4-week cycle (standard protocol arm) or gemcitabine as a weekly low-dose (250 mg/m2) over 6-hour infusion (LD6H arm). Results:?We enrolled eighty-two eligible frail elderly patients with advanced pancreatic cancer. The patients were randomly assigned to receive either standard gemcitabine protocol (40 patients) or low-dose (250 mg/m2) gemcitabine over 6-hour infusion, given weekly (42 patients). There was no significant difference between the standard group and low-dose group as regard of the overall response rate (p = 0.654), the disease control rate (DCR) (p = 0.845), the median progression-free survival (PFS) (p = 0.908) and the overall survival (OS) (p = 0.331). The low-dose regimen had a significantly lower incidence of adverse effects grades 3 or 4 when compared to the standard regimen: (p = 0.024 for fatigue, p = 0.027 for hypotension, p = 0.012 for each anemia as well as thrombocytopenia, and p = 0.006 for neutropenia). Conclusion:?Low-dose gemcitabine over 6-hour infusion is equally effective and less toxic when compared to standard gemcitabine protocol in frail elderly patients with advanced pancreatic adenocarcinoma. So, we recommend the low-dose gemcitabine for frail elderly patients with advanced pancreatic cancer.

Primary Debulking Surgery for Stage III Epithelial Ovarian Cancer Has a Better Outcome Than Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery

Background:?Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer.?Methods:?This study was performed on eligible patients with ovarian cancer admitted in Surgical Oncology and Medical Oncology departments at South Egypt Cancer Institute-Assiut University in the period from January 2010 to December 2015. Patients were divided into two groups, the first group included those who have NACT and underwent IDS plus adjuvant chemotherapy, and the second group included those who underwent PDS followed by adjuvant chemotherapy.?Results:?This study included 380 cases. One hundred and fifty-four patients (40.53%) had IDS. The remaining two hundred and twenty-six patients (59.47%) underwent PDS. In this study, treatment modality was significant for both disease-free survival (DFS) and overall survival (OS). DFS was significantly reduced after IDS when compared to PDS (median DFS: 33.00 months vs. 45.00 months, respectively;p??0.001). Also, OS was significantly reduced after IDS when compared to PDS. (Median OS: 43 months vs. 46 months, respectively;p = 0.047). Moreover, this drop of the survivals mainly occurred in specific subgroups such as the elderly patients, patients with bad performance status, suboptimal cytoreduction, as well as high-grade tumors. Conclusion:?This study showed that PDS resulted in a better disease-free survival and overall survival than IDS. Moreover, OS and DFS have significantly dropped in specific patients’ subgroups. Therefore, patients selection should be considered.

Laparoscopy Assisted Distal Gastrectomy for Cancer at a Tertiary Center in Egypt. Is It Safe and Feasible?

Background: Laparoscopic radical gastrectomy for cancer has significant short- and long-term advantages. The feasibility and safety of laparoscopicdistal gastrectomy for cancer (LADG) is unclear in low to middle income countries as resources are limited. Therefore, the aim of this study was to evaluate the safety and feasibility of (LADG) in low to middle income countries;Egypt as an example. Methods: Thirty four Patients with stage I-II cancer at the pylorus and antrum have been enrolled for LADG between 2012 and 2015 with the reuse of single use vascular sealing device has been evaluated. Results: Finally 27 patients had been included in the study and successful LADG has been done for all selected cases. The average operative time was 151 ± 10 minutes. The average estimated blood loss was 73.3 ± 13 ml. No intra-operative complications have been recorded. The average time for post-operative patient ambulation was 9 hours (SD ± 1.8) and for oral fluid intake was 3.5 SD ± 1 days. The average duration of the hospital stay was 9.3 ± 1.2 days. The average number of retrieved lymph nodes was 21.7 ± 3.8 days. All the cases had free surgical margin. The median number of reuse of the vascular sealing device was 3.8 times (3 - 5 times). Conclusion: Laparoscopic distal gastrectomy for cancer could be safe and feasible in developing countries and give similar results for that of developed countries. Safe reuse of single use expensive parts of some instruments for laparoscopy could help in utilization of these advanced surgeries in low to middle income countries. Long term follow up as well as comparative studies with open surgery are required.