Browsing by Author "Shrikhande, Shailesh V"
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Item Detection of gall bladder cancer metastases in rare sites by PET scan.(2007-11-24) Shukla, Parul J; Barreto, Savio G; Shrikhande, Shailesh V; Mohandas, K M; Purandare, N; Rangarajan, VItem Docetaxel/Oxaliplatin/Capecitabine (TEX) triplet followed by continuation monotherapy in advanced gastric cancer(Indian Cancer Society, 2018-01) Ostwal, Vikas; Bose, Subhadeep; Sirohi, Bhawna; Poladia, Bhavesh; Sahu, Arvind; Bhargava, Prabhat; Doshi, Vipul; Dusane, Rohit; Nashikkar, Chaitali; Shrikhande, Shailesh V; Ramaswamy, AnantIntroduction: Docetaxel/oxaliplatin/capecitabine (TEX) is a commonly used combination chemotherapeutic regimen in advanced gastric cancer (AGC). Application strategies in routine clinical practice are reported in this study. Materials and Methods: Patients diagnosed with AGC, receiving biweekly TEX (docetaxel - 60 mg/m (2)-D1; oxaliplatin - 85 mg/m (2)-D1, and capecitabine 500–625 mg/m (2) orally twice daily for 14 days) between July 2012 and May 2016 were retrospectively analyzed for tolerance, prognostic factors, event-free survival (EFS), and overall survival (OS). The proportion of patients continuing and terminating chemotherapy at various time-points was enumerated. Results: Overall, 208 patients were started on TEX. Median EFS was 6.34 months (95% confidence interval [CI] 5.80–6.87), and median OS was 15.31 (95% CI 12.65–17.96). Post 8 cycles of TEX, further 30 patients (14.4%) were continued on chemotherapy (docetaxel, capecitabine, or TEX) whereas 47 patients (22.6%) were on observation only, and there was a statistically significant difference in the median OS of these two groups (22.55 months vs. 14.89 months; P = 0.028). Raised serum alkaline phosphatase (SAP) levels (>100 U/L) predicted inferior survival (P = 0.006). Conclusion: TEX chemotherapy is a feasible, efficacious triplet regimen that can be used in clinical practice. SAP levels >100 U/L is a poor prognostic factor, as observed in this study. An initial “induction” such as combination chemotherapy regimen followed by monotherapy as continuation requires further evaluationItem Feasibility of laparoscopic abdomino-perineal resection for large-sized anorectal cancers: a single-institution experience of 59 cases.(2009-03-11) Shukla, Parul J; Barreto, Savio G; Hawaldar, Rohini; Nadkarni, Mandar; Kanitkar, Gajanan A; Kerkar, Rajendra; Shrikhande, Shailesh VBACKGROUND: Laparoscopic surgery for anorectal carcinoma is steadily gaining acceptance. While feasibility has already been reported, there are no reports addressing the impact of the actual size of large tumors on laparoscopic resectability. AIM: To assess the feasibility and short-term results (including oncological surrogate end points) of performing laparoscopic abdomino-perineal resection (APR) for large rectal cancers. MATERIALS AND METHODS: Data of 59 patients undergoing laparoscopic APR (LAPR) for anorectal malignancies were reviewed retrospectively. Outcomes were evaluated considering the surgical procedure, surface area of the tumor and short-term outcomes. RESULTS: Of the 59 cases, LAPR could be completed in 53 (89.8%) patients. Thirty-one (58.4%) patients had Astler-Coller C2 stage disease. The mean surface area of the tumors was 24+/-17.5 (4-83) cm2. The number of median lymph nodes harvested per case was 12 (1-48). Circumferential resection margin (CRM) was positive in 11 (20.7%) patients. No mortality was reported. CONCLUSION: This appears to be the first report analyzing the impact of the size of the rectal tumor in LAPR. The data clearly indicates that LAPR is not hampered by the size of the tumor. There appears to be a need for preoperative radiotherapy and chemotherapy before undertaking surgery on larger tumors in view of the higher circumferential resection margin positivity.Item Hepatic resection for metastasis from adenoid cystic carcinoma of parotid gland.(2005-01-22) Qureshi, Sajid S; Nadkarni, Mandar S; Shrikhande, Shailesh V; Desai, Sangeeta; Deodhar, Kedar; Ramadwar, Mukta; Shukla, Parul JAdenoid cystic carcinoma is the commonest malignant tumor of the submandibular and minor salivary glands; the parotid gland constitutes a small share of this neoplasm. We present a 30-year-old woman with solitary liver metastasis from an adenoid cystic carcinoma of the parotid gland, which had been surgically treated 10 years ago. The patient underwent successful resection of this metastasis.Item Impact of intra-operative ultrasonography in liver surgery.(2005-03-10) Shukla, Parul J; Pandey, Durgatosh; Rao, Pramod P; Shrikhande, Shailesh V; Thakur, Meenakshi H; Arya, Supreeta; Ramani, Subhash; Mehta, Shaesta; Mohandas, K MBACKGROUND/OBJECTIVE: Intra-operative ultra-sonography (IOUS) during surgery for primary and metastatic hepatic tumors identifies additional lesions and helps in determining the most optimal surgical strategy. We assessed the impact of IOUS in liver surgery at our hospital, a tertiary-care cancer center. METHODS: Patients with potentially resectable hepatic tumors underwent surgical exploration. The relationship of the tumor with regard to the intrahepatic vasculature was determined by IOUS. A search was also made for additional lesions not detected by pre-operative imaging modalities. In appropriate cases, IOUS was also used to assist resection and radiofrequency ablation/ethanol injection. RESULTS: Between January 2003 and January 2005, 52 patients underwent surgery for primary or secondary hepatic tumors. IOUS was performed in 48 of these patients. It detected additional hepatic lesions in 14 patients (29.2%). IOUS contributed to changing the operative plan in 21 patients (43.8%). It was directly responsible for avoiding resection or ablation in 7 patients (14.6%), 5 of whom had multiple bilobar lesions, 1 had IOUS-guided biopsy that revealed caseating granuloma on frozen section, and 1 patient had no lesion on IOUS. Three patients had extent of resection changed based on IOUS findings. IOUS also guided radiofrequency ablation in 8 patients and ethanol injection in one patient. CONCLUSION: IOUS is an essential tool in surgery for hepatic tumors. In addition to accurate staging, it also aids in safe resection and radiofrequency ablation in appropriate cases.Item Isolated gall bladder metastasis from renal cell carcinoma.(2006-05-01) Pandey, Durgatosh; Kane, Shubada V; Shukla, Parul J; Shrikhande, Shailesh V; Tongaonkar, Hemant BGall bladder metastasis from renal cell carcinoma is rare. We report a 46-year-old man with isolated gall bladder metastasis from renal cell carcinoma 11 months after radical nephrectomy. He underwent cholecystectomy and frozen section revealed the metastatic tumor. Sixteen months later, the patient is free of disease.Item Metastatic pancreatic cancer: Another option.(2011-11) Shrikhande, Shailesh V; Gupta, Sudeep; Ostwal, VikasItem Pancreatic resectional surgery: an evidence-based perspective.(2008-04-09) D'souza, Melroy A; Shrikhande, Shailesh VA diagnosis of pancreatic cancer carries a very dismal prognosis, with the 5-year survival rate being the lowest of all types of cancer. Surgical resection offers the only hope for cure in these patients. Pancreatic resectional surgery is technically demanding, and while mortality has decreased in centers of excellence, the morbidity remains significant. Numerous controversies exist regarding various aspects of complex pancreatic resections. This review attempts to address these controversies with an evidence-based perspective. We performed a literature search in MEDLINE (www.pubmed.org) with relevant key words and the corresponding MeSH terms. The search was limited to English language publications on human subjects. A manual cross-reference search of the bibliographies of relevant papers was carried out to identify publications for possible inclusion.Item Postoperative deep vein thrombosis in patients with colorectal cancer.(2008-03-13) Shukla, Parul J; Siddachari, Ravichand; Ahire, Sanjay; Arya, Supreeta; Ramani, Subhash; Barreto, Savio G; Gupta, Sudeep; Shrikhande, Shailesh V; Jagannath, P; Desouza, Luis JDeep vein thrombosis (DVT) is reported to be common among patients undergoing surgery for colorectal cancer. This randomized controlled trial was aimed to determine the efficacy of low molecular-weight heparin in the prophylaxis of DVT in this high-risk group and was truncated early in view of an unexpectedly low incidence of DVT. Between March 2002 and January 2004, a total of 99 patients with colorectal cancer - selected for surgery in the lithotomy position - were randomized before surgery to either receive dalteparin or no drug (51 and 48 patients, respectively) during the perioperative period. Duplex ultrasonography was performed before and after the surgery. We also looked for distal venous thrombosis, pulmonary embolism, hemorrhage and any mortality. No episode of DVT occurred in either the drug arm or the observation arm. There was no death following surgery. The incidence of DVT in Indian patients operated for colorectal cancer in the lithotomy position was negligible.Item Primary neuroendocrine carcinoma presenting as mesenteric cyst.(2007-05-21) Punpale, Ajay S; Shrikhande, Shailesh V; Sumeet, Gujral; Shukla, Parul JPrimary neuroendocrine carcinoma occurring in the mesentery is extremely rare. Surgical resection is the best treatment modality, with a chance of cure. We present a 65-year-old man with large mesenteric cyst and absence of bowel involvement. Histology showed a well-differentiated neuroendocrine tumor.