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        Real world clinical outcomes of adjuvant sequential chemoradiation in patients with gallbladder carcinomas with poor performance status

        Rakesh Kapoor,Kannan Periasamy,Rajesh Gupta,Arun Yadav,Divya Khosla 대한방사선종양학회 2020 Radiation Oncology Journal Vol.38 No.4

        Purpose: The purpose of the study is to analyze the overall survival, relapse-free survival, and relapse patterns of adjuvant sequential chemoradiation for gallbladder cancers after curative resection in patients with poor performance status. Materials and Methods: We retrospectively reviewed clinical records of gallbladder patients with pathologic stage T2-4 or node positivity treated with sequential chemoradiation at our institute between January 2015 and January 2019. Sequential chemoradiotherapy protocol consisted of six cycles of gemcitabine 1,000 mg/m2 and oxaliplatin 100 mg/m2 administered every 2 weekly and postoperative radiation therapy (45 Gy in 25 fractions over 5 weeks) by three-dimensional conformal technique. Results: A total of 36 patients were included. The median overall survival and relapse-free survival was 26 months (95% confidence interval [CI], 21.4-30.5) and 21 months (95% CI, 11.8-30.1), respectively. The 2-year overall and relapse-free survival rates were 55.1% (95% CI, 37.9%-72.3%) and 44.7% (95% CI, 27.5%-61.9%), respectively. Locoregional, systemic, and combined recurrence were noted in 2 (5.5%), 14 (38.8%), and 3 (8.3%) patients, respectively. On univariate analysis, tumour grading significantly influenced relapse free survival; nodal stage and overall stage demonstrated a statistically significant influence on overall survival (p < 0.05) with a trend towards significance for lymphovascular invasion. On multivariate analysis, no significant factors were found. Grade 3 and 4 haematological adverse events were observed only in 2 (5.5%) with chemotherapy. No grade 3 and 4 adverse events were observed due to radiation therapy. Conclusion: Sequential chemoradiation is feasible and tolerable with acceptable efficacy in the adjuvant setting in patients unfit for concurrent chemoradiotherapy.

      • KCI등재

        Inflammatory Myofibroblastic Tumor of the Urinary Bladder Managed by Laparoscopic Partial Cystectomy

        Manas Ranjan Pradhan,Priyadarshi Ranjan,Ram Nawal Rao,Saurabh Sudhir Chipde,Krishna Pradhan,Rakesh Kapoor 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.11

        Inflammatory myofibroblastic tumor of the urinary bladder is a rare mesenchymal tumor with uncertain malignant potential. It often mimics soft tissue sarcomas both clinically and radiologically. Surgical resection in the form of partial cystectomy or transurethral resection remains the mainstay of treatment. Herein we report the case of an inflammatory myofibroblastic tumor in a young girl, which was managed by laparoscopic partial cystectomy. To the best of our knowledge, this is the first reported case of laparoscopic management of an inflammatory myofibroblastic tumor of the urinary bladder.

      • KCI등재후보

        Impact of diabetes mellitus on morbidity and survival after pancreaticoduodenectomy for malignancy

        Kunal Bikram Deo,Aditya Atul Kulkarni,Praveen Kumar-M,Gautham Krishnamurthy,Sunil Shenvi,Surinder Singh Rana,Rakesh Kapoor,Rajesh Gupta 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2

        Backgrounds/Aims: Diabetes mellitus (DM) is a known risk factor for morbidity, length of hospital stay, or mortality after surgery, however, its impact on postoperative course and long-term survival after pancreaticoduodenectomy (PD) is not clear. Methods: This is a retrospective analysis of prospectively maintained database of 141 patients with periampullary and pancreatic head adenocarcinoma operated between January 2001 and March 2019. Clinico-pathological records and follow-up data were retrieved and analyzed. Cumulative hazard was computed for comparing the survival between DM and non-DM. Results: DM was present in 31/141 (21.9%) patients, while 16/31 (51.6%). were new-onset DM (NODM). Tumor size, lymphovascular & perineural invasion, type of surgery, lymph node positivity and R0 resection rate were comparable between diabetic and non-diabetic. There was no significant difference in postoperative pancreatic fistula, delayed gastric emptying, infectious complication, hospital stay and mortality between DM and non-diabetics. Patients with DM had worse survival at 3 years (OS: HR, 3.11 [1.43-6.76] p=0.004, DFS: HR, 2.61 [1.23-5.53] p=0.01) and 5 years (OS: HR, 3.32 [1.46-7.53] p=0.004, DFS: HR, 2.87 [1.29-6.41] p=0.009). On multivariate analysis, DM (3 year OS: HR, 2.61 [1.14-5.98] p=0.022, DFS: HR, 2.19; p=0.058) (5 year OS: HR, 2.55; p=0.04, DFS: HR, 2.25; p=0.068) and pylorus resecting surgery were significantly associated with worse survival at 3 and 5 years. Conclusions: Preoperative DM has no significant effect on postoperative course but has negative impact on 3-year and 5-year OS and DFS after PD for pancreatic and periampullary adenocarcinoma.

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