Browsing by Author "B, Thakur"
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Publication Clinical study of sentinel lymph node biopsy in early uterine cervical carcinoma(Kathmandu University, 2005) Ying, Wu Hong; B, ThakurBackground: Radical hysterectomy and complete pelvic lymphadenectomy is the standard treatment for early cervical carcinoma. But the rate of pelvic and paraaortic nodal metastasis is found to be low, pointing that most of the patients possibly undergo unnecessary nodal dissection. Aim: To study the value of sentinel lymph nodes (SLNs) in prediction of the pelvic lymph node status and to determine the significance of SLN detection in pelvic lymph node dissection in patients with early stage cervical carcinoma. Settings and design: Retrospective study. Methods: From August 2002 to August 2004, 20 patients with early stage cervical carcinoma, planned to undergo radical hysterectomy and extensive pelvic lymph node dissection received an intracervical injection of a blue dye to identify and perform resection of SLN. The SLNs were pathologically compared with non-SLNs with frozen section, paraffin section, and anti-cytokeratin immunohistochemical staining. Results: Out of 20 patients, SLNs were detected in 15 patients. A total of 46 SLNs were identified and the mean was 3 per patient. The detection rate of SLN was 75%. Sensitivity, specificity and accuracy of the SLN biopsy were 75%, 100% and 95%, respectively. Conclusion: SLN detection can predict the pelvic lymph node status in early stage cervical carcinoma, but the feasibility and safety of this technique to substitute conventional surgical modality should be evaluated by large series of prospective studies. Keywords: Cervical cancer; Sentinel lymph node biopsy; Lymph node excisionPublication Origin and countermeasure for common skin flap complications after radical operation for breast cancer(Kathmandu University, 2006) Wu Hongying; Zhang Chun Shan; B, ThakurObjective: To discuss the various factors which cause the common skin flap complications after radical operation for breast cancer Methods: Two hundred sixteen patients with T1-3N0-1M0 breast cancer underwent radical surgery at The Cancer Hospital of Xingtai City, China during 1995-2003. Patey mastectomy was performed in majority of patients. Skin flaps were dissected using scalpel after injecting adrenaline containing saline into subcutaneous tissue. Diathermy was used only to stop bleeding vessels. A subset of patients who developed abnormal vascularity of skin flaps, seroma collection and flap necrosis was analyzed. Pressure garment and suction drains were used routinely. Flap necrosis < 3cm2 was allowed to heal with secondary intention whereas larger defects were skin grafted. Results: In 56 patients, flap associated complications were noted. Abnormal vascularity, flap necrosis and seroma collection were absorbed in 34 (15.7%), 13 (6%) and 9 (4.2%) patients, respectively. Eight patients (3.7%) required skin grafting. All patients were discharged with full recovery. Conclusion: To minimize the skin flap complications after radical surgery for breast cancer, lesser use of cautery, injection of adrenaline containing solution into subcutaneous tissue, routine use of suction drains and application of pressure garment may be recommended. Key Words: Modified radical mastectomy; seromaPublication Use of greater omentum in thoracic onco-surgery(Kathmandu University, 2007) B, Thakur; CS, Zhang; FM, CaoBackground: Omentum is well known for its immunocompetence and good blood supply; and therefore, is being used in various complex thoracic procedures. Specially, in situations when staplers, sealants and total parenteral nutrition may not be used because of financial constraints, omentum may prove very helpful in preventing post- operative fatal complications. Methods: A retrospective review of 61 patients was undertaken. Patients were categorized into two groups. In group I, omentum was sutured to the anastomosis for prophylaxis of leak from gastro-oesophagectomy after radical surgery for cancer of cardia and oesophagus. In group II, it was used for therapeutic purpose, to control diffuse air leak from lung parenchyma after chest wall and invaded lung resection for malignant chest wall tumours (subgroup A) and treatment of post pneumonectomy bronchopleural fistula for NSCLC of right lung (subgroup B). Gastro- oesophagectomy, closure of bronchial stump and suturing of lung parenchyma after wedge resection was done with manual suturing technique only. Results: Group I: There were 57 patients with the diagnosis of cancer of cardia and oesophagus, who underwent radical surgery. Transthoracic approach was used in 96.5% patients, whereas 3.5% patients underwent transhiatal resection. Anastomotic level was located in chest in 68.4% and in neck in 31.6% patients. The leakage rate was 5.4%. Group II: There were three patients in subgroup A, all with lesions located in left side of chest wall. There was one patient in subgroup B. Chest tube was removed after a mean time of 2 days and after 4 days in subgroup A and B, respectively. There was 1 mortality (1.6%) secondary to chylothorax. Conclusion: Use of pedicled omentum appears to be a very simple technique to prevent the anastomotic leak after radical surgery for cancer of cardia and oesophagus, and to seal the diffuse parenchymal pulmonary leak after various procedures in thorax. Key words: greater omentum; omentoplasty; omentopexy