Jyoutishman Saikia

Background: Volume‐replacement oncoplastic breast‐conserving surgery (VR‐OBCS) reconstructs the lumpectomy cavity with autologous tissue and spares the contralateral breast. Chest‐wall perforator flaps (CWPFs)—lateral, anterior, and medial intercostal artery perforator (LICAP, AICAP, MICAP) flaps—together with a pedicled latissimus dorsi (LD) flap form the usual toolkit, but most programs depend on hand‐held color Doppler for perforator mapping and indocyanine‐green (ICG) angiography for perfusion assessment, neither of which is widely available in resource‐limited oncology units. We evaluated whether a structured radiological assessment using ARR, BEV, and aORV could facilitate preoperative planning for volume replacement oncoplastic breast‐conserving surgery (VR‐OBCS). Methods: Consecutive women undergoing VR‐OBCS at an Indian tertiary cancer center (January 2023–March 2025) were reviewed retrospectively. Eligibility required an anticipated resection ratio (ARR) ≥ 0.15 or expected poor cosmesis after standard BCS; an ARR of 0.20–0.40 was the usual planning range for perforator‐based volume replacement. Flap choice followed a quadrant‐based map; the pedicled LD flap was reserved for defined indications. Perforator zones were identified by intercostal‐space counting; color Doppler and ICG were never used. The primary endpoint was primary R0 resection (SSO–ASTRO 2014 “no ink on tumor”); secondary endpoints included flap loss, Clavien–Dindo morbidity, oncological events, and 12‐month BREAST‐Q satisfaction. Results: One hundred thirty women (mean age 47.7 ± 5.5 years) were treated: LICAP in 68 (52.3%), MICAP in 29 (22.3%), AICAP in 21 (16.2%), and pedicled LD in 12 (9.2%); 42.3% received neoadjuvant chemotherapy. Primary R0 was 95.4%, with all six margin‐positive women achieving R0 at re‐excision (final R0 100%). No total or partial flap loss occurred. Thirty‐day morbidity was 25.4% (maximum Clavien–Dindo IIIa) and late morbidity 16.9%. At a median follow‐up of 15.9 months (IQR 12.3–22.6), no locoregional or distant recurrence and no disease‐related death were recorded. The median BREAST‐Q Satisfaction‐with‐Breasts score was 86 (IQR 78–92); none preferred mastectomy. Conclusions: Simple preoperative calculation of BEV, aORV, and ARR can guide selection between standard or type I oncoplastic BCS, perforator‐flap volume replacement, and muscle‐based reconstruction. This approach achieved reliable margin clearance, preserved flap viability, and high patient satisfaction without Doppler or ICG, making it a practical planning tool for resource‐limited centers.

Gastroesophageal junction (GEJ) cancers have shown a rising global incidence, with unique anatomical and biological features distinguishing them from esophageal and gastric carcinomas. This study evaluates the clinicopathological characteristics, treatment modalities, survival outcomes, and recurrence patterns of GEJ cancers in an Indian population. This study was conducted on 107 patients with histologically confirmed GEJ carcinoma treated at a tertiary cancer center in India between 2012 and 2024. Demographic, clinical, radiological, surgical, and survival data were reviewed. Staging was based on endoscopy and contrast-enhanced CT. Multimodality treatment strategies were implemented, including neoadjuvant chemoradiotherapy (CROSS), chemotherapy (FLOT), and definitive chemoradiotherapy for unresectable cases. Survival was analyzed using Kaplan–Meier methods, and predictors of recurrence were assessed using Cox regression. The cohort had a male-to-female ratio of 3.45:1 with a mean age of 53 years. Adenocarcinoma was the predominant histology (63.6%). Curative resection was achieved in 79.4%, with an R1 rate of 2.4%. The most common surgical approach was Ivor Lewis esophagectomy (63.6%). The 2-, 3-, and 5-year disease-free survival (DFS) rates were 82%, 75%, and 56%, respectively; overall survival (OS) rates were 88%, 77%, and 59%. Recurrence occurred in 35.3% of patients, predominantly systemic. On multivariate analysis, lympho-vascular invasion, extent of lymphadenectomy, and pathological stage significantly predicted recurrence. Gastroesophageal junction cancers in India predominantly affect middle-aged males and are mostly adenocarcinomas. Multimodality treatment, including neoadjuvant therapy and extended lymphadenectomy, shows promising survival. However, systemic recurrence remains a major challenge. Early detection, personalized treatment, and standardized follow-up are essential to improve outcomes. These findings highlight the urgent need for resource-sensitive national strategies to tackle the rising burden of GEJ cancers.

Primary squamous cell carcinoma (SCC) of the orbit is a rare and uncommon form of invasive epithelial malignancy, with few cases reported. Due to its rarity, treatment protocols remain undefined, and the therapy choices are debated. We present the case of a male in his early 50s from a low-income country who underwent treatment based on basic oncoplastic principles. He presented with a painful, blind right eye for 4 months, with clinical and imaging studies ruling out other primary malignancies. The diagnosis was locally advanced primary orbital SCC. A multidisciplinary team recommended orbital exenteration with craniofacial resection, followed by reconstruction using a temporalis sling flap and nasolabial advancement flap. Six months postsurgery, the patient showed good progress with normal vision in the unaffected eye. Primary orbital SCC, though rare, can be successfully treated with surgical resection and oncoplastic reconstruction, even in resource-limited settings.

Background: Soft tissue sarcomas recur despite optimal multimodality treatment. Being rare, and heterogeneous, there is no consensus on follow‐up protocol and management of recurrences.Materials: This is a retrospective analysis of the adult soft tissue sarcoma database. All the patients undergoing curative surgery between 1993 and 2020 were included. We studied the recurrence patterns in terms of time and anatomical location concerning age, gender, site, size, histology, grade and treatment and identified the predictive factors for local (LR) and systemic recurrences (SR).Results: A total of 984 patients were included. In a median follow‐up of 37 months, 31% (305) of patients developed recurrence. Of these, there were 12% LR and 19% SR. The median time to LR and SR was 1.07 years (0.581–2.30) and 1.03 years (0.529−1.80) respectively. The median time to recurrence was least in retroperitoneum, 0.827 years (0.471−2.34), followed by extremity, 1.60 years (0.495–3.73); trunk, 1.95 years (0.696–4.27) and head & neck, 2.21 years (0.909−4.05). Extremity and head & neck STS had more SR, while RP & trunk had a higher rate of LR. Common subtypes associated with LR were extraskeletal chondrosarcoma/osteosarcoma (n = 14, 27.27%), DFSP (n = 5, 26.32%), and leiomyosarcoma (n = 22, 24.44%) and; with SR were rhabdomyosarcoma (n = 4, 50%), angiosarcoma (n = 2, 33.33%), and pleomorphic liposarcoma (n = 23, 27.71%). Recurrence was curatively treated in 32% of patients. The 5‐year overall survival in patients with LR and SR were 76.3% and 41.2% respectively. In a multivariate analysis, age > 50 years and extremity site were predictors of local recurrence whereas male sex, high grade, and adjuvant chemotherapy were predictors of systemic recurrence.Conclusions: The study shows a higher incidence of early LR in RP and late LR in the trunk while a higher incidence of early SR in extremities and late SR in the head and neck. The highest risk for SR and LR is associated with synovial sarcoma and liposarcoma respectively. This pattern of recurrence may guide in individualizing the follow‐up frequency and imaging modality as well as in doing the timely intervention.

Background and Objectives: The role of cell‐free DNA (cfDNA) in operable nonsmall cell lung cancer (NSCLC) is unclear. This study was aimed to evaluate the feasibility for identification of cfDNA in pleural lavage fluid and its correlation with plasma in resectable NSCLCs.Methods: Consecutively resected NSCLCs were evaluated for cfDNA levels in preoperative plasma (PLS1), intraoperative pleural‐lavage (PLV) and postoperative (at 1 month) plasma sample (PLS2). CfDNA was isolated and measured quantitatively by qPCR in a TaqMan probe‐detection approach using the human β‐actin gene as the amplifying target.Results: All (n = 34) except one were negative for malignant cells in PLV cytology. CfDNA could be isolated from all the three samples (PLS1, PLV, and PLS2) successfully in each patient. The median cfDNA levels in PLS1, PLV and PLS2 were 118 ng/mL (IQR 61−158), 167 ng/mL (IQR 59.9−179.9) and 103 ng/mL (IQR 66.5−125.4) respectively. The median follow‐up was 34.1 months (IQR 25.2−41.6). A significant overall‐survival (OS) and disease‐free survival (DFS) were recorded for patients with cfDNA level cut‐offs at 125, 170, and 100 ng/mL, respectively for PLS1, PLV, and PLS2. Patients with raised cfDNA in PLS1 (>125 ng/mL) and PLV (>170 ng/mL) had significantly poorer 2‐year OS, p = 0.005 and p = 0.012, respectively. The hazards (OS) were also higher for those with raised cfDNA in PLV (HR = 5.779, 95% CI = 1.162−28.745, p = 0.032). PLV (>170 ng/mL) had increased pleural recurrences (p = 0.021) and correlated significantly with poorer DFS at 2‐years (p = 0.001) with increased hazards (HR = 9.767, 95% CI = 2.098−45.451, p = 0.004). Multivariable analysis suggested higher cfDNA in PLV as a poor prognostic factor for both OS and DFS.Conclusions: Among patients with operable NSCLC, it is feasible to identify cfDNA in pleural lavage and correlate PLV cfDNA with pleural recurrences and outcomes.

Introduction: The lateral intercostal artery perforator flap (LICAP) has emerged as one of the safest and less morbid flaps for lateral and central breast defects. We hereby describe a reproducible no Doppler single position (NDSP) technique to harvest it in single position without handheld Doppler, making it a versatile flap for lateral breast defects in resource‐limited setting also.Materials and Methods: With this technique, we performed a total of 22 LICAP turnover flaps over a period of 18 months from January 2020 to June 2021. In all 22 cases, the indication of flap was to fill the post‐breast conservation surgery (BCS) defects in outer quadrant of breast. All LICAP flaps were harvested by surface marking of anatomical landmarks and without handheld Doppler.Results: Out of 22 LICAP turnover flaps, thirteen were harvested for left breast and nine for right breast. The median width and length of the flap were 12.2 cm and 19.6 cm, respectively. The additional mean operative time was 41 min. All LICAP flaps survived well, and grade 1 Clavien‐Dindo morbidity was documented in four cases. Mean hospital stay was 2.6 days. All patients received radiotherapy on their stipulated schedule. Early cosmetic outcome was good, and long‐term outcomes are awaited.Conclusion: NDSP‐LICAP flap is a workhorse for lateral breast defects. Precise knowledge of perforators and anatomical landmarks can be used for harvesting these flaps, thus avoiding ultrasound Doppler and dedicated training for perforator localization. This technique has short learning curve without the need for any plastic surgery training. The early cosmetic outcomes are good.