Publications by authors named "Kanuj Malik"

10 Publications

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Primary Renal Synovial Sarcoma Case Series: Clinical Profile and Management of a Rare Entity.

Urol Int 2021 Nov 29:1-3. Epub 2021 Nov 29.

Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India.

Synovial sarcomas occur predominantly in the extremities. Primary renal synovial sarcoma is a rare entity. Very few cases have been reported in the literature. Clinical and radiological features are similar to renal cell carcinoma with the diagnosis being established after surgery based on histopathology, immunohistochemistry, and chromosome studies. There are no established guidelines on the role of adjuvant treatment in the management of this disease. We herein present a series of 3 cases managed at 2 institutions. In the current series, all patients had venous thrombus, and surgery was the mainstay of treatment. One patient received neoadjuvant chemotherapy after a preoperative biopsy which was done as she did not respond to chemotherapy for a presumptive diagnosis of Wilm's tumor.
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http://dx.doi.org/10.1159/000520223DOI Listing
November 2021

Factors Predicting Nodal Metastasis in Penile Cancer: Analysis from a Tertiary Center.

Urol Int 2021 Nov 24:1-6. Epub 2021 Nov 24.

Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India.

Introduction: Lymph node metastasis is an important prognostic marker in penile cancer. Identification of occult metastasis is by lymphadenectomy based on the histological features of primary tumor; however, this leads to unnecessary surgical morbidity in node negative patients.

Methods: A retrospective analysis of all surgically treated penile cancer patients managed at our institute from January 2011 to March 2014 was performed. Patient characteristics, histological factors, and lymph node involvement were identified. Logistic regression analysis was used to compute odds ratio (OR) in univariate and multivariate analysis.

Results: Ninety seven patients underwent surgical management at our institute during the abovementioned period. Grade III tumor, presence of lymphovascular invasion, tumor thickness >10 mm, perineural invasion (PNI) and Ki67 >50% were significantly associated with nodal metastasis. On multivariate analysis, only presence of PNI was found to be significant (OR: 6.82) (95% confidence interval: 1.72-27.03) (p = 0.006).

Conclusion: PNI is a strong independent predictor of occult lymph node metastasis in penile cancers. Its inclusion in stratification of clinically node negative patients will identify high-risk patients who will benefit from prophylactic lymphadenectomy.
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http://dx.doi.org/10.1159/000519918DOI Listing
November 2021

Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial.

Scand J Urol 2021 Sep 23:1-6. Epub 2021 Sep 23.

Apollo Cancer Hospital, Chennai, India.

Background: Post-operative lymphorrhea is a well-known complication of inguinal lymph node dissection. However, the interventions to reduce the duration of drain have not been sufficiently elaborated.

Objectives: We evaluated the potential role of intra-operative mapping of lymphatic leakage with peri-incisional methylene blue injection and clipping of lymphatics after inguinal block dissection in reducing postoperative lymphorrhea.

Methods: We randomized 39 inguinal dissections done for various malignancies such as for carcinoma penis, urethra, malignant melanoma, rectum into 19 dissections (Interventional group) and 20 dissections (Control group). In the interventional group, after the completion of inguinal dissection, two ml of methylene blue dye was injected 4-8cm from the incision to identify the leaking lymphatics and they were clipped.

Results: The primary outcome was the decrease in duration of days of drain and was found to have significant reduction of 3.07 days in the interventional arm. (p value-0.02). The secondary outcome was the reduction of 21 ml of mean drain output in the interventional group ( = 0.09). The number of lymphatics clipped was not found to have statistical correlation with the duration of drain and the mean drain output.

Conclusion: The intraoperative mapping of lymphatic channels using methylene blue after inguinal dissection reduces the number of days of drain .
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http://dx.doi.org/10.1080/21681805.2021.1980096DOI Listing
September 2021

Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection (PC RPLND) for Nonseminomatous Germ Cell Tumour: Experience from a Tertiary Cancer Centre.

Indian J Surg Oncol 2021 Jun 25;12(2):374-377. Epub 2021 Mar 25.

Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India.

Postchemotherapy RPLND remains an integral part of management of testicular tumours. Nerve-sparing techniques can minimize the ejaculatory dysfunction due to the procedure. We report our functional and oncological outcomes for nerve-sparing RPLND in postchemotherapy settings. We analysed data from all patients undergoing nerve-sparing PC RPLND from January 1990 to December 2013 at our institute. Antegrade ejaculation and fertility issues were determined by patient history. Nerve sparing was achieved in 30% of patients undergoing PC RPLND. Of the 33 patients who underwent nerve-sparing PC RPLND, 19 (57.8%) had antegrade ejaculation. The mean time to antegrade ejaculation was 6.8 months. After a median follow-up of 75.61 months, 5-year disease-free survival was 98%. Nerve-sparing RPLND can improve functional outcomes without increasing recurrence rates in post chemotherapy setting.
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http://dx.doi.org/10.1007/s13193-021-01313-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272781PMC
June 2021

Utility and Safety of Repeat Transurethral Resection of Bladder Tumor Performed at a Tertiary Center.

South Asian J Cancer 2020 Jun 14;9(2):86-89. Epub 2020 Dec 14.

Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.

 Repeat transurethral resection of bladder tumor (ReTURBT) has become an integral part of the management of superficial bladder cancers at various urological centers around the world. Early detection of residual disease, leading to upstaging in some cases, leads to decrease in recurrence rates. Our study aimed to analyze the impact of ReTURBT in detecting residual tumor and tumor recurrences, hence validating the benefits of procedure as a routine.  A total of 152 patients with superficial bladder cancer who were treated at Cancer Institute (WIA) between January 2005 and December 2013 were analyzed and followed up for 3 years.  Of the 152 cases who underwent ReTURBT, 47 patients had residue in the final histopathology of the resected specimen (31%). The overall rate of upstaging to muscle-invasive disease following ReTURBT was 3.3%. The mean follow-up period was 47.13 months, during which 25 (17%) out of 147 patients who underwent ReTURBT had disease recurrence. There was no additional morbidity due to ReTURBT as compared with the primary procedure.  ReTURBT is an effective procedure in treating recurrent tumors also as long as they remain superficial. The procedure when performed with utmost care in experienced hands remains a very safe procedure to be followed as a routine and standard.
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http://dx.doi.org/10.1055/s-0040-1721213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745745PMC
June 2020

Gastrointestinal Stromal Tumours (GIST): Indian Experience of Rare Malignancy.

Indian J Surg Oncol 2020 Sep 22;11(3):348-354. Epub 2020 May 22.

Department of Medical Oncology, Cancer Institute (WIA), Chennai, 600020 India.

GISTs are rare tumours of the GI tract arising from the intestinal cells of Cajal. Though various risk stratification systems have been proposed, none has been universally accepted. We audited the survival and recurrence patterns in our patients and evaluated clinicopathological features to identify prognostic factors affecting survival. We conducted a retrospective analysis of patients treated at our hospital from 1999 to 2012. Patient variables, clinicopathological factors and treatment variables were collected. Sixty-three patients were evaluated and treated at our institute of which 38 were non-metastatic. The most common site of origin was the stomach. On univariate analysis, presence of metastasis, male gender, high mitotic rate, non-gastric primary and epithelioid histology were significantly associated with poor overall survival. Tumour size > 10 cm, mitotic rate > 10/50 hpf and presence of necrosis significantly affected disease-free survival for non-metastatic patients. Multivariate analysis showed higher mitotic rate and non-gastric primary to correlate with worse outcome. In our experience, a high mitotic rate and non-gastric primary independently predicted a poor prognosis in GIST.
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http://dx.doi.org/10.1007/s13193-020-01095-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501329PMC
September 2020

A retrospective analysis of patients undergoing postchemotherapy retroperitoneal lymph node dissection and metastasectomy in advanced nonseminomatous germ cell tumors.

Indian J Urol 2020 Apr-Jun;36(2):112-116. Epub 2020 Apr 7.

Department of Surgical Oncology, Apollo Specialty Hospital, Chennai, Tamil Nadu, India.

Introduction: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and metastasectomy play an important role in the management of advanced-stage nonseminomatous germ cell tumors (NSGCT). We aimed to analyze preoperative parameters that could predict postoperative histology.

Materials And Methods: We analyzed the data of 72 patients who underwent PC-RPLND and 14 patients who underwent metastasectomy after receiving cisplatin- or carboplatin-based chemotherapy for advanced stage NSGCT at our institute from 1994 to 2015. Clinical and pathological parameters such as the histology of orchidectomy, RPLND and metastasectomy, serum tumor markers, and the pre and post chemotherapy retroperitoneal lymph node size were recorded.

Results: Seventy-two patients with a mean age of 28 years underwent PC-RPLND. Of the various variables evaluated, only percentage change in nodal size was found to be statistically significant in predicting necrosis ( = 0.004). A decrease of 75% was found to predict the necrosis with a specificity of 100%. There was 84.6% concordance between the histology of RPLND and that of metastasectomy.

Conclusion: A 75% reduction in tumor size is highly predictive of absence of viable tumor or teratoma, however larger series are required to confirm these findings. RPLND histopathologies have a high concordance with metastasectomy histology and thus can be used as a guide to tailor further management.
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http://dx.doi.org/10.4103/iju.IJU_301_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279107PMC
April 2020

Paediatric Renal Synovial Sarcoma: Another Diagnostic Pathological Dilemma.

Indian J Surg Oncol 2020 Mar 27;11(1):138-141. Epub 2019 Oct 27.

3Department of Pathology, Christian Medical College, Vellore, India.

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http://dx.doi.org/10.1007/s13193-019-00989-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064649PMC
March 2020

Isolated regional nodal metastasis in giant cell tumor of the bone: Case report and review of literature.

South Asian J Cancer 2020 Jan-Mar;9(1):58

Department of Pathology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/sajc.sajc_244_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956574PMC
January 2020

Usefulness of narrow-band imaging in transurethral resection of bladder tumor: Early experience from a tertiary center in India.

South Asian J Cancer 2019 Oct-Dec;8(4):226-228

Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.

Background: The current standard for diagnosis and treatment of urinary bladder cancer is transurethral resection of bladder tumor (TURBT) using white light guidance. Narrow band imaging (NBI) has emerged as a promising method for identifying additional bladder lesions. Various studies have been published to evaluate its sensitivity in identifying new lesions and its impact on decreasing recurrences. In this study, we evaluated our early experience using NBI in TURBTs.

Aims And Objective: The aim of the study is to determine the accuracy of NBI in identifying additional malignant lesions during TURBT.

Materials And Methods: We retrospectively collected data for all patients who underwent either TURBT or repeat TURBT with white light and NBI from November 2016 to July 2017 at Cancer Institute (WIA). The number of additional lesions identified using NBI was evaluated along with its correlation with the final histopathology.

Results: Forty patients were analysed of which 20 underwent TURBT and 20 underwent repeat TURBT. Of these, 36 patients had complete resection of tumour. Additional lesions were detected in 6 patients (14%) by NBI of which 2 (33%) were malignant histology. The additional lesions detected were carcinoma in situ and no patient was upstaged.

Conclusion: The inclusion of NBI to conventional white light TURBT increases the sensitivity for identifying additional lesions. The limitation of NBI is high false positivity and its availability. Long term follow up studies with larger subset of patients are required to evaluate its role in decreasing recurrences and justification in routine clinical practice.
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http://dx.doi.org/10.4103/sajc.sajc_367_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852624PMC
December 2019
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