Publications by authors named "Kapila Manikantan"

19 Publications

  • Page 1 of 1

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction.

Indian J Plast Surg 2021 Jan 30;54(1):53-57. Epub 2020 Nov 30.

Department of Head and Neck Surgery, TATA Medical Center, Kolkata, West Bengal, India.

 The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer.  This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap.  At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.
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http://dx.doi.org/10.1055/s-0040-1721522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012785PMC
January 2021

Radiation-induced hypothyroidism in patients of oral squamous cell carcinoma: A retrospective analysis of 195 patients.

Indian J Cancer 2021 Jan 27. Epub 2021 Jan 27.

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India.

Background: Radiation-induced hypothyroidism (RIH) is common after neck irradiation, and biochemical evaluation of thyroid function is recommended periodically for early diagnosis and treatment. This study aimed to evaluate the predictors of RIH after completion of adjuvant radiotherapy (RT) for primary oral squamous cell carcinoma (OSCC).

Methods: This is a retrospective study involving 195 patients who received RT after surgery for OSCC between August 2011 and December 2016. Thyroid function tests were obtained every 6 months and patients were considered to be hypothyroid if thyroid-stimulating hormone level was >5 mIU/mL.

Results: The study cohort comprised 130 men with a median age of 52 years (range 21-77 years). About 107 (54.87%) patients developed hypothyroidism, with a median of 21 months (range 2-67 months) for the development of RIH. Women [41 (63.1%) versus 66 (50.8%), p=0.035], addition of chemotherapy [36 (63.2%) versus 71 (51.4%), p= 0.019], and higher cumulative dose to the thyroid gland (median dose 4690 cGy versus 2981 cGy, P < 0.001) resulted in higher incidence of RIH on univariate analysis. On multivariate Cox regression analysis, female sex (P = 0.042), bilateral irradiation (P = 0.046), and cumulative dose to the thyroid (P = 0.001) were factors associated with increased risk of developing RIH.

Conclusion: The addition of chemotherapy, high dose of radiation to the thyroid gland, bilateral irradiation, and female sex were at higher risk of developing RIH. However, more studies are required to identify the dose-volume constraints of the thyroid gland.
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http://dx.doi.org/10.4103/ijc.IJC_946_19DOI Listing
January 2021

Factors predicting contralateral nodal spread in papillary carcinoma of thyroid.

Indian J Cancer 2021 Jan 27. Epub 2021 Jan 27.

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India.

Background: Lymph node metastasis (LNM) is evident in about 20-50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC.

Methods: A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed.

Results: Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM.

Conclusion: Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.
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http://dx.doi.org/10.4103/ijc.IJC_684_19DOI Listing
January 2021

Nodal yield and topography of nodal metastases from oral cavity squamous cell carcinoma - An audit of 1004 cases undergoing primary surgical resection.

Oral Oncol 2021 02 16;113:105115. Epub 2020 Dec 16.

Head and Neck Surgery, Tata Medical Center, Kolkata, India.

Objectives: Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols.

Methods: Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center.

Results: The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence.

Conclusion: This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105115DOI Listing
February 2021

Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma.

Head Neck 2021 Feb 6;43(2):520-533. Epub 2020 Oct 6.

Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India.

Background: The prognostic significance of various histopathologic lymph node-based biomarkers in oral squamous cell carcinoma (OSCC) needs further evaluation.

Methods: Retrospective analysis of 212 OSCC patients with regional metastasis to determine the association of extranodal extension (ENE), extent of ENE, size of metastatic deposit, lymph node yield (LNY), lymph node ratio (LNR), and topography of involvement with survival outcomes.

Results: The presence of ENE, larger nodal deposit, higher pN stage, lymph nodes in the lower levels, and patients who did not receive adjuvant treatment had poor disease-free survival (DFS). In addition, more positive nodes and high LNR showed worse overall survival (OS). ENE beyond 5 mm resulted in poorer outcomes. Larger sizes of metastatic deposit predisposed to ENE. Multivariate analyses showed only lower level of neck involvement to affect both DFS and OS.

Conclusions: Lymph node metastasis to lower levels and other lymph node characteristics affect prognosis and must be considered in the evolution of staging systems for OSCC.
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http://dx.doi.org/10.1002/hed.26499DOI Listing
February 2021

Contribution of Weight and Volume of the Extirpated Thyroid Gland on Voice Alterations After Total Thyroidectomy in Patients With Papillary Carcinoma of the Thyroid.

J Voice 2020 Mar 19. Epub 2020 Mar 19.

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India. Electronic address:

Purpose: Voice change after thyroid surgery is common despite preservation of laryngeal nerves. In this study, we sought to find if the change in voice after total thyroidectomy is related to the weight and volume of the removed thyroid gland.

Methods: This is a prospective cohort study of 50 patients of papillary carcinoma of the thyroid treated with total thyroidectomy from December 2016 through May 2018. Both objective and subjective voice parameters were analyzed preoperatively and at 1 and 3 months following surgery.

Results: A cohort of 29 patients, with a median age of 31 years (18-64 years), comprising 22 women were eligible for final analysis. Speaking fundamental frequency showed a mean change of 17.21 Hz (SD 34.49) while the mean intensity change was 5.54 dB (SD 18.21). The mean weight and volume of thyroid gland was 18.99 g (SD 8.93) and 15.67 ml (SD 8.70), respectively. On multivariate analysis, both weight and volume affected the range of frequency (P = 0.002 and 0.035, respectively) and range of intensity (P = 0.014 and 0.008, respectively).

Conclusion: Larger thyroid tumors are more likely to be associated with transient change in voice quality following their surgical removal despite physical preservation of external and recurrent laryngeal nerves, which may persist up to 3 months. This study affirms that perturbations in voice after thyroidectomy can still exist in spite of clinical demonstration of integrity of neuromuscular function.
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http://dx.doi.org/10.1016/j.jvoice.2020.02.014DOI Listing
March 2020

Redefining adequate margins in oral squamous cell carcinoma: outcomes from close and positive margins.

Eur Arch Otorhinolaryngol 2020 Apr 2;277(4):1155-1165. Epub 2020 Jan 2.

Department of Head and Neck Surgery, Tata Medical Center, Calcutta, West Bengal, 700160, India.

Purpose: Adequacy of surgical margins impacts outcomes in oral cancer. We sought to determine whether close and positive margins have different outcomes in patients with oral cancer.

Methods: Retrospective data from 612 patients with oral carcinoma were analyzed for the effect of margin status on locoregional recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS).

Results: A total of 90 cases (14.7%) had close margins and 26 patients (4.2%) had positive margins. Recurrences were documented in 173 patients (28%), of which 137 (22% of the study sample) were locoregional, and 164 patients (27%) had died. Among patients with close or positive margins, a cutoff of 1 mm optimally separated LRFS (adjusted p = 0.0190) and OS curves (adjusted p = 0.0168) whereas a cutoff of 2 mm was sufficient to significantly separate DFS curves (adjusted p = 0.0281).

Conclusions: Patients with oral carcinoma with positive margins (< 1 mm) had poorer outcomes compared to those with close margins (1-5 mm) in terms of LRFS, DFS and OS. There is a suggestion that a cutoff of < 2 mm might provide slightly more separation for DFS.
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http://dx.doi.org/10.1007/s00405-019-05779-wDOI Listing
April 2020

Clinicopathologic Determinants of Outcome in Pathologic T4a (pT4a) Squamous Cell Carcinoma of the Gingivobuccal Subsite of the Oral Cavity.

Indian J Surg Oncol 2019 Dec 27;10(4):594-599. Epub 2019 Jun 27.

1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700160 India.

Carcinoma of the gingivobuccal complex is one of the most common cancers in India and patients usually present in an advanced stage. There is limited data in literature regarding the factors predicting outcome in pathological T4a patients. In this study, we aimed to study the clinic-pathological factors which may influence treatment outcomes in pT4a patients. This is a retrospective study of 121 patients who underwent surgery for oral squamous cell carcinoma between August 2011 and December 2016, staged pT4a. Overall survival (OS) and disease-free survival (DFS) were analyzed for variables including age, depth of invasion, margin status, differentiation, nodal status, extranodal spread, lymphovascular and perineural spread, and adjuvant treatment. The study cohort comprised 93 males with mean age 60.28 years (S.D. 11.25). Median DFS was 21 months (range 9 to 2374 days) whereas median OS was 24.5 months (range 9 to 2374 days). On univariate analysis, lymphovascular invasion, perineural invasion, cervical nodal metastasis, and extranodal extension had a statistically significant effect on both DFS and OS. On multivariate analysis, age ( = 0.014) and adjuvant radiotherapy ( = 0.010) were the statistically significant factors affecting OS. None of the factors affected DFS on multivariate analysis. Patients staged pT4a with cervical nodal metastasis, extranodal extension, lymphovascular invasion, and perineural invasion have reduced OS and DFS. On multivariate analysis, lower age at presentation and adjuvant radiation improved patient outcome.
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http://dx.doi.org/10.1007/s13193-019-00950-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895327PMC
December 2019

Factors Affecting Postoperative Complications After Reconstructive Surgery in Oral Carcinoma Patients: A Prospective Study of 100 Patients.

Indian J Otolaryngol Head Neck Surg 2019 Oct 19;71(Suppl 1):341-347. Epub 2018 Mar 19.

1Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal 700156 India.

Postoperative complications may result in significant functional morbidity, poor cosmetic results, prolonged hospitalization, preclusion of optimal treatment for the cancer, or even be pose threat to life. We prospectively assessed postoperative complications in 100 patients who underwent surgical resection with free or pedicled flap reconstruction as a primary modality of treatment in patients with carcinoma of the oral cavity. One hundred consecutive patients who underwent reconstructive surgery for oral cancer were prospectively analyzed for age, gender, comorbidities, tumor stage, nodal stage, primary sub-site of tumour, reconstructive procedure (free or pedicled), duration of surgery, blood transfusions during surgery, preoperative weight and body mass index, patient generated subjective global assessment status and tracheostomy to determine their effect on postoperative complications as determined on the CD scale. The sample comprised 100 patients with a mean age of 52.12 years (range 24-80 years) and 74% men (M:F ratio 3:1). A total of 40 patients developed surgical complications (including two deaths) while medical complications were seen in 10 patients (including one death). Tracheostomy (52 vs. 7%,  = 0.002) and age (54 vs. 49 years,  = 0.031) were associated with higher complication rate. Higher age and tracheostomy is associated with higher complications in postoperative period.
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http://dx.doi.org/10.1007/s12070-018-1304-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848619PMC
October 2019

Novel Technique to Increase the PMMC Flap Pedicle Length by Coplanar Rotation Along the Pedicle Axis.

J Maxillofac Oral Surg 2019 Dec 23;18(4):637-639. Epub 2019 Jan 23.

Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal 700 156 India.

Pectoralis major myocutaneous flap (PMMC) continues to be a prime tool in the armamentarium for the reconstruction of head and neck malignancies even though free flaps have proved their versatility in functional and cosmetic outcomes. It still holds significance in both primary reconstruction and salvage procedures in head and neck malignancies. Inadequate infrastructure and resources make PMMC a preferred choice in many high-volume centres of developing countries. However, the length of the PMMC flap becomes a limiting factor for the distance that flap can be transferred when extensive reconstructions are being planned (Kudva et al. in J Maxillofac Oral Surg 14:481-483, 2015). We propose a modification in the conventional technique that maximises the length of the pedicle in orofacial reconstruction. Our technique allows the rotation of skin paddle along the longitudinal axis of the pedicle at the distal end along the same plane. This technique provides an easily reproducible and reliable technique that enables the surgeon to enhance the reach of the skin paddle and flexibility considerably.
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http://dx.doi.org/10.1007/s12663-019-01184-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795666PMC
December 2019

Unusual loco-regional presentation in papillary carcinoma of thyroid: A case series.

Indian J Cancer 2019 Oct-Dec;56(4):325-329

Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India.

Background: Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites.

Materials And Methods: Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series.

Results And Conclusion: Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases.
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http://dx.doi.org/10.4103/ijc.IJC_368_18DOI Listing
February 2020

Simultaneous Triple Primary Head and Neck Malignancies: A Rare Case Report.

Head Neck Pathol 2016 Jun 17;10(2):233-6. Epub 2015 Oct 17.

Department of Head & Neck Surgical Oncology, Tata Medical Center, Kolkata, India.

The occurrences of multiple primary malignant tumours in the head and neck region are reported as simultaneous, synchronous, or metachronous based on their chronology of presentation. Lymphoid malignancies presenting in association with squamous cell carcinoma in the head and neck region are extremely rare. We report a case of a 71 year old male patient with simultaneous triple primary malignancies of different histologic origin, involving larynx (squamous cell carcinoma), thyroid (papillary thyroid carcinoma) and lymph nodes (non-Hodgkin's lymphoma).
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http://dx.doi.org/10.1007/s12105-015-0664-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838955PMC
June 2016

Current concepts of surveillance and its significance in head and neck cancer.

Ann R Coll Surg Engl 2011 Nov;93(8):576-82

Grant Medical College, Mumbai, India.

Follow-up in head and neck cancer (hNC) is essential to detect and manage locoregional recurrence or metastases, or second primary tumours at the earliest opportunity. A variety of guidelines and investigations have been published in the literature. This has led to oncologists using different guidelines across the globe. The follow-up protocols may have unnecessary investigations that may cause morbidity or discomfort to the patient and may have significant cost implications. In this evidence-based review we have tried to evaluate and address important issues like the frequency of follow-up visits, clinical and imaging strategies adopted, and biochemical methods used for the purpose. This review summarises strategies for follow-up, imaging modalities and key investigations in the literature published between 1980 and 2009. A set of recommendations is also presented for cost-effective, simple yet efficient surveillance in patients with head and neck cancer.
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http://dx.doi.org/10.1308/003588411X604794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566680PMC
November 2011

Tracheo-oesophageal party wall thickness in laryngectomised patients in India: implications for surgical voice restoration.

J Surg Oncol 2010 Jan;101(1):78-83

Department of ENT and Head & Neck Surgery, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai 400008, Maharashtra, India.

Objective: To document accurately the tracheo-oesophageal party wall thickness (PWT) intra-operatively in patients undergoing total laryngectomy and to correlate it with constitutional parameters like height, weight, body mass index (BMI), age, and gender. Also, to correlate PWT with the length of tract (LOT), that is prosthesis size, as measured using the standard valve length measuring device provided by the manufacturers.

Methods: Twenty-eight patients of carcinoma larynx, following removal of the diseased larynx had their tracheo-oesophageal PWT measured using a special custom-designed and calibrated external (or outside) calliper and a primary trachea-oesophageal puncture (TOP) was made and inserted 10-14 days postoperative with an appropriately sized Blom-Singer(R) indwelling voice prosthesis.

Results: The mean PWT was 3.1 mm. PWT showed significant correlation with the weight of the patients (P = 0.006). There was no significant correlation between PWT and height, BMI, age or gender of the study group. The average LOT was found to be 4.8 mm (SD 1.5). There was a significant correlation (P = 0.009) between PWT and initial LOT, with the most commonly used prosthesis sizes being 4-6 mm.

Conclusions: The study shows that Indian patients with a thin party wall require a smaller prosthesis size and it is advisable to measure the PWT intra-operatively. Tracheo-oesophageal PWT in laryngectomised patients in India: implications for surgical voice restoration.
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http://dx.doi.org/10.1002/jso.21427DOI Listing
January 2010

Dysphagia in head and neck cancer.

Cancer Treat Rev 2009 Dec 13;35(8):724-32. Epub 2009 Sep 13.

Department of ENT and Head and Neck Surgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India.

Dysphagia is an important symptom of head and neck cancer (HNC), as well as representing a significant complication of its treatment. The treatment of HNC can result in neuromuscular and sensory damage affecting any stage of the swallow. The protective mechanisms during swallowing afforded by the structures in the pharynx are also affected in HNC. This article reviews the effect of the various treatment modalities in HNC on the swallowing mechanism. Various interventions which may play in role in relieving this dysphagia are also discussed. Due stress has been laid on the need for a multi-disciplinary approach for an optimal outcome in rehabilitating a patient's swallow after treatment for HNC.
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http://dx.doi.org/10.1016/j.ctrv.2009.08.008DOI Listing
December 2009

Making sense of post-treatment surveillance in head and neck cancer: when and what of follow-up.

Cancer Treat Rev 2009 Dec 9;35(8):744-53. Epub 2009 Sep 9.

Department of ENT and Head and Neck surgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India.

Follow-up in patients treated for head and neck cancer (HNC) is aimed at early detection of recurrence, metastases and second primary tumours. Various modalities for the routine follow-up of patients with HNC have been proposed and studied in the literature. Consequently, practising head and neck surgeons and oncologists all over the world use different guidelines and protocols to follow-up their patients. These guidelines involve follow-up intervals of varying intensity and schedule an assortment of investigations that may be neither logical nor practical. This follow-up process may be difficult to administrate, cause unnecessary discomfort and morbidity to the patient and can have serious cost-implications to the healthcare system. This review summarises strategies for follow-up, imaging modalities and key investigations in the literature published between 1980 and 2009. In this structured review, we have assessed studies in the literature that have addressed follow-up intervals, imaging tests, tumour markers, endoscopy and thyroid function tests as a part of the routine post-treatment surveillance in HNC patients. Studies analysing the cost benefit of such surveillance have also been addressed. Based on the evidence presented, we have compiled definitive recommendations for effective surveillance/post-treatment follow-up in patients with HNC.
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http://dx.doi.org/10.1016/j.ctrv.2009.08.007DOI Listing
December 2009

Challenges for the future modifications of the TNM staging system for head and neck cancer: case for a new computational model?

Cancer Treat Rev 2009 Nov 22;35(7):639-44. Epub 2009 Aug 22.

Department of ENT and Head and Neck Surgery, Grant Medical College and Sir J.J. Group of hospitals. Mumbai 400 008, India.

The TNM system of staging cancers is a simple and effective method to map the extent of tumours. It had traditionally strived to maintain a balance between being simple and user-friendly on one hand and comprehensive on the other. A number of revisions have taken place over the years with the goal of improving utility. However, numerous controversies surround the TNM system. There is a school of thought that contends that patient co-morbidity and specific tumour-related factors should be incorporated to add further prognostic capabilities in the TNM system, but this raises concerns that such an approach may unnecessarily complicate the system. This review highlights some controversies that surround the TNM system and suggests prognostic indicators that may be added to make it more useful in guiding treatment decisions and predicting outcomes.
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http://dx.doi.org/10.1016/j.ctrv.2009.04.010DOI Listing
November 2009