Priya Bhati

Evaluating the tozzi classification system in diaphragm surgeries for advanced ovarian cancer: Clinical applicability and perioperative outcomes

Over 70 % of advanced ovarian cancer cases involve metastasis to the peritoneum, diaphragm, and liver. Standardised diaphragm surgeries are vital for achieving complete cytoreduction and enhancing patient prognosis. This study evaluates the clinical utility of Tozzi's classification for diaphragm surgeries and examines perioperative outcomes in advanced ovarian cancer debulking. Patients who underwent diaphragm surgery during cytoreductive procedures for ovarian cancer were classified using Tozzi's classification based on disease extent, and liver mobilisation and perioperative outcomes were analysed. Among 38 patients (71 % stage III; 52.6 % interval surgeries), 39.4 % were Type I, 28.9 % Type II, and 31.5 % Type III. Ascites was more common in Type II (77.8 %, p = 0.04), while Type III had more imaging-detected lesions (83.3 %, p = 0.03). Type III surgeries required longer durations (405 ± 136 min, p = 0.04) and more intraoperative interventions (58.3 %, p = 0.01). ICU care was needed in 50 % of cases, with a median stay of two days, mainly for Type III. Pulmonary complications occurred in 10.5 %, and the median hospital stay was six days. Tozzi's classification predicts surgical complexity and morbidity, particularly for Type III cases, aiding surgical planning and optimising patient outcomes.

Diagnostic Accuracy of Fluorescein Sodium for Targeted Cervical Biopsies

Visual inspection methods for cervical cancer screening are widely used in low resource settings. Fluorescent sodium could improve accuracy of cancer screening. This study aimed to assess diagnostic accuracy of fluorescein sodium (FNa) to detect cervical neoplasia. Seventy consecutive patients referred for colposcopy were enrolled prospectively. Acetic acid, Lugol's iodine, and FNa were used sequentially. Biopsies were taken from all abnormal areas. If there was no obvious abnormality, two random biopsies and endocervical curettage were done. Reference standard was the highest grade lesion on cervical biopsy with a threshold of CIN2+. The patterns of each staining agent were recorded as absent, faint, or distinct. Diagnostic accuracy estimates with 95% confidence intervals were calculated. Correlation between the various tests were also determined using the kappa statistic. There were 27 cases of CIN2+ (38.6%). The sensitivity of any fluorescence for CIN2+ was 82% (62, 94) and for distinct fluorescence was 59% (39, 78). The specificity was 65% (49, 79) for any fluorescence and 95% (84, 99) for distinct fluorescence, the same as for Swede score > 7. For any fluorescence, the positive likelihood ratio was 2.34 (1.5, 3.65) and the negative likelihood ratio was 0.28 (0.13, 0.65). For distinct fluorescence, the positive likelihood ratio was 12.74 (3.18, 51.1) and the negative likelihood ratio was 0.43 (0.27, 0.68). There was moderate correlation between FNa and the other tests. Distinct fluorescence with FNa was very specific, low cost, and easy to perform and may contribute to confirm CIN2+ disease.

A randomized controlled trial comparing large versus small stitch incision closure in gynaecological malignancies (CLaSSIC Study)

The study aimed to compare Small Stitch Closure (SSC) and Large Stitch Closure (LSC) techniques for reducing incisional ventral hernia (IVH) and surgical site infection (SSI) rates in gynaecological malignancies. We conducted a single-blind, randomised controlled trial at our gynaecological oncology department. Patients aged ≥18 years scheduled for elective oncological surgery with midline laparotomy were randomly assigned to receive small stitches of 5 mm every 5 mm or large stitches of 1 cm every 1 cm. Between March 1, 2022, and August 13, 2023, 218 patients were randomly assigned to either the LSC group (n = 110) or the SSC group (n = 108). Follow-up ended on August 20, 2024, with 213 patients completing it. After one year, the SSC group had significantly lower rates of IVH at 3.7 % compared to 12.1 % for the LSC group (p = 0.02); this difference remained significant in multivariate analysis (p = 0.04, OR: 5.78). SSI rates were similar, with the LSC group at 2.8 % and the SSC group at 3.5 % (p = 0.11). In the multivariate analysis, preoperative chemotherapy was significantly associated with IVH (p = 0.04, OR: 3.83), while a postoperative hospital stay of 72 h or more increased the risk of SSI (p = 0.02, OR: 11.51). LSC was associated with a significantly higher rate of IVH compared to SSC, while SSI rates were similar between both groups. Preoperative chemotherapy was a key factor influencing IVH, and a longer postoperative hospital stay led to increased SSI rates.