CP-4
Control of Cystic Artery During Laparoscopic Cholecystectomy,
Clipping Versus Bipolar Electrocautry: Institution Based
Experience
Irfan Nazir Mir
ABSTRACT
Background: This study was undertaken to determine the
efficacy of use of bipolar electrocautry in dealing with cystic
artery during laparoscopic cholecystectomy, and to establish
weather bipolar electrocautry is an equivalent alternative to
conventional clip application.
Methods: About 200 patients undergoing laparoscopic
cholecystectomy were selected on a prospective basis and
divided into two groups- A and B(100 patients in each group.
a comparative study was done between the two group. Clips
were used to control cystic artery in group A patients and
bipolar electrocautry was used for the same in group B.
Results: In group A, 3 patients had clip slippage
intraoperatively which was dealt by reapplication of clips.in
group B,2 patient had intraoperative bleeding from cystic
artery few minutes after application of bipolar thermal
energy which was dealt by applying clips. In both the groups
no postoperative bleeding was encountered.
Conclusions: During laparoscopic cholecystectomy, clip
usage and bipolar electrocautry are equally competent in
achieving haemostasis of cystic artery.
Keywords: Clips, Cystic artery, Laparoscopic cholecystectomy,
elctrocautry.
CP-5
Title:- Clinico-epidemiological and management trends of
breast cancer over past 25 years : A tertiary care centre
experience
Dr. Eshan Verma*1, Rajinder Parshad1, Suhani1,
Hemanga K. Bhattacharjee1 , S. Mathur2, Haresh KP3
1
Surgical Disciplines, 2 Pathology, 3 Radiation Oncology,
All India Institute of Medical Sciences, New Delhi, India
Introduction: Breast cancer is the commonest cancer among
women. With advancing knowledge and technology,
awareness about the disease and its management strategies
have evolved over the past decades. This audit was
undertaken to study the changing trends in our patients and
their outcomes.
Materials & Methods: This is a retrospective review of data
collected from 1993 to May 2018 of a single unit run breast
cancer clinic (BCC) in the Department of Surgical Disciplines,
AIIMS New Delhi. Details on demography, socioeconomic
status, clinical and pathological profile, treatment response
and outcomes were recorded. All cases were restaged
according to AJCC VIII TNM classification. The trends over
these years were categorized into 3 block years from 1993-
2000, 2001-2010 and 2011-2018 May. Disease-free survival
36
(DFS) was calculated from the time of intervention to the time
of first recurrence. Time of first recurrence was equated to
time of death if the interval between them was not known.
Overall survival (OS) was calculated from the time to
intervention till the time of death. These ‘time to event’
variables were described using the life tables and Kaplan
Meier product limit estimator for patients registered till June
2016 (analysis done in August 2018).
Results: The study comprised of 1825 cases with 98.5% being
ladies. There has been an increase in the number patients
attending the clinic over the 3 blocks i.e. 317 , 693 & 815
respectively. Male breast cancer patients also increased
during this time (14%, 17.8% & 67.8%) . Trend of known
reproductive risk factors did not show any change. Though
the T1 tumors increased over 3 block years, proportion of EBC
remained the same at around 53%. Clinically node negative
disease has not changed significantly over these block years
with around 55% burden of clinically node positive disease.
Hormone receptor tumours did not show any proportionate
change during these block years however according to
luminal classification TNBC tumours with an increase in each
block year. They formed 24% of total cases where receptor
status available. Grade 3 tumours progressively increased
during these blocks. Proportion of patientsrecieving NACT
has increased along with a change in chemotherapy regimens
used during these blocks. Anthracyclines and taxane based
regimens are now used with a proportionate increase in
clinical and pathological complete remission rates. Although
mastectomy remained the most commonly performed
procedure during these blocks there has been a shift towards
BCS especially during the last decade with a percentage
increase of 21.3%. USG guided excision has increased
substantially during the last block years. Also the number of
breast reconstructions has increased over these block years
with a significant increase in level 1 and 2 oncoplasties. SLNB
has become a standard of care for node negative disease with
a proportionate increase in the number of SLNB over these
blocks. Brachytherapy has been increasingly used for suitable
patients. More number of patients are recieving trastuzumab
therapy. The 5 & 10 year DFS was 71.46% & 60.60%. The 5 &
10 year OS was 75.5% and 62.4%.
Conclusion: Regular audit helps in understanding &
evaluating the clinico-epidemiological trends and
management outcomes. Breast cancer is a major burden in
India with substantial proportions of locally advanced and
metastatic breast cancer which is alarming. Awareness
among population about the disease, its screening and
management is important for detection of disease at an early
stage.