Browsing by Author "Esha Pai"

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Completely Linear Stapled Versus Handsewn Cervical Esophagogastric Anastomosis After Esophagectomy
(Springer India, 2018) Tarun Kumar; Ravi Krishanappa; Esha Pai; Raxith Sringeri; T.B. Singh; Jyoti Swain; Sindhuri Kondapavuluri; Manoj Pandey
Very limited data is present which compares completely linear stapled to handsewn cervical esophagogastric anastomosis. Primary objective was to determine whether linearly stapled (LS) anastomosis has lower clinically apparent leaks, when compared to handsewn anastomosis (HS). Secondary objectives were morbidity, mortality, overall leak and stricture rates, and presence of a symptomatic cervical stricture. This is a comparative study of 77 patients who underwent LS (n = 29) and HS (n = 48) cervical anastomosis. Anastomotic leak was found to be 19.4% (15/77). In the HS group, 27.08% (13/48) and in the LS group, 6.89% (2/29), respectively, leaked (p = 0.03), relative risk (RR)—3.93 (95% CI 1.21–15.25). 32.5% (23/77) patients remained admitted for more than 14 days. 52.1% (25/48) patients in the HS group were discharged within 14 days of surgery; whereas; 93.1% (27/29) were discharged in LS group (p = 0.001), RR—6.95 (95% CI 2.13–25.94). Overall, 90-day mortality was 7.8% (6/77). In the HS group, 8.3% (4/48) patients died while in the LS group, 6.8% (2/29) patients died (p = 0.82), RR—1.21(95% CI 0.27–5.53). In the HS group, 6.25% (3/48) patients were diagnosed with stricture compared to 6.8% (2/29) patients in the LS group (p = 0.9), RR—0.91 (95% CI 0.19–4.44). Overall stricture rate was 6.4% (5/77). Cervical anastomosis done with linear staplers has less leak rates compared to handsewn anastomosis. © 2018, Association of Surgeons of India.
Efficacy and safety of cetuximab-based versus platinum-based chemoradiation in HNSCC: evidence from a meta-analysis of 10 randomized controlled trials
(Springer Science and Business Media Deutschland GmbH, 2025) Tarun Kumar; Nishu Kesh; Atindra Kumar Pandey; Ankita Chakrawal; Bhavana Singh; Manjusha Pal; Monika Rajput; Ruhi Dixit; Esha Pai; Manoj Pandey
Background: Platinum-based chemoradiotherapy (CTRT) is the standard treatment for head and neck squamous cell carcinoma (HNSCC). While cetuximab-based radiotherapy (CxRT) has been proposed as an alternative, its efficacy remains controversial. Multiple meta-analyses have compared CxRT with CTRT for HNSCC though they combined randomized controlled trials (RCTs) with lower-evidence studies, compromising result validity. This study presents the first meta-analysis using exclusively RCT data, providing the highest level of evidence for clinical decision-making. Methods: We systematically searched MEDLINE, Embase, Cochrane, and SCOPUS, identifying 10 RCTs (n = 2,557 patients). Primary outcomes included overall survival (OS), disease-free survival (DFS), and all-cause mortality; secondary outcomes were Grade ≥ 3 toxicities. Hazard ratios (HRs) and odds ratios (ORs) were pooled using random effect models. Results: CxRT was associated with a 50% higher recurrence risk (HR 1.50, 95% CI 1.07–2.10) and 27% increased all-cause mortality (OR 1.27, 95% CI 1.05–1.55) compared to CTRT. OS did not differ significantly (HR 1.33, 95% CI 0.79–2.22). Toxicity profiles varied: CxRT had higher mucositis (OR 1.17, 95% CI 1.04–1.32) and skin rash (OR 3.46, 95% CI 1.28–9.36), while CTRT showed more anemia (OR 0.15, 95% CI 0.05–0.52) and nausea/vomiting (OR 0.31, 95% CI 0.19–0.53). Conclusion: CxRT is inferior to CTRT in HNSCC, with poorer disease control and survival outcomes. The lack of biomarker (EGFR/RAS) stratification in trials may have contributed to suboptimal patient selection. While CxRT may be an option for cisplatin-ineligible patients, platinum-based therapy appears to be the standard. Future research should optimize cetuximab’s role through biomarker-driven selection. © The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO) 2025.
Evarts Ambrose Graham and the First Successful Pneumonectomy: a Brief Account
(Springer India, 2017) Esha Pai; Tarun Kumar
[No abstract available]
Intrathoracic versus cervical anastomosis in esophagectomy for esophageal cancer: Are these procedures indeed comparable?
(Elsevier Inc., 2022) Esha Pai; Tarun Kumar
[No abstract available]
Lymphadenectomy in ovarian cancers: a meta-analysis of hazard ratios from randomized clinical trials
(BioMed Central Ltd, 2022) Roli Purwar; Rakesh Ranjan; Kishan Soni; Manoj Pandey; Satyanshu K. Upadhyay; Esha Pai; Tarun Kumar
Background: The debate surrounding systematic lymphadenectomy in the epithelial cancers of the ovary (EOC) was temporarily put to rest by the LION trial. However, there was a glaring disparity between the number of patients registered and the number of patients randomized suggesting inadvertent selection. A subsequent meta-analysis after this trial included all types of studies in the literature (randomized, non-randomized, case series, and, retrospective cohort), thus diluting the results. Methods: We conducted a meta-analysis of hazard ratios of randomized controlled trials, to study the role of systematic para-aortic and pelvic lymph node dissection in the EOC. A detailed search of MEDLINE, Cochrane, and Embase databases was done to look for the published randomized controlled trials (RCT) comparing lymphadenectomy versus no lymphadenectomy in EOC. A meta-analysis of hazard ratios (HR) was performed for overall survival (OS) and progression-free survival (PFS) using fixed and random effect models. The quality of the RCTs was evaluated on Jadad’s score, and the risk of bias was estimated by the Cochrane tool. Results: A total of 1342 patients with EOC were included for quantitative analysis. On meta-analysis, HR for PFS was 0.9 (95% CI 0.79–1.04) favoring lymphadenectomy. HR for OS was 1 (95% CI 0.84–1.18) signifying no benefit of systematic lymphadenectomy. Conclusion: The results show a trend towards increased PFS which did not reach statistical significance nor translate into any meaningful benefit in OS. There is still a need for a greater number of well-conducted, suitably powered trials to convincingly answer this question. © 2022, The Author(s).
Neoadjuvant strategies in resectable carcinoma esophagus: A meta-analysis of randomized trials
(BioMed Central Ltd., 2020) Tarun Kumar; Esha Pai; Rajesh Singh; Neville J. Francis; Manoj Pandey
Background: The survival benefit of neoadjuvant therapy in resectable carcinoma esophagus has been elucidated. We performed a meta-analysis in light of new studies and long-term results of past trials. The search strategy was refined to include only "neoadjuvant" so that any bias by adjuvant treatment is eliminated. Methods: A detailed search of MEDLINE, Embase, and Cochrane Library was done. Only published randomized English language trials were included. Data were categorized as neoadjuvant concurrent chemoradiation (NACRT), neoadjuvant chemotherapy (NACT), neoadjuvant radiotherapy (NART), and neoadjuvant sequential chemoradiotherapy (SCRT). Meta-analysis was done using odds ratio (OR) and 95% CI using fixed/random effects model. Heterogeneity was tested by chi-square and I 2 test. Z probability calculated significant difference across subgroups. Outcomes assessed were overall survival (OS) and disease-free survival (DFS) at 3 and 5 years, respectively, mortality (30/90 day) and failures (local/systemic). Results: Twenty-five randomized trials involving 5272 patients were included for quantitative analysis. NACRT was evaluated in 12 studies (2676 patients). Superior 3-year OS (OR = 0.68 CI 0.52-0.90, p = 0.007), 3-year DFS (OR = 0.55 CI 0.45-0.68, p = 0.00001), and 5-year DFS (OR = 0.59 CI 0.47-0.74, p = 0.00001), with lower failures (OR = 0.52 CI 0.37-0.73, p = 0.0001), were seen in favor of NACRT at the cost of increased perioperative mortality (OR = 1.79 CI 1.15-2.80, p =.01). However, 5-year OS (OR = 0.78 CI 0.60-0.1.01, p = 0.06) was not found to be significantly superior. NACT, NART, and SCRT were not found to have any benefit over surgery alone. Conclusion: This meta-analysis presents strong evidence favoring NACRT over upfront surgery. It also shows no survival advantage of neoadjuvant chemotherapy. © 2020 The Author(s).
Solitary precaval right renal artery
(Blackwell Publishing, 2020) Esha Pai; Tarun Kumar
[No abstract available]
Sternocleidomastoid flap for pedicled reconstruction in head & neck surgery- revisiting the anatomy and technique
(BioMed Central Ltd, 2021) Apurva Srivastava; Tarun Kumar; Shashi Kant Pandey; Ram Chandra Shukla; Esha Pai; Manoj Pandey
Background: Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle. Methods: It is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage. Results: Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle. Conclusion: Based on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps. © 2021, The Author(s).
Technique of Antiperistaltic Left Colonic Conduit
(Springer, 2020) Esha Pai; Tarun Kumar
We describe a case of total esophagogastrectomy with colonic pull-up, in a case which was initially planned for an Ivor Lewis approach. Reconstruction was done using antiperistaltic left colon conduit based on left branch of middle colic artery. What inspired us to write this report is that, this procedure finds place in many discussions of various studies but nowhere is its detailed technique described. Gastric conduit is the workhorse of esophageal cancer surgery, but sometimes an alternative is required when primary conduit has failed or the stomach is not available due to previous surgery or disease extension. © 2020, Association of Surgeons of India.
Whole Breast Reconstruction in Developing India: a Cancer Surgeon’s Experience with the Pedicled Transverse Rectus Abdominis (TRAM) Flap
(Springer, 2022) Esha Pai; Tarun Kumar
Challenges in the Indian surgical oncology practice are varied — too many patients per surgeon, long operative waitlists, lacking infrastructure, and often a dearth of plastic surgeons. Immediate whole breast reconstruction is rarely offered after mastectomy. Given the unavailability of a dedicated plastic surgery team, we initiated pedicled transverse rectus abdominis myocutaneous (TRAM) flaps in our practice to give patients a more holistic treatment. We present the first 33 cases done solely by a surgical oncologist. We retrospectively evaluated 33 patients from January 2017 to December 2019 who underwent pedicled TRAM flap for immediate whole breast reconstruction following mastectomy for cancer. The primary endpoint was to study the incidence of severe flap-related complications of the pedicled TRAM flap at the mastectomy site when done by a surgical oncologist. Secondary endpoints were flap necrosis-rates and donor site morbidity. Exclusion criteria were age > 60 years, body mass index > 30 kg/m2, diabetes mellitus, and prior abdominal surgery. Flap-related complications were classified according to Andrades et al. and donor site complications were classified as wound dehiscence, infection, hematoma, seroma, and hernia. Frequencies and percentages and median with interquartile range were used respectively for categorical and continuous variables. Flap-related morbidity was 21.2% (7/33), while donor site complications were 24.2% (8/33). Flap necrosis (partial or total), mastectomy-related complications, and incisional hernia were not seen in any of the patients. Median operative time was 180 min. Pedicled TRAM flap is feasible and safe when performed by surgical oncologists, immediately after mastectomy, in the developing world. Psychosocial acceptance remains challenging, and requires dedicated counselling and inter-patient communication. © 2022, The Author(s), under exclusive licence to Indian Association of Surgical Oncology.