Browsing by Author "J.F. Neville"

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Cancer surgery during COVID increased the patient mortality and the transmission risk to healthcare workers: results from a retrospective cohort study (NCT05240378)
(BioMed Central Ltd, 2022) Kishan Soni; J.F. Neville; Roli Purwar; Tarun Kumar; Ghanshyam Yadav; Nimisha Verma; Manoj Pandey
Background: India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. Method: The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. Results: A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly higher. A total of 71 patients had COVID-19, of which 62 were preoperative and 9 postoperative, while 30/38 healthcare workers contracted COVID-19, of which 7 had the infection twice and 3 were infected after two doses of vaccination; there was no mortality in healthcare workers. Conclusion: The present study demonstrates higher mortality rates after surgery in cancer patients, with no significant change in morbidity rates. A substantial proportion of HCWs were also infected though there was no mortality among this group. The results suggest higher mortality in cancer patients despite following the guidelines and protocols. © 2022, The Author(s).
Comparative Analysis of Radial Forearm Free Flap and Submental Island Flap in Reconstruction of Post-glossectomy Defects of Oral Squamous Cell Carcinoma and Quality of Life Assessment
(Springer, 2024) Akhilesh Kumar Singh; Arjun Mahajan; Janani Anandkumar; Naresh Kumar Sharma; Farhan Durrani; Neeraj Kant Agrawal; P. G. Naveen Kumar; J.F. Neville
Aim: Reconstruction of tongue defects has always been a challenging aspect of onco-surgery. Although a variety of locoregional and free flaps have been advocated, it still poses a challenge due to its complex function in deglutition and speech articulation. Hence, this study aims at reducing the dilemma of flap selection for better patient outcome. Materials and Methods: Among 16 tongue carcinoma cases, 6 cases were reconstructed using submental island flap (SIF) and 10 using radial forearm free flap (RFFF). These 2 flaps were compared in terms of parameters like intraoperative time, hospital stay, overall survival, pain, cosmesis, and recreation of anatomy, and functions like deglutition and articulation of speech. Patients were followed for oncologic safety and recurrence. Obtained data were statistically analysed using IBM® SPSS®. Result: SIF showed significantly higher activity score (P = 0.001) with reduced flap harvest time (P = 0.014) but showed difficulty in deglutition (P = 0.03) compared to RFFF. It was concluded that in cases of RFFF mobility and functional outcome was superior, but flap harvest time was considerably higher. Overall patient survival rate was better in cases of RFFF in long-term follow-up, but flap survival rate was significantly higher in SIF owing to better vascularity. Conclusion: In highly compromised cases and salvage cases where microvascular flaps are contraindicated, submental flap being a local flap with comparable overall survival rate, better cosmesis hence, serves as a reliable flap for reconstruction of glossectomy defects. © The Association of Oral and Maxillofacial Surgeons of India 2024.
Comparative Evaluation of Nasolabial Flap, Buccal Fat Pad and Platysma Myocutaneous Flap for Reconstruction of Oral Sub Mucous Fibrosis Defects
(Springer, 2023) Akhilesh Kumar Singh; Rathindra Nath Bera; J.F. Neville; Richik Tripathi; Naresh Kumar Sharma; Jananni Anand Kumar; Mehul Shashikant Hirani; Nishtha Chauhan
Moderately advanced (stage III) and advanced (stage IV a & b) OSMF requires surgical intervention for management A number of options are available for reconstruction of post OSMF oral cavity defects. In our study we retrospectively compared buccal fat pad, nasolabial flap and platysma flap for reconstruction of the buccal mucosal defects. Patient records were obtained from the medical records section of the Institute and divided into three groups; group A (buccal fat pad), group B (nasolabial group) and group C (platysma flap). Maximal mouth opening and intercommisural distance were the primary outcomes. Kruskal Wallis test was used to test the mean difference between three groups. Mann–Whitney test was used for intergroup comparisons. Wilcoxon signed rank test was used to evaluate the mean difference in outcomes at each follow up interval. A p value of < 0.05 was considered as statistically significant at 95% confidence interval. After 1 year follow up patients in platysma group had significantly better mouth opening (39.84 ± 1.65 mm) compared to both buccal fat pad (36.69 ± 3.41 mm) and nasolabial groups (37.94 ± 0.43 mm). Inter commisural distance was significantly better in patients reconstructed with platysma flap (59.21 ± 0.99 mm) compared to both buccal fat pad (54.11 ± 1 mm) and nasolabial flap (56.84 ± 1.48 mm). Platysma flap lead to significantly better maximal mouth opening compared to both nasolabial and buccal fat pad. Both buccal fat pad and nasolabial lead to comparable mouth opening. Inter commissural distance is maximum with platysma flap followed by nasolabial flap and buccal fat pad. © 2023, Association of Otolaryngologists of India.
En Block Versus Separate Management of Cervical Nodes in Tongue and Floor of the Mouth Cancers- Is There a Difference? An Analysis of 85 Cases in a Tertiary Care Institute
(Springer, 2022) J.F. Neville; Mandar Tilak; Akhilesh Kumar Singh; Naresh Kumar Sharma; Janani Anand Kumar; Nitesh Mishra; Farhan Durrani
To evaluate difference in local recurrence, regional (neck) recurrence as well as distant metastases between cases operated with en-block excision of primary cancer and neck nodes versus their separate removal, in squamous cell carcinomas of anterior 2/3 of tongue and floor of the mouth. A total 85 patients of cT1-T4a N0-N2b of carcinoma anterior 2/3 of tongue and floor of mouth were evaluated. Amongst these patients 39 cases of in-continuity en-block neck dissection and 46 cases of discontinuous neck dissection were evaluated for post-operative complications as well as oncological outcome for a follow up period of 3 years. Patient population was similar in both groups with tongue cancers being the commonest site and tobacco being the most common addiction. Primary site hematoma was seen more in the in-continuity en-block neck dissection group with a p-value of 0.0276, which was statistically significant. Post-operative oro-cutaneous fistula occurred more in in-continuity enblock neck dissection as compared to discontinuous neck dissection, but the difference was not statistically significant. Local recurrence rate was significantly more in cases of discontinuous neck dissection (19.565) as compared to in-continuity en-block neck dissection (5.12%) with a p-Value 0.0481. A statistically non-significant but higher loco-regional recurrence was observed in cases of discontinuous neck dissection as compared to cases of in-continuity en-block neck dissection (10.56% vs 2.56). In the present study recurrence-free survival RFS 3 year in cases of en-block in-continuity neck dissection (84.06%) cases as compared to discontinuous neck dissection cases (63.04%) with p Value 0.025698. In-continuity en-block in continuity neck dissection has lower loco-regional recurrence and may impact overall distant metastases. Though early postoperative complications are more in in-continuity en-block in continuity neck dissection as compared to discontinuous neck dissection, most are managed conservatively. Further studies with a larger sample size are needed to evaluate its outcome in a comprehensive manner. © 2021, Association of Otolaryngologists of India.