Papers by nagendra parvataneni
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2017
The objective of this study was to investigate significance of mild and moderate dysplasia at sur... more The objective of this study was to investigate significance of mild and moderate dysplasia at surgical margin for survival and loco-regional recurrence. Study design Authors investigated primary oral squamous cell carcinoma(OSCC) patients with negative margins retrospectively from the database of tertiary cancer hospital, all patients were treated between Jan 2010 to Dec 2012, margin dysplasia was investigated in a multivariate analysis for loco-regional recurrence and overall survival. Results A total of 425 patients fulfilled inclusion criteria, among them, 28 patients had mild dysplasia and 29 patients had moderate dysplasia; median period of follow up was 46.63 ±10.04 SD months. Most of the patients with mild and moderate dysplasia in the margin were tobacco users (p=0.007), univariate analysis showed lower survival among the patients with margin dysplasia (mild + moderate), (p=0.043) and the multivariate cox regression revealed moderate dysplasia at margin was as an independent significant factor for survival (<0.0001) when adjusted with other cofounders. Conclusion Patients with mild or moderate dysplasia at surgical margin were often tobacco users and moderate dysplasia in the margin is an independent significant indicator for survival of oral cancer patients in this single institute retrospective study.
British Journal of Oral and Maxillofacial Surgery, 2016
British Journal of Oral and Maxillofacial Surgery, 2015
Please cite this article in press as: Gokavarapu S, et al. Revision of margins under frozen secti... more Please cite this article in press as: Gokavarapu S, et al. Revision of margins under frozen section in oral cancer: a retrospective study of involved margins in pT1 and pT2 oral cancers.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2015
Carcinoma of tongue is associated with a high risk of occult metastasis and mortality despite ear... more Carcinoma of tongue is associated with a high risk of occult metastasis and mortality despite early-stage detection and therapy; the critical tumor thickness at which this risk increases has been demonstrated as 4 mm or greater. There are no sufficient data in the published literature to evaluate the role of postoperative radiation therapy (PORT) in the treatment of pT1-T2 N0 oral tongue cancers with depth of invasion 4 mm or greater. Historical cohorts of patients with primary pT1-T2 N0 oral tongue cancer of depth of invasion 4 mm or greater treated surgically from January 2010 to December 2012 were included in the study, and negative margins on initial resection were filtered. Locoregional recurrence and death were analyzed among the patients who received PORT and those who did not. A total of 103 patients fulfilled the above-mentioned criteria, with 62 patients receiving PORT and 41 patients not receiving PORT; median period of follow-up was 41.3 months. Logistic and Cox regression models showed no significant difference in locoregional recurrences (P = .078) and survival (P = .339) between patients who received PORT and those who did not receive PORT. PORT did not influence survival of patients with stage I and stage II deep tongue cancers, with 4 mm or greater tumor invasion depth.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2015
Verrucous carcinoma (VC) is an uncommon variant of squamous cell carcinoma characterized by proli... more Verrucous carcinoma (VC) is an uncommon variant of squamous cell carcinoma characterized by proliferative outgrowing clinical appearance of the tumor, Incidence of VC is 2-12 % among oral cancers, the true incidence of VC can be accessed only from surgically treated cases since thorough processing of the entire tumor is necessary for accurate diagnosis, foci of invasive squamous cell carcinoma are found often in the substance of these tumors, thus, over reporting of this tumor is not uncommon. The retrospective data of a tertiary cancer hospital was analysed to understand the clinical challenges and outcome of patients with VC. The frequent association of VC with second primary oral cancer (22.7 %) observed in our series highlights the multi centricity of carcinogenesis in these patients.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2014
The critical tumor depth at which the risk of occult metastasis increases in tongue cancer has be... more The critical tumor depth at which the risk of occult metastasis increases in tongue cancer has been demonstrated as C4-5 mm. Conventional T staging might not be an accurate predictor for survival in situations wherein infiltrative growth pattern is easily overlooked. Thus risk of death associated with increase in tumor depth per millimeter might be useful to understand patient's disease status during follow up. Historical cohorts of patients with pT1N0 and pT2N0 primary squamous cell carcinoma of tongue treated between January 2010 and December 2011 were selected and analyzed in univariate and multivariate cox-regression model to indicate the risk of death associated with an increase in each millimeter of tumor depth. The median period of follow up was 34 months. Total 67 patients fulfilled the above mentioned criteria, among them 11 patients died by the end of study period. The mean (SD) age of the patients studied was 49.7 (12.7) years and their age ranged from 21 to 74 years. Among these 66 % (n = 44) were males. In the univariate log-rank test, margin status (p = 0.016), t-stage (p = 0.018) and increased tumor depth (p \ 0.0001) were risk factors for occurrence of death. When adjusted for other risk factors in the multivariate coxregression model, per one unit increase of tumor depth (mm) there was 1.07 (95 % CI 0.95, 1.21) units increased risk of death. Depth of tumor with increase in each millimeter in tongue cancer appears to be associated with risk of death irrespective of regional lymphatic spread.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2014
Complex anatomy of oral cavity makes it difficult for a surgeon to assess margins of oral cancer ... more Complex anatomy of oral cavity makes it difficult for a surgeon to assess margins of oral cancer accurately and positive margins compromise loco regional disease control, thus surgeon may rely on frozen section assessment for marginal status. We discussed the prognostic value of frozen section in early carcinoma of oral cavity. 90 patients with pT1 and pT2 oral cavity cancer operated from January 2010 to December 2011 under single consultant surgeon were retrospectively evaluated. Log rank test and multivariate cox regression model was used for testing frozen section against the survival and recurrence free status. Survival of patients with positive or negative frozen section was significant (p = 0.037), Survival of patients with positive or negative histology report was significant (p = 0.004), however; prognosis of patients with positive margins despite revision under frozen control was poorer to the patients with negative margin. Frozen section assessment is accurate but their use in the surgery of oral cavity cancer might not improve loco regional disease control or survival when used routinely.
Journal of Maxillofacial and Oral Surgery, 2014
Introduction Studies have reported 20 % of conventional squamous cell carcinoma in patients with ... more Introduction Studies have reported 20 % of conventional squamous cell carcinoma in patients with verrucous carcinoma (VC), later these cancers were termed as hybrid VC. It is important to distinguish both while planning treatment since hybrid VC requires addressing regional lymphatics in addition to respective surgery. Information on odds of missing the foci of invasion on routine incision biopsy might be useful in this regard. Patients and Methods Records of all the patients surgically treated for oral cancer from Jan 2010 to Oct 2013 in a Tertiary Cancer Centre was analyzed. Patients diagnosed with primary VC or Verrucous Hyperplasia on incision biopsy were included in the study. Proportion of patients undiagnosed for invasive component on incision biopsy was calculated, multivariate analysis of the sample was performed to find associated cofounders. Results Fifty-five patients who reported with the diagnosis of VC (n = 53) or Verrucous Hyperplasia (n = 2) on incision biopsy were included in the study. Twenty-seven were diagnosed as VC and 28 as hybrid VC after excision. This corresponded to 51 % (n = 28) of cases missing invasive component on incision biopsy. VC was significantly more commonly seen in lip and in buccal mucosa, hybrid VC was more commonly seen in tongue and gingiva and this association was statistically significant (p = 0.031) in our study. Conclusion Incision biopsy is extremely unreliable to diagnose and differentiate oral Hybrid VC from VC or Verrucous Hyperplasia. Caution is required while planning treatment of these patients regarding possibility of presence of conventional squamous cell carcinoma within these tumors.
International Journal of Surgical Oncology, 2014
Introduction.Among all prognostic factors, “margin status” is the only factor under clinician’s c... more Introduction.Among all prognostic factors, “margin status” is the only factor under clinician’s control. Current guidelines describe histopathologic margin of >5 mm as “clear margin” and 1–5 mm as “close margin.” Ambiguous description of positive margin in the published data resulted in comparison of microscopically “involved margin” and “close margin” together with “clear margin” in many publications. Authors attempted to compare the outcome of close and clear margins of stage I and stage II squamous cell carcinoma of oral cavity to investigate the efficacy of description of margin status.Patients and Methods.Historical cohorts of patients treated between January 2010 and December 2011 at tertiary cancer hospital were investigated and filtered for stage I and stage II primary squamous cell carcinomas of oral cavity. Patients with margin status of tumor at margin or within 1mm from cut margin were excluded and analyzed in multivariate logistic regression model for locoregional re...
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Papers by nagendra parvataneni