Papers by Waheed Yousry A Gareer
Journal of Coloproctology, Jun 1, 2022
Background Peritoneal carcinomatosis (PC) is a lethal regional progression in patients with color... more Background Peritoneal carcinomatosis (PC) is a lethal regional progression in patients with colorectal cancer (CRC). Treatment with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) achieves better local control than systemic palliative chemotherapy. Objectives To assess the efficacy on the prognosis of CRS and HIPEC compared with CRS only and to identify possible clinicopathological factors associated with the recurrence of PC. Methods The present retrospective study included all colorectal carcinoma cases with PC subjected to CRS with or without HIPC from January 2009 to June 2018 at the National Cancer Institute (NCI), Cairo University, Cairo, Egypt. The outcome is evaluated in terms of recurrence-free survival (RFS) and its predictors. Results Out of the 61 patients, 45 patients (73.8%) underwent CRS plus HIPEC, and 16 (26.2%) underwent CRS alone. The 1-year RFS was 55.7%, with a median of 12 months. The risk factors for recurrence identified in the univariate analysis were T4 primary tumor, high-grade, positive lymphovascular invasion (LVI), positive extracapsular nodal spread, and patients treated with CRS only, without HIPEC. In the multivariate analysis, the independent risk factors for recurrence were high grade and patients treated with CRS only. Conclusion T4 primary tumor, high grade, positive LVI, and positive extracapsular nodal spread seemed to be important predictors of recurrence following the treatment of PC. Our study also demonstrated that the addition of HIPEC to CRS improved the RFS.
Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Nov 1, 2013
Objective: To assess the accuracy of clinical intraoperative lymph node examination, and relation... more Objective: To assess the accuracy of clinical intraoperative lymph node examination, and relation between preoperative clinical examination and postoperative histopathological examination of lymph nodes in head and neck cancer. Study design: Cohort study. Level of evidence: Level II.
European Archives of Oto-rhino-laryngology, Sep 27, 2014
This study aimed to evaluate the operative outcomes of using gastric pull-up (GPU), pectoralis ma... more This study aimed to evaluate the operative outcomes of using gastric pull-up (GPU), pectoralis major myocutaneous flap (PMMF), and jejunal free flap (JFF) to reconstruct the hypopharynx after resection of hypopharyngeal and cervical esophageal carcinoma. Retrospective clinical study.
Journal of Cancer Therapy, 2019
Journal of Cancer Therapy, 2017
Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substa... more Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precise staging is the pouring force behind the use of diagnostic laparoscopy (DL). Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Study design: In this prospective study, 62 patients with lower esophageal, gastric and peri-pancreatic carcinomas were joined after written informed consent. All patients were examined with laparoscopy and LUS with the help of frozen section analysis to any doubtful metastatic site, peritoneal fluid and ascitic fluid analysis. Results: DL helped us to avoid needless laparotomy in 22.5% of patients, reducing its post-operative complications, hospital stay and cost. DL also helped us to do palliative management either in the form of gastric bypass or laparoscopic celiac plexus block. Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies.
Journal of King Abdulaziz University-medical Sciences, 1994
We report our experience in laparoscopic appendectomy starting October1991 till May 1992. One hun... more We report our experience in laparoscopic appendectomy starting October1991 till May 1992. One hundred and seven patients with acute (85%) and seventeen patients with chronic (15%) appendicitis were operated upon successfully using the laparoscope. The appendix was gangrenous, forming a mass or an abscess in twenty-three patients (215%). In spite of that, only two patients had minor post-operative wound infection, i.e., less than (2%) where the wound formed superficial abscess without any growth. All patients had an uneventful recovery and were discharged home within 24 to 72 hours post-operatively.
European Journal of Cancer, Sep 1, 2011
We had 27 cases of GIST, 17 male, 10 female, mean age 66.3 year-old (39 to 92 y.o.). The primary ... more We had 27 cases of GIST, 17 male, 10 female, mean age 66.3 year-old (39 to 92 y.o.). The primary lesion of GIST were 3 of esophagus (11.1%), 13 of stomach(48.1%), 2 of duodenum(7.4%), 7 of small intestine(25.9%) and 2 of large intestine(7.4%). We operated 25 cases without 1 of duodenum with liver metastases and 1of small intestine with giant tumour. Conventional curative operation was carried out 17 cases. Laparoscopic curative operated 5 cases were less than 5 cm in size. Non curative operated 3 cases were all dead. 22 of curative operation had no postoperative adjuvant therapy and they are all alive without recurrence. Treatment of imatinib mesylate administered 5, 1 was effective and 4 were not effective. 1 effective case arisen from duodenum with liver metastases is alive in 74 months from the start of this therapy. Conclusions: The goal of surgical treatment is complete gross resection with an intact pseudocapsule. Lymphadenectomy is usually unnecessary because lymph node metastases are so rare with GIST and sarcoma in general. The first choice of surgical treatment of GIST is conventional curative resection of tumours according to Japanese Guideline. In selective cases of small tumour, laparoscopic complete resection is allowed for minimally invasive surgery. Treatment of imatinib mesylate should be done firstly in inoperative cases and secondly in cases of incomplete resection.
European Journal of Cancer, Sep 1, 2015
therapy, disease free survival and overall survival. Statistical analysis was done using SPSS ver... more therapy, disease free survival and overall survival. Statistical analysis was done using SPSS version 22. Results: In the neoadjuvant group (group A) (n = 89) the median age of patients was 53 years (range 31−80 years), most of the patients (70%) presented with complaint of postmenopausal bleeding. Of the total patients, 69 (77.5%) underwent radical surgery and 5 (8.5%) received radiotherapy after NACT. Among the 69 patients, who underwent surgery, 54(78.3%) also received radiation. The overall response to induction chemotherapy was 84%. In the chemo radiation group (group B) (n = 65) median age was 56 years (33−75 years). Vaginal bleeding (34%) followed by postmenopausal bleeding (32%) was major presenting complaints in this group. Overall response to the complete treatment was 91%. The median follow up time was 14.3 months in group A and 12.2 months in group B. The disease free survival for NACT group was 32 months (95% CI 26.8-36.5) whereas for CTRT group it was 28 months (95% CI 23.5−33) with 12 and 13 recurrences per group (p = 0.226). In NACT group overall survival was 46.2 months (95% CI 44-48.3) and for CTRT group it was 38.3 months(95% CI 36.6−40) with 3 and 2 deaths per group (p = 0.883). Conclusion: Present study shows comparable results, with no difference in survival(DFS and OS) between both the groups. Moreover three fourth of patients in the NACT/RS arm required adjuvant radiation increasing cost and toxicity. Further studies should be performed with larger number of patients and longer duration of follow up to find the subset of patients who might benefit with this experimental approach. No conflict of interest.
Journal of the Egyptian National Cancer Institute, Dec 1, 2011
Introduction: The need for accurate intrahepatic staging is crucial for patients with primary or ... more Introduction: The need for accurate intrahepatic staging is crucial for patients with primary or secondary hepatic malignancies. Currently available data indicate that laparoscopy with laparoscopic ultrasound provides information similar to that obtained by intraoperative ultrasound and that it is able to identify small intrahepatic lesions not diagnosed by preoperative conventional imaging techniques. Objective: To determine the role of preoperative laparoscopy and laparoscopic ultrasonography in patients with potentially resectable hepatic focal lesion or candidate for radiofrequency ablation based on preoperative imaging. Material and methods: From March 2004 to March 2007, 55 patients with potentially resectable hepatic focal lesions were candidates for exploratory laparotomy based on preoperative abdominal ultrasonography and triphasic spiral CT. All cases were then reevaluated prior to surgery using laparoscopy and laparoscopic ultrasound. All these procedures were performed within a time period of
PubMed, Jun 1, 1987
Reconstruction of the breast (BR) after mastectomy without using a prosthetic implant has always ... more Reconstruction of the breast (BR) after mastectomy without using a prosthetic implant has always presented a challenge for plastic surgeons, allowing them to avoid complications due to foreign body and to provide a more natural reconstructed breast. Out of 66 women who underwent BR using the rectus abdominis musculocutaneous flap, 52 received no implant. Ten upper rectus (ERF) and 42 lower rectus (TRAM) were the two procedures applied. The ERF has been abandoned due to the 9% rate of complete necrosis encountered among the total series of rectus flap regardless of the implant inclusion. Partial necrosis was also the most frequent complication of the TRAM (28% among those not having received an implant), but the reconstruction was nevertheless possible in all the cases. The TRAM technique produced abdominal sequelae in 45% of the no-implant cases, though it also improved the cosmetic aspect of the abdomen in an equal number of cases, particularly in obese women. Overall cosmetic results were also better for the TRAM without implant than for the ERF (72% good vs. 51%). Moreover the BR without implant could be performed in only 48% of the total ERF, as compared to 93% of the total TRAM. The major advantage of such BR without implant is that it provides a reconstructed breast which appears more symmetrical to the contralateral breast and which remains even after several years of follow-up.
Journal of the Egyptian National Cancer Institute, Sep 1, 2011
Background: The standard treatment for women with endometrial cancer is total abdominal hysterect... more Background: The standard treatment for women with endometrial cancer is total abdominal hysterectomy and pelvic lymphadenectomy for surgical staging. Total laparoscopic radical hysterectomy (TLH) is an alternative approach providing surgical and patient related advantages to laparoscopy. Methods: Twenty female patients with early stage endometrial cancer were operated upon by TLH and pelvic lymphadenectomy, aiming to assess the safety and efficacy of TLH. Results: The mean operative time was 296.8 min conversion to laparotomy was done in one patient due to bleeding from the uterine vessels. The mean blood loss was 517.5 cc. The uterus was removed transvaginally in 18 patients (90%) and via a small Pfannenstiel incision in two patients (10%). The mean number of pelvic lymph nodes retrieval was 21.2. Postoperative bleeding occurred in one patient (5%) which necessitated exploration. One patient (5%) suffered a pulmonary embolism. Four patients (20%) developed pyrexia, and one patient (5%) suffered from a chest infection. One patient (5%) had wound infection. The mean hospital stay was 4.5 days (range 3-10). Conclusion: TLH with pelvic lymphadenectomy is a safe and effective approach in the treatment of early endometrial carcinoma.
European Journal of Surgical Oncology (EJSO), 2016
European Journal of Cancer, 2011
Gastroenterology, 2018
Background: Despite advances in medical therapy for UC, many patients still need surgery. Data on... more Background: Despite advances in medical therapy for UC, many patients still need surgery. Data on UC colectomy and ileal pouch anal anastomosis surgery (IPAA) rates in the United States are limited. We examined colectomy rates during emergent admissions and IPAA rates in a national database of hospitalizations. Methods: We analyzed data from the United States Nationwide Inpatient Sample (NIS) from 2000 through 2014. Inclusion criteria were admissions with a primary UC ICD-9-CM diagnosis code and age $ 18. Emergent cases were defined as admission through the emergency room. We considered only the ICD-9-CM code for subtotal colectomy (45.8) within this group as the outcome variable. We defined a second cohort of UC patients admitted electively with an outcome variable of ICD-9-CM code for IPAA (35.05, 35.06) which was used as a surrogate measure of overall need for colectomy (final stage procedure for vast majority). Patient and hospital-level demographics (age, race, gender, insuranace type, hospital type) were also analyzed. Temporal trends of colectomy were analyzed utilizing joinpoint regression analysis with calculation of annual percentage change (APC). Results: A total 470,720 admissions were included over the study period. Colectomy rate among patients emergently admitted to the hospital significantly declined over 10 years (APC-7.35%, p<0.05) while the rate of elective IPAA remained stable (APC-0.21%, p=n.s.) (Figure 1). Emergent colectomy rates were higher in teaching hospitals. Colectomy rate among emergent admissions declined similarly across all demographics. However, IPAA rates were significantly higher among whites and those with private insurance (Figure 2). Conclusions: There has been a significant decline in emergent UC colectomy in the United States, likely due to more effective inpatient medical care. However, overall need for surgery appears to be stable given unchanged IPAA rates. This suggests a limited impact on overall surgery rates with a shift from emergent to elective procedures. There are disparities in IPAA rates based on race and insurance type.
Journal of Cancer Therapy
Background and goals Sexual dysfunction is a well-documented complication of rectal cancer surger... more Background and goals Sexual dysfunction is a well-documented complication of rectal cancer surgery, with a reported incidence of 18%-59%. The objective of this study is to evaluate the incidence of sexual dysfunction (SD) in males after radical resection for rectal cancer and to compare the outcome of open versus laparoscopic rectal resection for different age groups. Patients and methods This prospective randomized study assessed outcomes in male patients that underwent rectal resection for rectal cancer from January 2012 until March 2015 at two large tertiary hospitals in Cairo, Egypt. The patients were randomly allocated into two groups (laparoscopic and open technique) of 40 patients each using the odd number policy for patient allocation. Patients included in each group were further subdivided into two groups according to the type of rectal resection either anterior resection (AR) or abdominoperineal resection (APR). Erectile function was evaluated preoperatively and postoperatively at 3 and 6 months using the International Index of Erectile Function (IIEF) questionnaire. Results There was no significant difference between the laparoscopic and open total mesorectal excision (TME) groups when comparing IIEF score preoperatively. At 3 months postoperatively, the laparoscopic arm showed better results over the open arm (abnormal IIEF in 57.5% vs. 67.5%). The study demonstrated dramatic improvement in SD in both groups at 6 months postoperatively (abnormal IIEF score of 40% in the laparoscopic vs. 42.5% in the open arm) with no significant difference in IIEF score between the two groups (p-value 0.876). At 3 and 6 months postoperatively, younger patients showed significant improvement in SD compared to older patients in both groups with more significant improvement in the laparoscopic group (16.7% vs. 40%). Patients with APR show more SD compared with AR patients whether laparoscopic or open as How to cite this paper: Gareer, H., Gareer, W.Y. and Hussien, A. (2019) Evaluation of Male Sexual Dysfunction Associated with Laparoscopic versus Open Resection in Rectal Cancer in Different Age Groups.
Asian Pacific journal of cancer prevention : APJCP, 2015
Endometrial carcinoma is the most common gynecological cancer and its treatment is still controve... more Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy. Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-ao...
Gastroentérologie clinique et biologique, 1985
Local recurrences (LR) after curative surgery have been analyzed in series of 173 rectal adenocar... more Local recurrences (LR) after curative surgery have been analyzed in series of 173 rectal adenocarcinomas treated between 1973 and 1983. LR predictive factors were analyzed by univariate and multivariate (Cox model) studies. Five factors had no predictive value on LR: age, sex, tumor differentiation, tumor size, and number of metastatic nodes. Five factors had a predictive value on LR: severe clinical symptoms (fixation, obstruction and perforation) (p = 0.03), tumors localized within five cm of the anal verge (p less than 0.001), intramural infiltration (p = 0.09), localization of positive nodes (p = 0.02), and tumor emboli inside the vessels (p less than 0.01). The multivariate study underlined the two main predictive factors: the tumor site within 5 cm of the anal verge (p less than 0.001) and involvement of the serosa (p = 0.05). An equation of LR risk is presented and four subgroups of different LR risk patients are defined. This study might provide guidelines for indications an...
The Chinese-German Journal of Clinical Oncology, 2011
Abstract Objective The aim of our study was to investigate the feasibility and safety of thoracos... more Abstract Objective The aim of our study was to investigate the feasibility and safety of thoracoscopic internal mammary lymphadenectomy as a method to refine and thereby improve nodal staging in breast cancer. Methods During the period from June 2004 to ...
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Papers by Waheed Yousry A Gareer