Amer J Durrani

Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom

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Publications (6)12.58 Total impact

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    ABSTRACT: Anal squamous cell carcinoma with lymph node metastases carries a poor outcome. There remains a need for a better method to diagnose inguinal lymph node metastases which is minimally invasive, accurate and avoids unnecessary irradiation to the groin with its associated significant co-morbidity. The aim of this study was to evaluate the role of sentinel lymph node (SLN) biopsy in anal squamous cell carcinoma. The systematic review was conducted in accordance with PRISMA guidelines. The Medline, Central and Embase databases were searched using the terms 'sentinel lymph node' and 'anus neoplasms'. The systematic review identified 17 studies, containing 270 patients. SLN detection rate varied from 47%-100%. The presence of nodal metastases varied from 0-44%. The complication rate varied from 0-59%.The rate of development of subsequent inguinal lymph node metastases in those previously SLN biopsy-negative (a surrogate marker for false negative rate) ranged from 0-18.75%. SLN biopsy is a feasible method of assessing lymph node status in patients with anal squamous cell carcinoma. Longer follow up is required to evaluate the proportion of patients who are SLN biopsy-negative and subsequently develop nodal metastases. More studies are required to ascertain whether SLN biopsy should be the main method of assessing inguinal lymph node involvement in patients with anal squamous cell carcinoma.
    International Journal of Surgery (London, England) 07/2013; 11(9). DOI:10.1016/j.ijsu.2013.07.005 · 1.65 Impact Factor
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    ABSTRACT: AIM: This paper aims to simplify the approach to reconstruction of the perineum after resection of malignancies of the anal canal, lower rectum, vulva, and vagina. MATERIALS AND METHODS: The data were collected from 2 centers, namely, Addenbrooke's Hospital, University of Cambridge, United Kingdom and Christchurch Hospital, University of Otago, New Zealand. All patients who underwent perineal reconstruction from 1997 to 2009 at Christchurch Hospital (13 years) and 2001 to 2009 at Addenbrooke's Hospital (9 years) were included. The diagnosis (indication), primary surgery, reconstructive surgery, complications, tumor outcomes (recurrence and survival), and follow-up were entered into a database (Microsoft Excel; Redmond, Wash). The incidence of previous radiotherapy, requirement for adjuvant radiotherapy, and length of inpatient stay were also recorded. RESULTS: Forty-six patients were identified for this study-13 in New Zealand and 33 in Cambridge. Indications for perineal reconstruction included resection of anal and rectal malignancies (24), vulval and vaginal malignancy (19), perineal sarcoma (1), and perineal squamous cell carcinoma arising in an enterocutaneous fistula (Table 1). The reconstructive strategies adopted included rectus abdominis myocutaneous flaps (26), gluteal fold flaps (9), gracilis V-Y or advancement flaps (7) and others (4), gluteal rotation flaps (1), local flap (2), and free latissimus dorsi flaps (1). CONCLUSIONS: Although various surgeons performed the reconstructive surgeries at 2 different centers, the essential approach remained the same. Smaller defects were best treated by local flaps, whereas the rectus abdominis flap remained the standard option for larger defects that additionally required closure of dead space. On the basis of our 2 center experience, we propose a simple algorithm to facilitate the planning of reconstructive surgery for the perineum.
    Annals of plastic surgery 07/2012; DOI:10.1097/SAP.0b013e3182414485 · 1.46 Impact Factor
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    ABSTRACT: Closure of the perineum following radical excision of pelvic tumours can prove to be a complex surgical problem. A number of pedicled flaps have been used for perineal reconstruction in order to reduce post-operative complications such as infection and abscess formation. The aim of this case series was to analyse the use of pre-operative computer tomography (CT) angiography to guide flap selection for perineal reconstruction following radical excision of pelvic tumours. We conducted a retrospective review to identify all patients who underwent CT angiography prior to radical excision of pelvic tumours and planned flap reconstruction over an 18 month period. Six patients were identified and are presented in this case series. Patients' medical records, histology reports, pre-operative investigations and CT angiograms, complications and follow-up were reviewed. The mean patient age was 58.3 years, with a male to female ratio of 1:2. Four out of six patients (66.6%) underwent pre-operative radiotherapy. The deep inferior epigastric arteries (DIEA) were visualised in all six cases (100%) and the pre-operative CT angiography helped guide flap choice in all cases (100%). In one case, narrowing of the DIEA vessels was noted precluding the use of a DIEA-based flap. One patient had a minor superficial wound dehiscence. Pre-operative CT angiography allows accurate visualisation of the DIEA system including perforator vessels. CT angiography is a useful tool, providing the surgical team with significant additional information to aid pre-operative planning and optimise reconstructive choice and outcome.
    International Journal of Surgery (London, England) 03/2012; 10(4):217-20. DOI:10.1016/j.ijsu.2012.03.013 · 1.65 Impact Factor
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    ABSTRACT: The transverse rectus abdominis musculocutaneous (TRAM) flap based on the deep inferior epigastric artery is useful in head and neck reconstruction as it provides substantial skin and soft tissue cover, and allows volume to be replaced in large defects. A major advantage is the anatomical reliability of the deep inferior epigastric pedicle. We report a case in which neither rectus abdominis muscles had a blood supply from the deep inferior epigastric artery, which necessitated a change in the planned reconstruction. We review variations in the anatomical course of the artery and, although rare, stress the importance of reconstructive surgeons being aware of such variations.
    British Journal of Oral and Maxillofacial Surgery 04/2011; 49(3):233-4. DOI:10.1016/j.bjoms.2010.04.008 · 1.13 Impact Factor
  • Andrei Ilczyszyn, Hyder Ridha, Amer J Durrani
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    ABSTRACT: Chyle leakage post head-and-neck resection is a rare but potentially life-threatening complication. Management may be problematic and prolonged. Recently, thoracoscopic ligation of the thoracic duct has emerged as a promising technique to definitively treat this difficult problem. We present a recent case of a hemimandibulectomy, radical modified neck dissection and osseocutaneous fibular-free-flap complicated by a chyle leakage. The chyle leak was successfully treated with thoracoscopic ligation of the thoracic duct. In the light of our clinical experience and following a thorough literature review, we have proposed that complicated or high-output chyle leaks (>1000 ml day(-1)) should be treated with early thoracoscopic thoracic duct ligation.
    Journal of Plastic Reconstructive & Aesthetic Surgery 02/2011; 64(9):e223-30. DOI:10.1016/j.bjps.2010.12.018 · 1.47 Impact Factor
  • British Journal of Surgery 01/2009; 96(S5):1-72. · 5.21 Impact Factor