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"ABSTRACTPurposeLysophosphatidylcholine (LPC), which is generated from phosphatidylcholine (PC) and metabolized by autotaxin (ATX), modulates immune responses via its anti-inflammatory property. We investigated the association between LPC and postoperative complications (POCs) after colorectal cancer surgery (CRC).MethodsThe subjects of this study were 43 patients who underwent surgery for CRC. Peripheral blood samples were collected preoperatively and immediately after surgery, and on postoperative days (PODs) 1, 3, 5, and 7. Patients were divided into a No-POC group (n = 33) and a POC group (n = 10). Blood LPC, IL-6, PC, and ATX levels were measured by specific enzymatic assays or ELISA.ResultsThe postoperative to preoperative LPC ratios were lowest on POD 1 in both groups. The POC group had significantly lower LPC ratios throughout the perioperative period than the No-POC group. The LPC ratios were inversely correlated with IL-6. The predictive impact of LPC ratios on POCs was demonstrated by ROC analysis (cut-off 51.2%, AUC 0.798) and multivariate analysis (OR 15.1, P = 0.01). The postoperative PC ratios decreased more after surgery in the POC group. ATX levels did not change significantly in either group.ConclusionsDecreased postoperative LPC is associated with increased postoperative inflammatory response and POCs. The decreased PC supply to the circulation is a mechanism of the postoperative LPC decrease."

"PURPOSE: To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.METHODS: The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.RESULTS: The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p = 0.0028), an interval between surgery and closure of 6 months or longer (p = 0.0049), and an operation time of 145 min or longer (p = 0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p = 0.0025), the interval between surgery and closure (odds ratio, 3.4780; p = 0.0039), and operation time (odds 2.5179; p = 0.0260) were independent risk factors.CONCLUSIONS: Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer."

"ABSTRACTPurposeGeriatric surgery poses specific challenges due to patient vulnerability in relation to aging. We analyzed perioperative challenges concerning super-elderly patients with breast cancer.MethodsBetween 2013 and 2018, 908 patients with breast cancer were treated surgically. Of these, two patient groups were compared: Group A (≥ 85 years old, n = 34, 3,7%) and Group B (75-84 years old, n = 136, 15%).ResultsIn Groups A and B, 26,4% and 36,8% of patients lived alone, respectively. Group A patients had higher rates of psychiatric and cardiovascular disease (32,4% and 41,2%) than Group B (8,8% and 16,2%) (p = 0,0009 and p = 0,0031, respectively). There was no marked difference in the type of surgery or length of hospital stay between groups, and most complications involved surgical site disorders. Postoperatively, Group A had a higher rate of delirium (29,4%) than Group B (3,7%) (p < 0,0001). The 30-day postoperative mortality rate was 0, and 76,5% of Group A and 45,6% of Group B patients received no adjuvant therapy (p = 0,0024).ConclusionsAge alone does not constitute a contraindication for appropriate surgery, although there are some challenges necessary to consider for super-elderly patients."

"Latar belakang: Kanker kolorektal termasuk masalah yang cukup besar sebagai penyebab kematian kedua dari keseluruhan keganasan dalam skala global. Banyak faktor yang memengaruhi mortalitas pada pasien kanker kolorektal terutama pascapembedahan. penelitian ini bertujuan untuk mengetahui faktor apa saja yang berpengaruh terhadap mortalitas pasien kanker kolorektal resektabel pascapembedahan dan menyusun sistem skor prognosis yang mampu memprediksi mortalitas pada pasien tersebut.Metode: Penelitian kohort retrospektif ini melibatkan pasien kanker kolorektal di RS Ciptomangunkusumo, Indonesia, dari Januari 2016-April 2020 yang terdiagnosis kanker kolorektal resektabel. Data-data dikumpulkan dari penelusuran rekam medis, laporan operasi, laporan histopatologi, dan laporan hasil laboratorium. Mortalitas dinilai pada tiga tahun setelah dilakukan pembedahan secara kuratif.Hasil: 214 pasien kanker kolorektal resektabel diikutkan dalam penelitian. Ukuran tumor ≥5 cm, staging T3/T4, tidak mendapatkannya kemoterapi adjuvan, tidak tercapainya free circumferensial margin, dan kadar CEA > 11,4 ng/mL memiliki hubungan bermakna dengan peningkatan mortalitas tiga tahun. Sistem skor prognosis mortalitas tiga tahun yang dibuat mampu memprediksi terjadinya luaran dengan sensitifitas 91,3% dan spesifisitas 67,6%.Kesimpulan: Sistem skor prognosis yang terdiri dari lima variabel secara signifikan mampu memprediksi angka mortalitas tiga tahun dengan luaran sensitifitas yang tinggi

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Background: Colorectal cancer is a major issue as the second leading cause of death among all malignancies on a global scale. Various factors influence mortality in colorectal cancer patients, especially after surgery. This study aims to identify factors affecting mortality in resectable colorectal cancer patients after surgery and to develop a prognostic scoring system capable of predicting mortality in these patients.

Methods: This retrospective cohort study involved colorectal cancer patients at Ciptomangunkusumo Hospital, Indonesia, from January 2016-April 2020 diagnosed with resectable colorectal cancer. Data were collected from medical records, operation reports, histopathology reports, and laboratory test results. Mortality was assessed three years after curative surgery.

Results: A total of 214 resectable colorectal cancer patients were included in the study. Tumor size ≥ 5 cm, T3/T4 staging, absence of adjuvant chemotherapy, unachieved free circumferential margin, and CEA levels > 11.4 ng/mL were significantly associated with increased three-year mortality. The constructed three-year mortality prognostic scoring system was able to predict outcomes with a sensitivity of 91.3% and a specificity of 67.6%.

Conclusion: The prognostic scoring system, consisting of five variables, is significantly capable of predicting three-year mortality rates with high sensitivity."

"ABSTRACTPurpose: Postoperative pneumonia affects the length of stay and mortality after surgery in elderly patients with colorectal cancer (CRC). We aimed to determine the risk factors of postoperative pneumonia in elderly patients with CRC, and to evaluate the impact of laparoscopic surgery on elderly patients with CRC.Methods: We retrospectively investigated 1473 patients ≥ 80 years of age who underwent surgery for stage 0-III CRC between 2003 and 2007. Using a multivariate analysis, we determined the risk factors for pneumonia occurrence from each baseline characteristic.Results: Among all included patients, 26 (1.8%) experienced postoperative pneumonia, and restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events, and open surgery were determined as risk factors (odds ratio [95% confidence interval], 2.78 [1.22-6.20], 2.71 [1.22-6.30], 3.60 [1.37-8.55], and 3.57 [1.22-15.2], respectively). Furthermore, postoperative pneumonia was more frequently accompanied by increasing cumulative numbers of these risk factors (area under the receiver operating characteristic curve = 0.763).Conclusions: Laparoscopic surgery may be safely performed in elderly CRC patients, even those with respiratory impairment and a history of cerebrovascular events."

"It has been proposed that minor oral surgery can be performed safely in patients taking antithrombotic therapy without interrupting treatment; however, there is little evidence-based guidance about how to manage postoperative hemorrhage in patients taking antithrombotics, and few randomized trials that help to inform the risk–benefit ratio of continuing or suspending antithrombotic therapy. The aim of this study was to identify risk factors for postoperative hemorrhage to create a protocol for patients undergoing minor oral surgery with antithrombotic therapy. One hundred and two patients were enrolled, who subsequently underwent 142 minor oral surgical procedures while taking antithrombotic therapy. Demographic details including age and sex, laboratory coagulation investigations, and episodes of postoperative hemorrhage were recorded. The prothrombin time-international normalized ratio (PT-INR) of participants taking warfarin was <3.0 in all cases (mean 1.89 ± standard deviation 0.52; range 1.11–2.82). The activated partial thromboplastin time (APTT) was significantly associated with postoperative hemorrhage, which was significantly increased in patients taking warfarin alone or in combination with an antiplatelet agent compared with an antiplatelet agent alone. In 7 cases, postoperative hemorrhage continued for 4 days and more, requiring additional local hemostatic management. Our findings suggest that minor oral surgery can be performed under antithrombotic therapy without the need of discontinuing the antithrombotic agents. Local hemostatic materials did not suppress postoperative hemorrhage. APTT is a possible prediction factor for postoperative hemorrhage in such patients and, therefore, should be determined prior to minor oral surgery in addition to PT-INR value."

"ABSTRAKNama : Subhan RumoningProgram Studi : Ilmu Penyakit DalamJudul : Durasi Operasi sebagai Prediktor Komplikasi Paru Pasca Operasi Non Kardiak di RSCM Latar belakang : Di Indonesia, sebanyak 18,4 pasien yang menjalani operasi non-kardiak di RSUPN Cipto Mangunkusumo Indonesia mengalami Komplikasi Paru Pasca Operasi Post-operative Pulmonary Complication/PPC . Beberapa penelitian menunjukkan durasi operasi memiliki hubungan dengan PPC. Penelitian ini bertujuan untuk mengetahui peranan durasi operasi sebagai prediktor kejadian komplikasi gagal napas dan pneumonia dalam 30 hari pasca operasi. Metode : Penelitian menggunakan desain kohort retrospektif pada November 2016-Juli 2017 dengan data rekam medis pasien yang menjalani operasi di RSUPN Cipto Mangunkusumo tahun 2012-2016. Sampel penelitian diambil dengan metode consecutive sampling yang memenuhi kriteria inklusi dan eklusi, dilihat luarannya selama 30 hari pasca operasi. Hasil : Dari 102 pasien diketahui 58,8 perempuan, 35,5 41-50 tahun, 25,5 berpendidikan SMA, 34,3 tidak bekerja, 77,5 tidak mengalami penurunan berat badan, 80,4 tidak merokok, tidak ada yang memiliki riwayat PPOK, 61,8 anestesi umum, 64,7 operasi elektif dan 51,96 lokasi operasi di abdomen. Didapatkan 10,8 mengalami gagal napas dan 6,9 mengalami pneumonia. Dari analisis bivariat, durasi operasi tidak dapat digunakan sebagai prediktor kejadian gagal napas p 0,106; RR 3,56; CI 95 0,885 -14,280 maupun pneumonia p 0,701; RR 1,61; CI 95 0,342-7,601 . Kesimpulan : Durasi operasi tidak dapat digunakan sebagai prediktor tunggal dalam memprediksi kejadian komplikasi gagal napas maupun pneumonia pasca operasi.

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ABSTRACTABSTRACT Name Subhan Rumoning Study Program Internal MedicineTitle Duration of Surgery as a Predictor of Post operative Pulmonary Complications in Non cardiac Surgeries at RSCM Background In Indonesia, 18.4 patient done non cardiac surgery at RSUPN Cipto Mangunkusumo Indonesia had Post operative Pulmonary Complications PPC . Studies shown that duration of surgery associated with PPC. This study aims to know the role of duration of surgery as a predictor of respiratory failure and pneumonia in post operative patient during 30 days after surgery. Method This cohort retrospective study were conducted from November 2016 until July 2017 using medical records of patients who underwent surgery at RSUPN Cipto Mangunkusumo from 2012 until 2016. Samples were taken by consecutive sampling which fulfilled inclusion and exclusion criteria, and being followed up until 30 days after surgery. Result From 102 patients, 58.8 were females, 35.5 were 41 50 years old, 25.5 were high school graduated, 34.3 were not employed, 77.5 weren rsquo t having any weight reduction, 80.4 not smoking, none had COPD, 61.8 underwent general anesthesia, 64.7 underwent elective surgery and 51,96 operation site in abdomen. From all samples, 10.8 had respiratory failure and 6.9 had pneumonia. From bivariate analysis, duration of surgery can rsquo t be a predictor of either with respiratory failure p 0,106 RR 3,56 CI 95 0,885 14,280 or pneumonia p 0,701 RR 1,61 CI 95 0,342 7,601 . Conclusion . Duration of surgery can rsquo t be a single predictor to predict respiratory failure and pneumonia as PPC"

"PURPOSE: To identify the possible roles of carcinoembryonic antigen (CEA) testing after liver resection for synchronous colorectal liver metastasis (CLM).METHODS: The subjects of this retrospective study were patients who underwent complete resection of primary tumors and synchronous CLM between 1997 and 2007 at 20 institutions in Japan. We studied the associations between perioperative CEA levels and the characteristics of recurrence.RESULTS: Recurrence was detected during the median follow-up time of 52 months in 445 (73.7%) of the total 604 patients analyzed. A postoperative CEA level >5 ng/ml was an independent predictor, with the highest hazard ratio (2.25, 95% confidence interval 1.29-3.91, P = 0.004). A postoperative CEA level >5 ng/ml had a specificity of 86.2% and a positive predictive value of 84.2% for recurrence. Patients with a high postoperative CEA level had a significantly higher recurrence rate, with a shorter time until recurrence and a higher frequency of multiple metastatic sites than those with a low postoperative CEA level. Among the patients with recurrence, 173 (52.7%) had an elevated CEA level (>5 ng/ml) when recurrence was detected.CONCLUSIONS: A postoperative CEA level >5 ng/ml was an independent predictor of recurrence; however, CEA testing was not a reliable surveillance tool to identity recurrence after liver resection."