The Thai Journal of Surgery

A Comprehensive Case Series: Outcomes and Insights from the First Three Simultaneous Pancreas Kidney Transplants at Ramathibodi Hospital

2024-09-23T16:07:04+07:00

Abstract

Background: Pancreas transplantation, particularly in the context of Type 1 diabetes mellitus (T1DM) with end-stage renal disease (ESRD), has emerged as a pivotal therapeutic intervention, substantially ameliorating both the clinical and quality-of-life outcomes for affected individuals. While previous research has underscored its efficacy in enhancing longevity, mitigating cardiovascular risks, and improving overall well-being, its widespread adoption, particularly the simultaneous pancreas-kidney transplantation (SPK) approach, remains constrained by various factors, notably donor availability and the requisite multidisciplinary care infrastructure.

Methods: This study presents the treatment outcomes of the initial three cases of SPK performed at Ramathibodi Hospital in Thailand. The operative techniques employed adhered to established protocols, including intraoperative porto-enteric drainage for endocrine function and enteric drainage for exocrine function. Noteworthy intraoperative considerations encompassed meticulous vascular reconstruction, heparinization protocols, and vigilant monitoring of hematological parameters to forestall potential complications.

Results: Each case presented unique clinical profiles and postoperative trajectories. Complications, such as postoperative hematoma and declining hematocrit levels, were managed judiciously, with successful resolution and favorable graft outcomes observed during subsequent follow-up periods. Importantly, all patients demonstrated prompt postoperative glycemic control and satisfactory renal function, obviating the need for further dialysis or medical intervention.

Conclusion: SPK emerges as a highly efficacious therapeutic avenue for individuals afflicted with T1DM and ESRD, offering tangible improvements in health outcomes and the prospect of restored quality of life. As evidenced by the outcomes of the initial cases presented herein, SPK holds promise as a viable treatment modality warranting further exploration and dissemination within the clinical landscape.

Rare Axillary Cancer of Unknown Primary Originating from the Breast in Male Patient with PALB2 Pathogenic Variants: A Case Report

2024-12-23T17:40:09+07:00

Abstract

Background: Cancer of unknown primary (CUP) accounts for less than 5% of all cancers. Male breast cancer is a rare disease. The occurrence of bilateral breast involvement is even rarer, at approximately 0.5-2.5%. Genetic factors contribute to about 5-10%, with partner and localizer of BRCA2(PALB2) gene mutations accounting for 1-2%.

Case Report: We found a male with breast cancer who initially presented with metastatic adenocarcinoma at the axillary lymph node of unknown primary origin. After axillary lymph node dissection (ALND) with radiation therapy (RT), adjuvant chemotherapy, and regular surveillance, recurrence was observed on the same other side as the axillary lymph node. The PALB2 gene abnormality was also identified. Finally, he underwent prophylactic bilateral mastectomy, and the pathology report included bilateral benign breast tissue.

Conclusion: Patients without Breast cancer gene (BRCA)mutations should be offered next-generation sequencing (NGS) multi-gene panel testing to detect other abnormalities when personal is suggestive of a hereditary syndrome. The roles of bilateral prophylactic mastectomy, ALND, and RT will be discussed with the patient.

Comparison Between Early Breast Cancer Patients Who Underwent Sentinel Lymph Node Examination by One-Step Nucleic Acid Amplification and Conventional Pathological Examination in Terms of Breast Cancer Treatment and Survival Outcome

2024-09-13T15:33:53+07:00

Background: Sentinel lymph node biopsy (SLNB) is a standard axillary staging for early breast cancer. One-step nucleic acid amplification (OSNA) is a new molecular technique for intraoperative examination to measure the copies of cytokeratin 19 (CK19) mRNA. A higher proportion of micrometastasis detected by OSNA has been reported. However, the impact on treatment planning and survival outcomes is still inconclusive.

Objectives: To compare the adjuvant systemic treatment in the patients who underwent SLNB examination by conventional pathological examination and OSNA assay and survival outcomes between these two groups.

Patients and Methods: A retrospective review of patients with early breast cancer who underwent SLNB from 2014-2018 was performed. Adjuvant systemic treatments were compared between the two groups using Chi-square statistics. The log-rank test analyzed the survival outcome.

Results: There were 109 and 110 patients in the OSNA and conventional groups, respectively. The OSNA group had a higher proportion of positive SLN than the conventional group (40.4% vs. 18.2%; p = 0.004). A higher percentage of the patients in the OSNA group received doxorubicin/cyclophosphamide followed by paclitaxel (43.9% vs. 23.0%, p = 0.041). A higher proportion of the patients in the OSNA group received HER2-targeted therapy (12.8% vs. 3.6%; p = 0.013). There was no difference in axillary recurrence, disease-free survival, or overall survival.

Conclusion: Utilization of the OSNA technique resulted in a higher proportion of positive SLN and led to the escalation of the chemotherapy regimen. However, the impact on survival outcomes could not be demonstrated. The OSNA technique should be applied in selected patients who require immediate ALND after positive SLNs or need a decision to avoid ALND in cases of limited metastasis in SLNs.

Laparoscopic Surgery for Groin Hernia Repair: Single-Center Experience

2024-09-23T15:56:34+07:00

Background: Inguinal hernia arises from a condition characterized by a weakened abdominal wall. Laparoscopic inguinal hernia surgery is one treatment option. Due to the increasing use of laparoscopic inguinal hernia repair at Srinagarind Hospital, we are interested in studying these patients' side effects and treatment outcomes.

Materials and Methods: A descriptive study collected data between December 2011 and May 2022 at Srinagarind Hospital, Khon Kaen University. The medical records were reviewed, and data was collected. Descriptive statistics were used to analyze the data and report the side effects and treatment outcomes.

Results: A total of 269 patients underwent laparoscopic inguinal hernia repair. Among these patients, 251 were males (93.31%), and 18 were females (6.69%). The median age of the patients was 64 (IQR, 54-71). The most common comorbidities were hypertension (36.43%) and benign prostatic hyperplasia (BPH) (26.32%). The most common diagnosis was indirect inguinal hernia (40.89%). The overall median operative time was 65 minutes (IQR, 55-90). The median blood loss during the procedure was 5 milliliters (IQR, 5-10). The most common complication observed was hematoma, which occurred in approximately 16 cases (5.95%). Infection occurred in two cases (0.74%), and the recurrence rate was 1.49%.

Conclusions: Laparoscopic surgery for inguinal hernia repair was found to be efficient, safe, and comparable to other international studies regarding complications and recurrent rates, with no reported mortality.

The Success Rate and Complications of Central Venous Catheterization for General Surgery Patients in a Tertiary Hospital

2024-08-05T11:30:35+07:00

Objective: Central venous catheterization (CVC) is one of the essential surgical procedures. It can lead to life-threatening complications. This prospective study aimed to evaluate the success rate and complications of central venous catheterization.

Methods: This prospective observational cohort study collected data from patients undergoing central venous catheterization at the General Surgery Department, Rajavithi Hospital, from October 2020 to September 2022. Demographic information, the number of insertion attempts, operator details, success rates, the method used (ultrasound (US)-guided or anatomical landmark), and complications were recorded. Data analysis employed descriptive statistics, chi-square tests, student’s t-tests, and binary logistic regression.

Result: 310 patients were enrolled. The overall success rate for central venous catheter (CVC) insertion was 95.2%. The US-guided method showed a significantly higher success rate compared to the anatomical landmark method (99.3% vs. 91.2%, P = 0.001), with 82.1% catheterized successfully on the first attempt using the US-guidance versus 50.9% with the landmark method (P < 0.001). The overall mechanical complication rate was 4.2%, including arterial puncture (1.6%), hematoma (0.3%), pneumothorax (0.3%), self-limiting arrhythmias (0.6%), and improper catheter placement (1.3%). The CRBSI rate was 7.7%, higher when occurring more than 15 days post-insertion (P < 0.001). Complication rates were significantly lower with the US-guided method compared to the landmark method (0.7% vs. 7.5%, P = 0.003). Procedures performed by 3^rd to 4^th-year residents also had lower complication rates compared to 1^st to 2^nd-year residents (0.3% vs. 3.9%, P = 0.023).

Conclusion: The US-guided catheterization demonstrates a high success rate, fewer attempts, and reduced complication rates. Therefore, its regular use in catheterization procedures is strongly recommended.