Journal of the Association of General Surgeons of Thailand under the Royal of Patronage of HM the King

Factor associated with prolong drain insertion time in breast cancer patients underwent surgery at Lamphun hospital

Sasiwimol Tepjuk — 2025-02-28

Background: Breast cancer remains the most common malignancy in female patients, with surgical intervention being the primary treatment approach. One of the most common postoperative complications is the formation of seroma underneath the surgical incision. The standard management for seroma following modified radical mastectomy (MRM) or mastectomy typically involves the placement of subcutaneous closed-suction drainage. However, the optimal timing for drainage placement and the appropriate duration of drainage remains uncertain. We observed that some patients had their closed-suction drains removed earlier, leading to a shorter hospital stay compared to others. Therefore, this study aims to identify risk factors associated with prolonged indwelling of closed-suction drains after breast cancer surgery at Lamphun Hospital.

Method: This retrospective cohort study entailed a total of 301 female patients, aged 20 years or older, who had a medical record of receiving breast cancer surgery in Lamphun Hospital from January 2019 to December 2023. Patients were divided into two groups: the "standard drainage" group, where drainage catheters were removed within 6 days, and the "prolonged drainage" group, where catheters remained in place for more than 6 days. Binary logistic regression analysis was performed to elicit risk factors associated with prolonged drainage.

Results: Among 301 female breast cancer patients who underwent surgery at Lamphun Hospital, the mean age was 59.4 ± 10.4 years, and their average BMI was 24.1 ± 4.4 kg/m². The most common comorbidities were hypertension, dyslipidemia, and diabetes mellitus, in the order of prevalence. Most patients had stage IIA breast cancer, and 98.6% of all patients underwent modified radical mastectomy (MRM). Of the 301 patients, 179 (59.5%) were in the prolonged drainage group. Statistically significant risk factors for prolonged drainage included: BMI (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] = 1.20–4.90, p = 0.014), the number of axillary lymph nodes removed (aOR 1.30, 95% CI = 1.02–1.68, p = 0.033), and the 48-hour postoperative drain output (aOR 1.12, 95% CI = 1.07–1.18, p < 0.001).

Conclusions: Prolonged drainage was significantly associated with higher BMI, a greater number of axillary lymph nodes removed, and greater 48-hour postoperative drain output. These findings may help guide postoperative care for patients at higher risk of requiring prolonged drainage.

Keywords: Breast cancer, close suction drainage, duration of postoperative surgical drain, seroma

Comparison of Postoperative intravenous painkiller usage and Hospital length Between Early and Delayed Open Appendectomy

potchara saechua — 2025-04-08

The comparison of early appendectomy versus delayed appendectomy reveals no significant differences in overall postoperative complications. Nevertheless, variations in postoperative pain and recovery duration are observed across individual cases. The present study aims to compare the frequency of intravenous painkiller usage, and the length of postoperative hospitalization between patients undergoing appendectomy within eight hours versus those appendectomy after eight hours following hospital admission. The cross-sectional study included 486 total appendectomies at Pattani Hospital between July 2022 and July 2024.

Results showed, for cases of uncomplicated appendicitis, there was no difference in postoperative intravenous painkiller usage between appendectomies performed within 8 hours of hospital admission and those performed after 8 hours (0.8 and 0.8 times/case; p=0.907). However, for complicated appendicitis, appendectomies within 8 hours were significantly less postoperative intravenous painkiller usage compared to those performed after 8 hours (1.4 and 2.5 times/case; p=0.020). Meanwhile, the length of hospital stay after appendectomy were not different between early and delayed appendectomy for both uncomplicated and complicated appendicitis groups.

Conclusions: Performing an appendectomy for acute appendicitis beyond eight hours after hospital admission does not prolong the postoperative hospital stay. However, appendectomy within eight hours of the hospital arrival can reduce the need for postoperative analgesics. The decision to proceed with surgical intervention remains dependent on the patient’s informed consent, the time of the patient’s arrival, and the urgency of accessing emergency operating facilities outside regular working hours, all of which vary according to the specific context of each hospital.

Clinicopathological finding and prognosis in bilateral breast cancer: Nakhonphanom hospital

Natawan Hunpayon — 2025-04-20

Background and objectives: The incidence of bilateral breast cancer is 2-12% of patients with breast cancer. This study aimed to study and compare cliniopathological finding, associated factor, previous treatment and prognosis of patients with bilateral breast cancer, both of synchronous and metachronous bilateral breast cancer (SBBC and MBBC) who visited Nakhonphanom hospital.

Material and methods: This study was a single center, retrospective descriptive study. Data was collected from medical records. 32 patients with bilateral breast cancer. (24 MBBC and 8 SBBC) who visited at Nakhonphanom hospital between 1^st October 2014 – 30^thSeptember 2024 were selected from the database. A total of 196 patients with unilateral breast cancer were selected as the control group. Data was analyzed by statistical distribution, frequency, mean and standard deviation (SD). The continuous data was tested for normal distribution. Quantitative variables were compared mean among two groups by Independent t-test and compared the mean more than two groups using one-way ANOVA test. Nominal categorical data was compared proportion using Fisher’s exact test. The statistically significant variance was p-value < 0.05.

Result: The incidence of bilateral breast cancer in Nakhonphanom hospital is 4.15%. Diagnosis breast cancer at premenopausal period is associated risk of bilateral breast cancer, significantly (p=0.003), especially SBBC. (p=0.008) ER negative and PR negative of the first cancer are associated factors of bilateral breast cancer, significantly. (p<0.001, p=0.047) The interval between diagnosis the first and the second cancer in MBBC ranged 7-216 months. Patients who were lost to follow up had poor prognosis.

Conclusion: Associated factors of bilateral breast cancer are diagnosis breast cancer in premenopausal period and ER/PR negative. Breast cancer patients should be followed up and surveillance to prevent and aware breast cancer in contra lateral breast.