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Hubungan Nilai Carcinoembryonic Antigen dengan Derajat Diferensiasi pada Karsinoma Kolorektal di RSUP Prof. Dr. R. D. Kandou Manado Wesley, John; Mambu, Toar; Sapan, Heber; Sumanti, Winfried M.
Jurnal Biomedik : JBM Vol 10, No 2 (2018): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.10.2.2018.20086

Abstract

Abstract: Colorectal cancer is a serious health problem in Indonesia as well as in North Sulawesi. Serum carcinoembryonic antigen (CEA) is a progmostic factor in patients with this disease. This study was aimed to obtain the correlation between the histopathological differentiation stage and serum CEA level in colorectal cancer patients at Prof. Dr. R. D. Kandou Hospital Manado. This was an analytical correlation study. Subjects were colorectal cancer patients who had preoperative serum CEA level and histopathological differentiation stage results. Data were analyzed with Anova test (variant analysis) and Spearman Rho test. The results showed that there were 58 colorectal cancer patients enrolled in this study. The patients’ data were obtained from the Digestive Surgery clinic and nursery room of Prof. Dr. R. D. Kandou Hospital Manado. Of the 58 patients, 37 (63.79%) had moderate differentiated colorectal cancer. Related to serum CEA level, 23 patients (39.65%) had moderate differentiated colorectal cancer with serum CEA level 20-100 ng/ml. The Spearman Rho test showed that there was a positive correlation between serum CEA level and histopathoplogical differentiation stage of cancer (r = 0.877 and P = 0.001). Conclusion: There was a significant correlation between serum CEA level and histopathological differentiation stage of colorectal cancer. The better the differentiation stage, the higher the serum CEA level.Keywords: carcinoembryonic antigen, colorectal cancer, differentiation stageAbstrak: Karsinoma kolorektal (KKR) telah menjadi masalah kesehatan yang serius di Indonesia dan Sulawesi Utara pada khususnya. Kadar carcinoembryonic antigen (CEA) merupakan salah satu faktor prognostik pada penderita KKR. Penelitian ini bertujuan untuk mengetahui hubungan antara derajat diferensiasi histopatologik dengan kadar CEA dalam serum pada pasien KKR di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ini ialah analitik korelatif. Subyek penelitian ialah 58 pasien KKR yang mempunyai hasil pemeriksaan kadar CEA serum preoperasi dan pemeriksaan derajat diferensiasi histopatologik. Analisis statistik menggunakan uji Anova (analisis variansi) dan korelasi Spearman Rho. Data pasien diambil dari pasien yang datang dan kontrol di Poliklinik Bedah Digestif serta dari ruang perawatan Bedah Digestif RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian memperlihatkan derajat diferensiasi tumor kolorektal terbanyak ialah diferensiasi sedang/moderate differentiated yaitu 37 pasien (63,79%). Bila dihubungkan dengan nilai CEA serum, yang terbanyak ditemukan ialah jenis diferensiasi sedang pada pasien dengan kadar CEA serum 20-100 ng/ml sebanyak 23 orang (39,65%). Uji Spearman Rho memperlihatkan bahwa kadar CEA berkorelasi positif dengan derajat diferensiasi KKR (r = 0,877 dan P = 0,0001). Simpulan: Terdapat korelasi bermakna antara kadar CEA serum dan derajat diferensiasi kanker kolorektal. Derajat diferensiasi KKR yang baik memiliki kadar CEA yang tinggi.Kata kunci: carcinoembryonic antigen, karsinoma kolorektal, derajat differensiasi
Kadar Bilirubin, Alkalin Fosfatase, dan Gamma Glutamil Transpeptidase Serum sebagai Prediktor Batu Duktus Koledokus pada Pasien Batu Empedu Simtomatik Kaunang, Maria; Panelewen, Jimmy; Mambu, Toar
Jurnal Biomedik : JBM Vol 11, No 1 (2019): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.11.1.2019.23209

Abstract

Abstract: Complications of the common bile duct stone occur in 10-15% of patients with gallstones. Bilirubin, alkaline phosphatase (ALP), and gamma glutamyl transpeptidase (GGT) are routine laboratory tests performed on patients with gallstones. This study was aimed to determine whether bilirubin, ALP, and GGT serum could be used as predictors of common bile duct stone in patient with symptomatic gallstone at Prof. Dr. R. D. Kandou Hospital Manado and its satellite hospitals. This was a prospective analytical observational study with a cross sectional design. Subjects were 38 patients with symptomatic gallstone that underwent definitive surgery. The bilirubin, ALP, and GGT serum levels were taken at presentation. Receiver operating character-istic curve analysis was used to determine optimal biochemical cut-off value of each parameter. The results showed that of 38 patients, 22 patients were male and 16 patients were female. The mean ages were 52 years in males and 47 years in females. There were 28 patients proven to have stones in common bile ducts. All parameters were proven to be effective in predicting common bile duct stone, as follows: bilirubin cut-off point was 1.6 U/L with sensitivity of 96.4% and specifity of 90%; ALP cut-off point was 114 U/L with sensitivity of 82.1% and specifity of 90%; and GGT cut-off point was 102.5 U/L with sensitivity of 85.7% and specifity of 90%. Conclusion: Bilirubin, ALP, and GGT serum levels can be used as predictors of common bile duct stone in patient with symptomatic gallstone.Keywords: bilirubin, ALP, GGT, common bile duct stoneAbstrak: Komplikasi batu duktus koledokus terjadi pada 10-15% pasien dengan batu empedu. Bilirubin, alkalin fosfatase (ALP), and gamma glutamil transpeptidase (GGT) merupakan pemerik-saan laboratorium rutin pada pasien dengan batu empedu. Penelitian ini bertujuan untuk menentukan apakah bilirubin, ALP, dan GGT serum dapat dipakai sebagai prediktor batu duktus koledokus pada pasien dengan batu empedu simtomatik di RSUP Prof. Dr. R. D. Kandou Manado dan rumah sakit jejaringnya. Jenis penelitian ialah observasional analitik prospektif dengan desain potong lintang. Pemeriksaan kadar bilirubin, ALP, dan GGT serum dilakukan pada semua subyek saat didiagnosis batu empedu simtomatik. Receiver operating characteristic curve analysis diguna-kan untuk menentukan nilai titik potong biokimia yang optimal dari setiap parameter. Hasil penelitian mendapatkan sebanyak 38 pasien dengan batu empedu simtomatik yang menjalani operasi definitif, terdiri dari 22 pasien laki-laki and 16 pasien perempuan. Rerata usia subyek ialah 52 tahun pada laki-laki dan 47 tahun pada perempuan. Terdapat 28 pasien terbukti dengan batu duktus koledokus. Semua parameter terbukti efektif dalam memrediksi batu doktus koledokus sebagai berikut: titik potong bilirubin serum 1,6 U/L dengan sensitivitas 96,4% and spesifitas 90%; titik potong ALP serum 114 U/L dengan sensitivitas 82,1% dan spesifitas 90%; titik potong GGT serum 102,5 U/L dengan sensitivitas 85,7% dan spesifitas 90%. Simpulan: Kadar bilirubin, ALP, dan GGT serum dapat dipakai sebagai prediktor batu duktus koledokus pada pasien dengan batu empedu simtomatik.Keywords: bilirubin, ALP, GGT, batu duktus koledokus
Penggunaan CONUT Score sebagai Prediktor Komplikasi Pasca Pem-bedahan Kanker Kolorektal di RSUP Prof. Dr. R. D. Kandou Manado Sundah, Hendry; Mambu, Toar; Tjandra, Ferdinand; Sapan, Heber B.; Sumanti, Winfrid M.
Jurnal Biomedik : JBM Vol 11, No 1 (2019): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.11.1.2019.23212

Abstract

Abstract: Nutritional status is one of the factors that influence the metabolic and physiological conditions. Cancer patients, especially colorectal cancer (CRCA), will suffer from decreased nutritional status during their sickness. CONUT score is beneficial to evaluate the nutritional and immunity status of the patients and has been proved to correlate with post operative complications and length of stay. This study was aimed to evaluate the relationship between CONUT score and postoperative complications in CRCA patients. This was an analytical observational study with a cross sectional design. Subjects were 38 patients of CRCA that underwent operation and were admitted at Surgery Inpatients Installation of Prof. Dr. R. D. Kandou Hospital Manado. The result of logistic regression analysis indicated that there was a significant correlation between CONUT score and the risk of complication. The higher the CONUT score, the higher the risk of complication. The determination of complication diagnostic value based on CONUT score was obtained by using ROC curve. The ROC analysis showed that the AUC of CONUT score was 0.977 >0.700 and the cutoff point of CONUT score was 5.5. Patients with CONUT score >5.50 had a tendency to get postoperative complications with the sensitivity of 86.6%, specifity of 95.6%, and accuracy of 94.74%. Conclusion: CONUT score can be used as a screening method to predict the occurence of postoperative complications in CRCA patients.Kata kunci: colorectal cancer, CONUT score, postoperative complicationsAbstrak: Salah satu faktor yang memengaruhi keadaan metabolik dan fisiologik ialah status nutrisi. Penderita kanker terlebih kanker kolorektal (KKR) akan mengalami pengurangan nutrisi selama perjalanan penyakit. CONUT score bermanfaat untuk mengevaluasi status gizi dan imunitas pasien serta terbukti berkolerasi dengan komplikasi serta jumlah hari rawat di rumah sakit pasca pembedahan. Penelitian ini bertujuan untuk mengetahui hubungan CONUT score dengan komplikasi pasca pembedahan KKR. Jenis penelitian ialah analitik obser-vasional dengan desain potong lintang. Subyek penelitian ialah 38 pasien KKR yang menjalani operasi dirawat di Instalasi Rawat Inap Bedah RSUP Prof. Dr. R. D. Kandou Manado. Hasil analisis regresi logistik menyatakan terdapat hubungan yang sangat bermakna antara CONUT score dan kejadian komplikasi. Hubungan ini menyatakan bahwa makin tinggi CONUT score makin besar risiko terjadinya komplikasi. Penentuan nilai diagnostik kom-plikasi berdasarkan CONUT score diperoleh melalui kurva ROC. Berdasarkan analisis ROC diperoleh AUC CONUT score 0,977 >0,700. Hasil analisis ROC memperoleh titik potong CONUT score = 5,5. Pasien dengan CONUT score >5,50 memiliki kecenderungan mengalami komplikasi dengan sensitivitas 86,6%, spesifitas 95,6%, dan nilai akurasi 94,74%. Simpulan: CONUT score dapat digunakan sebagai metode skrining untuk memrediksi terjadinya komplikasi pasca pembedahan kanker kolorektal.Kata kunci: karsinoma kolorektal (KKR), CONUT score, komplikasi pasca pembedahan
Delayed Staged Hepatectomy for Metastatic Colorectal Cancer: A Single Case Report Tendean, Michael; Paparang, Steven; Tjandra, Ferdinand; Mambu, Toar; Panelewen, Jimmy; Salem, Billy
e-CliniC Vol. 13 No. 2 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i2.59701

Abstract

Abstract: Liver metastases are common in patients with colorectal cancer; almost 70% will develop liver metastases during the course. The recommended treatment for colorectal liver metastasis (CRLM) is multidisciplinary, including liver resection and chemotherapy. We reported a 52-year-old female with stage 3B distal third rectal adenocarcinoma which eight months earlier underwent Mile’s procedure plus total mesorectal excision (TME) followed by adjuvant radiotherapy (50gy). During surveillance, liver metastases was found at segments 4B-5. A delayed anatomical staged hepatectomy segments 4B-5 was performed. Intraoperative USG findings suggested liver metastases at segments 7, 8, and 3, and non-anatomical liver resection was performed in accordance with parenchymal liver sparing principles. No post-hepatectomy liver failure (PHLF) was detected, but billoma occured at 1-month post hepatectomy. USG guided percutaneous drainage was performed to resolve the billoma. Colorectal metastasis (CRLM) was detected at six months post-hepatectomy, and the patient underwent adjuvant chemotherapy with improvement in survival rate. In conclusion, delayed staged hepatectomy for CRLM is a safe and beneficial procedure, though there is still no guideline regarding the sequence of resection. Keywords: hepatectomy; colorectal metastasis; billoma; colorectal cancer