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Compliance of Patients with Locally Advanced Colorectal Cancer to Chemotherapy Using FOLFOX compared to XELOX Regimen Kusnadi, Dana S.; Putranto, Agi S.; Saunar, Rofi Y.; Kekalih, Aria; Moenadjat, Yefta
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Adjuvant chemotherapy become the treatment of choice in advance colorectal cancer to prevent recurrence. Studies showed that FOLFOX and XELOX regimen has been proven to increase overall survival rate and disease free survival. This study is aimed to compare XELOX response to FOLFOX regimen in our center, which is characterized by advanced stage neoplasm in the first presentation with low compliance. It also aimed to find out affecting factors of such response. Method. We run a retrospective study enrolled of 133 subjects with colorectal carcinoma of stage III and high–risk stage II who received adjuvant chemotherapy and treated in dr. Cipto Mangunkusumo– and Fatmawati General Hospital. Consecutive sampling was instituted, CEA level and one year mortality rate was recorded as variables of the efficacy, which was then associated with subjects’ compliance. Statistical analysis was done using Chi square or Fisher test, and a multivariate logistic regression. Significance was found as the difference met <0.05 with confidence interval of 95%. Results. We found there is no significant difference between the two regimens with efficacy (p = 0.61). There is significant correlation between the regimen (p = 0.001 and 0.000); with compliance is found much higher in FOLFOX (86% compared to 45%). We also found statistically significant of influencing factors the efficacy, i.e. Karnofsky score >90 (OR = 5.8; p = 0.004), body mass index both of normal and more (OR = 4.7; p = 0.006), and with histopathologic grading of moderate differentiated (OR = 6.3; p = 0.003). Conclusion. FOLFOX and XELOX regimen has been shown to have a same efficacy in response in our center. However, compliance showed a strong correlation to efficacy and FOLFOX regimen showed much higher rather than XELOX. Karnofsky score and body mass index should be subjects of consideration to increase the response of such adjuvant chemotherapy.

Comparison of Japanese Classification with the TNM System in the Assessment of Staging in Sigmoid and Rectal Cancer Patients at dr. Cipto Mangunkusumo and Fatmawati General Hospital: A Preliminary Study Putranto, Agi S.; Kristianto, Yusak; Wangge, Grace
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Lymph node metastasis of colorectal cancer is an independent prognostic factor and used as a guideline for adjuvant therapy. Paralleled to this, TNM staging system has been used widely and nowadays referred to a gold standard of colorectal cancer staging. So far, such a system classifies the staging based on the numbers of positive lymph node involvement. Japanese classification was another kind of system do that categorize based on the distribution of lymph nodes involved (i.e. paracolic/rectal, intermediate, root of mesenteric artery). Method. This was a preliminary study analyzed of 15 subjects with sigmoid and rectal cancer underwent surgery at dr. Cipto Mangunkusumo and Fatmawati General Hospital between September and October 2015. We studied the specimen for histopathological evaluation focused on the numbers of positive lymph nodes and the distribution of lymph node metastasis. Staging was carried out using both of TNM system and Japanese classification, and these variables were subjected to agreement analysis. Results. We found more than twelve lymph nodes from each sample. Based on TNM staging system, there are seven subjects on stage II, three subjects with stage IIIb and five subjects with stage IIIc, meanwhile based on Japanese Classification, there were seven subjects with stage II, one subjects with stage IIIa and seven subjects with stage IIIb. Analysis of agreement between both of classifications resulted in coefficient Kappa of 49.3% (moderate category) with p-value of 0.04. Conclusion. Our preliminary study showed that agreement between both of classifications to specify sigmoid and rectal staging is in moderate category. Japanese classification is feasible to be used. Agreement accuracy may be obtained with a bigger sample.

Clinical Presentation of Abdominal Tuberculosis Putranto, Agi S.; Bakti, Purnama S.; Mazni, Yarman; Jeo, Wifanto S.; Lalisang, Toar JM.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Nowadays, tuberculosis remains an issue of global. It may have affected all gastrointestinal organs, including peritoneum. Thus, diagnostic approach of this abdominal tuberculosis remains challenging as it may present non–specific features and mimics other abdominal pathologies. A study focused on clinical and laboratory findings, imaging and evaluation of management of those diagnosed as abdominal tuberculosis was required. Method. A cross–sectional study proceeded retrospectively aimed for an evaluation. All abdominal tuberculosis managed in dr Cipto Mangunkusumo General Hospital, Jakarta and Fatmawati General Hospital, Jakarta during January 2011 to December 2013 were enrolled. Data collected from data registration, subject’s characteristic, clinical findings, laboratory findings, and imaging were variables subjected to analysis. Results. There were forty–eight subjects recorded. The most symptoms found were abdominal pain (81.25%), abdominal distention (72.9%), fever (68.75%) and weight loss (68.75%). While as most laboratory findings were leukocytosis (52%) and elevated erythrocyte sedimentation rate, ESR (72.9%). And up to 50% subject showed normal chest x–ray while as other showed non–specific features for pulmonary tuberculosis. Conclusion. Clinical presentations showed to be diverse. Laboratory finding, and imaging maybe valuable to diagnose abdominal tuberculosis, although chest x–ray represents non–specific features for pulmonary tuberculosis. Evaluation of these clinical findings and lead to accurate diagnostic approach; which was determine the characteristics associated with abdominal tuberculosis diagnostics value..

Anastomosis in Intestinal Tuberculosis: A Systematic Review Putranto, Agi S.; Muchtar, Stefanny
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. The heterogeneity of manifestations in intestinal tuberculosis requires different approach. One step or two steps surgical procedure referred to the method of choice to reduce morbidity and mortality. The review aimed to find out the indication to perform primary anastomosis in intestinal tuberculosis. Method. A systematic review was conducted in accordance with PRISMA guideline in June 2018. Literature searches were performed through online databases sites (PubMed, EBSCO, and Ovid) using keywords “intestinal tuberculosis” AND “surgery” AND “anastomosis”. Intestinal pathology, surgical procedures, anastomosis leaks, enterocutaneous fistula, and mortality were the variables of outcome have been analyzed. Results. Twelve articles of cohort studies were critically appraised and analyzed. The selection of the surgical procedure depends on condition, extent disease, nutritional status, and surgeon’s preferences. Resection and primary anastomosis are safe in an obstructive lesion with low incidence of enterocutaneous fistula and anastomosis leaks. The two steps procedure is advisable in intra–abdominal sepsis. Conclusion. In subjects without intra–abdominal sepsis, intestinal resection with primary anastomosis as a definitive procedure might be considered in obstructive lesions and in perforated lesions, with low risk to have anastomosis leaks and enterocutaneous fistulas. In contrast, in septic subjects, two steps procedure is advisable.

Intestinal Duplication Management in Adult Patients: A Systematic Review Putranto, Agi S.; Siregar, Sun P.; Satrio, Taufik B.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Gastrointestinal duplication is a rare congenital abnormality found in adults. This intestinal duplication may be associated with complications i.e. perforation, bleeding, obstruction and malignancy. Degeneration to malignancy is a basic consideration to treat a radical surgery, which is preventive. This systematic review aims to provide evidences to evaluate the preventive or conservative surgery in the management. Method. A systematic review conducted according to preferred reporting items for systematic review and meta–analysis protocols (PRISMA). Literature search proceeded on PubMed and ScienceDirect using keywords "malignancy arising from adult duplication gastrointestinal "AND" treatment ". All articles are selected based on inclusion and exclusion criteria. The data evaluated included postoperative complications, recurrence, follow–up and recovery. Results. There were eleven articles – which were case reports – analyzed. These articles reported preventive surgery provide a better outcome than conservative one. Conclusion. Case reports in the study showed that 63% of intestinal duplication were developed to malignancy, requiring preventive surgery (level of evidence IV). However, this should be judge with a careful clinical assessment.

Association Between the Adequacy of Preoperative Antituberculosis Treatment with Abdominal Postoperative Morbidity and Mortality on Tuberculosis Patients El Anshori, Riza; Putranto, Agi S.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. The adequacy of tuberculosis treatment before abdominal surgery is a dilemma faced by surgeons who aims for low risk of morbidity and mortality. In addition, there is no data on morbidity and mortality post abdominal operation on TB patients in RSCM and RS Persahabatan. Therefore, this research aims to show the correlation between the adequacy of preoperative TB treatment and postoperative morbidity (fistula enterocutaneous, obstruction, and surgical site infection) and mortality. Method. This study is a descriptive-analytic cross-sectional study done in Cipto Mangunkusumo Hospital dan Persahabatan Hospital using total sampling method, a total of 59 subjects with TB and had undergone abdominal operation and was admitted from January 2011 to August 2017, that fulfilled the criteria of this study. Bivariate and multivariate analysis using SPSS was done to analyze the correlation between TB treatment adequacy and postoperative morbidity and mortality. Results 46 subjects (78%) did not receive adequate preoperative TB treatment. The morbidity rate in this study is 29 subjects 49.25% with significant correlation with the adequacy of preoperative TB treatment (p = 0.030). From the three morbidities in this study (fistula enterocutaneous, obstruction, surgical site infection), only surgical site infection (SSI) has significant correlation with TB treatment adequacy (p = 0.048). There is no significant correlation with postoperative mortality (p = 0.564). Compared to elective surgery, emergency surgery has higher morbidity (OR = 1.62; 95% CI 0.58 - 4.53) and SSI (OR = 2.02; 95% CI 0.63 - 6.46) incidence. A significant difference in the incidence of SSI between clean and dirty surgery wound was found (p = 0.030). Multivariate analysis showed that both adequacy of antituberculosis treatment and surgery type are independent risk factors for morbidity (p = 0.025). Conclusion: Adequate preoperative TB treatment lowers the postoperative morbidity such as surgical site infection. There is no significant correlation between adequate preoperative TB treatment and mortality, and other morbidities such as fistula enterocutaneous and obstruction. Morbidity and SSI are more likely to happen in emergency surgery than elective surgery. Both adequacy of antituberculosis treatment and surgery type are independent risk factors for morbidity.

Preoperative CA 19-9 Level as Additional Predictor of Pancreatic Head Adenocarcinoma Resectability Pasihulizan, Pasihulizan; Putranto, Agi S.
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Determining eligibility criteria for resection is the basis of pancreatic head adenocarcinoma treatment planning, yet the currently used CT scan only has 80% accuracy as its primary modality. This study aimed to investigate preoperative CA 19-9 level use to help predict resectability of pancreatic head adenocarcinoma. Method. Determining eligibility criteria for resection is the basis of pancreatic head adenocarcinoma treatment planning, yet the currently used CT scan only has 80% accuracy as its primary modality. This study aimed to investigate preoperative CA 19-9 level use to help predict resectability of pancreatic head adenocarcinoma. Results. There were 54 subjects enrolled in the study, with the Mean age of both unresectable and resectable subjects is 53.78±11.13 years. Twenty-nine were assigned as an unresectable group and 25 subjects as a resectable group. We found significant differences in CA 19-9 serum albumin levels and Karnofsky score between the resectable and unresectable groups. The cut-off point for CA 19-9 levels was 140.65 U/mL, with a sensitivity of 82.76% (64.23% -94.15%), specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. Conclusion. CA 19-9 was significantly associated with eligibility criteria for pancreatic head carcinoma resection. CA 19-9 has a good diagnostic value as an additional predictor for resectable pancreatic head carcinoma.

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