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Radiotherapy Role in Rectal Cancer at Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia Jeffri Jeffri; Ferdinand Tjandra; Michael Tendean; Toar Mambu; Enrico Napitupulu
Medical Scope Journal Vol. 4 No. 2 (2023): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v4i2.47630

Abstract: Rectal cancer (RC) remains as a major health burden, being the 3rd most common form of cancer and leading cause of death. RC effects as much as 12.8 per 100 adult population with a mortality rate as high as 9.5%.1 Efforts were made to reduce morbidity and mortality due to rectal cancer. One of them is radiotherapy acting as both neoadjuvant and adjuvant. Thus study aimed to emphasize the role of radioteraphy in treating rectal cancer patients at Prof. Dr. R. D. Kandou General Hospital, Manado. This was a retrospective study using data of all rectal cancer outpatients seeking at Prof. Dr. R. D. Kandou General Hospital, Manado. from 2017-2020 especially of those receiving radiotherapy treatment in radiology department. The results obtained a total 119 patients, 28 of them received radiotherapy based on staging and clinical judgement. From the radiotherapy group, 46.4% patient received neoadjuvant radiotherapy primary to surgical procedure, and among the neoadjuvant group 71.4% received long course radiotherapy. From the neoadjuvant radiotherapy group, 46.4% became resectable and 46.4% among them underwent Miles Procedure. In conclusion, rectal cancer is still a health problem, and radiotherapy as one of the modality play major role as neoadjuvant and adjuvant treatment.

Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP): A Single Centre 5-Year Experience Michael Tendean; Toar D. B. Mambu; Ferdinand Tjandra; Billy Salem; Jimmy Panelewen; Everly Corputty
e-CliniC Vol. 11 No. 3 (2023): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v11i3.46027

Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) and related procedures are established as necessary techniques in the diagnosis and treatment of biliopancreatic diseases. Caution is needed due to the high risk of complications that can be fatal. The main complications are pancreatitis, bleeding, perforation, biliary stents, and lithiasis treatment issues. This study aimed to evaluate the therapeutic ERCP at Prof. Dr. R. D. Kandou Hospital between 2017-2021. This was a retrospective study using patients’ medical record data. The results obtained a total of 196 ERCP procedures performed at Prof. Dr. R. D. Kandou Hospital in that period. Variations of etiology, technical difficulties, and morbidities were recorded. The success rate of endoscopic stone extraction was 77.9 %, EPBD 10.71 %, and stenting for biliary drainage 97.3 %. Etiology varied from bile duct stone (74%); malignancies of the pancreas (8%), duodenum (2%), and periampullary (4%); Klatskin tumor (5.6%); and other malignancies (5%). Associated morbidities were melena 2%, pancreatitis 1%, and cholangitis 0.5%. In conclusion, endoscopic retrograde cholangiopancreatography is a reliable method for the diagnosis and treatment of hepatobiliary and pancreatic diseases, shown by the low incidence of morbidities and mortalities. Keywords: endoscopic retrograde cholangiopancreatography; biliopancreatic diseases

Billiary Tract Obstruction due to Gallbladder Carcinoma at Prof. Dr. R. D. Kandou General Hospital: Two Case Reports Michael Tendean; Toar D. B. Mambu; Leonard A. Melatunan
Medical Scope Journal Vol. 5 No. 2 (2023): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v5i2.46217

Abstract: Gallbladder cancer is the fifth most common gastrointestinal malignancy with a high mortality rate. Detection of gallbladder carcinoma in early stages can be difficult, despite improvements in ultrasound and CT-Scan imaging. It is possible to cure gallbladder cancer surgically at an early stage. We reported two cases of gall bladder carcinoma, 65-year-old and 52-year-old females, with the chief complaints of abdominal pain in the right upper quadrant (RUQ) and obstructive jaundice in both cases. The abdominal CT-scans showed circumferentially irregular focal thickening of gallbladder wall, and severe intra and extrahepatic cholestasis. Endoscopic preoperative biliary drainage using biliary stent was performed in one case. Open cholecystectomy with in toto common bile duct resection and portal lymphadenectomy followed by roux en-y hepaticojejunostomy reconstruction were performed for both cases. Both patients are still well with no cancer recurrences over two-year follow-up. The symptoms of gall bladder cancer were non-specific, and commonly included RUQ abdominal pain, weight loss, anorexia, nausea or vomiting, jaundice, and pruritus. Imaging with ultrasound and CT-Scan had improved preoperative diagnosis of gallbladder cancer. Outcomes of patient with incidental finding of gallbladder cancer had better prognosis since it provided the patient to be staged and managed appropriately with resection. In conclusion, early detection of gallbladder cancer results in better surgical outcome and less patient morbidity and mortality which shows its importance. Keywords: gallbladder carcinoma; early-stage detection; common bile duct resection

Korelasi antara Neutrophil-to-Lymphocyte Ratio dan Kadar Carcinoembryonic Antigen Pra-Pasca Operasi pada Kanker Kolorektal Michael Iskandar; Michael Tendean; Billy Salem; Fredrik G. Langi
Medical Scope Journal Vol. 5 No. 2 (2023): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v5i2.46621

Abstract: Colorectal cancer is the third most common cancer in Indonesia with a mortality rate at fourth rank. A balance between systemic inflammation and immunity is necessary in the stratification of risk, treatment, and prognosis of various cancers. This study aimed to determine the relationship between neutrophil-to lymphocyte ratio (NLR) and carcinoembryonic antigen (CEA) in the survival of post-operative colorectal cancer patients. This was a retrospective hospital-based cohort study using the R statistical analysis tool version 4.2.2. The results obtained 88 colorectal cancer patients with histopathologically confirmed. Most were nearly 60 years old, with a relatively balanced proportion of men and women. The median of resected mass size was around 6 cm, 80% of tumors located in the rectum and rectosigmoid, a balanced proportion of stage II and III (44%), moderate differentiation (86%), with decreased NLR post-operation (median of 3,8 to 2,6), and decrased CEA post-operation (median 8,6 to 6,3). In conclusion, there is a positive correlation between NLR and CEA level, however, it is limited until three months post operation. After three months, the correlation is undetected anymore. Keywords: neutrophil-to-lymphocyte ratio; carcinoembryonic antigen; colorectal cancer; pre and post operation Abstrak: Kanker kolorektal merupakan keganasan ketiga terbanyak di dunia dengan angka mortalitas urutan ke-empat. Keseimbangan antara peradangan sistemik dan imunitas diperlukan dalam stratifikasi risiko, pengobatan, dan prognosis berbagai jenis keganasan. Penelitian ini bertujuan untuk mengetahui hubungan antara neutrophil-to lymphocyte ratio (NLR) dan kadar carcinoembryonic antigen (CEA) pada kesintasan pasien kanker kolorektal pasca operasi. Jenis penelitian ialah kohort retrospektif berbasis rumah sakit dengan alat analisis statistik R versi 4.2.2. Hasil penelitian mendapatkan 88 pasien terkonfirmasi histopatologik kanker kolon rektal, berusia hampir 60 tahun, proporsi laki-laki dan perempuan relatif berimbang, median ukuran masa yang direseksi sekitar 6 cm, 80% tumor terletak di daerah rektum dan rektosigmoid, stadium II dan III presentasi berimbang (44%), diferensiasi sedang (86%), NLR menurun pada pasca operasi (median 3,8 menjadi 2,6), dan CEA menurun pada pasca operasi (median 8,6 menjadi 6,3). Simpulan penelitian ini ialah terdapat hubungan positif antara neutrophil-to-lymphocyte ratio (NLR) dan kadar carcinoembryonic antigen (CEA), tetapi hanya terbatas sampai tiga bulan pasca operasi. Korelasi keduanya tidak terdeteksi lagi setelah tiga bulan pasca operasi. Kata kunci: neutrophil-to-lymphocyte ratio; carcinoembryonic antigen: kanker kolon rektal; pre dan pasca operasi

Validity of Predictive Markers for Post ERCP Pancreatitis Patients: A Single Centre Study Michael Tendean; Toar D. B. Mambu; Leonard A. Melatunan
Medical Scope Journal Vol. 6 No. 2 (2024): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v6i2.51513

Abstract: Endoscopic retrograde cholangiopancreatography (ERCP) is a proprietary procedure, endoscopic modality, and specialized procedure used to diagnose and treat disorders of the pancreatic and biliary systems. The incidence of reported post-ERCP complications varied among several studies including post ERCP pancreatitis (PEP), duodenal perforation, and cholangitis. In this study, the author would like to show certain intra procedural factors related to PEP incidence. This was a retrospective study of secondary data of patients undergoing ERCP procedures from 2017-2022 at Prof. Dr. R. D. Kandou Hospital, Manado. Length of procedure, cannulation on pancreatic duct, pancreatogram, double wire technique, and the use of certain common bile duct (CBD) stone retrieval techniques such as endoscopic papillary balloon dilatation (EPBD) were recorded and analyzed. The results showed that based on the analyzed data, the percentage of pancreas cannulation was 8%, pancreatogram 5%, double-wire technique 3%, and EPBD procedure 10%, Incidence rate of PEP in all ERCP procedures was 19%. Increased amylase/lipase enzymes were found in 13 of 24 patients (54%) who underwent cannulation; 8 of 16 patients (50%) who underwent pancreatogram; 4 of 9 patients (44%) who underwent double wire procedure; and 10 of 30 patients (33%) who underwent EPBD. This PEP could be caused by several risk factors during ERCP including cannulation, pancreatogram, double wire, and EPBD. Number of cannulation attempt could result in trauma to the ampulla. Pancreatogram could result in hydrostatic, chemical, and allergic injury. Any manipulation of the pancreas that caused trauma could trigger the incidence of PEP. Assessment of the occurrence of PEP was based on increases in lipase and amylase enzyme values by four times the normal value and tested 6 hours after procedure. We could reduce the incidence of PEP by providing prophylactic therapy before ERCP. In conclusion, PEP is the most common complication in ERCP procedures and can be risky in patients with high risk factors. In this study, factors that affecting the incidence of PEP are cannulation, pancreatogram, double wire and EPBD. Keywords: endoscopic retrograde cholangiopancreatography; pancreatitis; complications

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