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Comparison of Postoperative Outcomes in Colorectal Cancer Patients Undergoing Enhanced Recovery After Surgery (ERAS) vs Non-ERAS: A Retrospective Study Erdiansyah Reza Lesmana; Ida Bagus Budhi Surya Adnyana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.724

Abstract

Colorectal cancer (CRC) represented a significant global health burden, contributing to approximately 10% of all cancer-related mortality worldwide. While surgery remained the primary treatment for resectable CRC, the postoperative period was often characterized by prolonged recovery and complications. Enhanced Recovery After Surgery (ERAS) protocols emerged as a multimodal approach to mitigate these challenges by attenuating surgical stress, optimizing nutritional status, minimizing opioid consumption, promoting early mobilization, and improving psychological well-being. This study aimed to compare the postoperative outcomes between colorectal cancer patients who underwent surgery with ERAS protocols and those who followed traditional non-ERAS recovery pathways. A retrospective cohort study was conducted at a single academic institution. The study population comprised 201 adult patients who underwent surgical resection for colorectal cancer between January 2020 and December 2024. Patients were categorized into two groups: the ERAS group (n=135), who were managed according to a standardized ERAS protocol, and the non-ERAS group (n=66), who received traditional postoperative care. Statistical analysis involved independent samples t-tests for continuous variables and chi-square tests for categorical variables, with a significance level set at p < 0.05. The ERAS group demonstrated a statistically significant reduction in the mean length of hospital stay compared to the non-ERAS group (7.67 days vs. 8.83 days, p < 0.001). While the ERAS group exhibited slightly higher mean hemoglobin levels postoperatively (11.29 g/dL vs. 11.14 g/dL, p = 0.56), this difference was not statistically significant. Notably, the incidence of postoperative complications was lower in the ERAS group (1 case) compared to the non-ERAS group (4 cases), with a p-value of 0.051, indicating a trend towards significance. In conclusion, the implementation of an ERAS protocol was associated with improved postoperative outcomes in colorectal cancer patients, specifically a significant decrease in the length of hospital stay and a trend towards a lower rate of complications. These findings supported the integration of ERAS pathways into the standard of care for colorectal cancer surgery to enhance patient recovery, potentially reduce healthcare costs, and improve overall patient outcomes.
Intracrine Dynamics of Luminal Breast Cancer: Correlating Intratumoral Estradiol with Estrogen Receptor Alpha Overexpression in an Advanced-Stage Cohort Erdiansyah Reza Lesmana; Widyanti Soewoto; Brian Wasita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1542

Abstract

Background: In postmenopausal breast cancer, systemic serum estradiol levels often fail to reflect the biologically active concentrations within the tumor microenvironment, a phenomenon known as intracrineology. While the roles of estrogen receptor alpha (ERα) and beta (ERβ) are well-characterized, the specific relationship between local ligand concentration and receptor expression in advanced-stage malignancies remains under-investigated. This study investigates the correlation between intratumoral estradiol (E2) concentration and the expression of ER isoforms in Luminal A and Luminal B subtypes. Methods: A retrospective cross-sectional study was conducted on 56 tissue samples (38 Luminal A, 18 Luminal B) from patients at Dr. Moewardi Regional General Hospital, Indonesia. Pre-analytical variables were strictly controlled, ensuring cold ischemia time was less than one hour. Expressions of E2, ERα, and ERβ were quantified using immunohistochemistry and assessed via H-Scores. Due to non-normal data distribution, associations were analyzed using Spearman’s Rho and Generalized Linear Models (GLM) with a Gamma distribution and log-link function, coupled with bootstrapping to generate robust confidence intervals. Results: The cohort was characterized by advanced disease, with 85.7% of patients presenting with Stage III or IV breast cancer. Luminal A tumors exhibited significantly higher mean intratumoral E2 (91.58 versus 56.67; p = 0.038) and ERα expression (122.23 versus 109.72; p = 0.045) compared to Luminal B. A significant positive correlation was observed between tissue E2 and ERα (Rho = 0.347; p = 0.009). GLM analysis confirmed E2 as a significant predictor of ERα expression (p = 0.015), independent of age and stage. No significant correlation was found between E2 and ERβ (p = 0.113). Conclusion: Intratumoral estradiol is a significant positive correlate of ERα expression in luminal breast cancer, supporting the existence of a ligand-driven autocrine maintenance loop even in advanced stages. The lack of correlation with ERβ suggests divergent regulatory mechanisms. These findings reinforce the rationale for therapies targeting local aromatase activity.
Intracrine Dynamics of Luminal Breast Cancer: Correlating Intratumoral Estradiol with Estrogen Receptor Alpha Overexpression in an Advanced-Stage Cohort Erdiansyah Reza Lesmana; Widyanti Soewoto; Brian Wasita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1542

Abstract

Background: In postmenopausal breast cancer, systemic serum estradiol levels often fail to reflect the biologically active concentrations within the tumor microenvironment, a phenomenon known as intracrineology. While the roles of estrogen receptor alpha (ERα) and beta (ERβ) are well-characterized, the specific relationship between local ligand concentration and receptor expression in advanced-stage malignancies remains under-investigated. This study investigates the correlation between intratumoral estradiol (E2) concentration and the expression of ER isoforms in Luminal A and Luminal B subtypes. Methods: A retrospective cross-sectional study was conducted on 56 tissue samples (38 Luminal A, 18 Luminal B) from patients at Dr. Moewardi Regional General Hospital, Indonesia. Pre-analytical variables were strictly controlled, ensuring cold ischemia time was less than one hour. Expressions of E2, ERα, and ERβ were quantified using immunohistochemistry and assessed via H-Scores. Due to non-normal data distribution, associations were analyzed using Spearman’s Rho and Generalized Linear Models (GLM) with a Gamma distribution and log-link function, coupled with bootstrapping to generate robust confidence intervals. Results: The cohort was characterized by advanced disease, with 85.7% of patients presenting with Stage III or IV breast cancer. Luminal A tumors exhibited significantly higher mean intratumoral E2 (91.58 versus 56.67; p = 0.038) and ERα expression (122.23 versus 109.72; p = 0.045) compared to Luminal B. A significant positive correlation was observed between tissue E2 and ERα (Rho = 0.347; p = 0.009). GLM analysis confirmed E2 as a significant predictor of ERα expression (p = 0.015), independent of age and stage. No significant correlation was found between E2 and ERβ (p = 0.113). Conclusion: Intratumoral estradiol is a significant positive correlate of ERα expression in luminal breast cancer, supporting the existence of a ligand-driven autocrine maintenance loop even in advanced stages. The lack of correlation with ERβ suggests divergent regulatory mechanisms. These findings reinforce the rationale for therapies targeting local aromatase activity.