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"ABSTRACTPurposeTo classify the shape of the remnant stomach after Billroth-I (B-I) reconstruction and evaluate the relationship between the shape of the remnant stomach and the postoperative clinical outcomes.MethodsOne hundred and ninety-five consecutive patients with gastric cancer underwent distal gastrectomy with B-I reconstruction between May 2006 and October 2014. We retrospectively reviewed their medical records and radiological findings. Finally, the shapes of the remnant stomach of 150 patients were classified as either straight type (type A) or stagnant type (type B). The clinical outcomes were compared with respect to the types of remnant stomach.ResultsThe incidence of anastomotic leakage was significantly higher in the type A group than in the type B group (9.4 vs. 1.5%, p = 0.044). The body weight change ratio after surgery was significantly lower in the type B group than in the type A group [p = 0.0068, two-way repeated measures analysis of variance (ANOVA)], while the serum albumin levels showed marginally significant improvement in the type B group compared with the type A group (p = 0.0542, two-way repeated measures ANOVA).ConclusionThe shape of the remnant stomach after distal gastrectomy with B-I reconstruction might influence the degree of anastomotic leakage and long-term nutritional status."

"ABSTRACTPurpose: Whether or not gastrectomy is feasible for very elderly gastric cancer patients is unclear. This study aimed to clarify the feasibility and safety of surgical treatment for patients in this age group.Method: The study included 55 very elderly patients with resectable gastric cancer who underwent gastrectomy (≥ 85 years of age; very-E group). The surgical outcomes were compared with those of 611 elderly patients (75-84 years old; E group).Results: Female sex, a poor physical and performance status, and a low serum albumin level patients were more frequent in the very-E group than in the E group. Lymphadenectomy was less aggressive in the very-E group than in the E group (P < 0.001). The overall postoperative complication rate was not significantly different between the groups (46 vs 33%; P = 0.073). A multivariate analysis to predict the overall survival identified male sex (hazard ratio 1.75, 95% confidence interval 1.30-2.36), low body mass index (2.19, 1.52-3.16), poor performance status (2.14, 1.60-2.86), low serum albumin level (1.84, 1.37-2.48), and advanced tumor stage (1.71, 1.29-2.27) but not age (1.31, 0.84-2.03) as independent prognostic factors.Conclusion: Chronological age alone is not a contraindicative factor for gastrectomy in very elderly patients."

"Pendahuluan: Enhanced Recovery After Surgery (ERAS) bertujuan untuk menstandardisasi manajemen perioperatif dan meningkatkan luaran klinis. Implementasi ERAS pada total knee replacement (TKR) mengurangi mortalitas, transfusi, komplikasi, dan length of stay (LOS) tanpa mempengaruhi readmisi. Studi ini bertujuan mengevaluasi ERAS pada pasien TKR unilateral di Indonesia.Metode: Penelitian ini menggunakan desain klinis acak tersamar tunggal di RSUPN Dr. Cipto Mangunkusumo dan RS Fatmawati, Jakarta, dengan 55 pasien TKR unilateral berusia 60-70 tahun dengan OA grade III-IV sebagai subjek. Metode analisis data melibatkan SPSS dengan uji normalitas, Chi-square, T tidak berpasangan, dan Mann Whitney untuk menilai efektivitas ERAS dibandingkan dengan protokol konvensional.Hasil: Hasil menunjukkan bahwa protokol ERAS meningkatkan skor Knee Special Score (KSS) (p=0,001, mean difference=4,09) dan Oxford Knee Score (OKS) (p<0,001, mean difference=4,98), serta mengurangi durasi rawat inap (p<0,001, mean difference=-2,15 hari) dan nyeri pascaoperasi (p<0,001, mean difference=-2,01) dibandingkan protokol konvensional. Faktor pre-operatif dan post-operatif seperti usia, komorbiditas, dan mobilisasi dini memberikan pengaruh terhadap durasi lama rawat inap. ERAS efektif menurunkan nyeri pascaoperasi dan meningkatkan skor KSS serta OKS. Integrasi edukasi praoperatif, manajemen nyeri, mobilisasi dini, dan perawatan perioperatif komprehensif meningkatkan hasil fungsional.Kesimpulan: Program ERAS secara signifikan memperbaiki skor KSS, OKS, mengurangi durasi rawat inap, dan menurunkan nyeri pascaoperasi pada pasien TKR unilateral dibandingkan protokol konvensional.

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Introduction: Enhanced Recovery After Surgery (ERAS) aims to standardize perioperative management and improve clinical outcomes. ERAS implementation in total knee replacement (TKR) reduces mortality, transfusions, complications, and length of stay (LOS) without affecting readmissions. This study aims to evaluate ERAS in unilateral TKR patients in Indonesia.

Methods: This study utilized a single-blind randomized clinical trial design at RSUPN Dr. Cipto Mangunkusumo and RS Fatmawati, Jakarta, involving 55 unilateral TKR patients aged 60-70 years with grade III-IV OA. Data analysis methods included SPSS, normality tests, Chi-square, independent T-tests, and Mann Whitney tests to evaluate the effectiveness of ERAS compared to conventional protocols.

Result: The results show that the ERAS protocol improves Knee Society Score (KSS) (p=0.001, mean difference=4.09) and Oxford Knee Score (OKS) (p<0.001, mean difference=4.98) scores, reduces length of stay (p<0.001, mean difference=-2.15 days), and decreases postoperative pain (p<0.001, mean difference=-2.01) compared to conventional protocols.

Discussion: Pre-operative and post-operative factors such as age, comorbidities, and early mobilization influence the length of stay. ERAS effectively reduces postoperative pain and improves KSS and OKS scores. Integrating preoperative education, pain management, early mobilization, and comprehensive perioperative care enhances functional outcomes.

Conclusion: The ERAS program significantly improves KSS, OKS scores, reduces length of stay, and decreases postoperative pain in unilateral TKR patients compared to conventional protocols."

"Penanganan cedera Anterior Cruciate Ligament (ACL) berupa operasi rekonstruksidengan mengambil graft tendon pada tubuh pasien sendiri sebagai pengganti ACL.Peroneus Longus Tendon graft merupakan alternatif graft untuk meminimalisirkomplikasi yang berkaitan dengan penggunaan graft dari area sekitar lutut.Peroneus Longus tendon graft dikatakan memiliki komplikasi pada donor siteantara lain instabilitas ankle serta menurunnya kekuatan fleksi 1st ray dan eversiankle. Penelitian ini mencari perbedaan terkait dengan komplikasi donor sitedengan membandingkan tehnik pengambilan graft dengan dan tanpa penjahitanpada distal stump Peroneus Longus tendon terhadap peroneus brevis tendon.Penelitian ini adalah studi yang mencari hubungan antar variabel dengan desainrandomized controlled trial untuk mengetahui luaran fungsional secara subyektifdan obyektif. Rata-rata usia subyek adalah 26.08 ± 2.4 tahun. Dari 13 subjek, 11laki-laki dan 2 perempuan. Pada kelompok penjahitan didapatkan rerata deltakekuatan otot pre operasi terhadap 6 bulan pasca operasi 0.88±0.22 kg, sedangkanpada kelompok tanpa penjahitan adalah 0.67 (0.33-6) kg. Pada kelompok denganpenjahitan didapatkan rerata Clarke’s angle pasca operasi 6 bulan 39.67± 1.28derajat dan pada kelompok tanpa penjahitan distal stump adalah 39.5± 1.50 derajat.Pada pengukuran subyektif The American Orthopedic Foot and Ankle Score(AOFAS), dan visual analogue scale foot and ankle (VAS-FA), kelompok denganpenjahitan lebih superior daripada tanpa penjahitan dalam hal kenyamanan pasien.Pengambilan graft peroneus longus baik dengan dan tanpa penjahitan distal stumptidak menurunkan kekuatan otot plantarfleksi dan tidak menyebabkan perubahanbentuk arch kaki. Penjahitan distal stump saat pengambilan graft peroneus longusmengurangi kemungkinan komplikasi nyeri baik pada 3 bulan dan 6 bulan pascaoperasi.

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Anterior Cruciate Ligament (ACL) rupture treatment is a reconstructive surgery by

taking a tendon graft on the patient's own body as a substitute for ACL. Peroneus

Longus Tendon graft is an alternative graft to minimize complications related to

the use of graft from the area around the knee. Peroneus Longus tendon graft is

said to have complications at donor sites including ankle instability and decreased

flexion strength of 1st ray and ankle eversion. This study looked for differences

related to donor site complications by comparing graft harvest techniques with and

without suturing of the Peroneus Longus tendon distal stump to the peroneus brevis

tendon. This study is a study that looks for relationships between variables with

randomized controlled trial designs to find out functional outcomes subjectively

and objectively. The mean age of the subjects was 26.08 ± 2.4 years. Of the 13

subjects, 11 were male and 2 were female. In the suturing group, the mean preoperative

delta muscle strength of 6 months postoperatively was 0.88 ± 0.22 kg,

whereas in the group without suturing it was 0.67 (0.33-6) kg. In the group with

suturing, the mean Clarke’s angle postoperatively was obtained 6 months 39.67 ±

1.28 degrees and in the group without distal stump suturing was 39.5 ± 1.50

degrees. In the subjective measurements of The American Orthopedic Foot and

Ankle Score (AOFAS), and visual analogue scale foot and ankle (VAS-FA), group

with suturing are superior to those without suturing in terms of patient comfort.

Peroneus longus graft harvesting both with and without distal stump suturing does

not decrease plantarflexion muscle strength and does not cause changes in foot

arch. Distal stump suturing reduces the"

"ABSTRACTPurpose: Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional treatment due to the possibility of lymph node metastasis. The aim of this study was to elucidate the clinical outcomes of these additional treatments.Methods: The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy and 31 received chemoradiotherapy (CRT).Results: The median follow-up periods were 45 months in the esophagectomy group and 41 months in the CRT group. The overall survival did not differ significantly between the groups (P = 0.46). However, there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence due to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, six patients; CRT group, ten patients), none in the esophagectomy group had recurrence, whereas four in the CRT group died of esophageal cancer (P = 0.031).Conclusion: The overall survival did not differ significantly between the groups. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion."

"Pendahuluan: Osteosarkoma adalah tumor tulang ganas primer pada anak-anak dan remaja. Penelitian ini bertujuan untuk membandingkan hasil dan kelangsungan hidup pada pasien osteosarkoma pasca operasi di RSCM Jakarta dari tahun 2010 hingga 2022 dan faktor-faktor yang mempengaruhinya.Metode: Penelitian ini merupakan penelitian kohort retrospektif dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Subjek adalah pasien osteosarkoma femoralis distal yang menjalani disartikulasi pinggul atau amputasi transfemoral pada 2010-2020. Data yang dikumpulkan dan dianalisis meliputi karakteristik pasien, kelangsungan hidup, metastasis dan skor MSTS.Hasil: Jumlah subjek penelitian adalah 42. Subjek amputasi transfemoral lebih tua dibandingkan disartikulasi pinggul (p=0,048). Insiden metastasis lebih banyak pada amputasi dibandingkan dengan disartikulasi pinggul (p=0,001). Subjek disartikulasi pinggul memiliki diameter tumor yang jauh lebih besar daripada subjek amputasi transfemoral (p=0,031).Pembahasan: Hubungan yang signifikan antara diameter tumor dan kelangsungan hidup terjadi karena diameter tumor terkait dengan kejadian metastasis  dan kejadian metastasis terkait dengan kelangsungan hidup. Tidak ada perbedaan yang signifikan antara skor MSTS dan jenis amputasi karena kedua kelompok subjek menggunakan kruk, faktor sosial ekonomi untuk membuat prostesis, dan kesulitan dalam mencapai ukuran tunggul yang ideal dalam kasus tumor.Kesimpulan: Ada hubungan yang signifikan antara diameter tumor dan metastasis dengan kelangsungan hidup dan diameter tumor dengan metastasis.

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Pendahuluan: Osteosarkoma adalah tumor tulang ganas primer pada anak-anak dan remaja. Penelitian ini bertujuan untuk membandingkan hasil dan kelangsungan hidup pada pasien osteosarkoma pasca operasi di RSCM Jakarta dari tahun 2010 hingga 2022 dan faktor-faktor yang mempengaruhinya.

Metode: Penelitian ini merupakan penelitian kohort retrospektif dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Subjek adalah pasien osteosarkoma femoralis distal yang menjalani disartikulasi pinggul atau amputasi transfemoral pada 2010-2020. Data yang dikumpulkan dan dianalisis meliputi karakteristik pasien, kelangsungan hidup, metastasis dan skor MSTS.

Hasil: Jumlah subjek penelitian adalah 42. Subjek amputasi transfemoral lebih tua dibandingkan disartikulasi pinggul (p=0,048). Insiden metastasis lebih banyak pada amputasi dibandingkan dengan disartikulasi pinggul (p=0,001). Subjek disartikulasi pinggul memiliki diameter tumor yang jauh lebih besar daripada subjek amputasi transfemoral (p=0,031).

Pembahasan: Hubungan yang signifikan antara diameter tumor dan kelangsungan hidup terjadi karena diameter tumor terkait dengan kejadian metastasis dan kejadian metastasis terkait dengan kelangsungan hidup. Tidak ada perbedaan yang signifikan antara skor MSTS dan jenis amputasi karena kedua kelompok subjek menggunakan kruk, faktor sosial ekonomi untuk membuat prostesis, dan kesulitan dalam mencapai ukuran tunggul yang ideal dalam kasus tumor.

Kesimpulan: Ada hubungan yang signifikan antara diameter tumor dan metastasis dengan kelangsungan hidup dan diameter tumor dengan metastasis."

"PURPOSES: The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis.METHODS: Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n = 10) and a non-comorbidity group (n = 83).RESULTS: There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P = 0.629), conversion rate (P = 0.114), or intraoperative blood loss (P = 0.147) between the comorbidity and non-comorbidity groups.CONCLUSION: Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery."