Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
ABSTRACT
Purpose: To establish if the number of pancreatic acinar cells at the pancreatic cut end is a predictor of postoperative pancreatic fistula (POPF). Methods: The number of acinar cells was assessed histologically in 121 consecutive patients who underwent pancreaticoduodenectomy (PD) between April, 2012 and July, 2016. Results: POPF developed in 23 of the 121 patients. Univariate analysis revealed that male sex, long operating time, high volume of blood loss, soft remnant pancreas, large pancreatic duct, and the number of pancreatic acinar cells were significantly associated with POPF. Multivariate analysis revealed that male sex (p = 0.022) and the number of pancreatic acinar cells (p < 0.0001) were independently associated with POPF. In the receiver operating characteristic (ROC) curve analysis, the area under curve was 0.83895 when the cut off value of the number of pancreatic acinar cells to predict POPF was 890. Sensitivity and specificity of the number of pancreatic acinar cells were 82.6 and 77.6%, respectively. Conclusions: A large number of pancreatic acinar cells at the cut end of the stump is predictive of POPF after PD. Although POPF is associated with multiple factors and the number of acinar cells is only one of these, our study is the first to confirm this common intuition of surgeons, which has not been assessed definitively before.

Abstrak :
Latar belakang: Keganasan pankreas merupakan salah satu penyebab morbiditas dan mortalitas signifikan di dunia dengan 90% kasus adalah adenokarsinoma yang umumnya terdiagnosis stadium lanjut karena tidak memiliki gejala klinis spesifik dan keterbatasan dalam menegakkan diagnosis. Adenokarsinoma pankreas disebabkan oleh perubahan histologik dari neoplasma intraepitelial pankreas (PanIN) dan mutasi genetik antara lain aktivasi onkogen KRAS serta inaktivasi gen supresor tumor seperti CDKN2A/p16, p53, BRCA2 dan Small Mothers Against Decapentaplegic 4 (SMAD4) atau disebut juga Deleted in Pancreatic Cancer, locus 4 (DPC4). Mutasi DPC4 ditemukan pada 55% kasus dan relatif spesifik pada adenokarsinoma pankreas. Penelitian ini dilakukan untuk menilai ekspresi DPC4 pada adenokarsinoma pankreas dengan sampel fine-needle aspiration biopsy (FNAB) dengan tujuan meningkatkan akurasi diagnosis. Bahan dan cara: Penelitian ini menggunakan desain potong lintang. Sampel diambil dari data arsip Departemen Patologi Anatomik FKUI/RSCM terdiri atas kelompok data berpasangan dengan 9 kasus adenokarsinoma dan 5 kasus nonadenokarsinoma dari Januari 2012-Agustus 2018 serta kelompok data tidak berpasangan dengan 10 kasus adenokarsinoma dari Januari 2017-Agustus 2018. Dilakukan pulasan DPC4 pada sampel sitologi dan histopatologik. Penilaian mengunakan persentase cut off positif >50% sel tumor. Hasil: Ekspresi DPC4 negatif didapatkan pada 5 kasus adenokarsinoma dan 0 kasus nonadenokarsinoma data berpasangan, serta 5 kasus adenokarsinoma data tidak berpasangan. Uji Fisher s exact yang dilakukan mendapatkan hasil ekspresi DPC4 pada adenokarsinoma dan nonadenokarsinoma data berpasangan tidak berbeda bermakna dengan nilai p>0.05. Kesimpulan: Tidak didapatkan perbedaan yang bermakna antara ekspresi DPC4 pada adenokarsinoma dan nonadenokarsinoma. ......Background: Pancreatic malignancy is one of the causes of significant morbidity and mortality in the world with 90% of cases were adenocarcinomas which are generally diagnosed in advanced stages because there is no specific clinical symptom and limitation in making a diagnosis. Pancreatic adenocarcinoma is caused by histological changes of intraepithelial pancreatic neoplasms (PanIN) and genetic mutations including activation of KRAS oncogenes and inactivation of tumor suppressor genes such as CDKN2A/p16, p53, BRCA2 and Small Mothers Against Decapentaplegic 4 (SMAD4) or also called Deleted in Pancreatic Cancer, locus 4 (DPC4). DPC4 mutations is found in 55% of cases and relatively specific in pancreatic adenocarcinoma. This study was conducted to assess the expression of DPC4 in pancreatic adenocarcinoma using a fine-needle aspiration biopsy (FNAB) sample to increase diagnosis accuracy. Materials and methods: This was a cross-sectional study. Samples were taken from archival data of the Anatomical Pathology Department of FKUI/RSCM consisting of paired data group with 9 cases of adenocarcinoma and 5 cases of nonadenocarcinoma from January 2012 to August 2018 and unpaired data group with 10 cases of adenocarcinoma from January 2017 to August 2018. All cytology and histopathologic samples were stained with DPC4 antibody and evaluated using a positive cut-off> 50% of tumor cells. Results: Negative DPC4 expression was found in 5 cases of adenocarcinoma and 0 cases of nonadenocarcinoma in paired data group, and 5 cases of unpaired data group adenocarcinoma. The Fisher s exact showed no significant difference of DPC4 expression between adenocarcinoma and nonadenocarcinoma paired data group with p value> 0.05. Conclusion: There was no significant difference in the expression of DPC4 between adenocarcinoma and nonadenocarcinoma.

Abstrak :
Background: One of the causes of chronic diarrhea is pancreatic exocrine insufficiency. Chronic diarrhea cases are commonly encountered in Indonesia. Materials & Methods: All patients with chronic diarrhea at hospitals in Jakarta were included in this study and dyspeptic patients were used as control subjects. The study and control subjects must submit their stool for fecal pancreatic elastase-1 examination at a private laboratory in Jakarta. Mild/moderate pancreatic exocrine insufficiency was defined if the concentration was between 100 - 200 [ig El/g stool. Severe pancreatic exocrine insufficiency was defined if the concentration was below 100 [ig El/g stool. The data was analyzed using Fisher or Kruskal-Wallis tests. Results: There were 32 chronic diarrhea patients with a male to female ratio of 19/13 (59.38%/40.62%). The most frequent age range was 50-59 years old (39.5%). The characteristics (sex, age and race) of chronic diarrhea patients were matched with the characteristics of dyspeptic patients as control subjects (p > 0.05). The fecal elastase-1 results in chronic diarrhea displayed greater pancreatic exocrine insufficiency (< 200 fig El/g stool) than in dyspepsia (control) (>_ 200 fj,g El/g stool, p < 0.001). The mean fecal elastase-1 result in chronic diarrhea and in dyspepsia were 316.29 ±_ 195.44 vs. 475.93 +. 65.33 fig El/g stool (p < 0.001). Six patients (18.74%) were established as having severe pancreatic exocrine insufficiency. Seven patients (21.88%) were found with mild/moderate pancreatic exocrine insufficiency. Conclusion: Pancreatic exocrine insufficiency was found frequently in chronic diarrhea.

Abstrak :
PURPOSES: Pancreatic fistula (PF) is a challenging complication of pancreaticoduodenectomy (PD). Soft pancreas is reported as a risk factor for PF; however, palpation by the surgeon is not an objective method of evaluating pancreatic texture. We conducted this study to investigate whether a texture analyzer called a Tensipresser can be used to quantify pancreatic tissue hardness and predict the development of postoperative PF.

METHODS: We assessed pancreatic texture in 85 patients who underwent PD. After surgeons assessed the texture of the pancreas subjectively, the physical properties were measured on the pancreatic margin intraoperatively, by the two-bite method using the Tensipresser. The incidence and severity of PF were based on the definitions of the International Study Group on Pancreatic Fistula.

RESULTS: Symptomatic PF (grade B and C) developed in 16% of the patients. Patients were divided into two groups based on the Tensipresser measurement: those with a soft and fragile pancreas with hardness < 2070 gw/cm2 and cohesiveness < 0.65 (SF group); and all other patients (non-SF group). In the univariate and multivariate analysis, a small pancreatic duct diameter (<4 mm), no conduction of preoperative chemoradiation therapy, and inclusion in the SF group were significant predictors of PF.

CONCLUSION: The Tensipresser can evaluate pancreatic texture objectively, helping to define intraoperatively, those at risk of the development of PF.

Abstrak :
Latar Belakang: Kanker pankreas adalah penyebab kematian keempat yang berhubungan dengan keganasan di Amerika Serikat, dan diperkirakan akan menjadi penyebab kematian kedua di tahun 2030 di United Kingdom. Indonesia belum memiliki data kesintasan kanker pankreas dan faktor-faktor yang memengaruhinya.Tujuan: Mengetahui kesintasan 1 tahun kanker pankreas dan faktor- faktor yang memengaruhinya di RS dr. Cipto Mangunkusumo, Jakarta.Metode: Dilakukan penelitian kohort retrospektif menggunakan data dari rekam medis pasien kanker pankreas RS dr. Cipto Mangunkusumo antara Januari 2012 - Desember 2016. Faktor umur, jenis kelamin, metastasis, stadium, komorbid dan pengobatan dianalisis secara bivariat dan multivariat menggunakan Cox Proportional Hazards Regression untuk mendapatkan Hazard Ratio HR setiap faktor prognosis. Kesintasan kumulatif 1 tahun setelah diagnosis dinyatakan dengan kurva Kaplan- Meier.Hasil: Dari 83 subyek penelitian proporsi laki-laki adalah 62.7, usia ge; 50 tahun 68,7, dengan rentang usia 33-79 tahun, dan rata-rata 55 tahun. Pada analisis bivariat didapati hubungan bermakna secara statistik kesintasan dengan variabel komorbid HR 2,116 IK 95 1,335-3,513 p< 0,002, metastasis HR 3,802 IK 95 1,995-7,249 p ......Background Pancreatic cancer is the fourth leading cause of death associated with malignancy in the United States, and is thought to be the second leading cause of death in 2030 in the United Kingdom. Currently, Indonesia has no data on the survival of pancreatic cancer and the factors that affect it. Aim This study aims to know the 1 year survival of pancreatic cancer and its influencing factors. Methods A retrospective cohort study was performed using data from the medical record of pancreatic cancer patients in dr Cipto Mangunkusumo General Hospital, Jakarta, from January 2012 to December 2016. Age, sex, metastasis, stage, comorbidities, and treatment were analyzed bivariate and multivariate using Cox Proportional Hazards Regression to obtain Hazard Ratio HR for each prognostic factor. The 1 year cumulative survival rate after diagnosis is expressed by the Kaplan Meier Curve.Results Of 83 subjects, the proportion of male was 62,7, age ge 50 years 68,7, with age range 33 79 years, and 55 years on average. In bivariate analysis, there was a statistically significant relationship of survival with comorbidities HR 2.116 95 CI 1.335 3.513 p 0.002, metastasis HR 3.802 95 CI 1.995 7.249 p 0.001, palliative treatment HR 2.108 95 CI 1.077 4.125 p 0.029 and group without treatment HR 2.924 95 CI 1.496 5.716 p 0.002. Multivariate analysis showed that metastasis provided the greatest risk of death with HR 4.306 95 CI 2.125 8.724 p 0.001. Palliative group HR was 2.510 95 CI 1.245 5.061 p 0.010 while the group without treatment gave HR 2.535 95 CI 1.277 5.032 p 0.008. Conclusion The overall survival of 1 year of pancreatic cancer patients was 14, with median survival of 6 months. The presence of metastasis and the decision not to do curative therapy Whipple surgery in patients with pancreatic cancer in dr Cipto Mangunkusumo General Hospital are the primary factors that negatively affect the 1 year survival rate.

Abstrak :
ABSTRAK
Latar Belakang dan tujuan: Karsinoma pankreas merupakan keganasan gastrointestinal kedua terbanyak dan merupakan salah satu tumor dengan angka kematian tinggi. Operasi reseksi merupakan satu-satunya terapi kuratif. Kegagalan dalam evaluasi preoperatif dari menyebabkan resiko operasi, terlambatnya pasien mendapat terapi paliatif serta meningkatkan biaya pengobatan. Penelitian ini bertujuan untuk mengevaluasi penilaian resektabilitas karsinoma pankreas pada CT-scan abdomen dibandingkan penemuan operasi serta faktor-faktor yang mempengaruhinya. Metode: Dilakukan pembacaan ulang CT scan pasien karsinoma pankreas pada sistem PACS Departemen Radiologi RSCM dan dibandingkan dengan laporan operasi pada rekam medis. Hasil: Uji statistik McNemar dari hubungan CT-scan dan operasi n=21 menunjukan p > 0,99, dengan nilai R = 0,52 p = 0,017 . Uji McNemar dari hubungan kesesuaian gambaran CT-scan abdomen dan penemuan operasi dengan teknik pemeriksaan CT-scan p > 0,05.Uji McNemar hubungan kesesuaian gambaran CT-scan abdomen dan penemuan operasi dengan interval CT-scan dan operasi p > 0,99. Uji McNemar hubungan kesesuaian gambaran CT-scan abdomen dan penemuan operasi dengan lama sakit p > 0,05. Kesimpulan: Terdapat kesesuaian antara gambaran CT-scan abdomen dengan penemuan saat operasi terhadap keterlibatan vaskuler pada karsinoma pankreas. Lama sakit, interval CT-scan dan operasi serta teknik pemeriksaan CT-scan memperlihatkan kecenderungan tidak berhubungan.Kata Kunci: CT-scan abdomen; karsinoma pankreas; laparatomi; resektabilitas ABSTRACT
Background and Objective : Pancreatic carcinoma is malignancy in gastrointestinal with high mortality. Surgery is the only curative therapy. Failure evaluation prior to surgery leads to the risk of non-curative surgery, delayed palliative and increased treatment costs. This study aims to evaluate the resectability assessment of pancreatic carcinoma in preoperatif CT-scan compared to surgical findings and the factors that influence it. Methods : Patients with pancreatic carcinoma whose CT scans were in the PACS system of the Radiology Department RSCM reevaluated and compared with surgical reports. Results : McNemar 39;s analysis of the preoperative CT-scan and surgical findings n=21 p>0.99, with R=0.52 p=0.017 . The McNemar analysis conformity relationship between preoperative abdominal CT scan and surgical findings with CT-scan technique p>0.05. McNemar analysis conformity relationship between preoperative abdominal CT-scan and surgical findings with CT-scan interval and surgery p> ?? ??0.99. McNemar analysis conformity relationship between preoperative abdominal CT-scan and surgical findings with prolonged illness p> ?? ??0.05. Conclusion : There is a suitability between preoperative abdominal CT-scan and the surgical findings of vascular involvement in pancreatic carcinoma. Length of prolonged illness, interval between CT-scan and surgery as well as CT-scan technique showed a tendency not to correlate.

Abstrak :
Pendahuluan: Pembedahan merupakan pilihan tatalaksana kuratif terbaik kanker pancreas, oleh karena itu sangat penting untuk dapat menegakkan diagnosis secara akurat sejak awal. Skor BACAP dan CA 19-9 telah diterima sebagai prediktor resektabilitas kanker pancreas yang cukup baik, dan akurasinya diharapkan akan meningkat apabila keduanya dikombinasikan. Studi ini bertujuan untuk mengetahui keluaran yang dihasilkan oleh kombinasi skor BACAP dan penanda tumor CA 19-9. Metode: Penelitian potong lintang retrospektif ini melibatkan pasien kanker pankreas yang telah menjalani operasi di RSUPN Dr. Cipto Mangunkusumo Indonesia pada periode Januari 2017 hingga April 2023. Data diperoleh dari medical record. Pasien dengan penyakit penyerta seperti jaundice karena obstruksi batu bilier, pankreatitis, sirosis hati, kelainan paru dan pasien dengan neoadjuvant akan diekslusi. Nilai  CA 19-9 diperoleh melalui pemeriksaan Chemiluminescent Immunoassay, titik potong 140,6 dipilih berdasarkan penelitian sebelumnya di RSCM. Nilai skor BACAP melibatkan enam variabel klinis dan radiologis dan dapat diperoleh dengan mengaplikasikan kalkulator yang terdapat pada http://jdlp.fr/resectability/. Hasil: Total 87 pasien yang dilibatkan pada penelitian ini didapatkan keluaran skor BACAP yaitu sensitivitas sebesar 50,0%, spesifisitas 100%; PPV 100%; NPV 73,8%, dan akurasi 75,9% (AUC 94,6%). Sementara modifikasi skor BACAP menghasilkan sensitivitas 83,1%, spesifisitas 85,7%, PPV 70,5%, NPV 92,5%, dan akurasi 83,9% (AUC 89,4%). Kesimpulan: Kombinasi CA 19-9 dan skor BACAP menghasilkan skor modifikasi dengan keluaran yang lebih baik dibandingkan skor BACAP dalam memprediksi resektabilitas karsinoma pankreas. ......Background: Surgery remains the best choice curative treatment for pancreatic cancer. Therefore, it is crucial to establish accurate diagnosis from the beginning. BACAP score and CA 19-9 have been identified as good predictors of pancreatic cancer resectability, and their accuracy is expected to increase when combined. This study aimed to determine the outcomes produced by the combination of the BACAP score and CA 19-9 tumor marker Methods: This was a retrospective cross-sectional study involved 87 pancreatic cancer patients who underwent surgery between January 2017 and April 2023. The research data was obtained from medical records. The presence of other diseases such as biliary stones, strictures, pancreatitis, liver cirrhosis, or other pulmonary abnormalities, and prior neoadjuvant chemotherapy were excluded. The CA 19-9 value was obtained through a blood examination using the Chemiluminescent Immunoassay method. The cut-off point of 140.6 has been selected and determined based on previous studies at RSCM. The BACAP score, comprising 6 variables (Abdominal pain, weight loss, tumor size, thrombosis, tumor location, and performance status), was applied to the entire research sample using the BACAP score calculator available at http://jdlp.fr/resectability/. Results: A total 87 patients were included. BACAP score yields a sensitivity of 50.0%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 73.8%, and accuracy of 75.9% (AUC 94.6%). While modified BACAP score yielded a sensitivity of 83.1%, specificity of 85.7%, PPV of 70.5%, NPV of 92.5%, and accuracy of 83.9% (AUC 89.4%). Conclusion: The combination of CA 19-9 and the BACAP score yields a modified score with better outcomes compared to the BACAP score alone in predicting the resectability of pancreatic carcinoma.

Abstrak :
Kami melaporkan hasil 31 pankreatikoduodenektomi dari 141 tumor periampula pada peroide 1994-2002. Di antara kasus, terdapat 16 perempuan; rentang usia 17-68 tahun. Ikterus adalah keluhan tersering, 14 penderita dengan kadar albumin di bawah 3,5 g/dl dan 10 penderita dengan kadar bilirubin lebih dari 10 mg/dl. Telah dilakukan 17 Whipple klasik, 11 pankreatiokoduodenektomi dengan preservasi pilorus dan 3 total pankreatektomi+duodenektomi. Rerata lama operasi 436 menit (290-570). Penderita dikelompokkan dalam 2 periode, antara 1994-1999 dan sesudahnya. Dengan meningkatnya pengalaman, perdarahan intra operatif menurun dari rerata 2000 ml ke 400 ml. Gambaran histopatologi menunjukkan 11 adeno karsinoma kaput pankreas, 11 adeno karsinoma ampula Vater, 4 adeno karsinoma duodenum, 2 kista jinak kaput pankreas dan 3 tumor jinak. Mortalitas operatif terjadi pada 4 penderita dari 12 penderita periode pertama, dan hanya 1 pada 19 penderita sisanya. Komplikasi tersering adalah kebocoran anastomosis ke pankreas yang terjadi pada 14 penderita, dan 4 dari kebocoran tersebut menyebabkan mortalitas operatif. Rentang rawat antara 12 - 47 hari pasca bedah. Sampai akhir laporan ini, 7 penderita hidup tanpa penyakit, dan 4 penderita putus kontak. Rekurensi terjadi pada 13 penderita dari 22 penderita yang terjadi antara 4-24 bulan sesudah operasi, dan 12 penderita meninggal 2-3 minggu kemudian. Tiga penderita meninggal karena sebab yang lain. Kesimpulan: pankreatikoduodenektomi adalah tehnik yang efektif, dan mortalitas operatif dapat diturunkan, khususnya morbidas kebocoran pankreas yang dapat ditangani. (Med J Indones 2004; 13: 166-70).

---

We reported our experience on 31 pancreaticoduodenectomy out of 141 periampullary tumors during 1994 until 2002; 16 of them were female, and age average 17-68 years. Jaundice was the most common presenting sign; 14 patients showed plasma albumin lower than 3.5 g/dl, and 10 patients had bilirubin level more than 10 mg/dl. We performed classical Whipple technique in 17, pyloric preserving pancreaticoduodenectomy in 11, and total pancreaticoduodenectomy in 3 patients. The mean of operative time was 436 minutes (290-570 minutes). The patients were grouped into 2 periods, between 1994-1999 and thereafter. With experience, the amount of blood loss has decreased from 2000 ml to 400 ml. Histopathologic results showed adenocarcinoma of the pancreas head in 11, adenocarcinoma of the ampulla of Vater in 11, carcinoma of duodenum in 4, head of pancreas benign cyst in 2, and benign tumor in 3 patients. The surgical mortality was 4 in the first 12 patients, in contrast to only 1 in the last 19 patients. The most serious complication was pancreatic leakage in 14 patients, in 4 of them it was responsible as the cause of death. The length of stay after operation varied between 12 and 47 days. Until the end of this report 7 patients are still alive, and 4 patients lost of contact. Recurrence was detected in 13 out of 22 survivors, occurring between 4 to 24 months after operation and 12 patients died 2-3 months later. Three patients died due to other causes. We conclude that pancreoticoduodenectomy is an effective technique, and the operative mortality is decreasing. Furthermore, morbidity especially from pancreatic leakages can be treated in our hospital. (Med J Indones 2004; 13: 166-70).

Abstrak :
PURPOSE: A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP. METHODS: One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density. RESULTS: Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037). CONCLUSION: Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use.