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"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. "

"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 markerMethods: 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."

"ABSTRACTPurpose Adenosquamous carcinoma (ASC) of the pancreas is a rare malignancy, associated with a poor prognosis after surgical resection, with reported median survival times (MSTs) ranging from 4.4 to 13.1 months. We conducted this study to investigate the long-term outcomes of patients after the resection for ASC.MethodsBetween 2002 and 2016, a total of 456 patients underwent resection for ASC or adenocarcinoma (AC) of the pancreas. ASC was confirmed in 17 (3.7%) of these patients. We analyzed the clinicopathological characteristics and survival of these 17 patients in comparison with those of patients with AC of the pancreas.ResultsThe operative procedures performed were pancreaticoduodenectomy (n = 6) and distal pancreatectomy (n = 11). Seven (41.2%) of the 17 patients underwent combined organ resection. R0 resection was achieved in 16 (94.1%) patients. The 5-year overall survival (OS) rate and MST were 40.3% and 20.9 months, respectively. A squamous component of ≥ 60% (P = 0.001) and R1 resection (P < 0.001) were significantly associated with poor OS for patients with ASCConclusionThis study revealed longer survival and a higher R0 resection rate after aggressive combined resection in our ASC patients than those in previous studies. Although this was only a small series, our findings suggest that local control with aggressive resection may be an effective treatment protocol for ASC patients."

"ABSTRAKPelaksanaan praktek klinik selama masa residensi Keperawatan Medikal Bedah peminatan Digestif bertujuan untuk mampu menampilkan peran perawat spesialis sebagai pemberi asuhan keperawatan lanjut, pendidik, advokat, konselor, kolaborator, pembaharu dan peneliti secara khusus pada keahlian Digestif. Peran pemberi asuhan keperawatan lanjut dilakukan dengan menggunakan Model Adaptasi Roy pada pasien dengan kanker pankreas dan 30 kasus pasien dengan masalah digestif lainnya. Salah satu karaktristik perawat spesialis adalah memberikan intervensi keperawatan berbasis bukti Evidence-based Nursing practice , yang dilakukan melalui penggunaan Animal Naming Test ANT untuk mengidentifikasi gangguan fungsi kognitif pada pasien sirosis hepatis yang sedang dirawat.

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ABSTRACT Animal Naming Test ANT yang diterapkan pada 16 pasien sirosis telah berhasil mengidentifikasi lebih banyak pasien yang mengalami gangguan kognitif dibandingkan dengan asesmen klinis yang sudah ada di ruang perawatan. Inovasi dalam pelayanan keperawatan yang dilakukan melalui program inovasi kelompok berupa penerapan kegiatan ERAS yakni memberikan minuman karnohidrat Maltodextrin, mobilisasi dini dan mengunyah permen, terbukti berhasil meningkatkan pemulihan perawatan pasien pembedahan sistem pencernaan.

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The purpose of Clinical learning practice during Medical Surgical Nursing Residency Program, with specialisation in digestive, is to facilitate the student in developing capability to perform the roles of nurse specialist as advanced nursing care provider, educator, advocator, counselor, collaborator, innovator and researcher. Advance nursing care provider role is implemented by using Roy Adaptation Model on pancreatic carcinoma patiet and 30 other digestive cases. Evidence Based Nursing Practice as other character of nurse specialist practice was performed by applying animal naming test ANT to identify cognitive problem in hospitalized cirrhotic patients. It is based on the importance for nurse to recognize early cognitive dysfunction to provide better nursing care especially in latent asymptomatic hepatic encephalopathy that common happens in cirrhosis patient. ANT was tested on 16 hospitalized cirrhotic patients and succeeded in identifying more cirrhosis patient with cognitive dysfunction compared to available assessments in ward. The innovation program which was implementing ERAS activities carbohydrate loading, early mobilization and chewing gum have proven to be effective perioperative management in digestive surgery. "

"Latar Belakang: Kanker pankreas merupakan penyakit dengan kesintasan rendah dan kesulitan untuk melakukan diagnosis. Pemeriksaan Computed Tomography (CT)-Scan abdomen dan Ca 19-9 merupakan modalitas yang murah, mudah, dan terjangkau dalam diagnosis kanker pankreas. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) merupakan pemeriksaan baku emas untuk diagnosis kanker pankreas tetapi belum banyak tersedia di fasilitas kesehatan di IndonesiaTujuan: Penelitian ini bertujuan untuk mengetahui kemampuan diagnostik CT-Scan abdomen dan Ca 19-9 dibandingkan dengan EUS-FNA dalam diagnosis kanker pankreas.Metode: Desain studi ini adalah potong lintang dengan melihat rekam medis 62 pasien dengan kecurigaan kanker pankreas di RSCM pada tahun 2015-2019. Diambil pasien-pasien yang memiliki data Ca 19-9 dan CT-Scan abdomen yang kemudian dilakukan EUS-FNA untuk penegakan diagnosis kanker pankreas.Hasil: Sensitivitas dan spesifisitas CT-Scan abdomen masing-masing 76,27% dan 100%, sedangkan Ca 19-9 masing-masing 67,8% dan 33,33%. Nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), dan akurasi CT-Scan abdomen masing-masing adalah 100%, 17.65%, tidak dapat dinilai, 0,24 , dan 77,42%. Nilai duga positif, NDN, RKP, RKN, dan akurasi untuk Ca 19-9 masing-masing adalah 95.24%, 5%, 1,02, 0,97, dan 66,13%.Kesimpulan: Kombinasi pemeriksaan CT-Scan Abdomen dan Ca 19-9 memiliki sensitivitas yang tinggi untuk kanker pankreas. Computed Tomography abdomen dapat digunakan untuk diagnosis kanker pankreas dengan sensitivitas dan spesifisitas yang baik.

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Introduction: Pancreatic cancer is a disease with low survival rate and difficult to diagnose. Abdominal computed tomography (CT) and Ca 19-9 are diagnostic modalities which are easy, simple, and non-invasive in diagnosis of pancreatic cancer. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) is the gold standard for diagnosis of pancreatic cancer but it is not available in many health care facilities in Indonesia.Purpose: This study aims to know the diagnostic accuracy of abdominal CT and Ca 19-9 compared to EUS-FNA for diagnosis of pancreatic cancer.Methods: The design of this study is cross-sectional by searching medical record of 62 patients with clinical suspicion of pancreatic cancer in Cipto Mangunkusumo hospital from year 2015-2019. Patients who undergo EUS-FNA with clinical suspicion of pancreatic cancer and have abdominal CT and Ca 19-9 data is included.Results: The sensitivity and specificity of abdominal CT are 76.27% and 100%, respectively, and Ca 19-9 are 67.8% and 33.33%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of abdominal CT are 100%, 17.65%, unmeasurable, 0.24 , and 77.42%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of Ca 19-9 are 95.24%, 5%, 1.02, 0.97, and 66.13%, respectively.Conclusion: The combined sensitivity of abdominal CT and Ca 19-9 has high sensitivity to diagnose pancreatic cancer. Abdominal CT can be used to diagnose pancreatic cancer with good sensitivity and specificity."

"Kanker pankreas adalah penyakit di mana sel-sel tumor ganas (kanker) berkembang di jaringan pankreas, yaitu organ di belakang perut bagian bawah dan di depan tulang belakang, yang membantu tubuh menggunakan dan menyimpan energi dari makanan dengan memproduksi hormon untuk mengontrol kadar gula darah dan enzim pencernaan untuk memecah makanan. Biasanya, kanker pankreas jarang terdeteksi pada tahap awal. Salah satu tanda seseorang mengalami kanker pankreas adalah diabetes, terutama jika itu bertepatan dengan penurunan berat badan yang cepat, penyakit kuning, atau rasa sakit di perut bagian atas yang menyebar ke punggung. Di antara berbagai jenis kanker, kanker pankreas memiliki tingkat kelangsungan hidup terendah, yaitu hanya sekitar 3-6% dari mereka yang didiagnosis yang dapat bertahan hidup selama lima tahun. Jika pasien didiagnosis tepat waktu untuk perawatan, peluang mereka untuk bertahan hidup akan meningkat. Terdapat penanda tumor yang biasa digunakan untuk mengikuti perkembangan kanker pankreas, yaitu CA 19-9 yang dapat diukur dalam darah. Orang sehat dapat memiliki sejumlah kecil CA 19-9 dalam darah mereka. Kadar CA 19-9 yang tinggi seringkali merupakan tanda kanker pankreas. Tetapi kadang-kadang, kadar tinggi dapat menunjukkan jenis kanker lain atau gangguan non-kanker tertentu, seperti sirosis dan batu empedu. Karena kadar CA 19-9 yang tinggi tidak spesifik untuk kanker pankreas, CA 19-9 tidak dapat digunakan dengan sendirinya untuk skrining atau diagnosis. Ini dapat membantu memantau perkembangan kanker dan efektivitas pengobatan kanker. Dalam studi ini, metode Kernel-based Support Vector Machine digunakan untuk mengklasifikasikan hasil tes darah CA19-9 menjadi dua bagian; data pasien yang didiagnosis dengan kanker pankreas atau pasien normal (tidak terdiagnosis kanker pankreas). Metode ini memperoleh akurasi sekitar 95%.

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Pancreatic cancer is a disease in which malignant (cancerous) tumor cells develop in pancreatic tissue; organ behind the lower abdomen and in front of the spine, which helps the body use and store energy from food by producing hormones to control blood sugar levels and digestive enzymes to break down food. Usually, pancreatic cancer is rarely detected at an early stage. One sign of a person with pancreatic cancer is diabetes, especially if it coincides with rapid weight loss, jaundice, or pain in the upper abdomen that spreads to the back. Among various types of cancer, pancreatic cancer has the lowest survival rate of only about 3-6% of those diagnosed who can survive for five years. If patients are diagnosed on time for treatment, their chances of survival will increase. There is a tumor marker commonly used to follow the course of pancreatic cancer, namely CA 19-9 which can be measured in the blood. Healthy people can have small amounts of CA 19-9 in their blood. High levels of CA 19-9 are often a sign of pancreatic cancer. But sometimes, high levels can indicate other types of cancer or certain noncancerous disorders, including cirrhosis and gallstones. Because a high level of CA 19-9 is not specific for pancreatic cancer, CA 19-9 cannot be used by itself for screening or diagnosis. It can help monitor the progress of your cancer and the effectiveness of cancer treatment. In this study, the Kernel-based Support Vector Machine method is used to classify CA19-9 blood test results into two sections including data on patients diagnosed with pancreatic cancer or normal patients. This method will get an accuracy of around 95%."