Mastectomy without drain at pectoral area: a randomized controlled trial.

OBJECTIVES: Mastectomy is still one of the standard alternative procedures for the management of female breast cancer. Axillary node dissection is also performed to establish the accurate staging. After operation, the axilla must be drained because of lymphatic leakage. Whether the raw surface at the pectoral area should be drained or not is an interesting controversial point. The authors conducted a randomized controlled trial to compare outcomes after modified radical mastectomy (MRM) with and without drainage at the pectoral area. METHODS: Sixty patients who agreed to be treated with MRM and had given their consent were enrolled. Mastectomy was performed to remove the breast tissue proper by scalpel in order to minimize tissue injury. The axillary contents were removed by sharp instrument. After bleeding had stopped, patients were randomly allocated to one or other of 2 groups: group I (n = 30): only 1 drain was inserted at the axilla area; group II (n = 30): 2 conventional drains were inserted into the pectoral area and axilla area. The size of tube drain and negative suction pressure were constant in all cases. Volume of contents was recorded daily. Subcutaneous seroma or hematoma were carefully observed and confirmed by ultrasonography 3-5 days after operation. Overall drainage contents and complications were compared. RESULTS: The mean weight of breast tissue of group I was 632.1 g and group II 654.0 g (p = 0.81). Total drainage contents (median) from the two groups were 250 cm3 and 231 cm3 respectively (p = 0.796). Complications occurred in 1 case in group I and 2 cases in group II (p = 0.35). None of the above differences were statistically significant. CONCLUSION: Mastectomy by scalpel can be performed without drainage at the pectoral area. Overall complications in the conventional group and the group without drain did not differ significantly.

Phase III trial of 5FU with alfa-interferon in advanced colorectal carcinoma: Preliminary report.

The phase III clinical trial of 5FU with Alfa-interferon in advanced colorectal carcinoma was applied in Songklanagarind Hospital, between January 1991 and August 1993. The patients were randomized in two groups: 10 patients for 5FU alone and 12 patients for 5FU with Alfa-interferon groups. 2 patients (20%) showed partial response in the 5FU with Alfa-interferon treatment regimen. Median survival time in the 5FU group was 9.4 months compared with 18.7 month in the 5FU with Alfa-interferon group. The results of response rate and survival time of both groups were not statistically different.

Cystosarcoma phyllodes: A Clinical study of 18 cases at Songklanagarind Hospital.

Cystosarcoma phyllodes is an uncommon breast tumor with a wide variety of pathologic and clinical features. The surgical management of cstosarcoma phyllodes is controversial and the tumor may recur after management by excision of the mass. We performed a retrospective study of 18 patients treated for cystosarcoma phyllodes between September 1983 and March 1991 at Songklanagarind Hospital. All patients received surgical treatment (eleven excision of the mass, three wide excision and four mastectomy). The mean follow up was 48.3 months (1 week – 92 months). One patient was found with local recurrence after treatment by excision of the mass. It is suggested that the treatment for cystosarcoma phyllodes should be wide excision for benign cystosarcoma phyllodes. Mastectomy has been indicated for large tumor and for malignant cystosarcoma but axillary dissection is not worthwhile.

Surgical treatment of oesophageal cancer: 10–year experiences.

Clinical data from 278 patients with oesophageal carcinoma admitted to Songklanagarind Hospital, Songkla, Thailand between February 1982 and December 1992 were analysed to evaluated the effects on survival of various tumours and surgical techniques. There were 217 males and 61 females, average age 62.4 years (range 30-85 years), mean length of tumour 5.8 cm. (range 5-13.5 cm.). 216 cases were squamous cell carcinoma 14 cases a denocarcinoma, and 7 cases others. There were 4 techniques for surgical resection: 182 cases were operated on by modified Lewis-Tanner method, 40 cases by transmittal blunt resection, 29 cases by 3-stage technique and 27 cases by pharyngo-laryngo-oesophagectomy. Three-year, five-year, and ten-year survival rates from this report were 17.9%, 12.6% and 4.2% respectively. Respected patients stage 3 and 4, with albumin level equal to or less than 3 gm%, FEV1 equal to or less than 70% and anastomotic leakage were significantly associated with lower survival rates. No statistical significance among the techniques of surgical resection was noted.

Carcinoma of the oesophagus in the southern part of Thailand, studies of patiens and residence in 366 cases.

366 cases of carcinoma of the oesophagus in Songklanagarind Hospital, from February 1982 to August 1987, were studied. There were 274 male and 92 female patients, Male to female ratio was 2.97:1. Mean age was 62.58 years with mean age in male patients 63.59 and female 59.62. There were 45 Muslim patients (12.3%). Location of tumour was most common at the midthoracic portion (50.98). There were 111 patients from Songkhla, 57 from Nakhon Si Thammarat, 40 from Phatthalung, 39 from Trang, 27 from Narathiwat, 23 from Pattani, 18 from Yala, 17 from Surat Thani, 10 from Krabi, 10 from Satun, 5 from Phuket, 4 from Phangnga, 2 from Ranong and 1 from Trat, Chumphon, Bangkok. The incidence at tumour for males in Songkhla was 3.27/100,000 and the incidence of frmales was 0.92/100,000.

Cervical oesophageal webs: Report of two cases.

Two cases of oesophageal webs, admitted at Songklanagarind Hospital, were diagnosed by symptoms and signs of Plummer-Vinson syndrome :- dysphagia, glossitis, anaemia; and by darium oesophagography and oesophagoscopy. The patients were treated with oesophageal dilatation and the results were satisfactory. Relevant literatures have also been reviewed.

Achalasia of the oesophagus: Experiences of surgical treatment.

During a 5-year period, 14 patients were treated for achalasia of the oesophagus. The male-to-female ratio was 1:1.3, and a mean age of 43.4 years. The chief presenting complaint was dysphagia (71.4%). The radiological findings were mild degree 21.3%, moderate degree 71.5% and severe degree 7.2%. Oesophagomyotomy was perforemed in 13 patients, resulting excellent result 53.8%, good result 23.1%, fair result 15.4% and poor result 7.7%. This report showed the surgical technique and follow up of these patients in the past 5 years.

Substernal gastric bypass for palliation of oesophageal carcinoma; a report of 10 patients.

A review of 10 patients who underwent substernal gastric bypass with oesophageal exclusion for palliative treatment of carcinoma of the oesophagus is presented. The patients were old (average 67.3 years.); all had pulmonary problems or unresectable oesophageal carcinoma. There was anastomotic leakage in 2 cases. Blowout of oesophageal stump occurred in 4 cases: two at the upper oesophagus and two at the lower oesophagus. Five patients died in the hospital, one from subdiaphramatic abscess, one from aspiration of contrast media, and the others died from progressive cachexia. The longest survival was 18 months in one patient.