Clinical Predictive Score for Cholecystectomy Wound Infection: WEBAC Score.

BACKGROUND: Most common surgical complications in cholecystectomy are surgical site infections (SSIs). SSIs have many factors, including patient, surgical, and disease factors. This study aims to find the factors which relate to SSIs 30 days after cholecystectomy and contribute to the scoring system to predict SSIs. METHODS AND MATERIAL: The data of patients who underwent cholecystectomy from January 2015 to December 2019 were retrospectively collected from a prospectively collected infectious control registry. The SSI was defined following the CDC criteria and assessed before discharge and at a 1-month follow-up. Variables that were independently predictive of the increased SSIs were included in the risk score. RESULTS: The patients who underwent cholecystectomy were 949, which were divided into 28 patients who had SSIs and 921 who had no SSIs. The rate of SSIs was 3%. The factors related to SSI in cholecystectomy were age ≥ 60 years (p = 0.045), history of smoking (p = 0.004), retrieval bag use (p = 0.005), preoperative ERCP (p = 0.02), and wound class III and IV (p = 0.007). Risk assessment was using five variables (WEBAC): (1) wound classifications, (2) preoperative ERCP, (3) retrieval plastic bag use, (4) aged ≥ 60 years, and (5) history of smoking (cigarette). If patients were aged ≥ 60 years and had a history of smoking, no plastic bag use, preoperative ERCP, or wound class III or IV, these parameters would all be scored 1 each. The WEBAC score revealed the probability of SSIs in cholecystectomy wounds. CONCLUSION: The WEBAC score represents a convenient and simple tool to predict the probability of SSI in the patients who underwent cholecystectomy and might increase the surgeons' awareness of postoperative SSI.

Intraoperative Molecular Analysis of Total Tumor Load in Sentinel Lymph Node: A Predictor of Axillary Status in Early Breast Cancer.

BACKGROUND: Axillary lymph node dissection (ALND) remains the standard of care in breast cancer patients with positive sentinel lymph node (SLN). However, approximately 40-60% of patients with positive SLNs have not developed to non-SLN metastasis and ALND seems to be an overtreatment. The purpose of this study was to analyze predictors and define a specific cut-off of total tumor load (TTL) of CK19 that can be used as a predictive factor of non-SLN metastasis in early breast cancer patients. MATERIALS AND METHODS: The records of 238 patients with cT1-3N0 breast cancer who had an intraoperative SLN evaluation performed through One-Step nucleic acid (OSNA) assay at Songklanagarind Hospital between 1 January 2015 and 31 December 2019 were examined. Univariate and Multivariate analysis was used to identify clinicopathologic features in SLN-positive patients that predict metastasis to non-SLNs. Finally, receiver operative characteristics (ROC) curves were used to choose an optimal TTL cut-off value. RESULTS: Of a total of 110 patients who had a positive SLN, only 48 (43.64%) were found to have positive nodes in non-SLN. Multivariate analysis revealed that lymphovascular invasion, type of SLN metastasis and SLN TTL (copies/µL) were independent predictors of positive non-SLNs.  TTL cut-off value was 19,000 copies/µL, with an AUC of 0.838 with 72.7% sensitivity and 84.7% specificity to predict non-SLN metastasis. CONCLUSIONS: The likelihood of positive non-SLNs in patients who showed a positive SLN correlates with lymphovascular invasion, type of SLN metastasis and SLN TTL (copies/µL). Our result revealed that the patients with a SLN TTL ≥19,000 copies/µl continue to attract the recommendation to proceed with ALND. This cut-off value can then help clinicians to assess which patients would benefit from ALND.

Serum ß-2 microglobulin levels are associated with distant metastasis in patients with breast cancer.

Serum ß-2 microglobulin (ß2-M) levels have been identified to be higher in patients with cancer than in healthy individuals. The aim of the present study was to evaluate the association between serum ß2-M levels and clinicopathological characteristics of patients with breast cancer in a prospective cohort study, and to evaluate the effect of ß2-M on cancer cell migration in vitro. Serum samples from 200 female patients with histologically confirmed invasive breast cancer were collected between 2017 and 2019. Their clinicopathological information was obtained and analyzed. The ß2-M levels were identified to be associated with age, histologic subtype and metastatic status. When the diagnostic association of ß2-M and metastatic status was analyzed, the area under the receiver operating characteristic curve was 0.78. Using a cut-off serum ß2-M level of 1.9 µg/ml, the sensitivity for diagnosing metastatic status was 87.5%, the specificity was 65.0%, and the diagnostic odds ratio was 2.47. Upon age stratification, the association between the ß2-M level and metastatic status was significant only in the group aged >55 years. In survival analysis, ß2-M levels >1.9 µg/ml were associated with a poor survival outcome. In vitro, the MCF-7 breast cancer cell line exhibited increased cellular migration following treatment with 30 µg/ml ß2-M. Serum ß2-M may be a predictor of metastatic status in breast cancer.

Body image transformation after breast cancer diagnosis and treatment in southern Thai women.

OBJECTIVE: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. METHODS: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. RESULTS: Participants' body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. CONCLUSION: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.

The Pre-Treatment Neutrophil-Lymphocyte Ratio: a Useful Tool in Predicting Non-Sentinel Lymph Node Metastasis in Breast Cancer Cases

Background: The sentinel lymph node (SLN) biopsy is a highly accurate predictor of overall axillary nodal status in early breast cancer patients. There is however, still a debate on which patients with a positive SLN can benefit from axillary lymph node dissection (ALND). Numerous studies have been designed to identify variables that are predictive of non-SLN metastasis to avoid a complete ALND. The aim of this study was to determine whether the pre-treatment neutrophil-lymphocyte ratio (NLR) can be a predictive factor of non-SLN metastasis in early breast cancer patients. Materials and Methods: The records of 214 consecutive patients with cT1-3N0 invasive breast cancer who had undergone intraoperative SLN evaluation at Songklanagarind Hospital between the 1stof March 2011 and the 30thof May 2016 were examined. Data on patient demographics, tumor variables and NLR were collected and factors for non-SLN metastasis were analyzed using multivariate logistic regression. The power of the NLR was quantified with receiver operating characteristics (ROC) curves as measured by the areas under curves (AUC). Results: Multivariate analysis established presence of lymphovascular invasion (OR 8.4, 95%CI 2.3-31.3, p=0.002), macrometastasis (OR 6.6, 95%CI 1.8-24.7, p=0.005), and NLR (OR 2.3, 95%CI 1.1-4.8, p=0.033) as predictive factors of non-SLN metastasis with statistical significance. The AUC for NLR was 0.7 (95%CI 0.6-0.8) with an optimal cut-off of 2.6 giving a sensitivity of 62%, a specificity of 83.8%, a positive predictive value of 77.3% and a negative predictive value of 70.5%. Conclusion: Pre-treatment NLR is a useful diagnostic aid for predicting additional non-SLN metastasis.

Breast Conserving Therapy and Quality of Life in Thai Females: a Mixed Methods Study.

BACKGROUND: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). MATERIALS AND METHODS: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. RESULTS: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. CONCLUSIONS: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.

The efficacy of cefazolin in reducing surgical site infection in laparoscopic cholecystectomy: a prospective randomized double-blind controlled trial.

BACKGROUND: A prophylactic antibiotic is recommended in open cholecystectomy surgeries, but in laparoscopic cholecystectomies such prophylaxis is controversial. Recent reviews have not found conclusive evidence that routine prophylaxis, especially in low risk patients, is effective. This clinical trial was undertaken to evaluate the efficacy of cefazolin in reducing surgical site infection SSI in laparoscopic cholecystectomies in a sample not screened for high or low risk patients. METHODS: A randomized double-blind controlled trial was conducted in a single university hospital. Scheduled cholecystectomy patients without selection for patient risk factors were randomized into two groups. Pre-operatively, group A patients received a placebo of 10 ml isotonic sodium chloride, and group B patients received 1 g of cefazolin as a prophylactic antibiotic. All patients underwent a standard laparoscopic cholecystectomy, and were followed up for at least 30 days. RESULTS: Two hundred ninety-nine patients were randomized (149 in group A and 150 in group B). SSI occurred in seven patients (2.34 %), five (1.67 %) in the placebo group, and two (0.67 %) in the prophylactic antibiotic group. The difference was not statistically significant (p value = 0.512), and no specific risk factors for post-operative infection were identified. CONCLUSIONS: A single dose of preoperative prophylactic cefazolin has no significant benefit in reducing the incidence of SSI in laparoscopic cholecystectomy. Whether or not to use a prophylactic depends on the individual patient, and the consideration of the attending surgeon.

Clinical features of complicated acute appendicitis.

OBJECTIVE: To identify the clinical features associated with complicated (gangrenous or perforation) acute appendicitis in the patients who underwent appendectomy. MATERIAL AND METHOD: A consecutive series of adult patients with acute appendicitis who underwent appendectomy at Songklanagarind Hospital between 2005 and 2010 were retrospectively analyzed. RESULTS: Nine hundred twenty four patients were evaluated. Median (interquartile range) age was 34.9 (22.4, 50.1) years. There were 669 (72.4%) simple acute appendicitis and 255 (27.6%) complicated acute appendicitis. Multivariate analyses showed that age >60 years (OR 1.93, 95% CI 1.23-3.02), duration of symptoms >12 hours (OR 3.29, 95% CI 2.25-4.8), anorexia (OR 1.69, 95% CI 1.2-2.37), body temperature >38 degreesC (OR 2.38, 95% CI 1.59-3.58), generalized tenderness (OR 5.36, 95% CI 2.4-11.95), guarding (OR 1.5 95% CI 1.08-2.08), bandemia (OR 1.65, 95% CI 1.16-2.34), pyuria (OR 1.66, 95% CI 1.07-2.57), urine specific gravity >1.020 (OR 1.66, 95% CI 1.18-2.33), and duration from visit to surgery >12 hours (OR 1.82, 95% CI 1.18-2.82) were related to complicated acute appendicitis. CONCLUSION: Ten clinical features can be used to predict the risk of complicated acute appendicitis. However, the strong factors are duration of symptoms, body temperature, and generalized tenderness. They should be the useful tools for acute appendicitis management, especially in limited resources situation.

Correlation of Wilms' tumor 1 isoforms with HER2 and ER-α and its oncogenic role in breast cancer.

BACKGROUND: Wilms' tumor 1 (WT1) gene has different functional properties depending on the isoform type. This gene correlates with cell proliferation in various types of cancer. Here, we investigated the expression of WT1 isoforms in breast cancer tissues, and focused on the oncogenic role through estrogen receptor-alpha (ER-α) and human epidermal growth factor receptor 2 (HER2). MATERIALS AND METHODS: Expression of WT1(17AA+) and (17AA-) was investigated in adjacent normal breast and breast cancer using Reverse transcription-polymerase chain reaction and western blotting. The correlation of WT1 isoforms with HER2 and ER-α was examined using MCF-7 cells stably-overexpressing WT1s and siRNA against WT1 gene. RESULTS: The expression of WT(17AA-) was significantly found in adjacent normal breast tissues. A mixture of WT1(17AA+) and WT1(17AA-) were highly expressed in breast carcinoma tissues. MCF-7 cells overexpressing WT1+/+ and WT1+/- represented strong expression of ER-α and HER2. Moreover, the silencing of WT1+/+ and WT1+/- resulted in a decrease of both ER-α and HER2 and led to a decrease of cell numbers. CONCLUSION: Our results suggest that WT1(17AA+) was exhibited dominantly in breast carcinoma tissues. WT1+/+ and WT1+/- correlated with the high expression of ER-α and HER2, leading to cell proliferation and might be involved in cancer development and progression.

Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients.

BACKGROUND: Predicting the major complications after esophagectomy is important and may help in preselecting patients who are most likely to benefit from surgery, especially in locally advanced esophageal cancer patients who have poor prognosis. OBJECTIVE: To identify the factors associated with the development of pneumonia and anastomotic leakage complications, and the survival characteristics in locally advanced esophageal cancer patients. METHODS: A consecutive series of 232 locally advanced esophageal cancer patients (183 men and 49 women, median age 63 years) who underwent esophagectomy at Prince of Songkla University Hospital between 1998 and 2007 was analyzed. RESULTS: There were nine (3.8%) 30-day mortalities. Pneumonia occurred in 53 patients (22.8%) and anastomotic leakage in 37 patients (15.9%). Multivariate analyses showed that low body mass index was related to leakage (p = 0.015), while soft-diet dysphagia (p = 0.009), forced expiratory volume in 1 second <75% (p = 0.0005), type of surgery (McKeown technique) (p = 0.019), and long operative time (p = 0.006) were related to pneumonia. The median survival rate was 13.0 months. Stage 2b patients had longer survival than stages 3 and 4a patients (p = 0.0001). CONCLUSION: Patient body mass index, dysphagia, spirometry, type of surgical technique, and operative time can help predict the likelihood of pulmonary or leak complications after esophagectomy. TNM (Tumor, Node, Metastasis) staging can help predict the overall survival after resection in locally advanced cases.