Role of Autologous Fibrin Glue (AFG) to Reduce Drainage Volume After Modified Radical Mastectomy for Breast Cancer

Background: Seroma is arguably the most significant complication that can happen after mastectomy. Although seroma is not a life-threatening complication, this condition can lead to severe morbidities. This situation can cause prolonged hospital stays and delayed adjuvant therapy. In this regard, autologous fibrin glue is a hemostatic agent that can accelerate fibrin formation, stop vascular oozing, and decrease dead space. Therefore, this research was performed to evaluate autologous fibrin glue function in lowering seroma volume after mastectomy and shortening the length of hospital stay.Methods: This randomized control trial research was designed to compare the effect of autologous fibrin glue to a control group that did not receive autologous fibrin glue. Seroma volume was calculated every 24 hours. The drains were then removed after the production of seroma less than 30 mL/24 hours.Results: We recruited 20 patients for each of the two groups who met the inclusion criteria. Age, histopathology type, breast cancer stage, number of lymph nodes, and tumor size did not significantly differ. However, patients in the fibrin glue group had significantly lower cumulative drain production. The median seroma volume in the treatment group was 9.30 mL, while the median in the control group was 20.90 mL (p < 0.05).Conclusions: Autologous fibrin glue significantly decreased seroma formation and length of hospital stay.

Cryotherapy as A Prophylaxis of Mucositis in Children with Cancer Undergoing Chemotherapy at Dr. M. Djamil General Hospital

Background: Mucositis is one of the side effects of chemotherapy, which can be a severe problem for children with cancer. Cryotherapy can cause vasoconstriction and decrease blood flow to the oral mucosa, resulting in lower concentrations of chemotherapy agents to prevent mucositis. This study aims at determining the effectiveness of oral cryotherapy as prophylaxis mucositis in children with cancer undergoing chemotherapy.Methods: This quasi-experiment study with a pretest-posttest control-group design involved 45 respondents (22 in the intervention group and 23 in the control group) selected using consecutive sampling. The data collection instrument was the WHO mucositis scale. Results: Of the 45 children undergoing chemotherapy, 24 (53.3%) were of school age, 25 (55.6%) were male, 33 (73.3%) had good nutritional status, and 17 (37.8%) had mild neutropenia before undergoing chemotherapy. All respondents (100%) did not experience mucositis, but after chemotherapy, 9 children (40.9%) in the intervention group had mucositis, and 19 children (82.6%) experienced mucositis in the control group. The data were analyzed using the Wilcoxon test to see the difference between the intervention group and the control group and the Chi-Square test with Yates’s correction to see the effect of cryotherapy on the prevention of mucositis. The results showed that there was a difference in the incidence of mucositis between before and after intervention in the intervention group (p = 0.003) and the control group (p = 0.000), and cryotherapy was effective in preventing mucositis (p = 0.01).Conclusions: Cryotherapy is effective against the prevention of mucositis. Nurses and families need to be able to apply oral cryotherapy and other evidence-based treatment as a method to prevent mucositis

Characteristics of Chest X-Ray in Patients with Cancer at the Dharmais Cancer Hospital Emergency Room during the COVID-19 Pandemic

Background: Conventional chest X-ray (chest X-ray) in Dharmais Cancer Hospital emergency room (ER) is still the primary modality to diagnose patients with cancer with dyspnoea complaints. Chest X-ray was also carried out to screen inpatients at the Dharmais Cancer Hospital ER at the beginning of the COVID-19 pandemic in Indonesia. It was essential because patients in the Dharmais Cancer Hospital ER were patients with cancer, with low immunity and a high risk of being exposed to various infections. Thus, the purpose of this study was to determine the characteristics of chest X-rays in patients with cancer at the Dharmais Cancer Hospital ER during the COVID-19 pandemic in February-May 2020. Methods: This was a descriptive study. The population involved was all patients at the Dharmais Cancer Hospital ER who received chest X-ray support, with the inclusion criteria for diagnosing lung cancer, breast cancer, cervical cancer, colorectal cancer, and blood cancer (Leukemia) from February to May 2020. Data analysis employed univariate analysis by utilizing tables and graphs in presenting the data.Results: 289 samples met the research criteria. The highest visits were patients with breast cancer (41.2%). The most common thoracic images were pleural effusion (34.3%), followed by bronchopneumonia (31.1%), normal lung (16.6%), lung mass (7.6%), pneumonia (5.2%), and others (5.2%), consisting of atelectasis, bronchitis, fibrosis/chronic pulmonary process, pulmonary emphysema, cardiomegaly, and specific process. Besides, the chest x-ray bronchopneumonia was 31.1% (90 samples), accompanied by pleural effusion of 44.4%. From the chest X-ray, pleural effusions were 34.3% (99 samples), with lung cancer being the most common with pleural effusions (48.4%).Conclusions: More than 80% of chest x-ray performed in the ER are abnormal. Also, breast cancer is the highest in the Dharmais Cancer Hospital ER cases, with the highest chest x-ray of pleural effusion.

The Implementation of Modified ERAS Protocol in Laparoscopic Radical Cystectomy: An Outcome at Universitas Gadjah Mada Urological Institute

Background: Enhanced recovery after surgery (ERAS) protocol is multimodal perioperative care designed to achieve enhanced postoperative outcomes. Unfortunately, all these elements are not always fully applied due to each center’s limitations. In this study, the ERAS protocol was modified and implemented in patients with bladder cancer who underwent laparoscopic radical cystectomy (LRC). This study aimed to evaluate the outcomes of the modified ERAS protocol in LRC surgery. Methods: The retrospective study design was used to evaluate 35 patients (27 males and 8 females) who underwent LRC with the application of the perioperative modified ERAS protocol. All information relating to perioperative, intraoperative, and postoperative patient data was obtained from medical records. All complications that occurred were classified according to the Clavien-Dindo classification.Results: The mean age in this study was 58.3 ± 9.2, and the most common pathological finding was urothelial carcinoma. Intraoperative blood loss was 318.5 ± 112.5 cc with those requiring intraoperative blood transfusion of 4.8 ± 2.0 patients. The mean first diet was 2.1 ± 1.2 days. For bowel activities, the first flatulence was 1.6 ± 0.8 days. The mean mobilization with first sitting was 1.8 ± 0.9 days. Seventeen percent of patients experienced intraoperative complications and postoperative complications were encountered in 28.6% of patients. According to the ClavienDindo classification, most complications were grades 1-2 (17.1%). There was no incidence of mortality in this study.Conclusions: These promising results, including the postoperative recovery and complications rates, require validation with multi-center and randomized studies to confirm the benefits of the modified ERAS protocol in minimally invasive procedures, especially LRC surgery

Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Introduction: Choroidal metastases are infrequent in breast cancer, but if they present, they usually signify the disseminated disease and poor prognosis. The challenges in treating choroidal metastases are not only to prolong survival but also to preserve vision, improving the quality of life. Case Presentation: Our patient was firstly diagnosed with stage-three triple-negative breast cancer at the age of 32 years. She had surgery, adjuvant chemotherapy with anthracycline regime, as well as adjuvant radiotherapy. Her disease firstly recurred two years later with pleural effusion, but it was controlled with six cycles of docetaxel. She was in remission until ten years later when she presented with a worsening dry cough and progressive blurring of vision in both eyes. CT restaging showed multiple sub-centimeter bilateral lung nodules, singular pleural metastases, and multiple bone metastases. Choroidal metastases were also confirmed with the ophthalmological assessment which includes CT of the orbit. She received short-course palliative radiotherapy followed immediately by eribulin. Then, she started monthly bisphosphonates. She was able to read again four months after radiotherapy, and her vision remains normal to date. The latest PET scans showed no FDG avid disease in the lungs with pleural metastases significantly reduced in size. Bone metastases remain stable and asymptomatic. It has been nearly four years since the diagnosis of choroidal metastases. She is still on eribulin at an adjusted dose and interval. She remains asymptomatic from her bone, lung, and choroidal metastases. Conclusions: Short-course radiotherapy to the orbit, followed by continuous administration of eribulin, can lead to prolonged survival with a good quality of life in triple-negative breast cancer with choroidal metastases

Local Recurrence of Primary Cardiac Leiomyosarcoma After Resection: A Rare Case

Introduction: Leiomyosarcoma (LMS) is a fatal tumor, though primary cardiac is very rarely encountered. In this report, we evaluated the surgical and medical management of primary cardiac LMS, which is a sporadic tumor.Case Presentation: A 60-year-old female patient was examined for pulmonary edema after penicillin allergy in May 2019, while transthoracic echocardiography (ECHO) revealed an appearance compatible with a 5x3.5 cm mass in the right atrium. In addition, transesophageal ECHO showed a 7x4.6 cm foreground mass compatible with a myxoma in the right atrium (RA). The patient was then operated on emergency. Besides, an adjuvant ifosfamide-mesna-doxorubicine (IMA) protocol was planned to be given to the patient after local radiotherapy.Conclusions: In this report presented, we made RT and chemotherapy treatment plans in the case of recurrence without R0 surgery. Recurrence rates of up to 50% can occur in LMS, and systemic chemotherapy can be applied after relapse

Advance Malignant Phyllodes Tumor with Active Bleeding in Children: A Rare Case

Introduction: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, there are only a few large pediatric phyllodes tumor series. Current guidelines do not differentiate treatment recommendations between children and adults.Case Presentation: A 12-year-old girl presented with a lump in her right breast which grew rapidly within a month. On physical examination, we found a mass on the right breast sized ± 10 x 10 cm; the lump was fragile and bled easily. The patient’s condition was getting worse and worse. Due to this deterioration, we performed a mastectomy immediately.Conclusions: The incidence of malignant phyllodes tumor in children is very rare and required prompt treatment in emergency cases.

Small Cell Neuroendocrine Carcinoma in Head and Neck

Introduction: Poorly differentiated neuroendocrine carcinomas (NECs) originating from the eye are rare and very highly malignant diseases with a poor prognosis. Small cell NEC of the head and neck is a rare disease and highly aggressive. Early recognition and treatment are crucial for reducing morbidity and mortality. Case Presentation: A 19-year-old male visited our oncology surgery outpatient department due to the progressive neck mass enlargement originating from the eye. The patient was previously diagnosed with invasive choroid malignant melanoma of the left eye which had metastasized to the lymph nodes of the left neck. He underwent a surgical removal/exenteration of the left eye. The result showed that the patient’s survival with poorly differentiated tumors was about 14% while patients with well-differentiated NEC had a survival rate of 34%. It also indicates that the prognosis of these tumors is very poor with a total of over 90% of patients having distant metastatic disease. Histopathological examination showed the tumor tissue and its immunohistochemistry with positive streaks of CD56, NSE, Synaptophysin, and Ki67 suggested small cell NEC.Conclusions: it is crucial to establish an early diagnosis of these tumors to reduce morbidity and mortality. No optimal treatment for such disease has yet been established.

The Accuracy of Confocal Laser Endomicroscopy in Diagnosing Bladder Cancer: A Systematic Review & Meta-Analyses

Background: Multiple advancements of endoscopic technology were designed to enhance the sensitivity and specificity of the diagnostic tools of bladder cancer; thus, we perform a meta-analysis to compare diagnostic performance between confocal laser endomicroscopy (CLE) and biopsy for detecting bladder cancer.Methods: We compared CLE’s accuracy in diagnosing bladder cancer reported by studies obtained from the electronic database MEDLINE, CENTRAL, and CINAHL, from May to June 2020. The pooled effect estimate was calculated employing the DerSimonian and Laird random-effects model. We only included moderate to high-quality studies, which had been assessed by the QUADAS-2 tool.Results: Eight studies were included in this review; five of those were good-quality studies. A total of 519 samples from 345 patients were included in the pooled effect estimate calculation. Pooled sensitivity and specificity of CLE in diagnosing bladder cancer were 90.2% (0.86, 0.93) and 78.1% (0.71, 0.85), respectively. The use of white-light cystoscopy (WLC) before CLE increased its specificity (56.8% versus 84.6%). Pooled sensitivity and specificity of CLE in predicting lowgrade lesion were 73% (0.66, 0.80) dan 83% (0.78, 0.87), respectively. Meanwhile, pooled sensitivity and specificity of CLE in predicting high-grade lesion were 73% (0.66, 0.78) and 79% (0.73, 0.83), respectively.Conclusions: CLE has good accuracy in distinguishing malignant and benign tumors. Grading tumors with this modality is also accurate. The use of probe CLE (pCLE), coupled with WLC, will increase its specificity.

Early Experience of Oncological Reconstructive Surgery at Dharmais National Cancer Center

Background: Oncological reconstructive surgery is a new paradigm in which it combines oncologic principles with reconstruction techniques. This study aims to present patients’ characteristics who had undergone oncological reconstructive surgery at the Department of Surgical Oncology, Dharmais National Cancer Center. Methods: This descriptive study identified patients’ characteristics who underwent oncological reconstructive surgery, their cancer types, and their therapies. All data were obtained from surgery registration and medical records from January 2019 to January 2020. Data were then presented in number and percentage.Results: A total of 174 patients had undergone oncological reconstructive surgery within one year. The mean age of all patients was 48.2 ± 16.7 years old. Most patients were female (72.1%), with breast cancer making up most cases (43.7%). Most of the participants also underwent mastectomy (42.1%), which was later followed by various reconstruction types. Sixty patients received free tissue transfer with microsurgery (34.4%), of which head and neck cancer constituted most cases. In addition, the most common donor site for the free flap was the Anterolateral Thigh (41.7%). Of all 174 patients, 75.2% presented with locally advanced cancer, and 17.8% had metastatic cancer. Within one year of follow-up, the survival rate was 87.4%, while local recurrence was 3%. Conclusions: The oncological reconstructive surgery approach plays a therapeutic and reconstructive role, and such might be the preferred method of choice for patients presenting with advanced-stage cancer