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Law JH, Lau J, Pang NQ, Khoo AMG, Cheong WK, Lieske B, Chong CS, Lee KC, Tan IJW, Siew BE, Lim YX, Ang C, Choe L, Koh WL, Ng A, Tan KK. Preoperative Quality of Life and Mental Health Can Predict Postoperative Outcomes and Quality of Life after Colorectal Cancer Surgery. Medicina (Kaunas) 2023; 59:1129. [PMID: 37374333 DOI: 10.3390/medicina59061129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: It remains unclear which domains of preoperative health-related quality of life (HRQOL) and mental health are predictive of postoperative clinical and patient-reported outcomes in colorectal cancer (CRC) patients. Materials and Methods: A prospective cohort of 78 CRC patients undergoing elective curative surgery was recruited. The EORTC QLQ-C30 and HADS questionnaires were administered preoperatively and one month after surgery. Results: Preoperative cognitive functioning scores (95% CI 0.131-1.158, p = 0.015) and low anterior resection (95% CI 14.861-63.260, p = 0.002) independently predicted poorer 1-month postoperative global QOL. When postoperative complications were represented using the comprehensive complication index (CCI), poorer preoperative physical function scores were associated with higher CCI scores (B = -0.277, p = 0.014). Preoperative social function score (OR = 0.925, 95% CI 0.87 to 0.99; p = 0.019) was an independent predictor for 30-day readmission, while physical functioning score (OR = -0.620, 95% CI -1.073--0.167, p = 0.008) was inversely related to the length of hospitalization. The overall regressions for 1-month postoperative global QOL (R2: 0.546, F: 1.961, p = 0.023) and 30-day readmission (R2: 0.322, χ2: 13.129, p < 0.001) were statistically significant. Conclusions: Various QLQ-C30 domains were found to be predictive of postoperative outcomes, including complications, readmission, and length of hospitalization. Preoperative cognitive dysfunction and low AR were independent predictors of poorer postoperative global QOL. Future research should seek to examine the efficacy of targeting specific baseline QOL domains in improving clinical as well as patient-reported outcomes after CRC surgery.
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Affiliation(s)
- Jia-Hao Law
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Jerrald Lau
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore
| | - Ning-Qi Pang
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Athena Ming-Gui Khoo
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Wai-Kit Cheong
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Bettina Lieske
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Choon-Seng Chong
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Kuok-Chung Lee
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Ian Jse-Wei Tan
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Bei-En Siew
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Yi-Xuan Lim
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Chermaine Ang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Lina Choe
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Wei-Ling Koh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Alyssa Ng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Ker-Kan Tan
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore
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Choe L, Lau J, Fong SY, Chew E, Chow WM, Pang Y, Lim TZ, Chong CS, Chew MH, Foo FJ, Koh FHX, Wong ML, Koh GCH, Tan KK. Colorectal cancer patients advocating screening to their siblings: a randomized behavioral intervention. Gastrointest Endosc 2022; 95:519-526.e2. [PMID: 34896444 DOI: 10.1016/j.gie.2021.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/20/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Siblings of colorectal cancer (CRC) patients are at increased risk of developing CRC, but screening rates remain low. Through a randomized behavioral intervention, this study aimed to determine whether patients can advocate screening to their siblings using a tailored educational package. METHODS CRC survivors were recruited and randomized into relaying either tailored materials (intervention group) or existing national screening guidelines (control group) to their siblings. Siblings could respond to the study team if they were interested in learning about CRC screening. Study outcomes were patient advocacy rates (number of patients who had successfully contacted at least 1 eligible sibling) between groups and the proportion of eligible siblings who responded. RESULTS Between May 2017 and March 2021, 219 CRC patients were randomized to the intervention (n = 110) and control (n = 109) groups. Patient advocacy rates were high and did not differ significantly between groups. However, only 14.3% of eligible siblings (n = 85) responded to the study team. Siblings of patients from the intervention group were more likely to respond (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0; P < .05). Moreover, after controlling for potential confounders, siblings aged ≥60 years were significantly less likely to respond (adjusted odds ratio, .3; 95% confidence interval, .1-.7; P < .01). CONCLUSIONS CRC patients are willing advocates of screening, and siblings contacted by patients from the intervention group were also more likely to reach out to the study team. However, overall sibling response rates were low despite advocacy, suggesting that patient-led advocacy should at best be used as an adjunct to other, multipronged CRC screening promotion modalities.
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Affiliation(s)
- Lina Choe
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Si-Ying Fong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emily Chew
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen-Min Chow
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yan Pang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tian-Zhi Lim
- Division of Surgical Oncology, National University Cancer Institute, Singapore
| | - Choon-Seng Chong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Surgical Oncology, National University Cancer Institute, Singapore; University Surgical Cluster, National University Health System, Singapore
| | - Min-Hoe Chew
- Department of Colorectal Surgery, Division of General Surgery, Sengkang General Hospital, Singapore
| | - Fung-Joon Foo
- Department of Colorectal Surgery, Division of General Surgery, Sengkang General Hospital, Singapore
| | - Frederick Hong-Xiang Koh
- Department of Colorectal Surgery, Division of General Surgery, Sengkang General Hospital, Singapore
| | - Mee-Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Surgical Oncology, National University Cancer Institute, Singapore; University Surgical Cluster, National University Health System, Singapore
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Desi N, Tong QY, Teh V, Chan JJ, Zhang B, Tabatabaeian H, Tan HQ, Kapeli K, Jin W, Lim CY, Kwok ZH, Tan HT, Wang S, Siew BE, Lee KC, Chong CS, Tan KK, Yang H, Kappei D, Yeo GW, Chung MCM, Tay Y. Global analysis of RNA-binding proteins identifies a positive feedback loop between LARP1 and MYC that promotes tumorigenesis. Cell Mol Life Sci 2022; 79:147. [PMID: 35195778 PMCID: PMC11072786 DOI: 10.1007/s00018-021-04093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
In addition to genomic alterations, aberrant changes in post-transcriptional regulation can modify gene function and drive cancer development. RNA-binding proteins (RBPs) are a large class of post-transcriptional regulators that have been increasingly implicated in carcinogenesis. By integrating multi-omics data, we identify LARP1 as one of the most upregulated RBPs in colorectal cancer (CRC) and demonstrate its oncogenic properties. We perform LARP1:RNA interactome profiling and unveil a previously unexplored role for LARP1 in targeting the 3'UTR of oncogenes in CRC. Notably, we identify the proto-oncogenic transcription factor MYC as a key LARP1-regulated target. Our data show that LARP1 positively modulates MYC expression by associating with its 3'UTR. In addition, antisense oligonucleotide-mediated blocking of the interaction between LARP1 and the MYC 3'UTR reduces MYC expression and in vitro CRC growth. Furthermore, a systematic analysis of LARP1:protein interactions reveals IGF2BP3 and YBX1 as LARP1-interacting proteins that also regulate MYC expression and CRC development. Finally, we demonstrate that MYC reciprocally modulates LARP1 expression by targeting its enhancer. In summary, our data reveal a critical, previously uncharacterized role of LARP1 in promoting CRC tumorigenesis, validate its direct regulation of the proto-oncogene MYC and delineate a model of the positive feedback loop between MYC and LARP1 that promotes CRC growth and development.
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Affiliation(s)
- Ng Desi
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Qing Yun Tong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - Velda Teh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - Jia Jia Chan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - Bin Zhang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - Hossein Tabatabaeian
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - Hui Qing Tan
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Katannya Kapeli
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Wenhao Jin
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Chun You Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - Zhi Hao Kwok
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
- Division of Pulmonary and Critical Care, Boston University, Boston, MA, 02118, USA
| | - Hwee Tong Tan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Shi Wang
- Department of Pathology, National University Health System, Singapore, Singapore
| | - Bei-En Siew
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuok-Chung Lee
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Choon-Seng Chong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Henry Yang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Dennis Kappei
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Gene W Yeo
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Department of Cellular and Molecular Medicine, Stem Cell Program and Institute for Genomic Medicine, University of California, La Jolla, San Diego, USA
| | - Maxey Ching Ming Chung
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore
| | - Yvonne Tay
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117596, Singapore.
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Chong C, Lin S, Liang Buan B, Sim W, Jain S, Ying Chang H, Lee K. Side-to-side versus end-to-side ileocolic anastomosis in right-sided colectomies: A cohort control study. J Minim Access Surg 2022; 18:408-414. [PMID: 35046183 PMCID: PMC9306133 DOI: 10.4103/jmas.jmas_161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims: The three main types of anastomotic configurations following colorectal resection are Side-to-Side Anastomosis (S-S), End-to-Side Anastomosis (E-S) and End-to-End Anastomosis (E-E). This study aims to present results from a local cohort supplemented by a systematic review with meta-analysis of existing literature to compare the post-operative outcomes between E-S and S-S. Methods: A cohort study of patients who underwent right colectomy with E-S or S-S anastomosis, was conducted at the National University Hospital Singapore. Electronic databases Embase and Medline were systematically searched from inception to 21 August 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Studies were included if they compared post-operative outcomes between E-S and S-S. Results: In the cohort study, 40 underwent E-S and 154 underwent S-S. Both post-operative ileus (12.5% vs. 29.2%, P = 0.041) and length of hospital stay (9.35 days vs. 14.04 days, P = 0.024) favoured E-S, but anastomotic bleed favoured S-S (15.0% vs. 3.2%, P = 0.004). Five studies were included in the meta-analysis with 860 E-S and 1126 S-S patients. Similarly, post-operative ileus (odds ratio [OR] =0.302; 95% confidence interval [CI]: 0.122–0.747; P = 0.010) and length of hospital stay (mean differences = ‒1.54 days; CI: ‒3.00 to ‒0.076 days; P = 0.039) favoured E-S. Additional sensitivity analysis including only stapled anastomosis showed a lower rate of anastomotic leak in E-S patients (OR = 0.185; 95% CI: 0.054–0.627; P = 0.007). Conclusions: This is the first systematic review to show that the E-S technique produces superior post-operative outcomes after right colectomy compared to S-S. However, the choice of anastomosis was largely surgeon dependent, but surgeon factors were not reported.
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Desi N, Teh V, Tong QY, Lim CY, Tabatabaeian H, Chew XH, Sanchez-Mejias A, Chan JJ, Zhang B, Pitcheshwar P, Siew BE, Wang S, Lee KC, Chong CS, Cheong WK, Lieske B, Tan IJW, Tan KK, Tay Y. MiR-138 is a potent regulator of the heterogenous MYC transcript population in cancers. Oncogene 2022; 41:1178-1189. [PMID: 34937878 PMCID: PMC8856960 DOI: 10.1038/s41388-021-02084-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022]
Abstract
3'UTR shortening in cancer has been shown to activate oncogenes, partly through the loss of microRNA-mediated repression. This suggests that many reported microRNA-oncogene target interactions may not be present in cancer cells. One of the most well-studied oncogenes is the transcription factor MYC, which is overexpressed in more than half of all cancers. MYC overexpression is not always accompanied by underlying genetic aberrations. In this study, we demonstrate that the MYC 3'UTR is shortened in colorectal cancer (CRC). Using unbiased computational and experimental approaches, we identify and validate microRNAs that target the MYC coding region. In particular, we show that miR-138 inhibits MYC expression and suppresses tumor growth of CRC and hepatocellular carcinoma (HCC) cell lines. Critically, the intravenous administration of miR-138 significantly impedes MYC-driven tumor growth in vivo. Taken together, our results highlight the previously uncharacterized shortening of the MYC 3'UTR in cancer, and identify miR-138 as a potent regulator of the heterogenous MYC transcript population.
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Affiliation(s)
- Ng Desi
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore ,grid.4280.e0000 0001 2180 6431Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597 Singapore
| | - Velda Teh
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Qing Yun Tong
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Chun You Lim
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Hossein Tabatabaeian
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Xiao Hong Chew
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Avencia Sanchez-Mejias
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore ,grid.5612.00000 0001 2172 2676Present Address: Department of Experimental and Health Sciences, Pompeu Fabra University, 08003 Barcelona, Spain
| | - Jia Jia Chan
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Bin Zhang
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Priyankaa Pitcheshwar
- grid.4280.e0000 0001 2180 6431Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
| | - Bei-En Siew
- grid.4280.e0000 0001 2180 6431Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shi Wang
- grid.410759.e0000 0004 0451 6143Department of Pathology, National University Health System, Singapore, Singapore
| | - Kuok-Chung Lee
- grid.410759.e0000 0004 0451 6143Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Choon-Seng Chong
- grid.4280.e0000 0001 2180 6431Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.410759.e0000 0004 0451 6143Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Wai-Kit Cheong
- grid.410759.e0000 0004 0451 6143Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Bettina Lieske
- grid.4280.e0000 0001 2180 6431Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.410759.e0000 0004 0451 6143Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ian Jse-Wei Tan
- grid.410759.e0000 0004 0451 6143Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- grid.4280.e0000 0001 2180 6431Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.410759.e0000 0004 0451 6143Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Yvonne Tay
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore. .,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.
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Lee KY, Lau J, Siew BE, Chua YK, Lim YX, Lim XY, Chong CS, Tan KK. Does pulmonary metastasectomy of colorectal metastases translate to
better survival? A systematic review. Ann Acad Med Singap 2021. [DOI: 10.47102/annals-acadmedsg.2021255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Introduction: Surgical resection of the primary and metastatic tumour is increasingly recommended
in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well
studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases.
This systematic review was conducted to examine the current evidence on the role of lung metastasectomy
(LUM) in CRC.
Methods: Three databases were systematically searched, to identify studies that compared survival
outcomes of LUM, and factors that affected decision for LUM.
Results: From a total of 5,477 records, 6 studies were eventually identified. Two papers reported
findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival
benefit in patients who underwent LUM compared to those who did not. When compared against patients
who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent
LUM were also more likely to have a single pulmonary tumour, and metachronous disease.
Conclusion: The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective
reviews, and the single randomised clinical trial performed was not completed. More prospective studies
are required to understand the true effect of LUM on outcomes in metastatic CRC.
Keywords: Colorectal cancer, pulmonary metastasectomy, pulmonary metastases, survival
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Affiliation(s)
- Kai-Yin Lee
- National University Health System, Singapore
| | | | | | | | | | - Xin-Yi Lim
- National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- National University Health System, Singapore
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Buan JLB, So WZ, Lim XC, Chong CS. Outcomes of robotic low anterior resection versus transanal total mesorectal excision for rectal cancer. BJS Open 2021; 5:6395103. [PMID: 34642737 PMCID: PMC8511809 DOI: 10.1093/bjsopen/zrab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background The quality of total mesorectal excision (TME) is regarded as a fundamental key to the oncological outcome of rectal cancer. Robotic low anterior resection (RLAR) and transanal TME (TaTME) were developed to overcome the technical challenges of conventional open TME. This study aimed to compare the short- and long-term outcomes of RLAR versus TaTME for rectal cancer. Methods Retrospective data from patients undergoing RLAR or TaTME at a colorectal unit in Singapore were analysed. The primary outcomes were the short-term clinical and pathological results including specimen margins and quality of TME. Secondary outcomes were recurrence, disease-free survival (DFS), and overall survival rates. Results A total of 80 patients who underwent either RLAR or TaTME were analysed. The TaTME group had a shorter operating time than the RLAR group (354 versus 481 min respectively; P < 0.001) and fewer stays in the high-dependency and intensive care units (38.1 versus 73.7 per cent; P = 0.010). There was a higher rate of readmissions at 30 days in the TaTME group (19.0 versus 0 per cent; P = 0.006). Specimens from TaTME had greater proximal (14.0 versus 10.0 cm; P = 0.045) and distal (2.50 versus 1.65 cm; P = 0.021) margins. Patients undergoing TaTME had borderline longer DFS (25.9 versus 15.7 months; P = 0.049). Subgroup analysis of patients with (y)pT3–4 tumours showed fewer positive circumferential resection margins with TaTME (0 versus 18.2 per cent; P = 0.019) and improved DFS (25.9 versus 15.7 months; P = 0.017). Conclusion Superior margins were obtained with TaTME, especially in locally advanced tumours, although TaTME was associated with a higher readmission rate compared with RLAR.
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Affiliation(s)
- J L B Buan
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore
| | - W Z So
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - X C Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore
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Lim XC, Nistala KRY, Ng CH, Lin SY, Tan DJH, Ho KY, Chong CS, Muthiah M. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis. World J Gastroenterol 2021; 27:3925-3939. [PMID: 34321855 PMCID: PMC8291020 DOI: 10.3748/wjg.v27.i25.3925] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/21/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has shown to be effective in management of colorectal neoplasm in the Asian countries, while its implementation in Western countries where endoscopic mucosal resection (EMR) is preferred is still debatable.
AIM To compare the surgical, histological, and oncological outcomes between ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.
METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc, complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR.
RESULTS Of 281344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world.
CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR. With appropriate training, ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps, without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.
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Affiliation(s)
- Xiong Chang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | | | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Choon-Seng Chong
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Mark Muthiah
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
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9
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Wong C, Lim WH, Jain SR, Ng CH, Tai CH, Devi MK, Samarasekera DD, Iyer SG, Chong CS. 46 The Hidden Truth About Gender Bias in Surgery. A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Gender discrimination remains pervasive in surgery, significantly impacting current and future surgeons and population health. This study analyses the gender barriers and critical retention factors for female surgeons and trainees in surgery.
Method
Five electronic databases were searched till May 2020. Titles and abstracts were sieved, followed by a full text review. Data synthesis and inductive thematic analysis were conducted using the Thomas and Harden methodology.
Result
14 articles were included, involving 528 participants. Four themes were generated–unfavourable working environment, male-dominated culture, societal pressures and progress towards gender equality. Females in surgery often faced harassment, disrespect and perceptions of incompetence, resulting in hostile work conditions, which were aggravated by the inadequate support and mentorship. The persistence of male-dominated cultures was observed, with females facing prejudice and exclusion from professional and social circles. Differential treatment and higher expectations of female surgeons also arose from entrenched societal pressures. Despite these, increased acceptance of motherhood and greater recognition of contributions by female surgeons were reported, indicating some progress in gendered culture.
Conclusions
There is a need to increase female surgical leadership and allocate resources to address the deep-rooted causes of biased surgical culture and ingrained perceptions, to achieve greater gender equality in surgery.
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Affiliation(s)
- C Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Tai
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - M K Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - D D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S G Iyer
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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10
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Koh JWH, Ng CH, Lee MH, Chin YH, Ong ZH, Tham HY, Chong CS, Shim HH, Fo FJ. 19 Colectomy Rate for Moderate to Severe Ulcerative Colitis with Biologics. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Biologics are recommended by both the ACG and ECCO community for the treatment of ulcerative colitis. Yet, current literature has yet to estimate the rate of colectomies after biologic therapy, and thus a pooled meta-analysis was conducted the rate of colectomies in 1month, 6 months, 1 year, 2years and five years after biologics.
Method
Medline and Embase were searched for articles examining biologics use in moderate to severe UC or acute severe UC (ASUC) from inception to 21st May 2020. Analysis of proportions were undertaken after a freeman-tukey double arcsine transformation.
Results
The pooled overall colectomy rates of ASUC and moderate to severe UC were 9% (CI: 4% - 14%) at one month, 18% (CI: 13% - 25%) at six months, 21% (CI:16% - 27%) at one year, 29% (CI:24% - 34%) at two years and 38% (CI:30% - 45%) at five years. Additionally, colectomy rates were consistently lower comparing between articles before and after 2010. At one-year, overall colectomy rate following infliximab use was at 25%, golimumab at 15%, vedolizumab at 14%, and adalimumab at 3%.
Conclusions
Colectomy rates in the era of biologics ranged from 8% to 38% and lower post-2010 showing significant improvement in management and supporting the utility of biologics in Ulcerative colitis management.
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Affiliation(s)
- J W H Koh
- National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - M H Lee
- National University Singapore, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z H Ong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - C S Chong
- National University Hospital, Singapore, Singapore
| | - H H Shim
- Singapore General Hospital, Singapore, Singapore
| | - F J Fo
- Sengkang General Hospital, Singapore, Singapore
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11
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Ow ZGW, Sim W, Nistala KRY, Ng CH, Chong CS. 10 Complete Mesocolic Excision Produces Favorable Survival Outcomes Compared to Conventional Colectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Conventional colectomy, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) D2 Lymphadenectomy (LND2), are the standards of care for the surgical management of colon cancer. Colectomy with complete mesocolic excision (CME) and JSCCR D3 Lymphadenectomy (LND3) are alternative, and more radical procedures, that provide greater lymph nodal clearance. However, controversy exists over the long-term survival benefits of CME/LND3 over non-CME colectomies (NCME)/LND2.
Method
In this study, we performed a meta-analysis to compare the survival outcomes of CME/LND3 with NCME/LND2. Medline and Embase databases were searched for articles reporting survival outcomes of both CME/LND3 and NCME/LND2, with comparisons presented using odds ratios (OR).
Results
Ten studies were included in this analysis. Overall and disease-free survival favored CME/LND3 (3-year OS: OR = 1.56; CI 1.22-2.00; p = 0.0004, 5-year OS: OR = 1.29; CI 1.02-1.64, p = 0.03, 3-year DFS: OR = 1.45; CI 1.12-1.88; p = 0.005, 5-year DFS: OR = 1.61; CI 1.14-2.28; p = 0.007). Overall and disease-free survival rates at five years were 79.8% and 85.9%, and 74.6% and 78.0%, in the CME/LND3 and NCME/LND2 groups respectively.
Conclusions
This is the first meta-analysis to demonstrate that CME/LND3 has superior long-term survival outcomes compared to NCME/LND2, hence a strong case can be made for incorporating CME/LND3 into standard care practice.
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Affiliation(s)
- Z G W Ow
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - W Sim
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - K R Y Nistala
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C H Ng
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C S Chong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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12
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Lim SY, Wang R, Tan DJH, Chin YH, Ng CH, Tham HY, Buan BJL, Chong CS. 368 Perioperative Outcomes in Open versus Laparoscopic Surgery in Elderly Patients Undergoing Right Hemicolectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients.
Method
We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted.
Results
84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS.
Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance.
Conclusions
LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.
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Affiliation(s)
- S Y Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - R Wang
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - D J H Tan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - B J L Buan
- National University Hospital, Singapore, Singapore
| | - C S Chong
- National University Hospital, Singapore, Singapore
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13
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Ng CH, Jain SR, Ow ZGW, Lim WH, Tham HY, Wong NW, Chong CS, Foo FJ. 20 Post-Operative Biologics and the Rate of Recurrence in Crohn’s Disease. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Post-operative recurrence after Crohn’s surgery poses a significant challenge to clinicians with an estimated of 70-90% recurrence rate. However, with the advent of biologics, reduction of recurrence after surgery has been observed in various landmark trials. Hence, we aim to quantify the rate of recurrence with post-operative biologics.
Method
Searches were done on Embase and Medline database for articles using biologics for post-operative management. A single arm meta-analysis with generalized linear mixed model and Clopper-Pearson method confidence interval was applied in the synthesis of the data on six months, one year, two year and five year.
Results
A total of 1,864 abstracts were identified, with a final total of 24 articles and 1042 patients were included in the meta-analysis. The one-year rate of recurrence for surgical, endoscopic and clinical was 3.08% (CI: 0.74% - 11.95%), 19.93% (15.81% - 24.81%) and 13.06% (CI: 8.18% - 18.92%) respectively. Correspondingly, the five-year recurrence 16.90% (CI: 9.57% - 28.11%), 84.21% (CI: 72.35% - 91.57%), 5.60% (CI: 9.92% -23.66%) respectively.
Conclusions
An observed reduction in surgical rates was reduced at five years with post-operative Crohn’s disease with biologics. Biologics therapy thus can be considered as a suitable alternative for reducing post-operative recurrence in individuals with higher risk.
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Affiliation(s)
- C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - N W Wong
- National University Hospital, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - F J Foo
- Sengkang General Hospital, Singapore, Singapore
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14
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Nistala KRY, Yeo JW, Ow ZGW, Ng CH, Law JH, Wong KY, Soon YY, Chong CS. 295 Radiotherapy for Curative-intent Metastatic Rectal Cancer: A Systematic Review and Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The role and optimal regimen of radiotherapy in curative-intent treatment of metastatic rectal cancer is unclear and hence a single arm meta-analysis was performed.
Method
Medline, Embase and Cochrane Library databases were searched up to 16 May 2020. A Meta-analysis of binomial data was performed using a Freeman-Tukey double arcsine transformation, and pooled estimates were used to construct risk ratios and confidence intervals via the Katz-logarithmic method. Additionally, comparative meta-analysis was performed with the Mantel Haenszel model.
Results
18 studies were included. Rectal pathological complete response (pCR) was observed in 14% of tumours treated with radiotherapy (n = 57/388, CI 0.07 to 0.23). Comparative meta-analysis of cohort studies showed that treatment regimens including radiotherapy were associated with higher pT1 tumour and better oncological outcomes compared to regimens without radiotherapy. Katz-logarithmic method showed that neoadjuvant radiotherapy had a higher proportion of pN0 staging (RR = 1.81, 95% CI 1.06 to 3.09, p = 0.029) and better oncological outcomes compared to adjuvant radiotherapy, and that short course radiotherapy (SCRT) had a lower proportion of pT3 tumours (RR = 0.778, 95% CI 0.609 to 0.994, p = 0.044) and similar oncological outcomes compared to long course radiotherapy (LCRT).
Conclusions
This study supports the evidence that radiotherapy should be used in curative intent metastatic rectal cancer.
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Affiliation(s)
- K R Y Nistala
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J W Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J H Law
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - K Y Wong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Y Y Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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15
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Tay PWL, Xiao JL, Lim WH, Wong NW, Chong CS. 207 Laparoscopic versus Open Surgery for Locally Advanced Colon Cancer: A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
While an increasing number of studies substantiate the non-inferiority of laparoscopy to open surgery for pT4 colon cancer, studies investigating its value specific to the subgroup pT4a in right hemicolectomies remain scarce.
Method
We performed a retrospective cohort analysis in National University Hospital of Singapore of patients who underwent a right hemicolectomy for pT4 colon cancer. Statistical analysis was performed using Wilcoxon rank sum test and chi square/fisher exact.
Results
In total, 65 patients had T4 colon cancer. 55 underwent right hemicolectomy and 10 underwent extended right hemicolectomy. Baseline demographics were similar in laparoscopic (n = 27) and open (n = 38) groups, with no significant difference in proportion of pT4a patients (p = 0.724). For pT4, 30-day mortality (7%, 5% respectively, p = 0.723), overall survival (p = 0.1903) and disease-free survival (p = 0.3476) did not differ significantly between laparoscopic and open groups. R0 resection rates were significantly higher in laparoscopic group (p = 0.039). pT4a subgroup analysis found similar observations. Other complications including postoperative wound infection and anastomotic bleed were not significantly different for both T4 and T4a analysis.
Conclusions
This study presented comparable safety and oncological outcomes between the two surgical methods for right hemicolectomy, suggesting laparoscopy to be a viable alternative approach for locally advanced right colon cancer.
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Affiliation(s)
- P W L Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J L Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - N W Wong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore, Singapore
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16
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Ng CH, Chin YH, Nistala KRY, Jain SR, Ow ZGW, Wong NW, Tham HY, Lim WH, Chong CS. 189 Preliminary Results from an Innovative Surgical Research Group for Medical Students. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Learning research in medical school can be daunting and difficult with many lacking appropriate guidance. Particularly, research in surgery can be difficult with most clinicians tied to long hours from clinical duties, leaving medical students lost to learn the ropes for medical research.
Method
We started a surgical research group in January of 2020 under a shepherd sheep model. Shepards were senior medical students who had previous experience in research and were provided resources from consultants on statistics and research designs. Thereafter, each Shepard were paired with junior medical students (sheep) and a resident to provide clinical background. Research was then carried out small teams with minimal guidance from consultants.
Results
To date, the group has published 11 articles (median impact factor: 2.41, range: 1.89 - 3.42), 3 articles in revision and 9 articles in review.
Conclusions
We provide preliminary evidence of a successful model for building medical student research in surgery. While current analysis was limited to meta-analysis and systematic review due to the availability of data, current expansion is currently underway to expand to observational studies.
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Affiliation(s)
- C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - K R Y Nistala
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - N W Wong
- National University Hospital, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, Singapore, Singapore
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17
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Lee MH, Ng CH, Chin YH, Muthiah M, Foo FJ, Chong CS. Incidence of SARS-CoV-2 infection in inflammatory bowel disease. J Gastroenterol Hepatol 2020; 35:2021-2022. [PMID: 32779774 PMCID: PMC7404756 DOI: 10.1111/jgh.15191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023]
Affiliation(s)
- M H Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - M Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - F J Foo
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore
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18
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Koh FH, Chan HL, Petersson F, Chong CS. Thinking out of the Gut: a case of obscure lower GI bleeding. Gut 2017; 66:2068-2159. [PMID: 27965282 DOI: 10.1136/gutjnl-2016-313252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/08/2022]
Abstract
CLINICAL PRESENTATION A middle-aged man was admitted for episodes of fresh per-rectal bleeding, which were not associated with defecation. He was recently investigated for macrocytic anaemia in the outpatient haematology clinic. Examination of the perineum revealed grade 1 internal haemorrhoids with no signs of bleeding.Initial laboratory tests revealed macrocytic anaemia (haemoglobin 10.5 g/dL, normal 12.9-17.0 g/dL; mean corpuscular haemoglobin 95.3 fL, normal 80.0-95.0 fL). Peripheral blood film showing blasts, dysplastic neutrophils, nucleated red blood cells and hypogranular platelets.The patient underwent a sigmoidoscopy and rubber band ligation of the internal haemorrhoids after persistent fresh per-rectal bleeding. The bleeding persisted with the development of hypotension and a significant drop of haemoglobin to 4.8 g/dL requiring blood transfusions and intensive care monitoring. Repeated endoscopy, including intubation of the terminal ileum, revealed uncomplicated right-sided diverticulosis. CT mesenteric angiography performed during an episode of significant bleeding revealed extravasation of contrast in the ileum, but mesenteric angiography was unsuccessful, possibly due to a temporary cessation of bleeding. Bleeding subsequently recurred and in light of the persistent bleeding with no clear source and with a total of 12 units of packed cell transfused, exploratory laparotomy, on-table enteroscopy (figure 1) with small bowel resection was performed. Histopathological examination of the specimen was performed (figures 2-4).gutjnl;66/12/2068/GUTJNL2016313252F1F1GUTJNL2016313252F1Figure 1Multiple ileal lesions with stigmata of recent bleed.gutjnl;66/12/2068/GUTJNL2016313252F2F2GUTJNL2016313252F2Figure 2Area of ulceration associated with atypical mononuclear infiltrate.gutjnl;66/12/2068/GUTJNL2016313252F3F3GUTJNL2016313252F3Figure 3Atypical mononuclear infiltrate composed of cells with enlarged, irregular nuclei containing variably prominent nucleoli.gutjnl;66/12/2068/GUTJNL2016313252F4F4GUTJNL2016313252F4Figure 4Atypical cells displayed cytoplasmic expression of myeloperoxidase. QUESTION What is the diagnosis?
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Affiliation(s)
- Frederick H Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore, Singapore
| | - Hian-Li Chan
- Department of Haematology-Oncology, National Univeristy Hospital, National University Health System, Singapore, Singapore
| | - Fredrik Petersson
- Department of Haematology-Oncology, National Univeristy Hospital, National University Health System, Singapore, Singapore
| | - Choon-Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore, Singapore
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19
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Kow AWC, Ang BLS, Chong CS, Tan WB, Menon KR. Innovative Patient Safety Curriculum Using iPAD Game (PASSED) Improved Patient Safety Concepts in Undergraduate Medical Students. World J Surg 2017; 40:2571-2580. [PMID: 27417109 DOI: 10.1007/s00268-016-3623-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION While healthcare outcomes have improved significantly, the complex management of diseases in the hospitals has also escalated the risks in patient safety. Therefore, in the process of training medical students to be proficient in medical knowledge and skills, the importance of patient safety cannot be neglected. A new innovation using mobile apps gaming system (PAtient Safety in Surgical EDucation-PASSED) to teach medical students on patient safety was created. Students were taught concepts of patient safety followed by a gaming session using iPad games created by us. This study aims to evaluate the outcome of patient safety perception using the PASSED games created. METHODS An interactive iPad game focusing on patient safety issues was created by the undergraduate education team in the Department of Surgery, Yong Loo Lin School of Medicine at the National University of Singapore. The game employed the unique touched-screen feature with clinical scenarios extracted from the hospital sentinel events. Some of the questions were time sensitive, with extra bonus marks awarded if the student provided the correct answer within 10 s. Students could reattempt the questions if the initial answer was wrong. However, this entailed demerit points. Third-year medical students posted to the Department of Surgery experienced this gaming system in a cohort of 55-60 students. Baseline understanding of the students on patient safety was evaluated using Attitudes to Patient Safety Questionnaire III (APSQ-III) prior to the game. A 20 min talk on concept of patient safety using the WHO Patient Safety Guidelines was conducted. Following this, students downloaded the apps from ITune store and played with the game for 20-30 min. The session ended with the students completing the postintervention questionnaire. RESULTS A total of 221 3rd year medical students responded to the survey during the PASSED session. Majority of the students felt that the PASSED game had trained them to understand the processes of medical error (p < 0.001), that their understanding on patient safety issues improved (p = 0.007), and the training prepared them to prevent medical errors (p < 0.001). Many students also recognized the importance of error reporting, where they felt comfortable reporting errors committed by themselves (p < 0.001) or by other people (p < 0.001). They also felt comfortable discussing with the supervisor on medical errors (p < 0.001). Students responded that better teamwork will reduce medical errors (p = 0.003), and teaching teamwork skills will reduce medical errors (p = 0.002). After the PASSED session, students felt that patients could play an important role in preventing medical errors (p < 0.001). They felt that patient safety should be emphasized in undergraduate training (p = 0.024). The level of understanding about concepts of patient safety was also found to improve progressively from the 2nd posting to the 5th posting for both the pre-PASSED and post-PASSED intervention. The pre-PASSED scores for Posting 2 (3.59 ± 1.931), Posting 3 (4.11 ± 1.833), Posting 4 (4.84 ± 1.653), and Posting 5 (4.88 ± 1.642) were significantly higher than the post-PASSED scores for Posting 2 (4.46 ± 2.020), Posting 3 (5.17 ± 1.845), Posting 4 (5.88 ± 1.843), and Posting 5 (5.80 ± 1.843), respectively (p < 0.001). CONCLUSION Using iPad game (PASSED) to enhance the patient safety teaching has successfully improved the awareness and understanding of patient safety in clinical practice. This training model can be used to teach more senior medical students on the complexity of patient safety issues in medicine.
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Affiliation(s)
- A W C Kow
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, 1E, Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore.
| | - B L S Ang
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C S Chong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - W B Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K R Menon
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Xu R, Tan KK, Chong CS. Response to Re: Bacteriological study in perianal abscess is not useful and not cost-effective. ANZ J Surg 2017; 87:421. [PMID: 28470702 DOI: 10.1111/ans.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Roland Xu
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
| | - Choon-Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
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Xu RW, Tan KK, Chong CS. Response to Re: Bacteriological study in perianal abscess is not useful and not cost-effective. ANZ J Surg 2016; 86:954. [PMID: 27784139 DOI: 10.1111/ans.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Roland W Xu
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
| | - Choon-Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore
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Tan CHN, Chong CS, Fong YF, Rauff S, Tan KK. Laparoscopic Anterior Resection with Transvaginal Specimen Extraction (TVSE) for Colorectal Cancer and Concomitant Total Hysterectomy and Bilateral Salpingo-Oophrectomy (THBSO): A Technical Description. Ann Surg Oncol 2016; 24:441. [PMID: 27495281 DOI: 10.1245/s10434-016-5478-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Natural orifice specimen extraction (NOSE) has evolved to circumvent the need for a specimen extraction site. Transvaginal specimen extraction (TVSE) for colorectal disease has been shown to be safe and feasible in selected cases.1 , 2 We describe our technique of TVSE in a case of laparoscopic ultra-low anterior resection (ULAR) with defunctioning ileostomy (DI) with a concomitant total hysterectomy and bilateral salpingo-oophrectomy (THBSO). METHODS AND RESULTS A 74-year-old Chinese female was diagnosed with a mid-rectal cancer following colonoscopic evaluation for a change in bowel habits. Preoperative magnetic resonance imaging (MRI) suggested T2N0 disease and the patient was recommended for upfront surgery following multidisciplinary discussion. Computed tomography (CT) scan confirmed a 4.3 × 3.4 cm right adnexal cystic lesion, without enhancing septations or soft tissue component. No metastatic disease was identified. The patient underwent a laparoscopic ULAR with DI and THBSO with TVSE; operative time was 469 min. The specimen showed a 2.5 cm mid-rectal tumour. Histology revealed a pT3N1a moderately differentiated adenocarcinoma of the mid rectum, with 1 of 20 lymph nodes involved by metastatic carcinoma. The quality of the total mesorectal excision (TME) was good, with no breach in the mesorectal fascia. The distal and radial margins were 1.5 and 3.0 cm, respectively. The patient recovered well postoperatively, with minimal wound site pain, and was discharged well on postoperative day 5. CONCLUSION TVSE is oncologically safe and feasible in certain malignant colorectal pathologies. It is an option to consider in selected cases that require a concomitant gynecological procedure.
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Affiliation(s)
- Chun-Han Nigel Tan
- Division of Colorectal Surgery, Department of Surgery, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Choon-Seng Chong
- Division of Colorectal Surgery, Department of Surgery, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yoke-Fai Fong
- Division of Benign Gynaecology and Minimally Invasive Surgery, Department of Obstetrics and Gynaecology, National University Health System, Singapore, Singapore
| | - Shakina Rauff
- Division of Reproductive Endocrinology and Infertility and Minimally Invasive Surgery, Department of Obstetrics and Gynaecology, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, Department of Surgery, National University Health System, Singapore, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Affiliation(s)
- S W H Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - C S Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - D W K Chong
- School of Pharmacy, International Medical University, Bukit Jalil, Malaysia
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Xu RW, Tan KK, Chong CS. Bacteriological study in perianal abscess is not useful and not cost-effective. ANZ J Surg 2016; 86:782-784. [DOI: 10.1111/ans.13630] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/30/2016] [Accepted: 04/10/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Roland W. Xu
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital; National University Health System; Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital; National University Health System; Singapore
| | - Choon-Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital; National University Health System; Singapore
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Tan KK, Chong CS, Tsang CB, Koh DC. Outcomes Following Surgery for Distal Rectal Cancers: A Comparison between Laparoscopic and Open Abdomino-Perineal Resection. Med J Malaysia 2013; 68:348-352. [PMID: 24145265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Oncologic outcomes following laparoscopic abdomino-perineal resection (APR) for distal rectal cancer are infrequently reported. This study aims to compare the long term outcomes between laparoscopic and open APR in distal rectal cancers. METHODS A retrospective review of all patients who underwent APR for distal rectal cancer from May 2001 to November 2009 was performed. RESULTS Forty-two patients, median age 60 (24 - 86) years, formed the study group. Laparoscopic resection was attempted in 16 patients and was successful in all but one. Patients with recurrent diseases, previous abdominal operations and neoadjuvant chemoradiation were more likely to undergo open APR. There were no differences in the T-staging, number of lymph nodes harvested or the final stage of the disease between the two groups. The laparoscopic APR group had a shorter median length of hospitalization (7 vs. 10 days, p < 0.05), but longer operative duration (300 vs. 240 minutes, p > 0.05). Excluding the 9 (21.4%) patients with metastatic disease on presentation, 13 (39.4%) developed recurrence after a median follow up of 24 (4 - 107) months. Twenty (47.6%) patients died from their advanced disease subsequently while one (2.4%) died from a noncancer related cause. Analysis showed that tumour stage and circumferential resection margin positivity were associated with a poorer survival. The types of approach had no significant impact on the survival. CONCLUSION Laparoscopic APR for distal rectal cancer yields similar oncologic outcomes as open APR. Long-term outcome is determined by the tumour stage and circumferential resection margin and not the approach.
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Affiliation(s)
- K K Tan
- National University Health System, Department of Surgery, Division of Colorectal Surgery, Singapore.
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Tan KK, Wong J, Yan Z, Chong CS, Liu JZ, Sim R. Colonic diverticulitis in young Asians: a predominantly mild and right-sided disease. ANZ J Surg 2013; 84:181-4. [PMID: 23796226 DOI: 10.1111/ans.12273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND The management of diverticulitis in young Asian patients remains challenging. This study aimed to highlight the issues of managing diverticulitis in young Asians. METHODS A retrospective review of all patients who were admitted for acute colonic diverticulitis from October 2003 to December 2008 was performed. Patients who were ≤50 year old were considered 'young' and formed the study group. RESULTS The study group consisted of 142 patients. The majority (n = 126, 88.7%) had right-sided diverticulitis and most (n = 117, 82.4%) were mild in severity. Most of the patients who underwent emergency surgery were for suspected appendicitis (39/56, 69.6%). When we compared between those aged ≤50 and >50 years, the older group had worse diverticulitis (odds ratio (OR), 4.90, 95% confidence interval (CI), 2.00-11.99), been operated for indications other than suspected appendicitis (OR, 13.08, 95% CI, 5.42-31.56) and undergone a colectomy (OR, 9.96, 95% CI, 4.12-24.10). The younger group had a much higher incidence of right-sided disease (OR: 7.80, 95% CI: 4.32-14.07). Over a median follow-up of 40 (6-90) months, 7 (4.9%) patients were readmitted for a total of eight times for recurrent attacks of diverticulitis and all were successfully treated conservatively. Five other patients underwent elective surgery for persistent symptoms. CONCLUSION Diverticulitis in young Asians is often right-sided and mild in severity. A significant proportion is only diagnosed when operated for presumed appendicitis. Recurrent attacks are uncommon and can often be treated non-surgically.
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Affiliation(s)
- Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore
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Abstract
INTRODUCTION Management of sigmoid volvulus is often challenging because of its prevalence in high-risk patients and the associated perioperative morbidity and mortality rates. This study was designed to review the management and outcome of all patients admitted with sigmoid volvulus. METHODS A retrospective review of all patients who were admitted for sigmoid volvulus from October 2001 to June 2009 was performed. Diagnosis was confirmed on clinical evaluation, radiological studies, and/or intraoperative findings. RESULTS Seventy-one patients, median age 73 (range, 17-96) years, were admitted a total of 134 times for acute sigmoid volvulus during the study period. The majority (n = 51, 71.8%) were older than aged 60 years, and 41 (57.7%) had at least one premorbid condition. Seven (9.9%) patients underwent emergency surgery on presentation. The remaining 64 (90.1%) patients were initially managed conservatively using a flatus tube and/or sigmoidoscopic decompression. One patient had an endoscopic-related perforation and required emergency surgery. Another ten patients failed conservative management for which nine underwent operative intervention. The last patient refused surgery and died subsequently. Fifty-three (74.6%) patients had successful conservative management; seven of them underwent elective surgery subsequently. Of the remaining 46 patients, 28 (60.9%) were admitted for recurrent sigmoid volvulus. Of these 28 patients, 12 eventually had elective surgery after successful decompression, whereas the remaining 16 were not operated. In our series, three patients died after emergency surgery and there was no mortality after elective surgery. Another six patients died from medical conditions that were unrelated to sigmoid volvulus. CONCLUSIONS Acute sigmoid volvulus is a surgical emergency, although the majority (75%) can be successfully decompressed nonoperatively. Emergency surgery in these patients is associated with a mortality of 17.6% in our series. Elective definitive surgery is suggested in view of the high recurrence rate (>60%) and the considerable risks of emergency surgery.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
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Chan CYW, Kwan MK, Saw LB, Deepak AS, Chong CS, Liew TM, Lee CS. Post-operative health related quality of life assessment in scoliosis patients. Med J Malaysia 2008; 63:137-139. [PMID: 18942300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adolescent Idiopathic Scoliosis is a spinal deformity which affects patients' self image and confidence. Surgery is offered when the curve is more than 50 degrees based on its likelihood of progression. Studies on the radiological outcome of scoliosis correction are abundant. Therefore, it is the objective of this study to evaluate the health related quality of life in scoliosis patients who had undergone surgical correction in University Malaya Medical Center, Kuala Lumpur, Malaysia using Scoliosis Research Society-22 (SRS-22) patient questionnaire. This is a prospective evaluation of SRS-22 scores of thirty eight patients operated in our center over the past five years with a minimum follow up of one year. There were thirty two females and six males. Twenty six (68.4%) were Chinese, eight (21.1%) Malay and four (10.5%) Indian patients. The age of the patients ranged from twelve to twenty eight years, with a mean age of 18.4 +/- 3.5. Based on the King and Moe's classification, sixteen patients had King's 3 curve. The mean pre-operative Cobb angle was 68.6 degree and post-operative Cobb angle was 35.8 degree. The average curve correction was 48.5%. The overall score for SRS-22 was 4.2. The SRS-22 scores were highest for the pain domains and lowest for the functional domains. Satisfaction domain scored 4.3. The function domain scored significantly higher in those who have twenty four months or less follow up duration. Curve magnitude and the amount of correction did not significantly alter the SRS scores. In conclusion, patients were satisfied with the outcome of their operation. Although pain was common, the intensity of the pain was minimal. The amount of curve correction did not correlate with the quality of life after operation.
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Affiliation(s)
- C Y W Chan
- Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur.
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Abstract
We report a case of vertebral osteochondroma of C1 causing cord compression and myelopathy in a patient with hereditary multiple exostosis. We highlight the importance of early diagnosis and the appropriate surgery in order to obtain a satisfactory outcome.
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Affiliation(s)
- Y S Chooi
- University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Nutter FW, Tylka GL, Guan J, Moreira AJD, Marett CC, Rosburg TR, Basart JP, Chong CS. Use of remote sensing to detect soybean cyst nematode-induced plant stress. J Nematol 2002; 34:222-231. [PMID: 19265937 PMCID: PMC2620572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Integrating remote sensing and geographic information systems (GIS) technologies offers tremendous opportunities for farmers to more cost effectively manage the causes of crop stress. Initial soybean cyst nematode (SCN) population densities from 995 2-x-3-m quadrats were obtained from a soybean field near Ames, Iowa, in 2000. The percentage of sunlight reflected from each quadrat was measured weekly using a multispectral radiometer beginning in mid-May and continuing through mid-September. Aerial images were obtained at heights above the field ranging from 45 to 425 m on 12 dates during the soybean growing season. This was accomplished using color film and infrared film in conjunction with a filter to measure reflectance in the near-infrared region (810 nm). Satellite images (Landsat 7) were obtained for five dates during the 2000 growing season. Maps depicting initial SCN population densities, soybean yield, soy oil, and soy protein were generated using the GIS software program ArcView. Percentage reflectance (810 nm), aerial image intensity, and satellite image intensity data then were regressed against soybean yield, soy oil, and soy protein concentrations obtained from each geospatially referenced soybean quadrat. Percentage reflectance measurements explained up to 60% of the variation in initial SCN population densities within soybean quadrats and up to 91% of the variation in soybean yield. Aerial image and satellite image intensities explained up to 80% and 47% of the variation in soybean yield, respectively. Percentage reflectance data also explained 36% and 54% of the variation in oil and protein concentrations of the harvested soybeans, respectively. These results indicate that remote sensing coupled with GIS technologies may provide new tools to detect and quantify SCN population densities and their impacts on the quantity and quality of soybean yield.
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Lim HH, Chong CS. Scoliosis in a patient with lipodystrophy--treatment difficulties and literature review. Med J Malaysia 1999; 54:368-70. [PMID: 11045066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A 12 year-old Chinese schoolgirl presented with left-sided scoliosis at the age of 9 years. She has a rare defect in lipid metabolism, which is not known to be associated with spinal deformity. Her scoliotic curve deteriorated despite bracing. We report a rare occurrence of scoliosis in patient with lipodystrophy and the difficulty of using instrumented fusion in treating this condition.
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Affiliation(s)
- H H Lim
- Department of Orthopaedics, University of Malaya, Lembah Pantai, Kuala Lumpur
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Lo Nigro C, Chong CS, Smith AC, Dobyns WB, Carrozzo R, Ledbetter DH. Point mutations and an intragenic deletion in LIS1, the lissencephaly causative gene in isolated lissencephaly sequence and Miller-Dieker syndrome. Hum Mol Genet 1997; 6:157-64. [PMID: 9063735 DOI: 10.1093/hmg/6.2.157] [Citation(s) in RCA: 222] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Classical lissencephaly (smooth brain) or generalized agyria-pachygyria is a severe brain malformation which results from an arrest of neuronal migration at 9-13 weeks gestation. It has been observed in several malformation syndromes including Miller-Dieker syndrome (MDS) and isolated lissencephaly sequence (ILS). A gene containing beta-transducin like repeats, now known as LIS1, was previously mapped to the ILS/MDS chromosome region on 17p13.3. We recently localized the classical lissencephaly critical region to the LIS1 gene locus by molecular analysis of key ILS and MDS patients. We have now characterized the structure of LIS1, which consists of 11 exons, and have searched for the presence of subtle mutations in 19 ILS patients who showed no gross rearrangements of LIS1. Single strand conformational polymorphism (SSCP) analysis revealed band-shifts for three patients, each involving a different coding exon, which were not observed in their respective parental DNAs. Sequence analysis identified these de novo mutations as dA --> dG transition in exon VI at nucleotide 446, a dC --> dT transition in exon VIII at nucleotide 817, and a 22 bp deletion at the exon IX-intron 9 junction from nucleotide 988 to 1,002+7, which causes skipping of exon IX in the mature LIS1 transcript. These changes are predicted to result in an H149R amino acid substitution, an R273X premature translation termination, and abolition of amino acids 301-334, in the respective LIS1 proteins. These data thus confirm LIS1 as the gene responsible for classical lissencephaly in ILS and MDS.
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Affiliation(s)
- C Lo Nigro
- Laboratorio di Genetica Molecolare, San Raffaele Hospital, Milan, Italy
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Bradley DA, Chong CS, Tajuddin AA, Shukri A, Ghose AM. Low-momentum-transfer incoherent gamma -ray scattering by moderate- to high-atomic-number elements. Phys Rev A 1992; 45:2097-2100. [PMID: 9907206 DOI: 10.1103/physreva.45.2097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Bradley DA, Chong CS. Spectrometry and dosimetric evaluation of the gamma-ray emissions of 241Am. Int J Rad Appl Instrum A 1991; 42:767-70. [PMID: 1666633 DOI: 10.1016/0883-2889(91)90181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
New, detailed measurements have been made of the photon spectrum of the radionuclide 241Am. Observations, recorded for a 95% confidence level over local background, provide affirmation of a number of lines previously considered to be of equivocal existence. A number of hitherto unreported emissions are similarly observed. Peak areas, expressed as a percentage of that for the 59.54 keV emission, have been ascribed to all lines of the detailed spectrum. This leads to an estimated increase in the value of exposure calculated from the measured fluence spectrum, relative to that from the 59.54 keV line, of (3.1 +/- 0.8)%, taking into account all emissions beyond the predominating 59.54 keV gamma-ray emission.
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Affiliation(s)
- D A Bradley
- School of Physics, University of Science of Malaysia, Penang
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Bradley DA, Chong CS, Tajuddin AA, Shukri A, Ghose AM. Small-angle coherent gamma -ray scattering for moderate- to high-atomic-number elements. Phys Rev A 1990; 41:5974-5979. [PMID: 9903000 DOI: 10.1103/physreva.41.5974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
Low-energy X rays are clearly observed in the energy spectra of Amersham 137Cs afterloading sources. Examination is made of the effects of encapsulation and source train attenuation on the source spectra. Estimates of the resulting X-ray intensities are also made.
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Abstract
Photon absorptiometric measurements of several elements, mixtures and substances of biomedical interest have been performed. The 144.5 keV photons of 141Ce and the associated x-ray emissions of 203Hg at 75 keV and 137Cs at 33 keV in addition to the more commonly applied energies of 279.2 and 661.6 keV respectively, have been utilised. The concept of effective atomic numbers and the choice of tissue-equivalent substitutes has been examined with reference to the experimental findings.
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Chong CS, Ahmad GU. Gamma activity of some building materials in West Malaysia. Health Phys 1982; 43:272-273. [PMID: 7129886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Ni C, Kimball GP, Craft JL, Wang WJ, Chong CS, Albert DM. Calcifying epithelioma: a clinicopathological analysis of 67 cases with ultrastructural study of 2 cases. Int Ophthalmol Clin 1982; 22:63-86. [PMID: 7061199 DOI: 10.1097/00004397-198202210-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hu SJ, Chong CS, Subas S. 238U and 232Th in cassiterites samples and amang by-products. Health Phys 1981; 40:248-250. [PMID: 7216807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
The dynamic behaviour of model membranes in the form of sonicated liposomes in excess water was studied by means of 90 degrees C light scattering and turbidity measurements. Computer calculations based on the Rayleigh-Gans theory of light scattering were used to estimate the average size of lipid vesicles dispersed in water, taking into account the various structures of the vesicles. Normal reversible changes in the scattered light intensity and turbidity with temperature could be accounted for mainly by the changes in the refractive index of the lipid and irreversible anomalous changes were explained on the basis of fusion of smaller aggregated vesicles.
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