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Ng TP, Loo BYK, Yong N, Chia CLK, Lohsiriwat V. Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM. Ann Surg Oncol 2024; 31:3366-3376. [PMID: 38285304 DOI: 10.1245/s10434-024-14943-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. MATERIALS AND METHODS We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. RESULTS A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. CONCLUSIONS This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.
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Affiliation(s)
- Trina Priscilla Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Brandon Yong Kiat Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nicole Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clement Luck Khng Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Visnu Lohsiriwat
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chia CLK, Sae-Lim C, Lai HW, Chandrachamnong K, Huang HI, Chen DR, Chen ST. Single-port three-dimensional (3D) endoscopic-assisted breast surgery-preliminary results and patient-reported satisfaction in 145 breast cancer and gynecomastia cases. World J Surg Oncol 2023; 21:335. [PMID: 37880770 PMCID: PMC10601236 DOI: 10.1186/s12957-023-03191-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Minimal-accessed (robotic and endoscopic) breast cancer surgery is increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional endoscopic-assisted breast surgery (S-P 3D EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions. METHODS Patients who underwent S-P 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, and the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein. RESULTS During the study period, 145 patients underwent 164 procedures of S-P 3D EABS. One hundred fifty (91.5%) procedures were endoscopic-assisted nipple-sparing mastectomy (S-P 3D E-NSM; 117 therapeutic procedures for breast cancer, 13 prophylactic mastectomies, 20 procedures for gynecomastia). Fourteen (8.5%) procedures of endoscopic-assisted breast-conserving surgery (S-P 3D E-BCS) were performed (12 S-P 3D E-BCS, 2 S-P 3D E-BCS with 3D videoscope-assisted partial breast reconstruction, which was 1 case of latissimus dorsi flap and 1 case of omental flap). The mean operative time was 245 ± 110 min in S-P 3D E-NSM and 260 ± 142 min in S-P 3D E-BCS. The mean intraoperative blood loss was 49.7 ± 46.9 ml in S-P 3D E-NSM and 32.8 ± 17.5 ml in S-P 3D E-BCS. Subnipple biopsy showed positive malignancy in 3 (2.6%) S-P 3D E-NSM patients. None of the S-P 3D E-BCS patients found margin involvement; however, 3 (2.6%) reported margin involvement in S-P 3D E-NSM patients. Thirty-two complications were found (24.6%): 7 (5.3%) transient nipple-areolar complex (NAC) ischemia, 7 (5.3%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow-up time of 34 months, there were 2 (1.5%) patients with locoregional recurrence, 9 (6.9%) distant metastasis, and 2 (1.5%) mortality. 78.6% (77/98) of patients answering the cosmetic-evaluated questionnaire reported good and excellent overall satisfaction. CONCLUSIONS S-P 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.
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Affiliation(s)
- Clement Luck Khng Chia
- Department of Surgery, Breast Surgery Service, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hung-Wen Lai
- Department of Surgery, Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
- Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
- Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Korawan Chandrachamnong
- Department of Surgery, Division of Breast Surgery, Police General Hospital, Bangkok, Thailand
| | - Hsin-I Huang
- Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan
| | - Dar-Ren Chen
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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Ng MSP, Jabir AI, Ng TDR, Ang YI, Chia JL, Tan DNH, Lee J, Mahendran DCJ, Tudor Car L, Chia CLK. Evaluating TESLA-G, a gamified, telegram-delivered, quizzing platform for surgical education in medical students: protocol for a pilot randomised controlled trial. BMJ Open 2023; 13:e068740. [PMID: 37380211 PMCID: PMC10410996 DOI: 10.1136/bmjopen-2022-068740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Online multiple-choice question (MCQ) quizzes are popular in medical education due to their ease of access and ability for test-enhanced learning. However, a general lack of motivation among students often results in decreasing usage over time. We aim to address this limitation by developing Telegram Education for Surgical Learning and Application Gamified (TESLA-G), an online platform for surgical education that incorporates game elements into conventional MCQ quizzes. METHODS AND ANALYSIS This online, pilot randomised control trial will be conducted over 2 weeks. Fifty full-time undergraduate medical students from a medical school in Singapore will be recruited and randomised into an intervention group (TESLA-G) and an active control group (non-gamified quizzing platform) with a 1:1 allocation ratio, stratified by year of study.We will evaluate TESLA-G in the area of endocrine surgery education. Our platform is designed based on Bloom's taxonomy of learning domains: questions are created in blocks of five questions per endocrine surgery topic, with each question corresponding to one level on Bloom's taxonomy. This structure promotes mastery while boosting student engagement and motivation. All questions are created by two board-certified general surgeons and one endocrinologist, and validated by the research team. The feasibility of this pilot study will be determined quantitatively by participant enrolment, participant retention and degree of completion of the quizzes. The acceptability of the intervention will be assessed quantitatively by a postintervention learner satisfaction survey consisting of a system satisfaction questionnaire and a content satisfaction questionnaire. The improvement of surgical knowledge will be assessed by comparing the scores of preintervention and postintervention knowledge tests, which consist of separately created questions on endocrine surgery. Retention of surgical knowledge will be measured using a follow-up knowledge test administered 2 weeks postintervention. Finally, qualitative feedback from participants regarding their experience will be obtained and thematically analysed. ETHICS AND DISSEMINATION This research is approved by Singapore Nanyang Technological University (NTU) Institutional Review Boards (Reference Number: IRB-2021-732). All participants will be expected to read and sign a letter of informed consent before they are considered as recruited into the study. This study poses minimal risk to participants. Study results will be published in peer-reviewed open-access journals and presented in conference presentations. TRIAL REGISTRATION NUMBER NCT05520671.
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Affiliation(s)
| | - Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Tony De Rong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi-Ian Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeng Long Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - James Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University Surgical Cluster, National University Hospital, Singapore
| | - Dinesh Carl Junis Mahendran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Clement Luck Khng Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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Chan KS, Chong MTH, Chia CLK, Cheung KL. Revisiting primary endocrine therapy versus surgery in older women with breast cancer: meta-analysis. Br J Surg 2023; 110:420-431. [PMID: 36718056 DOI: 10.1093/bjs/znac435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Old age is associated with increased co-morbidities, resulting in reduced life expectancy. Primary endocrine therapy is an alternative to primary surgical therapy for patients with breast cancer and increased co-morbidities. The aim was to review outcomes of primary endocrine therapy versus primary surgical therapy in older women with breast cancer. METHODS PubMed, Embase (Ovid), Scopus, and the Cochrane Library were searched systematically from January 2000 to May 2022. Single-arm studies were excluded. Primary outcomes were overall survival and breast cancer-specific survival. Secondary outcomes were local and regional failure of primary endocrine therapy, recurrence after primary surgical therapy, and health-related quality of life. RESULTS There were 14 studies including 14 254 patients (primary endocrine therapy 2829, 19.8 per cent; primary surgical therapy 11 425, 80.2 per cent), with the addition of four major studies (9538 patients) compared with the latest review in 2014. Seven studies defined primary surgical therapy as surgery plus adjuvant endocrine therapy, and six studies included patients with oestrogen receptor-positive tumours only. Patients in the primary endocrine therapy group were older than the primary surgical therapy group (mean difference 2.43 (95 per cent c.i. 0.73 to 4.13) years). Primary endocrine therapy led to worse overall survival than primary surgical therapy (HR 1.42, 95 per cent c.i. 1.06 to 1.91). Subgroup analysis of RCTs and prospective studies, however, showed comparable overall survival. Breast cancer-specific survival was also comparable (HR 1.28, 95 per cent c.i. 0.87 to 1.87). At 6 weeks, operated patients had significant arm symptoms and illness burden following major breast surgery compared with patients receiving primary endocrine therapy. Health-related quality of life, measured by the European Organization for Research and Treatment of Cancer QLQ-C30 and EuroQol EQ-5D-5L™, was comparable in the two treatment groups. CONCLUSION Overall survival was worse among older women receiving primary endocrine therapy in an analysis including all studies, but comparable in RCTs and prospective studies. This may be due to confounding by age and co-morbidities in retrospective cohort studies of primary endocrine therapy.
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Affiliation(s)
- Kai Siang Chan
- Breast Surgical Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Michelle Tian Hui Chong
- Breast Surgical Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Clement Luck Khng Chia
- Breast Surgical Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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Woon CY, Goh SSN, Soh LS, Yeo CFC, Ong MW, Wong B, Leong JHT, Goo JTT, Chia CLK. Surgical margins assessment reduces re-excision rates in breast-conserving surgery. Ann Acad Med Singap 2023. [DOI: 10.47102/annals-acadmedsg.2021454] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Woon CY, Goh SSN, Soh LS, Yeo CFC, Ong MW, Wong B, Leong JHT, Goo JTT, Chia CLK. Surgical margins assessment reduces re-excision rates in breast-conserving surgery. Ann Acad Med Singap 2023; 52:48-51. [PMID: 36730806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Chang Yi Woon
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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Sui Yeo JL, Min Yong NTW, Junis Mahendran DC, Khng Chia CL. Approach to goitre in family medicine practice. Singapore Med J 2022; 63:604-614. [PMID: 36453431 PMCID: PMC9728309 DOI: 10.4103/singaporemedj.smj-2021-091] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Soon MKS, Martinengo L, Lu J, Car LT, Chia CLK. The Use of Telegram in Surgical Education: Exploratory Study. JMIR Med Educ 2022; 8:e35983. [PMID: 36099020 PMCID: PMC9518707 DOI: 10.2196/35983] [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] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 07/06/2022] [Accepted: 09/02/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram's role in medical education remains relatively unexplored. OBJECTIVE This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. METHODS A Telegram channel "Telegram Education for Surgery Learning and Application (TESLA)" was created to supplement medical students' learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. RESULTS Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. CONCLUSIONS The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy.
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Affiliation(s)
- Marcus Khai Siang Soon
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Junde Lu
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Clement Luck Khng Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Wang JX, Soh LS, Mahendran DCJ, Woon CY, Chia CLK. Rare case of perforated giant gastric ulcer with concurrent thyroid storm: A case report. World J Surg Proced 2022; 12:8-12. [DOI: 10.5412/wjsp.v12.i1.8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate. The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic pathways. We present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered well.
CASE SUMMARY A 53-year-old male chronic smoker, with no previous medical history, presented with severe generalized abdominal pain and vomiting for one day duration. Further history revealed weight loss, diarrhea, and anxiety over the past three months. On clinical examination, patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute, his blood pressure was low at 90/50mmHg. His abdomen was tender with generalized peritonism. In view of his clinical history, a thyroid screen was ordered which showed raised thyroxine (T4) levels of 90.3 pmol/L and low thyroxine stimulating hormone (TSH) levels of 0.005 μU/mL. Chest X-ray showed no sub-diaphragmatic free air, but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free fluid. The working diagnosis was perforated peptic ulcer complicated by thyroid storm. An urgent endocrinologist consult was made, and patient was started on beta blocker and intravenous steroids pre-operatively. The patient underwent emergency laparotomy with washout and patch repair of the perforated gastric ulcer. Patient was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s iodine. Histology of the ulcer edges showed no malignancy. On post-operative day seven, T4 decreased to 20.4 pmol/L, TSH was 0.005 mLU/L. His thyroid function test subsequently normalized 3 mo post-operatively with T4 18.1 pmol/L, TSH 1.91 mLU/L. Patient’s recovery was otherwise uneventful. Thyroid receptor antibody subsequently was positive, and patient was managed for Grave’s disease by the endocrinologist.
CONCLUSION This case highlights the rare but life-threatening clinical emergency of peptic ulcer perforation complicated by thyroid storm. Multidisciplinary perioperative management is crucial to optimize patient for surgery and damage control principles should be taken for an acute surgical patient with concurrent endocrine crisis.
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Affiliation(s)
- Jasper Xiangwei Wang
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Lin Seong Soh
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | | | - Chang Yi Woon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Chen RY, Goh RY, Leung HT, Cheng S, Tan VKM, Chia CLK, Goo JTT, Ong MW. Clinical Significance of Radiologically Detected Small Indeterminate Extra-Mammary Lesions in Breast Cancer Patients. Eur J Breast Health 2022; 18:252-257. [DOI: 10.4274/ejbh.galenos.2022.2022-1-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/30/2022] [Indexed: 12/01/2022]
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Goh SSN, Shelat VG, Lee BGW, Chen RY, Oh SL, Chia CLK. A multi-center study on recurrent inguinal hernias: assessment of surgeons' compliance to guideline-based repair and evaluation of short-term outcomes. Hernia 2021; 25:1223-1229. [PMID: 32862259 DOI: 10.1007/s10029-020-02288-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION As patients with recurrent inguinal hernia (RIH) are at a higher risk of perioperative complications, international guidelines have been developed to mitigate these risks by recommending the reverse approach for repair. We aim to study the characteristics of RIH, compliance to guidelines-based repair (GR) and determine factors influencing compliance to guidelines. METHODS A retrospective study of patients with RIH was carried out at two tertiary institutions in Singapore, over 10 years from January 2010 to 2020. RESULTS There were 16 patients with bilateral recurrences and 214 patients with unilateral recurrences. The characteristics of patients with non-guidelines-based repair (NGR) versus GR were similar, p > 0.05. GR was performed for 128 (52.1%) hernias as compared to NGR for 118 (47.9%) hernias. The open approach was more common in NGR than GR, 115/118 (89.8%) versus 58/128 (45.3%), p < 0.001. Forty (n = 40, 16.3%) RIH presented emergently, of which 37 underwent NGR while 3 underwent GR, p < 0.0001. More consultants were present during GR 103/128 (80.5%) as compared to NGR 78/118 (66.1%), p = 0.018. Emergency presentation of hernia recurrence, OR 7.74 (CI 6.11-9.20), p = 0.005, and open repair during the index repair were significantly associated with NGR, OR 6.63 (CI 4.42-8.84), p = 0.01. Median length of stay was shorter in the GR 1 day (IQR 1-2 days) versus 2 days (IQR 2-5 days) in the NGR group, p = 0.02. CONCLUSION The compliance rate of GR for RIH is 52%. NGR for RIH had acceptable short-term outcomes. For elective presentation of RIH, GR should be encouraged given a shorter length of hospital stay.
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Affiliation(s)
- S S N Goh
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore.
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
| | - V G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - B G W Lee
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - R Y Chen
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - S L Oh
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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Ng DY, Tudor Car L, Ng MJM, Lu J, Leung J, Goo TT, Chia CLK. Identifying barriers to early presentation in patients with locally advanced breast cancer (LABC) in Northern Singapore: Qualitative study. PLoS One 2021; 16:e0252008. [PMID: 34032802 PMCID: PMC8148318 DOI: 10.1371/journal.pone.0252008] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Breast cancer is the leading cause of death in Singaporean women, with advanced stage rendering a poorer prognosis. This study aims to explore the barriers to early presentation, information needs and sources in patients with locally advanced breast cancer (LABC). MATERIALS & METHODS A convenience sample of patients who presented with locally advanced breast cancer to the Department of General Surgery in a teaching tertiary hospital were recruited for the study. We conducted semi-structured interviews face to face with the recruited patients. We recorded the interviews, transcribed them verbatim and analysed using thematic content analysis. RESULTS Twenty-three participants were recruited of which 12 were Chinese and 11 were Malay women. Mean age was 60 years (± 13 SD). The most common knowledge barrier resulting in delay was the misconception that a breast lump must be painful to be malignant. Other knowledge barriers include the lack of knowledge and misinformation from the internet or other social media platforms. Some perceived barriers include fear of diagnosis, fear of treatment and fear of imposing financial burden on family members. A significant proportion of participants were also not aware of a national breast screening programme. CONCLUSIONS Our study has found that barriers to early presentation of women with locally advanced breast cancer remain similar and have persisted over the years despite targeted efforts. There is a need for a rethink of existing strategies and to develop new innovative ways to reach out to this group of patients.
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Affiliation(s)
- Ding Yi Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorraine Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Marcus Jia Ming Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junde Lu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Joelle Leung
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tiong Thye Goo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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Chuang XE, Chan DYS, Oon ML, Wang S, Chia CLK. Inflammatory myofibroblastic tumour causing intestinal obstruction in a patient with neurofibromatosis type 1. Ann R Coll Surg Engl 2021; 103:e53-e55. [PMID: 33559560 PMCID: PMC9773897 DOI: 10.1308/rcsann.2020.7003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Inflammatory myofibroblastic tumours (IMTs) are rare tumours with unpredictable biological behaviour ranging from benign to locally invasive and rarely, distant metastasis. While neurofibromatosis type 1 (NF1) may manifest with gastrointestinal soft tissue tumours, this is the first report in the literature that describes an IMT occurring in a NF1 patient who presented with intestinal obstruction. Our patient presented with intestinal obstruction secondary to an obstructing terminal ileum mesenteric tumour. En bloc bowel resection was performed, with histology revealing an IMT and an adjacent neurofibroma. The resection margins were clear and the patient was free of recurrence at six months.
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Affiliation(s)
| | - DYS Chan
- Khoo Teck Puat Hospital, Singapore
| | - ML Oon
- National University Hospital, Singapore
| | - S Wang
- National University Hospital, Singapore
| | - CLK Chia
- Khoo Teck Puat Hospital, Singapore
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14
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Affiliation(s)
- Sabrina Cheok
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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15
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Chan KS, Chia CLK, Ng FKL, Seow WHJ, Leong DY, Shelat VG. Impaired Handgrip Strength Does Not Predict Postoperative Morbidity in Major Hepatobiliary Surgery. J Surg Res 2020; 256:549-556. [PMID: 32799004 DOI: 10.1016/j.jss.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Assessment of preoperative handgrip strength (HGS) is an objective and inexpensive bedside tool, which has been investigated to predict morbidity risk in elective surgery. However, its use is not validated in patients undergoing major elective hepatobiliary surgery (MEHS). The aim of this study is to investigate the use of HGS to predict morbidity in patients undergoing MEHS. METHODS This is a single-center prospective study involving 81 patients who underwent MEHS over 21 mo from July 2014 to March 2016. MEHS was defined as any hepatobiliary surgery expected to last more than 2 h and/or with an anticipated blood loss of ≥500 mL. HGS was assessed in both dominant and nondominant hands with standardization and subsequently recorded and expressed as a percentage of a general, age- and gender-matched normative values. RESULTS The mean age was 65.2 ± 9.5 y with male predominance (n = 52, 64.2%). Approximately, half of the patients underwent liver resection (n = 43, 53.1%). There was no difference in the incidence of Clavien-Dindo ≥ grade IIIA in both dominant HGS (impaired HGS 8/33 [24.2%], normal HGS 6/48 [12.5%]; P = 0.170) and nondominant HGS (impaired HGS 8/33 [21.1%], normal HGS 6/43 [14%]; P = 0.399). Dominant and nondominant HGS showed poor discriminatory ability in the prediction of Clavien-Dindo ≥ grade IIIA complications (dominant HGS area under the curve [AUC] = 0.572; nondominant HGS AUC 0.545). However, the use of dominant HGS showed moderate discriminatory ability to predict the length of hospital stay ≥21 d (AUC = 0.759). CONCLUSIONS The use of HGS may not predict Clavien-Dindo ≥ grade IIIA complications, but predicts a prolonged length of hospital stay ≥21 d.
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Affiliation(s)
- Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Felicia Kai Lin Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore.
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16
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Lai AFW, Enjiu PT, Chan TYS, Chia CLK. Frugal innovation in the pandemic: finding the solution from within. Br J Surg 2020; 107:e323. [PMID: 32652552 DOI: 10.1002/bjs.11778] [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: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022]
Affiliation(s)
- A F W Lai
- Department of Peri-Operative Services, Singapore
| | - P T Enjiu
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - T Y S Chan
- Department of Peri-Operative Services, Singapore
| | - C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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17
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Affiliation(s)
- C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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18
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Oh SL, Chia CLK, Chen YR, Goo TTJ, Rao AD, Tan KY, Ong MW. Laparoscopic surgery in a patient with atypical presentation of COVID-19: salient points to reduce the perils of surgery. Singapore Med J 2020; 61:443-444. [PMID: 32480435 DOI: 10.11622/smedj.2020086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Shen Leong Oh
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | | | | | | | - Anil Dinkar Rao
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Marc Weijie Ong
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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19
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Chan KS, Zeng D, Leung JHT, Ooi BSY, Kong KT, Yeo YH, Goo JTT, Chia CLK. Measuring upper limb function and patient reported outcomes after major breast cancer surgery: a pilot study in an Asian cohort. BMC Surg 2020; 20:108. [PMID: 32430021 PMCID: PMC7236525 DOI: 10.1186/s12893-020-00773-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer. Methods This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21 years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1 week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected. Results Median age was 62.5 years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p = 0.775), while abduction improved from baseline (p = 0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p = 0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p = 0.010) but not for patients with only sentinel lymph node biopsy (p = 0.396). Conclusion This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes.
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Affiliation(s)
| | - Ding Zeng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Belinda Si Yin Ooi
- Department of Physiotherapy, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Kit Teng Kong
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yi Heng Yeo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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20
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Chia CLK, Lee DJK, Goo JTT. Comment on: Association between surgeon special interest and mortality after emergency laparotomy. Br J Surg 2020; 107:e231. [PMID: 32352157 DOI: 10.1002/bjs.11615] [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: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - D J K Lee
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - J T T Goo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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21
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Goh SNS, Chia CLK, Ong JW, Quek JJX, Lim WW, Tan KY, Goo JTT. Improved outcomes for index cholecystectomy for acute cholecystitis following a dedicated emergency surgery and trauma service (ESAT). Eur J Trauma Emerg Surg 2020; 47:1535-1541. [PMID: 32020247 DOI: 10.1007/s00068-020-01308-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Si Ning Serene Goh
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - Clement Luck Khng Chia
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jing Wen Ong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - John Jian Xian Quek
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Woan Wui Lim
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Jerry Tiong Thye Goo
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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22
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He C, Lu J, Ong MW, Lee DJK, Tan KY, Chia CLK. Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review. Hernia 2019; 24:717-731. [PMID: 31784913 DOI: 10.1007/s10029-019-02098-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) has been increasing in popularity over the years. Seroma formation is a common complication of LVHR. The aim of this study is to review the current evidence on seroma prevention strategies following LVHR. METHODS A systematic search of PubMed, Embase (1946-13 February 2019) and Medline (1946-13 February 2019) databases was conducted using terms which include "seroma", "hernia, ventral" and "laparoscopy". All studies are comparative retrospective or prospective human adult studies in peer-reviewed journals describing at least one intra-operative intervention designed to decrease the rate of seroma formation in laparoscopic ventral hernia repair. RESULTS The database searches identified 3762 citations, and 21 studies were included for final analysis. Five studies compared the different methods of mesh fixation, nine studies compared primary defect closure (PFC) and bridged repair, two studies compared the effect of different types of meshes, two studies looked into the use of electrical cauterization, one study compared single- site laparoscopy with conventional laparoscopy, one study looked into the use of fibrin sealant and one study compared transabdominal preperitoneal placement of mesh with conventional repair. PFC appears to be the most promising with large studies showing a low rate of seroma formation with additional benefits of decreasing wound infection and recurrence rate. Cauterisation of hernia sac and injection of fibrin sealant also show promising results but are mainly derived from small studies. Other strategies did not demonstrate benefit. CONCLUSION Currently, primary fascial closure appears to be the most promising strategy available to decrease seroma formation after LVHR based on the results of large studies. Other promising strategies that decrease dead space such as cauterisation of the sac and fibrin sealant injection will require further multicentre trials to confirm benefit before an increase in operative time and cost can be justified for their routine use.
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Affiliation(s)
- C He
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - J Lu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - M W Ong
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - D J K Lee
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - K Y Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore.
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23
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Affiliation(s)
- C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - Y S Tai
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - K-Y Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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24
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Chia CLK, Mantoo SK, Tan KY. 'Start to finish trans-institutional transdisciplinary care': a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis 2016; 18:O43-50. [PMID: 26500155 DOI: 10.1111/codi.13166] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 05/17/2015] [Accepted: 09/22/2015] [Indexed: 02/08/2023]
Abstract
AIM The frail elderly surgical patient is at increased risk of morbidity after major surgery. A transdisciplinary Geriatric Surgery Service (GSS) has been shown to produce consistently positive results in our institution. A trans-institutional transdisciplinary Start to Finish (STF) programme was initiated incorporating seamless prehabilitation and rehabilitation to enhance the outcome further. METHOD Patients who underwent major colorectal resection in Khoo Teck Puat Hospital and were managed under the GSS from January 2007 to December 2014 were included in this prospective study. The STF programme was initiated from January 2012. The surgical outcome of patients managed under the GSS before the initiation of STF was compared with that after its implementation. RESULTS There were 57 patients after the initiation of the STF programme compared with 60 patients managed before STF. There were 26.4% and 25% of frail patients in the STF group compared with the non-STF group (P = 0.874). The mean length of hospital stay was significantly shorter in the STF group (8.4 days vs 11.0 days, P = 0.029). Functional recovery in patients available for follow-up at 6 weeks showed 100% (46/46) recovery in the elective STF group who received prehabilitation and 95.7% (45/47) in the elective non-STF group who did not (P = 0.157). There were no significant differences in a Clavien-Dindo complication score of Grade 3 or more and 30-day mortality between the two groups. CONCLUSION Through a trans-institutional transdisciplinary approach, we managed to achieve a significantly shorter hospital stay in frail patients having colorectal surgery. All elective patients who received prehabilitation achieved full functional recovery.
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Affiliation(s)
- C L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - S K Mantoo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - K Y Tan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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25
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Lee YZ, Chia CLK, Chanyaputhipong J, Lim EKW. Fashion misadventure: small bowel perforation caused by magnetic tongue studs usage. ANZ J Surg 2015; 88:E355-E356. [PMID: 26573994 DOI: 10.1111/ans.13367] [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] [Indexed: 11/29/2022]
Affiliation(s)
- Yao Zong Lee
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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