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Mongkolmafai O, Jeerakornpassawat D, Tantipalakorn C, Charoenkwan K, Suprasert P, Srisomboon J, Tongsong T. Efficacy of Lidocaine Spray for Pain Reduction during Colposcopy-Directed Cervical Biopsies: A Randomized Controlled Trial. Medicina (Kaunas) 2024; 60:630. [PMID: 38674275 PMCID: PMC11051754 DOI: 10.3390/medicina60040630] [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] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score. Results: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (<0.001), and tended to decrease, though not significantly (p = 0.06), when compared with the control group. No complication with the intervention was observed. Conclusions: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure.
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Affiliation(s)
| | | | - Charuwan Tantipalakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (O.M.); (D.J.); (K.C.); (P.S.); (J.S.); (T.T.)
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Monthatip K, Boonnag C, Muangmool T, Charoenkwan K. A machine learning-based prediction model of pelvic lymph node metastasis in women with early-stage cervical cancer. J Gynecol Oncol 2024; 35:e17. [PMID: 37921601 PMCID: PMC10948976 DOI: 10.3802/jgo.2024.35.e17] [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: 05/11/2023] [Revised: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To develop a novel machine learning-based preoperative prediction model for pelvic lymph node metastasis (PLNM) in early-stage cervical cancer by combining the clinical findings and preoperative computerized tomography (CT) of the whole abdomen and pelvis. METHODS Patients diagnosed with International Federation of Gynecology and Obstetrics stage IA2-IIA1 squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix who had primary radical surgery with bilateral pelvic lymphadenectomy from January 1, 2003 to December 31, 2020, were included. Seven supervised machine learning algorithms, including logistic regression, random forest, support vector machine, adaptive boosting, gradient boosting, extreme gradient boosting, and category boosting, were used to evaluate the risk of PLNM. RESULTS PLNM was found in 199 (23.9%) of 832 patients included. Younger age, larger tumor size, higher stage, no prior conization, tumor appearance, adenosquamous histology, and vaginal metastasis as well as the CT findings of larger tumor size, parametrial metastasis, pelvic lymph node enlargement, and vaginal metastasis, were significantly associated with PLNM. The models' predictive performance, including accuracy (89.1%-90.6%), area under the receiver operating characteristics curve (86.9%-91.0%), sensitivity (77.4%-82.4%), specificity (92.1%-94.3%), positive predictive value (77.0%-81.7%), and negative predictive value (93.0%-94.4%), appeared satisfactory and comparable among all the algorithms. After optimizing the model's decision threshold to enhance the sensitivity to at least 95%, the 'highly sensitive' model was obtained with a 2.5%-4.4% false-negative rate of PLNM prediction. CONCLUSION We developed prediction models for PLNM in early-stage cervical cancer with promising prediction performance in our setting. Further external validation in other populations is needed with potential clinical applications.
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Affiliation(s)
- Kamonrat Monthatip
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chiraphat Boonnag
- Biomedical Informatics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Charoenkwan K, Apaijai N, Sriwichaiin S, Chattipakorn N, Chattipakorn SC. Alterations in mitochondria isolated from peripheral blood mononuclear cells and tumors of patients with epithelial ovarian cancers. Sci Rep 2024; 14:15. [PMID: 38168673 PMCID: PMC10762226 DOI: 10.1038/s41598-023-51009-z] [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: 10/02/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024] Open
Abstract
Metabolic alterations play an essential role in ovarian carcinogenesis. The flexibility of mitochondrial functions facilitates cellular adaptation to the tough environment associated with carcinogenesis. An understanding of the differences in mitochondrial functions in normal ovaries and cancers could provide a basis for further exploration of future mitochondria-based screening, diagnosis, prognostic prediction, and targeted therapy for epithelial ovarian cancers. The main objective of this study was to assess mitochondrial function profiles measured from PBMCs and ovarian tissues of epithelial ovarian cancers in comparison with normal ovaries. A total of 36 patients were recruited for the study, all of whom underwent primary surgical treatment for malignant epithelial ovarian neoplasm. Of these, 20 patients were in the early stage and 16 patients were in the advanced stage. Additionally, 21 patients who had pelvic surgery for benign gynecologic conditions, with normal ovaries incidentally removed, were recruited as controls. At the time of surgery, a blood sample was collected from each participant for PBMC isolation, and ovarian tissue was retained for molecular studies. These studies included the examination of oxidative stress, mitochondrial mass, mitochondrial respiration, mitochondrial reactive oxygen species (ROS), mitochondrial membrane potential (MMP) changes, and mitochondrial swelling. Clinical and histopathological data were also collected and compared between different stages of epithelial ovarian cancers: early-stage (group 1), advanced-stage (group 2), and normal ovaries (group 3). The levels of cellular oxidative stress, mitochondrial mass, and mitochondrial biogenesis in the peripheral blood mononuclear cells (PBMCs) of participants with ovarian cancer were significantly lower than those of the control group. However, the mitochondrial respiratory parameters measured from the PBMCs were similar across all three groups. Furthermore, mitochondrial membrane depolarization and mitochondrial swelling were observed in ovarian tissues of both early-stage and advanced-stage cancer groups. We demonstrated the dynamic nature of mitochondrial ROS production, biogenesis, and respiratory function in response to epithelial ovarian carcinogenesis. The flexibility of mitochondrial functions under diverse conditions may make it a challenging therapeutic target for ovarian cancer.
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Affiliation(s)
- Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nattayaporn Apaijai
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sirawit Sriwichaiin
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Tuscharoenporn T, Muangmool T, Charoenkwan K. Adjuvant pelvic radiation versus observation in intermediate-risk early-stage cervical cancer patients following primary radical surgery: a propensity score-adjusted analysis. J Gynecol Oncol 2023:34.e42. [PMID: 36807745 DOI: 10.3802/jgo.2023.34.e42] [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] [Received: 06/06/2022] [Revised: 11/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To compare survival outcomes, posttreatment complications, and quality of life (QoL) of early-stage cervical cancer patients with intermediate-risk factors between those who received adjuvant pelvic radiation and those without adjuvant treatment. METHODS Stages IB-IIA cervical cancer patients classified as having intermediate-risk following primary radical surgery were included. After propensity score weighted adjustment, all baseline demographic and pathological characteristics of 108 women who received adjuvant radiation and 111 women who had no adjuvant treatment were compared. The primary outcomes were progression-free survival (PFS) and overall survival (OS). The secondary outcomes included treatment-related complications and QoL. RESULTS Median follow-up time was 76.1 months in the adjuvant radiation group and 95.4 months in the observation group. The 5-year PFS (91.6% in the adjuvant radiation group and 88.4% in the observation group, p=0.42) and OS (90.1% in the adjuvant radiation group and 93.5% in the observation group, p=0.36) were not significantly different between the groups. There was no significant association between adjuvant treatment and overall recurrence/death in the Cox proportional hazard model. However, a substantial reduction in pelvic recurrence was observed in participants with adjuvant radiation (hazard ratio=0.15; 95% confidence interval=0.03-0.71). Grade 3/4 treatment-related morbidities and QoL scores were not significantly different between the groups. CONCLUSION Adjuvant radiation was associated with a lower risk of pelvic recurrence. However, its significant benefit in reducing overall recurrence and improving survival in early-stage cervical cancer patients with intermediate-risk factors could not be demonstrated.
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Affiliation(s)
- Thunwipa Tuscharoenporn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Nantasupha C, Pojchamarnwiputh S, Charoenkwan K. Minilaparotomy, Cyfra21-1, and Other Predicting Factors for Suboptimal Cytoreductive Surgery in Advanced Epithelial Ovarian Cancer: A Pilot Study. Asian Pac J Cancer Prev 2022; 23:4119-4124. [PMID: 36579993 PMCID: PMC9971459 DOI: 10.31557/apjcp.2022.23.12.4119] [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] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Currently, there is no reliable method to predict the result of the primary cytoreduction to decide whether to go on primary cytoreductive surgery or receive neoadjuvant chemotherapy. This study aimed to identify candidate predicting factors from clinical data, serum biomarkers, CT/MRI imaging, and minilaparotomy for suboptimal cytoreduction in women with advanced epithelial ovarian cancer. METHODS Women who were clinically suspicious of advanced-stage epithelial ovarian, fallopian tube, and peritoneal cancer undergoing primary cytoreductive surgery were recruited. Clinical data, abdominopelvic CT/MRI, and serum biomarkers, including CA125, HE4, and Cyfra21-1, were collected preoperatively. At the start of the surgery, a minilaparotomy incision was made, the peritoneal cavity was assessed, and the operating surgeons gave the impression of whether the optimal cytoreductive surgery would be attainable. Subsequently, the incision was extended as necessary, and the standard cytoreductive surgery was attempted. After the procedure completion, the surgical outcome (optimal vs. suboptimal cytoreduction) and other operative outcomes were recorded. The association between the potential predicting factors and the surgical outcome was examined. RESULTS Fourteen patients were included in this pilot study. Twelve patients were diagnosed with primary ovarian or fallopian tube cancer, while two had ovarian metastasis from colorectal cancer. The optimal cytoreduction was achieved in eight women. After minilaparotomy, the surgeons could predict suboptimal surgery correctly in five out of six cases (OR: 24.12, 95%CI: 2.34-Inf., p<0.01). Moreover, no patient with the finding of rectosigmoid invasion from CT had optimal surgery (OR: 12.96, 95%CI: 1.26-Inf., p=0.03). Lastly, increased serum cyfra21-1(>8 ng/mL) and HE4 (>83 pmol/L) were significantly associated with suboptimal cytoreduction, with OR: 35.00, 95%CI: 1.74-702.99, p=0.02 and OR: 15.00, 95%CI: 1.03-218.30, p=0.05, respectively. CONCLUSION The finding of rectosigmoid invasion from abdominal CT, increased serum cyfra21-1 and HE4, and the initial minilaparotomy impression were potentially associated with suboptimal cytoreduction.
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Affiliation(s)
- Chalaithorn Nantasupha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. ,For Correspondence:
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Nantasupha C, Muangmool T, Charoenkwan K. Prognostic Factors for Advanced Epithelial Ovarian Cancer Following Primary Cytoreductive Surgery or Neoadjuvant Chemotherapy. Asian Pac J Cancer Prev 2022; 23:3791-3799. [PMID: 36444592 PMCID: PMC9930965 DOI: 10.31557/apjcp.2022.23.11.3791] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Indexed: 11/30/2022] Open
Abstract
AIM To examine the association between clinicopathological factors and survival in advanced epithelial ovarian, tubal, and primary peritoneal cancers patients who had primary cytoreductive surgery (CRS) and those that received neoadjuvant chemotherapy (NAC). METHODS Women who had CRS or NAC between 2008-2017 were included. Association between clinical characteristics, pretreatment imaging, serum markers, surgical and pathological factors, and disease recurrence/progression/death was examined in multivariable analysis. RESULTS Two hundred and three women were recruited in this study (CRS 128 women and NAC 75 women). Median overall survival was 33.7 months for the CRS group and 27.9 months for the NAC group (p=0.04). Median progression-free survival was 14.9 months in the CRS group and 12.1 months in the NAC group (p=0.04). For the CRS group, factors independently associated with increased risk of death included primary peritoneal carcinoma (adjusted hazard ratio [aHR] 6.94), stable disease/progression at treatment completion (aHR 5.97), and initial tumor size of more than 12 cm (aHR 1.87). For the NAC group, stable disease/progression after complete treatment (aHR 6.45) and pre-treatment platelet to lymphocyte ratio of more than 310 (aHR 2.20) were significantly associated with an increased risk of death. CONCLUSIONS NAC appeared to be a good alternative treatment for stage III/IV tubo-ovarian carcinoma. The worse survival outcome associated with primary peritoneal carcinoma and large initial tumor size in the patients who received CRS suggested that NAC could be an attractive option for those with these characteristics.
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Xue Z, Angara S, Guo P, Rajaraman S, Jeronimo J, Rodriguez AC, Alfaro K, Charoenkwan K, Mungo C, Domgue JF, Wentzensen N, Desai KT, Ajenifuja KO, Wikström E, Befano B, de Sanjosé S, Schiffman M, Antani S. Image Quality Classification for Automated Visual Evaluation of Cervical Precancer. Med Image Learn Ltd Noisy Data (2022) 2022; 13559:206-217. [PMID: 36315110 PMCID: PMC9614805 DOI: 10.1007/978-3-031-16760-7_20] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Image quality control is a critical element in the process of data collection and cleaning. Both manual and automated analyses alike are adversely impacted by bad quality data. There are several factors that can degrade image quality and, correspondingly, there are many approaches to mitigate their negative impact. In this paper, we address image quality control toward our goal of improving the performance of automated visual evaluation (AVE) for cervical precancer screening. Specifically, we report efforts made toward classifying images into four quality categories ("unusable", "unsatisfactory", "limited", and "evaluable") and improving the quality classification performance by automatically identifying mislabeled and overly ambiguous images. The proposed new deep learning ensemble framework is an integration of several networks that consists of three main components: cervix detection, mislabel identification, and quality classification. We evaluated our method using a large dataset that comprises 87,420 images obtained from 14,183 patients through several cervical cancer studies conducted by different providers using different imaging devices in different geographic regions worldwide. The proposed ensemble approach achieved higher performance than the baseline approaches.
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Affiliation(s)
- Zhiyun Xue
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Sandeep Angara
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Peng Guo
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | | | - Jose Jeronimo
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | | | | | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand 50200
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Joel Fokom Domgue
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Wentzensen
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Kanan T Desai
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | | | - Elisabeth Wikström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Brian Befano
- Information Management Services, Calverton, MD, USA
| | - Silvia de Sanjosé
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Mark Schiffman
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Sameer Antani
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
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Louthrenoo O, Boonchooduang N, Likhitweerawong N, Charoenkwan K, Srisurapanont M. The Effects of Neurofeedback on Executive Functioning in Children With ADHD: A Meta-Analysis. J Atten Disord 2022; 26:976-984. [PMID: 34697957 DOI: 10.1177/10870547211045738] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Possible beneficial effects of neurofeedback in improving ADHD functional outcomes have been increasingly reported. This meta-analysis aimed to evaluate the relationship between neurofeedback and executive functioning in children with ADHD. METHODS PubMed, EMBASE, EBSCO, Web of Science, and Cochrane databases were searched to identify studies reporting the effects of neurofeedback on executive functioning, including response inhibition, sustained attention, and working memory, assessed by neuropsychological tests. Only randomized controlled studies of children aged 5 to 18 years were included using a random-effects model. RESULTS Ten studies were included. The effects of neurofeedback were not found on three domains of executive functions. A meta-regression analysis revealed a trend of numbers of neurofeedback sessions positively associated with response inhibition (p = .06). CONCLUSION Results did not show the benefits of neurofeedback on executive functions assessed by neuropsychological tests. Future studies should focus on standard neurofeedback protocols, the intensity of intervention, and neuropsychological outcomes.
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Chiewhatpong P, Charoenkwan K, Smithiseth K, Lapisatepun W, Lapisatepun P, Phimphilai M, Muangmool T, Cheewakriangkrai C, Suprasert P, Srisomboon J. Effectiveness of enhanced recovery after surgery protocol in open gynecologic oncology surgery: A randomized controlled trial. Int J Gynaecol Obstet 2022; 159:568-576. [PMID: 35396709 DOI: 10.1002/ijgo.14211] [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] [Received: 11/11/2021] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the effectiveness of applying the recommended enhanced recovery after surgery (ERAS) protocol compared with our usual care in women with gynecologic malignancy undergoing elective laparotomy. METHODS From June 2020 to May 2021, 93 women with gynecologic cancers (cervix, endometrium, and ovary) undergoing elective laparotomy at our institution were randomly assigned into an intervention group (ERAS protocol, 46 women) or control group (usual care, 47 women). For the intervention group, each woman was brought through the pre-specified ERAS protocol starting from preoperative counseling to postoperative management. For the control group, participants underwent routine standard care. The primary outcomes were length of hospital stay and postoperative pain. RESULTS The intervention group demonstrated shorter hospital stay by 20 h (47.48 h vs 67.17 h, P = 0.02) with lower postoperative pain score at postoperative day 0 (1.58 vs 4.00, P < 0.01) and day 1 (1.00 vs 2.67, P < 0.01) while having decreased opioid consumption (P < 0.01). The intervention group also had faster recovery of gastrointestinal function. Overall, good compliance to most of the ERAS pathway domains was obtained. CONCLUSION The ERAS protocol demonstrates benefits on shortening hospital stay, reducing pain, and bowel function recovery without increasing complications in our population. CLINICAL TRIAL REGISTRATION The present study was registered at clinicaltrials.gov (NCT04201626) on December 3, 2019. Initial participant enrollment began on June 1, 2020. Access through URL of the registration site: https://clinicaltrials.gov/ct2/show/NCT04201626?cond=ERAS&cntry=TH&draw=2&rank=3.
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Affiliation(s)
- Phasawee Chiewhatpong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kannika Smithiseth
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Warangkana Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Panuwat Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mattabhorn Phimphilai
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalong Cheewakriangkrai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prapaporn Suprasert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jatupol Srisomboon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Pradit L, Tantipalakorn C, Charoenkwan K, Suprasert P, Srisomboon J, Muangmool T. Efficacy of Listening to Music on Pain Reduction during Colposcopy-Directed Cervical Biopsy: A Randomized, Controlled Trial. Medicina (B Aires) 2022; 58:medicina58030429. [PMID: 35334605 PMCID: PMC8955114 DOI: 10.3390/medicina58030429] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objective: To investigate the efficacy of listening to music on pain reduction during colposcopy-directed cervical biopsy (CDB). Materials and Methods: From June 2020 to November 2021, 240 women undergoing CDB were enrolled. The participants were randomized into three groups: Group 1, colposcopic examination while wearing headphones and listening to music; Group 2, colposcopy while wearing headphones but not listening to music; Group 3 (control group), colposcopy while neither listening to music nor wearing headphones. All participating women completed a 10 cm visual analog scale for subjective pain at three time points: baseline, immediately after cervical biopsy, and 15 min after the procedure. The primary endpoint was the biopsy pain score. Result: Of the 240 women, a sample size of 80 was randomly assigned per group. The clinical–pathological and procedure-related characteristics of the participants in all groups were similar. The mean baseline pain score between each group was not significantly different (2.83 in the music group, 2.54 in group 2, and 2.94 in the control group, p = 0.47). There were no significant differences between each group in terms of mean biopsy pain score (4.21 in the music group, 4.24 in group 2, and 4.30 in the control group, p = 0.98). The differences in changes between the baseline pain score and the biopsy pain score were not statistically significant (1.39 in the music group, 1.70 in group 2, and 1.36 in the control group, p = 0.69). In the multiple comparison analysis, the differences in changes between the biopsy pain score and the baseline pain score between each group were also not statistically significant. There were no complications with the intervention observed. Conclusion: This study demonstrated that there was no beneficial effect of listening to music on pain reduction during colposcopy-directed cervical biopsies.
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Lertkhachonsuk AA, Charoenkwan K, Wilailak S, Kasemsarn P, Srisomboon J. The 7th Biennial Meeting of the Asian Society of Gynecologic Oncology, November 25th to 27th, 2021. J Gynecol Oncol 2022; 33:e36. [PMID: 35128862 PMCID: PMC8899874 DOI: 10.3802/jgo.2022.33.e36] [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] [Received: 01/15/2022] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Arb-aroon Lertkhachonsuk
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jatupol Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Abstract
Transgender people may choose to affirm their gender identity with gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS). The effects of GAHT and GAS on sexual health in transgender people have not been well elucidated. This systematic review aimed to appraise the current scientific literature regarding sexual desire, arousal, orgasm, pain, and satisfaction in transmen and transwomen before, during, and after gender transition. Overall, sexual dysfunction is common in both transmen and transwomen. GAHT and GAS may help to improve sexual satisfaction. More studies that focus on sexual health in the transgender population are urgently needed.
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Affiliation(s)
- Natnita Mattawanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Chiang Mai 50200, Thailand.
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Chiang Mai 50200, Thailand
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle NE-WRMB1301, Atlanta, GA 30322, USA; Atlanta VA Medical Center, Decatur, GA, USA
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Suvannasarn R, Muangmool T, Wongpakaran N, Charoenkwan K. Health-related quality of life for early-stage cervical cancer survivors after primary radical surgery followed by radiotherapy versus radical surgery alone. J OBSTET GYNAECOL 2021; 42:1217-1224. [PMID: 34553649 DOI: 10.1080/01443615.2021.1945013] [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: 11/12/2022]
Abstract
This study compared the quality of life (QoL) of 265 stage IA2-IIA cervical cancer patients treated with radical surgery alone (group 1: 137 patients) versus those who underwent primary radical surgery followed by radiotherapy (group 2: 128 patients) and identified clinical characteristics that predict the poor quality of life. All participants completed quality of life questionnaires: EORTC QLQ-C30 and CMU cervical cancer QoL. For the EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL scale and summary scores. Group 1 participants had better scores on the physical functioning domain and some symptom scales/items. For the CMU Cervical Cancer QoL, group 1 participants had better scores on gastrointestinal, lymphatic, and sexual/hormonal domains. In multivariable analysis, adjuvant radiation was consistently associated with poor quality of life in most domains. In general, early-stage cervical cancer survivors had a satisfactory quality of life. The clinical significance of the quality of life score differences between the study groups remains debateable.Impact statementWhat is already known on this subject? For women with early cervical cancer, surgery is the main treatment providing not only a good chance for a cure by total removal of the cancer but also an opportunity to preserve the hormone-producing function of the ovary as well as the flexibility of the vagina. However, radiation treatment may be indicated after surgery in some patients depending on the findings from surgery. Because of the concern about increased complications and decreased long-term quality of life following the combined treatments, some may elect to avoid surgery and receive radiation alone in the first place. In this study, we compared the quality of life of women who had surgery alone to those who had surgery followed by radiation. This information is currently lacking in the medical literature.What do the results of this study add? We found that, in general, women with early cervical cancer had a satisfactory quality of life. For a patient who is surgically fit and chooses to receive primary surgery, if radiation is subsequently required, she could still expect the acceptable long-term quality of life-although slightly less satisfactory than receiving surgery alone but not inferior to those who receive primary radiation treatment.What are the implications of these findings for clinical practice and/or further research? These findings will be useful for pre-treatment counselling and posttreatment supportive care. The information regarding disease-related and treatment-induced morbidity should be thoroughly discussed with the patients before and after treatment. Also, the use of questionnaires examining general well-being together with a cancer-specific quality of life is recommended for the systematic evaluation of cancer survivors.
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Affiliation(s)
- Runchida Suvannasarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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14
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Nantasupha C, Thonusin C, Charoenkwan K, Chattipakorn S, Chattipakorn N. Metabolic reprogramming in epithelial ovarian cancer. Am J Transl Res 2021; 13:9950-9973. [PMID: 34650675 PMCID: PMC8507042] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Cancer cells usually show adaptations to their metabolism that facilitate their growth, invasiveness, and metastasis. Therefore, reprogramming the energy metabolism is one of the current key foci of cancer research and treatment. Although aerobic glycolysis-the Warburg effect-has been thought to be the dominant energy metabolism in cancer, recent data indicate a different possibility, specifically that oxidative phosphorylation (OXPHOS) is the more likely form of energy metabolism in some cancer cells. Due to the heterogeneity of epithelial ovarian cancer, there are different metabolic preferences among cell types, study types (in vivo/in vitro), and invasiveness. Current knowledge acknowledges glycolysis to be the main energy provider in ovarian cancer growth, invasion, migration, and viability, so specific agents targeting the glycolysis or OXPHOS pathways have been used in previous studies to attenuate tumor progression and increase chemosensitization. However, chemoresistant cell lines exert various metabolic preferences. This review comprehensively summarizes the information from existing reports which could together provide an in-depth understanding and insights for the development of a novel targeted therapy which can be used as an adjunctive treatment to standard chemotherapy to decelerate tumor progression and decrease the epithelial ovarian cancer mortality rate.
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Affiliation(s)
- Chalaithorn Nantasupha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
| | - Chanisa Thonusin
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai UniversityChiang Mai, Thailand
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
| | - Siriporn Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai UniversityChiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai UniversityChiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai UniversityChiang Mai, Thailand
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15
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Charoenkwan P, Shoombuatong W, Nantasupha C, Muangmool T, Suprasert P, Charoenkwan K. iPMI: Machine Learning-Aided Identification of Parametrial Invasion in Women with Early-Stage Cervical Cancer. Diagnostics (Basel) 2021; 11:diagnostics11081454. [PMID: 34441388 PMCID: PMC8391438 DOI: 10.3390/diagnostics11081454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023] Open
Abstract
Radical hysterectomy is a recommended treatment for early-stage cervical cancer. However, the procedure is associated with significant morbidities resulting from the removal of the parametrium. Parametrial cancer invasion (PMI) is found in a minority of patients but the efficient system used to predict it is lacking. In this study, we develop a novel machine learning (ML)-based predictive model based on a random forest model (called iPMI) for the practical identification of PMI in women. Data of 1112 stage IA-IIA cervical cancer patients who underwent primary surgery were collected and considered as the training dataset, while data from an independent cohort of 116 consecutive patients were used as the independent test dataset. Based on these datasets, iPMI-Econ was then developed by using basic clinicopathological data available prior to surgery, while iPMI-Power was also introduced by adding pelvic node metastasis and uterine corpus invasion to the iPMI-Econ. Both 10-fold cross-validations and independent test results showed that iPMI-Power outperformed other well-known ML classifiers (e.g., logistic regression, decision tree, k-nearest neighbor, multi-layer perceptron, naive Bayes, support vector machine, and extreme gradient boosting). Upon comparison, it was found that iPMI-Power was effective and had a superior performance to other well-known ML classifiers in predicting PMI. It is anticipated that the proposed iPMI may serve as a cost-effective and rapid approach to guide important clinical decision-making.
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Affiliation(s)
- Phasit Charoenkwan
- College of Arts, Media and Technology, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Watshara Shoombuatong
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok 73170, Thailand;
| | - Chalaithorn Nantasupha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
| | - Tanarat Muangmool
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
| | - Prapaporn Suprasert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (C.N.); (T.M.); (P.S.)
- Correspondence:
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16
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Supreechaya P, Tantipalakorn C, Muangmool T, Charoenkwan K, Suprasert P, Srisomboon J. Survival Outcomes and Prognostic Factors of Borderline Ovarian Tumors. Asian Pac J Cancer Care 2021. [DOI: 10.31557/apjcc.2021.6.3.249-255] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objective: Borderline ovarian tumor (BOT) is a distinct but heterogeneous group of tumors defined by histopathology as atypical epithelial proliferation without stromal invasion. Women with BOT are usually younger than those with invasive carcinoma. This study aimed to evaluate the survival outcomes and prognostic factors of patients with BOT in a single institute in the northern region of Thailand. Methods: The medical records of patients with BOT who were treated at Chiang Mai University Hospital between January 1, 2008 and December 31, 2019 were reviewed. The survival outcomes were analyzed by the Kaplan-Meier method and prognostic factors were analyzed by univariate and multivariate approaches. Results: 168 patients with BOT were enrolled in the study. The median age was 48.8 years. At the median follow-up time of 25.4 months, 9 patients (5.3%) developed recurrence and 2 (1.1%) experienced progression to invasive carcinoma. The 5-year progression-free survival (PFS) and overall survival were 93.2% and 97.4%, respectively. By univariate analysis, advanced stage (p=0.02), tumor size smaller than 10 cm (p=0.03), conservative surgery (p=0.03), and bilateral tumors (p=0.07) were significantly associated with worse PFS. Hysterectomy was a protective factor for recurrence with the hazard ratio of 0.09 (95% CI, 0.01 – 0.77; p= 0.03). Cell types, pelvic lymphadenectomy, micro-invasion, and non-invasive peritoneal implant did not significantly affect PFS. By multivariate analysis, early stage (p=0.01), tumor size larger than 10 cm (p=0.04), and hysterectomy (p=0.03) were significantly associated with better survival. Conclusion: Patients with BOT had excellent survival outcomes. Tumor size of larger than 10 cm, early-stage disease, and hysterectomy were significant prognostic factors for better survival outcomes. Conservative surgery should be offered to patients who desire to preserve future fertility and long-term follow-up is needed to assure recurrence - free.
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Chantawong N, Charoenkwan K. Effect of Elastic Abdominal Binder on Pain and Functional Recovery Following Gynecologic Cancer Surgery: A Randomized Controlled Trial. ACTA ACUST UNITED AC 2021; 57:medicina57050481. [PMID: 34065997 PMCID: PMC8151580 DOI: 10.3390/medicina57050481] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Clinicians have been using elastic abdominal binder for stabilizing incision site after major abdominal surgery. However, the benefits of that practice have never been formally assessed. The aim of this study was to examine the effects of the use of elastic abdominal binder on postoperative pain and recovery of gynecologic cancer patients. Materials and Methods: One-hundred and nine women diagnosed with cervical, endometrial, or ovarian cancer, who underwent open abdominal surgery were assigned randomly into two groups: intervention (56 patients) and control (53 patients). The women in the intervention group applied abdominal binder from postoperative day 1. For the control group, the women did not wear the binder or similar devices. The primary outcomes were pain and functional recovery. Subgroup analysis on participants age ≥ 50 was also performed. Results: For the entire study cohort, the baseline, postoperative day 1, and postoperative day 2 pain scores in the intervention group were significantly lower than the control group. However, there was no significant difference between the groups for postoperative day 3 pain score and for the change in pain scores from the baseline value. Of note, the age ≥ 50 subgroup represented a more balanced cohort with comparable baseline pain scores between the study groups. For this population, the pain scores for postoperative day 1–3 were significantly lower in the intervention group. The intervention group had a longer six-minute walking distance on postoperative day 3 with a trend toward a smaller difference in the day 3 distance from the baseline. Conclusions: The potential benefits of abdominal binder use in reducing postoperative pain and improving functional recovery after open gynecologic cancer surgery could be demonstrated only in those age ≥ 50.
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18
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Techata A, Muangmool T, Wongpakaran N, Charoenkwan K. Effect of cancer stage on health-related quality of life of patients with epithelial ovarian cancer. J OBSTET GYNAECOL 2021; 42:139-145. [PMID: 33938358 DOI: 10.1080/01443615.2021.1877647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/12/2022]
Abstract
We compared the quality of life (QoL) of women with early versus advanced epithelial ovarian cancer and examined predicting factors for the poor QoL. We classified 157 participants into 108 with early disease (stage I-II) and 49 with advanced disease (stage III-IV). They completed two questionnaires: EORTC QLQ-C30 and Chiang Mai University (CMU) ovarian cancer QoL. For EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL, functional scales, and summary scores. The advanced group had worse scores on symptom scales specifically appetite loss and constipation. For CMU Ovarian Cancer QoL, the advanced group had worse scores only in the gastrointestinal domain but not in urinary, lymphatic, and sexual/hormonal domains. These findings remained mostly unchanged after excluding those with recurrence. In multivariable analysis, currently receiving treatment was consistently associated with worse QoL scores. The advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy.IMPACT STATEMENTWhat is already known on this subject? Survival outcome for women with epithelial ovarian cancer varies depending mainly on stage. Those who survive advanced stage disease could expect long-term disease and treatment-related morbidities that significantly affected QoL. However, there has been very limited information regarding QoL of women who have the early disease in comparison to those with more advanced disease especially in the context of Asian culture.What do the results of this study add? Apart from the higher prevalence of gastrointestinal symptoms reported by the patients with advanced disease, the general well-being and other symptom-specific domains of QoL were comparable between women with early and advanced diseases. Receiving treatment is a consistent predictor for poor QoL.What are the implications of these findings for clinical practice and/or further research? In comparison to early-stage epithelial ovarian cancer, the advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy. This information will be useful for patient counselling. Future research should examine the underlying causes of this finding.
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Affiliation(s)
- Apichaya Techata
- Faculty of Medicine, Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Faculty of Medicine, Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Faculty of Medicine, Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
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19
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Kingnate C, Charoenkwan K, Kumfu S, Apaijai N, Jaiwongkam T, Khunamornpong S, Chattipakorn N, Chattipakorn SC. Platinum-based chemotherapy and bevacizumab instigate the destruction of human ovarian cancers via different signaling pathways. Biochem Pharmacol 2021; 188:114587. [PMID: 33932471 DOI: 10.1016/j.bcp.2021.114587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
The standard chemotherapy regimens of ovarian cancer are platinum-based chemotherapy (carboplatin and paclitaxel) and bevacizumab (BEV). However, the effects of BEV alone or combined with carboplatin and paclitaxel on mitochondrial dynamics, mitochondrial function, mitophagy, apoptosis, inflammation and vascular endothelial growth factor (VEGF) in human ovarian cancer mitochondria and cells have not yet been investigated. Therefore, we aimed to test the hypothesis that 1) platinum-based chemotherapy and BEV equally damage isolated mitochondria from human ovarian cancers, and ovarian cancer cells through inducing mitochondrial dynamics dysregulation, mitochondrial dysfunction, increased mitophagy and apoptosis, as well as altered inflammation and VEGF; and 2) combined therapies exert greater damage than monotherapy. Each isolated human ovarian cancer mitochondria (n = 16) or CaOV3 cells (n = 6) were treated with either platinum-based chemotherapy (carboplatin 10 μM and paclitaxel 5 μM), BEV (2 mg/mL) or combined platinum-based chemotherapy and BEV for 60 min or 24 h, respectively. Following the treatment, mitochondrial dynamics, mitochondrial function, mitophagy, apoptosis, cytotoxicity, inflammation and VEGF were determined. Platinum-based chemotherapy caused ovarian cancer mitochondria and cell damage through mitochondrial dysfunction, increased cell death with impairment of membrane integrity, and enhanced VEGF reduction, while BEV did not. BEV caused deterioration of ovarian cancer mitochondria and cells through mitochondrial-dependent apoptosis, but it had no effect on cell viability. Interestingly, combined platinum-based chemotherapy and BEV treatments had no addictive effects on all parameters except mitochondrial maximal respiration, when compared to monotherapy. Collectively, these findings suggest that platinum-based chemotherapy and BEV caused human ovarian cancer mitochondrial and cell damage through different mechanisms.
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Affiliation(s)
- Chalita Kingnate
- Department of Obstetrics and Gynecology, Lamphun Hospital, Lamphun 51000, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sirinart Kumfu
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nattayaporn Apaijai
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thidarat Jaiwongkam
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Surapan Khunamornpong
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand.
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20
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Charoenkwan K, Wilailak S. The 6th Biennial Meeting of the Asian Society of Gynecologic Oncology, October 10th to 12th, 2019. J Gynecol Oncol 2021; 31:e38. [PMID: 31833261 PMCID: PMC6918884 DOI: 10.3802/jgo.2020.31.e38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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21
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Pattanakuhar S, Charoenkwan K, Witwattanadittakul N, Kwanchuay P, Hathaiareerug C. Interventions for reducing pain during needle electromyography (EMG) examination. Hippokratia 2020. [DOI: 10.1002/14651858.cd013753] [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: 11/10/2022]
Affiliation(s)
- Sintip Pattanakuhar
- Department of Rehabilitation Medicine; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | | | - Photsawee Kwanchuay
- Department of Rehabilitation Medicine; Thammasat University; Khlong Luang, Pathum Thani Thailand
| | - Chanasak Hathaiareerug
- Department of Physical Medicine and Rehabilitation; Phramongkutklao College of Medicine; Bangkok Thailand
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22
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Kingnate C, Charoenkwan K, Kumfu S, Apaijai N, Jaiwongkam T, Khunamornpong S, Chattipakorn N, Chattipakorn S. Platinum-based chemotherapy and bevacizumab-induced mitochondrial damage in human epithelial ovarian cancers via different pathways. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.141] [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] [Indexed: 11/26/2022]
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23
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Cheewakriangkrai C, Kietpeerakool C, Charoenkwan K, Pattanittum P, John D, Aue‐aungkul A, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer. Cochrane Database Syst Rev 2020; 3:CD013253. [PMID: 32168393 PMCID: PMC7069600 DOI: 10.1002/14651858.cd013253.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diagnosis of endometrial (womb) cancer is normally made at an early stage, as most women with the disease experience abnormal vaginal bleeding, which prompts them to seek medical advice. However, delays in presentation and referral can result in delay in diagnosis and management, which can lead to unfavourable treatment outcomes. This is particularly a problem for pre- and peri-menopausal women. Providing educational information to women and healthcare providers regarding symptoms relating to endometrial cancer may raise awareness of the disease and reduce delayed treatment. OBJECTIVES To assess the effectiveness of health education interventions targeting healthcare providers, or individuals, or both, to promote early presentation and referral for women with endometrial cancer symptoms. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), both individually randomised and cluster-RCTs. In the absence of RCTs we planned to include well-designed non-randomised studies (NRS) with a parallel comparison assessing the benefits of any type of health education interventions. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated whether potentially relevant studies met the inclusion criteria for the review, but none were found. MAIN RESULTS A comprehensive search of the literature yielded the following results: CENTRAL (1022 references), MEDLINE (2874 references), and Embase (2820 references). After de-duplication, we screened titles and abstracts of 4880 references and excluded 4864 that did not meet the review inclusion criteria. Of the 16 references that potentially met the review inclusion, we excluded all 16 reports after reviewing the full texts. We did not identify any ongoing trials. AUTHORS' CONCLUSIONS There is currently an absence of evidence to indicate the effectiveness of health education interventions involving healthcare providers or individuals or both to promote early presentation and referral for women with endometrial cancer symptoms. High-quality RCTs are needed to assess whether health education interventions enhance early presentation and referral. If health education interventions can be shown to reduce treatment delays in endometrial cancer, further studies would be required to determine which interventions are most effective.
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Affiliation(s)
- Chalong Cheewakriangkrai
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadMuangChiang MaiThailand50200
| | - Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadMuangChiang MaiThailand50200
| | - Porjai Pattanittum
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Public Health FacultyMitraparp RoadMueng DistrictKhon KaenKhon KaenThailand40002
| | | | - Apiwat Aue‐aungkul
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Pongsuvareeyakul T, Charoenkwan K, Suprasert P, Khunamornpong S. Primary signet ring cell carcinoma with neuroendocrine differentiation arising in mucinous borderline tumor of the ovary. Gynecol Oncol Rep 2019; 31:100522. [PMID: 31872017 PMCID: PMC6909212 DOI: 10.1016/j.gore.2019.100522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 11/24/2019] [Indexed: 11/24/2022] Open
Abstract
Primary signet ring cell carcinoma in ovarian mucinous tumor is rare. The most important differential diagnosis is metastatic carcinoma. We report a case of primary ovarian signet ring cell carcinoma in mucinous tumor. Clinicopathological correlation is essential to establish the correct diagnosis.
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Affiliation(s)
- Tip Pongsuvareeyakul
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Prapaporn Suprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Surapan Khunamornpong
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Charoenkwan K, Nantasupha C. Methods of pain control during endometrial biopsy: A systematic review and meta-analysis of randomized controlled trials. J Obstet Gynaecol Res 2019; 46:9-30. [PMID: 31667985 DOI: 10.1111/jog.14152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/13/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
Abstract
AIM To review effectiveness of methods for reducing pain during endometrial biopsy. METHODS PubMed, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched for randomized controlled trials that examined effectiveness of pain control methods for endometrial biopsy. Risk of bias was assessed from sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Heterogeneity was examined from forest plot, statistical tests of homogeneity, and I2 statistic. For meta-analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated. RESULTS Twenty-six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] -1.31, 95% confidence interval [CI] -2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low-pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD -2.22, 95% CI -3.72 to -0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD -0.96, 95% CI -1.53 to -0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti-inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies. CONCLUSION Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.
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Affiliation(s)
- Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalaithorn Nantasupha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Charoenkwan K, Srisomboon J. The Annual Meeting of the Thai Gynecologic Cancer Society 2019: Meeting report. J Gynecol Oncol 2019; 30:e118. [PMID: 31576703 PMCID: PMC6779612 DOI: 10.3802/jgo.2019.30.e118] [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] [Received: 09/08/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jatupol Srisomboon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Chankhunaphas W, Charoenkwan K. Effect of elastic abdominal binder on pain and functional recovery after caesarean delivery: a randomised controlled trial. J OBSTET GYNAECOL 2019; 40:473-478. [PMID: 32401106 DOI: 10.1080/01443615.2019.1631768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/18/2022]
Abstract
The Elastic abdominal binder has been widely employed by clinicians for pain relief, wound complications prevention, improved pulmonary function, and stabilisation. However, these proposed benefits have not been properly examined in women following caesarean delivery. We aimed to examine the effects of post-caesarean elastic abdominal binder use on recovery by comparing post-operative pain, mobility and quality of life. Pregnant women undergoing caesarean delivery were randomly assigned into two groups: abdominal binder (90 patients) and control (90 patients). The primary outcomes included the daily visual analogue scale pain scores and the distance from the six-minute walk test. Baseline characteristics were similar between the groups. There was no significant difference in pain scores and six-minute walking distance between the study groups. There was no significant between-group difference in quality-of-life dimensions, overall health status, and post-operative complication. The positive effects of elastic abdominal binder use following caesarean delivery could not be demonstrated in this study.Impact statementWhat is already known on this subject? Elastic abdominal binder is commonly used after laparotomy to support incision. There was evidence to support the benefit of abdominal binder in reducing psychological distress during the first five days following laparotomy for other indications. From limited number of studies addressing caesarean section, the evidence for the benefits of the binder on pain, symptom distress, and change in haemoglobin level is conflicting.What do the results of this study add? In contrast to the results of the previous study, the beneficial effects of abdominal binder on pain reduction, functional recovery, and quality of life following caesarean delivery could not be demonstrated in this study.What are the implications of these findings for clinical practice and/or further research? The use of elastic abdominal binder after caesarean delivery is not associated with reduction of postoperative pain, faster functional recovery, and improved quality of life in our population. Further studies in other population with different characteristics may be worthwhile.
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Affiliation(s)
- Wisit Chankhunaphas
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Wudtisan J, Tantipalakorn C, Charoenkwan K, Sreshthaputra RA, Srisomboon J. Factors Associated with Development of High-Grade Squamous
Intraepithelial Lesions of the Uterine Cervix in Women Younger
than 30 Years. Asian Pac J Cancer Prev 2019; 20:1031-1036. [PMID: 31030470 PMCID: PMC6948903 DOI: 10.31557/apjcp.2019.20.4.1031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 01/12/2023] Open
Abstract
Objective: To determine the factors associated with the increased risk of developing high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30 years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP) between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzed the factors associated with the development of HSIL by comparing two age groups between women aged < 30 years and those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. age at sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitted diseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated with the increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results: During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years (control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexual partners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007) and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the development of HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status and underlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiple sexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women younger than 30 years. Cervical cancer screening should be considered in young women with such factors.
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Affiliation(s)
- Jongpeeti Wudtisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Charuwan Tantipalakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Rung-Aroon Sreshthaputra
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Jatupol Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Srisomboon S, Tantipalakorn C, Charoenkwan K, Srisomboon J. Cervical Screening Results Leading to Detection of Adenocarcinoma in Situ of the Uterine Cervix. Asian Pac J Cancer Prev 2019; 20:377-382. [PMID: 30803195 PMCID: PMC6897002 DOI: 10.31557/apjcp.2019.20.2.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Adenocarcinoma in situ (AIS) of the uterine cervix is a preinvasive lesion of the invasive adenocarcinoma. We analyzed the cervical screening results leading to detecting the AIS lesions including the coexistence of AIS lesions with high-grade squamous intra-epithelial lesions (HSIL) and invasive carcinoma. Methods: Women who were diagnosed and received treatment for AIS at Chiang Mai University Hospital between January 1, 2007 and August 31, 2016 were retrospectively reviewed. The inclusion criteria were the women who had pathological diagnosis of AIS obtained from cervical punch biopsy or excisional cone biopsy with either loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC). The patient characteristics, diagnostic work-up and treatment details were reviewed, including the cervical screening results prior to the diagnosis of cervical AIS, pathologic results of excisional cone biopsy and hysterectomy specimens. Results: During the study period, 75 women with AIS pathology undergoing excisional cone biopsy with either LEEP (n=62) or CKC (n=13) were identified. The abnormal cytologic screening leading to detection of AIS was the squamous cell abnormality accounting for 57.3%. Abnormal glandular cytology accounted for 37.3%. The most common abnormal cervical screening results was HSIL cytology (n = 25) followed by AIS cytology (n = 13). Normal cytology was noted in 4 women in whom 3 were positive for HPV 18 and 1 had AIS on the endocervical polyp. AIS coexisted with HSIL and invasive carcinoma were detected in cone biopsy specimens in 21 (28%) and 29 (38.7%) patients, respectively. Conclusion: The majority of cervical screening results leading to detection of cervical AIS was the squamous cell abnormality accounting for 57.3% in which, HSIL cytology was the most common. Abnormal glandular cytology accounted for only 37.3%. Diagnostic cone excision is recommended if AIS lesion is noted in cervical biopsy specimen since nearly 40% have coexisting invasive lesions.
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Affiliation(s)
- Santipap Srisomboon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang aMai, Thailand.
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Piyawetchakarn R, Charoenkwan K. Effects of lidocaine spray for reducing pain during endometrial aspiration biopsy: A randomized controlled trial. J Obstet Gynaecol Res 2019; 45:987-993. [DOI: 10.1111/jog.13932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ratpaporn Piyawetchakarn
- Department of Obstetrics and Gynecology, Faculty of MedicineChiang Mai University Chiang Mai Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of MedicineChiang Mai University Chiang Mai Thailand
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Cheewakriangkrai C, Kietpeerakool C, Aue-aungkul A, Charoenkwan K, Pattanittum P, John D, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chalong Cheewakriangkrai
- Faculty of Medicine, Chiang Mai University; Department of Obstetrics and Gynecology; 110 Intawaroros Road Muang Chiang Mai Thailand 50200
| | - Chumnan Kietpeerakool
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Apiwat Aue-aungkul
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai University; Department of Obstetrics and Gynecology; 110 Intawaroros Road Muang Chiang Mai Thailand 50200
| | - Porjai Pattanittum
- Khon Kaen University; Department of Epidemiology and Biostatistics, Public Health Faculty; Mitraparp Road Mueng District Khon Kaen Khon Kaen Thailand 40002
| | | | - Pisake Lumbiganon
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
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Nantasupha C, Charoenkwan K. Predicting factors for resumption of spontaneous voiding following nerve-sparing radical hysterectomy. J Gynecol Oncol 2018; 29:e59. [PMID: 29770629 PMCID: PMC5981110 DOI: 10.3802/jgo.2018.29.e59] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/04/2018] [Revised: 02/06/2018] [Accepted: 03/28/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To determine factors affecting voiding recovery on the day of Foley catheter removal (postoperative day 7, POD7) after nerve-sparing radical hysterectomy (NSRH) for early-stage cervical cancer. Methods Early-stage cervical cancer patients, who underwent type C1 radical hysterectomy between January 2006 and June 2016 were included. Clinical and pathological data were reviewed. Association between inability to attain adequate voiding function on POD7 and potential predicting factors were evaluated in univariate and multivariate analysis. Results Of 755 patients, 383 (50.7%) resumed adequate voiding function on POD7 while 372 (49.3%) did not. Tumor size was larger in patients whose voiding function was inadequate (2.5 vs. 2.0 cm, p=0.001). Lengths of resected parametria and adjacent vagina were more extensive in patients with inadequate voiding function (p<0.001). In univariate analysis, factors significantly associated with inability to attain adequate voiding function included tumor size >4 cm (p<0.001), primary surgeon (p<0.001), postoperative urinary tract infection (p<0.01), grossly visible tumor (p<0.01), and not having prior conization (p<0.01). In multivariate analysis, tumor size >4 cm, postoperative urinary tract infection, and primary surgeon were significantly associated with inability to attain adequate voiding function on POD7. Conclusion Extent of disease represented by tumor size, urinary tract infection as well as individual surgeon's technique independently predict resumption of adequate voiding function on POD7 following NSRH.
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Affiliation(s)
- Chalaithorn Nantasupha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. ,
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Wongluecha T, Tantipalakorn C, Charoenkwan K, Srisomboon J. Effect of lidocaine spray during colposcopy-directed cervical biopsy: A randomized controlled trial. J Obstet Gynaecol Res 2017; 43:1460-1464. [DOI: 10.1111/jog.13380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/04/2017] [Accepted: 04/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tanyalak Wongluecha
- Department of Obstetrics and Gynecology; Chiang Mai University; Chiang Mai Thailand
| | | | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology; Chiang Mai University; Chiang Mai Thailand
| | - Jatupol Srisomboon
- Department of Obstetrics and Gynecology; Chiang Mai University; Chiang Mai Thailand
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Charoenkwan K, Kietpeerakool C. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in women with gynaecological malignancies. Cochrane Database Syst Rev 2017; 6:CD007387. [PMID: 28660687 PMCID: PMC6353272 DOI: 10.1002/14651858.cd007387.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This is an updated version of an original Cochrane review published in Issue 6, 2014. Pelvic lymphadenectomy is associated with significant complications including lymphocyst formation and related morbidities. Retroperitoneal drainage using suction drains has been recommended as a method to prevent such complications. However, findings from recent studies have challenged this policy. OBJECTIVES To assess the effects of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy on lymphocyst formation and related morbidities in women with gynaecological cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2017) in the Cochrane Library, electronic databases MEDLINE (1946 to March Week 2, 2017), Embase (1980 to 2017 week 12), and the citation lists of relevant publications. We also searched the trial registries for ongoing trials on 20 May 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared the effect of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy in women with gynaecological cancer. Retroperitoneal drainage was defined as placement of passive or active suction drains in pelvic retroperitoneal spaces. No drainage was defined as no placement of passive or active suction drains in pelvic retroperitoneal spaces. DATA COLLECTION AND ANALYSIS We assessed studies using methodological quality criteria. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We examined continuous data using mean difference (MD) and 95% CI. MAIN RESULTS Since the last version of this review, we have identified no new studies for inclusion. The review included four studies with 571 women. Regarding short-term outcomes (within four weeks after surgery), retroperitoneal drainage was associated with a comparable rate of overall lymphocyst formation when all methods of pelvic peritoneum management were considered together (2 studies; 204 women; RR 0.76, 95% CI 0.04 to 13.35; moderate-quality evidence). When the pelvic peritoneum was left open, the rates of overall lymphocyst formation (1 study; 110 women; RR 2.29, 95% CI 1.38 to 3.79) and symptomatic lymphocyst formation (2 studies; 237 women; RR 3.25, 95% CI 1.26 to 8.37) were higher in the drained group. At 12 months after surgery, the rates of overall lymphocyst formation were comparable between the groups (1 study; 232 women; RR 1.48, 95% CI 0.89 to 2.45; high-quality evidence). However, there was a trend toward increased risk of symptomatic lymphocyst formation in the group with drains (1 study; 232 women; RR 7.12, 95% CI 0.89 to 56.97; low-quality evidence). AUTHORS' CONCLUSIONS Placement of retroperitoneal tube drains has no benefit in the prevention of lymphocyst formation after pelvic lymphadenectomy in women with gynaecological malignancies. When the pelvic peritoneum is left open, the tube drain placement is associated with a higher risk of short- and long-term symptomatic lymphocyst formation. We found the quality of evidence using the GRADE approach to be moderate to high for most outcomes, except for symptomatic lymphocyst formation at 12 months after surgery, and unclear or low risk of bias.
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Affiliation(s)
- Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadChiang MaiThailand50200
| | - Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Abstract
BACKGROUND Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with electrosurgery may include poor wound healing and complications such as surgical site infection. OBJECTIVES To assess the effects of electrosurgery compared with scalpel for major abdominal incisions. SEARCH METHODS The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. SELECTION CRITERIA Studies considered in this analysis were randomised controlled trials (RCTs) that compared electrosurgery to scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. DATA COLLECTION AND ANALYSIS Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. MAIN RESULTS The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared electrosurgery to scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between electrosurgery and scalpel (7.7% for electrosurgery versus 7.4% for scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing.It is uncertain whether electrosurgery decreases wound dehiscence compared to scalpel (2.7% for electrosurgery versus 2.4% for scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision).There was no clinically important difference in incision time between electrosurgery and scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between electrosurgery and scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision).There was no clinically important difference in mean blood loss between electrosurgery and scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. AUTHORS' CONCLUSIONS The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the scalpel and electrosurgery. There is a need for more research to determine the relative effectiveness of scalpel compared with electrosurgery for major abdominal incisions.
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Affiliation(s)
- Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadChiang MaiThailand50200
| | - Zipporah Iheozor‐Ejiofor
- The University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Kittipan Rerkasem
- Chiang Mai UniversityDivision of Vascular and Endovascular Surgery, Department of Surgery, Faculty of MedicineChiang MaiThailand
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Jitkunnatumkul A, Tantipalakorn C, Charoenkwan K, Srisomboon J. Subsequent Oophorectomy and Ovarian Cancer after Hysterectomy for Benign Gynecologic Conditions at Chiang Mai University Hospital. Asian Pac J Cancer Prev 2016; 17:3845-3848. [PMID: 27644627] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
This study was undertaken to determine the incidence of subsequent oophorectomy due to ovarian pathology or ovarian cancer in women with prior hysterectomy for benign gynecologic conditions at Chiang Mai University Hospital. Medical records of women who underwent hysterectomy for benign gynecologic diseases and pre-cancerous lesions between January 1, 2004 and December 31, 2013 at Chiang Mai University Hospital were retrospectively reviewed. The incidence and indications of oophorectomy following hysterectomy were analyzed. During the study period, 1,035 women had hysterectomy for benign gynecologic conditions. Of these, 590 women underwent hysterectomy with bilateral salpingo-oophorectomy and 445 hysterectomy with bilateral ovarian preservation or unilateral salpingo-oophorectomy. The median age was 47 years (range, 11-75 years). Ten women (2.45 %) had subsequent oophorectomy for benign ovarian cysts. No case of ovarian cancer was found. The mean time interval between hysterectomy and subsequent oophorectomy was 43.1 months (range, 2-97 months) and the mean follow-up time for this patient cohort was 51 months (range, 1.3-124.9 months). According to our hospital-based data, the incidence of subsequent oophorectomy in women with prior hysterectomy for benign gynecologic conditions is low and all present with benign conditions.
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Affiliation(s)
- Aurapin Jitkunnatumkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail :
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Suprasert P, Suwansirikul S, Charoenkwan K, Cheewakriangkrai C, Suwansirikul S. Outcome of the Gynecologic Oncology Patients Surveillance Network Program. Asian Pac J Cancer Prev 2015; 16:4901-3. [PMID: 26163612 DOI: 10.7314/apjcp.2015.16.12.4901] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The gynecologic oncology patients surveillance network program was conducted with the collaboration of 5 provincial hospitals located in the north of Thailand (Chiang Rai, Lamphun Nan, Phayao and Phrae). The aim was to identify ways of reducing the burden and the cost to the gynecologic cancer patients who needed to travel to the tertiary care hospital for follow up. The clinical data of each patient was transferred to the provincial hospital by the internet via the website www.gogcmu.or.th. All the general gynecologists who participated in this project attended the training course set up for the program. From January 2011 to February 2014, 854 patients who were willing to have their next follow-up at the network hospitals close to their home were enrolled this project. Almost of them were residents in Chiang Rai province and the most common disease was cervical cancer. After the project had been running for 1 year, 604 of the enrolled patients and 21 health-care personnel who had participated in this project were interviewed to assess its success. Some 85.3% of the patients and 100% of the health-care personnel were satisfied with this project. However, 60 patients had withdrawn, the most common reason being the lack of confidence in the follow up at the local provincial hospital. In conclusion, it is possible to initiate a gynecologic oncology patients' surveillance network program and the initiation could reduce the problems associated with and the cost the patients incurred as they journeyed to the tertiary care hospital.
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Affiliation(s)
- Prapaporn Suprasert
- Department of Patholgy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail :
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Jerachotechueantaveechai T, Charoenkwan K, Wongpakaran N. Prevalence and predicting factors for anxiety in thai women with abnormal cervical cytology undergoing colposcopy. Asian Pac J Cancer Prev 2015; 16:1427-30. [PMID: 25743810 DOI: 10.7314/apjcp.2015.16.4.1427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To compare prevalence of anxiety in women with abnormal cervical cytology (Pap) undergoing colposcopy to that of women attending the outpatient clinic for check-up and to examine predicting factors. MATERIALS AND METHODS In this cross-sectional analytical study, 100 women with abnormal cervical cytology (abnormal Pap group) and 100 women who attended our outpatient clinic for check-up (control group) were recruited from June 2013 to January 2014. The Hospital Anxiety and Depression Scale (HADS) was employed to determine anxiety in the participants with the score of ≥ 11 suggestive of clinically significant anxiety. The prevalence of anxiety and the mean HADS scores for anxiety were compared between the groups. For those with abnormal Pap, association between clinical factors and anxiety was assessed. A p-value of < 0.05 was considered significant. RESULTS Median age was different between the groups, 44.0 years in the abnormal Pap group and 50.0 years in the control group (p=0.01). The proportion of participants who had more than one sexual partner was higher in the abnormal Pap group, 39.2% vs. 24.7% (p=0.03) and the prevalence of anxiety was significantly higher 14/100 (14.0%) vs. 3/100 (3.0%) (p < 0.01). The prevalence of depression was comparable between the groups. The mean HADS scores for anxiety and depression subscales were significantly higher in the abnormal Pap group, 6.6 vs. 4.8 (P < 0.01) and 3.9 vs. 3.1 (p=0.05), respectively. For the abnormal Pap group, no definite association between clinical factors and anxiety was demonstrated. CONCLUSIONS The prevalence of anxiety in women with abnormal Pap awaiting colposcopy was significantly higher than that of normal controls. Special attention including thorough counselling, with use of information leaflets and psychological support, should be directed to these women.
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Chittrakul S, Charoenkwan K, Wongpakaran N. Prevalence of Anxiety May Not be Elevated in Thai Ovarian Cancer Patients Following Treatment. Asian Pac J Cancer Prev 2015; 16:1251-4. [DOI: 10.7314/apjcp.2015.16.3.1251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- Kittipat Charoenkwan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Abstract
BACKGROUND This is an updated version of the original Cochrane review published in 2007. Traditionally, after major abdominal gynaecologic surgery postoperative oral intake is withheld until the return of bowel function. There has been concern that early oral intake would result in vomiting and severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence, and anastomotic leakage. However, evidence-based clinical studies suggest that there may be benefits from early postoperative oral intake. OBJECTIVES To assess the effects of early versus delayed (traditional) initiation of oral intake of food and fluids after major abdominal gynaecologic surgery. SEARCH METHODS We searched the Menstrual Disorders and Subfertility Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), electronic databases (MEDLINE, EMBASE, CINAHL), and the citation lists of relevant publications. The most recent search was conducted 1 April 2014. We also searched a registry for ongoing trials (www.clinicaltrials.gov) on 13 May 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) were eligible that compared the effect of early versus delayed initiation of oral intake of food and fluids after major abdominal gynaecologic surgery. Early feeding was defined as oral intake of fluids or food within 24 hours post-surgery regardless of the return of bowel function. Delayed feeding was defined as oral intake after 24 hours post-surgery and only after signs of postoperative ileus resolution. DATA COLLECTION AND ANALYSIS Two review authors selected studies, assessed study quality and extracted the data. For dichotomous data, we calculated the risk ratio (RR) with a 95% confidence interval (CI). We examined continuous data using the mean difference (MD) and a 95% CI. We tested for heterogeneity between the results of different studies using a forest plot of the meta-analysis, the statistical tests of homogeneity of 2 x 2 tables and the I² value. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS Rates of developing postoperative ileus were comparable between study groups (RR 0.47, 95% CI 0.17 to 1.29, P = 0.14, 3 RCTs, 279 women, I² = 0%, moderate-quality evidence). When we considered the rates of nausea or vomiting or both, there was no evidence of a difference between the study groups (RR 1.03, 95% CI 0.64 to 1.67, P = 0.90, 4 RCTs, 484 women, I² = 73%, moderate-quality evidence). There was no evidence of a difference between the study groups in abdominal distension (RR 1.07, 95% CI 0.77 to 1.47, 2 RCTs, 301 women, I² = 0%) or a need for postoperative nasogastric tube placement (RR 0.48, 95% CI 0.13 to 1.80, 1 RCT, 195 women).Early feeding was associated with shorter time to the presence of bowel sound (MD -0.32 days, 95% CI -0.61 to -0.03, P = 0.03, 2 RCTs, 338 women, I² = 52%, moderate-quality evidence) and faster onset of flatus (MD -0.21 days, 95% CI -0.40 to -0.01, P = 0.04, 3 RCTs, 444 women, I² = 23%, moderate-quality evidence). In addition, women in the early feeding group resumed a solid diet sooner (MD -1.47 days, 95% CI -2.26 to -0.68, P = 0.0003, 2 RCTs, 301 women, I² = 92%, moderate-quality evidence). There was no evidence of a difference in time to the first passage of stool between the two study groups (MD -0.25 days, 95% CI -0.58 to 0.09, P = 0.15, 2 RCTs, 249 women, I² = 0%, moderate-quality evidence). Hospital stay was shorter in the early feeding group (MD -0.92 days, 95% CI -1.53 to -0.31, P = 0.003, 4 RCTs, 484 women, I² = 68%, moderate-quality evidence). Infectious complications were less common in the early feeding group (RR 0.20, 95% CI 0.05 to 0.73, P = 0.02, 2 RCTs, 183 women, I² = 0%, high-quality evidence). In one study, the satisfaction score was significantly higher in the early feeding group (MD 11.10, 95% CI 6.68 to 15.52, P < 0.00001, 143 women, moderate-quality evidence). AUTHORS' CONCLUSIONS Early postoperative feeding after major abdominal gynaecologic surgery for either benign or malignant conditions appeared to be safe without increased gastrointestinal morbidities or other postoperative complications. The benefits of this approach include faster recovery of bowel function, lower rates of infectious complications, shorter hospital stay, and higher satisfaction.
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Affiliation(s)
- Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Chiang Mai, 50200, Thailand.
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Sethasathien P, Charoenkwan K, Siriaunkgul S. Accuracy of Intraoperative Gross Examination of Myometrial Invasion in Stage I-II Endometrial Cancer. Asian Pac J Cancer Prev 2014; 15:7061-4. [DOI: 10.7314/apjcp.2014.15.17.7061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mahawerawat S, Charoenkwan K, Srisomboon J, Khunamornpong S, Suprasert P, Sae-Teng CT. Surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Asian Pac J Cancer Prev 2014; 14:5375-8. [PMID: 24175829 DOI: 10.7314/apjcp.2013.14.9.5375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was undertaken to evaluate the surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Data for 58 patients who underwent modified radical hysterectomy or radical hysterectomy with pelvic lymphadenectomy between January 2003 and December 2012 at Chiang Mai University Hospital were retrospectively reviewed. The analysis included clinico-pathological risk factors (nodal metastasis, parametrial involvement), adjuvant treatment, 5-year disease-free survival and 5-year overall survival. All pathologic slides were reviewed by a gynecologic pathologist. Follow-up methods included at least cervical cytology and colposcopy with directed biopsy if indicated. Univariate analysis was performed to identify factors associated with median survival. At the median follow up time of 73 months, the 5-year disease-free survival and the 5-year overall survival were 97.4% and 97.4%, respectively. Two (3.4%) patients had pelvic lymph node metastases. In a univariate analysis, there was no statistically significant association between survival and prognostic factors such as age, histological cell type, lymph-vascular space invasion, vaginal margin status and lymph node status. Surgical and survival outcomes of women with stage IA2 cervical cancer are excellent. No parametrial involvement was detected in our study. Patients with stage IA2 cervical cancer may be treated with simple or less radical hysterectomy with pelvic lymphadenectomy.
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Affiliation(s)
- Sukanda Mahawerawat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail:
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Charoenkwan K, Kietpeerakool C. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in patients with gynaecological malignancies. Cochrane Database Syst Rev 2014; 2014:CD007387. [PMID: 24894643 PMCID: PMC6457854 DOI: 10.1002/14651858.cd007387.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 1, 2010. Pelvic lymphadenectomy is associated with significant complications including lymphocyst formation and related morbidities. Retroperitoneal drainage using suction drains has been recommended as a method to prevent such complications. However, this policy has been challenged by the findings from recent studies. OBJECTIVES To assess the effects of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy on lymphocyst formation and related morbidities in gynaecological cancer patients. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 12) in The Cochrane Library, electronic databases MEDLINE (Nov Week 3, 2013), EMBASE (2014, week 1), and the citation lists of relevant publications. The latest searches were performed on 10 January 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared the effect of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy in gynaecological cancer patients. Retroperitoneal drainage was defined as placement of passive or active suction drains in pelvic retroperitoneal spaces. No drainage was defined as no placement of passive or active suction drains in pelvic retroperitoneal spaces. DATA COLLECTION AND ANALYSIS We assessed studies using methodological quality criteria. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We examined continuous data using mean difference (MD) and 95% CI. MAIN RESULTS Since the last version of this review, no new studies have been identified for inclusion. The review included four studies with 571 participants. Considering the short-term outcomes (within four weeks after surgery), retroperitoneal drainage was associated with a comparable rate of overall lymphocyst formation when all methods of pelvic peritoneum management were considered together (two studies, 204 patients; RR 0.76, 95% CI 0.04 to 13.35). When the pelvic peritoneum was left open, the rates of overall lymphocyst formation (one study, 110 patients; RR 2.29, 95% CI 1.38 to 3.79) and symptomatic lymphocyst formation (one study, 137 patients; RR 3.25, 95% CI 1.26 to 8.37) were higher in the drained group. At 12 months after surgery, the rates of overall lymphocyst formation were comparable between the groups (one study, 232 patients; RR 1.48, 95% CI 0.89 to 2.45). However, there was a trend toward increased risk of symptomatic lymphocyst formation in the group with drains (one study, 232 patients; RR 7.12, 95% CI 0.89 to 56.97). The included trials were of low to moderate risk of bias. AUTHORS' CONCLUSIONS Placement of retroperitoneal tube drains has no benefit in prevention of lymphocyst formation after pelvic lymphadenectomy in patients with gynaecological malignancies. When the pelvic peritoneum is left open, the tube drain placement is associated with a higher risk of short and long-term symptomatic lymphocyst formation.
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Affiliation(s)
- Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadChiang MaiThailand50200
| | - Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Sethasathien S, Charoenkwan K, Settakorn J, Srisomboon J. Predicting factors for positive vaginal surgical margin following radical hysterectomy for stage IB1 carcinoma of the cervix. Asian Pac J Cancer Prev 2014; 15:2211-5. [PMID: 24716959 DOI: 10.7314/apjcp.2014.15.5.2211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the incidence of positive vaginal surgical margins and determine the predicting factors following radical hysterectomy for stage IB1 carcinoma of the cervix. MATERIALS AND METHODS The clinical and histological data of 656 FIGO stage IB1 cervical cancer patients who had radical hysterectomy with bilateral pelvic lymphadenectomy (RHPL) from January 2003 to December 2012 were retrospectively reviewed and were analyzed for their association with a positive vaginal surgical margin. A p-value of < 0.05 was considered significant. RESULTS Thirty-five patients (5.3%) had positive vaginal surgical margins following RHPL; 24 (3.7%) for intraepithelial lesions and 11 (1.7%) for carcinoma. On multivariate analysis, microscopic vaginal involvement by high-grade squamous intraepithelial lesion and/or carcinoma (adjusted odd ratio (OR) 186.8; 95% confidence interval (CI) 48.5-718.5) and squamous histology (OR 8.7; 95% CI 1.7-44.0), were significantly associated with positive vaginal surgical margin. CONCLUSIONS Microscopic vaginal involvement by HSIL and/ or carcinoma are strong predictors for positive vaginal surgical margins for stage IB1 cervical cancer patients undergoing radical hysterectomy. Preoperative 'mapping' colposcopy or other strategies should be considered to ensure optimal vaginal resection.
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Affiliation(s)
- Sethawat Sethasathien
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail : ,
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Hongladaromp W, Tantipalakorn C, Charoenkwan K, Srisomboon J. Locoregional Spread and Survival of Stage IIA1 versus Stage IIA2 Cervical Cancer. Asian Pac J Cancer Prev 2014; 15:887-90. [DOI: 10.7314/apjcp.2014.15.2.887] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Jakkaew B, Charoenkwan K. Effects of gum chewing on recovery of bowel function following cesarean section: a randomized controlled trial. Arch Gynecol Obstet 2013; 288:255-60. [PMID: 23417198 DOI: 10.1007/s00404-013-2727-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 01/17/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the effects of gum chewing on recovery of bowel function after cesarean section. METHODS Fifty pregnant women who underwent cesarean section at Chiang Mai University hospital from September 2010 to December 2010 were recruited. After cesarean section, patients were randomized into two groups. In group 1 (conventional), patients were fed according to conventional feeding protocol without gum chewing. For group 2 (gum chewing), patients were asked to chew two pieces of sugarless gum for 30 min in the morning, noon, evening and bedtime until the first flatus, along with conventional postoperative feeding protocol. Categorical variables were analyzed using the Chi-square or Fischer's exact test, as appropriate. For continuous variables with skewed distribution, the Mann-Whitney U test was employed. RESULTS There were 25 patients in each group. Median time to the first flatus was shorter in the gum chewing group (36.37 vs. 41.33 h, P = 0.02). Also, there was a trend toward less abdominal cramping on days 1 and 2 in the gum chewing group. However, no difference in other outcome measures of bowel function recovery and ileus-related complications between the groups could be demonstrated. Approximately three-fourth of the women in each group had good tolerance to their first meal. Hospital stay and participants' satisfaction to the assigned feeding schedules were comparable between the study groups. CONCLUSION Gum chewing is associated with faster recovery of bowel function following cesarean section. It is safe, practical, inexpensive, and well tolerated.
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Affiliation(s)
- Bordin Jakkaew
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Suprasert P, Charoenkwan K, Siriaree S, Cheewakriangkrai C, Saeteng J, Srisomboon J. Outcome of cervical cancer patients with single-node compared with no nodal involvement treated with radical hysterectomy and pelvic lymphadenectomy. Int J Gynaecol Obstet 2013; 121:45-8. [PMID: 23343573 DOI: 10.1016/j.ijgo.2012.11.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 10/31/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate disease-free survival (DFS) after radical hysterectomy and pelvic lymphadenectomy (RHPL) among early-stage cervical cancer patients with single-node involvement versus patients with no nodal involvement. METHODS A retrospective review was conducted of the medical records of 843 patients undergoing RHPL at Chiang Mai University Hospital, Thailand, between January 1, 2002, and December 31, 2008. Neoadjuvant chemotherapy was administered when the operative schedule was more than 1 month after diagnosis and adjuvant chemoradiation was administered to high-risk patients. Five subgroups were defined on the basis of pelvic node involvement: group A (0 nodes; n=706), group B (1 node; n=65), group C (2 nodes; n=38), group D (3 nodes; n=13), and group E (≥4 nodes; n=21). RESULTS The 5-year DFS was comparable for groups A and B (94.3% versus 92.1%; P=0.454). In groups C, D, and E, the 5-year DFS was 85.9%, 75.0%, and 61.8%, respectively. The survival outcomes for groups A and B were significantly different from those of the other 3 groups (P<0.001). CONCLUSION Cervical cancer patients with single-node involvement had comparable survival outcomes to those without nodal metastases; however, patients with multiple node involvement had reduced DFS.
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Affiliation(s)
- Prapaporn Suprasert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Abstract
BACKGROUND Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons, though there are concerns about poor wound healing, excessive scarring, and adhesion formation. OBJECTIVES To compare the effects on wound complications of scalpel and electrosurgery for making abdominal incisions. SEARCH METHODS We searched the Cochrane Wounds Group Specialised Register (searched 24 February 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2); Ovid MEDLINE (1950 to February Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 23 February 2012); Ovid EMBASE (1980 to 2012 Week 07); and EBSCO CINAHL (1982 to 17 February 2012). We did not apply date or language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effects on wound complications of electrosurgery with scalpel use for the creation of abdominal incisions. The study participants were patients undergoing major open abdominal surgery, regardless of the orientation of the incision (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions included those in which the major layers of abdominal wall, including subcutaneous tissue and musculoaponeurosis (a strong sheet of fibrous connective tissue that serves as a tendon to attach muscles), were made by electrosurgery, regardless of the techniques used to incise the abdominal skin and peritoneum. Scalpel incisions included those in which all major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, were incised by a scalpel, regardless of the techniques used on the abdominal peritoneum. DATA COLLECTION AND ANALYSIS We independently assessed studies for inclusion and risk of bias. One review author extracted data which were checked by a second review author. We calculated risk ratio (RR) and 95% confidence intervals (CI) for dichotomous data, and difference in means (MD) and 95% CI for continuous data. We examined heterogeneity between studies. MAIN RESULTS We included nine RCTs (1901 participants) which were mainly at unclear risk of bias due to poor reporting. There was no statistically significant difference in overall wound complication rates (RR 0.90, 95% CI 0.68 to 1.18), nor in rates of wound dehiscence (RR 1.04, 95% CI 0.36 to 2.98), however both these comparisons are underpowered and a treatment effect cannot be excluded. There is insufficient reliable evidence regarding the effects of electrosurgery compared with scalpel incisions on blood loss, pain, and incision time. AUTHORS' CONCLUSIONS Current evidence suggests that making an abdominal incision with electrosurgery may be as safe as using a scalpel. However, these conclusions are based on relatively few events and more research is needed. The relative effects of scalpels and electrosurgery are unclear for the outcomes of blood loss, pain, and incision time.
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Affiliation(s)
- Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Suprasert P, Charoenkwan K, Khunamornpong S. Pelvic node removal and disease-free survival in cervical cancer patients treated with radical hysterectomy and pelvic lymphadenectomy. Int J Gynaecol Obstet 2011; 116:43-6. [PMID: 21978816 DOI: 10.1016/j.ijgo.2011.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/31/2011] [Accepted: 08/01/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the relationship between the number of pelvic nodes removed and 5-year disease-free survival in early-stage cervical cancer patients who underwent radical hysterectomy and pelvic lymphadenectomy (RHPL). METHODS The medical records of 826 cervical cancer patients who underwent RHPL and who had at least 11 pelvic nodes removed at Chiang Mai University Hospital between January 2002 and December 2008 were reviewed. The patients were divided into 4 groups according to the number of nodes removed: 11-20 nodes (n=243); 21-30 nodes (n=344); 31-40 nodes (n=171); and ≥ 41 nodes (n=68). The 5-year disease-free survival of patients in each group was compared. The clinicopathological factors were analyzed using Cox regression to identify independent prognostic factors. RESULT Five-year disease-free survival was not significantly different among the 4 groups. When patients with and without nodal involvement were considered separately, the 5-year disease-free survival in all groups was not significantly different. At multivariate analysis, the number of pelvic nodes removed was not an independent prognostic factor. CONCLUSION The number of pelvic nodes removed was not associated with 5-year disease-free survival or number of positive pelvic nodes.
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Affiliation(s)
- Prapaporn Suprasert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chiang Mai University, Chang Mai, Thailand.
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