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"ABSTRACTPurpose: Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional treatment due to the possibility of lymph node metastasis. The aim of this study was to elucidate the clinical outcomes of these additional treatments.Methods: The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy and 31 received chemoradiotherapy (CRT).Results: The median follow-up periods were 45 months in the esophagectomy group and 41 months in the CRT group. The overall survival did not differ significantly between the groups (P = 0.46). However, there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence due to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, six patients; CRT group, ten patients), none in the esophagectomy group had recurrence, whereas four in the CRT group died of esophageal cancer (P = 0.031).Conclusion: The overall survival did not differ significantly between the groups. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion."

"This book aims to give a homogeneous approach to esophageal cancer treatment, based on the author’s lifetime experience in conjunction with exhaustive review of recent literature. In each chapter surgeons and oncologists will find appropriate tools for correct management of the diagnosis and therapy of this difficult disease. The book analyzes all the aspects of staging and treatment, such as modern diagnostic and staging techniques (MRI or PET-CT), endoscopic treatment of early cancer, new minimally invasive and open surgical techniques, and combined treatment. In addition, there are chapters dedicated to the postoperative course of these patients, as well as their quality of life, with indications for the correct follow-up and treatment of relapses."

"Pasien kanker laring yang menjalani laringektomi total seringkali telah berada pada keadaan malnutrisi prabedah. Malnutrisi menyebabkan terlambatnya penyembuhan luka, timbul wound dehiscence, dan rentan terhadap infeksi. Nutrisi yang adekuat berupa makronutrien (karbohidrat, protein, lemak) dan mikronutrien (vitamin, mineral) berperan penting pada penyembuhan luka. Pasien pada serial kasus ini yaitu pasien karsinoma sel skuamosa laring pascalaringektomi total dan diseksi leher berusia 56-74 tahun yang dikonsulkan ke Gizi Klinik. Terapi medik gizi diberikan pada keempat pasien serial kasus sesuai dengan kondisi klinis masing-masing melalui jalur enteral. Suplementasi mikronutrien diberikan pada semua pasien. Hasil serial kasus ini menunjukkan bahwa selama perawatan di rumah sakit terdapat dua pasien yang mengalami kejadian wound dehiscence dan salah satu di antara kedua pasien tersebut juga mengalami fistula faringokutan. Keempat pasien pulang ke rumah dengan keadaan klinis yang membaik. Kesimpulan yang didapatkan yaitu selain terapi medik gizi yang adekuat untuk mempertahankan status gizi dalam mendukung proses penyembuhan luka, faktor usia dan perawatan luka turut berperan terhadap proses penyembuhan luka, namun hal ini masih memerlukan penelitian yang lebih lanjut.

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Laryngeal cancer patients who undergo total laryngectomy often have preoperative malnutrition. Malnutrition causes delayed wound healing, wound dehiscence, and susceptibility to infection. Adequate nutrition in the form of macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins, minerals) play an important role in wound healing. Patients in this case series were undergone total laryngectomy and neck dissection due to squamous cell carcinoma, aged 56-74 years who were consulted to Clinical Nutrition. Nutritional medical therapy was given to all four cases according to their clinical conditions through the enteral pathway. Micronutrient supplementation was given to all patients. The results of this case series showed that during hospital treatment there were two patients who experienced a wound dehiscence and one of the them also had a pharyngocutaneous fistula. The four patients discharged with improvement in clinical conditions. In conclusions, not only need an adequate nutritional medical therapy to maintain nutritional status in supporting the healing process, but also age factors and wound care have contributed to the healing process. However, it still requires further research."

"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV:239-242Oral squamous cell carcinorna ( OSCC ) is the most common malignant tumor of the oral cavity, and its account for 80-90% of all malignancies in oral cavity. The aim of this study was to detemine the presenceof p53 mutations and to associate these mutations with the histopathological type of OSCC such as well differentiated and poorly differentiated. Analitycal observational comparative study by cross sectional design was used. Forty untreated well and poorly differentiated OSCC biopsy sample and normal tissue biopsy material taken from 16 normal patients were analyzed for the presence of mutation in the conserved region of the p53 gene especially in exon 5 by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). The results of this study showed that p53 gene mutations were detected in exon 5; 11/40 (27,5%) with heterozygous mutation 9/11 (81,8%). The incidence in exon 5 of p53 gene mutation was significantly accociated with well differentiated 2/20 (l0%) and poorly diferentiated 9/20 (45%) OSCC(P=0,013). This study concludes that 1) mutation in exon 5 of p53 gene occured frequently in OSCC; 2) exon 5 of the p53 gene could be one of the the specific targets for histopathological grade of OSCC; 3) mutation in exon 5 of p53 gene could be important prognostic factor in OSCC."

"Pendahuluan Biportal Endoscopic Spine Surgery (BESS) merupakan salah satu metode minimal invasif untuk melakukan dekompresi struktur saraf pada Degeneratif Lumbal Canal Stenosis (DLCS). Teknik ini memiliki keunggulan dibandingkan teknik lainnya dalam preservasi jaringan lunak dan struktur posterior tulang belakang. Penambahan prosedur discectomy pada pembedahan terbuka diketahui akan menyebabkan penurunan tinggi diskus secara signifikan, mempercepat proses degenerasi pada diskus itu sendiri sehingga akan merubah biomekanika segmen vertebra dan menimbulkan nyeri bahkan instabilitas di kemudian hari. Untuk itu, dilakukan penelitian dengan membandingkan hasil luaran klinis dan radiologis pada DLCS yang dilakukan BESS dengan penambahan discectomy dan tanpa discectomyMetodologi Penelitian ini mengambil data dari 48 subjek DLCS yang memenuhi kriteria inklusi yang telah menjalani prosedur BESS. Kemudian dibagi menjadi kelompok BESS discectomy sebanyak 24 subjek dan BESS tanpa discectomy sebanyak 24 subjek secara consecutive sampling. Pada masing-masing kelompok dinilai luaran klinis berupa skala nyeri Numerical Rating Scale (NRS) dan skor Oswestry Disability Index (ODI) pre dan 1 tahun pasca operasi. Luaran radiologis dinilai berupa tinggi diskus pada x ray lumbal lateral berdiri pre dan pasca 1 tahun operasi dan adanya instabilitas dinilai dari translasi sagittal dinamik, angulasi sagittal dinamik pada x ray lumbal dinamik berdiri 1 tahun pasca operasiHasil Dari 48 orang subjek pada penelitian ini, rerata usia sebesar 57.56+8.37, sebagian besar berjenis kelamin perempuan 31 (64.6%), dengan level stenosis terbanyak pada L4-5 yaitu sebesar 64.6%, diikuti L5-S1 sebesar 25% dan L3-4 10.4%. Pada kelompok BESS discectomy didapatkan perbedaan yang bermakna terhadap skala nyeri NRS back dan leg pain, skor ODI, serta penurunan tinggi diskus pre dan pasca operasi 1 tahun (p<0,001), begitu juga dengan kelompok BESS tanpa discectomy. Perbandingan perbedaan penurunan tinggi diskus antara kedua kelompok pasca 1 tahun operasi, menunjukkan perbedaan yang signifikan yaitu pada BESS discectomy dengan rerata 1,63 + 0,87 mm, sedangkan pada BESS tanpa discectomy sebesar 0,46 + 0,36 mm (p <0,001). Perbandingan terjadinya instabilitas tidak menunjukkan perbedaan yang bermakna antara kedua kelompok ( p=0,234)Diskusi dan Kesimpulan Prosedur BESS pada kasus DLCS memberikan penurunan skala nyeri NRS back pain dan leg pain yang sama baiknya pada kelompok BESS discectomy dan BESS tanpa discectomy. Tidak didapatkan perbedaan terjadinya instabilitas pada kedua kelompok, meskipun didapatkan perbedaan penurunan tinggi diskus yang signifikan antara kedua kelompok setelah 1 tahun operasi.

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Introduction Biportal Endoscopic Spine Surgery (BESS) is a minimally invasive method for decompressing nerve structures in Degenerative Lumbar Canal Stenosis (DLCS). This technique has advantages over other techniques in the preservation of soft tissue and posterior structures of the spine. The addition of a discectomy procedure to open surgery is known to cause a significant reduction in disc height, accelerate the degeneration process of the disc itself so that it will change the biomechanics of the vertebral segments and cause pain and even instability in the future. For this reason, research was conducted by comparing the clinical and radiological outcomes of DLCS performed by BESS with the addition of discectomy and without discectomy.

Materials and Methods This study took data from 48 DLCS subjects who met the inclusion criteria who had undergone the BESS procedure. Then divided into BESS discectomy group with 24 subjects and BESS without discectomy with 24 subjects using consecutive sampling. In each group, clinical outcomes were assessed in the form of the Numerical Rating Scale (NRS) pain scale and Oswestry Disability Index (ODI) scores pre and 1 year after surgery. Radiological outcomes were assessed in the form of disc height on standing lateral lumbar x-ray pre and post 1 year of surgery and the presence of instability was assessed from dynamic sagittal translation, dynamic sagittal angulation on standing dynamic lumbar x ray 1 year post surgery.

Results Of the 48 subjects in this study, the average age was 57.56+8.37, the majority were female 31 (64.6%), with the highest level of stenosis at L4-5 (64.6%), followed by L5-S1 at 25% and L3-4 10.4%. In the BESS discectomy group, there were significant differences in the NRS back and leg pain scales, ODI scores, and reduction in disc height pre and post-operatively 1 year (p<0.001), as well as in the BESS group without discectomy. Comparison of the difference in disc height reduction between the two groups after 1 year of surgery, showed a significant difference,in BESS discectomy with a mean of 1.63 + 0.87 mm, while in BESS without discectomy it was 0.46 + 0.36 mm (p <0.001 ). Comparison of the occurrence of instability did not show a significant difference between the two groups (p=0.234)

Discussion and Conclusion The BESS procedure in DLCS cases provided an equally good reduction in the NRS back pain and leg pain scales in the BESS discectomy and BESS without discectomy groups. There was no difference in the occurrence of instability in the two groups, although there was a significant difference in disc height reduction between the two groups after 1 year of surgery.

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"Latar belakang: Kanker serviks menduduki peringkat kedua sebagai kanker tersering di seluruh dunia. Karsinoma sel skuamosa KSS adalah jenis histopatologi kanker serviks tersering. Prognosis terapi dan kesintasan KSS serviks menjadi informasi yang penting untuk pasien dan klinisi.Tujuan: 1.Memperbaiki prognosis dan respon terapi radiasi pasien KSS serviks; 2.Mengetahui respon pasca terapi radiasi pada pasien KSS serviks stadium IIIB; 3.Mengetahui prevalensi dan deskripsi sosiodemografi pasien KSS serviks stadium IIIB; 4.Mengetahui perbedaan klinikopatologik pasien KSS serviks stadium IIIB ditinjau dari: diameter massa serviks, derajat diferensiasi sel kanker, dan jenis histopatologi sel kanker; Mengetahui kesintasan 1 tahun setelah menjalani terapi radiasi. Metode: Dilakukan telaah historical kohort pada 76 pasien KSS serviks stadium IIIB di RSCM dari tahun 2016-2017. Pasien dikelompokkan menjadi KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB. Dilakukan analisis univariat, bivariat, dan multivariat. Kesintasan 1 tahun dianalisis dengan menggunakan Kaplan-Meier. Hasil: Prevalensi terbagi menjadi 36 pasien 47,4 dengan pembesaran KGB, dan 40 pasien 52,6 tanpa pembesaran KGB. Respon terapi radiasi pada KSS serviks IIIB dengan pembesaran KGB lebih rendah, RR 4,26 1,96 -9,27, IK 95 . Skor prediktor 2.1 sebagai titik potong untuk menentukan diagnosis respons negatif pada terapi radiasi LR 2,31, sensitivitas 96,3 , spesifisitas 58,3 , dan akurasi 77,3 . Deskripsi sosiodemografi dan klinikopatologi sebanding antara kedua kelompok. Kesintasan 1 tahun KSS serviks stadium IIIB tanpa pembesaran KGB lebih baik HR 9,57. Kesimpulan: Terdapat perbedaan bermakna terhadap respon terapi radiasi antara kelompok KSS serviks stadium IIIB dengan pembesaran KGB dan tanpa pembesaran KGB.

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Background: Cervical cancer is second rank as the most common cancer worldwide. Squamous cell carcinoma SCC is the most common histopathology type for cervical cancers. The radiotherapy prognostic and survival rate of cervical SCC becomes important information for patients and clinicians.

Objectives: 1 To improve prognostic and radiotherapy respond from SCC; 2 knowing the radiotherapy response in patients stage IIIB cervical SCC with lymph node enlargement LNE compared to without LNE; 3 knowing the prevalence and description of sociodemographic; 4 knowing clinicopathologic differences in stage IIIB cervical SCC patients in terms of: cervical mass diameter, differentiated grade of cancer cells, and histopathologic type of cancer cells. 5 Knowing 1 year survival rate after radiotherapy.

Method: A historical cohort study was undertaken in 76 patients with stage IIIB cervical SCC in RSCM from 2016-2017. Patients are grouped into stage IIIB cervical SCC with LNE and without LNE. Univariate, bivariate, and multivariate analyzes were performed. The 1-year survival was analyzed using Kaplan-Meier.

Results: Prevalence was divided into 36 patients 47.4 with LNE, and 40 patients 52.6 without LNE. The radiotherapy respon for stage IIIB cervical SCC with LNE is worst than without LNE, RR 4.26 1.96-9.27, 95 IK . Predictor score ge;2.1 as the cutoff point to determine negative response on radiotherapy LR 2.31, sensitivity 96.3 , specificity 58.3 , and accuracy 77.3 . Sociodemographic and clinicopathologic descriptions were comparable between the two groups. The 1-year survival of stage IIIB cervical SCC without LNE better than with LNE, HR 9.57 3.28 ndash;27.88 95 IK.

Conclusion: There was a significant difference to radiotherapy response between the stage IIIB cervical SCC with LNE and without LNE."

"ABSTRACTPurpose Adenosquamous carcinoma (ASC) of the pancreas is a rare malignancy, associated with a poor prognosis after surgical resection, with reported median survival times (MSTs) ranging from 4.4 to 13.1 months. We conducted this study to investigate the long-term outcomes of patients after the resection for ASC.MethodsBetween 2002 and 2016, a total of 456 patients underwent resection for ASC or adenocarcinoma (AC) of the pancreas. ASC was confirmed in 17 (3.7%) of these patients. We analyzed the clinicopathological characteristics and survival of these 17 patients in comparison with those of patients with AC of the pancreas.ResultsThe operative procedures performed were pancreaticoduodenectomy (n = 6) and distal pancreatectomy (n = 11). Seven (41.2%) of the 17 patients underwent combined organ resection. R0 resection was achieved in 16 (94.1%) patients. The 5-year overall survival (OS) rate and MST were 40.3% and 20.9 months, respectively. A squamous component of ≥ 60% (P = 0.001) and R1 resection (P < 0.001) were significantly associated with poor OS for patients with ASCConclusionThis study revealed longer survival and a higher R0 resection rate after aggressive combined resection in our ASC patients than those in previous studies. Although this was only a small series, our findings suggest that local control with aggressive resection may be an effective treatment protocol for ASC patients."

"Latar Belakang : Sarkoma sinovial adalah sarkoma jaringan lunak derajat tinggi. Modalitas terapi yang ada saat ini belum cukup memuaskan sehingga mendorong perlunya modalitas terapi baru, yaitu imunoterapi yang menargetkan NY-ESO-1 yang diekspresikan oleh sel tumor. Dalam penelitian, perbedaan ekspresi imunohistokimia NY-ESO-1 pada sarkoma sinovial dan diagnosis bandingnya yaitu malignant peripheral nerve sheath tumor (MPNST) dan dermatofibrosarcoma protuberans (DFSP) akan diteliti.Bahan dan Cara Kerja : Penelitian analitik potong lintang dilakukan terhadap 28 kasus sarkoma sinovial, 10 kasus MPNST dan 17 kasus DFSP yang berasal dari Departemen Patologi Anatomik FKUI/RSCM selama Januari 2013 sampai Juni 2019. Dilakukan pulasan NY-ESO-1 pada ketiga kelompok dan dikategorikan sebagai positif apabila terpulas pada lebih dari 50% sel tumor dengan intensitas positif sedang sampai kuat.Hasil : Ditemukan perbedaan bermakna ekspresi NY-ESO-1 pada kelompok sarkoma sinovial (18/28), MPNST (2/10) dan DFSP (1/17) (p<0,001). Pada analisis lebih lanjut sarkoma sinovial memiliki ekspresi NY-ESO-1 lebih tinggi secara signifikan terhadap MPNST (OR 7,2; p = 0,016; power  68,7%) dan terhadap DFSP (OR 28.8; p<0,001; power 98,9%).Kesimpulan : Sarkoma sinovial yang mengekspresikan NY-ESO-1 berpotensi untuk mendapat pemberian imunoterapi. Terdapat perbedaan ekspresi imunohistokimia NY-ESO-1 pada sarkoma sinovial terhadap MPNST dan DFSP.

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Background : Synovial sarcoma is a rare high grade soft tissue sarcoma. Nowdays, the available therapeutic modalities has not given a satisfactory result yet. Currently, there is a promising therapeutic strategy through immunotherapy targeting NY-ESO-1 which is expressed on tumor. The aim of this study was comparing NY-ESO-1 immunoexpression between synovial sarcoma and its histologic mimics i.e. malignant peripheral nerve sheath tumor (MPNST) and dermatofibrosarcoma protuberans (DFSP)Material and Methode : A cross sectional study was done in 28 cases of synovial sarcoma, 10 cases of MPNST and 17 cases of DFSP from archieval material in Department Anatomical Pathology, FMUI/RSCM from January 2013 to June 2019. Immunohistohemical stainning was performed using an antibody NY-ESO-1 and it was described positive if it was expressed in more than 50% of tumor with moderate to strong positive intensity.Results : There is a significant difference p<0,001) in NY-ESO-1 immunoexpression among synovial sarcoma (18/28), MPNST (2/10) and DFSP (1/17). Furthermore, synovial sarcoma showed a significantly higher immunoexpression compared to MPNST (OR 7,2; p = 0,016; power 68,7%) and DFSP (OR 28,8; p<0,001; power 98,9%).Conclusion : Synovial sarcoma showed a higher expression of NY-ESO-1 thus makes it as a good candidates for immunotherapy. There are differences in the expression of NY-ESO-1 in synovial sarcoma against MPNST and DFSP."

"Receptor activator of nuclear factor-kappa (RANK)/receptor activator of nuclear factor-kappa B ligand (RANKL) signaling helps putative cancer stem cells (CSC) to maintain their stemness. Expression of CD44 and RANKL was analyzed in oral squamous cell carcinoma specimen (n = 191). Moreover, RANKL expression was measured in cancer cell lines (BICR3, BICR56) by immunohistochemistry and western blot analysis. Scanned images were digitally analyzed using ImageJ and the immunomembrane plug-in. CD44 and RANKL expression on protein level was correlated with clinical characteristics and impact on survival. RANKL was co-labeled with CD44 in immunohistochemical and immunofluorescence double labeling experiments. Although high CD44+/RANKL+ co-expression was significantly associated with clinicopathological factors and worse survival, multivariate analysis did not demonstrate high CD44+/RANKL+ co-expression as independent prognostic factor. Immunohistochemical and immunofluorescence double labeling experiments revealed RANKL expression by CD44+ cancer cells. RANKL specificity was confirmed by western blot analysis. For the first time, this study provides evidence that RANKL expression in OSCC might be associated with disease recurrence and a cell compartment measured by CD44+/RANKL+ co-expression within the mucosal epithelial basal layer cells."