Browsing by Author "W. Dumronggittigule"

Filter results by typing the first few letters
Now showing 1 - 6 of 6
  • No Thumbnail Available
    PublicationMetadata only
    Incidence and risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy: A large tertiary center experience
    (2020-01-01) C. Tovikkai; W. Manoontrakul; P. Kositamongkol; P. Mahawithitwong; W. Dumronggittigule; P. Sangserestid; S. Limsrichamrern; Y. Sirivatanauksorn; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand| 2020 Objective: Pancreaticoduodenectomy (PD) is a major operation for the treatment of periampullary and pancreatic cancer, and the number of operations has increased in recent years. Postoperative pancreatic fistula (POPF) remains one of the important complications after PD. The present study aimed to analyze the incidence and risk factors of POPF. Materials and Methods: The clinical data of 227 patients who underwent PD in Siriraj Hospital between 2011 and 2016 were retrospectively reviewed. POPF was diagnosed and classified into three groups (grade A, B, or C) according to the International Study Group on Pancreatic Fistula (ISGPF). Clinically relevant pancreatic fistula (CR-POPF) takes into account only grade B or C. The risk factors of POPF after PD were analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors correlated with POPF. Results: In total, 227 patients were included in this study. POPF occurred in 96 patients (42.3%), and these were classified into ISGPF grade A patients, 21 (9.3%); grade B, 54 (23.8%); and grade C, 21 (9.3%). The CR-POPF rate was 33.1%. Multivariate analysis revealed soft gland texture [Odds ratio (OR): 6.7, 95% confidence interval (CI): 1.5 to 30.9], small pancreatic duct (P-duct) diameter of <3 mm [OR: 4.6, 95% CI: 1.0 to 21.4], and a surgeon’s experience of <10 years [OR: 6.5, 95% CI: 1.4 to 30.6] were significant risk factors of POPF. Regarding CR-POPF, these three risk factors were also found to be statistically significant in the multivariate analysis. Conclusion: Even though the study involved a high volume center, the incidence of POPF after PD was still high, with ISGPF grade B the most common group. Soft gland texture, small P-duct diameter, and low surgeon experience were the key independent risk factors for both POPF and CR-POPF.
  • No Thumbnail Available
    PublicationMetadata only
    Outcome and prognostic factors for periampullary carcinoma after pancreaticoduodenectomy: A single tertiary center experience
    (2020-05-01) P. Kositamongkol; T. Kumjornkijbovorn; P. Mahawithitwong; C. Tovikkai; W. Dumronggittigule; P. Sangserestid; S. Limsrichamrern; Y. Sirivatanauksorn; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2020. Objective: Pancreaticoduodenectomy (PD) remains the standard treatment in achieving long-term outcome for periampullary carcinoma. This study aims to evaluate outcome and prognostic factors of PD in a large tertiary center in Thailand. Materials and Methods: This study is a single-center, retrospective study including patients who underwent PD for periampullary carcinoma at Siriraj Hospital from 2011 to 2015. Univariate and multivariate analyses were performed to identify poor clinicopathological prognostic factors for survival after PD. Results: A total of 128 patients who underwent PD for periampullary carcinoma at Siriraj Hospital between 2011 and 2015 were included. Five-year overall survival was 16% with median survival time of 23 months. Patients with ampullary cancer (25.7%) and duodenal cancer (21.1%) had longer 5-year survival than pancreatic cancer (13.3%) and distal cholangiocarcinoma (0%) (p<0.001). Multivariate analysis showed that independent adverse prognostic factors were perineural invasion (HR: 3.94, 95% CI: 1.90 to 6.40, p<0.01), N2 nodal status (HR: 2.98, 95% CI: 1.16 to 7.64, p = 0.02), positive resection margin (HR: 1.93, 95% CI: 1.19 to 3.14, p = 0.047), lymphovascular invasion (HR: 1.73, 95% CI: 1.03 to 2.90, p = 0.03) and pre-operative albumin <3.5 g/dl (HR 1.71, 95% CI: 1.09 to 2.67, p = 0.02). Tumors with perineural invasion also had higher rate of lymphovascular invasion. Patients with low albumin level had higher proportion of T3 and T4 staging, and poorly differentiated tumors. Notably, pre-operative biliary drainage and total bilirubin were not significant predictive factors. Conclusion: Poor prognostic factors for periampullary carcinoma after PD included N2 nodal status, perineural invasion, lymphovascular invasion, positive resection margin and low albumin level. Therefore, radical surgical resection and pre-operative improvement of nutritional status should be considered.
  • No Thumbnail Available
    PublicationMetadata only
    Outcome of the surgical treatment of gallbladder cancer: A 10-year Single Center Experience
    (2020-01-01) W. Dumronggittigule; C. Tovikkai; P. Sangserestid; A. Pongpaibul; P. Kositamongkol; P. Mahawithitwong; S. Limsrichamrern; Y. Sirivatanauksorn; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand| 2020 Objective: Gallbladder cancer (GBC) is a rare cancer with extremely poor prognosis due to a usual late presentation with an advanced stage. Surgical resection is the only curative treatment. The present study aimed to analyze the outcome after curative resection and to identify the factors affecting prognosis in a single tertiary hospital. Materials and Methods: A retrospective analysis of GBC patients who underwent surgical resection from 2006 to 2015 at Siriraj Hospital was performed. The clinical characteristics, operative data, and pathological results were reviewed. Survival and prognostic factors were analyzed with the Kaplan–Meier method and Cox proportional hazards model, respectively. Results: In total, 69 GBC patients underwent surgery during the study period. Among these, 55 cases (80%) underwent resection with curative intent, while unresectable disease was found intraoperatively in 14 patients (20%). Preoperative hyperbilirubinemia was associated with unresectable disease. Among those who underwent curative resection, 37 cases (67%) achieved R0 resection, and 18 cases (33%) presented with a positive margin (R1 resection). The median disease-free survival (DFS) and overall survival (OS) were 18 and 24 months, respectively. The 1-year and 5-year DFS rates were 56% and 27%. The 1-year and 5-year OS rates were 72% and 29% respectively. Factors affecting the outcome according to univariate analysis included the completeness of resection, tumor stage, presence of perineural and lymphovascular invasion on the pathology, and the type of histopathology. Multivariate analysis identified the type of histopathology as an independent prognostic factor for OS (p = 0.008). The completeness of resection margin also showed a trend toward predicting OS, but this did not reach statistical significance (p = 0.079). Conclusion: The prognosis of GBC is dismal. Adenocarcinoma is associated with a better survival rate than non-adenocarcinoma.
  • No Thumbnail Available
    PublicationMetadata only
    Predictive factors of mortality in ruptured hepatocellular carcinoma
    (2020-05-01) P. Mahawithitwong; D. Charoensilavath; Y. Sirivatanauksorn; S. Limsrichamrern; P. Kositamongkol; C. Tovikkai; W. Dumronggittigule; P. Sangserestid; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2020 Background: Ruptured hepatocellular carcinoma (HCC) globally carries a high mortality rate. In Thailand, the incidence of ruptured HCC remains high and the data is still lacking. This study aims to identify the predictive factors of death in these patients. Materials and methods: This study is a retrospective review of 4,330 patients diagnosed with HCC admitted at Siriraj Hospital from January 2012 to June 2018. Forty-five patients diagnosed with ruptured HCC were included in this study. The patients were divided into a survivor group and a mortality group. Demographic data, clinical manifestations, biochemical data, tumor characteristics, and therapeutic procedures were collected. The mortality rate and factors associated with mortality were analyzed. Results: 10 patients and 35 patients were categorized in the survivor group and the mortality group, respectively. Demographic data between the two groups were comparable. Emergency hemostasis was achieved with transarterial embolization (TAE) in 40% of survivor group and 65% of mortality group. In survivor group, hepatectomy could be achieved in 80% of the patients. The multivariate analyses found that the predictive factors of death in ruptured HCC were the inability to undergo further definitive hepatectomy (p = 0.04) and high serum creatinine level (p = 0.01). Overall survival of ruptured HCC patients at 1-month, 1-year, and 3-year were 76.0%, 26.4%, 13.2%, respectively. Overall survival after hepatectomy at 1-month, 1-year, and 3-year were 100%, 100% and 75%, respectively. Conclusion: The predictive factors of death in ruptured HCC patients were the inability to undergo further hepatectomy and high serum creatinine level. Patients who underwent hepatectomy as a definitive treatment could achieve a better survival outcome after ruptured HCC.
  • No Thumbnail Available
    PublicationMetadata only
    Prophylaxis of hepatitis B after liver transplantation using low-dose short-course hepatitis B immunoglobulin plus antiviral drug
    (2019-02-01) S. Limsrichamrern; C. Tovikkai; S. Bunyajetpong; Y. Sirivatanauksorn; P. Kositamongkol; P. Mahawithitwong; S. Asavakarn; W. Dumronggittigule; Faculty of Medicine, Siriraj Hospital, Mahidol University
    © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND 2019. Background: The most common indication for liver transplantation (LT) in South East Asia is hepatitis B virus (HBV)-related liver disease. Without proper prophylaxis, HBV will recur rapidly after LT. Currently, there is no universally accepted regimen, and most transplant centers use high-dose hepatitis B immunoglobulin (HBIG) for prophylaxis, which is costly. Objective: To review the authors’ experience with low-dose short-course HBIG plus antiviral for HBV prophylaxis. Materials and Methods: Between July 2002 and December 2013, 90 patients who were positive for HBV surface antigen (HBsAg) underwent LT at the authors’ institute. The protocol included continuing previously prescribed antiviral drug or giving lamivudine 150 mg orally before the operation in patients who had never received antiviral drug. All patients received 1,200 to 2,000 international units (IU) of HBIG intravenously during anhepatic phase, and 1,200 to 1,600 IU of intravenous HBIG daily for six days postoperatively. Oral antiviral drug was continued postoperatively. HBV recurrence was defined as the reappearance of HBsAg in serum. Cumulative incidence function was used to calculated cumulative recurrence rate. Results: At the end of follow-up, the post-transplant HBsAg status was positive in six patients (6.7%); two patients at three months, one patient at one year, two patients at seven years, and one patient at ten years after LT. Cumulative HBV recurrence rate was 2.3% at one year, 3.5% at five years, and 11.3% at ten years after LT. The median time-to-recurrence was 49.5 months. All treatments were well tolerated with no serious adverse event. Conclusion: Combination of low-dose short-course HBIG and long-term oral antiviral drug is effective in preventing HBV recurrence after LT. Since HBIG is very expensive, this low-dose short-course HBIG prophylaxis regimen can reduce the cost of LT without increasing the HBV recurrence rate.
  • No Thumbnail Available
    PublicationMetadata only
    Quality of life among liver transplantation patients
    (2012-03-01) Y. Sirivatanauksorn; W. Dumronggittigule; S. Limsrichamrern; C. Iramaneerat; T. Kolladarungkri; P. Kositamongkol; P. Mahawithitwong; S. Asavakarn; C. Tovikkai; Faculty of Medicine, Siriraj Hospital, Mahidol University; Mahidol University
    Background: Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage disease. It offers a chance to return to an active and prolonged life. Recently, more attention is being paid to the health-related quality of life (HRQoL) of patients and their spouses or caregivers after OLT. The aim of this study was to analyze the pre- versus posttransplantation HRQoL of patients and their spouses or caregivers using generic and disease-specific health questionnaires. Material and Methods: The study was performed between October 2010 and January 2011 using the Short Form-36 (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) to evaluate the HRQoL. Results: Posttransplantation patients (N = 59, mean age 53.39 [range, 23 to 76] years, male 63.2%, female 36.8%) and their spouses and caregivers showed significantly better generic SF-36 HRQoL scores, namely, physical and social functioning, role limitations because of physical or emotional problems, bodily pain, vitality, as well as general and mental health compared with pretransplantation patients (N = 57, mean age 54.56 (range, 22 to 69) years, male 71.2%, female 28.8%). Similarly, the posttransplantation group showed significantly improved CLDQ scores in all domains: fatigue, activity, abdominal symptoms, systemic symptoms, emotional function, and worry. Conclusion: OLT improved HRQoL of end-stage liver patients and their spouses or caregivers. © 2012 by Elsevier Inc. All rights reserved.