Locally advanced low rectal cancers pose a challenge for surgeons as reported local recurrence remain high despite the performance of Total Mesorectal Excision and the provision of neoadjuvant treatment. Extralevator Abdominoperineal Excision offers better oncologic margins with reported decreased recurrence rates when compared to the conventional technique. The improvement in oncologic outcomes, however, comes at the cost of producing larger perineal defects—and with this comes concerns related to coverage. Presented here is a case of a patient with a locally advanced low rectal cancer with gluteal extension where a Vertical Rectus Abdominis Myocutaneous flap was utilized as a means of perineal reconstruction.

This is a case of a 56-year-old Filipina female who presented with a four-month history of a palpable right infraclavicular lymph node that was diagnosed as metastatic melanoma on histopathology and immunohistochemical staining with no apparent primary tumor on physical examination, nasopharyngoscopy, colonoscopy and imaging studies. Patient then underwent modified radical neck dissection, right, with an unremarkable intra-operative and post-operative course. This report aimed to document the clinical profile, laboratory and imaging parameters and treatment of melanoma of unknown primary on a 65-year-old female.

Liposarcoma is a malignant mesenchymal neoplasm composed of adipose tissue with varying degrees of atypia. While generally indolent, some tumors have the potential to grow enormously particularly if located in the retroperitoneum. We report a 49-year-old female generally asymptomatic except for a 1-year history of gradual abdominal enlargement. Contrast-Enhanced Computed Tomography (CT) of the abdomen showed a large retroperitoneal mass with characteristic features consistent with liposarcoma. On laparotomy, the mass was encapsulated with good plane of dissection, great vessels were preserved, however the right kidney and suprarenal gland were undetachable from the primary tumor hence was removed en bloc with the liposarcoma. The post-operative course was uneventful with excellent outcome after 6 months of follow-up. Final histopathologic diagnosis revealed low-grade, dedifferentiated liposarcoma, which has favorable prognosis following radical surgery.

Laparoscopic cholecystectomy has become the standard of care in the management of gallstone disease with a slightly increased risk for bile duct injury. It is therefore essential that a standard grading system can be utilized and thus predict whether cholecystectomy can be completed laparoscopically or warrants the need for bailout procedure to prevent biliary injury. This study includes all patients who underwent laparoscopic cholecystectomy in Capitol University Medical Center and Maria Reyna Xavier University Hospital from March 2021 to January 2022. Total of 220 patients underwent laparoscopic cholecystectomy but only 173 patients were included due to incomplete data. Age, BMI, sex and G10 scoring were collected. This scoring system focuses on four components: the gallbladder’s operative appearance, whether distended or contracted, ease of access including limited access due to adhesions from prior surgery, the presence of sepsis in the peritoneal cavity, either biliary peritonitis or purulent fluid, and/or a cholecystoenteric fistula, and the degree of gallbladder adhesions. Descriptive statistics and univariate analysis were used to determine the need for bailout procedure in laparoscopic cholecystectomy. It was found that each year increase in age raises the odds of doing bailout surgery by 8.2% (OR: 1.0823, p = 0.009), while higher G10 scores nearly triple the odds (OR: 2.9227, p < 0.0001). The G10 scoring system is a practical scoring system with easy to remember assessment variables. G10 score of greater than 3 with increasing age shown to have increased chance of employing bailout procedure.

This study aimed to determine the clinicopathologic predictors of hormone receptor [Estrogen Receptor (ER)/ Progesterone Receptor (PR)] and Her-2/Neu status of patients with breast cancer. The was an analytical, cross-sectional study with a three-year review of breast cancer patients in the three hospitals of Cordillera Consortium. Multinomial logistic regression analysis was used to determine the association of the clinicopathologic variables such as age, sex, time interval to diagnosis, cancer stage, site, focality and laterality of primary tumor, clinical lymph node status, distant metastasis, recurrence, cancer type, histologic grade, tumor size (T stage), lymphovascular invasion and pathologic nodal stage (N stage) with the hormone receptor and HER-2 status. A total of 143 patients were included in this study. The results showed that laterality (p 0.0154), histologic grade (p 0.0004), and tumor size (T stage) (p 0.049) are associated with the molecular subtypes. Luminal A, luminal B and basal-like subtypes were mostly located on the left while Her-2 enriched was mostly right-sided. All well differentiated tumors were luminal A. Luminal A and Luminal B were mostly moderately differentiated. While Her-2 enriched and basal-like were mostly poorly-differentiated type. Only Her2-enriched had T0 or complete disappearance of tumor (Complete Pathologic Response) among those given with neoadjuvant chemotherapy. In this cohort, there was no recorded tumor of ≤2cm under the basal-like. The clinicohistopathologic features of breast cancer such as laterality, histologic grade, and tumor size can be used as an adjunct to predict the molecular biology of invasive breast carcinoma patients.

OBJECTIVE

To evaluate the reliability and validity of the Filipino version of the Vascular Access Quality of Life (VASQoL) measure.

The Vascular Access Quality of Life (VASQoL) measure was translated to the Filipino language and, subsequently back translated to the English version by professors from the university. This translated questionnaire was face validated by a vascular surgeon, both adept in using both Filipino and English language. Pre-test was done on 10 subjects to assess cross cultural applicability of the questionnaire. Reliability was tested on 24 patients who were all diagnosed with Stage V Chronic Kidney Disease (CKD).

A total of 24 patients were recruited in the study with a mean age of 50.6, ranging from 15 to 77 years old. Slightly higher population of female versus male participants. For both test and retest, the internal consistency of the VASQoL was unacceptable with Cronbach’s alpha of 0.5209. Test-retest reliability showed almost perfect agreement except for one item (Q7) with substantial agreement.

The evaluation of the Filipino version of the VASQoL measure has revealed shortcomings in terms of reliability, suggesting that it may not be a dependable tool for assessing the experiences of patients with CKD undergoing hemodialysis (HD) in the Filipino population.

BACKGROUND

One of the most common complications of Self Expanding Metal Stent (SEMS) insertion for Central Airway Obstruction (CAO) is Stent Migration. This study aims to identify significant clinical factors associated with stent migration.

A retrospective cohort study of all patients who underwent SEMS insertion for CAO in the said tertiary hospital in the Philippines from January 2012 to July 2022 was done. Patient, operative and stent factors were obtained. Incidence rates for stent migration and repeat intervention, and unadjusted hazards ratio were computed and analyzed for the different clinical factors.

This study had 61 patients, with 65 SEMS placed. Nine patients had stent migration within 30 days, while nine patients had stent migration after 30 days. Incidence rate of stent migration within 30 days was 0.0074 per person-day (CI 0.0047-0.012), and incidence rate of stent migration at any time after insertion was 0.0050 per person-day (CI 0.0026-0.0096). Incidence rate for repeat intervention was 33.33%. No significant clinical factors were associated with stent migration within 30 days (all p > 0.05). For stent migration at any time after insertion, obesity (patient BMI range of 25.3 to 30.7) had a 252% increase in hazard for stent migration (HR = 3.52; 95% CI 1.12-11.11; p =0.032), while procedure duration of ≥ 110mins had a 80% decrease in hazard for stent migration (HR = 0.2; 95% CI 0.04-0.97; p = 0.046).

Obesity and procedure duration of ≥ 110 mins were significant factors for stent migration. Causality remains to be established.

INTRODUCTION

Despite advancements in surgical techniques aimed at preserving parathyroid function, postoperative hypocalcemia (PoH) remains a challenge following elective total thyroidectomy. Management typically involves postoperative calcium supplementation; however, some studies suggest preoperative calcium and/or vitamin D supplementation may prevent PoH. This paper analyzed existing studies to determine efficacy of preoperative calcium, with or without vitamin D, in preventing hypocalcemia in total thyroidectomy patients. Level of Evidence: Meta-analysis, Level IV.

A systematic review and meta-analysis was conducted with PROSPERO Registration No. CRD42024426410. Searches were performed on PubMED, PubMED Central, Embase, Cochrane Library, and HERDIN without date or language restrictions. Relevant studies underwent multiple screenings, with accepted individual studies assessed for bias or quality. Meta-analysis was performed using SPSS version 24.

A total of 345 studies were initially identified. Following deduplication, exclusion, and quality appraisal, 8 studies were included for analysis. Random effects model was utilized for all analysis due to heterogeneity in data. Results indicate that preoperative calcium, with or without vitamin D supplementation, correlated with higher postoperative calcium levels (z = 3.09, p < 0.001), reduced incidence of laboratory (z= 2.05, p = 0.03) and clinical hypocalcemia (z= 2.94, p < 0.001), and shorter hospital stay (z= 2.32, p = 0.01).

Results from the conducted meta-analysis support the proposed practice of providing calcium with or without vitamin D supplementation among patients who are to undergo total thyroidectomy procedures to prevent postoperative hypocalcemia.

OBJECTIVE

To determine the predictive value of ACR-TIRADS in detecting malignancy in thyroid nodules.

This is a retrospective, multi-center, cross-sectional analysis of patients who underwent ultrasound and thyroidectomy at three Cordillera Consortium hospitals between January 2019 and December 2021. Ultrasound reports were reviewed and correlated with histopathology reports to determine features associated with malignancy.

A study of 117 patients with thyroid nodules found significant differences in ACR-TIRADS subcategories. The risk of malignancy for TIRADS categories 1, 2, 3, 4, and 5 were 10%, 9.5%, 21.9%, 43.9%, and 76.97%, respectively. ACR-TIRADS demonstrated a high sensitivity of 92.1% and negative predictive value (NPV) of 90.3% as a rule-out test, and a specificity of 96.2% with a positive predictive value (PPV) of 76.9% as a rule-in test using TIRADS 5 as malignant. Correct classification of malignant nodules increased by cut-off value with the highest at 73.5% at the ≥5 cut-off value. Discussion: Thyroid nodules were more common in females under 55 years old. Certain sonographic features of thyroid nodules, such as being solid or predominantly solid, hypoechoic, lobulated/irregular, and having punctate echogenic foci, were associated with malignancy. The risk of malignancy at Cordillera Consortium hospitals was notably higher in this study. The ACR-TIRADS test yielded results consistent with previous studies, with TR 1 and 2 indicating benign nodules and TIRAD 3-5 indicating malignant nodules.

Due to a higher risk of malignancy, it is recommended to be more aggressive in performing biopsies for thyroid nodules at Cordillera Consortium hospitals. ACR-TIRADS is a reliable screening tool and is recommended as a confirmatory test (TIRADS 5) for thyroid malignancy. Biopsies are still recommended for TIRADS 3, 4, and 5 nodules to avoid unnecessary procedures and confusion among surgeons.

BACKGROUND

Worldwide, kidney transplantation is done as a renal replacement therapy for end-stage kidney disease patients. Lymphocoele is a common complication following renal transplantation, with an incidence varying between 0.6% and 33.9%. The use of the electrothermal bipolar sealing device (LigaSure) has proven superior to other vessel sealing techniques in several reports. As such, LigaSure device is expected to provide an alternative method to the standard silk-tie method during kidney transplantation.

To describe our experience on using Ligasure device in kidney transplantation at the National Kidney and Transplant Institute.

A prospective descriptive cross sectional research design among patients who underwent iliac vessel dissection using Ligasure device during kidney transplantation. Clinical outcomes were determined including operative time during iliac vessel dissection using LigaSure device, total and average JP drain output. Incidence of lymphocoele was observed by performing an allograft ultrasound on post operative day 14, 60 and 90.

Ultrasonographically, none of the patients in this study developed a lymphocele. Average use of Ligasure device during iliac vessel dissection was 16.92 minutes. Average daily JP drain output was 123mL and average JP drain output prior to JP drain removal was 25.44mL.

We did not observe any incidence of lymphocoele among patients wherein Ligasure device was used during iliac vessel dissection. Routine use of Ligasure device can be done without the risk of lymphocoele formation and can serve as an alternative from the traditional silk-tie method during iliac vessel dissection.