A significant challenge after performing resection of the esophagogastric region, is the reconstruction that follows. Esophagogastrostomy is a simple and direct method to restore gastrointestinal continuity using a single anastomosis but is associated with reflux esophagitis and anastomotic stenosis. This case report presents a 29-year-old man with a bleeding gastroesophageal junction leiomyoma who underwent a proximal gastrectomy and an esophagogastrostomy reconstruction with a double H-flap technique to reduce the incidence of gastric reflux. This illustrative description of the double H-flap technique created a valve mechanism that mimicked the function of the resected sphincter and cardia. This antireflux adjunct technique is reproducible and effective in preventing gastroesophageal reflux symptoms after an esophagogastrostomy.

Rationale/Objective: Neoadjuvant chemotherapy (NAC) is recommended for locally-advanced breast cancer (LABC) to improve resectability and provide in-vivo tumor response assessment. This study aimed to describe the clinical and pathologic tumor response of LABC patients after response-guided NAC. Methods: This is a retrospective cohort analysis of 128 LABC patients who underwent NAC using sequential doxorubicin/cyclophosphamide (AC) – docetaxel (T) regimen at the Philippine General Hospital Breast Care Center. Clinical and pathologic response rates were analyzed according to clinicopathologic variables including tumor intrinsic subtype. Results: Objective clinical response (complete and partial) was observed in 88% (111/128) of patients with 11% (14/128) achieving pathologic complete response (pCR). The hormone receptor-negative/ Her2-enriched (HR-/Her2+) subtype had the highest pCR rate (23.5%) followed by triple negative subtype (HR-/Her2-) at 19%. The hormone receptor-positive/Her2-positive (HR+/Her2+) subtype had the lowest pCR (4.7%). Two patients with initial poor response to AC but had good response upon shifting to T achieved pCR. Twelve patients (9.4%) had poor response to AC and T chemotherapy. Patients who were pre-menopausal (p=0.04), had ductal histology (p=0.03), with a HR-/Her2- (p=0.002) or HR+/Her2+ subtype (p=0.03) had good response to AC. Intrinsic subtype was not significantly associated with treatment response in those who received docetaxel. There was strong association between the pathologic and clinical responses (Spearman’s Rho score 0.69, p-value <0.0001). Conclusion Clinical and pathologic response to NAC was highly dependent on tumor subtype. Clinical response was predictive of pathologic response. Response-guided NAC allowed direct and early evaluation of tumor treatment response that allowed for treatment modifications.
Breast Neoplasms ; Neoadjuvant Therapy ; Drug Therapy

Objective: The study aimed to identify the pattern and clinicopathologic factors associated with locoregional failure (LRF) in locally-advanced breast cancer (LABC) patients who received neoadjuvant chemotherapy (NAC) and modified radical mastectomy (MRM) with or without adjuvant radiotherapy (RT). Methods: Retrospective cohort analysis of LABC patients who developed LRF following NAC and MRM with or without RT in the Breast Care Center, Philippine General Hospital from 2007-2010 was done. Clinicopathologic and treatment factors were compared between patients who developed and did not develop recurrence using Student's t-tests and Chi-square tests and logistic regression analysis, with p values ≤0.05 considered significant. Results: A total of 63 patients were included, 34 with locoregional recurrence (LR) and 29 without. Two-year locoregional recurrence rate (LRR) was 54% with mean time to recurrence at 263 days and chest wall as most common site. Simple logistic regression analysis showed age distribution, pathologic nodal status (pN), percentage positive pathologic lymph nodes, pathologic stage, lymphovascular invasion, and adjuvant RT to be predictors of LR. Furthermore, pN (OR 1.31, CI 1.07-1.59, p=0.01) and adjuvant RT (OR 0.14, CI 0.04-0.53, p=0.004) were independent predictors of LR on multiple logistic regression analysis. In the subset of patients without adjuvant RT, no independent predictor of LR was found on multiple logistic regression analysis. Conclusion Among patients with LABC who received NAC and MRM, locoregional recurrence occurred frequently, usually in the chest wall and within a year of treatment. The absence of adjuvant radiotherapy and increased number of positive pathologic lymph nodes were predictive of locoregional recurrence.
Neoadjuvant Therapy ; Recurrence

OBJECTIVE: To describe the clinicopathologic profile, management, and outcomes of patients with esophagogastric junction (EGJ) adenocarcinoma in the local setting. METHODS: Data was obtained from patients who had curative surgery for EGJ adenocarcinoma from 2004–2013 in the Philippine General Hospital. We used student's T-tests, analysis of variance, chi-squared and Fisher’s exact tests for comparisons and Cohen’s kappa index for correlation. A P value of less than or equal to 0.05 was considered significant. RESULTS: We included 88 patients (81.2% male) with mean age of 55.2 years. Eight percent were clinical Siewert type I; 23.9% were type II; 15.9% were type III; and majority (52.3%) were unknown type. Surgical approach and resection differed across the Siewert types (P<0.000). Thoracoabdominal approach (72.7%) and distal esophagectomy with total gastrectomy (77.3%) were the most common procedures. Many had at least pathologic T3 (80.6%), N2 (54.5%), and stage III (68.2%) disease. Neoadjuvant and adjuvant chemotherapy was given in 1.2% (1/82) and 48.6% (18/37), respectively. In-hospital morbidity was 40%; mortality was 4.5%; 1-year disease-free survival rate was 69.4%; and overall survival rate was 76.5%. Correlation was fair between preoperative and pathologic Siewert type (P=0.003) and poor between clinical and pathologic stage (P=0.115). Patients with recurrence had higher pathologic lymph nodes (P=0.029) and more advanced stage (P=0.022). CONCLUSION EGJ adenocarcinomas were locally advanced and had poor outcomes. Surgery should be individualized and multimodality approach considered.

Background: Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.

Objectives: The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines - Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program's surveillance follow-up rate.

Methods: This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient's hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.

Results: The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.

Conclusion: Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.