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The advantage of a transverse incision over a midline incision for open right hemicolectomy remains controversial.To compare the short-term surgical outcomes of right hemicolectomy through midline incision (RHML) and right hemicolectomy through right transverse incision (RHTR) for right-sided colon cancer.This retrospective study included 74 patients with right-sided colon cancer who underwent elective right hemicolectomies through midline or right transverse incision between February 2004 and June 2006 at the Department of Surgery, Faculty of Medicine Siriraj Hospital. Operative details, postoperative requirement of narcotics, recovery of bowel function, and oncological parameters were analyzed.Fifty-four patients underwent RHML and 20 patients underwent RHTR. Both approaches achieved adequate oncological resection of the tumor. The RHTR group were characterized by shorter operative times (105 vs. 140 minutes; p = 0.001), less blood loss (70 vs. 125 ml,; p = 0.004), faster discontinuation of intravenous narcotics (1.2 vs. 1.8 days; p = 0.03), and shorter length of hospital stay (6.0 vs. 7.9 days,; p = 0.02). Postoperative complications and time to recovery of bowel function were not significantly different.The authors suggest that RHTR is a safe and effective operation for right-sided colon cancer; which results in a significant reduction in operative time, duration of intravenous narcotics administration, and hospital stay compared with RHML. However, there is no difference in postoperative recovery of bowel function and complication rate.

Evaluate the efficacy and the tolerability of preoperative chemoradiation with high dose Capecitabine.Fifteen patients with locally advanced resectable rectal cancer were treated with Capecitabine 2,000 mg/m2/day, orally 7 days/week concurrent with whole pelvic irradiation 45 Gy in 25 fractions/5 weeks. Patients underwent surgery in the following 4-6 weeks.After complete treatment, 11 patients (73%) underwent surgery. Ten patients (66%) had sphincter preservative surgery; three of them had primary tumors located in the lower rectum. Five patients had grade 2 and one patient had grade 3 diarrhea. No grade 4 toxicity was reported.Preoperative Capecitabine 2,000 mg/m2/day concurrent with whole pelvic irradiation were effective and well tolerated The potential dose limiting toxicity effect was the diarrhea.

Background/Aims: To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage. Methods: We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003–2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by a multivariate model to determine their association with anastomotic leakage. Results: The patients’ median age was 64 years. Median tumor height was 8 cm (range 3–15) from the anal verge. Overall 30-day mortality rate was 1.2%. Postoperative complications were diagnosed in 38 patients (22%) including 14 cases of anastomotic leakage (8.2%), of which 10 cases (71%) required surgical intervention. Tumor height within 5 cm from the anal verge was the only independent factor for leakage (OR 4.04; 95% CI 1.25–13.08). Conclusion: A sphincter-saving operation without a protective stoma and pelvic drain can be performed safely in the vast majority of rectal cancer patients. Tumor height within 5 cm from the anal verge is an independent risk factor for anastomotic leakage. Thus, the routine use of a protective stoma and pelvic drainage might be unnecessary.

To determine the relationship between preoperative serum albumin and postoperative bowel function as well as surgical outcomes in right-sided colon cancer patients.This retrospective study in a university hospital included 84 patients who underwent elective right hemicolectomy for adenocarcinoma of the right-sided colon between January 2004 and December 2005. The patients had a preoperative serum albumin assessment. Serum albumin less than 3.5 g/dL was regarded as hypoalbuminemia. Postoperative outcomes were classified into mortality, morbidity (infectious and noninfectious complications), time to first bowel movement, time to resume normal diet, and hospital stay.Forty males (48%) and forty-four females (52%) with a mean age of 64 (range, 27-89) years were included. Forty-eight patients (57%) had hypoalbuminemia. No 30-day postoperative mortality occurred. All 14 postoperative complications occurred in hypoalbuminemic cases. Therefore, 29% of the hypoalbuminemics had complications whereas none occurred in nonhypoalbuminemics (p=0.001). In univariate analysis, hypoalbuminemia and postoperative complications were the risk factors for delayed postoperative recovery of bowel function and prolonged length of hospital stay. In multivariate analysis, hypoalbuminemia was the significant risk factor for postoperative complications (p0.001) and delayed time to first bowel movement (p=0.018) whereas postoperative complications were the significant risk factor for delayed time to resume normal diet (p0.001) and prolonged hospital stay (p0.001).Hypoalbuminemia is a potential predictor of delayed recovery of bowel function postoperatively and significantly associated with postoperative complications in right-sided colon cancer patients undergone right hemicolectomy.

Phase I multicenter study defined the maximal tolerated dose (MTD), dose-limiting toxicity (DLT) and safety profile of capecitabine in combination with preoperative radiation for patients with locally advanced rectal cancer (LARC).Patients were treated with oral capecitabine (700, 800, 900, 1000, 1100 and 1200 mg/m2 twice daily continuously) plus preoperative whole pelvic irradiation (45-46 Gy in 23-25 fractions over 5-6 weeks). Surgery was performed at the median of 42 days after chemoradiation treatment.Twenty-seven patients were in this trial. Eighteen patients (3 per dose level) had received capecitabine from 700 mg/m2 twice daily to the highest dose level of 1200 mg/m2 twice daily. There were no grade 3/4 DLTs during dose escalation, a further nine patients were included at the highest capecitabine dose. Two of the twelve patients (16%) receiving capecitabine 1200 mg/m2 twice daily developed grade 3 diarrhea and discontinued treatment. There were no other grade 3/4 adverse events. After capecitabine chemoradiation, 24 of 27 patients (89%) received definite surgery. Primary and lymph node down staging occurred in ten patients (42%). Sphincter-sparing surgery was performed in seven patients (26%) and abdominal-perineal resection was performed in 17 patients (63%).Preoperative capecitabine chemoradiation based on continuous daily capecitabine is very well tolerated in patients with LARC. The authors did not reach the MTD in the present study.

Purpose. The purpose of our study was to evaluate the short-term and long-term outcomes of emergency Lichtenstein tension-free hernioplasty for acutely incarcerated inguinal hernia. Methods. We conducted a retrospective study of patients who underwent emergency Lichtenstein hernioplasty for acutely incarcerated inguinal hernia between September 2002 and January 2006 in a major city hospital in Thailand. We analyzed the early postoperative complications and surgical outcomes. Results. All 24 patients were men, with a mean age of 53.8 ± 19.2 years (range 19–77). There was no perioperative mortality and only two postoperative complications (8.3%): a subcutaneous fl uid collection, which resolved spontaneously within 2 weeks; and a superfi cial surgical site infection, which was treated successfully by intravenous antibiotics. The hospital stay was 3.8 ± 2.1 days (range 2–12). All patients attended regular follow-up visits (mean 20.2 ± 10.7 months, range 3–43). Clinical recurrence was found in one patient (4.2%), 7 months postoperatively. Conclusion. Lichtenstein hernioplasty can be used effectively as an emergency operation for incarcerated inguinal hernia with a good outcome and an acceptably low rate of postoperative complications.

Pancreaticoduodenectomy (Whipple's operation) represents a considerable surgical challenge. The operative mortality rate after Whipple's operation is still less than 5%. Recent studies show pancreaticojejunostomy (PJ) anastomosis is the "Achilles heel" of the procedure. The authors present the results of Whipple's operation without mortality which were performed in the Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.From January 1991 to December 2003, thirty-seven consecutive patients who underwent Whipple's operation were enrolled in the present study. The ages ranged from 33 to 79 years (mean 57.13). There were 19 male and 18 female patients. Twenty-nine of them underwent a pylorus preserving pancreaticoduodenctomy (PPPD). Construction of the PJ anastomosis was mostly performed by a dunking technique, that is, the invagination of the pancreatic resected end into the jejunum.There was no postoperative mortality from anastomotic leakage. Surgical wound infections occurred in 7 patients, gastric atony in 2 patients, and PJ anastomosis leakage which created a fistula in 1 patient. All 37 patients were discharged in an improved condition following surgery. The median follow-up was 2 years (range: 4 month-11 years). Eighteen patients died from liver failure. Until now 19 patients are doing well.The authors demonstrated that the dunking technique used for PJ anastomosis in Whipple's operation provided a good result without any mortality rate.

AIM: To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS: The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS: The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m2; P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.