Publications by authors named "Kittipong Phinthusophon"

5 Publications

  • Page 1 of 1

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand.

Urol Int 2018 16;100(3):301-308. Epub 2018 Jan 16.

Introduction: Robot-assisted partial nephrectomy (RAPN) with different arterial clamping techniques has increasingly been performed to avoid ischemic injury to nephron. However, postoperative renal function remains controversial. We determine the impact of each renal arterial clamping on surgical and renal outcomes after RAPN.

Materials And Methods: Patients who underwent RAPN at Siriraj Hospital from 2010 to 2016 were retrospectively reviewed and stratified into 3 cohorts: main-clamp (MAC), selective-clamp, and off-clamp.

Results: Main, selective, and off-clamping were performed in 27, 38, and 12, respectively. Median tumor size and Radius, Exophytic or endophytic, Nearness to collecting system or sinus, Anterior or posterior, and Location relative to polar lines (RENAL) score were 3 cm and 7, respectively. Longer operative time was observed in MAC (p = 0.002) although estimated blood loss, transfusion rate, and complication were comparable. Warm ischemia time was not different between cohorts. However, number of patients with prolonged ischemia time in MAC were greater (p ≤ 0.01). All margins were negative. Median postoperative and latest glomerular filtration rate reduction were 3.8 and 5.3 mL/min/1.73 m2, respectively without significant difference between cohorts. On multivariable analysis, hypertension independently associated with reduced renal function preserved (p = 0.03). Median follow-up was 18 months.

Conclusions: Our study is the first to report surgical and renal functional outcomes after RAPN in Southeast-Asian population. Based on our experience, clamping techniques does not impact on renal functions and complication rate was low even in small-volume center.
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http://dx.doi.org/10.1159/000486319DOI Listing
December 2018

Accuracy of preoperative urinary symptoms, urinalysis, computed tomography and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer.

Asian Pac J Cancer Prev 2014 ;15(17):7241-4

Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail :

Background: To determine the accuracy of preoperative urinary symptoms, urinalysis, computed tomography (CT) and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer.

Materials And Methods: Records of patients with colorectal cancer and a suspicion of bladder invasion, who underwent tumor resection with partial or total cystectomy between 2002 and 2013 at the Faculty of Medicine Siriraj Hospital, were reviewed. Correlations between preoperative urinary symptoms, urinalysis, cystoscopic finding, CT imaging and final pathological reports were analyzed.

Results: This study included 90 eligible cases (71% male). The most common site of primary colorectal cancer was the sigmoid colon (44%), followed by the rectum (33%). Final pathological reports showed definite bladder invasion in 53 cases (59%). Significant features for predicting definite tumor invasion were gross hematuria (OR 13.6, sensitivity 39%, specificity 73%), and visible tumor during cystoscopy (OR 5.33, sensitivity 50%, specificity 84%). Predictive signs in CT imaging were gross tumor invasion (OR 7.07, sensitivity 89%, specificity 46%), abnormal enhancing mass at bladder wall (OR 4.09, sensitivity 68%, specificity 66%), irregular bladder mucosa (OR 3.53, sensitivity 70%, specificity 60% ), and loss of perivesical fat plane (OR 3.17, sensitivity 81%, specificity 43%). However, urinary analysis and other urinary tract symptoms were poor predictors of bladder involvement.

Conclusions: The present study demonstrated that the most relevant preoperative predictors of definite bladder invasion in patients with colorectal cancer are gross hematuria, a visible tumor during cystoscopy, and abnormal CT findings.
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http://dx.doi.org/10.7314/apjcp.2014.15.17.7241DOI Listing
June 2015

Laparoscopic radical prostatectomy: oncological and functional outcomes of 559 cases in Siriraj Hospital, Thailand.

J Med Assoc Thai 2011 Aug;94(8):941-6

Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: To evaluate the results of oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) during the first five years experience in Siriraj hospital.

Materials And Method: Between September 2004 and September 2009, the functional and oncological outcomes of 559 patients that underwent LRP were retrospectively evaluated.

Results: The distribution of pathological T stage was T2 (52.1%), T3 (39.9%), and T4 (2.9%). Lymph node metastasis (N1) were found in 19 patients (3.4%). The positive margin rates in pT2a-b, pT2c, pT3a, pT3b and pT4 were 13.2%, 34.7%, 65.9%, 72.7% and 76.9%, respectively. The 3-year biological progression free survival (bPFS) rate for all patients was 87.2%. Three-year bPFS rates in pT2a-b, pT2c, pT3a, pT3b and pT4 were 96.3%, 93%, 75%, 55.6% and 62.5% respectively. The continent rate at 12 months was 84% and potency rate at 12 months in group that received bilateral nerve sparing was 29.1%.

Conclusion: The oncological and functional results of our first LRPs in Thai men are acceptable and compared well with the early experience of previous studies. However, longer follow up is needed for further evaluation.
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August 2011

Laparoscopic radical prostatectomy: perioperative outcomes and morbidity of 559 consecutive cases in Siriraj Hospital, Thailand.

J Med Assoc Thai 2011 Jun;94(6):693-8

Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: To evaluate perioperative outcomes and morbidity of laparoscopic radical prostatectomy in Siriraj Hospital during a 5-year experience.

Material And Method: Five hundred fifty nine patients who underwent laparoscopic radical prostatectomy (LRP) by seven surgeons at Siriraj Hospital between September 2004 and September 2009 were included in the study. Data of perioperative results and postoperative parameters were retrospectively evaluated.

Results: Mean operative time was 257 minutes SD 75 (range 125 to 680 min). The mean operative time of the first 100 cases was significantly higher than of the last 100 cases (307 ml/min SD 95 versus 223 ml/min SD 56; p-value = 0.001). Mean estimated blood loss was 779 ml SD 607 (range 40 to 6,000 ml). Of 559 patients, 148 patients (26.5%) had blood transfusions. The blood transfusion rate in the first 100 cases was significantly higher than those of the last 100 cases (36.5% versus 15%; p-value = 0.016). The median duration of catheterization time was 8 days. The mean time of drain insertion was 4.2 days SD 1.8 (range 2 to 18 days) postoperatively. Hospital stay was 8.8 days SD 7.6 (range 3 to 149 days). Overall perioperative complications rate was 17.1%. Of these patients, 13.4% were minor complication (Clavien 1, 2) and 3.7% were major complication (Clavien 3, 4). There were no mortalities. Late complication rate was 2.1%, which most of them were stricture of anastomosis.

Conclusion: Perioperative outcomes and morbidity of LRP in a 5-year period were acceptable. Laparoscopic radical prostatectomy is technically demanding with an initially longer operative time and higher blood transfusion rate. The learning curve of the surgical team is needed to achieve good results.
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June 2011

Laparoscopic radical prostatectomy: transperitoneal laparoscopic radical prostatectomy versus extraperitoneal endoscopic radical prostatectomy.

J Med Assoc Thai 2007 Dec;90(12):2644-50

Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: To compare the perioperative results between Transperitoneal Laparoscopic Radical Prostatectomy (T-LRP) and Extraperitoneal Endoscopic Radical Prostatectomy (E-LRP).

Material And Method: Retrospective reviews of 125 patients who underwent laparoscopic radical prostatectomy by single surgeon (C.N) for stage T2-T3 adenocarcinoma of the prostate between May 2001 and July 2006 at Siriraj Hospital. Fifty-six cases had T-LRP and 69 cases had E-LRP The preoperative data (age, presenting PSA, and Gleason score), perioperative data (prostatic weight, operative time, intraoperative blood loss, the day of full oral diet, length of drain, and catheter time), pathologic stage, and margin status were compared.

Results: Mean age and Gleason score were comparable in both groups. Mean presenting PSA was lower in T-LRP (9.93) as compared to E-LRP (21.84) (p = 0.046). The mean prostatic weight was comparable in both T-LRP and E-LRP. The mean operative time of T-LRP (350) was significant longer than E-LRP (220) (p < 0.001). Mean intraoperative blood loss was more in T-LRP (883) as compared to E-LRP (605) (p = 0.001). Average blood transfusion was higher in T-LRP (1.23 unit) as compared to E-LRP (0.32). Postoperative full oral diet, length of drain, and catheter time in E-LRP were shorter than T-LRP (full diet: median 2 days vs. 3 days, p = 0.001) (length of drain: 4.98 days vs. 6.69 days, p = 0.002) (Catheter time: 8.9 days vs. 11.9 days, p = 0.002). Margin status were comparable in both groups but mean postoperative Gleason score was higher in E-LRP as compared to T-LRP (7.2 vs. 6.85, p = 0.022).

Conclusions: E-LRP resulted in significant less operative time, intraoperative blood loss, postoperative oral diet, length of drain and catheter time where as the pathological margin status was the same in both T-LRP and E-LRP.
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December 2007
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