Publications by authors named "Siripong Chewatanakornkul"

6 Publications

  • Page 1 of 1

Laparoscopic trans-hiatal approach in a rare case of double giant epiphrenic diverticula: A case report.

Asian J Endosc Surg 2021 Oct 3. Epub 2021 Oct 3.

Minimally Invasive Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

The transthoracic approach for esophageal diverticulectomy saves dissection but limits the amount of antireflux surgery that can be done. However, the laparoscopic trans-hiatal approach usually limits access to large diverticula located at the mid-thoracic level. We describe a 67-year-old Thai man who had two giant epiphrenic diverticula (ED) (11 × 7.6 cm and 3.2 × 3.4 cm). The highest part of the fundus of the larger ED was 12.6 cm above the hiatus. Preoperative esophageal manometry and an upper gastrointestinal study showed no obvious features of motility disorder. In addition, the clinical evaluation of the esophagogastroduodenoscopy revealed a hiatal hernia. Laparoscopic trans-hiatal esophageal diverticulectomy with intraoperative assessment by endoscopy was carried out. A partial wrap using Dor fundoplication was constructed without myotomy. There were no postoperative related complications. We believe that tailor-made operations in unusual cases can be safe using combined techniques to reduce postoperative morbidity.
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October 2021

Chalkley microvessel but not lymphatic vessel density correlates with axillary lymph node metastasis in primary breast cancers.

Asian Pac J Cancer Prev 2013 ;14(1):583-7

Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

This study aimed to investigate tumor microvessel density (MVD) and lymphatic vessel density (LVD) using the Chalkley method as predictive markers for the risk of axillary lymph node metastasis and their relationship to other clinicopathological parameters in primary breast cancer cases. Forty two node-positive and eighty node-negative breast cancers were immunostained for CD34 and D2-40. MVD and LVD were counted by the Chalkley method at x400 magnification. There was a positive significant correlation of the MVD with the tumor size, coexisting ductal carcinoma in situ (DCIS) and lymph node metastases (P<0.05). In multivariate analysis, the MVD (2.86-4: OR 5.87 95%CI 1.05-32; >4: OR 20.03 95%CI 3.47-115.6), lymphovascular invasion (OR 3.46, 95% CI 1.13-10.6), and associated DCIS (OR 3.1, 95%CI 1.04-9.23) independently predicted axillary lymph node metastasis. There was no significant relationship between LVD and axillary lymph node metastasis. However, D2-40 was a good lymphatic vessel marker to enhance the detection of lymphatic invasion compared to H and E staining. In conclusion, MVD by the Chalkley method, lymphovascular invasion and associated DCIS can be additional predictive factors for axillary lymph node metastases in breast cancer. No relationship was identified between LVD and clinicopathological variables, including axillary lymph node metastasis.
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December 2013

Clinical outcomes of gastrointestinal stromal tumor in southern Thailand.

World J Gastrointest Oncol 2012 Nov;4(11):216-22

Kittima Pornsuksiri, Siripong Chewatanakornkul, Walawee Chaiyapan, Surasak Sangkhathat, Department of Surgery and Tumor Biology Research Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

Aim: To review a single institutional experience in clinical management of gastrointestinal stromal tumors (GIST) and analyze for factors determining treatment outcome.

Methods: Clinicopathological data of patients with a diagnosis of GIST who were treated at our institute during November 2004 to September 2009 were retrospectively reviewed.

Results: Ninety-nine cases were included in the analysis. Primary tumor sites were at the stomach in and small bowel in 44% and 33%, respectively. Thirty-one cases already had metastasis at presentation and the most common metastatic site was the liver. Sixty-four cases (65%) were in the high-risk category. Surgical treatment was performed in 77 cases (78%), 3 of whom received upfront targeted therapy. Complete resection was achieved in 56 cases (73% of operative cases) and of whom 27 developed local recurrence or distant metastasis at a median duration of 2 years. Imatinib was given as a primary therapy in unresectable cases (25 cases) and as an adjuvant in cases with residual tumor (21 cases). Targeted therapy gave partial response in 7 cases (15%), stable disease in 27 cases (57%) and progressive disease in 13 cases (28%). Four-year overall survival was 74% (95% CI: 61%-83%). Univariate survival analysis found that low-risk tumor, gastric site, complete resection and response to imatinib were associated with better survival.

Conclusion: The overall outcomes of GIST can be predicted by risk-categorization. Surgery alone may not be a curative treatment for GIST. Response to targeted therapy is a crucial survival determinant in these patients.
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November 2012

Comparability of different pathologic protocols in sentinel lymph node evaluation: an analysis of two step-sectioning methods for the same patients with breast cancer.

Arch Pathol Lab Med 2009 Sep;133(9):1437-40

Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Context: The pathologic protocol for sentinel lymph node evaluation has yet to be standardized. Results from previous studies are troublesome to compare because they have been conducted on different sets of subjects with cancer.

Objective: To compare the detection of sentinel lymph node metastases by using step-sectioning methods at 20-microm and 150-microm intervals for the same patient with primary breast cancer.

Design: A total of 186, initially tumor-negative sentinel lymph nodes from a group of 80 patients with breast cancer were included. For all nodes, each paraffin block was cut serially to produce a total of 10 levels: 5 consecutive levels of sections for each of the 20-microm and 150-microm intervals. The nodal findings obtained at these intervals on hematoxylin-eosin and cytokeratin slides were compared by using the McNemar test.

Results: The overall detection rate for sentinel lymph node metastasis at intervals of 20 microm and 150 microm was 27.5% (22/80) and 20% (16/80), respectively. The overall agreement between the 20-microm and 150-microm sections was 82.5%. No macrometastasis was missed by either method. At the 20-microm interval, 2 cases of micrometastasis were missed, while 10 cases of isolated tumor cells were missed at the 150-microm interval. However, no statistical difference was observed for the final sentinel lymph node results with either method. (McNemar test, P = .18 for case-based results and P = .052 for nodal-based results).

Conclusions: The 20-microm and 150-microm interval step-sectioning methods produce comparable results for detection of metastatic deposits in sentinel lymph nodes.
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September 2009

Initial experience and result of thoracoscopic and laparoscopic esophagectomy.

J Med Assoc Thai 2008 Aug;91(8):1202-5

Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Background: Conventional esophagectomy requires either a laparotomy or a thoracotomy. Currently, the minimally invasive esophagectomy is an evolving alternative to the open technique.

Objective: Assess and evaluate the early outcomes of the authors' experiences with the minimally invasive esophagectomy for esophageal cancer.

Material And Method: Outcome data were collected prospectively from 28 consecutive patients, 22 men and six women with a mean age of 63 years and a range of 36-77 years.

Results: Thoracoscopic esophageal mobilizations were successful in 17 patients. Four patients were converted to open thoracotomy. Laparoscopic gastric mobilizations were successful in eight patients and only one patient was converted to laparotomy. Mortality was one (3.5%), and perioperative morbidity was nine (32%), including pneumonia, pleural effusion, wound infection, anastomosic leakage, and hoarseness.

Conclusion: Minimally invasive esophagectomy is feasible and can be performed at the Prince of Songkla University Hospital. Optimal results require appropriate patient selection and surgeon experience.
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August 2008

Preoperative carcinoembryonic antigen and albumin in predicting survival in patients with colon and rectal carcinomas.

J Clin Gastroenterol 2006 Aug;40(7):592-5

Faculty of Medicine, Department of Surgery, Songklanagarind Hospital, Prince of Songkla University, Hatyai, Songkla, Thailand.

Objective: To examine the relationship between postoperative outcomes of colorectal carcinoma patients and preoperative serum carcinoembryonic antigen (CEA) and albumin (ALB) levels and evaluate if these levels can accurately predict outcomes and/or be factor indicating adjuvant chemotherapy.

Background: CEA is a marker for colorectal carcinoma and its level usually increases before a distant metastasis is detected. Also, a low level of serum ALB is usually found in metastatic colorectal carcinoma patients.

Study: A retrospective cohort study of patients with colorectal carcinomas who were treated with curative surgery in Songklanagarind Hospital between 1998 and 2002.

Results: One hundred seventy patients were identified with a median survival of 1131 days (range 71 to 2293 d) and with an overall 5-year survival rate of 54%. Patients were stratified using CEA at 5 ng/mL and an ALB level at 3.5 g/dL into 4 groups: (1) low CEA, high ALB; (2) low CEA, low ALB; (3) high CEA, high ALB; and (4) high CEA, low ALB. The 5-year survival rates for groups 1 to 4 were 66%, 63%, 46%, and 34%, respectively. There was statistically significant difference in 5-year survival between the well-differentiated tumor with low CEA and the poorly differentiated tumor with high CEA (P=0.0115). The high CEA patients who had the well-differentiated tumor had longer survival than those with a poorly differentiated tumor (P=0.0412).

Conclusions: A preoperative CEA level greater than or equal to 5 ng/mL and ALB level less than 3.5 g/dL predict a poor survival chance for colorectal carcinoma patients. In high CEA patients, tumor differentiated is an independent factor affecting survival.
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August 2006