Efficacy of Curcuminoids in Managing Postoperative Pain after Total Laparoscopic Hysterectomy: A Randomized Controlled, Open-Label Trial.

BACKGROUND AND AIMS: Curcuminoids, which are substances extracted from turmeric (Curcuma longa), have anti-inflammatory and analgesic effects and a good safety profile. This study aimed to evaluate the clinical efficacy of curcuminoid extracts on reducing pain among patients who underwent laparoscopic hysterectomy. EXPERIMENTAL PROCEDURE: From November 2016 to December 2017, 98 participants were included in this clinical trial, and they were randomly assigned to the experimental and control arms according to blocks of four. The intraoperative findings did not significantly differ between the two groups. The experimental group received one tablet of curcuminoid extract 250 mg four times a day on postoperative days 1-3. Pain was evaluated at 24 and 72 h postoperatively using a 10-point visual analog scale (VAS). RESULTS AND CONCLUSION: The mean VAS scores at 24 h after surgery were 4.9 in the experimental group and 4.3 in the control group. Hence, the results did not significantly differ (p = 0.129). The mean VAS scores at 72 h after surgery were 1.8 in the experimental group and 2.8 in the control group (p = 0.001). The side effects in both groups were similar. Hence, curcuminoids can be an effective supplement for reducing pain after laparoscopic hysterectomy. The conclusion from this study is that curcuminoids may be an effective supplement to reduce postoperative pain following laparoscopic hysterectomy.

Efficacy of curcuminoids for reducing postoperative pain after laparoscopic gynecologic surgery: A pilot randomized trial.

Background Curcuminoids, which are substances extracted from turmeric, have been proved to have anti-inflammatory and analgesic effects along with a good safety profile. This study aimed to evaluate the clinical efficacy of curcuminoids for reducing postoperative pain in patients who undergo laparoscopic gynecologic surgery. Methods From November 2016 to December 2017, participants were randomly assigned, by blocks of four, to the intervention and control arms of the study. Altogether, 60 patients who were to undergo laparoscopic gynecologic surgery at our institution were enrolled. Intraoperative findings were not significantly different between the two groups. One tablet of curcuminoid extract 250 mg was given to patients in the intervention group four times a day on postoperative days 1-3. Pain was evaluated at 24 and 72 h postoperatively using a 10-point visual analog scale (VAS). Results The median VAS score 24 h after surgery was 3 (1-6) in the intervention group and 4.5 (3-7) in the control group, with the difference reaching statistical significance (p=0.001). The median VAS at 72 h after surgery was 1 (0-2) in the intervention group and 2 (1-5) in the control group (p<0.001). Conclusion Curcuminoids may be an effective supplement to reduce pain severity postoperatively following laparoscopic gynecologic surgery. Trial Registration TCTR20180215001 www.clinicaltrials.in.th.

Comparison of Perioperative and Oncologic Outcomes with Laparotomy, and Laparoscopic or Robotic Surgery for Women with Endometrial Cancer.

PURPOSE: To compare perioperative outcomes and oncologic outcomes in endometrial cancer patients treated with laparotomy, and laparoscopic or robotic surgery. MATERIALS AND METHODS: Endometrial cancer patients who underwent primary surgery from January 2011 to December 2014 were retrospectively reviewed. Perioperative outcomes, including estimated blood loss (EBL), operation time, number of lymph nodes retrieved, and intra and postoperative complications, were reviewed. Recovery time, disease free survival (DFS) and overall survival (OS) were compared. RESULTS: Of the total of 218 patients, 143 underwent laparotomy, 47 laparoscopy, and 28 robotic surgery. The laparotomy group had the highest EBL (300, 200, 200 ml, p<0.05) while the robotic group had the longest operative time (302 min) as compared with laparoscopy (180 min) and laparotomy (125 min) (p<0.05). Intra and postoperative complications were not different with any of the surgical approaches. No significant difference in number of lymph nodes retrieved was identified. The longest hospital stay was reported in the laparotomy group (four days) but there was no difference between the laparoscopy (three days) and robotic (three days) groups. Recovery was significantly faster in robotic group than laparotomy group (14 and 28 days, p=0.003). No significant difference in DFS and OS at 21 months of median follow up time was observed among the three groups. CONCLUSIONS: Minimally invasive surgery has more favorable outcomes, including lower blood loss, shorter hospital stay, and faster recovery time than laparotomy. It also has equivalent perioperative complications and short term oncologic outcomes. MIS is feasible as an alternative option to surgery of endometrial cancer.

D-dimer as a tumor marker in pre-operative assessment of adnexal masses.

OBJECTIVE: To determine the sensitivity, specificity, and predictive value ofserum D-dimer testing in preoperative assessment of adnexal masses. MATERIAL AND METHOD: D-dimer levels were measured pre-operatively in 200 women diagnosed with adnexal masses who underwent surgical treatment at Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital between June 2007 and May 2008. The CA-125 level was also recorded RESULTS: When using cut-off value at 500 ng/ml, D-dimer has 91.8% sensitivity, 71.9% specificity, 58.9% PPV and 95.2% NPV of the tests in differentiating benign from malignant adnexal masses, compared with CA-125, which had 75.4%, 73.0%, 59.7%, and 84.8% respectively (cut-off 65 U/ml). Furthermore, the likelihood ratio to be negative ofD-dimer test is high at 0.11. In patients with epithelial ovarian cancer, D-dimer is increased in 83% of early stage (stage 1) ovarian cancer while only 39% of early stage patients have CA-125 level above cut-off value. CONCLUSION: D-dimer could be a useful test in pre-operative assessment of adnexal masses. In this study D-dimer seems to be better than CA-125 in diferentiating benign from malignant adnexal tumors.

Is complete surgical staging necessary in clinically early-stage endometrial carcinoma?

The purpose of this study was to evaluate the incidence of pelvic/para-aortic node metastases and the other pathological characteristics from medical records of patients with endometrial carcinoma treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1996 and 2005. The records of 213 patients with endometrial carcinoma who had complete surgical staging were reviewed. A particular focus was on clinically early-stage disease. Clinical staging could be determined in 206 patients. Of the 206 patients, 182 (88.3%) presented with clinical stage I disease. However, only 142 (78%) of these patients were confirmed as surgical stage I and 22% were upstaged. Preoperative histologic grade was diagnosed inaccurately in 15.9% of patients and 7.7% were upgraded. Of patients with preoperative histologic grade 1, 33% had deep myometrial invasion, 8.2% had pelvic node metastasis, and 3.3% had para-aortic node metastasis. Even in clinical stage IaG1, pelvic node metastasis occurred in 5.6% and para-aortic node metastasis in 1.3%. It has been suggested that complete surgical staging may not be necessary in patients with low-risk endometrial carcinoma who have disease limited to the uterus without grade 3 or deep myometrial invasion. However, proper selection of such low-risk patients remains problematic. In situations where there is limited preoperative and intraoperative assessment of high-risk factors, particularly radiographic imaging and frozen section assessment, the role of complete surgical staging is beneficial.

Long term complications after radical hysterectomy with pelvic lymphadenectomy.

OBJECTIVE: To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy. MATERIAL AND METHOD: A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema. RESULTS: Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema. CONCLUSION: Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.

Outcome of recurrent and persistent disease of malignant ovarian germ cell tumor: a retrospective analysis at King Chulalongkorn Memorial Hospital.

Malignant ovarian germ cell tumor has one of the most successful treatment outcomes in gynecological malignancy. More than 80% of the patients can be cured from this rare type of tumor However, patients with recurrent and persistent disease after primary treatment are still the problem of management. The present study has reviewed the treatment outcome of this cancer in King Chulalongkorn Memorial Hospital during the 12 years periodfrom 1993 to 2004. The overall cases of malignant ovarian germ cell tumor were 71 cases, 8 cases had recurrent disease after primary treatment and all cases received platinum-based chemotherapy for the salvage treatment. All patients in this group received long-term survival with median survival time of 87 months. In patients with persistent disease, 10 cases that resisted to first line adjuvant chemotherapy. Cisplatin and Etoposide regimen was applied as second line treatment, but none of these patients received long term response. The survival outcomes in these 2 groups are significantly different. The overall survival from the treatment of malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital was 85.1%. In conclusion, the outcome of treatment in patients with recurrent disease after non-platinum chemotherapy is excellent. Salvage therapy in this group should contain platinum-based regimen. Patients whose disease persisted after platinum-containing regimen had a poor survival outcome.

Malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To determine the frequency, characteristics, treatment and outcome of patients with malignant ovarian germ cell tumor (MOGCT) in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000. STUDY DESIGN: Retrospective descriptive study MATERIAL AND METHOD: All patients with malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000 were analyzed by the characteristics of patients, treatment and outcome. RESULTS: Sixty-six patients with MOGCT were demonstrated in that period with a mean age of 22.6 years old. Most of the patients were nulliparous and premenopausal status. Primary surgery was done in all patients. Forty-two patients (63.6%) received conservative surgery. Eight patients received no adjuvant treatment after surgery due to stage 1A dysgerminoma and immature teratoma stage I grade I. Fifty-six patients received chemotherapy for adjuvant treatment. VAC regimen was given in 27 cases (40.9%) and PVB regimen was given in 25 cases (37.9%). Salvage therapy in the patients with persistent and recurrent disease was treated in 9 patients, who received a platinum-base of regimen. Two-year survival was 88% with the median time to follow up 24 months. Overall five-year survival in the present study was 85%. CONCLUSION: MOGCT in King Chulalongkorn Memorial Hospital had clinical characteristics similar to other studies in malignant ovarian germ cell tumor Treatment by VAC regimen still has benefit in selected group.