Introduction Several modalities are used to improve the outcome of liver resection surgery. Laser-based surgery may become promising option; therefore we aim to report our experience regarding the efficacy and safety of Thulium-Doped Fiber Laser (TDFL) 1940 nm in liver parenchyma resection. Methods A cross sectional study in which patients with pre-existing liver pathology during July 2019 and July 2020 were randomly assigned to receive liver resection using TDFL integrated with raman laser emitting at 1940 nm and 1470 nm wavelength. Data on estimated blood loss during liver transection, liver transection speed, morbidity rate, and postoperative variables including complications, length of hospital stay (days), and mortality were analyzed. Results A total of 17 consecutive liver resections were performed, among them are 7 major and 11 minor hepatectomies. The Multipulse TM+1470 were used on 8 procedures consisted of 1 major and 7 minor hepatectomies, the mean amount of blood loss during operation and liver transection was 628.13 ± 141.31 mL and 294.63 ± 94.81 ml, respectively. The mean liver transection speed was 1.52 ± 0.27 cm 2 /min. No biliary leak, post-hepatectomy-liver failure, and mortality were reported. Conclusion TDFL provided by Multipulse TM+1470 is an effective and safe tool for liver surgery, providing good hemostasis and allowing for safe and effective exposure of vascular. Further study with larger samples might be needed proved the efficacy and safety of TDFL in liver surgery.

Background: Colorectal cancer (CRC) is ranked as the third most common cancer worldwide.One of the leading causes of death in CRC patients is due to its metastasis. The liver is the most common site of metastasis. The best treatment to achieve long-term survival and cure patients with CRC liver metastasis is surgery, whether it’s sequential, delayed, or simultaneous resection.This case study aims to evaluate the simultaneous resection on the patient with synchronous colorectal liver metastasis.Case Presentation: From January-June 2020, in Prof. Dr. R. D. Kandou General Hospital, Manado, 2 patients were treated with simultaneous resection for CRC with resectable synchronous liver metastasis. Blood loss, bile leak, ascites, and post hepatectomy liver failure (PHLF) were observed as outcome parameters.Conclusion: Simultaneous resection is safe and exhibits advantages in the long-time survival of patients. However, the incidence of complications and mortality are higher in simultaneous resection than in staged resection.

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Colorectal cancer is a serious health problem in Indonesia as well as in North Sulawesi. Serum carcinoembryonic antigen (CEA) is a progmostic factor in patients with this disease. This study was aimed to obtain the correlation between the histopathological differentiation stage and serum CEA level in colorectal cancer patients at Prof. Dr. R. D. Kandou Hospital Manado. This was an analytical correlation study. Subjects were colorectal cancer patients who had preoperative serum CEA level and histopathological differentiation stage results. Data were analyzed with Anova test (variant analysis) and Spearman Rho test. The results showed that there were 58 colorectal cancer patients enrolled in this study. The patients’ data were obtained from the Digestive Surgery clinic and nursery room of Prof. Dr. R. D. Kandou Hospital Manado. Of the 58 patients, 37 (63.79%) had moderate differentiated colorectal cancer. Related to serum CEA level, 23 patients (39.65%) had moderate differentiated colorectal cancer with serum CEA level 20-100 ng/ml. The Spearman Rho test showed that there was a positive correlation between serum CEA level and histopathoplogical differentiation stage of cancer (r = 0.877 and P = 0.001). Conclusion: There was a significant correlation between serum CEA level and histopathological differentiation stage of colorectal cancer. The better the differentiation stage, the higher the serum CEA level.Keywords: carcinoembryonic antigen, colorectal cancer, differentiation stageAbstrak: Karsinoma kolorektal (KKR) telah menjadi masalah kesehatan yang serius di Indonesia dan Sulawesi Utara pada khususnya. Kadar carcinoembryonic antigen (CEA) merupakan salah satu faktor prognostik pada penderita KKR. Penelitian ini bertujuan untuk mengetahui hubungan antara derajat diferensiasi histopatologik dengan kadar CEA dalam serum pada pasien KKR di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ini ialah analitik korelatif. Subyek penelitian ialah 58 pasien KKR yang mempunyai hasil pemeriksaan kadar CEA serum preoperasi dan pemeriksaan derajat diferensiasi histopatologik. Analisis statistik menggunakan uji Anova (analisis variansi) dan korelasi Spearman Rho. Data pasien diambil dari pasien yang datang dan kontrol di Poliklinik Bedah Digestif serta dari ruang perawatan Bedah Digestif RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian memperlihatkan derajat diferensiasi tumor kolorektal terbanyak ialah diferensiasi sedang/moderate differentiated yaitu 37 pasien (63,79%). Bila dihubungkan dengan nilai CEA serum, yang terbanyak ditemukan ialah jenis diferensiasi sedang pada pasien dengan kadar CEA serum 20-100 ng/ml sebanyak 23 orang (39,65%). Uji Spearman Rho memperlihatkan bahwa kadar CEA berkorelasi positif dengan derajat diferensiasi KKR (r = 0,877 dan P = 0,0001). Simpulan: Terdapat korelasi bermakna antara kadar CEA serum dan derajat diferensiasi kanker kolorektal. Derajat diferensiasi KKR yang baik memiliki kadar CEA yang tinggi.Kata kunci: carcinoembryonic antigen, karsinoma kolorektal, derajat differensiasi

Introduction:The role of liver resection in secondary liver tumors are growing along with the consequences of Post Hepatectomy Liver Failure (PHLF). Systematic Extended Right Posterior Sectionectomy (SERPS) is offered as an alternative to resect secondary liver tumors in segment 6-7 with vascular invasion towards right hepatic vein (RHV) compared to the right hepatectomy procedure in the past. The goal of SERPS procedure itself is maintaining appropriate oncological border, while minimizing the risk of PHLF. Methods: We aim to describe two patients with liver metastases in segment 6-7 with RHV vascular invasion, due to GIST and colorectal cancer metastases, which undergone USG guided SERPS in 2020. We reported the patients' primary tumor characteristics, adjuvant chemotherapy, surgical outcomes, PHLF incidence measured with ISGLS criteria, and liver metastases recurrencies in 3 months post-operative. Results: No tumor recurrencies and mortalities due to primary tumors or complications were detected in 3 months post-operative follow-ups. No PHLF incidence were detected. Conclusions: SERPS is a safe and promising alternative for secondary liver tumors at segment 6-7 and RHV vascular invasion. Thus, minimizing the risk of PHLF by saving larger volume of future liver remnant.