Naresuan University Hospital

BACKGROUND:Hepatocellular carcinoma (HCC) commonly arises in cirrhotic livers. Laparoscopic hepatectomy (LH) has shown promising outcomes, but its safety in moderate liver dysfunction remains unclear. Despite comparable surgical indications for LH and open hepatectomy (OH), data on impaired liver function are scarce. The Japanese Liver Damage Grading System (LDGS), incorporating indocyanine green retention at 15 min, provides a precise functional assessment. AIM:To compare short-term and long-term outcomes of LH and OH in patients with HCC LDGS grade B or C. METHODS:The 97 patients with HCC and LDGS grade B or C who underwent hepatectomy (26 LH; 71 OH) between 2010 and 2022 at Tokyo Women's Medical University Hospital were retrospectively analyzed. Propensity score matching (1:1) was applied. Baseline biochemical and tumor characteristics were compared. Short-term and long-term outcomes were assessed. RESULTS:Before matching patients who underwent LH had smaller tumors (2.7 cm vs 4.5 cm, P = 0.004) and lower surgical difficulty scores (P < 0.001). After matching LH was associated with lower intraoperative blood loss (242 mL vs 941 mL; P = 0.049), reduced postoperative ascites (0% vs 21.2%; P = 0.035), and shorter hospital stay with no conversion to OH. The 5-year overall survival rate was significantly higher in the LH group (91% vs 36%; P = 0.021) while recurrence-free survival was comparable. CONCLUSION:LDGS provides a comprehensive assessment of surgical candidates with moderate cirrhosis. In patients with HCC and grade B or C liver damage, LH appears to have better long-term outcomes than OH due to reduced morbidity and preservation of liver function.

ABSTRACT Objective Although symptom assessment is fundamental to palliative care, its independent impact on survival remains unclear. This study addresses survival time differences between high and low symptom burden, assessed using the Edmonton Symptom Assessment System (ESAS), among terminal cancer patients (PPS ≤ 30) at Naresuan University Hospital. Material and Methods A bidirectional observational cohort study was conducted from October 1, 2019, to January 31, 2024. Patients were categorized into high or low symptom distress groups based on ESAS physical, emotional, and total symptom scores. Multivariable models adjusted for age, sex, BMI, Charlson Comorbidity Index, and metastatic sites. Survival impact was quantified using restricted mean survival time (RMST) and hazard ratios (HR). Results A total of 143 terminal cancer patients were included; 76 were males (53.15%) and the average age was 66.17 ± 12.11 years. HRs for high physical, emotional, and total symptom distress scores (TSDS) were 1.50 (95% CI: 1.02–2.20), 1.02 (95% CI: 0.64–1.63), and 1.34 (95% CI: 0.91–1.97), respectively. Only the physical domain remained significant after adjustment. RMST demonstrated that patients with high physical burden experienced a significant survival reduction of 3.70 days (95% CI: −7.17 to −0.23) within a 28‐day follow‐up period. Conclusions High physical symptom burden is significantly associated with shorter survival in terminal cancer patients. These findings highlight the prognostic importance of physical symptoms, emphasizing the need for effective symptom management to optimize remaining survival time.

To determine the detection rate, molecular characteristics, and clinical features of enterovirus and parechovirus infections in young infants with sepsis-like illness. A prospective study conducted from September 2023 to February 2025 at four Thai tertiary hospitals enrolled infants aged 0–3 months with sepsis-like symptoms who underwent routine laboratory tests and real-time reverse transcription polymerase chain reaction for enterovirus, human rhinovirus, and parechovirus. Of 56 infants with sepsis-like illness, 15 tested positive (26.8