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- Collin, Åsa, et al.
(författare)
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Impact of mechanical bowel preparation on survival after colonic cancer resection
- 2014
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Ingår i: British Journal of Surgery. - : Wiley: 12 months. - 0007-1323 .- 1365-2168. ; 101:12, s. 1594-
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Tidskriftsartikel (refereegranskat)abstract
- Background: A randomized study in 1999-2005 of mechanical bowel preparation (MBP) preceding colonic resection found no decrease in postoperative complications. The aim of the present study was to evaluate the long-term effect of MBP regarding cancer recurrence and survival after colonic resections. Methods: The cohort of patients with colonic cancer in the MBP study was followed up for 10 years. Data were collected from registers run by the National Board of Health and Welfare. Register data were validated against information in patient charts. Cox proportional hazards model was used for multivariable analysis of factors predictive of cancer-specific survival. Results: Register analysis showed significantly fewer recurrences, and better cancer-specific and overall survival in the MBP group. After validation, 839 of 1343 patients remained for analysis (448 MBP, 391 no MBP). Eighty (17.9 per cent) of 448 patients in the MBP group and 88 (22.5 per cent) of 391 in the no-MBP group developed a cancer recurrence (P = 0.093). The 10-year cancer-specific survival rate was 84.1 per cent in the MBP group and 78.0 per cent in the no-MBP group (P = 0.019). Overall survival rates were 58.8 and 56.0 per cent respectively (P = 0.186). Conclusion: Patients receiving MBP before elective colonic cancer surgery had significantly better cancer-specific survival after 10 years.
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| 2. |
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| 3. |
- Jung, Bärbel, et al.
(författare)
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Mechanical bowel preparation does not affect the intramucosal bacterial colony count
- 2010
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 25:4, s. 439-442
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to determine if mechanical bowel preparation (MBP) influences the intramucosal bacterial colony count in the colon. MATERIALS AND METHODS: Macroscopically normal colon mucosa was collected from 37 patients (20 with and 17 without MBP) who were undergoing elective colorectal surgery at three hospitals. The biopsies were processed and cultured in the same laboratory. Colony counts of the common pathogens Escherichia coli and Bacteroides as well as of total bacteria were conducted. The study groups were comparable with regard to age, gender, antibiotics use, diagnosis and type of resection. RESULTS: MBP did not influence the median colony count of E. coli, Bacteroides or total bacteria in our study. CONCLUSIONS: MBP did not affect the intramucosal bacterial count in this study. Further studies are suggested to confirm these findings.
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| 4. |
- Jung, Bärbel, et al.
(författare)
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Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection
- 2007
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Ingår i: British Journal of Surgery. - : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 94:6, s. 689-695
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recent studies have suggested that MBP does not lower the risk of postoperative septic complications after elective colorectal surgery. This randomized clinical trial assessed whether preoperative MBP is beneficial in elective colonic surgery.Methods: A total of 1505 patients, aged 18-85 years with American Society of Anesthesiologists grades I-III, were randomized to MBP or no MBP before open elective surgery for cancer, adenoma or diverticular disease of the colon. Primary endpoints were cardiovascular, general infectious and surgical-site complications within 30 days, and secondary endpoints were death and reoperations within 30 days.Results: A total of 1343 patients were evaluated, 686 randomized to MBP and 657 to no MBP. There were no significant differences in overall complications between the two groups: cardiovascular complications occurred in 5.1 and 4.6 per cent respectively, general infectious complications in 7.9 and 6.8 per cent, and surgical-site complications in 15.1 and 16.1 per cent. At least one complication was recorded in 24.5 per cent of patients who had MBP and 23.7 per cent who did not.Conclusion: MBP does not lower the complication rate and can be omitted before elective colonic resection.
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| 5. |
- Jung, Bärbel, et al.
(författare)
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Preoperative mechanical preparation of the colon : the patient's experience
- 2007
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482 .- 1471-2482. ; 7, s. 5-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials. METHODS: As part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 - 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary. RESULTS: 60 patients received mechanical bowel preparation (MBP) and 45 patients did not (No-MBP). In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively) patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03. CONCLUSION: Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying.
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| 6. |
- Jung, Bärbel, et al.
(författare)
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Rectal cancer treatment and outcome in the elderly : an audit based on the Swedish rectal cancer registry 1995-2004
- 2009
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Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407 .- 1471-2407. ; 9, s. 68-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Limited information is available regarding the effect of age on choice of surgical and oncological treatment for rectal cancer. The objective of this study was to assess the influence of age on treatment and outcome of rectal cancer. Methods: We utilized data in the Swedish Rectal Cancer Registry SRCR) from patients treated for rectal cancer in Sweden in 1995-2004. Results: A total of 15,104 patients with rectal cancer were identified, 42.4% of whom were 75 years or older. Patients >= 75 years were less likely to have distant metastases than younger patients 14.8% vs. 17.8%, P < 0.001), and underwent abdominal tumor resection less frequently 68.5% vs. 84.4%, P < 0.001). Of 11,725 patients with abdominal tumor resection anterior resection [AR], abdominoperineal excision [APE], and Hartmann's procedure [HA]), 37.4% were = 75 years. Curative surgery was registered for 85.0% of patients >= 75 years and for 83.9% of patients < 75 years, P = 0.11. Choice of abdominal operation differed significantly between the two age groups for both curative and non-curative surgery, The frequency of APE was similar in both age groups 29.5% vs. 28.6%), but patients >= 75 years were more likely to have HA 16.9% vs. 4.9%) and less likely to have preoperative radiotherapy 34.3vs. 67.2%, P < 0.001). The relative survival rate at five years for all patients treated with curative intent was 73% 70-75%) for patients >= 75 years and 78% 77-79%) for patients < 75 years of age. Local recurrence rate was 9% 8-11%) for older and 8% 7-9%) for younger patients. Conclusion: Treatment of rectal cancer is influenced by patient's age. Future studies should include younger and older patients alike to reveal whether or not age-related differences are purposive. Local recurrence following surgery for low tumors and quality of life aspects deserve particular attention.
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| 7. |
- Kodeda, Karl, et al.
(författare)
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Population-based data from the Swedish Colon Cancer Registry
- 2013
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Ingår i: British Journal of Surgery. - : Wiley-Blackwell. - 0007-1323 .- 1365-2168. ; 100:8, s. 1100-1107
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Tidskriftsartikel (refereegranskat)abstract
- Background Evaluating the external validity of clinical trials requires knowledge not only of the study population but also of a relevant reference population. The main aim of this study was to present data from a large, contemporary, population-based cohort of patients with colonic cancer. Methods Data on patients diagnosed between 2007 and 2011 were extracted from the Swedish Colon Cancer Registry. The data, registered prospectively in a national population of almost 10 million, included over 99 per cent of all diagnosed adenocarcinomas of the colon. Results This analysis included 18889 patients with 19526 tumours (3 center dot 0 per cent had synchronous tumours). The sex distribution was fairly equal, and the median age was 74 center dot 1 (interquartile range 65-81) years. The overall and relative (cancer-specific) survival rates after 3 years were 62 center dot 7 and 71 center dot 4 per cent respectively. Some 88 center dot 0 per cent of the patients were operated on, and 83 center dot 8 per cent had tumours resected. Median blood loss during bowel resection was 200 (mean 311) ml, and the median operating time was 160min; 5 center dot 6 per cent of the procedures were laparoscopic. Preoperative chemotherapy was administered to 2 center dot 1 per cent of patients; postoperative chemotherapy was planned in 90 center dot 1 per cent of fit patients aged less than 75 years with stage III disease. In patients operated on in an emergency setting (21 center dot 5 per cent), the preoperative evaluation was less extensive, the proportion of R0 resections was lower, and the outcomes were poorer, in both the short and long term. Conclusion These population-based data represent good-quality reference points.
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