| 1. |
- Bergvall, M., et al.
(författare)
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Better survival for patients with colon cancer operated on by specialized colorectal surgeons - a nationwide population-based study in Sweden 2007-2010
- 2019
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 21:12, s. 1379-1386
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Tidskriftsartikel (refereegranskat)abstract
- Aim Mortality and complication rates after surgery for colon cancer are high, especially after emergency procedures. The aim of the present study was to evaluate the importance of the formal competence of surgeons for survival and morbidity. Method The Swedish Colorectal Cancer Registry prospectively records data on patients diagnosed with cancer within the colon and rectum. A cohort of patients operated on for colon cancer between 2007 and 2010 were followed 5 years after surgery. Data on postoperative morbidity, mortality and long-term survival were compared with regard to formal competency of the most senior surgeon attending the procedure. Results This analysis includes 13 365 patients operated on for colon cancer, including 10 434 elective procedures and 2931 emergency cases. The overall 5-year survival was higher for those operated on by subspecialist colorectal surgeons compared with general surgeons (60% vs 48%; P < 0.001). Five-year survival after elective surgery was 63% vs 55% (P < 0.001) and 35% vs 31% (P < 0.05) after emergency procedures when performed by colorectal surgeons compared with general surgeons. Postoperative 30-day mortality was 3% after surgery performed by colorectal surgeons compared with 7% when performed by general surgeons. Mortality at 90 days was 6% after surgery performed by colorectal surgeons compared with 11% for patients operated on by general surgeons (P < 0.001). Conclusion Subspecialization in colorectal surgery is associated with better outcome for patients operated on for colon cancer, and effort should be made to increase the availability of colorectal surgeons for both acute and elective colon cancer surgery.
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| 2. |
- Bexe-Lindskog, Elinor, et al.
(författare)
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A population-based cohort study on adherence to practice guidelines for adjuvant chemotherapy in colorectal cancer
- 2014
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Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 14, s. 948-
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Tidskriftsartikel (refereegranskat)abstract
- Background: The value of adjuvant chemotherapy in colorectal cancer is well studied, and guidelines have been established. Little is known about how treatment guidelines are implemented in the everyday clinical setting. Methods: This national population-based study on nearly 34,000 patients with colorectal cancer evaluates the adherence to present clinical guidelines for adjuvant chemotherapy. Virtually all patients with colorectal cancer in Sweden during the years 2007-2012 and data from the Swedish Colorectal Cancer Registry were included. Results: In colon cancer stage III, adherence to national guidelines was associated with lower age, presence of multidisciplinary team (MDT) conference, low co-morbidity, and worse N stage. The MDT forum also affected whether or not high-risk stage II colon cancer patients were considered for adjuvant chemotherapy. Rectal cancer patients both in stage II and III were considered for adjuvant chemotherapy less often than colon cancer patients, but the same factors influenced the decision. Adjuvant chemotherapy was started later than eight weeks after surgery in 30% of colon cancer patients and in 38% of rectal cancer patients. Conclusions: In Sweden, the adherence to national guidelines for adjuvant chemotherapy in colon cancer stage III is acceptable in younger and healthier patients. MDT conferences are of major importance and affect whether patients are recommended for adjuvant chemotherapy. Special consideration needs to be given to certain subgroups of patients, particularly older patients and patients with poorly differentiated tumors. There is a need to shorten the waiting time until start of chemotherapy.
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| 3. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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A phase I/II study of neoadjuvant chemotherapy with Pemetrexed (Alimta) in rectal cancer.
- 2011
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Ingår i: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. - : Elsevier BV. - 1532-2157. ; 37:7, s. 583-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to assess the feasibility of preoperative chemotherapy and possible tumour response using Pemetrexed (Alimta) in rectal cancer.
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| 4. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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Age Aspects of Demography, Pathology and Survival Assessment in Colorectal Cancer
- 2010
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Ingår i: ANTICANCER RESEARCH. - : International Institute of Anticancer Research. - 0250-7005 .- 1791-7530. ; 30:12, s. 5227-5231
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to assess how age is related to differences in stage, tumour differentiation and treatment in colorectal cancer. Patients and Methods: A retrospective study in a consecutive series of colorectal cancer patients (n=2220) where age was related to demography, stage, tumour characteristics, treatment and outcome (OS/CSS) both as a continuous variable and grouped by high/low 10th percentiles, as young/old groups, with a third median reference group. Results: Young patients had more advanced cancer stages (p=0.012), higher N-status (p=0.011) and more frequent T4/G4 tumours. Old patients had higher postoperative mortality and were less likely to receive chemotherapy. The proportion of cancer-related deaths was stage-dependent and decreased with age. Conclusion: Cancer stage, tumour characteristics, treatment and outcome can vary with age in colorectal cancer. The increasing proportion of non-cancer deaths at a higher age can affect the use of overall survival as an outcome parameter, which may be of importance in evaluating clinical and translational research.
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| 5. |
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| 6. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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Tumour differentiation grade is associated with TNM staging and the risk of node metastasis in colorectal cancer.
- 2010
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Ingår i: Acta oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 49:1, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The tumour differentiation grade has been shown by numerous multivariate analyses to be a stage-independent prognostic factor in colorectal cancer. The aim of this study was to explore the importance of differentiation grading for the staging of colorectal cancer and how it relates to the components of the TNM system. MATERIAL AND METHODS: The study was a retrospective single-centre analysis of all patients undergoing surgical resection for colorectal cancer during the period 2002-2007 (n = 1239). The clinical parameters and pathology data of overall stage, differentiation grade, local tumour (T)-stage and metastasis status (M-stage) were included as well as the lymph node count of both assessed and metastatic nodes. The differentiation grade was correlated with demography, overall stage and each component of the TNM staging system. The correlation between differentiation grade and N-stage was also explored for the separate T-stages. RESULTS: The tumour differentiation grade correlated significantly with the overall TNM stage (p < 0.0001). The grade significantly correlated with the T-stage and the risk of having lymph node metastasis (p < 0.0001). A high grade was associated with a higher positive lymph node count in stage III disease (p < 0.0002). For the T-stages, the risk of node metastasis was significantly linked to the tumour grade. A low grade (G1) T2 had a 17% risk of lymph node metastasis compared to a 44% risk for a high grade (G4) T2. CONCLUSION: Tumour differentiation is an important prognostic factor. It correlates significantly with the overall stage of the TNM system and also to each of its components. The risk of having lymph node metastasis for each T-stage also correlates with the tumour grade. The findings can be of importance in postoperative risk assessment or when considering local resection procedures like TEM.
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| 7. |
- Erestam, Sofia, et al.
(författare)
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A survey of surgeons' perception and awareness of intraoperative time utilization.
- 2014
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Ingår i: Patient safety in surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Surgical teams' awareness of the time needed to perform specific phases of a surgical procedure is likely to improve communication in the operating theatre and benefit patient safety. The aim of this study was to assess surgeons' awareness of time utilization and the actual time needed to perform specific phases of an operation.
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| 8. |
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| 9. |
- Folkesson, J., et al.
(författare)
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Current considerations in colorectal cancer surgery
- 2015
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Ingår i: Colorectal Cancer. - : Future Medicine Ltd. - 1758-194X .- 1758-1958. ; 4:4, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- Colorectal cancer is one of the most common cancers in the world. The last decades improvement in survival in all stages of the disease has been achieved. Many factors contributes to this improvement; earlier diagnosis, better pre-operative staging, neoadjuvant radiochemotherapy, better surgical method and approach, introduction of pre- and postoperative multidisciplinary team conferences and adjuvant chemotherapy. Currently, new modalities are developing; robotics and organ preserving through wait-and-watch will give colorectal surgeons even more treatment options. This article highlights important aspects of colorectal cancer management now and in the future.
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| 10. |
- Folkesson, Joakim, et al.
(författare)
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Current considerations in colorectal cancer surgery
- 2015
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Ingår i: Colorectal Cancer. - 1758-194X .- 1758-1958. ; 4:4, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- Colorectal cancer is one of the most common cancers in the world. The last decades improvement in survival in all stages of the disease has been achieved. Many factors contributes to this improvement; earlier diagnosis, better pre-operative staging, neoadjuvant radiochemotherapy, better surgical method and approach, introduction of pre- and postoperative multidisciplinary team conferences and adjuvant chemotherapy. Currently, new modalities are developing; robotics and organ preserving through wait-and-watch will give colorectal surgeons even more treatment options. This article highlights important aspects of colorectal cancer management now and in the future.
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