| 1. |
- Jörgren, Fredrik, et al.
(författare)
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Anastomotic leakage after surgery for rectal cancer : a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival?
- 2011
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 13:3, s. 272-283
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Tidskriftsartikel (refereegranskat)abstract
- Aim The impact of anastomic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer is still controversial. We explored the impact of AL regarding local recurrence (LR), distant metastasis and overall recurrence (OAR). Overall and cancer-specific survival was analysed. Method Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5-year follow-up were analysed with multivariate methods. Results After validation, 114 patients with AL and 136 control patients with locally radical surgery for tumours in tumour-node-metastasis stages I-III were analysed. There was no difference detected between patients with AL and control patients regarding rates of LR [8% (9 of 114) vs 9% (12 of 136); P = 0.97], distant metastasis [18% (20 of 114) vs 23% (31 of 136); P = 0.37] and OAR [19% (22 of 114) vs 28% (38 of 136); P = 0.15]. The 5-year cancer-specific survival was almost 80% in both groups. In multivariate analysis, AL was not a risk factor of LR, distant metastasis or OAR and had no impact on 5-year overall or 5-year cancer-specific survival. Irrespective of the occurrence of AL, preoperative radiotherapy (P = 0.055) and rectal washout (P = 0.046) reduced the LR rate, but did not influence survival. Conclusion Anastomotic leakage was not proved to be a risk factor of worse oncological outcome. Hence, additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after AR might not be justified.
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| 2. |
- Jörgren, Fredrik, et al.
(författare)
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Risk factors of rectal cancer local recurrence : population-based survey and validation of the Swedish rectal cancer registry
- 2010
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Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 12:10, s. 977-986
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Despite advances in rectal cancer treatment, local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method: Local recurrence and survival rates of 4153 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results: The 5-year overall and cancer-specific survival rates were 45% and 62% respectively. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm and 6% at 11-15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0-5 cm: OR 0.50 (0.30-0.83), 6-10 cm: OR 0.42 (0.25-0.71), and 11-15 cm: OR 0.29 (0.13-0.64)]. Patients without preoperative RT had significantly higher LR risk after rectal perforation [OR 2.50 (1.48-4.24)], and almost significantly decreased LR risk when rectal washout was performed [OR 0.65 (0.43-1.00)]. Preoperative RT prolonged time to LR but did not significantly influence the survival among LR patients. LR was an isolated tumour manifestation in 103 (39%) patients with validated LR. Conclusion: Preoperative RT should be considered for rectal cancer also in the upper third of the rectum. Intraoperative perforation should be avoided, and rectal washout is indicated as valuable. Follow-up for the detection of isolated LR is important. Extended follow up should be considered for patients treated with RT.
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| 3. |
- Liu, Q, et al.
(författare)
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Administration of Lactobacillus plantarum 299v reduces side-effects of external radiation on colon anastomotic healing in an experimental model
- 2001
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 3:4, s. 245-252
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Preoperative radiotherapy of patients with rectal carcinoma is frequently used to reduce the incidence of local recurrence. However, the radiation therapy is associated with several complications, including diarrhea, retarded anastomotic healing and mucosal atrophy. Exogenous administration of lactobacilli has been demonstrated to be effective in stimulating intestinal mucosal growth and reduce mucosal inflammation. The objective of this study was to examine the effects of Lactobacillus plantarum 299v administration on external radiation injury in colon anastomotic healing at different time points. MATERIAL AND METHODS: Sprague-Dawley rats were treated with Lb. plantarum 299v or saline as control and received external radiation of the lower abdomen (10 Gy/day) on day 3 and 7 of the experiment. After 4 days, a colonic resection with anastomosis was performed. Animals were sacrificed on 4th, 7th and 11th day postoperatively. Body weight, white blood cell (WBC) count, mucosal myeloperoxidase (MPO) activity, hydroxyproline, nucleotide, DNA and RNA content, colonic bacterial microflora, bacterial translocation and histology were evaluated. RESULTS: On the 4th postoperative day body weight, WBC and MPO decreased significantly after radiation. On the 7th postoperative day MPO decreased after radiation. In the two irradiated groups it decreased significantly in the Lb. plantarum group compared to the radiated group without treatment. Collagen concentration on the 7th postoperative day was significantly higher in Lb. plantarum group without radiation compared to the group with radiation without Lb. plantarum. On the 11th postoperative day MPO was significantly higher in irradiated rats without treatment compared to Lb. plantarum treatment. The collagen concentration increased significantly in the irradiated Lb. plantarum group compared to the other two groups. CONCLUSION: The collagen content decreased and MPO activity increased significantly of the colonic anastomosis in irradiated rats without treatment compared to those treated with Lb. plantarum. It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic anastomotic healing.
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| 4. |
- Starck-Söndergaard, Marianne, et al.
(författare)
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Rectal endosonography can distinguish benign rectal lesions from invasive early rectal cancers.
- 2003
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 5:3, s. 50-246
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine whether an experienced ultrasound examiner, using good ultrasound equipment with high multifrequency probes, can discriminate between a high grade or low grade dysplastic adenoma (pT0) and very early invasive rectal cancers (pT1). Subjects and methodsSixty consecutive patients with clinically possibly pT0 or pT1 rectal tumours referred for transanal local excision underwent endorectal ultrasound examination. Lesions where the endorectal ultrasound image showed the mucosal layer to be expanded but the submucosal layer to be intact (uT0) were considered to represent a low grade or high grade dysplasia adenoma (pT0). An irregularity or disruption of the submucosal layer (uT1) was considered to characterize early invasive rectal cancers (pT1). The ultrasound staging was compared with the histological staging made on the basis of the diagnoses in the excised specimens. ResultsThe histopathological diagnoses were: invasive rectal cancer (n = 18, 10 pT1, 4 pT2, 4 pT3 cancers); high grade dysplastic adenoma (n = 21); low grade dysplastic adenoma (n = 18); non adenomatous benign lesions (n = 3). Endorectal ultrasound incorrectly classified two of the invasive cancers (both pT1 tumours) as noninvasive lesions. Five of 42 pT0 tumours were overstaged as uT1 tumours. Overstaging was more common in patients who had undergone a previous excision and in tumours with peritumoral inflammation and desmoplastic reaction. The sensitivity of endorectal ultrasound with regard to invasive cancer was 89% (16/18), specificity 88% (37/42), positive predictive value 76% (16/21), negative predictive value 95% (37/39), and accuracy 88% (53/60). Among pT0 and pT1 tumours, the corresponding figures were 80% (8/10), 88% (37/42), 62% (8/13), 95% (37/39), and 87% (45/52). ConclusionEndorectal ultrasound can distinguish between noninvasive lesions and invasive rectal cancers clinically of stage pT0 or pT1.
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| 5. |
- Amin, AI, et al.
(författare)
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A 5-cm colonic J pouch colo-anal reconstruction following anterior resection for low rectal cancer results in acceptable evacuation and continence in the long term
- 2003
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 5:1, s. 33-37
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Tidskriftsartikel (refereegranskat)abstract
- Background. Optimal treatment for low rectal cancer is total mesorectal excision, with most patients suitable for low colo-rectal or colo-anal anastomosis. A colon pouch has early functional benefits, although long-term function, especially evacuation, might mitigate against its routine use. The aim of this study was to assess evacuation and continence in patients with a colon pouch, and to examine the impact of possible risk factors. Methods. In 1998, all 102 surviving patients with a colon pouch, whose stoma had been closed for more than one year, were sent a postal questionnaire. A composite incontinence score was calculated from questions on urgency, use of a pad, incontinence of gas, liquid or faeces, and a composite evacuation score from questions on medication taken to evacuate, straining, the need and number of times returned to evacuate. Results. The response rate was 90% (50 M, 42 F), with a median age of 68 years (IQR 60-78) and median follow-up of 2.6 years (IQR 1.7-3.9). The anastomosis was 3 cm or less from the anus in 45/92 (49%), and incontinence scores were worse in this group (P = 0.001). There were significantly higher incontinence scores in females (P = 0.014). Age, preoperative radiotherapy, part of colon used for anastomosis, post-operative leak and length of follow-up had no demonstrable effect on either score. Conclusion. Gender and anastomotic height were the only variables which influenced incontinence. Ninety percent of patients reported that their bowel function did not affect their overall wellbeing, and none would have preferred to have a stoma.
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| 6. |
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| 7. |
- Andersson, Peter, 1957-, et al.
(författare)
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Health related quality of life in Crohn's proctocolitis does not differ from a general population when in remission
- 2003
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 5:1, s. 56-62
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Tidskriftsartikel (refereegranskat)abstract
- Objective All treatment in Crohn's disease, although palliative, aims at restoring full health. The objective of this study was to compare health-related quality of life and psychosocial conditions in patients with Crohn's proctocolitis with a general population.Patients and methods One hundred and twenty-seven patients with Crohn's proctocolitis (median age 44 years, 44.1% men) were compared with 266 controls (median age 45 years, 50.7% men). A questionnaire consisting of the Short Form-36 (SF-36), the Psychological General Well-Being Index (PGWB) and a visual analogue scale (VAS) evaluating general health as well as questions regarding psychosocial conditions was used. Disease activity was evaluated by Best's modification of the classical Crohn's Disease Activity Index.Results Patients in remission had a health related quality of life similar to controls according to the SF-36 apart from general health where scores were lower (P < 0.01). Patients with active disease scored lower in all aspects of the SF-36 (P < 0.001 or P < 0.0001) as well as the PGWB (P < 0.0001). In a model for multiple regression including age, gender, concomitant small bowel disease, permanent stoma, previous colonic surgery, disease activity, duration, and aggressiveness, disease activity was the only variable negatively predicting all 8 domains of the SF-36 in the patient group (P < 0.001). The mean annual sick-leave for patients and controls were 33.9 and 9.5 days (P < 0.0001), respectively. Sixty-eight percent of the patients and 78.4% of the controls (P = 0.04) were married or cohabited, 67.7% and 78.0% (P = 0.04), respectively, had children.Conclusion The health related quality of life for patients with Crohn's proctocolitis in remission does not differ from the general population. The disease has, however, a negative impact on parenthood, family life and professional performance.
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| 8. |
- Asplund, Dan, et al.
(författare)
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Outcome of extralevator abdominoperineal excision compared with standard surgery. Results from a single centre.
- 2012
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Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1463-1318. ; 14:10, s. 1191-6
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Extralevator abdominoperineal excision (APE) for low rectal tumours has been introduced to achieve improved local radicality. Fewer positive margins and intraoperative perforations have been reported compared with standard APE. The aim of this retrospective study was to compare short-term complications and results of the two techniques in our institution. Method: Consecutive patients with rectal cancer undergoing abdominoperineal excision between 2004 and 2009 were included. They were divided into two group of 79 patients in extralevator and standard APE. Patients with recurrence and those having a palliative procedure were excluded. Data were collected from hospital records and the colorectal cancer registry. Main endpointgs were wound infection, perineal wound revision, oncologic data and length of hospital stay. Results: CRM positivity did not differ significantly between groups (17%extralevator; 20% standard APE). Intraoperative perforation (13 vs. 10%) or local recurrence (7 in each group) were no different. Perineal wound infection was more common after extralevator APE (46 vs. 28%,p<0.05) as was perineal wound revision (22 vs.8% p<0.05). Hospital stay was longer after extralevator APE (median 12 vs. 11 days,p<0.05). Tumour height (median 4 cm) and pTNM-classification did not differ. Conclusion: The results do not show any advantage for extralevator APE. The oncologic data were no better and postoperative morbidity was increased. Further studies are needed before extralevator APE is widely adopted in clinical practice.
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| 9. |
- Bengtsson, Jonas, 1961, et al.
(författare)
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Can a failed ileal pouch anal anastomosis be left in situ?
- 2007
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Ingår i: Colorectal disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 9:6, s. 503-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Failure after ileal pouch-anal anastomosis (IPAA) is reported with a frequency of 10-20%. The failed IPAA can be excised or defunctioned. Indications for excision and further management of an indefinitely diverted pouch are poorly described. The aim of the present investigation was to investigate pouch-related problems and the histopathological pattern of the pouch mucosa in this group of patients. METHOD: In a cohort of 620 patients having IPAA with a median follow-up of 14 years, 56 patients with failure were identified. The patients with defunctioned pouches were assessed with regard to pouch-related problems and endoscopy with biopsies was performed. Biopsies were stained with haematoxylin-eosin, PAS for neutral mucins and Alcian blue/high iron diamine for sialomucins/sulphomucins. Morphological changes were grouped into three types modified according to Veress and assessed for dysplasia. RESULTS: Twenty-two patients with an indefinitely diverted pouch were found. The follow-up time after surgery for failure was 10 years. Thirteen patients completed the follow-up. Except for two patients with pelvic/perineal pain, there were no clinical problems. The majority of patients displayed mild to moderate macroscopic signs of inflammation. Morphologically, findings ranged from a preserved mucosal pattern to intense inflammatory reaction. No case of dysplasia or carcinoma was found. CONCLUSION: Most patients with an indefinitely diverted pouch had no complaints regarding the pouch. There was no case of dysplasia. Indefinite diversion may be preferable to pouch excision, especially given the associated morbidity.
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| 10. |
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| 11. |
- Brännström, Fredrik, et al.
(författare)
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Surgeon and hospital-related risk factors in colorectal cancer surgery
- 2011
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Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 13:12, s. 1370-1376
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to identify surgeon and hospital-related factors in a well-defined population-based cohort; the results of this study could possibly be used to improve outcome in colorectal cancer.METHOD: Data from the colonic (1997-2006) and rectal (1995-2006) cancer registers of the Uppsala/Örebro Regional Oncology Centre were used to assess 1697 patients with rectal and 2692 with colonic cancer. Putative risk factors and their impact on long-term survival were evaluated using the Cox proportional hazard model.RESULTS: The degree of specialization of the operating surgeon had no significant effect on long-term survival. When comparing the surgeons with the highest degree of specialization, noncolorectal surgeons demonstrated a slightly lower long-term survival for rectal cancer stage I and II (HR, 2.03; 95% CI, 1.05-3.92). Surgeons with a high case-load were not associated with better survival in any analysis model. Regional hospitals had a lower survival rate for rectal cancer stage III surgery (HR, 1.47; 95% CI, 1.08-2.00).CONCLUSION: Degree of specialization, surgeon case-load and hospital category could not be identified as important factors when determining outcome in colorectal cancer surgery in this study.
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| 12. |
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| 13. |
- Collin, Åsa, et al.
(författare)
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The effect of local gentamicin-collagen on perineal wound complications and cancer recurrence after abdominoperineal resection : a multicentre randomised controlled trial
- 2013
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 15:3, s. 341-346
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Perineal wound sepsis is a common problem after abdominoperineal resection of the rectum (APR), with an reported incidence of 10-15% in previously non-radiated patients, 20-30% in patients given preoperative radiation, and 50% among patients submitted to preoperative radiation combined with chemotherapy. The local application of gentamicin-collagen was evaluated to determine whether its use in the perineal wound reduced the risk complications and had an effect on cancer recurrence.Method: In this prospective multicentre (7 hospitals) randomised controlled trial, 102 patients undergoing APR due to cancer or benign disease were randomised into two groups including surgery with gentamicin-collagen (GS+ n=52), or surgery without gentamicin-collagen (GS- n=50), Patients were followed at 7, 30 and 90 days and at one and five years.Results: There were no statistically significant differences between the two groups regarding perineal wound complications, infectious or non-infectious or cancer recurrence.Conclusion: There was no statistically significant effect on perineal wound complications or cancer recurrence following the local administration of gentamicin-collagen during APR.
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| 14. |
- Corman, ML, et al.
(författare)
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Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation
- 2006
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 8:2, s. 98-101
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Tidskriftsartikel (refereegranskat)abstract
- An international working party was convened in Rome, Italy on 16–17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.
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| 15. |
- Floodeen, Hannah, 1981-, et al.
(författare)
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Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?
- 2013
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Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 15:3, s. 334-340
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of the study was to compare patients with symptomatic anastomotic leakage following low anterior resection of the rectum (LAR) for cancer diagnosed during the initial hospital stay with those in whom leakage was diagnosed after hospital discharge. Method Forty-five patients undergoing LAR (n=234) entered into a randomized multicentre trial (NCT 00636948), who developed symptomatic anastomotic leakage, were identified. A comparison was made between patients diagnosed during the initial hospital stay on median postoperative day 8 (early leakage, EL; n=27) and patients diagnosed after hospital discharge at median postoperative day 22 (late leakage, LL; n=18). Patient characteristics, operative details, postoperative course and anatomical localization of the leakage were analysed. Results Leakage from the circular stapler line of an end-to-end anastomosis was more common in EL, while leakage from the stapler line of the efferent limb of the J-pouch or side-to-end anastomosis tended to be more frequent in LL (P=0.057). Intra-operative blood loss (P=0.006) and operation time (P=0.071) were increased in EL compared with LL. On postoperative day 5, EL performed worse than LL with regard to temperature (P=0.021), oral intake (P=0.006) and recovery of bowel activity (P=0.054). Anastomotic leakage was diagnosed most often by a rectal contrast study in EL and by CT scan in LL. The median initial hospital stay was 28days for EL and 10days for LL (Pandlt;0.001). Conclusion The present study has demonstrated that symptomatic anastomotic leakage can present before and after hospital discharge and raises the question of whether early and late leakage after LAR may be different entities.
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| 16. |
- Folkesson, J, et al.
(författare)
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The circular stapling device as a risk factor for anastomotic leakage.
- 2004
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 6:4, s. 275-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate the relation between the type of circular stapler and anastomotic leak in rectal cancer surgery.BACKGROUND: During the past decades results from rectal cancer surgery have improved considerably regarding risk of local recurrence and survival. Two main paradigm changes are considered to be the cause for this: the introduction of total mesorectal excision (TME) and the increasing use of radiotherapy. However, rectal cancer surgery is associated with an unacceptably high frequency of complications of which anastomotic leak is one of the most severe ones. The hypothesis was raised that the choice of stapler influenced the leakage rates.METHODS: A questionnaire was sent to all departments of surgery (n = 66) performing rectal cancer surgery in Sweden to determine the choice of circular stapler when performing anterior resection for rectal cancer. These data were linked to the Swedish Rectal Cancer Registry for the period 1995-99.RESULTS: A total of 3316 patients had an anterior resection. The choice of circular stapling device was determined in 70% of the cases. When stapler A was used, the leakage rate was 11% whereas it was 7% when stapler B was used (P = 0.0039). In the cases where it was impossible to determine which stapler had been used the leakage rate was 8%.CONCLUSION: Quality control is an important part of medicine and the present study suggests that it also must include surgical instruments. A prospective randomised study is needed to confirm the results.
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| 17. |
- Gerjy, Roger, et al.
(författare)
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Excision of residual skin tags during stapled anopexy does not increase postoperative pain
- 2007
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 9:8, s. 754-757
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We studied whether excision of residual external skin tags causes additional pain in patients undergoing a stapled anopexy for muco-anal prolapse. Method: Seventeen patients in whom skin tags had been excised were compared with 24 patients having no excision. The patients were selected from a prospective database of haemorrhoid surgery if they had submitted a diary with self-reported postoperative pain scores as well as a self-reported symptom questionnaire preoperatively and postoperatively. The tags were excised with preservation of the subdermal fascia. Results: There were 41 patients who fulfilled the criteria for inclusion. Seventeen (group 1) had tags excised and 24 (group 2) did not. Fifty-nine per cent in group 1 and 67% in group 2 experienced preoperative prolapse needing manual reposition. The mean height of the staple line was 2 cm above the dentate line in both groups. Daily average postoperative pain recorded as the sum of a self-reported VAS rating over 14 days was 26 points in both groups. The peak pain experienced was 42 and 43 points respectively (not significant). Resolution of postoperative pain over 14 days was identical. The preoperative and postoperative symptom score was comparable in both groups. Conclusion: Excision of anal skin tags should be carried out at the time of stapled anopexy.
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| 18. |
- Gerjy, Roger, et al.
(författare)
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Long-term results of stapled haemorrhoidopexy in a prospective single centre study of 153 patients with 1-6 years follow-up
- 2012
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Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 14:4, s. 490-496
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Tidskriftsartikel (refereegranskat)abstract
- Aim The long-term results of stapled haemorrhoidopexy for prolapsed haemorrhoids were assessed using uniform methods to acquire data and pre-set definitions of failure, recurrence, residual symptoms and impaired continence. less thanbrgreater than less thanbrgreater thanMethod From October 1999 to May 2005, 153 patients underwent a stapled haemorrhoidopexy and were enrolled prospectively. They were assessed preoperatively, postoperatively and at the end of the study from replies to a questionnaire about symptoms and continence. Preoperatively, manual reduction of prolapse was required in 103 patients, skin tags were found in 115 patients (circumferential in 22) and impaired continence in 63. less thanbrgreater than less thanbrgreater thanResults In all, 145 patients completed preoperative and long-term protocols and were analysed as paired data, at a mean follow-up of 32 months. Failure to control the prolapse or recurrence was seen in 19 (13%) patients including nine reoperations for prolapse. Symptoms improved from 8.1 to 2.5 points on a 15-point scale (P = 0.001). Symptoms were not controlled in 25 (17%) patients. Continence improved from 4.7 to 2.9 points on a 15-point scale (P = 0.001). Twenty-five (17%) patients still had a continence disturbance. Altogether 51 (35%) patients had a deficient outcome with respect to prolapse, symptoms or continence. There were no major adverse events. less thanbrgreater than less thanbrgreater thanConclusion Restoration of the anal anatomy by stapled haemorrhoidopexy resulted in a significant improvement in haemorrhoid-associated symptoms and continence but a third of patients had poor symptom control including 13% with persisting prolapse.
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| 19. |
- Gerjy, Roger, et al.
(författare)
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Prolapse grade and symptoms of haemorrhoids are poorly correlated : result of a classification algorithm in 270 patients
- 2008
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Ingår i: Colorectal disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 10:7, s. 694-700
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Haemorrhoid prolapse is an indication for surgery. A correlation between worsening anatomy and increasing symptoms is commonly assumed. We developed a classification algorithm of prolapse and external component, and evaluated its correlation to symptoms before and after surgery. Method: A study population comprising 180 patients operated for haemorrhoids in a multicentre randomized trial plus a validation set comprising 90 patients operated by us. The classification used three items: (i) patient self-report of prolapse requiring manual reposition; (ii) surgeon assessment of prolapse when patient negated manual reposition; (iii) surgeon assessment of external component. Patient self-reported were rated by frequency (never, 0 points; monthly, 1 point; weekly, 2 points and daily, 3 points). The algorithm yielded three grades: 1, no prolapse; 2, spontaneously reducing prolapse and 3, prolapse needing manual repositioning. The degree of external component was affixed as A, none; B, one or few tags and C, circumferential. Results: Anatomical grades did not differ between the two sets of patients before or after surgery. Preoperatively, 69% had grade 3 prolapse. Postoperatively, 89% were classified as grades 1A or B. The symptom load was similar for grades 2 and 3; mean 6.5 points preoperatively and 1.8 points postoperatively. Conclusion: This anatomical classification, based on strict criteria, reliably staged the haemorrhoid prolapse. There was no unique preoperative symptom profile associated with any degree of prolapse with or without an external component. Restored anal anatomy relieved symptoms. The classification also defined recurrence of haemorrhoids.
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| 20. |
- Gillberg, A., et al.
(författare)
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A population-based audit of the clinical use of faecal occult blood testing in primary care for colorectal cancer
- 2012
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 14:9, s. e539-e546
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Tidskriftsartikel (refereegranskat)abstract
- Aim Symptoms related to colorectal cancer (CRC) are common. We investigated the value of the faecal occult blood test (FOBT), when administered in primary care, in the diagnosis of CRC. Method All patients who underwent a FOBT (Hemoccult II) at 20 public primary care centres in Sormland County, Sweden, during 2000-2005, were included (n = 9048). Linkage to the Swedish Cancer Registry identified all cases of CRC. Symptoms recorded at the time of the FOBT were retrieved from the patient records. The outcome from the FOBT to diagnosis and subsequent survival was compared between patients who were FOBT negative and patients who were FOBT positive. Results One-hundred and sixty-one patients were diagnosed with CRC within 2 years after undergoing a FOBT in primary care. These comprised 18% of all 917 patients diagnosed with CRC in the county during the study period. In 41 (25.4%) of the 161 patients the test was negative. Symptoms related to CRC were documented for 158 (98%) patients at the time the FOBT was administered. The median investigation time from the FOBT test to the diagnosis of CRC was 91 days: 80 days for FOBT-positive patients and 188 days for FOBT-negative patients (P < 0.001). This difference was signficant independent of age, sex and site of tumour. The hazard ratio for FOBT negativity, 3 years after the FOBT, when adjusted for age and sex, was 1.47 (95% CI, 0.812.68). Conclusion Despite having suggestive symptoms, 41 (4.5%) of 917 CRC patients had a negative FOBT result in primary care. This was associated with diagnostic delay and, potentially, a worse outcome.
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| 21. |
- Grevfors, Niklas, et al.
(författare)
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Can acute abdominal CT prioritise patients with suspected diverticulitis for a subsequent clean colonic examination?
- 2012
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 14:7, s. 893-896
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to investigate whether patients with diverticulitis can be prioritised with higher urgency for a subsequent full colonic examination based upon the emergency abdominal computerised tomography (CT) at the time of presentation.Method: All patients with a diagnosis of diverticulitis hospitalized during 2006 having CT on admission and a subsequent 'clean colon' examination were reviewed. The CT was reviewed by two independent and blinded senior radiologists (A and B) for signs inconsistent with diverticulitis and suggestive of malignancy. The patients were classified on CT into group 1 (normal findings, non-tumour pathology or benign polyps < 1 cm) and group 2 (benign polyps ≥ 1 cm and cancer).Results: 93 patients were reviewed with 83 in group 1and 10 in group 2. Radiologist A suggested high priority colonic examination in 18% and 50% of groups 1 and 2, and Radiologist B in 63% and 90%. There was a statically significant inter-observer difference and also lower accuracy of Radiologist B than Radiologist A in predicting a subsequent 'clean colon' examination.Conclusion: Using an emergency acute CT scan at the time of diagnosis of diverticulitis to predict a clean colon examination for neoplasia is not reliable since there is considerable degree of inter-observer difference between rediologista.
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| 22. |
- Gunnarsson, H., et al.
(författare)
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Emergency presentation of colon cancer is most frequent during summer
- 2011
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 13:6, s. 663-668
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The frequency of emergency colon cancer (ECC) was determined using a reproducible definition of 'emergency' to analyse the impact of mode of presentation on long-term prognosis and to search for risk factors for an emergency presentation. Method: All patients with colon cancer treated at one Swedish GDH between 1996 and 2005 (N = 604) were eligible. Patients admitted through the emergency room, operated on within three days and with an emergency condition confirmed at surgery were classified as ECC. Survival was analysed by Kaplan-Meier estimates and risk of death by Cox regression. Results: The rate of ECC was 97/585 (17%). Patients with ECC were older (median 77 vs 74, P = 0.02), they had more stage III and IV cancers (65% vs 47%; chi 2 = 9.4, P < 0.001) and had a cancer located in the caecum less often (20% vs 33%, chi 2 = 4.3 P = 0.04). ECC were most frequent between June and August (36%), whereas elective cases were evenly distributed throughout the year (chi 2 = 7.8; P = 0.049), Crude 5-year survival was 18% in ECC and 38% in the elective group (P < 0.001). The hazard ratio for death within five years in ECC, with 30-day mortality excluded and adjusted for age and sex was 2.25 (95% CI; 1.42-3.55). Conclusion: Emergency presentation of colon cancer is an independent and adverse risk factor for long-term survival. The causes of a seasonal variation need to be clarified.
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| 23. |
- Gustafsson, U M, et al.
(författare)
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Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula : a comparative study
- 2001
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 3:3, s. 189-197
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare endoanal ultrasound (EUS) with a 10-MHz probe vs. bodycoil magnetic resonance imaging (MRI) in the preoperative evaluation of anal fistula. SUBJECTS AND METHODS: 23 patients with fistula in the anal region underwent preoperative 0.5 T bodycoil MRI and 10 MHz EUS which included probing in 6 patients. The results of the EUS and MRI were compared against the surgical findings as a reference method. RESULTS: In classification of the primary tract there was agreement between EUS and surgical findings in 14 (61%) and between MRI and surgery in 11 (48%). Concerning the presence of an internal opening the corresponding figures were 17 (74%) and 10 (43%) and in judging the presence of an extension or an abscess 15 (65%) vs. 11 (48%), respectively. In three out of eight patients with nonhealing or recurrence after surgery preoperative imaging had shown an extension and/or an abscess that was not identified by the surgeon. CONCLUSION: EUS, sometimes complemented with probing, is well comparable to bodycoil MRI in classifying and describing the topography of an anal fistula.
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| 24. |
- Hallböök, Olof, 1954-, et al.
(författare)
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Safety of the temporary loop ileostomy
- 2002
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 4:5, s. 361-364
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the complications of the temporary loop ileostomy. Method. A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch-anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow-up period of 15 months. Results. Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re-operation was done due to small bowel obstruction (n = 5) or intra-abdominal abscess (n = 2). Elective re-operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra-abdominal sepsis and heart failure. Conclusion. In this series closure of the ostomy was associated with one death (0.5%) and overall ostomy-related morbidity included the need to re-operate in 6%.
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| 25. |
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| 26. |
- Ho, Kok Sun, et al.
(författare)
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Ileal pouch anal anastomosis for ulcerative colitis is feasible for septuagenarians.
- 2006
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Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1462-8910. ; 8:3, s. 235-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Proctocolectomy and ileal pouch anal anastomosis (IPAA) has become the standard surgery for patients with mucosal ulcerative colitis (MUC). Although there is no absolute age limitation, there are concerns as to its use in elderly patients due to the risks of potential complications and poor function. The aim of this study was to assess the complications and outcome of patients over the age of 70 years with MUC who underwent IPAA. Results in these patients were compared to the results in a group of patients aged less than 70 years who had IPAA. METHODS: After Institutional Review Board approval, a retrospective review of the medical records of patients with MUC who underwent IPAA was undertaken. These patients were divided into four age groups: <30 years of age, 30-49 years, 50-69 years, >or=70 years. RESULTS: From 1989 to 2001, 330 patients underwent IPAA for preoperative clinical and histopathological and postoperative histopathologically confirmed MUC; 17 were aged>or=70 years. The mean hospital stay was 5.8 (SEM 0.7) days in the patients aged<70 years and 6.0 (SEM 0.4) days in the patients aged>or=70 years (P=0.911). Postoperative complications occurred in 39% of patients>or=70 years and in 40% in the <70 years group (P=0.08). Pouch failure occurred in two (11.8%) patients>or=70 years and in 6 (1.9%)<70 (P=0.2). CONCLUSION: IPAA is a safe and feasible option in MUC patients over the age of 70 with functional results similar to results seen in younger patients.
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| 27. |
- Jestin, Pia, et al.
(författare)
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Risk factors for anastomotic leakage after rectal cancer surgery : a case-control study
- 2008
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 10:7, s. 715-21
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: With introduction of the total mesorectal excision technique and preoperative radiotherapy in rectal cancer surgery, the local recurrence rate has decreased and the overall survival has improved. One drawback, however, is the high anastomotic leakage rate of approximately 10-18%. Male gender and low anastomoses are known risk factors for such leakage. The aim of this study was to identify potentially modifiable risk factors. METHOD: In a case-control study, data from the Swedish Rectal Cancer Registry (1995-2000) were analysed. Cases were all patients with anastomotic leakage after an anterior resection (n = 134). Two controls were randomly selected for each case. The medical records (n = 402) were checked against a study protocol. Due to incorrect recording two cases and 28 controls were excluded from further analyses. RESULTS: In the multivariate analysis significant risk factors were American Society of Anesthesiologists score > 2 [OR = 1.40 (95% CI 1.05-1.83)], preoperative radiotherapy [OR = 1.34 (95% CI 1.06-1.69)], intraoperative adverse events [OR = 1.85 (95% CI 1.32-2.58)], level of anastomosis
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| 28. |
- Karlbom, Urban, et al.
(författare)
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Long-term functional outcome after restorative proctocolectomy in patients with ulcerative colitis
- 2012
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 14:8, s. 977-984
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to evaluate long-term functional outcome of ileal pouch-anal anastomosis for ulcerative colitis and to compare symptoms over time.Methods: 188 patients were operated with an ileal pouch-anal anastomosis. Short-term functional outcome has previously been evaluated with a symptom questionnaire. The same questionnaire was sent to the 162 patients who were alive and had an intact pouch. A symptom index was studied over time and in relation to early complications and pouchitis.Results: The response rate of the questionnaire was 139/162 at a median of 12.5 (9.5-21) years postoperatively. Overall, the symptom index remained unchanged over time but both the frequency of night-time defecation and episodes of night time incontinence increased. Patients' global assessment was unchanged with approximately 80 per cent stating an excellent or a good result. Frequency of pouchitis doubled in ten years. Symptom index for patients with episodic pouchitis (median 40 (8-89), p=0.018) and recurrent/chronic pouchitis (71 (8-136), p<0.001) was higher than in patients without pouchitis (29 (0-105). Early complications did not affect the symptom index.Conclusion: The overall functional outcome of ileal pouch-anal surgery for ulcerative colitis is stable over time. Patients' satisfaction with outcome remains high. Pouchitis is a determinant of functional outcome.
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| 29. |
- Khani, M. Hosseinali, et al.
(författare)
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Centralization of rectal cancer surgery improves long-term survival
- 2010
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 12:9, s. 874-879
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Tidskriftsartikel (refereegranskat)abstract
- Aim In 1996, rectal cancer surgery in the Swedish county of Vastmanland was centralized to a single colorectal unit. At the same time, total mesorectal excision and multidisciplinary team meetings were introduced. The aim of this audit was to determine the long-term results before and after centralization. Method All consecutive rectal cancer patients who underwent curative or palliative surgery at one of the county's four hospitals between 1993 and 1996 (n = 133, group 1) were compared with patients operated at the new centralized colorectal unit between 1996 and 1999 (n = 144, group 2). Results Preoperative radiotherapy was common in both groups, but in group 2, it was planned using MRI. Local recurrences were detected in 8% of all patients operated in group 1 vs 3.5% in group 2 (P = 0.043). The overall 5-year survival for all patients in group 1 was 38 vs 62% in group 2 (P = 0.003). According to multivariate analysis, the new colorectal unit was an independent predictor for improved long-term survival. Conclusion This population-based audit shows reduced local recurrence rate and prolonged overall survival for rectal cancer patients after centralization to a single colorectal unit with multidisciplinary management and increased subspecialization.
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| 30. |
- Khani, M. Hosseinali, et al.
(författare)
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Is the circumferential resection margin a predictor of local recurrence after preoperative radiotherapy and optimal surgery for rectal carcinoma?
- 2007
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 9:8, s. 706-712
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Circumferential resection margin (CRM) involvement has been correlated with a high risk of developing local recurrence. The aim of this study was to examine the prognostic significance of the CRM involvement after curative resection of rectal cancer in patients treated with preoperative radiotherapy and postoperative chemotherapy where indicated. METHOD: All patients with rectal cancer treated in a regional central unit from 1996 to 2004 were identified. A surgical resection was performed on 257 patients, and in 229 of these this was assessed as potentially curative. The CRM was examined in all patients. A CRM of < or = 1 mm was considered positive. RESULTS: A positive margin was seen in 19 (8%) patients. At a median follow up of 40 months, only four (1.7%) patients had developed local recurrence, one of whom had a positive CRM. In the four patients the tumour was 5 cm or less from the anal verge. There were no significant differences regarding local recurrence and survival between CRM positive and negative tumours. CONCLUSION: Rectal cancer managed by combined radiochemotherapy and surgery resulted in a low positive CRM rate and a low local recurrence rate. An involved CRM was not a predictor of local recurrence.
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| 31. |
- Kodeda, Karl, et al.
(författare)
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Local recurrence of rectal cancer: a population based cohort study of diagnosis, treatment and outcome.
- 2012
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Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1463-1318. ; 14:5, s. 230-7
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Local recurrence is an important endpoint of rectal cancer treatment, but details of this form of treatment failure are less well described. The aim of this study was to acquire deeper knowledge of local recurrence regarding symptoms, diagnostic work-up, clinical management, health-care utilization and outcome. Method: Of 671 patients with rectal cancer, 57 were diagnosed with local recurrence within 5 years after surgery. Their records were analysed. Results: At diagnosis of local recurrence 49(86%) of 57 patients were symptomatic and 40 (70%) were diagnosed between scheduled follow-up visits. The predominant symptom was pain. Forty five of the 57 (79%) had a palpable tumour. Most were deemed incurable at presentation and less than 10 (18%) were operated on with curative intent. Five years after the initial rectal cancer surgery, two patients were alive, with one free of disease. Despite the need for multiple interventions, including surgery, only 4 out of 40 patients were classified as being well palliated in the terminal stage. Conclusion: Follow-up after rectal cancer surgery by annual clinical examination is not sufficient to detect local recurrence when it is asymptomatic. Local recurrence of rectal cancer is often associated with intractable symptoms. These patients require frequent interventions and can rarely be cured if diagnosed at an advanced stage. Strategies for early detection of local recurrence and the management thereof require improvement.
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| 32. |
- Kodeda, Karl, et al.
(författare)
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Regional Differences in Local Recurrence Rates after Rectal Cancer Surgery.
- 2009
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Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1463-1318.
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Aim To analyse a substantial regional difference in local failure rate after rectal cancer surgery focusing on management. Methods National, population-based, prospective registry data were used, including comprehensive five year follow-up of 3,783 patients operated on in the period 1998-2000. Local recurrence rates were compared using crude rate, Kaplan-Meier estimates and competing risk methodology. Resected patients (651 regional and 3,132 national) were analysed and subgroup comparisons of management were performed. Results The crude local recurrence rate was 13.7 percent in the regional cohort and 7.1 percent in the national cohort. The absolute difference of 6.6 percent may partly be explained by systematic errors of underreporting (
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| 33. |
- Laurell, Helena, et al.
(författare)
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Acute diverticulitis : clinical presentation and differential diagnostics
- 2007
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 9:6, s. 496-501
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the clinical presentation of acute diverticulitis in an emergency department and to characterize the natural history of diverticulitis in the short perspective. Comparisons are made with an important differential diagnosis, nonspecific abdominal pain (NSAP). METHOD: Patients admitted to our hospital with abdominal pain of up to 7 days' duration were registered prospectively using a detailed schedule for history, symptoms and signs, from 1 February 1997 to 1 June 2000. Of 3349 patients initially included, 3073 (92%) were eligible for follow up after 1-3 years. RESULTS: Acute diverticulitis was the final diagnosis in 145 patients and NSAP in 1142 patients. The incidence of hospitalized patients with diverticulitis was 47 per year and 100 000 population, with a mean hospital stay of 3.3 days. Patients with diverticulitis, more frequently than NSAP, had a longer history and laboratory signs of inflammatory activity. Isolated left abdominal tenderness was more common in diverticulitis, whereas isolated right abdominal tenderness was more common in NSAP. Duration of symptoms on arrival was independent of age and was not correlated to C-reactive protein, leucocytes or body temperature. Sensitivity of diverticulitis as primary diagnosis was 64% and specificity 97%. Corresponding figures for NSAP were 43% and 90% respectively. Age and gender did not influence diagnostic accuracy or risk of surgery. CONCLUSION: Diverticulitis differs significantly from NSAP in clinical presentation and laboratory parameters. Sensitivity of primary diagnosis for diverticulitis and NSAP was low.
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| 34. |
- Liljegren, G, et al.
(författare)
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Acute colonic diverticulitis : a systematic review of diagnostic accuracy
- 2007
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Ingår i: Colorectal Disease. - Oxford : Wiley. - 1462-8910 .- 1463-1318. ; 9:6, s. 480-488
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Forskningsöversikt (refereegranskat)abstract
- Objective To appraise the literature on the diagnosis of acute colonic diverticulitis by ultrasound (US), computed tomography (CT), barium enema (BE) and magnetic resonance imaging (MRI).Method The databases of Pub Med, the Cochrane Library and EMBASE were searched for articles on the diagnosis of diverticulitis published up to November 2005. Studies where US, CT, BE, or MRI were compared with a reference standard on consecutive or randomly selected patients were included. Three examiners independently read the articles according to a prespecified protocol. In case of disagreement consensus was sought. The level of evidence of each article was classified according to the criteria of the Centre for Evidence-Based Medicine (CEBM), Oxford, UK.Results Forty-nine articles relevant to the subject were found and read in full. Twenty-nine of these were excluded. Among the remaining 20 articles, only one study, evaluating both US and CT reached level of evidence 1b according to the CEBM criteria. Two US studies and one MRI study reached level 2b. The remaining studies were level 4.Conclusion The best evidence for diagnosis of diverticulitis in the literature is on US. Only one small study of good quality was found for CT and for MRI-colonoscopy.
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| 35. |
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| 36. |
- Lundin, Erik, et al.
(författare)
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Scintigraphic assessment of slow transit constipation with special reference to right- or left-sided colonic delay
- 2004
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 6:6, s. 499-505
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Subtotal colectomy and ileorectal anastomosis for slow transit constipation has several side-effects. The motor abnormality in some patients may be segmental which could motivate a limited resection of the colon. Therefore a diagnostic tool to identify a segmental colonic motor dysfunction is needed. The aim of this study was to evaluate a scintigraphic method to assess colonic transit with special reference to right- or left-sided delay. METHODS: Twenty-three constipated patients (19 women, mean age 50 years) with slow colonic transit on radio-opaque marker studies and 13 healthy individuals (11 women, mean age 46 years) were studied. All subjects were examined with oral (111)Indium-DTPA scintigraphy. The scintigraphic results for patients and controls were presented as geometric centre of radioactivity and percent activity over time in the right, the left and the recto-sigmoid colon. The inter-observer variation in the interpretation of the scans was also evaluated. RESULTS: There was no difference in transit time between the groups of patients and controls in the right colon whereas the patients had a significant delay in the left colon (P < 0.05). Two patients had a marked delay in the right colon followed by relatively rapid transit in the left colon. The inter-observer correlation was good comparing the right, the left and the recto-sigmoid colon (r = 0.58-0.98, P < 0.01-0.001). CONCLUSION: The results indicate that colonic scintigraphy with oral (111)Indium-DTPA may help to select patients for a left or, in a few cases, a right hemicolectomy for slow transit constipation.
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| 37. |
- Lundin, Erik, et al.
(författare)
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Segmental colonic transit studies : Comparison of a radiological and a scintigraphic method
- 2007
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 9:4, s. 344-351
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Colonic transit studies are used to diagnose slow transit constipation (STC) and to evaluate segmental colonic transit before segmental or subtotal colectomy. The aim of the study was to compare a single X-ray radio-opaque marker method with a scintigraphic technique to assess total and segmental colonic transit in patients with STC. Methods: Thirty-one female patients (median age 46 years) with severe constipation and a prolonged or borderline prolonged colonic transit time on radio-opaque marker study were included in the study. They were subsequently investigated with 111 Indium-DTPA colonic transit scintigraphy, with a median time between the investigations of 4(range 1-27) months. Normal values of healthy female controls were used for comparison. Results: There was no difference between the two methods interms of prolonged or normal total colonic transit time. Twenty-nine of 31 female patients had a prolonged transit time only in one or two segments on the marker study. On scintigraphy, the transit time was prolonged for patients in the left (P < 0.05 to P < 0.001), but not in the right colon. With respect to prolonged or normal segmental transit time, there was a significant difference between the two methods only in the descending colon (P = 0.02). However, the results varied considerably for individual patients. Conclusion: Segmental colonic delay was a common finding. The two methods gave similar results for groups of patients, except in the descending colon. The variation of the results for individuals suggests that a repeated transit test may improve the assessment of total and segmental transit.
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| 38. |
- Matthiessen, P, et al.
(författare)
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Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer - occurrence and risk factors
- 2010
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Ingår i: COLORECTAL DISEASE. - : Wiley. - 1462-8910 .- 1463-1318. ; 12:4, s. 351-357
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of the study was to assess recto-vaginal fistula (RVF) after anterior resection of the rectum for cancer with regard to occurrence and risk factors. Method All female patients [median age 69.5 years, Union Internationale centre le Cancer (UICC) cancer stage IV in 10%] who developed a symptomatic RVF (n = 20) after anterior resection of the rectum for cancer from three separate cohorts of patients were identified and compared with those who developed conventional symptomatic leakage (n = 32), and those who did not leak (n = 338). Patient demography and perioperative data were compared between these three groups. Fourteen patient-related and surgery-related variables thought to be possible risk factors for RVF (anastomotic-vaginal fistula) were analysed. Results Symptomatic anastomotic leakage occurred in 52 (13.3%) of 390 patients. Twenty (5.1%) had an anastomotic-vaginal fistula (AVF) and 32 (8.2%) conventional leakage (CL). Patients with AVF required unscheduled re-operation and defunctioning stoma as often as those with CL. AVF was diagnosed later and more often after discharge from hospital compared with CL. Patients with AVF had lower anastomoses and decreased BMI compared with those with CL. Risk factors for AVF in multivariate analysis were anastomosis andlt; 5 cm above the anal verge (P = 0.001), preoperative radiotherapy (P = 0.004), and UICC cancer stage IV (P = 0.005). Previous hysterectomy was a risk factor neither for AVF nor for CL. Conclusion Anastomotic-vaginal fistula forms a significant part of all symptomatic leakages after low anterior resection for cancer in women. Although diagnosed later, the need for abdominal re-operation and defunctioning stoma was not different from patients with CL. Risk factors for AVF included low anastomosis, preoperative radiotherapy and UICC cancer stage IV.
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| 39. |
- Matthiessen, P., et al.
(författare)
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Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection
- 2008
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 10:1, s. 75-80
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This prospective study investigated the factors which might indicate anastomotic leakage after low anterior resection. Method: Thirty-three patients who underwent anterior resection for rectal carcinoma (n = 32) and severe dysplasia (n = 1), were monitored daily by serum C-reactive protein (CRP) and white blood cell count (WBC) estimations until discharge from hospital. Computed tomography (CT) scans were performed on postoperative days 2 and 7 and the amount of presacral fluid collection was assessed. All patients had a pelvic drain and the volume of drainage was measured daily. Results: The level of the anastomosis was at a median 5 cm (3-12 cm) above the anal verge. There was no 30-day mortality. Nine (27.2%) of the 33 patients developed a symptomatic anastomotic leakage which was diagnosed at a median of 8 days (range 4-14) postoperatively. The serum CRP was increased in patients who leaked from postoperative day 2 onwards (P = 0.004 on day 2, P < 0.001 on day 3-8). The WBC was decreased in preoperatively irradiated patients on days 1-5 (P = 0.021), with no difference seen between patients with or without leakage. Patients with leakage had a larger presacral fluid collection on CT on day 7 (median 76 ml vs 52 ml, P = 0.016) and a larger increase in the fluid collection between the first and the second CT examinations (28 ml vs 3 ml, P = 0.046). Conclusion: An early rise in serum CRP was a strong indicator of leakage. Monitoring of CRP for possible early detection of symptomatic anastomotic leakage is recommended.
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| 40. |
- Matthiessen, Peter, 1957-, et al.
(författare)
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Risk factors for anastomotic leakage after anterior resection of the rectum
- 2004
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 6:6, s. 462-469
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Surgical technique and peri-operative management of rectal carcinoma have developed substantially in the last decades. Despite this, morbidity and mortality after anterior resection of the rectum are still important problems. The aim of this study was to identify risk factors for anastomotic leakage in anterior resection and to assess the role of a temporary stoma and the need for urgent re-operations in relation to anastomotic leakage. Patients and methods. In a nine-year period, from 1987 to 1995, a total of 6833 patients underwent elective anterior resection of the rectum in Sweden. A random sample of 432 of these patients was analysed (sample size 6.3%). The associations between death and 10 patient-and surgery-related variables were studied by univariate and multivariate analysis. Data were obtained by review of the hospital files from all patients. Results. The incidence of symptomatic clinically evident anastomotic leakage was 12% (53/432). The 30-day mortality was 2.1% (140/6833). The rate of mortality associated with leakage was 7.5%. A temporary stoma was initially fashioned in 17% (72/432) of the patients, and 15% (11/72) with a temporary stoma had a clinical leakage, compared with 12% (42/360) without a temporary stoma, not significant. Multivariate analysis showed that low anastomosis (≤ 6 cm), pre-operative radiation, presence of intra-opcrative adverse events and male gender were independent risk factors for leakage. The risk for permanent stoma after leakage was 25%. Females with stoma leaked in 3% compared to men with stoma who leaked in 29%. The median hospital stay for patients Arithout leakage was 10 days (range 5-61 days) and for patients with leakage 22 days (3-110 days). Conclusion. In this population based study, 12% of the patients had symptomatic anastomotic leakage after anterior resection of the rectum. Postoperative 30-day mortality was 2.1%. Low anastomosis, pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for symptomatic anastomotic leakage in the multivariate analysis. There was no difference in the use of temporary stoma in patients with or without anastomotic leakage.
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| 41. |
- Matthiessen, Peter, et al.
(författare)
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Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection for cancer.
- 2009
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Ingår i: Colorectal Disease. - Chichester, West Sussex, United Kingdom : Wiley. - 1462-8910 .- 1463-1318.
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate patients with symptomatic anastomotic leakage diagnosed after hospital discharge. Methods: Patients undergoing low anterior resection of the rectum for cancer (n=234) who were included in a prospective multicenter trial (NCT 00636948) and who developed symptomatic anastomotic leakage diagnosed after hospital discharge (late leakage, LL; n=18) were identified. These patients were assessed in regard to patient characteristics, operative details, recovery on postoperative day five, length of hospital stay, and how the leakage was diagnosed. A comparison with those who did not develop symptomatic leakage (no leakage, NL; n=189) was performed. Minimum follow up was 24 months. Results: Median age was 69 years, 61% were females, and 6% had UICC cancer stage IV in LL. On postoperative day 5, LL had a postoperative course similar to NL in regard to morning temperature, per oral intake and bowel activity. The proportion of patients being on antibiotic treatment on postoperative day 5, regardless of indication, was 28% in LL compared with 4% in NL (P<0.001). The initial hospital stay was median 10 days for both LL and NL. If adding readmission for any reason, planned or unplanned, hospital stay was median 21.5 and 13 days in LL and NL, respectively (P<0.001). Conclusion: Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection of the rectum for cancer is not uncommon and has an immediate clinical postoperative course which may appear uneventful.
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| 42. |
- Morren, Geert, et al.
(författare)
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Audit of anal-sphincter repair
- 2001
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 3:1, s. 17-22
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveStructural damage of the anterior part of the anal sphincter is a major cause of faecal incontinence. Sphincter repair is the standard surgical treatment. This study was designed to analyse the results of anal sphincter repair, to identify possible predictors of outcome and to investigate the presence of bowel symptoms other than leakage at follow up.Patients and methodsFifty-five women (median age 39 years, range 24–73 years) who underwent anal sphincter repair between 1986 and 1997 at the University Hospital of Linköping answered a postal questionnaire. Current bowel function, degree of continence and the patients’ functional result as worse, unchanged, some improvement, good or excellent were assessed. Good or excellent function was regarded as a successful result, the rest as failure. Age, duration of symptoms, type of surgery, morbidity and length of follow up were analysed in relation to outcome. Results of pre- and post-operative anal manometry, endoanal ultrasound, anal sphincter electromyography and pudendal nerve function were also analysed.ResultsAfter a median (range) follow-up period of 40 months (5–137) months, 31 (56%) patients rated the result as either excellent (n=10) or good (n=21). Twenty-one (38%) patients rated the result as some improvement (n=14), unchanged (n=6) or worse (n=1). In three (5%) patients a colostomy was fashioned because of failure. Patients >50 years at surgery (n=18) had a worse outcome (P=0.001). Successful outcome was correlated to increased squeeze pressures post-operatively. The presence of post-operative urgency (P=0.01) and loose stools (P=0.02) was more common in patients with poor outcome. Eight patients became continent to formed and liquid stool.
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| 43. |
- Mroczkowski, Paweł, et al.
(författare)
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European quality assurance programme in rectal cancer : are we ready to launch?
- 2012
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 14:8, s. 960-966
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Tidskriftsartikel (refereegranskat)abstract
- Aim: There have been initiatives to create a European audit project. This paper addresses the issue of differences in data collected by different registries.Method: Patients with rectal cancer treated in 2008 and recorded in quality registries from Belgium, Germany/Poland, Spain and Sweden were analysed. The comparison included number of patients, gender, age, ASA-classification, preoperative diagnostic and staging procedures, neoadjuvant therapy, surgical treatment and quality of surgery, postoperative complications, and adjuvant treatment.Results: The Belgian database consisted of 622 patients, Germany/Poland 3,393, Spain 1,641 and Sweden 1,826. The percentage of patients in ASA-stages was highly variable.MRI-use was the highest in Spain and Sweden and very low in Germany/Poland. The percentage of cT4 stage tumours in Sweden was much higher than in all other countries. Sweden recorded the highest percentage of primary metastatic disease (20.3%), Belgium the lowest (10.2%). Neoadjuvant therapy in different protocols was administered to 41.2% patients in Germany/Poland, 50.8% in Spain, 55.2% in Belgium and 62% in Sweden.Laparoscopic surgery (conversion rate) was performed for cure in 5% (28%) of patients in Sweden, in 20.8% (20.6%) in Spain, in 28.6% (15.2%) in Belgium and in 14.5% (8.9%) in Germany/Poland.30 day mortality for anterior resection, abdominoperineal resection and Hartmann's procedure in Sweden, Belgium and Spain 2.0%, 2.3% and 3.1%, respectively. The German-Polish database reported an in-hospital mortality of 3.2%.Conclusion: A European quality assurance project in rectal cancer is possible only after data collection is standardised.
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| 44. |
- Myrelid, Pär, et al.
(författare)
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Split Stoma in Resectional Surgery of High Risk Patients with Ileocolonic Crohn’s Disease
- 2012
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Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 14:2, s. 188-193
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Surgery for Crohn’s disease (CD) is at high risk of anastomotic complications, with severe postoperative morbidity and even mortality. This retrospective study of high risk CD patients compared the outcome of primary anastomosis (PA) with that of split stoma (SS) and delayed anastomosis (DA). Methods: We performed 146 operations for ileocolonic CD from 1995-2006. Patient data were obtained from a prospectively registered data base. Patients with ≥2 preoperative risk factors (n=76) constituted high risk patients. Outcomes following PA or SS with DA were assessed. Results: The number of risk factors (mean) was 2.4 in the PA group and 3.5 in the SS group at time of resection and 0.2 (p<0.0001) at time of DA after 5.0 (2.3-12.6) months. Anastomotic complications occurred in 19 % (11/57) after PA compared with 0 % (0/19) after DA (p=0.038). The total number of operations and in-hospital time was 1.9 (±1.5) and 20.9 (±35.6) days after PA compared with 2.0 (±0.2) and 17.8 (±10.4) days after DA (p=0.70 and p=0.74). Conclusions: SS in high risk ileocolonic resections for CD, reduces the number of risk factors at the time of DA and the risk for anastomotic complications, compared to PA, without adding inhospital time or number of operations.
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| 45. |
- Nielsen, MB, et al.
(författare)
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Current management of locally recurrent rectal cancer
- 2011
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Ingår i: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. - : Wiley. - 1463-1318. ; 13:7, s. 732-742
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Tidskriftsartikel (refereegranskat)
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| 46. |
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| 47. |
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| 48. |
- Pasternak, Björn, et al.
(författare)
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Elevated intraperitoneal matrix metalloproteinases-8 and -9 in patients who develop anastomotic leakage after rectal cancer surgery: a pilot study
- 2010
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Ingår i: Colorectal Disease. - Chichester, West Sussex, United Kingdom : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 12:7, s. e93-e98
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Tidskriftsartikel (refereegranskat)abstract
- Objective Experimental studies suggest that matrix metalloproteinase (MMP) enzymes mediate the early tissue breakdown that leads to a decrease in intestinal anastomotic strength. Patients with upregulation of MMPs in intestinal biopsies have an increased rate of anastomotic leakage. We measured MMPs and their inhibitors [tissue inhibitors of metalloproteinases (TIMPs)] in postoperative intraperitoneal fluid after rectal cancer surgery, and hypothesized that they would be elevated in patients who later would develop anastomotic leakage.Method Twenty-nine patients with rectal carcinoma underwent low anterior resection of the rectum for cancer. Intraperitoneal fluid was collected via a pelvic drain at a median of 4 h postoperatively. MMP-1, -2, -3, -7, -8, -9 and -13 were determined using particle-based multiplex flow-cytometry. TIMP-1 and -2 were measured by enzyme-linked immunosorbent assays. MMP-9 was considered the main outcome variable.Results Ten patients developed anastomotic leakage. These patients had increased intraperitoneal MMP-9 [median difference (m.d.) 29%; P = 0.03] and MMP-8 (m.d. 58%; P = 0.02), compared with patients who did not develop leakage. There were no differences between the groups for other MMPs and TIMPs.Conclusion Matrix metalloproteinase-8 and -9 appear to have an important role in the development of anastomotic leakage and may be promising pharmacological targets to protect anastomotic integrity. We suggest further investigation of MMPs as markers for anastomotic leakage.
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| 49. |
- Penninckx, Freddy, et al.
(författare)
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Letter from the ESCP Executive
- 2011
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 13:10, s. 1188-1189
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Tidskriftsartikel (refereegranskat)
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| 50. |
- Persson, Eva, et al.
(författare)
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Stoma-related complications and stoma size – a 2-year follow up
- 2010
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Ingår i: Colorectal Disease. - : Blackwell Publishing Ltd. - 1462-8910 .- 1463-1318. ; 12:10, s. 971-976
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Aim The purpose of the study was to prospectively describe stoma configuration and evaluate stoma-related complications and their association with possible risk factors. Method All elective patients (n = 180) operated on with a formation of colostomy, ileostomy or loop-ileostomy between 2003 and 2005 were included in the study. Follow up took place on the ward postoperatively and five times during 2 years after discharge. On these occasions the diameter and height of the stoma were recorded. Complications such as peristomal skin problems, necrosis, leakage caused by a low stoma, stenosis, granuloma formation, prolapse and peristomal hernia formation were evaluated. Results Most complications occurred 2 weeks after discharge; 53% of patients with colostomies, 79% with loop-ileostomies and 70% of patients with end-ileostomy had one or more complications. The most common complication was skin problems and it was most common in patients with end-ileostomies (60%) and loop-ileostomies (73%). Postoperatively at ward review, the most common complication was necrosis, which occurred in 20% of patients with a colostomy. Granuloma formation was most frequent in colostomies. Almost all patients with an end-ileostomy and loop-ileostomy with a height lower than 20 mm had leakage and skin problems as had half of the patients with a colostomy height lower than 5 mm. Conclusion To prevent stoma-related complications, it is important to produce an adequate height of the stoma, with early and regular follow ups and adjustment of the appliance. To work closely in collaboration with the colorectal surgeons is of utmost important to provide feedback and in turn, to improve stoma outcome.
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