| 1. |
- Collin, Åsa, et al.
(författare)
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Impact of mechanical bowel preparation on survival after colonic cancer resection
- 2014
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Ingår i: British Journal of Surgery. - : Wiley: 12 months. - 0007-1323 .- 1365-2168. ; 101:12, s. 1594-
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Tidskriftsartikel (refereegranskat)abstract
- Background: A randomized study in 1999-2005 of mechanical bowel preparation (MBP) preceding colonic resection found no decrease in postoperative complications. The aim of the present study was to evaluate the long-term effect of MBP regarding cancer recurrence and survival after colonic resections. Methods: The cohort of patients with colonic cancer in the MBP study was followed up for 10 years. Data were collected from registers run by the National Board of Health and Welfare. Register data were validated against information in patient charts. Cox proportional hazards model was used for multivariable analysis of factors predictive of cancer-specific survival. Results: Register analysis showed significantly fewer recurrences, and better cancer-specific and overall survival in the MBP group. After validation, 839 of 1343 patients remained for analysis (448 MBP, 391 no MBP). Eighty (17.9 per cent) of 448 patients in the MBP group and 88 (22.5 per cent) of 391 in the no-MBP group developed a cancer recurrence (P = 0.093). The 10-year cancer-specific survival rate was 84.1 per cent in the MBP group and 78.0 per cent in the no-MBP group (P = 0.019). Overall survival rates were 58.8 and 56.0 per cent respectively (P = 0.186). Conclusion: Patients receiving MBP before elective colonic cancer surgery had significantly better cancer-specific survival after 10 years.
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| 2. |
- 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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| 3. |
- Folkesson, Joakim, et al.
(författare)
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Randomised multicentre trial of circular stapling devices
- 2012
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 27:2, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: In a register study, the risk of anastomotic leakage correlated to the choice of circular stapling device with a 4% difference between the two brands used. Based on those data, a randomised multicentre study was started to explore the risk of an anastomotic leakage based upon the surgical device. METHODS: Patients above 18 years with a rectal cancer, able to give informed consent, and scheduled for an anterior resection were eligible for the study. Perioperative randomisation was to Ethicon™ PROXIMATE™ ILS™ or Autosuture™ Premium Plus CEEA™. Anastomotic leakage was defined as a clinically manifest leak. RESULTS: Five hundred twenty-nine patients were randomised (58% male). A leak occurred in 8.3%. The anastomoses created by PROXIMATE™ ILS™ leaked in 25/265 (9.4%) anastomoses, and the Premium Plus CEEA™ leaked in 19/260 (7.3%), p = .419. CONCLUSION: No difference in the leak rate could be revealed. Several centres replaced one of the staplers by a new product, and the study was ended before the stipulated number of patients was reached. In the future, surgical devices may have to prove superiority in randomised trials or be monitored in quality registers before they can be introduced into day to day surgical practice.
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| 4. |
- Hesselager, Caroline, et al.
(författare)
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Short-term outcome after neoadjuvant high-dose-rate endorectal brachytherapy or short-course external beam radiotherapy in resectable rectal cancer
- 2013
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 15:6, s. 662-666
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Tidskriftsartikel (refereegranskat)abstract
- AIM:Total mesorectal excision with preoperative radiotherapy reduces local recurrence in rectal cancer, but radiotherapy increases the risk of complications. The study compared the immediate postoperative outcome after external beam radiotherapy with high dose endorectal brachytherapy (HDREBT).METHOD:Patients (n=318) treated with preoperative HDREBT, (26 Gy over 4 days) followed by surgery after 4-8 weeks were matched with 318 patients from the Swedish Rectal Cancer Register treated with 5 Gy daily over 5 days and surgery in the subsequent week (SCRT) and 318 having surgery alone. All 954 patients were followed for 30 days after surgery. Complications were divided into surgical, cardiovascular and infectious.RESULTS:The SCRT group had fewer cardiovascular complications (3.1%) than HDREBT (9.4%, p=0.002) and RT- (7.2%, p=0.03). Perioperative bleeding was less in HDREBT patients (379.3 ml) than SCRT (947.2 ml; p<0.0001) and RT- (918.9 ml), and the re-intervention rate was lower in HDREBT (4.1%) than SCRT patients (14.2%; p=0.005) and RT- (12.3%; p<0.005). The HDREBT group had fewer R2 resections than the SCRT and RT- groups, but a higher proportion of R0-resections than the RT- group (p=0.03).CONCLUSION:No major differences in postoperative complications were found. HDREBT patients had a higher rate of cardiovascular complications but less perioperative bleeding and fewer re-interventions. A longer interval between radiotherapy and surgery may be beneficial for tumour regression and this could be reflected in the number of radical resections.
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| 5. |
- Martling, Anna, et al.
(författare)
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New trends in rectal cancer treatment.
- 2014
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Ingår i: Colorectal Cancer. - : Future Medicine Ltd. - 1758-194X .- 1758-1958. ; 3:2, s. 215-222
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Tidskriftsartikel (refereegranskat)abstract
- SUMMARY The treatment philosophy for rectal cancer has changed a lot during the last three decades. In the 1970s it was more or less a pure surgical business and rectal cancer was considered radiation resistant. Owing to the unacceptable high local recurrence rates, surgery was changed (the total mesorectal excision technique) during the 1980s and treatment was, in many countries, concentrated to lager units. Moreover, the addition of adjuvant radiotherapy was tested during the same period in several randomized trials and demonstrated that the local recurrence rate could be reduced by 50%, provided the radiation dose was high enough. Since then, treatment has changed very rapidly with several interesting approaches, such as timing and type of radiotherapy, the place of chemotherapy, surgery with modern technique including laparoscopy; natural orifice transendoscopic surgery or robotics; and the whole idea of ‘wait-and-watch’ program. All of these new aspects are covered and discussed in the view of the standard-of-care in 2014.
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| 6. |
- Strigård, Karin, 1958-, et al.
(författare)
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The Easy-X magnetic stoma connector system. A future concept for stomal dressing?
- 2013
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 28:3, s. 371-374
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Tidskriftsartikel (refereegranskat)abstract
- A considerable proportion of stoma patients are disabled for various reasons and are elderly. To be able to dress their stoma themselves is of crucial importance for their integrity and social life. This study evaluates a novel stomal dressing system based on a magnetic connector-the Easy-X system. Twenty patients (8 women, mean age of 40-89 years) with a well-functioning colostomy tested the Easy-X system for 6 weeks. The system was judged by the patients using a multiple choice scale, and by the stoma nurses using a 10-grade VAS. Eighteen of 20 patients completed the trial. Ten patients rated the Easy-X as better than their ordinary system, 3 as equal to and 4 deemed it inferior. Despite this, only three were prepared to change to the Easy-X system. Eleven of 18 patients experienced discomfort with the new adhesive plate. Three patients suffered leakage less often and five patients more often than with their ordinary system. Stoma nurse ratings were available for 14 patients. Their evaluation of the magnetic connector in the Easy-X system was positive in eight cases, neutral in one case and negative in three cases. Global impression ratings were 3 positive, 3 negative and 5 neutral. The Easy-X system showed potential advantages over conventional stomal dressing systems, but the system must be improved in terms of a varied assortment of dressing products enabling individual fitting before a larger trial can be carried out on disabled patients. Furthermore, the increased use of metal has to be handled with an ecologic recycling system. A new stomal dressing system with a magnetic connector has potential advantages over conventional stomal dressings for disabled persons.
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