| 1. |
- Bergvall, M., et al.
(författare)
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Better survival for patients with colon cancer operated on by specialized colorectal surgeons - a nationwide population-based study in Sweden 2007-2010
- 2019
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 21:12, s. 1379-1386
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Tidskriftsartikel (refereegranskat)abstract
- Aim Mortality and complication rates after surgery for colon cancer are high, especially after emergency procedures. The aim of the present study was to evaluate the importance of the formal competence of surgeons for survival and morbidity. Method The Swedish Colorectal Cancer Registry prospectively records data on patients diagnosed with cancer within the colon and rectum. A cohort of patients operated on for colon cancer between 2007 and 2010 were followed 5 years after surgery. Data on postoperative morbidity, mortality and long-term survival were compared with regard to formal competency of the most senior surgeon attending the procedure. Results This analysis includes 13 365 patients operated on for colon cancer, including 10 434 elective procedures and 2931 emergency cases. The overall 5-year survival was higher for those operated on by subspecialist colorectal surgeons compared with general surgeons (60% vs 48%; P < 0.001). Five-year survival after elective surgery was 63% vs 55% (P < 0.001) and 35% vs 31% (P < 0.05) after emergency procedures when performed by colorectal surgeons compared with general surgeons. Postoperative 30-day mortality was 3% after surgery performed by colorectal surgeons compared with 7% when performed by general surgeons. Mortality at 90 days was 6% after surgery performed by colorectal surgeons compared with 11% for patients operated on by general surgeons (P < 0.001). Conclusion Subspecialization in colorectal surgery is associated with better outcome for patients operated on for colon cancer, and effort should be made to increase the availability of colorectal surgeons for both acute and elective colon cancer surgery.
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| 2. |
- Folkesson, J., et al.
(författare)
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Current considerations in colorectal cancer surgery
- 2015
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Ingår i: Colorectal Cancer. - : Future Medicine Ltd. - 1758-194X .- 1758-1958. ; 4:4, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- Colorectal cancer is one of the most common cancers in the world. The last decades improvement in survival in all stages of the disease has been achieved. Many factors contributes to this improvement; earlier diagnosis, better pre-operative staging, neoadjuvant radiochemotherapy, better surgical method and approach, introduction of pre- and postoperative multidisciplinary team conferences and adjuvant chemotherapy. Currently, new modalities are developing; robotics and organ preserving through wait-and-watch will give colorectal surgeons even more treatment options. This article highlights important aspects of colorectal cancer management now and in the future.
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| 3. |
- Folkesson, Joakim, et al.
(författare)
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Current considerations in colorectal cancer surgery
- 2015
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Ingår i: Colorectal Cancer. - 1758-194X .- 1758-1958. ; 4:4, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- Colorectal cancer is one of the most common cancers in the world. The last decades improvement in survival in all stages of the disease has been achieved. Many factors contributes to this improvement; earlier diagnosis, better pre-operative staging, neoadjuvant radiochemotherapy, better surgical method and approach, introduction of pre- and postoperative multidisciplinary team conferences and adjuvant chemotherapy. Currently, new modalities are developing; robotics and organ preserving through wait-and-watch will give colorectal surgeons even more treatment options. This article highlights important aspects of colorectal cancer management now and in the future.
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| 4. |
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| 5. |
- Kodeda, Karl, et al.
(författare)
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Time trends, improvements and national auditing of rectal cancer management over an 18-year period
- 2015
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 17:9, s. O168-O179
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The main aims were to explore time trends in the management and outcome of patients with rectal cancer in a national cohort and to evaluate the possible impact of national auditing on overall outcomes. A secondary aim was to provide population-based data for appraisal of external validity in selected patient series.Method: Data from the Swedish ColoRectal Cancer Registry with virtually complete national coverage were utilized in this cohort study on 29925 patients with rectal cancer diagnosed between 1995 and 2012. Of eligible patients, nine were excluded.Results: During the study period, overall, relative and disease-free survival increased. Postoperative mortality after 30 and 90days decreased to 1.7% and 2.9%. The 5-year local recurrence rate dropped to 5.0%. Resection margins improved, as did peri-operative blood loss despite more multivisceral resections being performed. Fewer patients underwent palliative resection and the proportion of non-operated patients increased. The proportions of temporary and permanent stoma formation increased. Preoperative radiotherapy and chemoradiotherapy became more common as did multidisciplinary team conferences. Variability in rectal cancer management between healthcare regions diminished over time when new aspects of patient care were audited.Conclusion: There have been substantial changes over time in the management of patients with rectal cancer, reflected in improved outcome. Much indirect evidence indicates that auditing matters, but without a control group it is not possible to draw firm conclusions regarding the possible impact of a quality control registry on faster shifts in time trends, decreased variability and improvements. Registry data were made available for reference.
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| 6. |
- Ljungman, David, et al.
(författare)
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Case Mix Difference Can Affect Evaluation of Outcome of Treatment for Colorectal Cancer
- 2015
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Ingår i: Anticancer Research. - 0250-7005. ; 35:7, s. 4073-4076
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the potential effects of patient selection, for example by organization, on survival as outcome parameter in colorectal cancer treatment. Patients and Methods: The main cohort was identified in a Hospital-based registry and outcome data of all 2,717 patients operated on for colorectal cancer between 2000-2011 were evaluated. A simulation of different center settings was performed using several potential selection criteria, including emergency cases, referral surgery and palliative resection, and used for comparison of outcome data. Results: Overall survival and cancer-specific survival can be significantly affected in both short-term (30-/90-day) mortality and long-term survival by factors of organizational level. Conclusion: Survival data as an outcome parameter can be affected by the composition of the patient cohort and thus reflect possible selection bias for example due to organization, referral patterns and practice customs. This potential bias should be acknowledged when making inter-hospital comparisons of outcome.
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| 7. |
- Wettergren, Yvonne, 1957, et al.
(författare)
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A pharmacokinetic and pharmacodynamic investigation of Modufolin(®) compared to Isovorin (®) after single dose intravenous administration to patients with colon cancer: a randomized study.
- 2015
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Ingår i: Cancer chemotherapy and pharmacology. - : Springer Science and Business Media LLC. - 1432-0843 .- 0344-5704. ; 75:1, s. 37-47
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Tidskriftsartikel (refereegranskat)abstract
- Leucovorin is commonly used as folate supplement in 5-fluorouracil-based chemotherapy, but needs to be converted to active 5,10-methylenetetrahydrofolate (methyleneTHF) intracellularly. This provides for interindividual differences. MethyleneTHF has recently been developed into the stable, distributable drug, Modufolin(®). The aim was to compare the concentration of folate metabolites in tumor, mucosa, and plasma of patients with colon cancer after administration of Modufolin(®) or Isovorin(®) (levo-leucovorin).
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| 8. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Preparedness for colorectal cancer surgery and recovery through a person-centred information and communication intervention - A quasi-experimental longitudinal design.
- 2019
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- To meet patients' information and communication needs over time in order to improve their recovery is particularly challenging for patients undergoing cancer surgery. The aim of the study was to evaluate whether an intervention with a person-centred approach to information and communication for patients diagnosed with colorectal cancer undergoing surgery can improve the patients' preparedness for surgery, discharge and recovery during six months following diagnosis and initial treatment. The intervention components involving a novel written interactive patient education material and person-centred communication was based on critical analysis of conventional information and communication for these patients. During 2014-2016, 488 consecutive patients undergoing elective surgery for colorectal cancer were enrolled in a quasi-experimental longitudinal study. In three hospitals, first a conventional care group (n = 250) was recruited, then the intervention was introduced, and finally the intervention group was recruited (n = 238). Patients' trajectories of preparedness for surgery and recovery (Preparedness for Colorectal Cancer Surgery Questionnaire-PCSQ) health related quality of life (EORTC QLQ-C30) and distress (NCCS Distress Thermometer) were evaluated based on self-reported data at five time points, from pre-surgery to 6 months. Length of hospital stay and patients' behavior in seeking health care pre- and post-surgery were extracted from patient records. Longitudinal structural equation models were used to test the hypothesized effects over time. Statistically significant positive effects were detected for two of the four PCSQ domains (patients searching for and making use of information, and making sense of the recovery) and for the role functioning domain of the EORTC QLQ-C30. Patients in the intervention group were also more likely to contact their assigned cancer "contact nurse" (a.k.a. nurse navigator) instead of contacting a nurse on duty at the ward or visiting the emergency department. In conclusion, the overall hypothesis was not confirmed. Further research is recommended on written and oral support tools to facilitate person-centred communication.
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