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- Sampo, M., et al.
(author)
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A web-based prognostic tool for extremity and trunk wall soft tissue sarcomas and its external validation
- 2012
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In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 106:6, s. 1076-1082
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Journal article (peer-reviewed)abstract
- BACKGROUND: We developed a web-based, prognostic tool for extremity and trunk wall soft tissue sarcoma to predict 10-year sarcoma-specific survival. External validation was performed. METHODS: Patients referred during 1987-2002 to Helsinki University Central Hospital are included. External validation was obtained from the Lund University Hospital register. Cox proportional hazards models were fitted with the Helsinki data. The previously described model (SIN) includes size, necrosis, and vascular invasion. The extended model (SAM) includes the SIN factors and in addition depth, location, grade, and size on a continuous scale. Models were statistically compared according to accuracy (area under the ROC curve = AUC) of 10-year sarcoma-specific survival prediction. RESULTS: The AUC of the SAM model in 10-year survival prediction in the Helsinki patient series was 0.81 as compared with 0.74 for the SIN model (P = 0.0007). The corresponding AUCs in the external validation series were 0.77 for the SAM model and 0.73 for the SIN model (P = 0.03). A web-based calculator for the SAM model is available at http://www.prognomics.org/sam. CONCLUSION: Addition of grade, depth, and location as well as tumour size on a continuous scale significantly improved the accuracy of the prognostic model when compared with a model that includes only size, necrosis, and vascular invasion. British Journal of Cancer (2012) 106, 1076-1082. doi:10.1038/bjc.2012.48 www.bjcancer.com Published online 21 February 2012 (C) 2012 Cancer Research UK
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| 2. |
- W-Dahl, Annette, et al.
(author)
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Timing of preoperative antibiotics for knee arthroplasties : Improving the routines in Sweden
- 2011
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In: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 5:1
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Journal article (peer-reviewed)abstract
- Background: A slight increase in revisions for infected joint arthroplasties has been observed in the Nordic countries since 2000 for which the reasons are unclear. However, in 2007 a Swedish study of the timing for prophylactic antibiotics in a random sample of knee arthroplasties found that only 57% of the patients had received the antibiotic during the optimal time interval 45-15 minutes before surgery. The purpose of the report was to evaluate the effect of measures taken to improve the timing of prophylactic antibiotics.Findings: Reporting this finding to surgeons at national meetings during 2008 the Swedish Knee Arthroplasty Register (SKAR) introduced a new report form from January 2009 including the time for administration of preoperative antibiotics. Furthermore, the WHO's surgical checklist was introduced during 2009 and a national project was started to reduce infections in arthroplasty surgery (PRISS). The effect of these measures was found to be positive showing that in 2009, 69% of the 12,707 primary knee arthroplasties were reported to have received the prophylaxis within the 45-15 min time interval and 79% of the first 7,000 knee arthroplasties in 2010. A survey concerning the use of the WHO checklist at Swedish hospitals showed that 73 of 75 clinics had introduced a surgical checklist.Conclusions: By registration and bringing back information to surgeons on the state of infection prophylaxis in combination with the introduction of the WHO checklist and the preventive work done by the PRISS project, the timing of preoperative prophylactic antibiotics in knee arthroplasty surgery was clearly improved.
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| 4. |
- Zoucas, Evita, et al.
(author)
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Pelvic Exenteration for Advanced and Recurrent Malignancy.
- 2010
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; Jul 1, s. 2177-2184
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Journal article (peer-reviewed)abstract
- BACKGROUND: Improved surgical techniques and oncological treatment render many advanced pelvic tumors amenable to curative resection. We evaluated morbidity, survival, and quality of life (QoL) after extended pelvic procedures. METHODS: From January 2003 to November 2008, 85 patients underwent multivisceral pelvic resection; 87% had colorectal or anal malignancies. Preoperatively, endoscopy and imaging procedures were performed, followed by multidisciplinary assessment. Fifty-eight percent received preoperative chemotherapy and pelvic irradiation. Exenteration was total in 32 patients and posterior in 48. Five posterior resections included partial cystectomy and 21 encompassed resection of the bony pelvis. Myocutaneous flaps were used for reconstruction in 33 cases. Urinary diversion was achieved by ileal conduit in 24 and by continent pouch in 8. QoL was evaluated prospectively in 22 late cases. RESULTS: All patients were evaluated. Clear margins were obtained in 66%. Median duration of surgery was 680 (310-1,320) min, and blood loss was 1,800 (350-19,000) ml. Morbidity was 68%, whereof major complications constituted 13%. Median hospital stay was 18 (5-70) days. There was no 90-day mortality. Median follow-up was 24 (3-71) months. Local control was obtained in 77 patients. Twenty-seven manifested disseminated disease without local recurrence, two developed isolated local recurrence, and six had local and systemic recurrences. Twenty-one died after a median of 11 (4-55) months follow-up. Survival was correlated with clear margins and time to relapse. QoL was improved at 16 months after surgery. CONCLUSIONS: Multivisceral pelvic surgery is possible with acceptable morbidity and QoL. Thorough patient selection and multimodal therapy are necessary to attain maximum benefit.
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