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Oncological Impact ...
Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer : A Nationwide Cohort Study
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- Boström, Petrus (author)
- Umeå universitet,Kirurgi,Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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- Kverneng Hultberg, Daniel (author)
- Umeå universitet,Kirurgi,Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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- Häggström, Jenny, 1980- (author)
- Umeå universitet,Statistik,Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
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- Haapamäki, Markku M., 1961- (author)
- Umeå universitet,Kirurgi,Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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- Matthiessen, Peter, 1957- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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- Rutegård, Jörgen, 1948- (author)
- Umeå universitet,Kirurgi,Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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- Rutegård, Martin, 1982- (author)
- Umeå universitet,Kirurgi,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM),Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå, Sweden
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(creator_code:org_t)
- Wolters Kluwer, 2021
- 2021
- English.
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In: Annals of Surgery. - : Wolters Kluwer. - 0003-4932 .- 1528-1140. ; 274:3, s. e236-e244
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Objective: The purpose of this study was to investigate the impact of tie level on oncological outcomes in rectal cancer surgery.Summary background data: Theoretically, a high tie of the inferior mesenteric artery could facilitate removal of apical node metastases and improve tumor staging accuracy. However, no appropriately sized randomized controlled trial exists and results from observational studies are not consistent.Methods: All stage I–III rectal cancer patients who underwent abdominal surgery with curative intention in 2007 to 2014 were identified and followed, using the Swedish Colorectal Cancer Registry. Primary outcome was cancer-specific survival, whereas overall and relative survival, locoregional and distant recurrence, and lymph node harvest were secondary outcomes, with high tie as exposure. We used propensity score matching to emulate a randomized controlled trial, and then performed Cox regression analyses to estimate hazard ratios (HRs) with confidence intervals (CIs).Results: Some 8287 patients remained for analysis, of which 37% had high tie surgery. After propensity score matching, the 5-year cancer-specific survival rate was overall 86% and we found no association between the level of tie and cancer-specific (HR 0.92, 95% CI 0.79–1.07) or overall (HR 0.98, 95% CI 0.89–1.08) survival, nor to locoregional (HR 0.85, 95% CI 0.59–1.23) or distant (HR 1.01, 95% CI 0.88–1.15) recurrence, nor to relative survival (HR 1.05, 95% CI 0.85–1.28). Stratification and sensitivity analyses were similarly insignificant, after adjustment for confounding. Total lymph node harvest was, however, increased after high tie surgery (P < 0.01), but no differences were seen regarding positive nodes (P = 0.72).Conclusion: In this nationwide cohort study, the level of tie did not influence any patient-oriented oncological outcome, neither overall nor in node-positive patients. This would allow the patient's anatomical configuration and the surgeon's preferences to determine the level of tie.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- level of tie
- ligation level
- mortality
- rectal cancer
- recurrence
- survival
- Surgery
- kirurgi
Publication and Content Type
- ref (subject category)
- art (subject category)
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