RESUMEN
BACKGROUND: The implementation of Enhanced Recovery After Surgery (ERAS) protocols has resulted in improved postoperative outcomes in colorectal cancer surgery. The evidence regarding feasibility and impact on outcomes in surgery for inflammatory bowel disease (IBD) is limited. METHODS: We performed a retrospective observational cohort study, comparing patient trajectories before and after implementing an IBD-specific ERAS protocol at Zealand University Hospital. We assessed the occurrence of serious postoperative complications of Clavien-Dindo grade 3 or higher as our primary outcome, with postoperative length of stay in days and rate of readmissions as secondary outcomes, using χ2, Mann-Whitney test, and odds ratios adjusted for sex and age. RESULTS: From 2017 to 2023, 394 patients were operated on for IBD and included in our study. In the ERAS cohort, 39/250 patients experienced a postoperative complication of Clavien-Dindo grade 3 or higher compared to 27/144 patients in the non-ERAS cohort (15.6% vs. 18.8%, p = 0.420) with an adjusted odds ratio of 0.73 (95% CI 0.42-1.28). There was a significantly shorter postoperative length of stay (median 4 vs. 6 days, p < 0.001) in the ERAS cohort compared to the non-ERAS cohort. Readmission rates remained similar (22.4% vs. 16.0%, p = 0.125). CONCLUSIONS: ERAS in IBD surgery was associated with faster patient recovery, but without an impact on the occurrence of serious postoperative complications and rate of readmissions.
Asunto(s)
Recuperación Mejorada Después de la Cirugía , Enfermedades Inflamatorias del Intestino , Tiempo de Internación , Readmisión del Paciente , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tiempo de Internación/estadística & datos numéricos , Enfermedades Inflamatorias del Intestino/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Protocolos Clínicos , Resultado del Tratamiento , Estudios de FactibilidadRESUMEN
OBJECTIVE: To analyze the prognostic implications of the lymph node ratio (LNR) in curative resected rectal cancer. SUMMARY BACKGROUND DATA: It has been proposed that the LNR has a high prognostic impact in colorectal cancer, but the lymph node ratio has not been evaluated exclusively for rectal cancer in a large national cohort study. METHODS: All 6793 patients in Denmark diagnosed with stage I to III adenocarcinoma of the rectum, and so treated in the period from 2003 to 2011, were included in the analysis. The cohort was divided into two groups according to whether or not neo-adjuvant treatment had been given. RESULTS: In a multivariate analysis the pN status, ypN status and lymph node yield were found to be independent prognostic factors for overall survival, irrespective of neo-adjuvant therapy. The LNR was also found to be a significant prognostic factor with a Hazard Ratio ranging from 1.154 (95% CI: 0.930-1.432) (LNR: 0.01-0.08) to 2.974 (95% CI: 2.452-3.606) (LNR > 0.5) in the group of patients who had surgery to begin with and from 1.381 (95% CI: 0.891-2.139) (LNR: 0.01-0.08) to 2.915 (95% CI: 2.244-3.787) (LNR > 0.5) in the group of patients who had neo-adjuvant treatment. CONCLUSIONS: The LNR reflects the influence on survival from N-status and the lymph node yield and since LNR was shown to be a significant prognostic predictor for overall survival in patients with curatively resected stage III rectal cancer irrespective of neo-adjuvant therapy we recommend that the introduction of LNR should be considered for rectal cancer in a revised TNM classification.
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Adenocarcinoma/secundario , Ganglios Linfáticos/patología , Neoplasias del Recto/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Anciano , Dinamarca/epidemiología , Femenino , Humanos , Incidencia , Metástasis Linfática , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estadificación de Neoplasias/métodos , Pronóstico , Neoplasias del Recto/epidemiologíaRESUMEN
AIMS: Colorectal cancer (CRC) is mainly a disease of the elderly. Our primary aim was to investigate if age had influence on treatment decisions in regards to surgery, referral to an oncologist and treatment by an oncologist. METHOD: We identified patients with CRC in our department from 2004 through 2011 in the Danish Colorectal Cancer Group (DCCG) database. According to age ≤75 and >75 years multivariate logistic regression analysis was used on treatment decisions: surgery, referral to an oncologist and oncologic treatment. Independent variables were age, ASA score, tumorlocation, stage, gender and year of diagnosis. Additional analysis was performed for stage III and IV patients as a subgroup. RESULTS: 1701 patients were included of which 525 were >75 years of age. In multivariate analysis there was no association between age and chance of surgery. Older patients had a significantly lower odds ratio for referral to an oncologist (OR 0.624, p < 0.0001) and for oncological treatment if referred (OR 0.218, p < 0.0001). Being an elderly patient with stage III or IV CRC OR was 0.233 for referral- and for receiving treatment by an oncologist OR was 0.210 (p < 0.0001 for both), after adjusting for possible confounders. CONCLUSION: Based on age elderly patients are on a lesser extent referred to an oncologist and get oncologic treatment less frequently. Surgically the elderly are not undertreated.
Asunto(s)
Adenocarcinoma/terapia , Neoplasias Colorrectales/terapia , Adhesión a Directriz/estadística & datos numéricos , Oncología Médica/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adenocarcinoma/patología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Colectomía , Neoplasias Colorrectales/patología , Bases de Datos Factuales , Dinamarca , Manejo de la Enfermedad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Guías de Práctica Clínica como Asunto , Factores Sexuales , Adulto JovenRESUMEN
PURPOSE: CT has been found superior to chest x-ray to detect lung malignances. However, indeterminate lung lesions (ILL) are found in 4-42% by using CT in staging colorectal cancer (CRC) patients. Our aim was to examine the frequency of ILL on staging CT and the rate of the ILL being malignant, and to investigate if PET/CT was useful in pointing out the malignant cases. METHODS: A prospective analysis of 238 consecutive patients operated for CRC followed median 24 months. All the patients had a preoperative staging CT. Patients with ILL had a PET/CT scan performed 3 months postoperatively and low dose chest CT performed 6, 12, 18 and 24 months postoperatively. RESULTS: Twenty percent of the patients had ILL. Four of these patients (8.5%) had lung metastases detected median 9 months postoperatively, while 2 (4.3%) had other lung malignancies. One patient had TB. In patients with normal staging chest CT 10 of the 185 patients (5.4%) developed lung metastases detected median 16 months postoperatively. This was significantly later than in patients with ILL (p < 0.001), but with regard to the number of patients developing lung metastases no significant difference was found between the groups (p = 0.12). CONCLUSIONS: Even though a relative low number of ILL turn out to be malignant it seems advisable to use PET/CT scan in the follow-up to detect lung metastases as early as possible to better the prognosis. For the same reason all CRC patients should have chest CT included in their follow-up 6-12 months postoperatively.
Asunto(s)
Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Imagen Multimodal , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
AIM: The study aimed to determine whether the lymph node yield (LNY) in rectal cancer is influenced by patient-related and histopathological factors and the use of preoperative chemoradiotherapy (CRT). METHOD: An analysis was carried out of the LNY in a nationwide Danish cohort of 7950 patients, treated by curative resection of Stage I-III rectal cancer during the period 2001-2011. The impact of year of diagnosis, age, gender, pathological stage of the tumour (pT-stage) and preoperative CRT on LNY was analysed. RESULTS: Twenty-nine per cent of the patients received preoperative CRT. The median LNY was 13 [interquartile range (IQR): 8-19]. A total of 43.4% of the patients had an LNY of < 12. The median LNY increased from 8 (IQR: 5-12) to 20 (IQR: 13-28) LNs over the years of the study period (P < 0.0001). Gender and body mass index (BMI) had no impact on the median LNY. Age had a minor impact, with a range of 12 (IQR: 8-18) to 13 (IQR: 9-20) (P < 0.0001). The LNY ranged from 9 (IQR: 6-14) to 16 (IQR: 10-26), according to pT-stage (pT0-pT4) (P < 0.0001). Median LNY, according to preoperative CRT or no preoperative CRT, was 10 (IQR: 6-16) and 14 (IQR: 8-18), respectively (P < 0.0001). The percentages of patients with an LNY of < 12, according to preoperative CRT or no preoperative CRT, were 58.7% and 37.1%, respectively (P < 0.0001). CONCLUSION: An increase in the LNY over the period of the study was observed, probably reflecting improved quality of surgery and histopathology. A minor significant reduction of LNY was found with increasing age of the patient. LNY was significantly related to pT-stage and to the use of preoperative chemoradiotherapy. For these reasons the minimum harvest of 12 LNs as a surrogate marker for the oncological quality of surgery should be questioned.
Asunto(s)
Adenocarcinoma/patología , Quimioradioterapia Adyuvante , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Neoplasias del Recto/patología , Adenocarcinoma/terapia , Anciano , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Estudios Prospectivos , Neoplasias del Recto/cirugía , Neoplasias del Recto/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: This study involved a large nationwide Danish cohort to evaluate the hypothesis that a high lymph node harvest has a positive effect on survival in curative resected Stage I-III colon cancer and a low lymph node ratio has a positive effect on survival in Stage III colon cancer. METHOD: Analysis of overall survival was conducted using a nationwide Danish cohort of patients treated with curative resection of Stage I-III colon cancer. All 8901 patients in Denmark diagnosed with adenocarcinoma of the colon and treated with curative resection in the period 2003-2008 were identified from the Danish Colorectal Cancer Group (DCCG). The impact of lymph node count and lymph node ratio was analysed. RESULTS: Overall 5-year survival was 56.8 and 66.6%, (P < 0.0001) for lymph node counts of fewer than 12 and 12 or more, respectively. The percentages of lymph node positive patients in the two groups were 29.8 and 40.3% (P < 0.0001), respectively. When putting the Stage III patients into four subgroups according to the lymph node ratio (cut-off points 1/12, 1/4 and 1/2) we found an overall 5-year survival rate of 68.1, 57.2, 49.3 and 32.4% (P < 0.0001). Lymph node count and lymph node ratio were independent prognostic factors in multivariate analysis. CONCLUSION: High lymph node count was associated with improved overall survival in colon cancer. Lymph node ratio was superior to N-stage in differentiating overall survival in Stage III colon cancer. Stage migration was observed.
Asunto(s)
Adenocarcinoma/secundario , Neoplasias del Colon/patología , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/cirugía , Dinamarca , Femenino , Humanos , Estimación de Kaplan-Meier , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND AND OBJECTIVE: Late postoperative hypoxaemia after upper abdominal surgery is common even among cardiopulmonary healthy patients. Atelectasis may develop after intubation and persist into or reveal a disposition for atelectasis in the postoperative period. Positive end-expiratory pressure (PEEP) eliminates peroperative atelectasis but the effect on perioperative oxygenation is controversial. This study evaluated the effect of peroperative PEEP optimized pulmonary compliance on perioperative oxygenation and complications. METHODS: Forty patients assessed by electrocardiography, spirometry, functional residual capacity and diffusion capacity were randomly assigned to receive positive end-expiratory pressure (PEEP) or zero end-expiratory pressure (ZEEP) during surgery. PaO2, SPO2 and complications in the postoperative period were evaluated without knowledge of peroperative PEEP or ZEEP application. RESULTS: Peroperative arterial oxygenation improved for all patients receiving PEEP, mean 2.1 kPa (0.7-3.5 kPa). There was no difference in postoperative median PaO2 between the groups. The differences in the incidence of late prolonged postoperative hypoxaemia and complications were 25% (-5% to 55%) and -1% (-31% to 29%) between the ZEEP and the PEEP group, but were not statistically significant.
Asunto(s)
Abdomen/cirugía , Rendimiento Pulmonar/fisiología , Oxígeno/sangre , Respiración con Presión Positiva , Adulto , Anciano , Anestesia , Anestesia General , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo IntraoperatorioRESUMEN
BACKGROUND: The incidence of late postoperative hypoxaemia and complications after upper abdominal surgery is 20-50% among cardiopulmonary healthy patients. Atelectasis development during anaesthesia and surgery is the main hypothesis to explain postoperative hypoxaemia. This study tested the predictive value of PaO2<19 kPa during combined general and thoracic epidural anaesthesia and the preoperative functional residual capacity (FRC) reduction in the 30 degree head tilt-down position for the development of late prolonged postoperative hypoxaemia, PaO2<8.5 kPa for a minimum of 3 out of 4 days, and other complications. Forty patients without cardiopulmonary morbidity, assessed by ECG, spirometry, FRC and diffusion capacity preoperatively, underwent upper abdominal surgery. PaO2 during anaesthesia and preoperative FRC reduction were compared to known risk factors for the development of hypoxaemia and complications: age, pack-years of smoking and duration of operation. The effect of optimizing pulmonary compliance with peroperative positive end-expiratory pressure (PEEP) on postoperative hypoxaemia and complications was evaluated in a blinded and randomized manner. RESULTS: Late prolonged postoperative hypoxaemia and other complications were found in 37% and 38% of the patients, respectively. Patients with PaO2>19 kPa during anaesthesia with F(I)O2=0.33 exhibited a risk, irrespective of PEEP status, of suffering late prolonged hypoxaemia of 0% (0;23) and patients with PaO2<19 kPa a risk of 52% (32;71), P<0.005. Having smoked more than 20 pack-years was associated with a 47% (19;75) higher incidence of postoperative complications than having smoked less than 20 pack-years, P<0.006. CONCLUSIONS: PaO2 during anaesthesia and smoked pack-years provide new tools evaluating patients undergoing upper abdominal surgery in order to predict the patients who develop late postoperative hypoxaemia and complications.
Asunto(s)
Abdomen/cirugía , Anestesia , Monitoreo de Gas Sanguíneo Transcutáneo , Hipoxia/diagnóstico , Cuidados Intraoperatorios , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Femenino , Humanos , Hipoxia/sangre , Hipoxia/terapia , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/terapia , Valor Predictivo de las Pruebas , Factores de TiempoRESUMEN
BACKGROUND: Pain is an important problem after ambulatory hernia repair. To assess the influence of the surgical technique on postoperative pain, two separate randomized, patient-blinded, controlled trials were performed in men with an indirect inguinal hernia. STUDY DESIGN: In study A, 48 patients with an internal inguinal ring smaller than 1.5 cm were randomly allocated to either simple extirpation of the hernial sac or extirpation plus annulorrhaphy. In study B, 84 patients with an internal inguinal ring wider than 1.5 cm were randomly allocated to extirpation plus annulorrhaphy or extirpation plus Lichtenstein mesh repair (modified). All operations were performed under unmonitored local anesthesia with standardized perioperative analgesia using methadone and tenoxicam. Pain was scored daily for the first postoperative week and after 4 weeks on a four-point verbal-rank scale (no, light, moderate, or severe pain) during rest, while coughing, and during mobilization (rising to the sitting position). Use of supplementary analgesics (paracetamol) was recorded. Cumulative daily pain scores for the first postoperative week and the number of patients who used supplementary analgesics were the main outcome measures. RESULTS: There were no significant differences in cumulative pain scores or use of supplementary analgesics between the treatment groups in either study. Cumulative pain scores were significantly higher during coughing and mobilization than during rest in both studies. CONCLUSIONS: Choice of surgical technique for open repair of a primary indirect inguinal hernia has no influence on postoperative pain.
Asunto(s)
Hernia Inguinal/cirugía , Dolor Postoperatorio , Adolescente , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
UNLABELLED: Cryoanalgesia versus sham treatment was applied to the ilioinguinal and iliohypogastric nerves after mesh repair of an inguinal hernia under local anesthesia in 48 male patients in a prospective, randomized, and observer- and patient-blinded trial. Pain was scored daily during rest, while coughing, and during mobilization to the sitting position for 1 wk and weekly for 8 wk on a four-point verbal rank scale. Use of supplementary analgesics and sensory disturbances were recorded. Assessments were made for allodynia, hyperalgesia, and mechanical pain detection thresholds 8 wk postoperatively. Cumulative pain scores for the first postoperative week were equal in the two groups, as was the use of analgesics. Eight weeks postoperatively, three cases of hyperalgesia to pinprick were detected in the cryoanalgesia group, and 10 patients in the cryoanalgesia group versus 5 in the sham-treatment group reported disturbed sensibility. We conclude that cryoanalgesia of the iliohypogastrical and ilioinguinal nerve does not decrease postherniorrhaphy pain. IMPLICATIONS: Does freezing of sensory nerves in the groin reduce pain after hernia repair? Extreme cold (-60 degrees C) was applied in a double-blind, randomized study. No difference in pain scores was found. Sensory disturbances were seen in treatment and control patients. Freezing cannot be recommended for pain relief after hernia repair.
Asunto(s)
Hernia Inguinal/cirugía , Hipotermia Inducida , Dolor Postoperatorio/terapia , Anciano , Método Doble Ciego , Ingle/inervación , Humanos , Hipotermia Inducida/efectos adversos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Nervios Periféricos , Estudios ProspectivosRESUMEN
BACKGROUND: The purpose of the study was to provide a detailed description of postoperative pain after elective day-case open inguinal hernia repair under local anaesthesia. METHODS: This was a prospective consecutive case series study. After 500 hernia operations in 466 unselected patients aged 18-90 years, pain was scored (none, light, moderate or severe) at rest, while coughing and during mobilization, daily for the first postoperative week and after 4 weeks. Pain scores were added together over the first postoperative week. RESULTS: On days 1, 6 and 28, 66, 33 and 11 per cent respectively had moderate or severe pain while coughing or mobilizing. Total pain scores were higher while coughing or mobilizing than at rest (P < 0.001). Younger patients had higher total pain scores than older patients while coughing or mobilizing (P0< 0.01), but not at rest. No significant differences were found between types of surgery or hernia. CONCLUSION: Pain remained a problem despite the pre-emptive use of opioids, non-steroidal anti-inflammatory drugs and local anaesthesia, irrespective of surgical technique.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Hernia Inguinal/cirugía , Dolor Postoperatorio/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestesia Local , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios ProspectivosRESUMEN
The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/normas , Hernia Inguinal/cirugía , Adolescente , Adulto , Anciano , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Servicio de Cirugía en Hospital/organización & administración , Servicio de Cirugía en Hospital/normas , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
PURPOSE: To compare 2 methods of colonic cleansing before double-contrast barium enema. A standard preparation of bisacodyl was compared with a preparation of dietary fibre (ispaghula). MATERIAL AND METHODS: The patients referred for double-contrast barium enema were randomly allocated to one of the colonic cleansing regimens. The effectiveness and patient acceptance of the preparations were evaluated. RESULTS: There was a significantly poorer colon cleanness score in the ispaghula group (p = 0.0001). Patient tolerance of the 2 regimens was not significantly different. CONCLUSION: Ispaghula alone is not sufficient as a cleansing preparation for double-contrast barium enema.
Asunto(s)
Bisacodilo/farmacología , Enema/métodos , Psyllium/farmacología , Sulfato de Bario , Colon/efectos de los fármacos , Humanos , Resultado del TratamientoRESUMEN
In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.
Asunto(s)
Hernia Inguinal/cirugía , Anciano , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/normas , Anestesia Local , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Reoperación , Encuestas y CuestionariosRESUMEN
From 1978 to the end of 1991, 66 patients were operated on for liver metastases from colorectal cancer. All patients had had a curative resection of their colorectal cancer. Forty resections of the liver were major anatomic resections. This study was undertaken to determine the indications for and value of liver resection for metastases from colorectal cancer. Five patients died in the postoperative period. All resections were intended to be curative, but in 16 of the patients the resection became noncurative. None of these patients lived more than two years after liver resection. Fifty patients with a curative resection had a three-year survival rate of 36 percent, postoperative death included. Recurrence in the liver was observed in 30 patients (60 percent) from three to 33 (median 11) months after the liver resection. Four patients had repeated resections performed. Two of them are alive without recurrence at respectively 34 and 60 months after the first liver resection. The difference in survival between curative and noncurative liver resection was highly significant (p = 0.01). Sex, age, Dukes' stage of primary colorectal cancer, synchronous or metachronous appearance of metastases, or number of metastases could not predict long-term prognosis. The only factors of predictive value were tumour size, a free resection margin, and no extrahepatic tumour. If it is possible to perform a curative resection, there should be few contraindications against liver surgery as it is the only treatment that can demonstrate long-term survival for approximately one-third of the patients, and it is the only possibility of cure. Palliative resection is not recommended.
Asunto(s)
Neoplasias del Colon/cirugía , Hepatectomía , Neoplasias Hepáticas/secundario , Neoplasias del Recto/cirugía , Adulto , Anciano , Neoplasias del Colon/patología , Contraindicaciones , Femenino , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias/mortalidad , Pronóstico , Neoplasias del Recto/patologíaRESUMEN
PURPOSE: This study was undertaken to determine the indications for and value of liver resection for metastases from colorectal cancer. METHODS: From 1978 through 1991, 66 patients were operated on for liver metastases from colorectal cancer. All patients had had a curative resection of their colorectal cancer. Forty resections of the liver were major anatomic resections. RESULTS: Five patients died in the postoperative period. All resections were intended to be curative, but in 16 of the patients the resection became noncurative. None of these patients lived more than two years after liver resection. Fifty patients with a curative resection had a three-year survival rate of 36 percent, postoperative death included. Recurrence in the liver was observed in 30 patients (60 percent) from 3 to 33 (median, 11) months after the liver resection. Four patients had repeated resections performed. Two of them are alive without recurrences 34 and 60 months after the first liver resection, respectively. The difference in survival between curative and noncurative liver resection was highly significant (P = 0.01). CONCLUSIONS: Sex, age, Dukes stage of primary colorectal cancer, synchronous or metachronous appearance of metastases, or number of metastases could not predict long-term prognosis. The only factors of predictive value were tumor size less than 4 cm in diameter, a free resection margin, and no extrahepatic tumor. If it is possible to do a curative resection, there should be few contraindications against liver surgery as it is the only treatment that can demonstrate long-term survival for approximately one-third of the patients, and it is the only possibility of a cure.
Asunto(s)
Neoplasias Colorrectales/patología , Hepatectomía/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Primarias Múltiples/secundario , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias Secundarias/secundario , Neoplasias Primarias Secundarias/cirugía , Análisis Actuarial , Adulto , Anciano , Anciano de 80 o más Años , Contraindicaciones , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/patología , Valor Predictivo de las Pruebas , Reoperación , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
A study was undertaken to determine the sensitivity of a computerized surveillance system for postoperative wound infection. From 1987 to 1990, 5177 orthopaedic operations were recorded. Four hundred and forty-five randomly selected patients received a questionnaire. Three hundred and eighty-eight (87.2%) replied. Of 355 (79.8%) usable answers, 75 (21.1%) stated to have had signs of infection, 50 (14.1%) had been seen by a doctor, 25 (7.0%) had not found this necessary. We found seven patients with deep wound infection of which three were not recorded. The sensitivity of the surveillance system concerning deep wound infection was found to be 57.1% (18.4-90.1), and for superficial wound infection to be 9.1% (1.9-24.3). We conclude that the surveillance system is not useful for the intended purpose. We propose to record a few selected types of operation, where all should be seen as out-patients at a suitable time following operation, and thereby get a more valid recording of the frequency of postoperative wound infection.
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Sistemas de Registros Médicos Computarizados/normas , Sistema de Registros/normas , Infección de la Herida Quirúrgica/epidemiología , Dinamarca/epidemiología , Estudios de Evaluación como Asunto , Humanos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/prevención & control , Encuestas y CuestionariosRESUMEN
A study among day-case and inpatients on an orthopaedic ward has been carried out to assess patient satisfaction. A single-page questionnaire were mailed to 445 patients, 388 (87.2%) returned the questionnaire. Three hundred and fifty five (79.8%) answers were usable. We found an overall rate of satisfaction with the given treatment of 71.3%, 20.3% were dissatisfied. We found the group of day-case patients more satisfied than the group of inpatients. The group of patients who underwent arthroscopic surgery were identified as being the most dissatisfied. There were among all patients a large group who were dissatisfied with the amount of perioperative information and especially the amount of postoperative out-patient control. We recommend a higher degree of written information including information about risk of complications and failures.
Asunto(s)
Enfermería Ortopédica/normas , Ortopedia/normas , Satisfacción del Paciente , Servicio de Cirugía en Hospital/normas , Dinamarca , Humanos , Enfermería Ortopédica/estadística & datos numéricos , Ortopedia/estadística & datos numéricos , Educación del Paciente como Asunto/normas , Cuidados Posoperatorios/normas , Servicio de Cirugía en Hospital/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
To evaluate the effect of somatostatin in the treatment of acute pancreatitis, 63 patients were randomly allocated to continuous intravenous infusion for three days of 250 micrograms of somatostatin (Dura Scan, Odense, Denmark) per hour (n = 33), or placebo (n = 30). Patients with a first attack of pancreatitis, serum amylase level of more than 450 units per liter and symptoms for less than 24 hours were eligible for participation in the study. Apart from a slightly significant faster decrease in serum amylase concentrations, we were unable to demonstrate any significant benefit from somatostatin with regard to paraclinical values and clinical course.