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Circumferential resection margin as a prognostic marker in the modern multidisciplinary management of rectal cancer.

https://arctichealth.org/en/permalink/ahliterature261759
Source
Dis Colon Rectum. 2015 Mar;58(3):275-82
Publication Type
Article
Date
Mar-2015
Author
Maziar Nikberg
Csaba Kindler
Abbas Chabok
Henry Letocha
Jayant Shetye
Kenneth Smedh
Source
Dis Colon Rectum. 2015 Mar;58(3):275-82
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Aged
Antineoplastic Protocols
Colectomy - adverse effects - methods - mortality
Disease Management
Fascia - pathology
Female
Humans
Intraoperative Care - adverse effects - methods
Male
Neoplasm Recurrence, Local - epidemiology - etiology
Prognosis
Prospective Studies
Rectal Neoplasms - epidemiology - pathology - surgery
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Abstract
A positive circumferential resection margin has been associated with a high risk of local recurrence and a decrease in survival in patients who have rectal cancer.
The purpose of this study was to analyze the involvement of circumferential resection margin in local recurrence and survival in a multidisciplinary population-based setting by using tailored oncological therapy and surgery with total mesorectal excision.
Data were collected in a prospective database and retrospectively analyzed. Between 1996 and 2009, 448 patients with rectal cancer underwent a curative bowel resection.
Population-based data were collected at a single institution in the county of Västmanland, Sweden.
Preoperative radiotherapy was delivered to 334 patients (74%); it was delivered to 35 patients (8%) concomitantly with preoperative chemotherapy. In 70 patients (16%), en bloc resections of the prostate and vagina were performed. Intraoperative perforations were seen in 7 patients (1.6%). The mesorectal fascia was assessed as complete in 117/118 cases. In 32 cases (7%), the circumferential resection margin was 1 mm or less. After a median follow-up of 68 months, 5 (1.1%) patients developed a local recurrence; one of them had circumferential resection margin involvement. The 5-year overall survival was 77%. In the multivariate analysis, the circumferential resection margin was not an independent factor for disease-free survival.
Mesorectal fascia was not assessed before 2007. The findings might be explained by a type II error but, from a clinical perspective, enough patients were included to motivate the conclusion of the study.
Circumferential resection margin is an important measurement in rectal cancer pathology, but the correlation to local recurrence is much less than previously stated, probably because of oncological treatment and surgery that respects the mesorectal fascia and, when required, en bloc resections. Circumferential resection margin should not be used as a prognostic marker in the modern multidisciplinary management of rectal cancer.
PubMed ID
25664704 View in PubMed
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Hartmann's procedure in rectal cancer: a population-based study of postoperative complications.

https://arctichealth.org/en/permalink/ahliterature266502
Source
Int J Colorectal Dis. 2015 Feb;30(2):181-6
Publication Type
Article
Date
Feb-2015
Author
Ingvar Sverrisson
Maziar Nikberg
Abbas Chabok
Kenneth Smedh
Source
Int J Colorectal Dis. 2015 Feb;30(2):181-6
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Digestive System Surgical Procedures - adverse effects
Elective Surgical Procedures - statistics & numerical data
Humans
Logistic Models
Middle Aged
Multivariate Analysis
Postoperative Complications - epidemiology - etiology
Rectal Neoplasms - surgery
Sweden - epidemiology
Abstract
Hartmann's procedure for rectal cancer patients is increasingly performed but few studies have reported the postoperative outcome. The purpose was to report postoperative complications and analyse risk factors in rectal cancer patients operated with Hartmann's procedure. To describe the selection and postoperative complication patterns, all bowel-resected rectal cancer patients were included.
Population-based data were from the county of Västmanland, Sweden. All rectal cancer patients operated with an elective bowel resection between 1996 and 2012 were included. Demographics and postoperative complications were prospectively registered and data retrospectively analysed.
Of the 624 patients included, 396 (64%) were operated with an anterior resection, 159 (25%) with an abdominoperineal excision and 69 (11%) a Hartmann's procedure of which 90% were low Hartmann's. Patients operated with a Hartmann's procedure were significantly older, had higher ASA-score, poorer WHO performance score and lower serum albumin levels. Operative time for Hartmann's procedure was a median of 49 and 99 min shorter than after anterior resection and abdominoperineal excision, respectively, and entailed less bleeding. Complications related to the pelvic and perineal dissections were more common after abdominoperineal excision compared with anterior resection and Hartmann's procedure (32 vs. 9 and 13%, p
PubMed ID
25421100 View in PubMed
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Hartmann's procedure vs abdominoperineal resection with intersphincteric dissection in patients with rectal cancer: a randomized multicentre trial (HAPIrect).

https://arctichealth.org/en/permalink/ahliterature278016
Source
BMC Surg. 2016 Jul 11;16(1):43
Publication Type
Article
Date
Jul-11-2016
Author
Kenneth Smedh
Ingvar Sverrisson
Abbas Chabok
Maziar Nikberg
Source
BMC Surg. 2016 Jul 11;16(1):43
Date
Jul-11-2016
Language
English
Publication Type
Article
Keywords
Abdomen - surgery
Adult
Aged
Colonoscopy
Dissection - methods
Follow-Up Studies
Humans
Laparoscopy - methods
Male
Perineum - surgery
Rectal Neoplasms - diagnosis - mortality - surgery
Rectum - diagnostic imaging - surgery
Robotics - methods
Survival Rate - trends
Sweden - epidemiology
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
The use of Hartmann's procedure in the old and frail and/or in patients with fecal incontinence is increasing, even though some data have reported high postoperative rates of pelvic abscesses. Abdominoperineal excision with intersphincteric dissection has been proposed as a better alternative and is performed increasingly both nationally and internationally. However, no studies have been performed to support this. The aim of this study is to randomize patients between Hartmann's procedure and abdominoperineal excision with intersphincteric dissection and compare post-operative surgical morbidity and quality of life. The hypothesis is that intersphincteric abdominoperineal excision provides less pelvic and perineal morbidity.
In this multicentre randomized controlled study, Hartmann's procedure will be compared with intersphincteric abdominoperineal excision in patients with rectal cancer unsuitable for an anterior resection. The patients are operated in different ways around the ano-rectum, otherwise the same procedure is performed with total mesorectal excision and all will receive a colostomy. The one-month postoperative control will focus on post-operative surgical complications, especially the perineal-pelvic, reoperations and other interventions. After one year, late complications such as pain in the perineal or pelvic area or disorders such as secretion or bleeding from the anorectal stump will be recorded and a follow-up of quality of life performed. Histological and oncological data will also be recorded, the latter up to 5 years post-operatively.
The HAPIrect trial is the first randomized controlled trial comparing standard low Hartmann's procedure with intersphincteric abdominoperineal excision in patients with rectal cancer with the aim of categorizing the post-operative surgical morbidity.
ClinicalTrials.gov Identifier: NCT01995396 . Date of registration November 25, 2013.
PubMed ID
27401339 View in PubMed
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Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry.

https://arctichealth.org/en/permalink/ahliterature279318
Source
Acta Oncol. 2016 Dec;55(12):1418-1424
Publication Type
Article
Date
Dec-2016
Author
Maziar Nikberg
Abbas Chabok
Henry Letocha
Csaba Kindler
Bengt Glimelius
Kenneth Smedh
Source
Acta Oncol. 2016 Dec;55(12):1418-1424
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Chemoradiotherapy
Endothelium, Vascular - pathology
Female
Follow-Up Studies
Humans
Lymph Nodes - pathology
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local - diagnosis - epidemiology
Neoplasm Staging
Perineum - pathology
Peripheral Nerves - pathology
Prognosis
Prospective Studies
Rectal Neoplasms - pathology - therapy
Registries
Survival Rate
Sweden - epidemiology
Young Adult
Abstract
Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level.
Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012.
Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p?
PubMed ID
27732105 View in PubMed
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Pretreatment quality of life in patients with rectal cancer is associated with intrusive thoughts and sense of coherence.

https://arctichealth.org/en/permalink/ahliterature293058
Source
Int J Colorectal Dis. 2017 Nov; 32(11):1639-1647
Publication Type
Journal Article
Date
Nov-2017
Author
Dan Asplund
Thue Bisgaard
David Bock
Jakob Burcharth
Elisabeth González
Eva Haglind
Yanislav Kolev
Peter Matthiessen
Carina Rosander
Jacob Rosenberg
Kenneth Smedh
Marina Åkerblom Sörensson
Eva Angenete
Author Affiliation
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, 416 85, Gothenburg, Sweden. dan.asplund@vgregion.se.
Source
Int J Colorectal Dis. 2017 Nov; 32(11):1639-1647
Date
Nov-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Denmark
Female
Humans
Male
Middle Aged
Neoplasm Staging - psychology
Palliative Care - psychology
Patient Care Management - methods
Psychological Techniques
Qualitative Research
Quality of Life
Rectal Neoplasms - pathology - psychology - therapy
Rumination, Cognitive
Sweden
Visual Analog Scale
Abstract
Quality of life may predict survival. In addition to clinical variables, it may be influenced by psychological factors, some of which may be accessible for intervention. The primary objective of this study was to investigate the association of intrusive thoughts and the patients' sense of coherence with pretreatment quality of life in patients with newly diagnosed rectal cancer.
Patients were prospectively included in 16 hospitals in Sweden and Denmark. They answered an extensive questionnaire after receiving their treatment plan. Clinical data were retrieved from national quality registries for rectal cancer.
Of 1248 included patients, a total of 1085 were evaluable. Pretreatment global health-related and overall quality of life was lower in patients planned for palliative compared with curative treatment (median 53 vs. 80 on the EuroQoL visual analogue scale, p 
Notes
Cites: Acta Oncol. 2016 Jun;55 Suppl 2:10-23 PMID 26859340
Cites: Lancet Oncol. 2009 Sep;10(9):865-71 PMID 19695956
Cites: J Epidemiol Community Health. 2005 Jun;59(6):460-6 PMID 15911640
Cites: N Engl J Med. 2002 Sep 12;347(11):790-6 PMID 12226149
Cites: N Engl J Med. 2012 Oct 25;367(17):1616-25 PMID 23094723
Cites: Dan Med J. 2014 May;61(5):A4841 PMID 24814743
Cites: Health Policy. 1996 Jul;37(1):53-72 PMID 10158943
Cites: Psychooncology. 2010 Mar;19(3):273-82 PMID 19353527
Cites: Psychol Health. 2000 Nov;14(6):1141-53 PMID 22175267
Cites: Br J Cancer. 2011 May 24;104(11):1697-703 PMID 21559017
Cites: Scand J Urol Nephrol. 2011 Mar;45(2):102-12 PMID 21114378
Cites: Br J Surg. 2007 Oct;94(10):1285-92 PMID 17661309
Cites: Dis Colon Rectum. 2009 Apr;52(4):662-8 PMID 19404072
Cites: Colorectal Dis. 2015 Sep;17(9):O168-79 PMID 26155848
Cites: Cancer J. 2008 Nov-Dec;14(6):414-9 PMID 19060607
Cites: J Psychosom Res. 2008 May;64(5):509-17 PMID 18440404
Cites: Soc Sci Med. 1993 Mar;36(6):725-33 PMID 8480217
Cites: J Clin Oncol. 2008 Apr 20;26(12):2020-6 PMID 18421055
Cites: Psychooncology. 2013 Aug;22(8):1889-94 PMID 23255459
Cites: Oncologist. 2011;16(12 ):1800-5 PMID 22128118
Cites: J Clin Oncol. 2011 Feb 20;29(6):755-60 PMID 21263086
Cites: Health Qual Life Outcomes. 2007 Dec 21;5:70 PMID 18154669
Cites: N Engl J Med. 1999 May 6;340(18):1383-9 PMID 10228188
Cites: Int J Colorectal Dis. 2016 Mar;31(3):635-41 PMID 26728024
Cites: Ann Oncol. 2010 Sep;21(9):1905-9 PMID 20231301
Cites: Health Qual Life Outcomes. 2009 Dec 23;7:102 PMID 20030832
Cites: J Epidemiol Community Health. 2007 Nov;61(11):938-44 PMID 17933950
Cites: J Psychosom Res. 2011 May;70(5):411-21 PMID 21511071
Cites: Lancet. 1989 Oct 14;2(8668):888-91 PMID 2571815
Cites: Int J Colorectal Dis. 2015 Nov;30(11):1563-70 PMID 26245948
Cites: Cancer Treat Rev. 2014 Jul;40(6):800-9 PMID 24679516
Cites: Radiother Oncol. 2014 Jan;110(1):195-8 PMID 24286634
Cites: Eur Urol. 2004 Aug;46(2):195-9 PMID 15245813
Cites: Br J Surg. 2001 Dec;88(12):1617-22 PMID 11736975
Cites: Health Qual Life Outcomes. 2013 Sep 11;11:154 PMID 24025241
Cites: N Engl J Med. 2004 Sep 16;351(12):1175-86 PMID 15371575
Cites: Br J Surg. 2013 Jun;100(7):941-9 PMID 23640671
Cites: Health Psychol Rev. 2014;8(3):339-61 PMID 25053218
Cites: Scand J Psychol. 2012 Dec;53(6):523-7 PMID 23170866
ErratumIn: Int J Colorectal Dis. 2018 Jan 13;: PMID 29332182
PubMed ID
28913686 View in PubMed
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Prevalence of fecal carriage of antibiotic-resistant bacteria in patients with acute surgical abdominal infections.

https://arctichealth.org/en/permalink/ahliterature143131
Source
Scand J Gastroenterol. 2010 Oct;45(10):1203-10
Publication Type
Article
Date
Oct-2010
Author
Abbas Chabok
Maria Tärnberg
Kenneth Smedh
Lars Påhlman
Lennart E Nilsson
Christian Lindberg
Håkan Hanberger
Author Affiliation
Department of Surgery, Uppsala University, Central Hospital, Västerås, Sweden. abbas.chabok@ltv.se
Source
Scand J Gastroenterol. 2010 Oct;45(10):1203-10
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Abdomen, Acute - surgery
Abdominal Abscess - microbiology - surgery
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Bacteria, Aerobic - drug effects - isolation & purification
Bacteria, Anaerobic - drug effects - isolation & purification
Bacterial Infections - epidemiology - microbiology
Drug Resistance, Multiple, Bacterial
Feces - microbiology
Female
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Prevalence
Prospective Studies
Sampling Studies
Surgicenters
Sweden - epidemiology
Abstract
Antibiotic resistance is increasing worldwide. The aims of the current study were to determine the fecal carriage of antibiotic-resistant bacteria and antibiotic treatment in surgical patients admitted to hospital due to acute intra-abdominal infections.
Eight Swedish surgical units participated in this prospective multicenter investigation. Rectal swabs were obtained on admission to hospital. Cultures were performed on chromogenic agar and antibiotic susceptibility testing was performed using the disk diffusion method. Extended-spectrum beta-lactamase (ESBL)-phenotype was confirmed by Etest.
Rectal samples were obtained and analyzed from 208 patients with intra-abdominal surgical infections. Surgery was performed in 134 patients (65%). Cephalosporins were the most frequently used empirical antibiotic therapy. The highest rates of resistance among Enterobacteriaceae were detected for ampicillin (54%), tetracycline (26%), cefuroxime (26%) and trimethoprim-sulfamethoxazole (20%). The prevalence of decreased susceptibility (I + R) for the other antibiotics tested was for ciprofloxacin 20%, piperacillin-tazobactam 17%, cefotaxime 14%, ertapenem 12%, gentamicin 3% and imipenem 0%. ESBL-producing Enterobacteriaceae were found in samples from 10 patients (5%). Three patients had five E. coli isolates producing AmpC enzymes.
This study shows a high rate of resistance among Enterobacteriaceae against antibiotics which are commonly used in Sweden and should have implications for the future choice of antibiotics for surgical patients.
PubMed ID
20521871 View in PubMed
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6 records – page 1 of 1.