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Associating liver partition and portal vein ligation for staged hepatectomy in patients with colorectal liver metastases--Intermediate oncological results.

https://arctichealth.org/en/permalink/ahliterature274971
Source
Eur J Surg Oncol. 2016 Apr;42(4):531-7
Publication Type
Article
Date
Apr-2016
Author
B. Björnsson
E. Sparrelid
B. Røsok
E. Pomianowska
K. Hasselgren
T. Gasslander
B A Bjørnbeth
B. Isaksson
P. Sandström
Source
Eur J Surg Oncol. 2016 Apr;42(4):531-7
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Colorectal Neoplasms - mortality - pathology - surgery
Female
Hepatectomy - methods
Humans
Incidence
Liver Neoplasms - mortality - secondary - surgery
Male
Middle Aged
Neoplasm Metastasis
Norway - epidemiology
Portal Vein - surgery
Postoperative Complications - epidemiology
Prognosis
Retrospective Studies
Survival Rate - trends
Sweden - epidemiology
Treatment Outcome
Abstract
Colorectal liver metastases (CRLM) not amenable for resection have grave prognosis. One limiting factor for surgery is a small future liver remnant (FLR). Early data suggests that associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) effectively increases the volume of the FLR allowing for resection in a larger fraction of patients than conventional two-stage hepatectomy (TSH) with portal vein occlusion (PVO). Oncological results of the treatment are lacking. The aim of this study was to assess the intermediate oncological outcomes after ALPPS in patients with CRLM.
Retrospective analysis of all patients with CRLM operated with ALPPS at the participating centres between December 2012 and May 2014.
Twenty-three patients (16 male, 7 female), age 67 years (28-80) were operated for 6.5 (1-38) metastases of which the largest was 40 mm (14-130). Six (27.3%) patients had extra-hepatic metastases, 16 (72.7%) synchronous presentation. All patients received chemotherapy, 6 cycles (3-25) preoperatively and 16 (70%) postoperatively. Ten patients (43%) were rescue ALPPS after failed PVO. Severe complications occurred in 13.6% and one (4.5%) patient died within 90 days of surgery. After a median follow-up of 22.5 months from surgery and 33.5 months from diagnosis of liver metastases estimated 2 year overall survival was 59% (from surgery) and 73% (from diagnosis). Liver only recurrences (n = 8), were treated with reresection/ablation (n = 7) while lung recurrences were treated with chemotherapy.
The overall survival, rate of severe complications and perioperative mortality associated with ALPPS for patients with CRLM is comparable to TSH.
PubMed ID
26830731 View in PubMed
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Differential Impact of Anastomotic Leak in Patients With Stage IV Colonic or Rectal Cancer: A Nationwide Cohort Study.

https://arctichealth.org/en/permalink/ahliterature281827
Source
Dis Colon Rectum. 2017 May;60(5):497-507
Publication Type
Article
Date
May-2017
Author
Andreas Nordholm-Carstensen
Hans Christian Rolff
Peter-Martin Krarup
Source
Dis Colon Rectum. 2017 May;60(5):497-507
Date
May-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anastomosis, Surgical - adverse effects - methods
Anastomotic Leak - diagnosis - etiology - mortality
Chemotherapy, Adjuvant - methods
Colectomy - adverse effects - methods
Colorectal Neoplasms - mortality - pathology - surgery
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Outcome and Process Assessment (Health Care)
Prognosis
Registries
Retrospective Studies
Risk factors
Survival Analysis
Abstract
Anastomotic leak has a negative impact on the prognosis of patients who undergo colorectal cancer resection. However, data on anastomotic leak are limited for stage IV colorectal cancers.
The purpose of this study was to investigate the impact of anastomotic leak on survival and the decision to administer chemotherapy and/or metastasectomy after elective surgery for stage IV colorectal cancer.
This was a nationwide, retrospective cohort study.
Data were obtained from the Danish Colorectal Cancer Group, the Danish Pathology Registry, and the National Patient Registry.
Patients who were diagnosed with stage IV colorectal cancer between 2009 and 2013 and underwent elective resection of their primary tumors were included.
The primary outcome was all-cause mortality depending on the occurrence of anastomotic leak. Secondary outcomes were the administration of and time to adjuvant chemotherapy, metastasectomy rate, and risk factors for leak.
Of the 774 patients with stage IV colorectal cancer who were included, 71 (9.2%) developed anastomotic leaks. Anastomotic leak had a significant impact on the long-term survival of patients with colon cancer (p = 0.04) but not on those with rectal cancer (p = 0.91). Anastomotic leak was followed by the decreased administration of adjuvant chemotherapy in patients with colon cancer (p = 0.007) but not in patients with rectal cancer (p = 0.47). Finally, anastomotic leak had a detrimental impact on metastasectomy rates after colon cancer but not on resection rates of rectal cancer.
Retrospective data on the selection criteria for primary tumor resection and metastatic tumor load were unavailable.
The impact of anastomotic leak on patients differed between stage IV colon and rectal cancers. Survival and eligibility to receive chemotherapy and metastasectomy differed between patients with colon and rectal cancers. When planning for primary tumor resection, these factors should be considered.
PubMed ID
28383449 View in PubMed
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Frailty is an independent predictor of survival in older patients with colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature264631
Source
Oncologist. 2014 Dec;19(12):1268-75
Publication Type
Article
Date
Dec-2014
Author
Nina Ommundsen
Torgeir B Wyller
Arild Nesbakken
Marit S Jordhøy
Arne Bakka
Eva Skovlund
Siri Rostoft
Source
Oncologist. 2014 Dec;19(12):1268-75
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Cognition Disorders - epidemiology
Colorectal Neoplasms - mortality - pathology - surgery
Comorbidity
Female
Frail Elderly
Geriatric Assessment
Humans
Male
Neoplasm Staging
Norway - epidemiology
Nutritional Status
Predictive value of tests
Prognosis
Prospective Studies
Risk factors
Survival Rate
Symptom Assessment
Abstract
Colorectal cancer (CRC) is prevalent in the older population. Geriatric assessment (GA) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients. The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors (TNM) stage and age.
A cohort of 178 CRC patients aged 70 and older were followed prospectively. All patients went through elective surgery, and GA was performed presurgery. The GA resulted in patients being divided into two groups: frail or nonfrail. All patients were followed for 5 years or until death. Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model.
Seventy-six patients (43%) were frail, and one hundred and two (57%) were nonfrail. Twenty-three patients (13%) died during the first year after surgery. One-year survival was 80% in the frail group and 92% in the nonfrail group. Five-year survival was significantly lower in frail (24%) than nonfrail patients (66%), and this difference was apparent both within the stratums of TNM stages 0-II and TNM stage III. In multivariable analysis adjusting for TNM stage, age, and sex, frailty was an independent prognostic factor for survival.
A GA-based frailty assessment predicts 1-year and 5-year survival in older patients after surgery for CRC. In localized and regional disease, the impact of frailty upon 5-year survival is comparable with that of TNM stage.
Notes
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PubMed ID
25355846 View in PubMed
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The impact of socioeconomic factors on 30-day mortality following elective colorectal cancer surgery: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature90496
Source
Eur J Cancer. 2009 May;45(7):1248-56
Publication Type
Article
Date
May-2009
Author
Frederiksen B L
Osler M.
Harling H.
Ladelund Steen
Jørgensen T.
Author Affiliation
Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Building 84/85, DK-2600 Glostrup, Denmark. birfre02@glo.regionh.dk
Source
Eur J Cancer. 2009 May;45(7):1248-56
Date
May-2009
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Colorectal Neoplasms - mortality - pathology - surgery
Comorbidity
Denmark - epidemiology
Female
Humans
Life Style
Logistic Models
Male
Middle Aged
Neoplasm Staging
Odds Ratio
Population Surveillance - methods
Postoperative Complications - mortality
Postoperative Period
Risk
Sex Factors
Social Class
Surgical Procedures, Elective - mortality
Abstract
We investigated postoperative mortality in relation to socioeconomic status (SES) in electively operated colorectal cancer patients, and evaluated whether social inequalities were explained by factors related to patient, disease or treatment. Data from the nationwide database of Danish Colorectal Cancer Group were linked to individual socioeconomic information in Statistics Denmark. Patients born before 1921 and those having local surgical or palliative procedures were excluded. A total of 7160 patients, operated on in the period 2001-2004, were included, of whom 342 (4.8%) died within 30 days of surgery. Postoperative mortality was significantly lower in patients with high income (odds ratio (OR)=0.82 (0.70-0.95) for each increase in annual income of EUR 13,500), higher education versus short education (OR)=0.60 (0.41-0.87), and owner-occupied versus rental housing (OR)=0.73 (0.58-0.93). Differences in comorbidity and to a lesser extent lifestyle characteristics accounted for the excess risk of postoperative death among low-SES patients.
PubMed ID
19136251 View in PubMed
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Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature307072
Source
BJS Open. 2020 02; 4(1):118-132
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-2020
Author
P Scherman
I Syk
E Holmberg
P Naredi
M Rizell
Author Affiliation
Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
Source
BJS Open. 2020 02; 4(1):118-132
Date
02-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Colorectal Neoplasms - mortality - pathology - surgery
Female
Hepatectomy - adverse effects
Humans
Liver Neoplasms - mortality - secondary - surgery
Male
Metastasectomy - adverse effects
Middle Aged
Postoperative Complications - epidemiology
Prognosis
Registries
Risk factors
Survival Analysis
Sweden - epidemiology
Young Adult
Abstract
Resection of the primary tumour is a prerequisite for cure in patients with colorectal cancer, but hepatic metastasectomy has been used increasingly with curative intent. This national registry study examined prognostic factors for radically treated primary tumours, including the subgroup of patients undergoing liver metastasectomy.
Patients who had radical resection of primary colorectal cancer in 2009-2013 were identified in a population-based Swedish colorectal registry and cross-checked in a registry of liver tumours. Data on primary tumour and patient characteristics were extracted and prognostic impact was analysed.
Radical resection was registered in 20?853 patients; in 38·7 per cent of those registered with liver metastases, surgery or ablation was performed. The age-standardized relative 5-year survival rate after radical resection of colorectal cancer was 80·9 (95 per cent c.i. 80·2 to 81·6) per cent, and the rate after surgery for colorectal liver metastases was 49·6 (46·0 to 53·2) per cent. Multivariable analysis identified lymph node status, multiple sites of metastasis, high ASA grade and postoperative complications after resection of the primary tumour as strong risk factors after primary resection and following subsequent liver resection or ablation. Age, sex and primary tumour location had no prognostic impact on mortality after liver resection.
Lymph node status and complications have a negative impact on outcome after both primary resection and liver surgery. Older age and female sex were underrepresented in the liver surgical cohort, but these factors did not influence prognosis significantly.
Para curar el cáncer colorrectal es necesaria la resección del tumor primario, pero cada día es más frecuente la realización de una metastasectomía hepática con intención curativa. Este estudio basado en un registro nacional analizó los factores pronósticos para los tumores primarios tratados con intención curativa, incluido un subgrupo de pacientes a los que se realizó una metastasectomía hepática. MÉTODOS: En el registro poblacional sueco de cáncer colorrectal se identificaron los pacientes a los que se realizó una resección primaria radical entre 2009-2013 y se cotejaron con un registro de tumores hepáticos. Se obtuvieron los datos sobre el tumor primario y las características del paciente, y se analizó su influencia en el pronóstico.
Se identificaron 20.853 pacientes con resección radical, de los que en un 38,9% se realizó la resección o ablación de metástasis hepáticas. La supervivencia relativa a 5 años, estandarizada por edad, después de la resección radical del cáncer colorrectal y después de la cirugía de las metástasis hepáticas colorrectales fue del 80,6% (i.c. del 95% 79,8-81,3) y del 49,6% (i.c. del 95%: 46,0-53,2), respectivamente. El análisis multivariable identificó la invasión ganglionar, las metástasis en varias localizaciones, una puntuación ASA alta y las complicaciones postoperatorias después de la resección del tumor primario como factores de riesgo tanto de la resección primaria como de la resección o ablación hepática. No tuvieron influencia sobre la mortalidad tras de la resección hepática ni la edad, el sexo o la ubicación del tumor primario. CONCLUSIÓN: El grado de invasión linfática y las complicaciones después de la resección primaria tuvieron un impacto negativo en los resultados tanto de la cirugía primaria, como de la cirugía hepática. Si bien la edad avanzada y el sexo femenino estaban infrarrepresentados en la cohorte de cirugía hepática, estos factores no influyeron significativamente en el pronóstico.
PubMed ID
32011815 View in PubMed
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The influence of training level and surgical experience on survival in colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature177381
Source
Langenbecks Arch Surg. 2004 Nov;389(6):524-31
Publication Type
Article
Date
Nov-2004
Author
Marja Hilska
Peter J Roberts
Jyrki Kössi
Hannu Paajanen
Yrjö Collan
Matti Laato
Author Affiliation
Department of Surgery, Turku University Central Hospital, 20520 Turku, Finland. marja.hilska@pp.inet.fi
Source
Langenbecks Arch Surg. 2004 Nov;389(6):524-31
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Aged
Clinical Competence
Colorectal Neoplasms - mortality - pathology - surgery
Female
Finland
Gastroenterology
Hospitals, Teaching
Humans
Male
Neoplasm Staging
Palliative Care
Prognosis
Retrospective Studies
Abstract
The effect of surgical training level, experience, and operation volume on complications and survival in colorectal cancer during a 10-year period in a medium-volume university hospital was retrospectively studied.
Four hundred and fifty-six patients were resected for primary colorectal adenocarcinoma during the 10-year period of 1981-1990, and of these, 387 patients underwent resection with curative intent. The surgeons were divided into three groups according to training level and volume: group 1, surgeons in training and other surgeons operating annually on only 1-4 patients; group 2, surgeons specializing in gastrointestinal surgery (average annual volume 4-13 operations); group 3, specialists in gastrointestinal surgery (average annual volume 3-8 operations). Postoperative morbidity and mortality rates, as well as long-term survival rates, were analysed, and comparisons were made between the patients in the three groups.
There were no statistically significant differences between the three groups in postoperative morbidity or mortality. Cancer-specific 5-year survival rate of all patients was 57%, and that of those resected in the aforementioned three groups was 51%, 63%, and 55%, respectively, P=0.087. The 5-year survival rates for colon cancer were 59% (total), 52%, 69%, and 58%, respectively, P=0.067, and for rectal cancer were 51% (total), 42%, 53%, and 52%, respectively, P=0.585.
There were no significant differences in the rates of postoperative mortality, morbidity, and long-term overall survival between the volume groups. However, in patients with colon cancer, there was a trend for better survival for those operated on by the surgeons specializing in gastrointestinal surgery, and in rectal cancer patients, a tendency of fewer local recurrences in those operated on by the specialist surgeons.
PubMed ID
15549371 View in PubMed
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[Laparoscopic resection of the colon]

https://arctichealth.org/en/permalink/ahliterature19952
Source
Klin Khir. 2000 Oct;(10):25-8
Publication Type
Article
Date
Oct-2000
Author
M D Kucher
Source
Klin Khir. 2000 Oct;(10):25-8
Date
Oct-2000
Language
Ukrainian
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Colorectal Neoplasms - mortality - pathology - surgery
English Abstract
Humans
Intestine, Large - pathology - surgery
Laparoscopy - methods
Middle Aged
Rectal Diseases - mortality - pathology - surgery
Survival Rate
Abstract
Possibilities of laparoscopic colonic resection and colectomy in the treatment of the patients with tumoral and nontumoral affection of colon and rectum were determined. Laparoscopic resection of colon and rectum was performed in 94 patients, including 67--for colorectal cancer. Due to the disease recurrency 10 patients died. Laparoscopic resection is the method of choice in the treatment of patients with nontumoral affection of colon.
PubMed ID
11247424 View in PubMed
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Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden.

https://arctichealth.org/en/permalink/ahliterature300520
Source
HPB (Oxford). 2018 05; 20(5):441-447
Publication Type
Comparative Study
Journal Article
Date
05-2018
Author
Valentinus T Valdimarsson
Ingvar Syk
Gert Lindell
Agneta Norén
Bengt Isaksson
Per Sandström
Magnus Rizell
Bjarne Ardnor
Christian Sturesson
Author Affiliation
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Surgery, Lund, Sweden.
Source
HPB (Oxford). 2018 05; 20(5):441-447
Date
05-2018
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Adenocarcinoma - mortality - secondary - surgery
Aged
Bile Duct Neoplasms - mortality - secondary - surgery
Colectomy - adverse effects - mortality
Colorectal Neoplasms - mortality - pathology - surgery
Female
Hepatectomy - adverse effects - mortality
Humans
Liver Neoplasms - mortality - secondary - surgery
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Registries
Risk factors
Sweden
Time Factors
Time-to-Treatment
Treatment Outcome
Abstract
Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.
Clinical, pathological and survival outcomes were compared between the liver-first strategy and the classical strategy (2008-2015). Overall survival was calculated.
A total of 623 patients were identified, of which 246 were treated with the liver-first strategy and 377 with the classical strategy. The median follow-up was 40 months. Patients chosen for the classical strategy more often had T4 primary tumours (23% vs 14%, P = 0.012) and node-positive primaries (70 vs 61%, P = 0.015). The liver-first patients had a higher liver tumour burden score (4.1 (2.5-6.3) vs 3.6 (2.2-5.1), P = 0.003). No difference was seen in five-year overall survival between the groups (54% vs 49%, P = 0.344). A majority (59%) of patients with rectal cancer were treated with the liver-first strategy.
The liver-first strategy is currently the dominant strategy for sCRLM in patients with rectal cancer in Sweden. No difference in overall survival was noted between strategies.
PubMed ID
29242035 View in PubMed
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Outcomes of Simultaneous Resections and Classical Strategy for Synchronous Colorectal Liver Metastases in Sweden: A Nationwide Study with Special Reference to Major Liver Resections.

https://arctichealth.org/en/permalink/ahliterature306541
Source
World J Surg. 2020 07; 44(7):2409-2417
Publication Type
Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2020
Author
Valentinus T Valdimarsson
Ingvar Syk
Gert Lindell
Per Sandström
Bengt Isaksson
Magnus Rizell
Agneta Norén
Bjarne Ardnor
Christian Sturesson
Author Affiliation
Department of Clinical Sciences Lund, Surgery, Skane University Hospital, Lund University, Lund, Sweden.
Source
World J Surg. 2020 07; 44(7):2409-2417
Date
07-2020
Language
English
Publication Type
Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Cohort Studies
Colectomy - methods
Colorectal Neoplasms - mortality - pathology - surgery
Female
Follow-Up Studies
Hepatectomy - methods
Humans
Liver Neoplasms - mortality - secondary - surgery
Male
Middle Aged
Postoperative Complications - epidemiology - etiology
Proctectomy - methods
Registries
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Abstract
About 20% of patients with colorectal cancer have liver metastases at the time of diagnosis, and surgical resection offers a chance for cure. The aim of the present study was to compare outcomes for patients that underwent simultaneous resection to those that underwent a staged procedure with the bowel-first (classical) strategy by using information from two national registries in Sweden.
In this prospectively registered cohort study, we analyzed clinical, pathological, and survival outcomes for patients operated in the period 2008-2015 and compared the two strategies.
In total, 537 patients constituted the study cohort, where 160 were treated with the simultaneous strategy and 377 with the classical strategy. Patients managed with the simultaneous strategy had less often rectal primary tumors (22% vs. 31%, p?=?0.046) and underwent to a lesser extent a major liver resection (16% vs. 41%, p?
PubMed ID
32185455 View in PubMed
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Palliative operations for colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature25111
Source
Dis Colon Rectum. 1990 Oct;33(10):846-50
Publication Type
Article
Date
Oct-1990
Author
J. Mäkelä
K. Haukipuro
S. Laitinen
M I Kairaluoma
Author Affiliation
Department of Surgery, Oulu University Central Hospital, Finland.
Source
Dis Colon Rectum. 1990 Oct;33(10):846-50
Date
Oct-1990
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Colorectal Neoplasms - mortality - pathology - surgery
Female
Humans
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Metastasis
Palliative Care
Postoperative Complications - mortality
Reoperation
Survival Rate
Abstract
A review of 96 consecutive patients who underwent palliative surgery for primary colorectal cancer was undertaken to clarify the value of palliation achieved with surgical treatment. The overall rate of postoperative mortality was 8 percent (8 of 96) and the overall rate of postoperative morbidity was 24 percent (23 of 96). The mortality rate was 5 percent (3 of 66) after resective surgery and 17 percent (5 of 30) after nonresective surgery. Three deaths were related to the malignant disease, three were related to the intra-abdominal infection, and two were related to formation of intestinocutaneous fistulas. Of the 8 patients who died, 1 had a tumor with local visceral involvement only and 7 had a tumor with more distant spread. Median survival was 10 months for all patients, 15 months for patients treated with resective surgery, and 7 months for nonresected patients. Five patients (5 percent) have survived for longer than 5 years. The median relief of preoperative cancer symptoms was 4 months (4 months after resective surgery and 1 month after nonresective surgery). Twenty-five patients have undergone second surgery. It is concluded that palliative resective surgery for colorectal cancer can improve patient comfort with an acceptable postoperative mortality rate when cancer growth is localized and in favorable cases with more distant spread, whereas nonresective surgery fails to achieve symptom relief.
PubMed ID
1698594 View in PubMed
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19 records – page 1 of 2.