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High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study.

https://arctichealth.org/en/permalink/ahliterature294215
Source
Colorectal Dis. 2017 Dec; 19(12):1067-1075
Publication Type
Evaluation Studies
Journal Article
Multicenter Study
Date
Dec-2017
Author
K Holmgren
D Kverneng Hultberg
M M Haapamäki
P Matthiessen
J Rutegård
M Rutegård
Author Affiliation
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Source
Colorectal Dis. 2017 Dec; 19(12):1067-1075
Date
Dec-2017
Language
English
Publication Type
Evaluation Studies
Journal Article
Multicenter Study
Keywords
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical - adverse effects
Anastomotic Leak - epidemiology - etiology
Female
Humans
Logistic Models
Male
Middle Aged
Neoplasm Staging
Prevalence
Proportional Hazards Models
Rectal Neoplasms - pathology - surgery
Rectum - surgery
Registries
Reoperation - adverse effects - methods
Retrospective Studies
Risk factors
Surgical Stomas - adverse effects
Sweden - epidemiology
Treatment Outcome
Abstract
Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.
Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.
A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.
Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.
Notes
CommentIn: Colorectal Dis. 2018 Apr;20(4):342 PMID 29327402
CommentIn: Colorectal Dis. 2018 Apr;20(4):342-343 PMID 29377501
PubMed ID
28612478 View in PubMed
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The importance of rectal washout for the oncological outcome after Hartmann's procedure for rectal cancer: analysis of population-based data from the Swedish Colorectal Cancer Registry.

https://arctichealth.org/en/permalink/ahliterature293075
Source
Tech Coloproctol. 2017 May; 21(5):373-381
Publication Type
Evaluation Studies
Journal Article
Date
May-2017
Author
F Jörgren
R Johansson
H Arnadottir
G Lindmark
Author Affiliation
Department of Surgery, Helsingborg Hospital, Lund University, 251 87, Helsingborg, Sweden. fredrik.jorgren@skane.se.
Source
Tech Coloproctol. 2017 May; 21(5):373-381
Date
May-2017
Language
English
Publication Type
Evaluation Studies
Journal Article
Keywords
Adult
Aged
Aged, 80 and over
Colostomy - methods
Female
Humans
Intraoperative Care - methods
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local - epidemiology - etiology
Rectal Neoplasms - mortality - surgery
Rectum - surgery
Registries
Survival Rate
Sweden
Therapeutic Irrigation - methods
Treatment Outcome
Abstract
During rectal cancer surgery the bowel may contain viable, exfoliated cancer cells, a potential source for local recurrence (LR). The amount and viability of these cells can be reduced using intraoperative rectal washout, a procedure that reduces the LR risk after anterior resection. The aim of this study was to analyse the impact of washout on oncological outcome when performed in Hartmann's procedure (HP) for rectal cancer.
A national cohort study on data for patients registered from 1995 to 2007 in the Swedish Colorectal Cancer Registry was carried out. The final analysis included patients belonging to TNM stages I-III who had undergone R0 HP with a registered 5-year follow-up. Multivariate analysis was performed.
A total of 1188 patients were analysed (686 washout and 502 no washout). No differences were detected between the washout group and the no washout group concerning rates of LR [7% (49/686) vs. 10% (49/502); p = 0.13], distant metastasis (DM) [17% (119/686) vs. 18% (93/502); p = 0.65], and overall recurrence (OAR) [21% (145/686) vs. 24% (120/502); p = 0.29]. For both groups, the 5-year cancer-specific survival was below 50%. In multivariate analysis, washout neither decreased the risk of LR, DM, or OAR nor increased overall or the cancer-specific 5-year survival.
The oncological outcome did not improve when washout was performed in HP for rectal cancer.
Notes
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PubMed ID
28560479 View in PubMed
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Level of vascular tie and its effect on functional outcome 2 years after anterior resection for rectal cancer.

https://arctichealth.org/en/permalink/ahliterature292627
Source
Colorectal Dis. 2017 Nov; 19(11):987-995
Publication Type
Evaluation Studies
Journal Article
Date
Nov-2017
Author
D Kverneng Hultberg
A A Afshar
J Rutegård
M Lange
M M Haapamäki
P Matthiessen
M Rutegård
Author Affiliation
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Source
Colorectal Dis. 2017 Nov; 19(11):987-995
Date
Nov-2017
Language
English
Publication Type
Evaluation Studies
Journal Article
Keywords
Aged
Fecal Incontinence - etiology - physiopathology
Female
Humans
Ligation - adverse effects - methods
Male
Mesenteric Artery, Inferior - surgery
Middle Aged
Postoperative Complications - etiology - physiopathology
Postoperative Period
Rectal Neoplasms - physiopathology - surgery
Rectum - surgery
Registries
Retrospective Studies
Sexual Dysfunction, Physiological - etiology - physiopathology
Sweden
Time Factors
Urinary Incontinence - etiology - physiopathology
Abstract
Previous research indicates that high tie of the inferior mesenteric artery during anterior resection for rectal cancer might be associated with an increased risk of postoperative functional disturbances. The goal of this population-based retrospective cohort study was to further investigate that association.
Patients who underwent anterior resection for rectal cancer from April 2011 to September 2012 were identified through the Swedish Colorectal Cancer Registry. Bowel and urogenital function were assessed by a postal questionnaire 2 years after surgery. Information on the level of mesenteric tie and clinical variables was retrieved from the registry. The outcome was defined as any defaecatory, urinary or sexual dysfunction as reported by the patient. The association between high tie and the outcome was evaluated with multivariable logistic and linear regression with adjustment for confounders, such as sex, body mass index, comorbidity and preoperative radiation.
With a response rate of 86%, 805 patients were included in the study. Of these, 46% were operated with high tie. After adjustment for confounders, high tie did not affect the risk of faecal incontinence (OR 0.85; 95% CI 0.59-1.22), urinary incontinence (OR 0.94; 95% CI 0.63-1.41) or various aspects of sexual dysfunction (erectile dysfunction, anejaculation, dyspareunia and coital vaginal dryness). However, an association between high tie and defaecation at night was detected (OR 1.44; 95% CI 1.02-2.03).
This study does not support that the level of vascular tie influences the risk of major defaecatory, urinary or sexual disturbances 2 years after anterior resection for rectal cancer.
PubMed ID
28544473 View in PubMed
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Nausea and vomiting of pregnancy: A study with pregnancy-unique quantification of emesis questionnaire.

https://arctichealth.org/en/permalink/ahliterature298575
Source
Eur J Obstet Gynecol Reprod Biol. 2018 Nov; 230:60-67
Publication Type
Evaluation Studies
Journal Article
Date
Nov-2018
Author
Pauliina Ellilä
Linda Laitinen
Miina Nurmi
Päivi Rautava
Mari Koivisto
Päivi Polo-Kantola
Author Affiliation
Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
Source
Eur J Obstet Gynecol Reprod Biol. 2018 Nov; 230:60-67
Date
Nov-2018
Language
English
Publication Type
Evaluation Studies
Journal Article
Keywords
Adolescent
Adult
Female
Finland - epidemiology
Humans
Middle Aged
Morning Sickness - diagnosis - epidemiology - etiology
Parity
Pregnancy
Risk factors
Severity of Illness Index
Surveys and Questionnaires
Symptom Assessment - methods
Young Adult
Abstract
Nausea and vomiting of pregnancy (NVP) is frequent, affecting up to 70-85% of pregnant women. However, severity of NVP especially in clinical practice is often uncertainly assessed and thus both under- and overdiagnosing is probable. Furthermore, risk factors for NVP, although recognized, are not well established. The aim of our study was to evaluate the severity of NVP with a structured questionnaire and evaluate associative risk factors.
Sample of 2411 women were recruited from maternity health care clinics. Severity of NVP was assessed with pregnancy-unique quantification of emesis (PUQE) questionnaire. Age, previous pregnancies, previous deliveries, previous miscarriages including ectopic pregnancies, previous pregnancy terminations, nationality, pre-pregnancy body mass index, smoking, marital status and employment were used as explanatory factors.
Altogether 88.0% of the women reported some level of NVP, of which 6.4% was severe, 52.2% moderate and 29.4% mild. Daily duration of NVP was?=?four hours in 12?h in 45.0%. Further, 18.8% of the women had vomiting episodes?=?three times and 37.4% retching episodes?=?three times in 12?h. Women with?=?two previous pregnancies had increased risk for more severe NVP (OR 2.17, 95%CI; 1.34-3.51, p?
PubMed ID
30243227 View in PubMed
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