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Cancer Resection (cancer + resection)
Selected AbstractsIn-hospital mortality after resection of biliary tract cancer in the United StatesHPB, Issue 1 2010James E. Carroll Jr Abstract Objective:, To assess perioperative mortality following resection of biliary tract cancer within the U.S. Background:, Resection remains the only curative treatment for biliary tract cancer. However, current data on operative mortality after surgical resections for biliary tract cancer are limited to small and single-center studies. Methods:, Using the Nationwide Inpatient Sample 1998,2006, a cohort of patient-discharges was assembled with a diagnosis of biliary tract cancer, including intrahepatic bile duct, extrahepatic bile duct, and gall bladder cancers. Patients undergoing resection, including hepatic resection, bile duct resection, pancreaticoduodenectomy, and cholecystectomy, were retained. The primary outcome measure was in-hospital mortality. Categorical variables were analyzed by chi-square. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality following resection. Results:, 31 870 patient-discharges occurred for the diagnosis of biliary tract cancer, including 36.2% intrahepatic ductal, 26.7% extrahepatic ductal, and 31.1% gall bladder. Of the total, 18.6% underwent resection: mean age was 69.3 years (median 70.0); 60.8% were female; 73.7% were white. Overall inpatient surgical mortality was 5.6%. Independently predictive factors of mortality included patient age ,50 (vs. <50; age 50,59 odds ratio [OR] 5.51, 95% confidence interval [CI] 1.70,17.93; age 60,69 OR 7.25, 95% CI 2.29,22.96; age , 70 OR 9.03, 95% CI 2.86,28.56), the presence of identified comorbidities (congestive heart failure, OR 3.67, 95% CI 2.61,5.16; renal failure, OR 4.72, 95% CI 2.97,7.49), and admission designated as emergent (vs. elective; OR 1.82, 95% CI 1.39,2.37). Conclusion:, Increased in-hospital mortality for patients undergoing biliary tract cancer resection corresponded to age, comorbidity, hospital volume, and emergent admission. Further study is warranted to utilize these observations in promoting early detection, diagnosis, and elective resection. [source] Post-discharge health care needs of patients after lung cancer resectionJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Kwua-Yun Wang Aims and objective., To determine the health care needs of patients after surgical resection of lung cancer at discharge and evaluate the significance of factors associated with such needs. Background., Other studies have found that symptom distress level, social supports and health beliefs are associated with health care needs. Design., Sixty-two participants were recruited from a thoracic surgery clinic at a medical centre in Taipei from July,December 2005. Data related to demographic variables, disease characteristics, functional status, symptom distress and social support were collected. Methods., The patients were administered the Karnofsky Performance Scale, the Symptom Distress Scale,Chinese Modified Form, the Social Support Scale (adapted from the Interpersonal Support Evaluation List), the Health Needs Scale and self-reported rating scales for pain. Data were analysed using Pearson's correlation coefficients and linear regression models. Results., Pulmonary function was found to be correlated with the level of need for health care information and physiological care. Self-perceived symptom distress and degree of distress were also correlated with levels of need for information, physiological care and psychosocial care. The level of pain was found to be correlated with the level of need for health care information and physiological care. After controlling for pain level, multivariate analysis revealed that self-perceived symptom severity (p = 0·032) and degree of distress (p = 0·043) were modestly correlated with the need for health care. Conclusions., Pulmonary function, self-perceived symptom distress, degree of distress and level of pain were correlated with the level of need for health care information and physiological care. Self-perceived symptom severity and degree of distress were independent predictors of health care needs. Relevance to clinical practice., Administration of relevant questionnaires to assess postoperative symptom distress may be necessary for optimal disease management. [source] Biopsy site for detecting Helicobacter pylori infection in patients with gastric cancerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009Chan Gyoo Kim Abstract Background:,Helicobacter pylori eradication is recommended in post-gastric cancer resection, but premalignant changes may prevent the detection of H. pylori. The aim of this study was to determine appropriate biopsy site for detecting H. pylori in gastric cancer patients. Materials and Methods:, Consecutive patients (194) with gastric adenocarcinoma were prospectively enrolled. Helicobacter pylori was evaluated by serology, histology and rapid urease test. Biopsy sites included antrum lesser curvature, upper body lesser curvature (UBLC) and upper body greater curvature (UBGC). Two biopsy specimens were obtained from each site for histological examination. One additional specimen was obtained from UBGC for the rapid urease test. Results:, The overall infection rate of H. pylori was 84.0% (95% CI 78.9,89.2). The sensitivity of histology for detecting H. pylori at various sites was: antrum (54.9%; 95% CI 45.7,63.9), UBLC (80.3%; 95% CI 72.2,87.0) and UBGC (95.1%; 95% CI 89.6,98.2). Specificities of all three biopsy sites were more than 95%. Sensitivity and specificity of the rapid urease test performed at UBGC were 96% and 100%, respectively. Sensitivities of histology decreased in correlation with increasing severity of atrophy and intestinal metaplasia (both P < 0.001 using the chi-square test for trend). The proportions of moderate to marked atrophy/intestinal metaplasia at UBGC (12.8%/14.7%) were significantly lower than those at antrum (50.0%/57.8%, P < 0.001 respectively) or UBLC (40.0%/48.9%, P < 0.001 respectively). Conclusions:, The UBGC side is the most sensitive and specific biopsy site to detect H. pylori in gastric cancer patients due to less frequent atrophy and intestinal metaplasia than at the antrum or UBLC side. [source] Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: A population-based study,JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2006Luke Bui MD Abstract Background and Objectives This study assessed lymph node counts, lymph node status (positive or negative), and survival among patients undergoing colon cancer surgery in Ontario, Canada. Methods We obtained data from the Ontario Cancer Registry on 960 patients who underwent a major colon cancer resection in years 1991,1993. Patients and hospitals were ranked by lymph node count to correlate lymph node counts and lymph node status. For node-negative patients we assessed the influence of patient, hospital, and tumor factors on lymph node counts and survival. Results The rate of node-positive patients was similar among the lymph node count groups. For example, the odds ratio of a patient being node positive if the lymph node count was 10,36 versus 1,3 was 1.0 (CI 0.6,1.6, P,=,0.42). Among node-negative patients, survival was improved for patients with a high (10,36) versus low (1,3) lymph node count (HR 0.6, CI 0.4,1.0, P,=,0.03). No patient, hospital, or tumor factors predicted both a higher lymph node count and improved survival. Conclusions In this population-based study of patients undergoing colon cancer surgery, higher lymph node counts did not correlate with increased rates of node-positive status. J. Surg. Oncol. 2006;93:439,445. © 2006 Wiley-Liss, Inc. [source] Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2006P. Hannemann Background:, For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. Methods:, In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results:, The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2,3 h before anaesthesia. Solid food was permitted up to 6,8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. Conclusion:, In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome. [source] Current concepts in the management of Helicobacter pylori infection,The Maastricht 2-2000 Consensus ReportALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2002P. Malfertheiner Significant progress and new insights have been gained in the 4 years since the first Maastricht Consensus Report, necessitating an update of the original guidelines. To achieve this, the European Helicobacter Pylori Study Group organized a meeting of specialists and experts from around the world, representatives from National Gastroenterology Societies and general practitioners from Europe to establish updated guidelines on the current management of Helicobacter pylori infection. The meeting took place on 21,22 September 2000. A ,test and treat' approach is recommended in adult patients under the age of 45 years (the age cut-off may vary locally) presenting in primary care with persistent dyspepsia, having excluded those with predominantly gastro-oesophageal reflux disease symptoms, non-steroidal anti-inflammatory drug users and those with alarm symptoms. Diagnosis of infection should be by urea breath test or stool antigen test. As in the previous guidelines, the eradication of H. pylori is strongly recommended in all patients with peptic ulcer, including those with complications, in those with low-grade gastric mucosa-associated lymphoid tissue lymphoma, in those with atrophic gastritis and following gastric cancer resection. It is also strongly recommended in patients who are first-degree relatives of gastric cancer patients and according to patients' wishes after full consultation. It is advised that H. pylori eradication is considered to be an appropriate option in infected patients with functional dyspepsia, as it leads to long-term symptom improvement in a subset of patients. There was consensus that the eradication of H. pylori is not associated with the development of gastro-oesophageal reflux disease in most cases, and does not exacerbate existing gastro-oesophageal reflux disease. It was agreed that the eradication of H. pylori prior to the use of non-steroidal anti-inflammatory drugs reduces the incidence of peptic ulcer, but does not enhance the healing of gastric or duodenal ulcer in patients receiving antisecretory therapy who continue to take non-steroidal anti-inflammatory drugs. Treatment should be thought of as a package which considers first- and second-line eradication therapies together. First-line therapy should be with triple therapy using a proton pump inhibitor or ranitidine bismuth citrate, combined with clarithromycin and amoxicillin or metronidazole. Second-line therapy should use quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline. Where bismuth is not available, second-line therapy should be with proton pump inhibitor-based triple therapy. If second-line quadruple therapy fails in primary care, patients should be referred to a specialist. Subsequent failures should be handled on a case-by-case basis by the specialist. In patients with uncomplicated duodenal ulcer, eradication therapy does not need to be followed by further antisecretory treatment. Successful eradica- tion should always be confirmed by urea breath test or an endoscopy-based test if endoscopy is clinically indicated. Stool antigen test is the alternative if urea breath test is not available. [source] Transnasal Esophagoscopy: A High-Yield Diagnostic Tool,THE LARYNGOSCOPE, Issue 6 2005Jennifer G. Andrus MD Abstract Objectives: Transnasal esophagoscopy (TNE) reveals a wide range of esophageal findings. TNE technique, indications, outcomes, advantages, limitations, and impact on patient care are described. Study Design: Retrospective chart review. Methods: Charts of the first 30 patients to undergo TNE in an academic otolaryngology practice were reviewed. Technique details, patient demographics, and procedure indications and findings as well as the disposition of patients in this series are described. TNE limitations are discussed with areas for future development. Results: Thirty patients who underwent unsedated outpatient TNE by their otolaryngologist are described. TNE was directed toward select indications: dysphagia, screening esophagoscopy given long-standing gastroesophageal reflux (GER) or laryngopharyngeal reflux (LPR), and esophageal surveillance with a new diagnosis of head and neck squamous cell carcinoma. Positive findings included mucosal cobblestoning, Barrett's esophagus, esophagitis, gastritis, candidal esophagitis, esophageal diverticulum, postcricoid mass, patulous esophagus, and absence of secondary esophageal peristalsis. Outcomes included referral to a gastroenterologist for evaluation, with or without biopsy; direct laryngoscopy or esophagoscopy with biopsy by the otolaryngologist; planned cancer resection by the otolaryngologist; and medical management of GER/LPR by the otolaryngologist. Conclusions: With appropriate selection criteria, TNE yields a high percentage of positive findings and wide range of esophageal abnormalities, directly impacting patient management. Available to otolaryngologists in the outpatient setting, TNE expedites interventions by providing a safe, effective alternative to rigid esophagoscopy under general anesthesia and flexible upper endoscopy with sedation. Patients will benefit from the integration of TNE into otolaryngologists' outpatient diagnostic armamentarium. [source] PERITONEAL CARCINOMATOSIS FROM COLORECTAL CANCER AND SMALL BOWEL CANCER TREATED WITH PERITONECTOMYANZ JOURNAL OF SURGERY, Issue 6 2006Mena Shehata Background: This study aims to assess the survival of patients who underwent peritonectomy, to assess the morbidity and mortality associated with the procedure and to review the published reports on the survival of patients with peritoneal spread of colorectal cancer (CRC). Methods: Peritonectomy involves resection of all visible peritoneal tumour and is followed by heated intraperitoneal chemotherapy. Peritonectomy with heated intraperitoneal chemotherapy is associated with a 3-year survival of 30,50% in patients with low peritoneal cancer index (PCI) with peritoneal carcinomatosis from CRC. There are approximately 1000 patients in phase 2 studies and a large survival advantage was shown in a randomized control trial. We have carried out over 100 peritonectomy procedures. This study describes 22 patients with peritoneal spread of gastrointestinal cancer treated with peritonectomy between 1996 and March 2005. Twenty of these patients had primary colorectal cancer and two patients had primary small bowel cancer. Results: Of the 22 patients who underwent peritonectomy, 8 patients are now deceased. The median follow up is now 16.1 months. At 12 months, the survival was 61.5% and at 24 months the survival was 46.1%, which are creditable results comparable with the world published reports. We found that those patients with all macroscopic residual tumour removed at the end of the procedure (completeness of cancer resection, CCR O) had improved 24-month survival compared with patients in whom there was incomplete tumour resection (53.3% survival vs 22.2%, respectively, P = 0.024). Patients with a PCI score less than 13 had better survival (P = 0.0003). Conclusions: Peritonectomy for peritoneal carcinomatosis from CRC offers patients improved survival. Our results are consistent with the published data with respect to improved survival in patients with low PCI and complete cytoreduction. [source] Case for postoperative surveillance following colorectal cancer resectionANZ JOURNAL OF SURGERY, Issue 1-2 2004Tim R. Worthington Over 4 years have elapsed since the first National Health and Medical Research Council (NHMRC) guidelines were published for the management of patients after potentially curative resection of colorectal cancer. New information has now been published indicating that more intensive follow up than was originally recommended might provide a survival benefit for patients. This new information should be considered when formulating new NHMRC guidelines. In particular, meta-analyses of published individual trials have suggested a survival advantage that was not evident in the individual studies. There have been significant developments in chemotherapy with new individual agents and use of agents in combination that have proved far more effective than previous protocols. The therapeutic effect of these developments is the downstaging of some patients with metastatic disease, which was previously unresectable, to undergo resection. Furthermore, there is now some evidence that palliation of patients with advanced disease is more effective if commenced before the development of symptoms and this needs to be considered in the assessment of the benefits of follow up. There have been limited studies of cost-effectiveness, but international analyses suggest that the costs associated with more intensive follow-up regimes are within the accepted cost parameters associated with the management of many other conditions. [source] Malnutrition after oesophageal cancer surgery in SwedenBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2007L. Martin Background: Oesophageal cancer resection carries a risk of nutritional disorders. The aim of this study was to estimate weight change after surgery in a population-based setting and to identify nutritional problems that might correlate with weight loss. Methods: Data were collected through the Swedish Esophageal and Cardia Cancer Register, a nationwide registry of oesophageal cancer surgery. Patients who underwent oesophageal cancer surgery between 2001 and 2004 were followed up until April 2005, and data on patient and tumour characteristics and surgical treatment were collected. Six months after surgery the patients were asked to complete a questionnaire about weight and a health-related quality of life questionnaire (European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) with an oesophageal-specific module (EORTC QLQ-OES18)). Results: The response rate to the questionnaire was 76·9 per cent and weight change in 226 patients was analysed. Six months after operation 63·7 per cent had lost more than 10 per cent of their preoperative BMI, and 20·4 per cent had lost more than 20 per cent. Appetite loss, eating difficulties and odynophagia were significantly linked to postoperative weight loss, whereas dysphagia or reflux did not correlate with malnutrition. Conclusion: Malnutrition is a considerable problem after oesophagectomy, and is linked to appetite loss, eating difficulties and odynophagia. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Patient personality predicts postoperative stay after colorectal cancer resectionCOLORECTAL DISEASE, Issue 2 2008A. Sharma Abstract Objective, Postoperative length of stay (LOS) is an important outcome after colorectal cancer surgery. The aim of this study was to evaluate the putative effects of personality, mood, coping and quality of life on LOS. Method, A consecutive series of 110 eligible patients undergoing elective resection for colorectal cancer were invited to participate in the study. A battery of psychometric questionnaires including the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy (colorectal), the Courtauld Emotional Control Scale, the Positive and Negative Affectivity Scale and the Eysenck Personality Questionnaire (EPQ) were administered 5,12 days before surgery. Nonparametric correlations were computed for psychometric scores, demographic variables and the LOS. Factors found to be significantly correlated on this analysis were entered into a multiple regression model to determine the independent predictors of LOS. Results, One hundred and four patients with colorectal cancer participated. Seventy were male (67%) and the mean age was 68 years (range 39,86). The median LOS was 10 days (range 4,108). LOS was negatively correlated with pre- and postoperative albumin levels, PANAS +ve affect, Functional Assessment of Cancer Therapy questionnaire with the colorectal module functional well-being score and EPQ extroversion score. LOS was strongly positively correlated with postoperative morbidity. LOS was positively correlated with CECS anger score, age and being male. Postoperative morbidity (, = 0.379, P = 0.007) and extroversion (, = ,0.318, P = 0.05) were independent predictors of LOS. Conclusion, Personality as measured by EPQ predicts postoperative LOS in patients with colorectal cancer. Extroverts have a higher pain threshold and this may be part of the explanation. [source] Targets and elective colorectal cancer: outcome and symptom delay at surgical resectionCOLORECTAL DISEASE, Issue 2 2005S. Bharucha Abstract Objective To determine, for elective patients with colorectal cancer, if associations exist between the length of symptom history at surgical resection and Dukes stage, completeness of the surgical procedure and patient survival. Patients and methods A prospective cohort study was undertaken. Five hundred and eighty-two patients with colorectal cancer, admitted for surgical resection after outpatient consultation, divided into four equal quartiles according to length of symptom history (short: n = 131, 0,103 days; medium: n = 136, 104,177 days; long: n = 136, 178,318 days; very long: n = 137, 319,1997 days). The main outcome measures used were the Extent of tumour (Dukes stage) at resection, completeness of resectional surgery (curative vs palliative), patient survival after resection. Results For patients undergoing elective surgical resection of colorectal cancer we did not find an association between Dukes stage and duration of patient history (Dukes stage C tumours were seen in 37% (CI: 26.2%-48.0%) of patients with a short symptomatic history as opposed to 34% (CI: 32%-62%) with a very long symptomatic history). Elective curative resection was not associated with a significantly different symptom duration than elective palliative resection (Palliative resections were performed in 24% (CI: 11.7%-36.4%) of patients with a short symptomatic history as opposed to 16% (CI: 2.4%-29.9%) with a very long symptomatic history). The median survival time for the four elective colorectal patient groups defined by length of symptomatic history was not significantly different , (short: n = 131, 4.3 years; medium: n = 136, 5.9 years; long: n = 136, 7.1 years; very long: n = 137, 5.0 years). Conclusion Tumour extent, completeness of resection and patient outcome after elective colorectal cancer resection was not found to have an association with length of patient history at the time of surgery. [source] Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patientsCOLORECTAL DISEASE, Issue 1 2005M. T. Eriksen Abstract Objective Mesorectal excision is successfully implemented as the standard surgical technique for rectal cancer resections in Norway. This technique has been associated with higher rates of anastomotic leakage (AL) and the purpose of this study was to examine AL in a large national cohort of patients. Methods This was a prospective national cohort study of 1958 patients undergoing rectal cancer surgery with anterior resection in Norway from November 1993 to December 1999. Results The overall rate of AL was 11.6% (228 of 1958 patients). In a multivariate analysis, the risk of AL was significantly higher in males (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1,2.2), in patients receiving pre-operative radiotherapy (OR 2.2, CI 1.0,4.7) and in low level (4,6 cm) (OR 3.5, CI 1.6,7.7) and ultra-low level (, 3 cm) anastomoses (OR 5.4, CI 2.3,12.9). The presence of a diverting stoma was associated with a 60% reduction in the risk of AL (OR 0.4, CI 0.3,0.7) for anastomoses 6 cm and below. 30-day mortality was significantly higher for the patients with AL (7.0%, CI 3.7,10.3) compared with no AL (2.4%, CI 1.7,3.2) AL had no significant effect on local recurrence rate (log rank P = 0.608). Conclusion Low anastomoses should be defunctioned to avoid AL and the associated high perioperative mortality. No effect of AL on local recurrence was found in this large cohort. [source] Tales from the frontline: the colorectal battle against SARSCOLORECTAL DISEASE, Issue 2 2004I. M. J. Bradford Abstract Objective The recent worldwide epidemic of Severe Acute Respiratory Disease (SARS) caused over 800 deaths and had a major impact on the health services in affected communities. The impact of SARS on colorectal surgery, particularly service provision and training, is unknown. This paper reports these changes from a single colorectal unit at the centre of the outbreak. Patients and methods Hospital databases and electronic patient records covering the 4 months duration of the SARS epidemic and an equivalent period preceding SARS were compared. Data was collected for inpatient admissions, outpatient consultations, operative surgery, colonoscopy and waiting times for appointments or surgery. Results The SARS epidemic resulted in reductions of 52% for new outpatient attendances, 59% for review attendances, 51% for admissions, 32% for surgical procedures and 48% for colonoscopies. Major emergency procedures, cancer resections and complex major procedures were unaffected. Operative procedures by trainees reduced by 48% and procedures by specialists reduced by 21%. Patients awaiting early or urgent outpatient appointments rose by 200% with waiting times for colonoscopy increased by a median 3, 5 or 9 weeks for outpatient, inpatient or non-urgent cases, respectively. The waiting time for minor elective colorectal surgery was extended by 5 months. Conclusion SARS resulted in a major reduction in the colorectal surgical caseload. The consequences were evidenced by a detrimental effect on waiting times and colorectal training. However, serious pathology requiring emergency or complex surgery was still possible within these constraints. [source] | ||||||||||||||||||||||