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Postoperative Mortality (postoperative + mortality)

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Medical Sciences	100%

Selected Abstracts

Clinical outcome and survival after esophagectomy for carcinoma in elderly patients

DISEASES OF THE ESOPHAGUS, Issue 2 2003
L. Bonavina
SUMMARY Advances in perioperative management have allowed more and more elderly patients to undergo major surgery with postoperative morbidity and mortality rates comparable to those of younger individuals. The aim of this study was to evaluate the impact of age on the clinical outcome and long-term survival of patients with esophageal carcinoma undergoing esophagectomy. Nine-hundred patients with esophageal carcinoma were divided into two groups: A (n = 403) with age , 65 years, and B (n = 497) with age < 65 years. One-hundred and fifty three (38%) patients of group A underwent surgery compared to 272 (55%) of group B (P < 0.01). Postoperative mortality, and the prevalence of anastomotic leak and respiratory complications were similar in both groups; conversely, there was a higher prevalence of cardiovascular complications in group A (13%vs 3%, P < 0.01). Five-year survival was about 35% in both groups. In conclusion, advanced age should no longer be considered an absolute contraindication to esophagectomy for carcinoma in selected patients. In fact, the postoperative mortality and long-term survival rates of elderly patients undergoing resection are comparable to that of younger individuals. [source]

Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2005
Ian Ganly MD
Abstract Background. Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies. Methods. One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications. Results. Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications. Conclusions. CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Does the Trainee's Level of Experience Impact on Patient Safety and Clinical Outcomes in Coronary Artery Bypass Surgery?

JOURNAL OF CARDIAC SURGERY, Issue 1 2008
L. Ray Guo M.D.
We designed this study to determine if there were any significant differences in patient demographics and clinical outcomes of coronary artery bypass procedures (CABG) performed by residents of PGY 4/lower, residents of PGY 5/6, fellows, or consultants. Methods: Standardized preoperative, intraoperative, and postoperative variables were prospectively collected and analyzed on 2906 isolated CABG procedures, performed between July 1999 and March 2006 with the primary surgeon prospectively classified as PGY4/lower, PGY5/6, fellow, and consultant. Results: The number of cases performed by residents of PGY4/lower, PGY5/6, fellows and consultants were 179, 263, 301, and 2163, respectively. Preoperative demographics and comorbidities were similar except PGY4/lower group had more diabetics and consultant group had more patients requiring IABP. More non-LIMA arterial conduits were used in the consultant and fellow groups. However, there were neither significant differences in the mean number of grafts nor in the composite postoperative morbidity, median ICU, and hospital lengths of stay. Observed in-hospital mortality was 2.2%, 1.5%, 1.7%, and 2.7% (p = 0.49), respectively. Conclusions: Preoperative patient demographics and operative data were similar in all groups except that patients requiring IABP preoperatively were more likely operated on by consultants and arterial revascularization was performed more commonly by consultants and fellows. Postoperative mortality and morbidity rates were similar among all groups, thus demonstrating that with appropriate supervision, trainees of all levels can safely be taught CABG. [source]

Combined biliary and gastric bypass procedures as effective palliation for unresectable malignant disease

ANZ JOURNAL OF SURGERY, Issue 6 2009
Christopher D. Mann
Abstract Background:, Although endoscopic treatment of jaundice is increasingly used in the palliation of unresectable malignant disease, surgical bypass still has a role to play in this setting. This study aimed to reappraise the short-term and long-term results of combined biliary/gastric bypass (hepaticojejunostomy and gastrojejunostomy) as palliation for unresectable malignant disease. Methods:, All patients undergoing simultaneous biliary and gastric bypass procedures for unresectable malignant disease between August 2000 and January 2006 were identified and outcomes reviewed. Results:, One hundred and two patients underwent open surgical biliary drainage procedures for palliation of malignant disease. Underlying malignant disease included pancreatic carcinoma (n = 88), duodenal adenocarcinoma (n = 6) and distal cholangiocarcinoma (n = 3). Thirty-one of the patients underwent a planned palliative bypass procedure, the remainder being carried out after unresectable disease was identified at laparotomy. Postoperative mortality and morbidity rates were higher in the group undergoing planned bypass. During follow up, two patients developed recurrent jaundice that required transhepatic stenting and two patients developed late gastric outlet obstruction requiring refashioning of the gastrojejunostomy. Conclusion:, Combined surgical biliary and gastric bypass achieved effective palliation of jaundice and gastric outlet obstruction until death in >95% of patients in this series. It remains first-line therapy in patients identified as having unresectable disease at laparotomy. [source]

Clinical outcome and survival after esophagectomy for carcinoma in elderly patients

Complications of craniofacial resection for malignant tumors of the skull base: Report of an International Collaborative Study,

Utility of the Gyrus open forceps in hepatic parenchymal transection

HPB, Issue 3 2009
Matthew R. Porembka
Abstract Objective:, This study aimed to evaluate if the Gyrus open forceps is a safe and efficient tool for hepatic parenchymal transection. Background:, Blood loss during hepatic transection remains a significant risk factor for morbidity and mortality associated with liver surgery. Various electrosurgical devices have been engineered to reduce blood loss. The Gyrus open forceps is a bipolar cautery device which has recently been introduced into hepatic surgery. Methods:, We conducted a single-institution, retrospective review of all liver resections performed from November 2005 through November 2007. Patients undergoing resection of at least two liver segments where the Gyrus was the primary method of transection were included. Patient charts were reviewed; clinicopathological data were collected. Results:, Of the 215 open liver resections performed during the study period, 47 patients met the inclusion criteria. Mean patient age was 61 years; 34% were female. The majority required resection for malignant disease (94%); frequent indications included colorectal metastasis (66%), hepatocellular carcinoma (6%) and cholangiocarcinoma (4%). Right hemihepatectomy (49%), left hemihepatectomy (13%) and right trisectionectomy (13%) were the most frequently performed procedures. A total of 26 patients (55%) underwent a major ancillary procedure concurrently. There were no operative mortalities. Median operative time was 220 min (range 97,398 min). Inflow occlusion was required in nine patients (19%) for a median time of 12 min (range 3,30 min). Median total estimated blood loss was 400 ml (range 10,2000 ml) and 10 patients (21%) required perioperative transfusion. All patients had macroscopically negative margins. Median length of stay was 8 days. Two patients (4%) had clinically significant bile leak. The 30-day postoperative mortality was zero. Conclusions:, Use of the Gyrus open forceps appears to be a safe and efficient manner of hepatic parenchymal transection which allows rapid transection with acceptable blood loss, a low rate of perioperative transfusion, and minimal postoperative bile leak. [source]

Evaluation of hernia repair operation in Child,Turcotte,Pugh class C cirrhosis and refractory ascites

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2007
Joo Kyung Park
Abstract Background and Aim:, Abdominal wall hernia is a common feature of decompensated liver cirrhosis and frequently causes life-threatening complications or severe pain. However, there have been no data reported on postoperative mortality, hepatic functional deterioration and recurrence rate according to Child,Turcotte,Pugh (CTP) class and to the presence of refractory ascites. Methods:, The study population comprised 53 liver cirrhosis patients who underwent hernia repair operation. Comparisons were made of 30-day mortality among the different CTP classes, and between those with or without refractory ascites. Liver function was also analyzed just before the operation, in the immediate postoperative period, and in the remote postoperative period. Results:, Seventeen patients were in CTP class A, 27 patients in class B, and 9 patients in class C. The median follow-up duration was 24 months. There was single 30-day postoperative mortality in class C, and no CTP class deterioration after 30 days of operation. There was no mortality or recurrences in 17 patients with medically refractory ascites. The difference in 30-day mortality according to CTP class and the presence of refractory ascites did not show statistical significance (P = 0.17 and 0.97, respectively). Conclusion:, Hernia operation could be done safely in CTP class A and B with low rate of recurrences, and there was no definitive increase in the operative risk in class C. In addition, refractory ascites did not increase operative risk and recurrence rate. Therefore, surgical repair might be recommended even in patients with refractory ascites and poor hepatic function to prevent life-threatening complications or severe pain. [source]

Resection and reconstruction of retrohepatic vena cava without venous graft during major hepatectomies

JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2007
Marcel Autran C. Machado MD
Abstract Background Progress in liver surgery has enabled hepatectomy with concomitant venous resection for liver malignancies involving the inferior vena cava (IVC). The authors describe an alternative technique for IVC reconstruction without the need of graft. Methods Parenchymal transection is performed from anterior surface of the liver down to the anterior or left lateral surface of the IVC using combination of two techniques reported elsewhere. IVC is clamped above and below the tumor and the liver in continuity with an invaded segment of IVC is removed en bloc. A transverse anastomosis of IVC is performed starting with running suture on the posterior wall followed by the anterior wall. Results This approach has been successfully employed in eight consecutive patients with IVC involvement. The procedures performed were 5 right hepatectomies, 1 right posterior sectionectomy, 1 right trisectionectomy, and 1 left trisectionectomy. Two patients needed total vascular exclusion (TVE) for 11 and 10 min, respectively. Blood transfusion was necessary in three patients. Pathologic surgical margins were free in all cases. No postoperative mortality was observed. Conclusion This technique of IVC reconstruction precludes the use of graft and minimizes the use of TVE decreasing ischemic damage to the remnant liver. J. Surg. Oncol. 2007;96:73,76. © 2007 Wiley-Liss, Inc. [source]

Concentrated preoperative radiotherapy for resectable gastric cancer: 20-years follow-up of a randomized trial

JOURNAL OF SURGICAL ONCOLOGY, Issue 2 2002
Vitali Skoropad MD
Abstract Background and Objectives The role of radiation therapy in resectable gastric cancer is questionable. To study the value of concentrated preoperative radiotherapy, a randomized clinical trial had been carried out. Methods From 1974 to 1978, 152 patients were randomized and underwent exploratory laparotomy; in 50 patients curative surgery was not possible, while 102 patients satisfied protocol requirements and entered in the trial. Patients in the experimental group were treated with preoperative radiotherapy (20 Gy/5 days) and subtotal or total gastrectomy. Patients in the control group underwent surgery alone. Results Study showed acceptable tolerance of radiotherapy regime with no increase of postoperative mortality and morbidity. There was no significant difference in survival between the two treatment groups (,2,=,0.349, df,=,1, P,=,0.555). Subset analysis also failed to demonstrate significant survival advantages of the combined treatment; however, some positive trends were seen in patients with locally advanced gastric cancer. Conclusions Concentrated preoperative radiotherapy in the dose of 20 Gy is safe and feasible, but seems to be insufficient to improve survival in gastric cancer patients. However, the results are promising in selected subgroups of patients, which encourages future trials with adjuvant radiation therapy. J. Surg. Oncol. 2002;80:72,78. © 2002 Wiley-Liss, Inc. [source]

Platelet activation, myocardial ischemic events and postoperative non-response to aspirin in patients undergoing major vascular surgery

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 10 2007
S. RAJAGOPALAN
Summary.,Objectives:,Myocardial ischemia is the leading cause of postoperative mortality and morbidity in patients undergoing major vascular surgery. Platelets have been implicated in the pathogenesis of acute thrombotic events. We hypothesized that platelet activity is increased following major vascular surgery and that this may predispose patients to myocardial ischemia.Methods:,Platelet function in 136 patients undergoing elective surgery for subcritical limb ischemia or infrarenal abdominal aortic aneurysm repair was assessed by P-selectin expression and fibrinogen binding with and without adenosine diphosphate (ADP) stimulation, and aggregation mediated by thrombin receptor-activating peptide and arachidonic acid (AA). Cardiac troponin-I (cTnI) was performed.Results:,P-selectin expression increased from days 1 to 3 after surgery [median increase from baseline on day 3: 53% (range: ,28% to 212%, P < 0.01) for unstimulated and 12% (range: ,9% to 45%, P < 0.01) for stimulated]. Fibrinogen binding increased in the immediate postoperative period [median increase from baseline: 34% (range: ,46% to 155%, P < 0.05)] and decreased on postoperative day 3 (P < 0.05). ADP-stimulated fibrinogen binding increased on day1 (P < 0.05) and thereafter decreased. Platelet aggregation increased on days 1,5 (P < 0.05). Twenty-eight (21%) patients had a postoperative elevation (> 0.1 ng mL,1) of cTnI. They had significantly increased AA-stimulated platelet aggregation in the immediate postoperative period and on day 2 (P < 0.05), and non-response to aspirin (48% vs. 26%, P = 0.036).Conclusions:,This study has shown increased platelet activity and the existence of non-response to aspirin following major vascular surgery. Patients with elevated postoperative cTnI had significantly increased AA-mediated platelet aggregation and a higher incidence of non-response to aspirin compared with patients who did not. [source]

Robotic vs. laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease: systematic review and meta-analysis

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2010
S. R. Markar
Abstract The aim of this meta-analysis was to compare clinical outcome following laparoscopic and robotic Nissen fundoplication. A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the requirement for re-operation, postoperative mortality and postoperative dysphagia. Secondary outcome measures were operative time, length of hospital stay, operative complications and cost. Six randomized trials, of 226 patients, were included in this meta-analysis. There was no significant difference in requirement for re-operation or in postoperative dysphagia. There was a significantly reduced total operative time in the laparoscopic group (weighted mean difference = 4.154; 95% CI = 1.932,6.375; p = 0.0002). There was no significant difference between robotic and laparoscopic groups for hospital stay or operative complications. Clinical results from robotic Nissen fundoplication were comparable to the standard laparoscopic approach, but there was associated increased operative time and procedure cost. Copyright © 2010 John Wiley & Sons, Ltd. [source]

A Rational Approach to the Use of Tracheotomy in Surgery of the Anterior Skull Base

THE LARYNGOSCOPE, Issue 2 2008
FRCS(C), Yadranko Ducic MD
Abstract Objective: To offer an algorithm for airway management in anterior skull base surgery. Methods: This is a retrospective review of 109 patients undergoing major anterior skull base surgery from a single senior surgeon's experience from September 1997 to May 2006. Results: We report only one (1%) postoperative mortality in this series and only seven major complications in six patients, including two cases of stroke, one case of cerebrospinal fluid (CSF) leak, and four cases of delayed osteoradionecrosis. No patients in this series developed tension pneumocephalus. The total major complication rate is 6%. Fifty-one (47%) patients received prophylactic tracheotomy, and 58 (53%) patients did not receive prophylactic tracheotomy. Eighty-eight (81%) patients received anterior skull base reconstruction with local flaps. Six (5.5%) patients required primary reconstruction with a free flap. Conclusion: We attribute the very low rate of major complications in this series and, in particular, no cases of tension pneumocephalus and rarity of CSF leaks primarily to prophylactic tracheotomy in selected patients and to a reconstructive strategy that emphasizes use of local vascularized tissue to reconstruct the anterior skull base. [source]

Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network,

ANAESTHESIA, Issue 3 2010
S. M. White
Summary The aim of this audit was to investigate process, personnel and anaesthetic factors in relation to mortality among patients with proximal femoral fractures. A questionnaire was used to record standardised data about 1195 patients with proximal femoral fracture admitted to 22 hospitals contributing to the Hip Fracture Anaesthesia Network over a 2-month winter period. Patients were demographically similar between hospitals (mean age 81 years, 73% female, median ASA grade 3). However, there was wide variation in time from admission to operation (24,108 h) and 30-day postoperative mortality (2,25%). Fifty percent of hospitals had a mean admission to operation time < 48 h. Forty-two percent of operations were delayed: 51% for organisational; 44% for medical; and 4% for ,anaesthetic' reasons. Regional anaesthesia was administered to 49% of patients (by hospital, range = 0,82%), 51% received general anaesthesia and 19% of patients received peripheral nerve blockade. Consultants administered 61% of anaesthetics (17,100%). Wide national variations in current management of patients sustaining proximal femoral fracture reflect a lack of research evidence on which to base best practice guidance. Collaborative audits such as this provide a robust method of collecting such evidence. [source]

SENSATION RECOVERY IMPROVED BY GREAT AURICULAR NERVE PRESERVATION IN PAROTIDECTOMY: A PROSPECTIVE DOUBLE-BLIND STUDY

ANZ JOURNAL OF SURGERY, Issue 5 2007
Dacita T. K. Suen
Background: The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery. Methods: Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two-point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long-term subjective assessment was also carried out beyond 2 years postoperatively. Results: A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12,42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation. Conclusion: Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised. [source]

POSSUM scoring for laparoscopic cholecystectomy in the elderly

ANZ JOURNAL OF SURGERY, Issue 7 2005
Andrew L. Tambyraja
Background: Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring is a validated scoring system in the audit of surgical outcomes; however, evaluation of this system has mostly been applied to open surgical techniques. The present study examines the validity of POSSUM in predicting morbidity and mortality in patients undergoing laparoscopic cholecystectomy (LC) with the recognized risk factor for postoperative mortality of advanced age. Methods: All patients aged 80 years or over undergoing LC in one surgical unit between January 1993 and December 1999 were identified from the surgical operations database of the hospital. Case-note review was used to collate data in terms of clinical and operative factors as described in POSSUM. Observed/POSSUM estimated (O/E) ratio of morbidity and 30-day mortality were calculated. Results: Laparoscopic cholecystectomy was performed in 76 patients aged 80 years or over during the study period. Of these patients, case notes for 70 patients (92%) were available for review. Median (range) age was 83 years (80,93 years) and median (range) American Society of Anesthesiologists score was 2 (2,4). Twenty-six (34%) of 70 patients underwent cholecystectomy during an acute admission. The mean physiology severity score was 23 and operative severity score, 8. A significant postoperative morbidity was observed in 15 (22%) of 70 patients. There was no 30-day mortality. Using exponential analysis, POSSUM predicted morbidity in 15 patients and mortality in seven patients. Thus, O/E ratios for morbidity and mortality were 1 and 0, respectively. Conclusion: POSSUM scoring performs well in predicting morbidity, but overpredicts mortality, after LC in patients aged over 80 years. An assessment of its application to other laparoscopic procedures merits evaluation. [source]

Thoracoscopic resection for intrathoracic neurogenic tumors

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2010
M Odaka
Abstract Introduction: The thoracoscopic approach is becoming the standard for intrathoracic neurogenic tumors, though certain technical issues still need to be resolved. The purpose of this study is to evaluate the feasibility of thoracoscopic surgery for intrathoracic neurogenic tumors. Methods: We evaluated short-term outcomes of 14 consecutive patients who underwent resection of intrathoracic neurogenic tumors between July 2005 and June 2009. Among them, three patients had tumors located at the thoracic apex, and one had a tumor with an intraspinal extension (dumbbell-type tumor). Results: A complete thoracoscopic resection was achieved in all patients with no postoperative mortality. The dumbbell-type tumor was resected with a combined neurosurgical,thoracoscopic approach. The postoperative course was uneventful in all patients. Conclusion: Our thoracoscopic approach was able to obtain satisfactory visualization of the field and enabled safe surgery for intrathoracic neurogenic tumors. This approach is minimally invasive and is indicated even for tumors located at the thoracic apex or those with intraspinal extensions. [source]

Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2010
I. Schwegler
Background: This study investigated whether nutritional risk scores applied at hospital admission predict mortality and complications after colorectal cancer surgery. Methods: Some 186 patients were studied prospectively. Clinical details, Reilly's Nutrition Risk Score (NRS) and Nutritional Risk Screening 2002 (NRS-2002) score, tumour stage and surgical procedure were recorded. Results: The prevalence of patients at nutritional risk was 31·7 per cent according to Reilly's NRS and 39·3 per cent based on the NRS-2002. Such patients had a higher mortality rate than those not at risk according to Reilly's NRS (8 versus 1·6 per cent; P = 0·033), but not the NRS-2002 (7 versus 1·8 per cent; P = 0·085). Based on the NRS-2002, there was a significant difference in postoperative complication rate between patients at nutritional risk and those not at risk (62 versus 39·8 per cent; P = 0·004) but not if Reilly's NRS was used (58 versus 44·1 per cent; P = 0·086). Nutritional risk was identified as an independent predictor of postoperative complications (odds ratio 2·79; P = 0·002). Conclusion: Nutritional risk screening may be able to predict mortality and morbidity after surgery for colorectal cancer. However, the diverse results reflect either the imprecision of the tests or the small sample size. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2006
C. Mariette
Background: The aim of this study was to determine the effect of neoadjuvant radiochemotherapy (RCT) on postoperative complications and survival after surgery for locally advanced oesophageal squamous cell carcinoma. Methods: Postoperative course and survival were compared in 144 patients who had neoadjuvant RCT and 80 control patients who had surgery alone for locally advanced oesophageal squamous cell carcinoma (radiological stage T3, N0 or N1, M0). Results: The two groups were comparable in terms of American Society of Anesthesiologists grade, age, sex, weight loss, tumour location, presence of lymph node metastasis and surgical approach. Postoperative mortality rates were 6·3 and 9 per cent (P = 0·481), with morbidity rates of 40·3 and 41 per cent (P = 0·887) in the RCT and control group respectively. Complete resection (R0) rates were 74·3 and 48 per cent respectively (P < 0·001). Significant downstaging was observed in the RCT group (P < 0·001), with 16·0 per cent of patients having a complete pathological response. Median survival was 29 versus 15 months, and the 5-year survival rate 37 versus 17 per cent (P = 0·002) in RCT and control groups respectively. Conclusion: Neoadjuvant RCT significantly enhanced R0 resection and survival rates in patients with stage T3 oesophageal squamous cell carcinoma, with no increase in postoperative mortality and morbidity rates. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Neoadjuvant chemoradiotherapy for operable oesophageal carcinoma: preliminary results from Sheffield

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001
I. McL.
Background: Surgical resection is the mainstay of treatment for potentially curable oesophageal carcinoma but the long-term survival rate remains 10,20 per cent. Neoadjuvant administration of chemoradiotherapy (NCR) may improve these values. In this study the authors reviewed their preliminary experience with NCR in Sheffield. Methods: Twenty-five patients with potentially resectable oesophageal carcinoma embarked on a regimen of NCR, with resection planned 4,6 weeks later. Chemotherapy incorporated two cycles of intravenous cis -platinum and 5-fluorouracil with external-beam radiotherapy administered synchronously (30,45 Gy). Results: Twenty-two of the 25 patients suffered side-effects from NCR, including one death, and seven patients failed to complete NCR as planned. The median interval from diagnosis to surgery was 121 days. Twelve out of 24 patients had significant postoperative complications, including two deaths. Seven patients had a complete histological response to NCR (three out of 15 for adenocarcinoma, four out of nine for squamous carcinoma). Conclusion: The complete histological response rate to NCR in these patients compares favourably with previous studies, as does the postoperative mortality, but this was at the expense of substantial morbidity and was associated with long delays from diagnosis to operation. At present it is not possible to predict which patients will respond favourably to NCR and whether they will benefit with improved survival. © 2001 British Journal of Surgery Society Ltd [source]

Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2001
Dr K. Smedh
Background: Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques. Methods: All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993,1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144). Results: The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0·001). Surgical complications dropped from 37 to 11 per cent (P < 0·001). The relaparotomy rate fell from 11 to 4 per cent (P < 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0·001). Conclusion: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half. © 2001 British Journal of Surgery Society Ltd [source]

The impact of pre- or postoperative radiochemotherapy on complication following anterior resection with en bloc excision of female genitalia for T4 rectal cancer

COLORECTAL DISEASE, Issue 4 2009
B. Szynglarewicz
Abstract Objective, The aim of the study was to assess the mortality and morbidity following extended anterior resection with excision of internal female genitalia combined with pre- or postoperative chemoradiotherapy in women with extensive rectal cancer. Method, The study included a consecutive series of 21 women with T4 adenocarcinoma of the rectum infiltrating the reproductive organs treated with curative intent between 1997 and 2003. All patients had an extended anterior sphincter preserving resection of the rectum (total mesorectal excision) and hysterectomy with or without posterior vaginal wall excision. In all patients, surgery was combined with adjuvant radiochemotherapy. Ten patients received preoperative radiotherapy (50.4 Gy) concurrently with two courses of chemotherapy [fluorouracil with folinic acid (FA)] followed by surgery within 6,8 weeks and subsequently four courses of postoperative chemotherapy. Eleven received postoperative chemoradiotherapy (50.4 Gy plus fluorouracil with FA). Results, There was no postoperative mortality. Postoperative complications were observed in 57% patients (early in 14% and late in 52%). These included: anterior resection syndrome with anorectal dysfunction in 52% (requiring proximal diversion in 5%), urinary complications in 24% (complete incontinence requiring a permanent catheter in 5%). In addition, postoperative acute bleeding requiring relaparotomy, delayed wound healing caused by superficial infection, anastomotic leakage, prolonged bowel paralysis, benign rectovaginal fistula and anastomotic stricture occurred (5% each). The risk of postoperative morbidity (52%) was similar for patients with or without preoperative radiochemotherapy. Conclusion, Despite this aggressive therapeutic approach, most postoperative complications were transient or could be treated. Preoperative radiochemotherapy did not increase the risk of morbidity. [source]