[Recurrence and survival after conventional low anterior resection for rectal cancer]

INTRODUCTION

The aim of the study was to evaluate the incidence of recurrence of local cancer, distant metastases and survival after conventional low anterior resection for cure in patients with rectal carcinoma, on the basis of the poor prognosis after colorectal cancer in Denmark.

MATERIAL AND METHODS

Consecutive patients operated on in the nine Danish departments of surgical gastroenterology in 1992-1993. Retrospective collection of data on recurrence of local cancer, distant metastases, and over-all survival at the end of 1996.

RESULTS

Of 268 patients, 77 (29%) developed recurrent local cancer and/or distant metastases. Forty-eight (18%) had local recurrence with a cumulative 5-year rate of 39%. Distant metastases were seen in 54 (20%). The local recurrence rate increased with increasing Dukes' tumour stage and was higher after operation by a non-specialist (30%) than by a consultant, another specialist, or a surgeon under training and supervised by a consultant (15-17%) (p = 0.04). Multiple regression showed that the recurrence rate was independent of tumour localisation, blood loss, transfusion, anastomotic leakage, and status of the surgeon. The cumulative crude 5-year survival was 50% and independent of the status of the surgeon.

DISCUSSION

Our relatively high local recurrence rate and the results in the literature after total mesorectal excision (TME) indicate that the conventional technique should be replaced by TME, which has become the recommended method in recent years. Furthermore, we propose a changed strategy in the treatment of rectal cancer. The patients should be treated in fewer departments with established teams of rectal cancer specialists taking part in all operations for rectal cancer.

[Surgical treatment of stomach cancer at a university hospital. A retrospective survey of the period 1990-1995]

AIM

A retrospective study of 69 cases of gastric cancer seen during the period from 1/1-1990 to 31/12-1994 treated in a University Hospital. The aim of the study was to describe morbidity, mortality and identify independent prognostic variables for mortality.

METHOD

Patient data were recovered from the hospital's central database. Mortality was chosen as end-parameter. Univariate log-rank-test identified statistically significant variables which were then analysed by Cox backward stepwise regressional analysis.

MATERIAL

Sixty-nine patients were available for analysis, median age 73 years. Fifty-one patients underwent operation. Eighteen patients did not have a surgical procedure due to disseminated disease. The overall postoperative morbidity was 25% and postoperative mortality 10%. The overall five-year survival rate was 8%, 12% for operated patients, 35% after radical and 0% after non-radical or omitted surgery. Age, radicality of operation, type of operation, Borrmann's tumour classification, and degree of depth of local infiltration were identified as significant factors for survival. Cox's analysis identified type of operation (p = 0.0002) and Borrmann's tumour classification (p = 0.001) as independent variables.

DISCUSSION

The overall five-year survival is low and has not changed over two decades in Denmark, whereas mortality and morbidity rates have improved. It should be recommended that: The treatment of gastric cancer must be centralised in order to develop preoperative examinations, operative technique and the necessary routine for the surgeons. All gastric ulcers must be considered malignant and biopsies taken accordingly.

[Anastomotic leakage after low anterior resection for rectal cancer]

A series of 377 consecutive patients were operated upon with low anterior resection for rectal cancer in the nine Danish departments of surgical gastroenterology during 1992-1993. A retrospective analysis was carried out to calculate the frequency of anastomotic leakage and to evaluate factors of potential influence on the development of leakage according to the literature. Sixty-three patients (17%) developed leakage, which was followed by an increased mortality within the first three postoperative months. Only two variables significantly influenced the leakage rate: male gender was associated with a higher leakage rate (p = 0.02), whereas departments with a low number of rectal cancer surgeons had a low rate of anastomotic leakage (p = 0.02). In conclusion, the rather high frequency of anastomotic leakage calls for further clinical and pathogenetic research in this field. Until then, we recommend the routine use of a peroperative leakage test and selective use of prophylactic ostomy in cases of unsatisfactory anastomosis. Furthermore, it is recommended that low anterior resection for rectal cancer is limited to few surgeons in each department in order to ensure a uniform quality and hopefully also thereby reduce the rate of anastomotic leakage.

[Prognosis in familial adenomatous polyposis. Results from the Polyposis Registry]

Regional and national polyposis registries have been established all over the world over last decades, with the aim to improve survival in patients with familial adenomatous polyposis (FAP). The Danish Polyposis Register was founded in 1971 and coordinates screening and prophylactic treatment. At the end of 1992 the register included 321 histologically verified FAP patients: 142/205 probands (69%) had colorectal cancer at the time of diagnosis of FAP versus only 2/116 call-up cases (2%). The 10-year cumulative crude survival was 94% among call-up cases versus only 41% among probands (p < 0.00001), and the survival increased significantly after establishment of the Polyposis Register in 1971. We conclude that centralized registration with identification and prophylactic examination of relatives at risk results in a substantial improvement of the prognosis.

[The effect of ranitidine on postoperative monocyte and neutrophil granulocyte function]

The histamine H-2-receptor antagonist ranitidine hydrochloride has been shown to alleviate trauma-, blood transfusion- and sepsis-induced immunosuppression. We evaluated the effect of ranitidine on the postoperative impairment of monocyte and neutrophil function in 24 patients undergoing major elective abdominal surgery. The patients were randomized to receive postoperative adjuvant treatment with ranitidine hydrochloride (100 mg) administered intravenously twice daily for four days, followed by oral ranitidine hydrochloride (150 mg) administered twice daily for five days (n = 11), or no adjuvant treatment (n = 13). Blood monocyte and neutrophil chemotaxis and chemiluminescence were analyzed before the operation and on post-operative days one, three and nine. Monocyte chemotaxis to C5a in the 13 control patients was significantly decreased on day one compared to day 0. Chemotaxis in the 11 ranitidine-treated patients increased significantly from day 0 to day one (p < .01 between groups). Neutrophil chemiluminescence to zymosan and N-f-methionyl-leucylphenylalanine was significantly increased in control patients on day one compared to day 0 (p < .05), while ranitidine reduced chemiluminescence to zymosan insignificantly on day one (p < .07 between groups). Five of the 13 control patients developed postoperative infectious complications, which were related to decreased monocyte chemotaxis to C5a and increased neutrophil chemiluminescence to zymosan when compared to noninfected patients. A significant difference (P < .05) in chemiluminescence to zymosan between infected and noninfected control patients was observed on day three, before clinical signs of infectious disease could be detected. There were no infectious complications in ranitidine-treated patients. These results support previous studies on the effect of ranitidine in reducing postoperative immunosuppression.

[A colostomy plug (the Conseal system). Assessment of early postoperative use]

The Conseal plug was evaluated in a four week period among 30 consecutive colostomy patients. The clinical trial, a multicenter study covering 11 Danish Hospitals, was started five to 12 days postoperatively among motivated patients in good physical condition. Twenty patients (67%) completed the trial. Ten patients (33%) gave up because of wound infection, leakage, extrusion of the foam part or fault in the test procedure. At the end of the trial all 20 patients wanted to continue using the plug and 84% were still using the Conseal system six months later. We conclude that the plug is well tolerated among motivated patients less than a week postoperatively and that the Conseal plug is a good alternative to the colostomy bag early in the postoperative course.

[Production of slides using a microdatamat]

For production of dias for presentation of scientific data, a personal computer, a dias programme and a camera are necessary. A microdatamat with a 80286 precessor, 20 MB hard disc and an EGA colour screen are the minimum configurations which can be recommended. A hard disc between 40 and 85 MB and a VGA screen provide a better solution. Out of the numerous dias programmes, Harvard Graphics appears to be suitable for production of dias for scientific use. In this programme, it is easy to combine text, graphic and hand drawing. Many other excellent programmes such as 35 mm Express and Mirage are also available. In the choice of camera, a solution of at least 4,000 x 4,000 lines is required and the camera concerned must be capable of working with recognized statistical and graphic parcels as more special graphs cannot be produced in ordinary dias programmes. Among the numerous cameras, the following may be mentioned: Montage which costs of 70,000 Danish crowns (approximately 6,000 pounds), Matrix PCR at 100,000 Danish crowns (approximately 9,000 pounds), Matrix QCR-Z at 200,000 Danish crowns (approximately 18,000 pounds) and Lasergraphic's two models at 60,000 and 120,000 Danish crowns, respectively (approximately 5,000 pounds and 10,000 pounds). In the price class of about 100,000 Danish crowns, Matrix PCR can be recommended particularly as this camera has an excellent optic and advanced self calibrating system. Among the cheaper cameras. Montage is recommended which e.g. functions well with Harvard Graphics.(ABSTRACT TRUNCATED AT 250 WORDS)