Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases

Background

Most treatments for cancer cause a decline in patients' health-related quality of life (HRQoL). Limiting this decline is a universal goal for healthcare providers. Using minimally invasive instead of open surgical techniques might be one way to achieve this. The aim of this study was to compare postoperative HRQoL after open and laparoscopic liver resection.

Methods

This was a predefined substudy of an RCT comparing open with laparoscopic liver resection. Patients with colorectal liver metastases were assigned randomly to open or laparoscopic parenchyma-sparing liver resection. HRQoL was assessed with the Short Form 36 questionnaire at baseline, and 1 and 4 months after surgery.

Results

A total of 280 patients were randomized, of whom 273 underwent surgery (129 laparoscopic, 144 open); 682 questionnaires (83.3 per cent) were available for analysis. One month after surgery, patients in the laparoscopic surgery group reported reduced scores in two HRQoL domains (physical functioning and role physical), whereas those in the open surgery group reported reduced scores in five domains (physical functioning, role physical, bodily pain, vitality and social functioning). Four months after surgery, HRQoL scores in the laparoscopic group had returned to preoperative levels, whereas patients in the open group reported reduced scores for two domains (role physical and general health). The between-group difference was statistically significant in favour of laparoscopy for four domains after 1 month (role physical, bodily pain, vitality and social functioning) and for one domain after 4 months (role physical).

Conclusion

Patients assigned to laparoscopic liver surgery reported better postoperative HRQoL than those assigned to open liver surgery. For role limitations caused by physical health problems, patients in the laparoscopic group reported better scores up to 4 months after surgery. Registration number: NCT01516710 (http://www.clinicaltrials.gov).

Trends in Abdominal Aortic and Iliac Aneurysm Repairs in Norway from 2001 to 2013

OBJECTIVE/BACKGROUND

The objective was to examine trends in abdominal aortic and iliac aneurysm repairs in Norway from 2001 to 2013, and study regional variations and organizational developments in this type of vascular surgery.

METHODS

This was a retrospective study on aortic and iliac aneurysm repairs using data from the Norwegian Patient Register. The vascular centers were categorized by yearly volume of repairs into small (<18), medium (18-49) and large (≥50). Incidence rates were assessed per 100,000 ≥ 60 years. The percentage of endovascular aneurysm repairs (EVAR) was calculated among the conducted repairs at the three categories of centers and the South-Eastern, Western, Central, and Northern Norway Regional Health Authority (NRHA).

RESULTS

The national incidence rates of intact repairs per 100,000 ≥ 60 years increased from 57.4 to 65.7 (p < .01). Ruptured repairs decreased from 19.7 to 9.2 (p < .01). The rate of EVAR increased from 6.0 to 29.9 (p < .01) in intact and from 0.4 to 2.5 (p < .01) in ruptured repairs. The vascular centers were reduced from 25 to 16. The rate of EVAR was 27.1% (p < .01) higher at large centers and 7.9% (p < .03) higher at medium centers compared with small centers, and from 11.1% to 15.7% higher (p < .01) at the Central, Western, and Northern NRHA compared with the South-Eastern NRHA, which had the most centers (also in the large category). The national increase in intact EVAR from 10.6% to 43.3% was less compared with many other Western countries.

CONCLUSION

During the study period the rates of intact repairs increased while the ruptured repairs decreased. EVAR was associated with centers performing high volumes of abdominal aortic and iliac aneurysm repairs and regional authorities organized with few centers.

The oslo CoMet study: randomised controlled study of open and laparoscopic liver resection for colorectal metastases

The 2013 Alpine Liver and Pancreatic Surgery meeting was held in Madonna di Campiglio, Italy. The meeting was organised by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The following abstracts were selected for presentation at the meeting.

Elderly people in a large Danish city

The Aalborg Model of elderly care contains the following new concepts: It is a comprehensive system, including housing, activities, a food service, practical assistance, nursing care, physical rehabilitation and counselling. High priority is given to the earlier detection of illness and of special needs in an attempt to enrich the quality of life of the elderly and to reduce the cost of treatment. Suitable, independent housing for the elderly has been integrated into ordinary residential areas. The elderly choose their own housing and the assistance they require based on the principle that they will be given help to help themselves, no matter where they live. The former division between visiting nurses and nursing homes has been eliminated, and the elderly are no longer classified according to "diagnosis." One exception to this is the geronto-psychiatric patients who are cared for in special nursing homes. The various kinds of assistance give many options to choose from, regardless of where you live. The services offered are flexible and are provided according to need. They can range from the once a week delivery of frozen, ready-to-serve dishes to extensive care both day and night. Decisions regarding the content and extent of the services are made by members of the permanent staff and the group leaders in cooperation with the elderly users. The various kinds of assistance can be adjusted to suit changing priorities and are provided in accordance with the special character of a local district. One group leader in each district is responsible for coordinating the services. The users have great influence.

Perforations in surgeons' gloves

The frequency of unused surgeons' gloves with perforations was investigated by using a watertightness test. Lot-to-lot variations and inter-lot variation were found. It is the responsibility of the manufacturer to ensure that the quality of the lot is in accordance with the stated Acceptable Quality Level.