Factors predicting recurrence in rectal cancer

Background: Rectal cancer treatment has improved through important incremental surgical and oncological developments over the past decades. Localized disease is highly treatable with multimodal surgical and oncological therapy. Prognosis is dependent on several factors with tumour stage at diagnosis being the most important. Furthermore, curative treatment is highly dependent on radical surgical resection. Positive circumferential resection margin (CRM), lateral lymph node metastases and tumour deposits are examples of high-risk clinical situations associated with increased risk of recurrence and subsequently impaired long-term outcome and are investigated in this thesis.Aims: Paper I & II, to investigate CRM-positive resections in rectal cancer and effect on local recurrence and distant metastasis risk. Paper III, to describe MRI-positive lateral lymph nodes – investigating therapy and outcome in high-risk rectal cancer. Paper IV, to investigate the prognostic significance of tumour deposits as a risk factor and in comparison with lymph node involvement in rectal cancer.Method: Paper I-II & IV are retrospective national cohort studies. Paper III is a retrospective regional cohort study. Patient data was gathered from the Swedish ColoRectal Cancer Registry, medical records and the Swedish Cause of Death registry. Patients for paper I & II were between 2005 – 2013, for paper III between 2009 – 2014 and för paper IV between 2011 – 2014.Main outcome measures: Paper I, local recurrence. Paper II, distant metastasis. Paper III, descriptive tumour characteristics, overall survival, local recurrence and distant metastasis. Paper IV, local recurrence, distant metastasis, overall and relative survival.Results and conclusions: Exact CRM was associated with increased local recurrence risk. Neoadjuvant radiotherapy does not decrease risk of local recurrence in CRM-positive patients. Only a subset of patients with R1-resection (CRM 0.0 mm) suffered local recurrence during follow-up. Exact CRM equal to or less than 1.0 mm may be a risk factor for distant metastasis. However, several other factors likely contribute to increased risk of distant metastasis in CRM-positive patients. MRI-positive lateral lymph nodes were associated with synchrounous distant metastasis. Neoadjuvant (chemo)radiotherapy, abdominal rectal resection and selective lymph node dissection may be a useful approach in patients with MRI-positive lateral lymph nodes. Tumour deposits increased risk of both local recurrence and distant metastasis and decreased survival. The prognosis of patients with tumour deposits were comparable to pN1a-b stage mesorectal lymph node involvement

Prevalence of Coxielle Burnetii anbitodies in Danish Dairy herds

<p>Abstract</p> <p>During recent years in Denmark higher rates of antibodies to <it>Coxiella burnetii </it>have been detected in animals and humans than previously reported. A study based on bulk tank milk samples from 100 randomly selected dairy herds was performed to estimate the prevalence and geographical distribution of antibody positive dairy herds. Using the CHEKIT Q-Fever Antibody ELISA Test Kit (IDEXX), the study demonstrated a prevalence of 59% antibody positive herds, 11% antibody intermediate herds and 30% antibody negative herds based on the instructions provided by the manufacturer. The geographical distribution does not indicate a relationship between the regional density of dairy farms and the prevalence of antibody positive dairy farms. The result supports the hypothesis of an increase in the prevalence of positive dairy herds compared to previous years.</p

Cervical myoma causing colonic obstruction in the first trimester of pregnancy – a case report

A 39-year-old nulliparous woman with a previously known cervical myoma was admitted to the obstetrics department during the first trimester with complaints of severe abdominal pain, lack of bowel movements and the suspicion of a clinical bowel obstruction. Because no literature on this exact condition could be found, clinical decisions were based on reports and practice in similar situations. Ultrasound revealed the progression of a cervical myoma (previously 9 cm across), now 12 × 12 × 11 cm in size and a distended large bowel. Sigmoidoscopy excluded intraluminal obstruction. The patient was treated with oral laxatives and enema without success and her condition deteriorated. The myomatous cervix was examined vaginally (bimanual manoeuvre) with the patient under anaesthesia; however, attempts to dislodge the obstruction proved unsuccessful. After surgical consultation the patient was planned for an emergency laparoscopic sigmoidostomy. The post-operative course was uneventful and the patient discharged. She delivered a healthy child with caesarean section in gestation week 36. Bowel continuity was later laparoscopically restored in conjunction with a hysterectomy. This case illustrates the importance of active multidisciplinary management in a case of severe colonic obstruction caused by pregnancy-related obstruction in the small pelvis. In this case, colonic perforation and abortion of the fetus were both avoided

Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution.

This study compared the non-invasive thoracic electrical bioimpedance Aesculon technique (TEB(Aesculon) ) with thermodilution (TD) to evaluate whether TEB(Aesculon) may offer a reliable means for estimating cardiac output (CO) in humans

Rektalcancer: : Risk för lokalt recidiv är beroende av RESEKTIONSMARGINAL

Rektalcancer är en sjukdom där behandlingsresultaten förbättrats kraftigt de senaste decennierna. Behandling för ändtarmscancer sker med antingen endast kirurgi eller kirurgi i kombination med onkologisk neoadjuvant behandling. Kirurgisk radikalitet, mikroskopisk marginal mellan tumörvävnad och frisk vävnad, är av stor betydelse för att minska risken för lokalrecidiv och öka överlevnade

Circumferential resection margin and local recurrence after rectal cancer surgery: a population-based study cohort

Aim: Studies have suggested that there is a difference in risk of local recurrence(LR) with circumferential resection margins (CRM) less than 1.0 mm. We aimed toexamine how exact resection margins affect LR risk.Method: Data from the Swedish Colorectal Cancer Registry (SCRCR) were usedfor retrospective analysis of resected rectal cancers between 2005 and 2013. Primaryendpoint was LR.Results: 12146 cases were identified of which 8666 cases were analysed after exclusion. 388 cases had CRM < 1.0 mm and 8278 cases CRM ≥ 1.0 mm. There were 42LR (11.4%) when CRM < 1.0 mm and 280 LR (3.5%) when CRM ≥ 1.0 mm. LRrate was 17% (n = 27/159), 7.1% (n = 15/210), 5.5% (n = 26/473) and 3.4%(n = 254/7550) when CRM was 0.0 mm, 0.1–0.9 mm, 1.0–1.9 mm andCRM ≥ 2 mm respectively. LR risk at CRM 0.0 mm was significantly increased compared to all other groups. No significant difference in LR between CRM 1.0–1.9 mm and ≥ 2 mm was observed. LR was diagnosed earlier when CRM < 1.0 mm.Conclusion: LR risk is related with accuracy to the surgical circumferential resec-tion margin distance. There was no difference in LR risk above CRM 1.0 mm.Most LRs occurred within two years after surgery when CRM was below 1.0 m