Crohnin taudin suolikirurgia

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Surgical recurrence in Crohn's disease : a comparison between different types of bowel resections

To compare recurrence frequency and location between different types of bowel resections in Crohn's disease patients. This was a retrospective study of consecutive patients undergoing bowel resection for Crohn's disease between 2006 and 2016. Type of primary operation was recorded and grouped as ileocolic resection, small bowel resection, segmental colon resection with colocolic anastomosis or colorectal anastomosis, colectomy with ileorectal anastomosis, or end stoma operation. Binary logistic regression was used to compare surgical recurrence frequency between groups. We also investigated how Crohn's disease location at reoperations was related to the primary bowel resection type. Altogether, 218 patients with a median follow-up of 4.7 years were included in our study. Reoperation was performed in 42 (19.3%) patients. The risk of reoperation using the ileocolic resection group as reference was the following: small bowel resection (odds ratio (OR) 2.95, 95% confidence interval (CI) 1.01-8.66; P = 0.049), segmental colon resection with colocolic or colorectal anastomosis (OR 6.20, 95% CI 2.04-18.87; P = 0.001), colectomy with ileorectal anastomosis (OR 26.57, 95% CI 2.59-273.01; P = 0.006), and end stoma operation (OR 4.62, 95% CI 1.90-11.26; P = 0.001). In case of surgical recurrence, the reoperation type and location correlated with the primary bowel resection type. Reoperation frequency in Crohn's disease is lower after ileocolic resection than after other types of bowel resections. Surgical recurrence in Crohn's disease tends to maintain the disease location of the primary operation. One third of Crohn's patients undergoing an end stoma operation will still need new bowel resections due to recurrence.Peer reviewe

Public participation in monitoring programmes as a tool for lakeshore monitoring: the example of Lake Pyhäjärvi, Karelia, Eastern Finland

AbstractLake Pyhäjärvi, on the border between Finland and Russia in Karelia, is a very valuable clear-water lake of the Lobelia type. It belongs to the European Union's Natura 2000 programme in Finland, and has been included in regional and national monitoring programmes since the 1960s. The main monitoring station is situated near the outlet of the lake. Deterioration of its water quality was suspected already in the 1980s because of decreasing Secchi depths (transparency) and increasing chlorophyll a.The occurrence of algal blooms on the lakeshores is monitored weekly during each summer at one site on Lake Pyhäjärvi (site 1). This is a part of nationwide intensive algae monitoring programme organised by the environmental authorities together with voluntary observers at some 270 lake sites in Finland since 1998. Since 1997, Secchi depth observations have been carried out by volunteers biweekly or monthly at 17 sites on the lake. In the vicinity of one of these transparency observation sites (station 100), intensive monitoring of algae has been carried out. At this lakeshore monitoring site 69 algal observations were made, ten of which recorded algal blooms during the study period 1998–2002. The observed algal blooms were caused by algae of the Anabaena species, mainly by Anabaena lemmermannii. At Lake Pyhäjärvi the number of algal bloom observations received from the public have decreased from the 1990s to the 2000s. The range of Secchi disc transparency was 5.0–8.4 m with a mean value of 6.2 m at station 100 and 4.3–7.7 m (mean 6.1 m) at the main monitoring station 2 during the open water periods in 1998–2002. During this study period, the maximum values at site 100 seem to have increased slightly, which might indicate some improvement in the water quality due to decreased point source loading.We conclude that the intensive algal monitoring results of 5 years at the lakeshore site and the transparency results — both compiled by trained volunteers — reflect an improvement in the state of Lake Pyhäjärvi in Karelia. This conclusion is in accordance with the long-term water quality and short-core studies of sedimentary diatoms in Lake Pyhäjärvi. We suggest that the intensive algal observations and transparency measurements are both suitable methods for the monitoring of lakeshores and lakes, and that both are suitable for voluntary monitoring. We found public participation a good tool for monitoring lakes and lakeshores

The prognostic value of extramural venous invasion in preoperative MRI of rectal cancer patients

Aim This study aimed to examine the prognostic value of extramural venous invasion observed in preoperative MRI on survival and recurrences. Method In total, 778 rectal cancer patients were evaluated in multidisciplinary meetings in Helsinki University Hospital during the years 2016-2018. 635 patients met the inclusion criteria of stage I-III disease and were intended for curative treatment at the time of diagnosis. 128 had extramural venous invasion in preoperative MRI. Results The median follow-up time was 2.5 years. In a univariate analysis extramural venous invasion was associated with poorer disease-specific survival (hazard ratio [HR] 2.174, 95% CI 1.118-4.224, P = 0.022), whereas circumferential margin = T3c or nodal positivity were not. Disease recurrence occurred in 17.3% of the patients: 13.4% had metastatic recurrence only, 1.7% mere local recurrence and 2.2% both metastatic and local recurrence. In multivariate analysis, extramural venous invasion (HR 1.734, 95% CI 1.127-2.667, P = 0.012) and nodal positivity (HR 1.627, 95% CI 1.071-2.472, P = 0.023) were risk factors for poorer disease-free survival (DFS). Circumferential marginPeer reviewe

Incident colorectal cancer in Lynch syndrome is usually not preceded by compromised quality of colonoscopy

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Is there a need for neoadjuvant short-course radiotherapy in T3 rectal cancer with positive lymph node involvement? A single-center retrospective cohort study

Background Neoadjuvant short-course radiotherapy is used to reduce local recurrences in stage III rectal cancer. Radiotherapy is not harmless, and meticulous total mesorectal excision surgery alone has been reported to result in low local recurrence rate in favorable stage III tumors. The aim was to evaluate the effect of short-course (5 x 5 Gy) radiotherapy on the local recurrence risk in patients with pT3N1-2 rectal cancer. Materials and methods This was a retrospective study with 151 consecutive pT3N1-2M0 rectal cancer patients operated on at Helsinki University Hospital, Helsinki, Finland, during January 2005 to June 2014. Short-course radiotherapy was given to 94 patients, and 57 patients were operated on without neoadjuvant radiotherapy. The main outcome measurement was the effect of radiotherapy on local recurrence. Also, the risk factors for local recurrence were analyzed. Results Local recurrence occurred in a total 17 of 151 (11.3%) patients, 8 of 57 (14.0%) in surgery only group compared with 9 of 94 (9.6%) in radiotherapy plus surgery group (p = 0.44). In univariate Cox regression analysis, the risk factors for local recurrence were tumor location under 6 cm from the anal verge (p = 0.01), involved lateral margin (p <0.001), tumor perforation (p <0.001), and mucinous histology (p = 0.006). In multivariate analysis, risk factors were tumor location under 6 cm from anal verge (p = 0.03) and involved lateral margin (p = 0.002). Conclusion Neoadjuvant short-course radiotherapy did not affect the local recurrence risk of pT3N1-2M0 rectal cancer. Further studies with larger patient number are needed to evaluate the role of short-course radiotherapy in different T3 subgroups (3a-c) as well as in N1 and N2 cancers in separate.Peer reviewe

Mechanical bowel preparation and oral antibiotics versus mechanical bowel preparation only prior rectal surgery (MOBILE2) : a multicentre, double-blinded, randomised controlled trial-study protocol

Introduction Mechanical bowel preparation (MBP) prior to rectal surgery is widely used. Based on retrospective data many guidelines recommend mechanical and oral antibiotic bowel preparation (MOABP) to reduce postoperative complications and specifically surgical site infections (SSIs). The primary aim of this study is to examine whether MOABP reduces complications of rectal surgery. Methods and analysis The MOBILE2 (Mechanical Bowel Preparation and Oral Antibiotics vs Mechanical Bowel Preparation Only Prior Rectal Surgery) trial is a multicentre, double-blinded, parallel group, superiority, randomised controlled trial comparing MOABP to MBP among patients scheduled for rectal surgery with colorectal or coloanal anastomosis. The patients randomised to the MOABP group receive 1 g neomycin and 1 g metronidazole two times on a day prior to surgery and patients randomised to the MBP group receive identical placebo. Based on power calculations, 604 patients will be enrolled in the study. The primary outcome is Comprehensive Complication Index within 30 days after surgery. Secondary outcomes are SSIs within 30 days after surgery, the number and classification of anastomosis dehiscences, the length of hospital stay, mortality within 90 days after surgery and the number of patients who received adjuvant treatment if needed. Tertiary outcomes are overall survival, disease-specific survival, recurrence-free survival and difference in quality-of-life before and 1 year after surgery. In addition, the microbiota differences in colon mucosa are analysed. Ethics and dissemination The Ethics Committee of Helsinki University Hospital approved the study. The findings will be disseminated in peer-reviewed academic journals.Peer reviewe