Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study

Background The clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians. Methods Between November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction. Results A total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P\0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms ([20 on the 0–100 scale, P\0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment. Conclusion SEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patientreported outcomes is important in evaluating SEMS treatment

Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study

Purpose: Many different operations have been proposed for treating rectal prolapse, with varying recurrence rates and functional outcome. The main purpose of this study was to assess long-term results of surgery for prolapse of the rectum. Methods: We carried out a retrospective study to evaluate changing trends in surgical strategies and outcome in all patients treated in our hospital over 19 years. Results: Ninety-three patients were operated and 30 (32%) experienced recurrence of external prolapse during a median (range) follow-up time of 82 (2–231) months. There were 37 reoperations for recurrence, bringing the total number of operations to 130. From 1998 to 2010, laparoscopic posterior suture rectopexy was the preferred abdominal procedure with Delorme’s operation as the perineal alternative. Observed recurrence rates were 15/49 (31%) and 8/15 (53%) during a median observation time of 84 and 9 months, respectively. From 2011 to 2017, these procedures were replaced by ventral mesh rectopexy and Altemeier’s rectosigmoidectomy. The observed recurrence rate for ventral mesh rectopexy was 3/22 (14%) during a median observation time of 29 months. The 30-day mortality rate was 3% and complication rate 14%. Conclusions: The recurrence rates were high after all procedures, with no significant difference between posterior suture rectopexy and ventral mesh rectopexy, but the short observation time for the latter procedure is a limitation of the study. Both procedures had low complication rates, and ventral mesh rectopexy had no mortality