Clinical Predictors for Reduced Long-Term Survival and Cause of Death after Curative Resection for Rectal Cancer

Purpose: To identify clinical predictors for reduced long-term survival and describe the cause of death after surgical treatment for rectal cancer. Methods: A retrospective follow-up study of 442 consecutive, unselected patients treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 years or until death. Predictors for death were assessed by Cox regression analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: 254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, abdominoperineal resection compared to low anterior resection, lack of lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. Conclusions: Age, tumour stage, type of surgery, lymph node dissection, residual tumour after surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.

Cause of Death and Clinical Predictors of Survival after Curative Resection for Colon Cancer

Background: Clinical predictors of death and survival in surgical treatment of colon cancer are easily confounded by the modern adjuvant and neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. Methods: Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. The adjusted Cox regression model showed that higher age (1.04 (95% CI: 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged survival. Conclusions: In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resection, lack of lymph node dissection, tumour stage, and preoperative blood transfusions are all significant predictors for reduced survival after surgery for colon cancer.

Prospective evaluation of the cause of acute pancreatitis,with special attention to medicines

AIM: To investigate the cause of acute pancreatitis(AP) by conducting a thorough investigation of drugs and their possible etiological role.METHODS: We investigated the cause of AP in a large retrospective cohort of 613 adult patients admitted with AP at the Akershus University Hospital, Norway, from 2000 until 2009, who were evaluated with standard ward investigations. This group was compared with a prospectively evaluated group(n = 57) admitted from January 2010 until September 2010 who investigated more extensively using medical history and radiological assessment.RESULTS: The groups were comparable with regards to gender, age, comorbidity and severity. The most common etiology was bile stones and alcohol, occurring in 60% in both groups. The prospective group was examined more thoroughly with regards to the use of alcohol and medicines. An increased number of radiological investigations during hospital stay and at follow-up were also performed. A more extensive use of radiological evaluation did not increase the detection frequency of bile stones. In the prospective group, more than half of the patients had two or more possible causes of pancreatitis, being mostly a combination of bile stones and drugs. No possible cause was found in only 3.5% of these patients, compared with 29.7% in the retrospective group.CONCLUSION: A detailed medical history and extensive radiological evaluation may determine a possible etiology in almost all cases of AP. Many patients have several possible risk factors, and uncertainty remains in establishing the definitive etiology.