Cause-specific mortality associated with leukoreduced, buffy coat-depleted, or no blood transfusion after elective surgery for colorectal cancer: a posttrial 15-year follow-up study.

BACKGROUND: We previously reported that both leukoreduced (LR) and buffy coat-depleted (BCD) blood transfusions had a detrimental effect on long-term overall survival in patients who underwent elective surgery for colorectal disease. This analysis investigates long-term cause-specific mortality in trial participants diagnosed with colorectal cancer (CRC). STUDY DESIGN AND METHODS: We used the Danish Civil Registration System to follow 448 trial participants with CRC, from their enrollment in 1992 to 1995 until January 2007. A total of 108 patients were transfused with BCD blood, 94 with LR blood, and 246 did not receive a transfusion (NT). We reviewed death certificates for study patients who died during follow-up. Cause-of-death data were coded according to the International Classification of Diseases (ICD-8 and -10). The Charlson Comorbidity Index was used for risk adjustment. RESULTS: A total of 43% of NT, 28% of BCD, and 27% of LR transfused patients were alive after 15 years of follow-up (p = 0.001 for transfused vs. NT patients). For LR-transfused versus NT patients the adjusted mortality ratio for death from rectal cancer was 1.81 (95% confidence interval [CI], 0.97-3.38), and for death from cardiovascular disease 2.12 (95% CI, 1.23-3.62). For BCD versus NT patients the adjusted mortality ratio for death from rectal cancer was 1.19 (95% CI, 0.61-2.33) and for cardiovascular disease it was 1.68 (95% CI, 0.97-2.91). CONCLUSION: LR transfusion is associated with decreased long-term survival due to death from cardiovascular disease. A similar but weaker tendency was observed for BCD transfusion.

Long-term survival after colorectal surgery associated with buffy-coat-poor and leucocyte-depleted blood transfusion: a follow-up study.

A Danish clinical trial showed that transfusion with leucocyte-depleted red blood cells reduces postoperative infectious complications compared with cells without buffy-coat. However, the effect on long-term outcome is unknown. We followed up the 142 cancer patients transfused with buffy-coat-poor red cells, the 118 transfused with leucocyte-depleted blood, and the 329 who were not transfused, until 2003. After 7 years' follow-up, survival for those with leucocyte-depleted blood transfusion (46 [41%]) was not significantly different from transfusion of blood without buffy-coat (59 [45%], p=0.51). Although survival is reduced by blood transfusion, it does not differ between the two transfusion regimens.

Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with increased risk of recurrence.

OBJECTIVE: Intrathoracic anastomotic leakage after intended curative resection for cancer in the esophagus or gastroesophageal junction has a negative impact on long-term survival. The aim of this study was to investigate whether an anastomotic leakage was associated with an increased recurrence rate. METHODS: This nationwide study included consecutively collected data on patients undergoing curative surgical resection with intrathoracic anastomosis, alive 8 weeks postoperatively, between 2003 and 2011. Patients with incomplete resection, or metastatic disease intraoperatively, were excluded. Only biopsy-proven recurrences were accepted. RESULTS: In total, 1085 patients were included. The frequency of anastomotic leakage was 8.6%. The median follow-up time was 29 months (interquartile range [IQR]: 13-58 months). Overall, 369 (34%) patients had disease recurrence, of which 346 patients died of recurrent gastroesophageal carcinoma. Twenty-three patients were alive with recurrence at the censoring date. In the study period, 333 patients died without signs of recurrent disease. The overall median time to recurrence was 66 weeks (IQR: 38-109 weeks). Distant metastases were found in 267 (25%), and local disease recurrence in 102 (9%) patients. Overall, 5-year disease-free survival in patients with leakage was 27%, versus 39% in those without leakage (P = .017). Anastomotic leakage was independently associated with higher risk of recurrence (hazard ratio [HR] = 1.63; 95% confidence interval [CI]: 1.17-2.29, P = .004) and all-cause mortality (HR = 1.57; 95% CI: 1.23-2.05, P < .0001). CONCLUSIONS: Intrathoracic anastomotic leakage increased the risk of recurrence in patients who underwent curative gastroesophageal cancer resection.

[Esophageal resections in Denmark 1997-2000]. / Esophagusresektioner i Danmark 1997-2000.

INTRODUCTION: We evaluated the changes in Denmark since the 1980s in the incidence, management and outcome of oesophageal resections. MATERIAL AND METHODS: The national patient hospital register and discharge information from the hospitals were examined for the number of oesophageal resections performed, the length of the postoperative stay, readmission, postoperative complications, and hospital mortality in the period 1/1-1997 to 30/6-2000. RESULTS: Twenty-six departments in 18 hospitals performed 476 resections. Five hospitals accounted for 92% of all the resections performed. In three hospitals, the resections were carried out in three different departments and 18 departments performed fewer than four resections per year. The postoperative stay was 19.2 days. The frequency of surgical complications was 19% and hospital mortality was 10.7%. DISCUSSION: The small number of oesophageal resections performed in many departments in Denmark is not in accordance with international recommendations, which say that the operation should be performed in high volume centres by experienced oesophageal surgeons, including thoracic surgeons, surgical gastroenterologists, and thoracic anaesthesiologists. On these results, it is recommended that the operation is performed in few centres and by few surgeons in multidisciplinary teams.

[Mallory-Weiss lesions]. / Mallory-Weiss laesioner.

INTRODUCTION: Mallory-Weiss syndrome (MW) has been know since 1929. Only few studies exist which focus on the prognosis of the lesion. No Danish MW data are available. The purpose of the study was to describe the demographics of patients admitted with an MW to a Danish surgical unit during a 5-year period and to investigate the prognosis of these patients. MATERIAL AND METHODS: Data from the patient records of 49 patients with endoscopically verified MW admitted through a five-year period were analysed. At follow-up, 35 patients were alive and contacted. A total of 29 responded. The mean time to follow-up from admittance was 42.7 months (range: 10.1-77.1). RESULTS: Haemostasis was achieved in all 49 patients. Sixteen received active therapy during the endoscopic procedure. Haemoglobin at admittance was lower (p = 0.008), the presence of bleeding stigmata higher (p < 0.0001) and the number of patients receiving blood transfusion higher (p = 0.01) among those receiving active therapy than among the group receiving no therapy at the time of their endoscopy. At follow-up, 50% of those receiving active therapy were dead (eight of 16) compared with 18% (six of 33) in the no-therapy group (p = 0.02). In the follow-up period, 10% of the patients admitted with an MW were re-admitted for a new gastrointestinal bleeding. CONCLUSION: Our data suggests that an attitude change is needed toward MW with bleeding stigmata. The course of the disease may not be as benign as generally believed. Further prospective studies designed to resolve this matter are needed.

[Liver surgery in Denmark 2002-2007]. / Leverresektioner i Danmark 2002-2007.

INTRODUCTION: We evaluated the organisation, management and outcome for patients undergoing elective liver resection in Denmark in the period 2002-2007. MATERIAL AND METHODS: Nationwide data based on the National Patient Registry and discharge information from hospital departments in the period 1 January 2002 to 31 December 2007 were analysed. RESULTS: Twenty-three departments performed 818 resections with five departments performing 96% and 18 departments performing 4% of the operations. The amount of non-anatomical resections constituted 30% (248 of 818) of the resections. The median postoperative stay was nine days, and the hospital mortality rate was 3.9%, distributed between 2.4% for non-anatomical resections, 2.9% for segmental resections and 5.2% for right-sided hepatectomy. CONCLUSION: The number of treated patients was too small as was the number referred to highly specialised liver surgery units. Moreover, the amount of non-anatomical resections was too high as was the average postoperative stay and the hospital mortality rate. In future, we propose that liver resections be centralised in 2-3 hospitals each capable of providing all the following services: surgery, hepatology, oncology and interventional radiology.

Endoscopic sphincterotomy and long-term risk of cholangiocarcinoma: a population-based follow-up study.

Sphincterotomy of the ampulla of Vater--a common diagnostic and therapeutic procedure that is sometimes done during endoscopic retrograde cholangiography (ERC)--allows reflux of intestinal content into the biliary tree. The resulting inflammation may contribute to malignant transformation of the biliary epithelium and therefore increase the risk of cholangiocarcinoma. We used data from population-based Danish health-care registries to examine the incidence of cholangiocarcinoma after ERC for 10 690 ERC patients who underwent sphincterotomy between 1977 and 2003 and 10,690 ERC patients who did not undergo sphincterotomy. Patients with sphincterotomy were matched to patients without sphincterotomy by sex and age at, calendar year of, and indication for ERC. The cholangiocarcinoma incidence rate for sphincterotomy patients was 404 per 100,000 person-years during the first year after ERC and decreased progressively at later times after ERC (79, 42, and 27 per 100,000 person-years during years 2, 3-5, and > 5, respectively). The corresponding rates for patients without sphincterotomy were 458, 12, 10, and 19 per 100,000 person-years, respectively. The gradual decrease in cholangiocarcinoma rate over time after ERC for sphincterotomy patients indicates that some of these patients had a cholangiocarcinoma that was present at the time of ERC but not diagnosed until 2-5 years later. The similar rates at the latest times after ERC suggest the lack of a causal association between sphincterotomy and cholangiocarcinoma.

[Long-term survival rate of patients transfused with leucocyte-depleted and buffy-coat-poor blood during colorectal surgery--secondary publication. An eight-year post-trial follow-up study]. / Overlevelse efter transfusion med leukocytdepleteret og buffycoat-depleteret blod ved kolorektal kirurgi--sekundaerpublikation. Et ottears post trial-opfolgingsstudie.

This study investigated the long-term survival rate of 589 patients enrolled in a trial in 1992-1995 who underwent colorectal surgery. The patients were randomised to receive leucocyte-depleted or buffy-coat-poor blood when transfusion was indicated. Significantly more of the non-transfused patients (59%) were alive seven years later compared to patients transfused with leucocyte-depleted blood (41%) and to patients transfused with buffy-coat-poor blood (45%).