Validation of the Danish Colorectal Cancer Group (DCCG.dk) database - on behalf of the Danish Colorectal Cancer Group.

AIM: The aim of this study was to validate the clinical quality database of the Danish Colorectal Cancer Group. The validation is meant to focus on core data regarding staging of the disease, treatment provided, patient-related factors and key complications. METHOD: This was a database validation study assessing the completeness of the database and the accuracy of the data by re-entering core variables into an online module in a blinded fashion and comparing re-entered data with the original database data. A sample of 5% of patients from the years 2014-2017 was randomly selected. RESULTS: The sample of 936 patients was identified and data were re-entered. The completeness of the data retrieved was a median of 96%, 100% and 99% for preoperative, intra-operative and postoperative variables, respectively. The overall accuracy was a median of 95%. The least accurate variable was date of diagnosis (50% perfect agreement), with agreement rising to 96% when near matches defined as correct date ± 30 days were included. Intra-operative variables were of high quality, as were data on surgical complications including anastomotic leakage, where agreement was 97%. CONCLUSION: This was the first major validation of the Danish Colorectal Cancer Group's database. Overall, the completeness and quality of data were high, but the validation process also identified weaknesses, which can be crucial for future users to acknowledge and consider.

Time trends of short-term mortality for octogenarians undergoing a colorectal resection in North Europe.

BACKGROUND: Decreased cancer specific survival in older colorectal patients is mainly due to mortality in the first year, emphasizing the importance of the first postoperative year. This study aims to gain an overview and time trends of short-term mortality in octogenarians (≥80 years) with colorectal cancer across four North European countries. METHODS: Patients of 80 years or older, operated for colorectal cancer (stage I-III) between 2005 and 2014, were included. Population-based cohorts from Belgium, Denmark, the Netherlands, and Sweden were collected. Separately for colon- and rectal cancer, 30-day, 90-day, one-year, and excess one-year mortality were calculated. Also, short-term mortality over three time periods (2005-2008, 2009-2011, 2012-2014) was analyzed. RESULTS: In total, 35,158 colon cancer patients and 10,144 rectal cancer patients were included. For colon cancer, 90-day mortality rate was highest in Denmark (15%) and lowest in Sweden (8%). For rectal cancer, 90-day mortality rate was highest in Belgium (11%) and lowest in Sweden (7%). One-year excess mortality rate of colon cancer patients decreased from 2005 to 2008 to 2012-2014 for all countries (Belgium: 17%-11%, Denmark: 21%-15%, the Netherlands: 18%-10%, and Sweden: 10%-8%). For rectal cancer, from 2005 to 2008 to 2012-2014 one-year excess mortality rate decreased in the Netherlands from 16% to 7% and Sweden: 8%-2%). CONCLUSIONS: Short-term mortality rates were high in octogenarians operated for colorectal cancer. Short-term mortality rates differ across four North European countries, but decreased over time for both colon and rectal cancer patients in all countries.

The effect of a multidisciplinary regional educational programme on the quality of colon cancer resection.

AIM: Mesocolic plane surgery with central vascular ligation produces an oncologically superior specimen following colon cancer resection and appears to be related to optimal outcomes. We aimed to assess whether a regional educational programme in optimal mesocolic surgery led to an improvement in the quality of specimens. METHOD: Following an educational programme in the Capital and Zealand areas of Denmark, 686 cases of primary colon cancer resected across six hospitals were assessed by grading the plane of surgery and undertaking tissue morphometry. These were compared to 263 specimens resected prior to the educational programme. RESULTS: Across the region, the mesocolic plane rate improved from 58% to 77% (P < 0.001). One hospital had previously implemented optimal surgery as standard prior to the educational programme and continued to produce a high rate of mesocolic plane specimens (68%) with a greater distance between the tumour and the high tie (median for all fresh cases: 113 vs 82 mm) and lymph node yield (33 vs 18) compared to the other hospitals. Three of the other hospitals showed a significant improvement in the plane of surgical resection. CONCLUSION: A multidisciplinary regional educational programme in optimal mesocolic surgery improved the oncological quality of colon cancer specimens as assessed by mesocolic planes; however, there was no significant effect on the amount of tissue resected centrally. Surgeons who attempt central vascular ligation continue to produce more radical specimens suggesting that such educational programmes alone are not sufficient to increase the amount of tissue resected around the tumour.

Intraoperative Tumor Perforation is Associated with Decreased 5-Year Survival in Colon Cancer: A Nationwide Database Study.

BACKGROUND: It is a widely held belief that intraoperative tumor perforation in colon cancer impairs survival and causes local recurrence, although the prognostic importance remains unclear. AIM: The aim of this study was to assess the effect of unintended intraoperative tumor perforation on postoperative mortality and long-term survival. MATERIAL AND METHODS: This national cohort study was based on data from a prospectively maintained nationwide colorectal cancer database. We included 16,517 colon cancer patients who were resected with curative intent from 2001 to 2012. RESULTS: Intraoperative tumor perforation produced a significantly impaired 5-year survival of 40% compared to 64% in non-perforated colon cancer. Intraoperative tumor perforation was an independent risk factor for death, hazard ratio 1.63 (95% confidence interval: 1.4-1.94), with a significantly increased 90-day postoperative mortality of 17% compared to 7% in non-perforated tumors, p < 0.001. We showed that tumor fixation, emergency operations, and laparotomies were associated with an increased risk of intraoperative tumor perforation. CONCLUSION: This nationwide study demonstrates that intraoperative tumor perforation in colon cancer is associated with statistically significant reduced long-term survival and increased postoperative mortality.

Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision?

AIM: we analysed the influence of standardization of colon cancer surgery with complete mesocolic excision (CME) on the quality of surgery measured by the pathological end-points of number of harvested lymph nodes, high tie of supplying vessels, plane of mesocolic resection and rate of R0 resection. METHOD: One hundred and ninety-eight patients with colonic carcinoma who underwent radical surgery between September 2007 and February 2009 were divided into two groups, including those undergoing surgery before (93) or after (105) 1 June 2008, when complete mesocolic excision (CME) was introduced as standard in our hospital. RESULTS: The overall mean high tie increased from 7.1 (CI, 6.5-7.6) to 9.6 (8.9-10.3) cm (P<0.0001) and the mean number of harvested lymph nodes from 24.5 (22.8-26.2) to 26.7 (24.6-28.8) (P=0.0095). There were no significant increases in these end-points in open right hemicolectomy, and in laparoscopic sigmoid resection the number of lymph nodes did not increase significantly. The plane of mesocolic resection, the rate of R0 resection and the risk of complications did not change significantly. The median (range) length of hospital stay increased from 4 (2-62) to 5 (2-71) days (P=0.04). CONCLUSION: Standardization of colonic cancer surgery with CME seems to improve the quality of surgery without increasing the risk of complications.

[Radical prostatectomy. The first 50 consecutive patients undergoing surgery at Rigshospitalet]. / Radikal prostatektomi. De første 50 konsekutive patienter opereret på Rigshospitalet.

INTRODUCTION: Radical prostatectomy has not been performed in Denmark until recently. In this paper, we report the results of the first patients undergoing a radical retropubic prostatectomy at Rigshospitalet. MATERIAL AND METHODS: Fifty consecutive patients, aged 47-68, median 59 years underwent radical prostatectomy. Ninety percent of the patients received three months of neoadjuvant endocrine therapy. RESULTS: Histopathology showed that 78% had organ-confined disease. During a median follow-up of 370 days, 11 patients (22%) developed biochemical failure, defined as a PSA value above 0.1 ng/ml. Although the number of patients is small and the follow-up limited, we confirmed correlations between preoperative characteristics and the risk of extraprostatic extension at tumour and biochemical progression. Surgery was performed without major complications. Erectile dysfunction was reported by 88%, whereas complete urinary continence was achieved in 90% of the patients.

Quantification of microvessel density of breast carcinoma: an assessment of the inter- and intraobserver variation.

The density profile of microvessels (MVD) has recently emerged as a prognostically independent morphological marker of various malignancies, including carcinoma of the breast. MVD-scoring may thus afford the pathologist the opportunity to identify subsets of early stage breast cancer patients, which may benefit from adjuvant therapy. Reproducibility studies are, however, mandatory. Fifty sections of invasive breast carcinoma, immunolabelled for Factor VIII-related antigen, were scored independently by two observers for the number of vessel-profiles (v-p) in the following manner: 1) 250 randomly selected high power fields (HPF) were scored by two analysts to evaluate the agreement of the counting per se; and 2) the hot spot(s), i.e. the zones considered the most vessel rich, in the 50 sections were identified and scored twice to evaluate the agreement on selecting hot spots. When the observers evaluated MVD in the very same 250 HPF a median deviation of 2 v-p (10%) was produced. The interobserver disparity was further accentuated when the participants independently had to identify the hot spots with a median deviation of 6 v-p (13%). Intraobserver variation was approximately equal to the interobserver discordance. Divergences were most conspicuous in fields with a complex vasculature. In conclusion the v-p scoring resulted in substantial inter- and intraobserver variation both in selecting hot spots and in performing the scoring per se. Alternative-scoring techniques, including strict stereological principles, should be considered in the morphological evaluation of angiogenesis.

The histopathology of human gastric mucosa inhabited by Helicobacter heilmannii-like (Gastrospirillum hominis) organisms, including the first culturable case.

The aim was to determine the prevalence of Helicobacter heilmannii-like organisms in human gastric biopsies and the associated histology compared with that of Helicobacter pylori-bearing gastric biopsies. Furthermore, the feasibility of culturing H. heilmannii was examined. A consecutive series of 727 gastric biopsies from 650 patients were prospectively scrutinized for H. heilmannii. Their distribution pattern was recorded as well as the affiliated morphology of the gastric mucosa. Additional biopsies from some of the patients were examined microbiologically. Four cases (0.6%)(95% confidence intervals: 0.01-1.2%) of the examined material harboured H. heilmannii. The bacterial burden was graded as sparse in three cases, moderate in one case. The distribution pattern was patchy; thus, in no case did all biopsies from one endoscopy comprise H. heilmannii. Adhesion to epithelial cells was infrequent. A mild gastritis, active in three cases, characterized all biopsies. Lymphoid aggregates occurred in biopsies from three patients. Micropapillary tufting of the epithelial layer and intestinal metaplasia were not apparent. Culture studies proved successful in the one of the four cases assayed. In conclusion the morphology of H. heilmannii-bearing mucosa deviates from that of H. pylori-associated mucosa by the absence of epithelial damage in the former. This observation can in part be explained by the predominant location of H. heilmannii at a distance from the epithelium in contrast to the conspicuous H. pylori adhesion to epithelial cells, coupled with a usually low bacterial burden and patchy occurrence of H. heilmannii as opposed to the generally more heavy infestation with H. pylori.

Metastasizing sarcoma of the aorta. A case report.

Sarcomas of the great vessels are rats. We report a case of a metastasizing sarcoma of the aorta. The patient was an 82-year-old male who presented with a subcutaneous tumour, which was initially classified as a malignant fibrous histiocytoma. Autopsy revealed a polypoid sarcoma of the luminal aspect of the aortic arch with metastases to several organs. By means of immunohistochemical staining, the aortic neoplasm was classified as an undifferentiated intimal sarcoma. The morphology of intimal sarcomas is very heterogeneous, and, when metastatic deposits are present, there may be considerable problems in differential diagnosis.

[Cervical cancer in Frederiksborg County 1990-1991]. / Livmoderhalskraeft i Frederiksborg Amt 1990-1993.

One hundred and eight patients from Frederiksborg County, Denmark with cervical cancer diagnosed from 1990 to 1993 were analysed concerning type of carcinoma, tumour stage and screening history. The following types of carcinoma were found: 87 (81%) squamous, 5 (5%) adenosquamous, 15 (14%) adenocarcinoma and one (1%) small cell carcinoma. All women aged 23-60 receive a written invitation to participate in the screening programme. Of the 57 patients who had never or only sporadically been screened 23 were outside the target population. Tumour stage was generally higher for the non-screened, i.e. only 57.9% stage I compared to 82.4% for the screened population. In 51 cases the following errors had occurred: seven sampling errors, 21 screening errors, 15 lack of follow-up of abnormal or inadequate smears, six inadequate cryotherapy and two interval cancers.