[Stenting for colorectal cancer obstruction in Icelandic patients].

INTRODUCTION: Self-expandable metal stents (SEMS) are a known treatment option for obstruction due to colorectal cancer. The objective of this project was to estimate the usage of such stents in Iceland between 2000-2018. We evaluated the number of patients who received the stent as a bridge to surgery (BtoS) or as a palliative therapy (PT) and evaluated complication rate and the technical and clinical success rate. MATERIAL AND METHODS: Retrospective review of patients in Landspitali University Hospital who received SEMS for malignant colorectal obstruction. Search was conducted using diagnostic and theraputic codes in the Icelandic electronic medical record system. RESULTS: A total of 43 patients with colorectal cancer received in total 53 SEMS for obstruction, the first patient in 2005. More patient received SEMS as PT (n=27) than as BtoS (n=16). Colon perforation occurred in 5 patients (12%). A resection with primary anastomosis was performed in 69% of the BtoS patients. The majority of the PT patients did not receive an operation (63%). Permanent stoma ratio was 27% for BtoS patients and 22% for PT patients. CONCLUSION: SEMS served as BtoS with resection and primary anastomosis for the majority of patients in the BtoS group. For a majority of patients in the PT group, SEMS could be used to avoid surgery. The perforation rate was relatively high. Information on techincal and clinical success was poorly recorded. Because of the retrospective nature of the study and the small population size all results should be interpreted with caution.

[Sigmoid volvulus at the University Hospital of Iceland 2000-2013].

Backround Sigmoid volvulus is an uncommon cause of bowel obstruction in most western societies. Treatment options include colonoscopy in uncomplicated disease with elective surgery later on. The aim of this study was to assess what treatment sigmoid volvulus patients receive along with long-term outcomes at Landspitali University Hospital. Methods The study was retrospective. Patients diagnosed with sigmoid volvulus at Landspitali University Hospital from 2000-2013 were included. Information regarding age, sex, and duration of hospital stay, treatment, short and long-term outcomes were gathered. Results Forty-nine patients were included in the study, of which 29 men and 20 women. Mean age was 74 (25-93). One patient underwent acute surgery on first arrival due to signs of peritonitis. Others (n=48) were treated conservatively in the first attempt with colonoscopy (n=45), barium enema (n=2) and rectal tube (n=1). Three other patients underwent acute surgery due to failed colonoscopy, 8 patients had planned surgery during the index admission. Thirty-six patients were discharged after conservative treatment with colonoscopy (n=35), barium enema (n=1) or rectal tube (n=1). Two patients came in for elec-tive surgery later on. Twenty-two patients (61%) had recurrence. Median time to recurrence was 101 days (1-803). Disease-free probability in 3, 6 and 24 months was 66%, 55% and 22% respec-tively. Total disease related mortality was 10.2%. Mortality (30 days) after acute surgery was 25% (1/4) and 16,6% (3/18) after planned surgery. Conclusions Sigmoid volvulus has high recurrence rate if not treated operatively. Total mortality due to sigmoid volvulus at Landspitali is low but surgery related mortality high.

[Outcome after surgical resection for rectal cancer and its precursors in Landspitali University Hospital 2008-2012].

BACKGROUND: Rectal cancer makes up 2-3% of all cancers in Iceland and surgery is the mainstay of its treatment. Information regarding those who undergo resection of the rectum because of rectal cancer or its precursors in Iceland today is lacking. The aim of this study was to evaluate what kind of surgical treatment rectal cancer patients receive at Landspitali University Hospital along with peri-operative and long-term outcomes. METHODS: The study was retrospective. All patients undergoing total or partial resection of the rectum for rectal cancer or its precursor from 2008-2012 in Landspitali University hospital were included. Information regarding age, sex, surgery, neoadjuvant and adjuvant treatment along with reoperations and survival were gathered. RESULTS: The total number of patients included were 144. Mean age was 66 years (33-89). Neoadjuvant treatment was used in 65 (45%) cases. Most of the patients (65%) underwent anterior resection of the rectum, 21% abdominoperineal resection, 11% Hartmann´s procedure and 3% other surgery. Majority of the patients had a cancer diagnoses (88%) but 12% had dysplastic adenomas. An anastomosis was made in 67% of cases, others (33%) got a permanent stoma. Reoperation rate within 30 days was 12%. Thirty day and 1 year mortality were 0.7% and 6.2% respectively. Average follow up time was 56 months (1-98). Local recurrence rate was 7,1%, five year survival rate was 77%. CONCLUSION: The surgical treatment for rectal cancer in Landspitali is up to international standard. Perioperative and long-term outcomes are similar to what other authors have reported.

[Choledocholithiasis after cholecystectomy at Landspítali--The National University Hospital of Iceland 2008-2011]. / Gallrásarsteinar eftir gallblöðrutöku á Landspítala 2008-2011.

INTRODUCTION: Symptoms of choledocholithiasis can appear after cholecystectomy. Stones diagnosed during the first two years following surgery are assumed to have been present at the time of surgery. The purpose of this study was to study patients who presented with choledocholithiasis at Landspitali--The National University Hospital of Iceland, during the period 2008-2011, who had previously undergone cholecystecomy and to assess whether cholodocholithiasis is underdiagnosed at the time of cholecystectomy. MATERIAL AND METHODS: The study was retrospective, data was collected from medical records at Landspitali. Among recorded data were liver function tests, imaging results, time from surgery to diagnosis, treatment and complications. RESULTS: Forty patients presented with choledocholithiasis after previous cholecystectomy. Mean age was 50 years (20-89) and women were 24 (60%). Mean time from surgery to diagnosis was 382 days. Diagnosis was confirmed with imaging in 35 (87.5% cases). Thirty six (90%) patients were treated with ERCP, one with PTC and one underwent open surgery. Three patients healed without treatment. Three patients developed complications from treatment. Thirty one (77.5%) had choledocholithiasis in the first 2 years following surgery. Incidence of previous choledocholithiasis, elevated bilirubin or widening of the choledochus without visible stones where similar for those diagnosed with choledocholithiasis in the first two years and those diagnosed later. CONCLUSION: Majority of patients are treated without surgery. Most stones are diagnosed during the first two years following surgery. For the majority of cases it can not be concluded that stones should have been suspected at time of cholecystectomy.

[Clostridium difficile infections at Landspítali - 1998-2008]. / Clostridium difficile sýkingar á Landspítala 1998-2008.

OBJECTIVE: To study the epidemiology and severity of C. difficile infections (CDI) at Landspítali over 11 year period, 1998-2008. MATERIAL AND METHODS: CDI were identified by a positive toxin assay in stools from the database of the Department of Microbiology. Chart review was conducted on patients diagnosed in January and June each year during the study period, a total of 237 infections. RESULTS: Overall, 1,861 of 11,968 submitted stool samples were positive for C. difficile toxin, representing 1,492 infections. The population-based incidence was 29% higher in the end than in the beginning of the period and was highest in the age group >80 years where it was 387 cases per 100,000 person-years. The incidence per 1,000 admissions and 10,000 hospital days increased by 71% and 102%, respectively. 47% of the infections were nosocomial. Most patients had history of antibiotic exposure prior to the infection and the most common symptom was diarrhea. Response to a single antibiotics course was good (93%). No patient required surgery due to colitis. CONCLUSION: The incidence of CDI was higher in 2008 than 11 years before. Most patients had well characterized risk factors for CDI. For most patients a single course of metronidazole treatment resolved the infection. Based on these data, the severity of CDI does not seem to be increasing in Iceland.