[Rectal cancer at Landspítalinn 1980-1995.].

OBJECTIVE: Surgery for rectal cancer is difficult and complications following surgery frequent. In the longer perspective a local recurrence is a serious problem. With better operative strategy and local radiation preoperatively a considerable progress has been made in treatment of this disease in large cancer centers. The aim of this study was to investigate symptoms, diagnostic delay, treatment, complications and survival of patients with rectal cancer treated at our institution. MATERIAL AND METHODS: A retrospective study of 43 consecutive patients (22 males, 21 females, mean age 73 years) diagnosed with rectal adenocarcinoma at Landspítalinn between 1980 and 1995 was performed. RESULTS: The most common symptoms were rectal bleeding (77%), change of bowel habits (63%) and abdominal pain (37%). More than 80% of the patients had a delay of more than one month before diagnosis and 53% of the tumors were located in the lower third of the rectum. One third of the patients were diagnosed with disease outside the rectum (Duke's-stage C and "D") and 54% were Duke's stage B. Of 43 patients 41 were operated, 30 (73%) with curative surgery. Low anterior resection of rectum was the most commonly performed procedure (n=17) with two cases of anastomostic leakage. Eleven patients underwent abdominoperineal resection and four patients were operated on because of metastasis with colostomy only. Surgical mortality was 0%. Five-year survival was 30% for the whole group and 52% for patients in stage B. CONCLUSION: There was no operative mortality in this series. Long-term survival for patients in comparable stages is inferior to recently published studies from larger and more specialized centers. The different results obtained could be explained by standardized surgical procedures and routine preoperative radiotherapy. Similar emphasis will be adopted to standardize rectal cancer surgery.

[Carcinoma of the colon in Iceland 1955-1989. An investigation of survival according to various pathological parameters.].

OBJECTIVE: The purpose of this study was to estimate various pathological parameters of colon carcinoma over a 35 year time period and evaluate their effect on survival of the patients. MATERIAL AND METHODS: All pathological specimens from patients diagnosed with colon carcinoma in Iceland in the period 1955 to 1989 were re-evaluated in order to determine the following pathological parameters: Tumour size, gross appearance, tissue type, grade, Dukes stage, lymphatic and/or blood vessel invasion, lateral margin involvement, Jass-group of tumour, peritumoural lymphocytic infiltrate, limitation of tumour growth to bowel wall, lymph node metastases, invasive tumour margin and colloid component in adenocarcinoma. Also the following parameters were determined in every case: Age at diagnosis, sex, year of diagnosis and tumour location within the bowel. All these parameters were evaluated with respect to survival of the patients. RESULTS: According to the Icelandic Cancer Registry 1265 patients were diagnosed with colon cancer in Iceland in the period under investigation. After re-evaluation 1205 patients fulfilled the criteria of a primary colon cancer and of those we were able to re-evaluate specimens from 1109 patients to determine histopathological parameters. In a univariable analysis most of the parameters investigated proved significant with respect to survival, except sex, anatomical location of tumour within the bowel, and the proportion of colloid component of tumour. In a multivariable analysis the age at diagnosis proved important as well as the year/period of diagnosis. The following pathological parameters evaluated had a significant prognostic input with regard to survival: Tumour grade, Dukes stage, number of lymph nodes with metastases, peritumoral lymphocytic infiltrate, lateral margin involvement in the surgical specimen and invasive growth pattern of tumour margin. CONCLUSIONS: Many pathological parameters are important in regard with prognostic evaluation of patients diagnosed with colon cancer. We suggest that pathologists should include in their surgical pathology specimen reports of colon cancer, in addition to traditional parameters, an evaluation of peritumoral lymphocytic infiltrate, lateral margin involvement with tumour and the growth pattern of tumour at the invasive margin.

[Acute pancreatitis. Prospective study of incidence, aetiology, severity, and mortality in Iceland.].

OBJECTIVE: To evaluate the aetiology, severity and mortality of patients with acute pancreatitis at Landspítali - University Hospital (LSH) and to estimate the incidence in Iceland. MATERIAL AND METHODS: A prospective study of all patients diagnosed with acute pancreatitis LSH during the one-year period October 1998 - September 1999 inclusive. The main outcome measures were APACHE II, Ranson, and Imrie scores, and C-reactive protein (CRP) concentrations. The Balthazar - Ranson criteria were used for scoring of computed tomograms (CT). RESULTS: Twenty seven of the 50 patients were male. The median age of the whole series was 60 years (range 19-85). The estimated incidence was 32/100000 for the first attack of acute pancreatitis. The causes were; gallstones 42%, alcohol 32%, miscellaneous 24%, and idiopathic 2%. Thirty three percentage of the patients had APACHE II scores 9, 38% had Ranson scores of 3, 50% had Imrie scores of 3, and 34% had CRP concentrations >210 mg/L during the first 4 days or >120 mg/L during the first week. Seven patients had severe pancreatitis. Two patients in the whole group died, and both had clinically severe pancreatitis. CONCLUSIONS: Incidence and aetiology of acute pancreatitis in Iceland is in concordance to that described in other studies. Prospective assessment makes it possible to evaluate the aetiological factors more accurately. Measurement of the CRP concentration is an attractive and simple alternative to the severity scoring systems currently in use.