Simultaneous or staged resection of synchronous colorectal cancer liver metastases: a 13-year institutional follow-up.

BACKGROUND: This study compared postoperative outcomes and survival rates of patients who underwent simultaneous or staged resection for synchronous colorectal cancer liver metastases. METHODS: Between 2005 and 2018, 126 patients were registered prospectively at a university hospital in Sweden, 63 patients who underwent simultaneous resection were matched against 63 patients who underwent staged resection. RESULTS: The length of hospital stay was shorter for the simultaneous resection group, at 11 vs 16 days, p = <0.001. Fewer patients experienced recurrence in the simultaneous resection group 39 vs 50 patients, p = 0.012. There were no significant differences in disease-free survival and overall survival between the groups. Age (hazard ratio [HR] 1.72; 95% CI 1.01-2.94; p = 0.049) and Clavien-Dindo score (HR 2.22; 95% CI 1.06-4.67; p = 0.035) had impact on survival. CONCLUSION: Colorectal cancer with synchronous liver metastases can be resected simultaneously, and enables a shorter treatment time without jeopardizing oncological outcomes.

Exposure limit values for nanomaterials--capacity and willingness of users to apply a precautionary approach.

In the European Union, the legal obligation for employers to provide a safe workplace for processing manufactured nanomaterials is a challenge when there is a lack of hazard information. The attitude of key stakeholders in industry, trade unions, branch and employers' organizations, and government policy advisors toward nano reference values (NRVs) has been investigated in a pilot study that was initiated by a coalition of Dutch employers' organizations and Dutch trade unions. NRVs are developed as provisional substitutes for health-based occupational exposure limits or derived no-effect levels and are based on a precautionary approach. NRVs have been introduced as a voluntary risk management instrument for airborne nanomaterials at the workplace. A measurement strategy to deal with simultaneously emitting process-generated nanoparticles was developed, allowing employers to use the NRVs for risk assessment. The motivational posture of most companies involved in the pilot study appears to be pro-active regarding worker protection and acquiescent to NRVs. An important driver to use NRVs seems to be a temporary certainty employers experience with regard to their legal obligation to take preventive action. Many interviewees welcome the voluntary character of NRVs, though trade unions and a few companies advocate a more binding status.

Mechanical bowel preparation does not affect the intramucosal bacterial colony count.

PURPOSE: The aim of this study was to determine if mechanical bowel preparation (MBP) influences the intramucosal bacterial colony count in the colon. MATERIALS AND METHODS: Macroscopically normal colon mucosa was collected from 37 patients (20 with and 17 without MBP) who were undergoing elective colorectal surgery at three hospitals. The biopsies were processed and cultured in the same laboratory. Colony counts of the common pathogens Escherichia coli and Bacteroides as well as of total bacteria were conducted. The study groups were comparable with regard to age, gender, antibiotics use, diagnosis and type of resection. RESULTS: MBP did not influence the median colony count of E. coli, Bacteroides or total bacteria in our study. CONCLUSIONS: MBP did not affect the intramucosal bacterial count in this study. Further studies are suggested to confirm these findings.

Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish Rectal Cancer Registry 1995-2004.

BACKGROUND: Limited information is available regarding the effect of age on choice of surgical and oncological treatment for rectal cancer. The objective of this study was to assess the influence of age on treatment and outcome of rectal cancer. METHODS: We utilized data in the Swedish Rectal Cancer Registry (SRCR) from patients treated for rectal cancer in Sweden in 1995-2004. RESULTS: A total of 15,104 patients with rectal cancer were identified, 42.4% of whom were 75 years or older. Patients > or = 75 years were less likely to have distant metastases than younger patients (14.8% vs. 17.8%, P < 0.001), and underwent abdominal tumor resection less frequently (68.5% vs. 84.4%, P < 0.001). Of 11,725 patients with abdominal tumor resection (anterior resection [AR], abdominoperineal excision [APE], and Hartmann's procedure [HA]), 37.4% were > or = 75 years. Curative surgery was registered for 85.0% of patients > or = 75 years and for 83.9% of patients < 75 years, P = 0.11. Choice of abdominal operation differed significantly between the two age groups for both curative and non-curative surgery, The frequency of APE was similar in both age groups (29.5% vs. 28.6%), but patients > or = 75 years were more likely to have HA (16.9% vs. 4.9%) and less likely to have preoperative radiotherapy (34.3 vs. 67.2%, P < 0.001). The relative survival rate at five years for all patients treated with curative intent was 73% (70-75%) for patients > or = 75 years and 78% (77-79%) for patients < 75 years of age. Local recurrence rate was 9% (8-11%) for older and 8% (7-9%) for younger patients. CONCLUSION: Treatment of rectal cancer is influenced by patient's age. Future studies should include younger and older patients alike to reveal whether or not age-related differences are purposive. Local recurrence following surgery for low tumors and quality of life aspects deserve particular attention.

Preoperative mechanical preparation of the colon: the patient's experience.

BACKGROUND: Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials. METHODS: As part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 - 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary. RESULTS: 60 patients received mechanical bowel preparation (MBP) and 45 patients did not (No-MBP). In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively) patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03. CONCLUSION: Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying.