Impact on follow-up strategies in patients with primary sclerosing cholangitis.

BACKGROUND & AIMS: Evidence for the benefit of scheduled imaging for early detection of hepatobiliary malignancies in primary sclerosing cholangitis (PSC) is limited. We aimed to compare different follow-up strategies in PSC with the hypothesis that regular imaging improves survival. METHODS: We collected retrospective data from 2975 PSC patients from 27 centres. Patients were followed from the start of scheduled imaging or in case of clinical follow-up from 1 January 2000, until death or last clinical follow-up alive. The primary endpoint was all-cause mortality. RESULTS: A broad variety of different follow-up strategies were reported. All except one centre used regular imaging, ultrasound (US) and/or magnetic resonance imaging (MRI). Two centres used scheduled endoscopic retrograde cholangiopancreatography (ERCP) in addition to imaging for surveillance purposes. The overall HR (CI95%) for death, adjusted for sex, age and start year of follow-up, was 0.61 (0.47-0.80) for scheduled imaging with and without ERCP; 0.64 (0.48-0.86) for US/MRI and 0.53 (0.37-0.75) for follow-up strategies including scheduled ERCP. The lower risk of death remained for scheduled imaging with and without ERCP after adjustment for cholangiocarcinoma (CCA) or high-grade dysplasia as a time-dependent covariate, HR 0.57 (0.44-0.75). Hepatobiliary malignancy was diagnosed in 175 (5.9%) of the patients at 7.9 years of follow-up. Asymptomatic patients (25%) with CCA had better survival if scheduled imaging had been performed. CONCLUSIONS: Follow-up strategies vary considerably across centres. Scheduled imaging was associated with improved survival. Multiple factors may contribute to this result including early tumour detection and increased endoscopic treatment of asymptomatic benign biliary strictures.

Surgery Improves Survival After Neoadjuvant Therapy for Borderline and Locally Advanced Pancreatic Cancer: A Single Institution Experience.

OBJECTIVE: Neoadjuvant therapy (NAT) has become part of the multimodality treatment for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC). SUMMARY BACKGROUND DATA: It is currently uncertain which are the preferable NAT regimens, who benefits from surgery, and whether more aggressive surgical strategy is motivated. METHODS: A retrospective cohort analysis was performed for all patients with BRPC/LAPC discussed and planned for NAT at multidisciplinary conference at Karolinska University Hospital from 2010 to 2017. RESULTS: Of 233 patients eligible, 168 (72%) received NAT and were reevaluated for possibility of resection. A total of 156 (67%) patients (mean 64 yrs, 53% male) had pancreatic adenocarcinoma, comprising the study group for survival analysis. LAPC was diagnosed in 132 patients (85%), BRPC in 22 (14%), and resectable tumor in 2 (1.3%). Fifty patients (40.3%) received full-dose NAT. Only 54 (34.6%) had FOLFIRINOX. The overall survival among resected patients was similar for BRPC and LAPC (median survival 15.0 vs 14.5 mo, P = 0.4; and 31.9 vs 21.8 mo, P = 0.7, respectively). Resected patients had better survival than nonresected, irrespective of the type or whether full-dose NAT was given (median survival 22.4 vs 12.7 mo; 1-, 3-, and 5-yr survival: 86.4%, 38.9%, 26.9% vs 52.2%, 1.5%, 0%, respectively (P < 0001). For all preoperative values of Ca 19-9, surgical resection had positive impact on survival. CONCLUSIONS: All patients with BRPC/LAPC who do not progress during NAT should be considered for surgical resection, irrespective of the type or dose of NAT given. Higher levels of Ca 19-9 should not be considered an absolute contraindication for resection.

Patient-reported adverse events after hernia surgery and socio-economic status: A register-based cohort study.

BACKGROUND: The aim of the present study was to assess how socio-economic background influences perception of an adverse postoperative event after hernia surgery, and to see if this affects the pattern of seeking healthcare advice during the early postoperative period. MATERIALS AND METHODS: All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire inquiring about adverse events. Data on civil status, income, level of education and ethnic background were obtained from Statistics Sweden. RESULTS: Of the 1643 patients contacted, 1440 (87.6%) responded: 1333 (92.6%) were men and 107 (7.4%) women, mean age was 59 years. There were 203 (12.4%) non-responders. Adverse events were reported in the questionnaire by 390 (27.1%) patients. Patients born in Sweden and patients with high income levels reported a significantly higher incidence of perceived adverse events (p < 0.05). Patients born in Sweden and females reported more events requiring healthcare contact. There was no association between registered and self-reported outcome and civil status or level of education. CONCLUSION: We detected inequalities related to income level, gender and ethnic background. Even if healthcare utilization is influenced by socio-economic background, careful information of what may be expected in the postoperative period and how adverse events should be managed could lead to reduced disparity and improved quality of care in the community at large.

Timing and type of disaster severity data available on Internet following the 2010 Haiti Earthquake.

Background To adequately plan relief, adequate information that describe and quantify the severity of a disaster, and estimate the number of affected population, is rapidly needed. However, needs assessments describing the severity of the disaster has been shown to be conducted too late in order to guide the first days relief interventions. The aim of this study was to assess availability of early disaster severity information on Internet during the first seven days following the 2010 Haiti earthquake and assess to which extent the information was consistent with later revelations. Methods We searched the well acknowledged web portal Relief Web for all Haiti postings during the first seven days (12 -18 January 2010) after the earthquake. A form was created to classify and quantify extracted severity variables found in the postings. The results were compiled, analysed and compared with CRED (Centre for Research on the Epidemiology of Disaster) official data made available later. Findings A total of 822 reports were posted where of 15 % provided a numerical estimate of the affected population, while 10% had an estimate on the number of dead. On day four 200 000 dead was reported, which is of the same magnitud compared to later official estimates (CRED data). Not a single report described the data collection method. Conclusions Within a few days of the 2010 Haiti earthquake it was possible to find surprisingly accurate information regarding severity of the earthquake but the available data must be questioned as no method was reported. More specialized and independent needs assessment agencies may improve availability of strategic information in the early onset of a disaster.