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  • Articles: DFG German National Licenses  (4)
  • Electronic Resource  (4)
  • Colon cancer  (4)
  • 1
    Electronic Resource
    Electronic Resource
    Colorectal cancer in patients with previous spinal cord injury (1996)
    Springer
    Diseases of the colon & rectum 39 (1996), S. 965-968 
    Details
    ISSN: 1530-0358
    Keywords: Colon cancer ; Rectal cancer ; Paraplegia ; Quadraplegia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract BACKGROUND: The optimum management of large-bowel cancer in patients with previous spinal cord injury (SCI) is uncertain. PURPOSE: The aim is to determine the outcome of patients with SCI who are undergoing colectomy or proctectomy for cancer. METHODS: A population-based study of patients receiving care at hospitals in the Department of Veterans Affairs system from 1987 to 1991 was performed. Patients with ICD-9 codes for SCI and colon and rectal cancer were identified. Patients with previous SCI who underwent colectomy or proctectomy for their cancer comprised the study population. Data were compiled from national computerized Veterans Affairs datasets, supplemented by individual operative reports and discharge summaries. RESULTS: Forty-four patients were evaluable. Mean age was 65 (range, 40–80) years, and mean time since SCI was 24 (range, 1–50) years. Mean follow-up was 4.6 years after resection. Distribution of tumors was 39 percent rightsided, 43 percent left-sided, and 18 percent rectal. All 32 patients with colonic tumors underwent resection; 26 of 32 patients (81 percent) had an anastomosis. Seven of eight (88 percent) rectal lesions were treated by abdominoperineal resection. Twenty-six of 44 patients (59 percent) presented with Stage III or IV disease. Twelve of 44 (27 percent) died, 8 of 12 from cancer. Overall 30-day mortality rate was 4.5 percent (2/44). In-hospital morbidity rate (pulmonary, cutaneous, and urinary tract only) was 34 percent. Among those who received postoperative chemotherapy, 80 percent completed treatment. CONCLUSIONS: Patients with previous SCI tolerate resection well. Tumor distribution and stage are similar to those of neurally intact patients. Morbidity is commonly related to pre-existing complications of SCI. Adjuvant therapy is well tolerated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02054682
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    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Risk factors for morbidity and mortality after colectomy for colon cancer (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 83-91 
    Details
    ISSN: 1530-0358
    Keywords: Colon cancer ; Surgical mortality ; Colectomy ; Veterans Affairs Medical Center ; National Surgical Quality Improvement Program
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Comorbid conditions affect the risk of adverse outcomes after surgery, but the magnitude of risk has not previously been quantified using multivariate statistical methods and prospectively collected data. Identifying factors that predict results of surgical procedures would be valuable in assessing the quality of surgical care. This study was performed to define risk factors that predict adverse events after colectomy for cancer in Department of Veterans Affairs Medical Centers. METHODS: The National Veterans Affairs Surgical Quality Improvement Program contains prospectively collected and extensively validated data on more than 415,000 surgical operations. All patients undergoing colectomy for colon cancer from 1991 to 1995 who were registered in the National Veterans Affairs Surgical Quality Improvement Program database were selected for study. Independent variables examined included 68 preoperative and 12 intraoperative clinical risk factors; dependent variables were 21 specific adverse outcomes. Stepwise logistic regression analysis was used to construct models predicting the 30-day mortality rate and 30-day morbidity rates for each of the ten most frequent complications. RESULTS: A total of 5,853 patients were identified; 4,711 (80 percent) underwent resection and primary anastomosis. One or more complications were observed in 1,639 of 5,853 (28 percent) patients. Prolonged ileus (439/5,853; 7.5 percent), pneumonia (364/5,853; 6.2 percent), failure to wean from the ventilator (334/5,853; 5.7 percent), and urinary tract infection (292/5,853; 5 percent) were the most frequent complications. The 30-day mortality rate was 5.7 percent (335/5,853). For most complications, 30-day in-hospital mortality rates were significantly higher for patients with a complication than for those without. Thirty-day mortality rates exceeded 50 percent if postoperative coma, cardiac arrest, a pre-existing vascular graft prosthesis that failed after colectomy, renal failure, pulmonary embolism, or progressive renal insufficiency occurred. Preoperative factors that predicted a high risk of 30-day mortality included ascites, serum sodium 〉145 mg/dl, “do not resuscitate” status before surgery, American Society of Anesthesiologists classes III and IV OR V, and low serum albumin. CONCLUSIONS: Mortality rates after colectomy in Veterans Affairs hospitals are comparable with those reported in other large studies. Ascites, hypernatremia, do not resuscitate status before surgery, and American Society of Anesthesiologists classes III and IV OR V were strongly predictive of perioperative death. Clinical trials to decrease the complication rate after colectomy for colon cancer should focus on these risk factors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237249
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Current follow-up strategies after resection of colon cancer (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 573-583 
    Details
    ISSN: 1530-0358
    Keywords: Colon cancer ; Curative resection ; follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The follow-up of patients after potentially curative resection of colon cancer has important clinical and financial implications for patients and society, yet the ideal surveillance strategy is unknown. PURPOSE: The aim of this study was to determine the current follow-up practice pattern of a large, diverse group of experts. METHODS: The 1,663 members of The American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request nine discrete follow-up evaluations in their patients treated for cure with TNM Stage I, II, or III colon cancer over the first five post-treatment years. These evaluations were clinic visit, complete blood count, liver function tests, serum carcinoembryonic antigen (CEA) level, chest x-ray, bone scan, computerized tomographic scan, colonoscopy, and sigmoidoscopy. RESULTS: Forty-six percent (757/1663) completed the survey and 39 percent (646/1663) provided evaluable data. The results indicate that members of The American Society of Colon and Rectal Surgeons generally conduct follow-up on their patients personally after performing colon cancer surgery (rather than sending them back to their referral source). Routine clinic visits and CEA levels are the most frequently performed items for each of the five years. The large majority (〉75 percent) of surgeons see their patients every 3 to 6 months for years 1 and 2, then every 6 to 12 months for years 3, 4, and 5. Approximately 80 percent of respondents obtain CEA levels every 3 to 6 months for years 1,2, and 3, and every 6 to 12 months for years 4 and 5. Colonoscopy is performed annually by 46 to 70 percent of respondents, depending on year. A chest x-ray is obtained yearly by 46 to 56 percent, depending on year. The majority of the members of The American Society of Colon and Rectal Surgeons do not routinely request computerized tomographic scan or bone scan at any time. There is great variation in the pattern of use of complete blood count and liver function tests. Members of The American Society of Colon and Rectal Surgeons from the United States tend to follow their patients more closely than do those living in other countries. The intensity of follow-up does not markedly vary across TNM Stages I to III. CONCLUSION: The surveillance strategies reported here rely most heavily on clinic visits and CEA level determinations, generally reflecting guidelines previously proposed in the current literature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050993
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Surveillance after curative colon cancer resection: Practice patterns of surgical subspecialists (1995)
    Springer
    Annals of surgical oncology 2 (1995), S. 472-482 
    Details
    ISSN: 1534-4681
    Keywords: Follow-up ; Colon cancer ; Cost analyses
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In the literature, suggested strategies for the follow-up of colon cancer patients after potentially curative resections vary widely. The optimal regimen to monitor for recurrences and new primary tumors remains unknown. The nationwide cost impact of wide practice variation is also unknown. Methods: The 1,070 members of The Society of Surgical Oncology (SSO) were surveyed using a detailed questionnaire to measure the practice patterns of surgical experts nationwide. Respondents were asked how often they use nine separate methodologies in follow-up during years 1–5 postsurgery for TNM stage I, II, and III patients. Costs were estimated for representative less and more intensive strategies. Results: Evaluable responses were received from 349 members (33%). Office visit and carcinoembryonic antigen analysis were performed most frequently. SSO members generally see patients every 3 months in years 1–2, every 6 months in years 3–4, and annually thereafter. There was wide variability in test ordering patterns and moderate variation between SSO and previously surveyed American Society of Colon and Rectal Surgeons members. The charge differential between representative less and more intensive follow-up strategies for each annual U.S. patient cohort is ∼$800 million. Conclusions: Actual practice patterns vary widely, indicating lack of consensus regarding optimal follow-up. The enormous cost differential associated with such variation is difficult to justify because there is no proven benefit of more intensive follow-up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02307079
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    Paper (German National Licenses)
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