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Rectal Cancer: Can the Results be Further Improved?
Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
2006 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperative treatments; a multitude of surgical and technical choices; possibilities of postoperative treatments and postoperative care and follow up. In this thesis, some aspects of this complex paradigm have been further investigated. One of the most feared complications after rectal cancer surgery is anastomotic leakage. The risk of anastomotic leakage is affected by non-influenceable factors related to the tumour and the patient. In the first paper, the risk of anastomotic leakage in relation to a surgical instrument, the circular stapler, was investigated. The risk of leakage was 7% or 11%, depending on the choice of instrument. In the second paper, a long-term evaluation of survival and local recurrence rates in the Swedish Rectal Cancer Trial was made. Randomisation was to either preoperative radiotherapy followed by surgery or surgery alone. After 13 years median follow-up, survival was 38% in the radiotherapy group and 30% in the surgery alone group. Differences in local recurrence rates were seen in all stages. Most rectal cancer operations carry a high risk of morbidity and mortality. For early stage cancers, a local procedure may be sufficient and in the third paper, population-based results of local excision of rectal cancer were explored. In stage I, cancer specific survival was the same after local excision as after major resection, but the relative survival was lower. The risk of local recurrence was higher after local excision than after resections. In the fourth paper, differences in survival rates in the Nordic countries and Scotland were investigated. The relative excess risk of death was highest in Denmark, but only in the first 90 postoperative days.

Through applying already existing knowledge and successively introducing new treatments, the results for rectal cancer treatment will be further improved.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis , 2006. , s. 48
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 172
Nyckelord [en]
Surgery, Rectal cancer, Anastomotic leak, Survival, Local recurrence, Local excision, International comparison
Nyckelord [sv]
Kirurgi
Identifikatorer
URN: urn:nbn:se:uu:diva-7154ISBN: 91-554-6659-1 (tryckt)OAI: oai:DiVA.org:uu-7154DiVA, id: diva2:168898
Disputation
2006-10-27, Grönwallsalen, Akademiska Sjukhuset, Uppsala, 09:15
Opponent
Handledare
Tillgänglig från: 2006-10-04 Skapad: 2006-10-04Bibliografiskt granskad
Delarbeten
1. The circular stapling device as a risk factor for anastomotic leakage
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2004 Ingår i: Colorectal Disease, ISSN 1462-8910, Vol. 6, nr 4, s. 275-279Artikel i tidskrift (Refereegranskat) Published
Identifikatorer
urn:nbn:se:uu:diva-94884 (URN)
Tillgänglig från: 2006-10-04 Skapad: 2006-10-04Bibliografiskt granskad
2. The Swedish Rectal Cancer Trial – long lasting benefits from radiotherapy on survival and local recurrence rate
Öppna denna publikation i ny flik eller fönster >>The Swedish Rectal Cancer Trial – long lasting benefits from radiotherapy on survival and local recurrence rate
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2005 Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, Vol. 23, nr 24, s. 5644-5650Artikel i tidskrift (Refereegranskat) Published
Identifikatorer
urn:nbn:se:uu:diva-94885 (URN)
Tillgänglig från: 2006-10-04 Skapad: 2006-10-04Bibliografiskt granskad
3. Population-based study of local surgery for rectal cancer
Öppna denna publikation i ny flik eller fönster >>Population-based study of local surgery for rectal cancer
2007 (Engelska)Ingår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 94, nr 11, s. 1421-1426Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The aim was to determine long-term survival and recurrence rates after local excision of rectal cancer from a prospectively registered population-based database. Methods: Swedish Rectal Cancer Registry data from 1995 to 2001, including 10181 patients of whom 643 (6-3 per cent) had a local excision, were analysed. Complete 5-year follow-up data from 1995 to 1998 were available. Cumulative relative and cancer-specific survival rates, and rates of local recurrence and distant metastases, were calculated by actuarial methods. Results: The 5-year cancer-specific survival rate for 256 patients with stage I disease who had local excision was 95-3 (95 per cent confidence interval 91-5 to 99-1) per cent. The 5-year local recurrence rate was 7-2 per cent. After adjustment for age, sex, tumour stage and preoperative radiotherapy, the relative risk of death from cancer was the same as that after major resection. Conclusion: Population-based results after local excision of rectal cancer are the same as those reported in controlled series for early-stage tumours after abdominal resection. A low relative survival and a high median age indicate the use of local excision in patients with a high level of co-morbidity. To achieve acceptable long-term results, optimal preoperative and postoperative staging is needed.

Nyckelord
Rectal disease, Anorectal disease, Malignant tumor, Intestinal disease, Digestive diseases, Rectum cancer, Treatment, Medicine, Surgery, Population, Public health
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-94886 (URN)10.1002/bjs.5715 (DOI)000251209800017 ()17661311 (PubMedID)
Tillgänglig från: 2006-10-04 Skapad: 2006-10-04 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
4. Survival in Rectal Cancer in the Nordic countries and Scotland
Öppna denna publikation i ny flik eller fönster >>Survival in Rectal Cancer in the Nordic countries and Scotland
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Manuskript (Övrigt vetenskapligt)
Identifikatorer
urn:nbn:se:uu:diva-94887 (URN)
Tillgänglig från: 2006-10-04 Skapad: 2006-10-04 Senast uppdaterad: 2010-01-13Bibliografiskt granskad

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