Plane of mesocolic dissection as predictor of recurrence after complete mesocolic excision for sigmoid colon cancer: A cohort study.

AIM: To investigate whether intramesocolic plane dissection assessed on fresh specimens by the pathologist is a risk factor for recurrence after complete mesocolic excision for sigmoid cancer when compared with mesocolic plane dissection. METHOD: Single-centre study based on prospectively registered data on patients undergoing resection for UICC stage I-III sigmoid colon adenocarcinoma during the period 2010-2017. The patients were stratified into either an intramesocolic plane group or a mesocolic plane group. Primary outcome was risk of recurrence after 4.2 years using inverse probability treatment weighting and competing risk analyses. RESULTS: Of a total of 332 patients, two were excluded as the specimen was assessed as muscularis propria plane, 237 (72%) specimens were deemed as mesocolic and 93 (28%) as intramesocolic. The 4.2-year cumulative incidence of recurrence after inverse probability treatment weighting was 14.9% (10.4-19.3) in the mesocolic group compared with 9.4% (3.7-15.0) in the intramesocolic group, thus the absolute risk difference between the mesocolic plane and intramesocolic plane was 5.5% (-12.5-1.6; p = 0.13) in favour of the intramesocolic group. CONCLUSION: Intramesocolic plane dissection was not a risk factor for recurrence after complete mesocolic excision for sigmoid cancer when compared with mesocolic plane dissection. No difference in risk of local recurrence, death before recurrence, and in overall survival after 4.2 years was observed between the two groups. With less than 1% of the specimens deemed as muscularis propria plane dissection, the classification appears unusable for the risk prediction of sigmoid colon cancer.

5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study.

BACKGROUND: The benefits of extensive lymph node dissection as performed in complete mesocolic excision are still debated, although recent studies have shown an association with improved long-term outcomes. However, none of these studies had an intention-to-treat design or aimed to show a causal effect; therefore in this study, we aimed to estimate the causal oncological treatment effects of complete mesocolic excision on right-sided colon cancer. METHODS: We did a population-based cohort study involving prospective data collected from four hospitals in Denmark. We compared the oncological outcome data of patients at one centre performing central lymph node dissection and vascular division after almost complete exposure of the proximal part of the superior mesenteric vein (ie, the complete mesocolic excision group) with three other centres performing conventional resections with unstandardised and limited lymph node dissection (ie, non-complete mesocolic excision; control group). We included data for all patients in the Capital Region of Denmark undergoing elective curative-intent right-sided colon resections for stages I-III colon cancer, as categorised by the Union for International Cancer Control (UICC; 5th edition), from June 1, 2008, to Dec 31, 2013. Patients were followed-up for 5·2 years after surgery. The primary outcome was the cumulative incidence of recurrence after 5·2 years of surgery. Inverse probability of treatment weighting and competing risk analyses were used to estimate the possible causal effects of complete mesocolic excision. This study is registered with ClinicalTrials.gov, number NCT03754075. FINDINGS: 1069 patients (813 in the control group and 256 in the complete mesocolic excision group) underwent curative-intent elective surgery for right-sided colon cancer during the study period. None of the patients were lost to follow-up regarding survival or recurrence status, and consequently no patient was censored in the analyses. The 5·2-year cumulative incidence of recurrence was 9·7% (95% CI 6·3-13·1) in the complete mesocolic excision group compared with 17·9% (15·3-20·5) in the control group, and the absolute risk reduction of complete mesocolic excision after 5·2 years was 8·2% (95% CI 4·0-12·4; p=0·00015). In the control group, 145 (18%) of 813 patients were diagnosed with a recurrence and 281 (35%) died during follow-up, whereas in the complete mesocolic excision group 25 (10%) of 256 patients were diagnosed with a recurrence and 75 (29%) died during follow-up. INTERPRETATION: This study shows a causal treatment effect of central mesocolic lymph node excision on risk of recurrence after resection for right-sided colon adenocarcinoma. Complete mesocolic excision has the potential to reduce the risk of recurrence and improve long-term outcome after resection for all UICC stages I-III of right-sided colon adenocarcinomas. FUNDING: The Tvergaard Fund, Helen Rude Fund, Krista and Viggo Petersen Fund, Olga Bryde Nielsen Fund, and Else and Mogens Wedell-Wedellsborg Fund.

[Gastric blow-out: complication after obesity surgery]. / Gastric blow-out: komplikation efter fedmekirurgi.

Laparoscopic gastric bypass is the most common type of surgery for morbid obesity in Denmark. The most frequent late complications after gastric bypass are ulcer, internal hernia and stenosis. Two cases of stenosis of the bileopancreatic limb with gastric blow-out are described. Urgent diagnosis with computed tomography and acute surgical treatment is vital as the complication can lead to gastric necrosis, pancreatitis, biliary stasis, sepsis and multi-organ failure within a very short time. Prompt contact to specialized surgeons is advocated.

[Acute esophageal necrosis]. / Akut øsofageal nekrose.

Acute esophageal necrosis (AEN), necrotizing esophagitis or "black esophagus", is a rare condition with less than 100 reported cases in the world literature. The condition arises due to necrosis of the esophageal mucosa leading to macroscopically black tissue. The condition is associated with a relatively poor prognosis with an overall mortality due to comorbidity of 32-36%. This case report describes a patient with AEN in the full length of the esophagus secondary to ischaemia due to bleeding and hypoperfusion. The patient died after 48 hours due to multi-organ failure.

[Loss of heterozygosity on chromosomes 1 and 19 in cases of primary brain tumour]. / Tab af heterozygositet på kromosom 1 og kromosom 19 i primaere hjernetumorer.

INTRODUCTION: Histological classification of brain tumours, including gliomas, can be difficult, and genetic investigations are increasingly significant in their classification and the development of treatment strategies. Oligodendrogliomas often show a loss of heterozygocity for the short arm of chromosome 1 and the long arm of chromosome 19 (LOH 1p/19q), changes that influence both treatment and prognosis. Our aim was to evaluate the incidence of combined loss of heterozygocity 1p and 19q in various glioma groups. MATERIALS AND METHODS: A total of 10 oligodendrogliomas (5 WHO grade II and 5 grade III), 10 mixed gliomas (5 WHO grade II and 5 grade III), 10 astrocytomas (5 WHO grade II and 5 grade III) and 11 glioblastomas (WHO grade IV) were investigated. Normal hippocampal tissue was used as a control. Formalin-fixed paraffin-embedded tissue was scrutinized with fluorescent in situ hybridization (FISH) with fluorochrome-conjugated double-strand DNA probes for 1p and 19q, respectively. RESULTS: A significiant loss of 1p/19q was found in the oligodendrogliomas; the astrocytomas showed a selective loss of 19q; the glioblastomas showed a selective loss of 1p but also polyploidy. CONCLUSION: This investigation confirms other reports on increased LOH 1p/19q in oligodendrogliomas. Various studies have demonstrated a large variation in the incidence of LOH 1p/19q. This might be due to inter- and intraobserver variability in the histological classification. Another factor might be variations in techniques. Most studies have been made on imprints. A standard for the method, including the number of cells counted, the cutoff limit and the statistical variation, is necessary for future studies and clinical use.