[Recurrence and survival after conventional low anterior resection for rectal cancer]. / Recidiv og overlevelse efter konventionel lav anterior resektion for cancer recti.

INTRODUCTION: The aim of the study was to evaluate the incidence of recurrence of local cancer, distant metastases and survival after conventional low anterior resection for cure in patients with rectal carcinoma, on the basis of the poor prognosis after colorectal cancer in Denmark. MATERIAL AND METHODS: Consecutive patients operated on in the nine Danish departments of surgical gastroenterology in 1992-1993. Retrospective collection of data on recurrence of local cancer, distant metastases, and over-all survival at the end of 1996. RESULTS: Of 268 patients, 77 (29%) developed recurrent local cancer and/or distant metastases. Forty-eight (18%) had local recurrence with a cumulative 5-year rate of 39%. Distant metastases were seen in 54 (20%). The local recurrence rate increased with increasing Dukes' tumour stage and was higher after operation by a non-specialist (30%) than by a consultant, another specialist, or a surgeon under training and supervised by a consultant (15-17%) (p = 0.04). Multiple regression showed that the recurrence rate was independent of tumour localisation, blood loss, transfusion, anastomotic leakage, and status of the surgeon. The cumulative crude 5-year survival was 50% and independent of the status of the surgeon. DISCUSSION: Our relatively high local recurrence rate and the results in the literature after total mesorectal excision (TME) indicate that the conventional technique should be replaced by TME, which has become the recommended method in recent years. Furthermore, we propose a changed strategy in the treatment of rectal cancer. The patients should be treated in fewer departments with established teams of rectal cancer specialists taking part in all operations for rectal cancer.

[Staging of rectal cancer by means of MRI. Experiences with the first twenty-five patients]. / Stadieinddeling af rectumcancer ved hjaelp af MR-scanning. Erfaring med de første 25 patienter.

INTRODUCTION: The Danish Surgical Society recommends preoperative radiation for patients with T4 tumours of the rectum. However, the clinical examination with regard to fixation, especially for tumours in the upper part of the rectum, is encumbered by much uncertainty. MR imaging is a new modality in the staging procedure of the patient with rectal cancer. Our experience with the first 25 patients is presented. METHODS: After clinical examination, an MRI of the rectum was done and in the case of a T4 tumour preoperative radiotherapy was established. Preoperative MRI staging was correlated with the histopathology of the resection specimen. RESULTS: In cases of tumours in the lower third of the rectum, we found total agreement between the clinical examination and the MRI findings. In the middle third it was impossible to assess clinical fixation in two out of seven patients and in the upper third it was impossible in eight out of ten. With respect to possible involvement of lymph nodes, the MRI revealed a true positive diagnostic frequency of 0.78, a true negative diagnostic frequency of 0.92, a true positive nosographic frequency of 0.88 and a true negative nosographic frequency of 0.85. The corresponding values for tumour invasion were 0.94, 0.75, 0.94 and 0.75. DISCUSSION: Our results seem to indicate that preoperative MRI--especially in patients with tumours in the upper two-thirds of the rectum--is suitable for predicting fixation. MRI also seems to be suitable in the complete staging of the patient with a tumour of the rectum.

[Femoro-popliteal bypass surgery in Denmark 1983-1987]. / Femoro-popliteal bypass-kirurgi i Danmark 1983-1987.

In a retrospective study of femoro-popliteal bypass surgery in Denmark during the period 1983 to 1987, a total of 1,532 operations were performed. Approximately 2/3 of the patients were operated upon for limb salvage, the remainder for severe disabling claudication. The perioperative lethality was below two per cent in all departments. Early occlusion rate was found to be between 21 and 11 per cent, leading to major amputation in about half of the patients.