Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study.

PURPOSE: The hypothesis in this study was that anaemia prior to surgery and perioperative red blood cell transfusion increases the risk for recurrence and overall mortality in patients with stages I-III colorectal cancer after abdominal resection with curative intent. METHODS: This is a Swedish single centre retrospective cohort study. Data on 496 consecutive radical abdominal resections stages I-III colorectal cancer performed at the Karolinska University Hospital 2007-2010 were extracted from the Swedish Colorectal Cancer Registry. Data were linked to local laboratory and transfusion databases to identify preoperative anaemia and perioperative transfusion. Disease recurrence was validated by scrutiny of patient records. A total of 496 stages I-III colorectal cancer patients were included in the analysis. Multivariate Cox regression analysis adjusted for tumour and patient characteristics were performed to assess risk for recurrence and overall mortality. RESULTS: Anaemia prior to surgery was associated with increased risk for overall mortality (HR 2.1, 95% CI 1.4-3.2). There was no association between anaemia and risk for recurrence (HR 1.6, 95% CI 0.97-2.6). Transfusion was not associated with increased risk of recurrence (HR 0.7, 95% CI 0.4-1.3) or overall mortality (HR 1.04, 95% CI 0.7-1.6). CONCLUSIONS: Anaemia prior to colorectal cancer surgery was associated with increased risk for overall mortality while a no increased risk was seen for recurrence. Previous findings indicating an association between blood transfusion and increased risk for recurrence could not be confirmed.

Volume of blood loss during surgery for colon cancer is a risk determinant for future small bowel obstruction caused by recurrence--a population-based epidemiological study.

PURPOSE: Small bowel obstruction (SBO) is a serious late complication after abdominal surgery. The pathogenesis of intra-abdominal adhesions has been extensively studied and reviewed, but the cascade of mechanisms involved is still not understood. The objective was to test the hypothesis that increasing volume of blood loss during surgery for colon cancer increases the risk for future SBO, mainly due to adhesions. METHODS: Data were retrieved from the Regional Quality Register for all patients undergoing locally radical surgery for colon cancer 1997-2003 (n = 3 554) and matched with the Swedish National Patient Register data on surgery and admission for SBO. Records were reviewed to determine the etiology of surgery for SBO. Uni- and multivariate Cox analyses were used. RESULTS: One hundred ten patients (3.1 %) underwent surgery for SBO >30 days after the index operation. Blood loss ≥250 ml was an independent risk factor for surgery for SBO due to recurrence (HR 2.20; 95 % CI 1.12-4.31). Amount of blood loss did not affect the risk for surgery for SBO due to adhesions. Furthermore, blood loss of ≥250 ml increased the risk for hospital admission for SBO not requiring surgery. CONCLUSIONS: Blood loss ≥250 ml during surgery for colon cancer is an independent risk factor for later surgery for SBO caused by tumor recurrence, not by adhesions.

Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer.

BACKGROUND: Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment. MATERIAL AND METHODS: Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours. RESULTS: Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated at hospitals with < 29 procedures per year had an odds ratio (OR) for MDT evaluation of 0.15. Age and tumour stage also influenced the chance of MDT evaluation. MDT evaluation significantly predicted the likelihood of being treated with preoperative radiotherapy in patients with pT3c-pT4 M0 tumours (OR 5.06, 95% CI 3.08-8.34), and pN+ M0 (OR 3.55, 95% CI 2.60-4.85), even when corrected for co-morbidity and age. CONCLUSION: Patients with rectal cancer treated at high-volume hospitals are more likely to be discussed at a MDT conference, and that is an independent predictor of the use of adjuvant radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals.

The importance of blood loss during colon cancer surgery for long-term survival: an epidemiological study based on a population based register.

OBJECTIVE: This study tested the hypothesis that the amount of blood loss during surgery for colonic cancer influences long-term survival. BACKGROUND: The perioperative blood loss during surgery for colorectal cancer relates to the risk for complications and early mortality. METHODS: All patients who underwent surgery for colon cancer between 1997 and 2003 in the health-care region of Uppsala/Örebro were prospectively registered at the regional oncological center. Data on patients who underwent radical surgery for stages I to III disease were analyzed. Patients who died within 6 months after surgery were excluded. Hazard ratios were calculated with uni- and multivariate Cox proportional hazard regression. Because of covariation, blood loss, blood transfusion, and complications were tested in separate multivariate analyses. RESULTS: Blood loss of 250 mL or more during surgery, male gender, occurrence of complications, age more than 75 years, and stage III disease were risk factors for overall mortality in the uni- and multivariate analyses. Perioperative blood transfusion was shown to be a risk factor in the univariate analysis only. CONCLUSIONS: The results support the hypothesis that degree of blood loss during surgery for colon cancer is a factor that influences long-term survival.