Registration and validity of surgical complications in colorectal cancer surgery

Gunnarsson, Ulf; Seligsohn, E; Jestin, Pia; Påhlman, Lars

doi:10.1002/bjs.4058

Cited by 100 publications

(75 citation statements)

References 23 publications

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“…Previous validation on several variables in the SCRCR against medical records, has shown the validity to be good [20,35]. A major concern of the present study is the lack of differentiation between venous and lymphatic vessel invasion, but one should keep in mind that venous invasion is easier to detect than lymphatic invasion on H&E staining, and few pathological departments have routinely used other stainings or immunohistochemical staining for elastin to detect LVI during the study period.…”

Section: Discussionmentioning

confidence: 88%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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Background: Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level. Materials and methods: Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012. Results: Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p ¼ .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence. Conclusions: Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.

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Section: Discussionmentioning

confidence: 88%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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“…First, this may be due to many minor postoperative complications being detected and treated on an outpatient basis, so that they did not appear in the discharge register. In addition, many in-hospital complications are simply not recorded 31 . However, there is no reason to believe that such a lack of data would be related to BMI or smoking status.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index and tobacco smoking on outcome after open appendicectomy

Sadr–Azodi

Lindström

Adami

et al. 2008

British Journal of Surgery

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Background: The effect of body mass index (BMI) and smoking on the risk of perforated appendix and postoperative complications in patients undergoing open appendicectomy for acute appendicitis was studied. Results: After adjustment for age, calendar period and BMI, smoking was significantly associated with an increased risk of perforated appendicitis (PA) (P = 0·004). The relative risk was 1·29 (95 per cent confidence interval 1·11 to 1·50) among current smokers with more than 10 pack-years of tobacco use. In patients with non-perforated appendicitis (NPA), the relative risk of overall postoperative complications was significantly associated with BMI (P < 0·001), and was 2·60 (1·71 to 3·95) in obese patients and 1·51 (1·03 to 2·22) in current smokers with more than 10 pack-years of tobacco use. In patients with PA, overweight, obesity and smoking status were not associated with an increased risk of overall postoperative complications.Conclusion: Perforation due to acute appendicitis was associated with current tobacco smoking. A BMI of 27·5 kg/m 2 or more and current smoking were associated with overall postoperative complications in patients with NPA.

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“…also imply higher risk of leakage -had these patients who in fact did not receive NSAIDs been correctly classified, it is plausible that the observed risk reduction would have been even larger. The outcome anastomotic leakage was collected at a patientbased level, but some underreporting is known for this registry variable [21] ; however, such misclassification is most probably unsystematic, and would, therefore, only attenuate the observed associations. Finally, using registry data, we analysed the share of anterior resection with primary anastomosis in relation to permanent stoma surgery (i.e.…”

Section: Discussionmentioning

confidence: 99%

Non-Steroidal Anti-Inflammatory Drug Use and Risk of Anastomotic Leakage after Anterior Resection: A Protocol-Based Study

Rutegård

Westermark²,

Hultberg³

et al. 2016

Dig Surg

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Background: Non-steroidal anti-inflammatory drugs (NSAIDs) have been introduced as opioid-sparing analgesics in colorectal surgery. However, recent research has implicated these drugs as risk factors for anastomotic dehiscence. Methods: The Swedish Colorectal Cancer Registry was used to identify all patients operated with anterior resection for rectal cancer at centres that performed more than 25 abdominal operations per year, from 2007 to 2012, inclusive. The registry provided individual patient data on demographic variables and symptomatic anastomotic leakage. The patient exposure to NSAIDs was defined according to the protocol of the hospital at which the patient was operated. Logistic regression was employed to estimate ORs and 95% CIs, adjusting for confounders. Results: The study cohort comprised 2,605 patients operated at 21 centres. In the NSAID group, 102/1,458 (7.0%) suffered an anastomotic leak, as compared to 124/1,023 (10.8%) in the non-NSAID group. With adjustment for confounding, patients treated at NSAID hospitals had a reduced risk of developing anastomotic leakage (OR 0.68; 95% CI 0.48-0.96). Conclusions: In this retrospective protocol-based study, NSAIDs did not increase the risk of anastomotic leakage after anterior resection for rectal cancer. The postoperative use of NSAIDs may not be detrimental, but more research is warranted.

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Registration and validity of surgical complications in colorectal cancer surgery

Abstract: Local interest and routine use of data for quality assurance are crucial factors for valid registers. Careful monitoring of validity is necessary for use of registry data in structured systems for improvement of surgical results.

Cited by 100 publications

References 23 publications

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

Impact of body mass index and tobacco smoking on outcome after open appendicectomy

Non-Steroidal Anti-Inflammatory Drug Use and Risk of Anastomotic Leakage after Anterior Resection: A Protocol-Based Study

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