Biomedical subjects

Ilmo H Kellokumpu

Publications and source records attributed to Ilmo H Kellokumpu.

5 recordsLinked to original sources

PubMed2006

Impact of functional results on quality of life after rectal cancer surgery.

PURPOSE: Quality of life is an important outcome measure that has to be considered when deciding treatment strategy for rectal cancer. The aim of this study was to find out the impact of surgery-related adverse effects on quality of life. METHODS: The RAND-36 questionnaire and questionnaires assessing urinary, sexual, and bowel dysfunction were administered to 94 patients with no sign of recurrence a minimum of one year after curative surgery. Results were compared with age-matched and gender-matched general population. RESULTS: Eighty-two (87 percent) patients answered the questionnaires. Major bowel dysfunction was as common after high anterior resection as after low anterior resection. Urinary complaints occurred as often after anterior resection as after abdominoperineal resection, but sexual dysfunction was more common after abdominoperineal resection. Overall, the patients reported better general health perception but poorer social functioning than population controls. In particular, elderly patients reported a significantly better quality of life in many dimensions than their population controls. There was no significant difference in quality of life between treatment groups. Major bowel dysfunction after anterior resection impaired social functioning compared with that of patients without such symptoms. Urinary dysfunction impaired social functioning and impotence impaired physical and social functioning. CONCLUSIONS: Quality of life after rectal cancer surgery is not worse than that of the general population. The major adverse impact of bowel and urogenital dysfunction is on social functioning. These adverse effects need to be discussed with the patient and preoperative function needs to be taken into account when choosing between treatment options. Permanent colostomy is not always the factor that disrupts a person's quality of life most.

Adult↗

PubMed2004

Complications and survival after surgery for rectal cancer in patients younger than and aged 75 years or older.

PURPOSE: An increasing number of rectal cancer patients are elderly and have comorbid medical diseases. This study was designed to compare perioperative morbidity, mortality, and survival after surgery for rectal cancer in patients younger than and aged 75 years or older. METHODS: Between 1980 and 1997, 294 patients with rectal cancer were admitted to the Fourth Department of Surgery, Helsinki University Central Hospital. Of these, 95 (32 percent) were aged 75 or older and comprise the elderly group. RESULTS: Major curative operation was possible in 59 of 95 patients in the elderly group and in 147 of 199 patients in the younger age group. Among those operated on with curative intent, 20 of 59 patients (34 percent) in the older age group and 39 of 147 patients (27 percent) in the younger age group had complications ( P = 0.31). Thirty-day mortality was 2 percent (n = 1) and 0, respectively. Although five-year crude survival was significantly lower in the older age group (43 vs. 65 percent, P = 0.01), five-year cancer-specific survival (60 vs.70 percent, P = 0.6) and disease-free, five-year survival (60 vs. 69 percent, P = 0.4) were similar in both groups. Patients (n = 17) treated with local excision had a cancer-specific survival of 81 and 83 percent in younger and older age groups, respectively. After palliative resection, the two-year survival was similar (20 vs. 24 percent) in both age groups. Ten elderly patients (11 percent) were not operated on at all in contrast to two patients (1 percent) younger than aged 75 years ( P = 0.003). CONCLUSIONS: Major, curative, rectal cancer surgery in selected elderly patients can be performed with similar indications, perioperative morbidity, and mortality, as well as five-year, cancer-specific and disease-free survival as in younger patients.

Adenocarcinoma↗

PubMed2004

Immediate repair of obstetric anal sphincter rupture: medium-term outcome of the overlap technique.

PURPOSE: Overlap sphincteroplasty is gaining popularity in the primary repair of obstetric sphincter ruptures. This study was designed to evaluate the medium-term outcome of the overlap technique. METHODS: Between August 1997 and October 2001, 31 consecutive females who were diagnosed with a complete third-degree or fourth-degree anal sphincter rupture underwent overlap sphincteroplasty immediately after delivery. Thirty of the females were followed-up for a median of 24 months. The outcome was assessed by clinical examination, anal endosonography, Wexner score, and pelvic floor electromyography. RESULTS: Median 24 (range, 12-63) months after delivery, 23 females (77 percent) were free of symptoms of anal incontinence. Occasional incontinence to flatus and liquid stool occurred in 17 and 7 percent of patients, respectively. Seven percent of patients had a Wexner incontinence score of > 9. The maximum mean resting pressure was 55 (range, 20-90) mmHg, and the maximum mean incremental squeeze pressure was 37 (range, 14-95) mmHg. On anal endosonography, an unrecognized internal sphincter rupture was found in one and a failed repair in two females. Overlap of the external sphincter was demonstrated in 29 patients (97 percent). One female with anal incontinence and persisting external sphincter rupture underwent redo sphincteroplasty. CONCLUSIONS: The median-term outcome of primary overlap repair for obstetric sphincter rupture is good; however, larger, randomized studies with a longer follow-up are needed to evaluate the advantage of this technique over the end-to-end technique.

Adult↗

PubMed2003

Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome.

PURPOSE: This study was undertaken to evaluate the efficacy and safety of laparoscopic repair for rectal prolapse. METHODS: A case-control study was undertaken. The case group consisted of a consecutive series of patients who underwent laparoscopic repair for rectal prolapse between February 1993 and June 2000. The control group underwent open prolapse repair between October 1987 and January 2000. RESULTS: There were 53 patients in each group. The groups were matched according to operation type, gender, and age. Median operative time was longer in the case group than in the control group (resection rectopexy 210 vs. 117 minutes, rectopexy 127.5 vs. 72 minutes, respectively). Median postoperative hospital stay was shorter in the case group than in the control group (resection rectopexy 5 vs. 7 days, rectopexy 4.5 vs. 7 days, respectively). Median intraoperative bleeding was minor in the case group (resection rectopexy 35 vs. 300 ml, rectopexy 15 vs. 100 ml, respectively). Mortality (0 vs. 4 percent), complications (23 vs. 30 percent), late complications (4 vs. 13 percent), and the rate of recurrent prolapse (6 vs. 13 percent) did not differ significantly between the groups. CONCLUSIONS: Laparoscopic repair for rectal prolapse is technically feasible and can be performed with mortality and morbidity rates comparable to those of the conventional technique. The main advantages of the laparoscopic approach appear to be a shorter hospital stay and lessened intraoperative blood loss. Recurrence rate is not increased in the short term.

Adult↗

PubMed2002

New approaches in the management of rectal carcinoma result in reduced local recurrence rate and improved survival.

OBJECTIVE: To find out whether total mesorectal excision (TME) technique alone or combined with preoperative radiotherapy reduces local recurrence rate and improves survival. DESIGN: Partly retrospective (the first period), partly prospective (the second period) study. SETTING: University hospital, Helsinki, Finland. SUBJECTS: 144 patients between 1980 and 1990 and 61 patients between 1991 and 1997 with rectal cancer, who underwent major curative surgery. INTERVENTIONS: A conventional surgical technique was used during the first period and TME alone or combined with preoperative radiotherapy when appropriate during the second period. MAIN OUTCOME MEASURES: Postoperative morbidity and mortality, local recurrence rate, and 5-year survival. RESULTS: After anterior resection 4/76 of the patients (5%) during the first period and 8/43 (19%) during the second period developed anastomotic leaks. Operative 30-day mortality was 1% (n = 1) and 0, respectively. Actuarial local recurrence rate was 17% in the first period and 9% in the second period. Actuarial crude 5-year survival improved from 55% to 78% and cancer-specific survival from 67% to 86% between the two study periods. CONCLUSIONS: Despite an increased number of anastomotic complications TME is safe. Refinement of the surgical technique together with preoperative radiotherapy yields lower local recurrence rates and an improved survival compared with conventional surgery alone.

Actuarial Analysis↗