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Biomedical subjects

J N Wiig

Publications and source records attributed to J N Wiig.

At least 19 recordsLinked to original sources
PubMed2003

Radical prostatectomy for locally advanced primary or recurrent rectal cancer.

AIM: Three papers including five patients have described en bloc radical prostatectomy for locally advanced rectal cancer. METHODS: Six patients (median age 63 years) underwent en bloc radical prostatectomy for locally advanced (3) or recurrent (3) rectal cancer involving the prostate. Quality of life questionnaires were answered postoperatively and the data prospectively entered in a database. RESULTS: One primary case had low anterior resection (LAR), the others abdominoperineal resections (APR) of R0 stage. Two recurrent cases had APRs and one tumour resection-all R1 stage. Anastomotic leakage led to construction of an ileal conduit in one patient and in two healed on conservative treatment. Follow up was 10-50 months. One patient died from distant metastases at 29 months postoperatively, one was operated for a single lung metastasis and one has disseminated lung metastases. None has developed local recurrence. Four of the five with anastomoses had good quality of life and none wanted an ileal conduit. CONCLUSION: In spite of a relatively high urinary leak rate the total complication rate seems to be lower than after pelvic exenteration. En bloc radical prostatectomy seems an option in selected patients otherwise needing pelvic exenteration for locally advanced or recurrent rectal cancer.

Aged↗
PubMed2001

Quality of life in patients with urinary diversion after operation for locally advanced rectal cancer.

AIMS: When locally advanced or recurrent rectal cancer involves the bladder or prostate, curative treatment often requires pelvic exenteration. The aim was to assess the quality of life (QoL) in disease-free patients with urinary diversion after extensive surgery for advanced rectal cancer. METHODS: Twelve patients with urinary diversion (cases) were compared with 25 randomly selected patients given the same treatment, but without urinary diversion (controls). An age- and gender-adjusted general population was identified (reference). QoL was assessed with the EORTC questionnaires QLQ-C30, QLQ-CR38, and parts of the QLQ-BLM30. RESULTS: The cases did not report significantly worse overall QoL than the controls or the reference population. Both cases and controls had low mean scores of sexual function, and high mean scores of male sexual problems. In the nine cases that had two stomas, overall QoL was not worse than in the control or reference groups. CONCLUSIONS: Tumour-free patients did not report worse QoL scores than the controls or the general population, despite most having two stomas and low sexual function. Fear of reducing the patient's QoL should not be a major contraindication when surgery with urinary diversion is warranted to obtain curative resection.

Aged↗
PubMed2000

Intra-operative irradiation (IORT) for primary advanced and recurrent rectal cancer. a need for randomised studies.

The aim of this study was to determine the impact of intra-operative irradiation (IORT) combined with pre-operative external beam irradiation (EBRT) and surgical resection in patients with locally advanced primary or recurrent rectal cancer. 64 patients with locally advanced primary cancer and 104 with recurrence had EBRT (46-50 Gy) before surgery. 80 patients received IORT (median dose 15 Gy energy 12 MeV). 80 patients had R0 resections, 47 R1 and 41 R2 resections. More R1 resections were performed in the IORT group, more R0 and R2 resections in the non-IORT group. Median follow-up was around 22 months. 146 patients were resected, 22 had exploratory laparotomy. The cumulative overall survival was similar for both the IORT and non-IORT groups. 5-year survival for primary cancers was 48% versus 28% for recurrences. No R2 resections survived 3.5 years. 5-year-survival for R0 resections was nearly 60% and around 30% for R1 resections. The survival curves of the patients given and not given IORT treatment was not statistically different when R0, R1 and R2 resections were analysed separately. IORT did not seem to influence the local recurrence rate when R0 and R1 resections were analysed separately or in a multivariate analysis. The IORT and non-IORT groups were not identical with regard to type of cancer and R-stage. Still the lack of an identifiable impact of IORT suggests that there is a need for randomised studies of the IORT effect.

Adenocarcinoma↗
PubMed1999

Location of pelvic recurrence after 'curative' low anterior resection for rectal cancer.

AIMS: It has been emphasized that the mesorectum is the key to local recurrence after resection for rectal cancer. In view of this we studied the location of recurrences, relative to the bed of the primary tumour, the neorectum and the level of anastomoses, in patients referred for recurrences after low anterior resection (LAR) in the < >. METHODS: The relative level above the anal verge of the primary cancer, the anastomosis and the recurrence was registered by proctoscopy in 46 patients operated on for recurrent cancer after low anterior resection. The origin of the recurrence was determined from the operative specimen. RESULTS: The median level of the primary cancers was 10 cm above the anal verge, with the anastomoses 2 cm lower, the majority being within 2 cm. Most recurrences were within 1 cm of the anastomosis. No rectal cancer occurred more than 3 cm distal to the anastomosis. Seventy to 80% of recurrences started peri-rectally, most invading the anastomosis. CONCLUSIONS: The tumour bed is most often the origin of the recurrence. Recurrences were mostly due to inadequate radial, and in a few cases longitudinal, dissection of the mesorectum. Virtually all recurrences were within reach of the examining finger. At follow-up of rectal cancers most local recurrences can therefore be identified earlier by digital examination than by proctoscopy.

Adult↗
PubMed1998

Mesorectal excision for rectal cancer: a view from Europe.

The local recurrence rate after rectal cancer surgery is discussed as related to conventional and total mesorectal excision (TME) techniques. Studies now show that the wide variation in results between centers and among surgeons depends, at least in part, on differences in surgical technique. We conclude that local tumor recurrence rate is lower after TME than after conventional surgery and emphasize the importance of a standardized macroscopic evaluation of the resected specimen. Population-based registration to evaluate the quality of surgery is recommended. It is also suggested that randomized studies on adjuvant treatment for rectal cancer should include a "surgery only" arm when a local tumor recurrence rate of 10% or less is being studied. Until such investigations are performed, we conclude that the role for adjuvant treatment is questionable and that TME surgery is preferred as the treatment option for Stage T1-T3 rectal cancers.

Europe↗
PubMed1997

Esophageal and gastric carcinoma in Norway 1958-1992: incidence time trend variability according to morphological subtypes and organ subsites.

The occurrence of adenocarcinoma (AC) of the esophagus and gastric cardia has shown large increases in many but not all examined populations. This trend is in contrast with a decrease in distal gastric AC and a relative stability of esophageal squamous cell carcinoma. Our study aimed to describe esophageal and gastric carcinoma time trends in the Norwegian population between 1958 and 1992 based on data from the Cancer Registry of Norway. Estimated esophageal AC rates have accelerated over the study period, reaching average annual increases of 17% in men and 14% in women between 1983 and 1992. The occurrence of esophageal squamous cell carcinoma was relatively stable in both sexes. Proximal gastric cancer rates were stable in males and decreased somewhat in females. Distal gastric tumors showed decreases in both sexes, but were more pronounced in females. The strong increase in esophageal AC incidence parallels similar increases in the United States and some other countries. Although the observed increase may be explained to some extent by a shift in the classification of esophago-cardial adenocarcinomas, the figures are compatible with a real increase. AC of the esophagus, the proximal stomach and the distal stomach exhibit different epidemiological features, both in terms of sex ratios and time trends, suggesting risk factor differences between the subsites.

Adenocarcinoma↗
PubMed1997

Combined modality treatment including intraoperative radiotherapy in locally advanced and recurrent rectal cancer.

BACKGROUND: Treatment of locally advanced and recurrent rectal cancer usually has a high local recurrence rate and poor survival. Promising results have been reported by combined external radiotherapy, extensive surgery and intraoperative radiotherapy (IORT). METHODS: One hundred fifteen patients with locally advanced rectal cancers fixed to the pelvic wall or locally recurrent rectal cancers underwent preoperative external radiotherapy with 46-50 Gy. Six to 8 weeks later radical pelvic surgery was attempted, and was combined with intraoperative electron beam radiotherapy (15-20 Gy) in 66 patients. The patients were followed closely to evaluate complication rate, local and distant recurrence rate and survival. RESULTS: Surgery with no macroscopic tumour remaining was obtained in 65% of the patients with no postoperative deaths. Pelvic infection was the major complication (21%). Although the observation time is short (3-60 months), the local recurrence rate seems low (22%) and survival seems promising (about 60% at 4 years) in patients with complete tumour resection, in contrast to patients with residual tumour (none living at 4 years). CONCLUSIONS: The combined modality treatment with preoperative external radiotherapy and extensive pelvic surgery with IORT is sufficiently promising to start a randomized trial on the clinical value of IORT as a boost treatment in the multidisciplinary approach to this disease.

Adult↗
PubMed1996

[Colonic perforation during combined steroid and radiotherapy. Diagnosis and treatment].

Eight patients with colon perforations after combined treatment with radiotherapy and steroid medication are studied retrospectively. Sigmoid diverticuli perforated after a minimum of 5 days treatment. The main symptom was a varying degree of abdominal pain. Clinical parameters were of limited value. The most important single examination was plain abdominal x-ray, though this was not positive in all cases. Seven patients were operated on, one with simple suture, the rest with Hartmann's procedure. None developed postoperative peritonitis. One died from cerebral infarction. Four died within 38 days postoperatively after discharge from hospital. Abdominal symptoms during high dose steroid treatment may indicate perforation of the colon. Immediate operative intervention may have an uncomplicated postoperative course.

Aged↗
PubMed1996

Evaluation of digitally guided fine needle aspiration cytology versus fine needle core biopsy for the diagnosis of recurrent rectal cancer.

The clinical value of transrectally digitally guided fine needle aspiration cytology (FNAC) was compared with fine needle core biopsy (FNCB), FNAC was performed with a 21G and FNCB with a 18G needle. No prophylactic antibiotic was given. In the first part of the study 100 patients (20 primary/80 recurrences, 17 benign/83 cancers) were studied by both techniques. In 93% a definite diagnoses was given in FNAC specimen versus 96% of the FNCB cases. There were no false positive cancer diagnoses. The sensitivity of the FNAC was 88% versus 68% of the FNCB specimens. This difference was statistically significant. In a second part of the study 142 specimens of recurrent cases were examined by FNAC including 78 of the patients of the first part. The negative predictive value was around 60% for FNAC versus around 40% for FNCB. Both techniques were without any major complications. For the diagnosis of a palpable recurrent pelvic tumour a digitally guided puncture may be tried before proceeding to CT or US guided examination. In our hands FNAC seems preferable to FNCB.

Aged↗
PubMed1996

Ki-67 index in fine needle aspiration cytology specimens from primary and recurrent rectal cancer.

A Ki-67 index was determined in 63 fine needle aspiration cytology (FNAC) specimens from patients with rectal cancer, 21 with primary cancers and 42 with local recurrences. Seventeen of the patients had received external irradiation before the examination. In primary cancers, in recurrences as well as in the post-irradiation cases, the mean percentage of Ki-67 positive cells was about 55% with a wide variation. The percentage of Ki-67 positive cells was independent of the length of the recurrence-free period. In conclusion, the Ki-67 antigen may well be studied in FNAC specimens. The presence of antigen did not correlate with development of recurrence, length of recurrence-free period or irradiation prior to the analysis.

Biopsy, Needle↗
PubMed1995

Field homogeneity of bevelled intraoperative electron beam cones: the influence of virtual focus surface distance.

Field flatness of bevelled intraoperative electron therapy cones were evaluated from dose profiles, taken at dmax, both in the longitudinal plane (long axis direction) and the transversal plane (short axis direction), and were found to depend strongly on the setting of the x-ray collimators. Dose gradients in the longitudinal plane of 10-12% were found for collimator settings of 5 mm larger than the cone diameter for low energies, while the dose gradient were smaller for higher energies, both decreasing with larger collimator setting. The dose increase, relative to the central dose, of the hot spots observed in the profile of the transversal plane were in the range of 5-10% for high energies and large collimator settings, decreasing to less than 3% for low electron beam energies and smaller collimator setting. A decrease in virtual focus to surface distance (VFSD) was found to accompany the increasing dose gradient in the longitudinal plane with decreasing collimator setting, this due to increased scatter of electrons at collimator level. Increasing scatter with smaller collimator setting is also indicated by the increase in photon contamination ranging from 1-2.5% for low energies and 3.5-5% for high energies.

Humans↗
PubMed1995

Prophylaxis of venographically diagnosed deep vein thrombosis in gastrointestinal surgery. Multicentre trials 20 mg and 40 mg enoxaparin versus dextran.

OBJECTIVE: To compare enoxaparin and dextran 70 for the prophylaxis of venographically diagnosed deep vein thrombosis (DVT) after gastrointestinal operations. DESIGN: Part 1: randomised double blind trial; Part 2: single blind study with historical controls. SETTING: Eight Norwegian hospitals. SUBJECTS: 381 Patients undergoing elective gastrointestinal operations. INTERVENTIONS: Part 1 (n = 329): enoxaparin 20 mg subcutaneously starting two hours before operation and continuing until the patient was fully mobilised or had had 10 injections and a placebo infusion of 0.9% sodium chloride, or dextran 70,500 ml at the start of the operation, on the evening of operation, and on the first, third, and fifth postoperative days and placebo subcutaneous injections. Part 2 (n = 52): enoxaparin 40 mg in the same regimen as part 1 (compared with 39 historical controls). Venograms 4-6 days post-operatively. MAIN OUTCOME MEASURE: Venographically confirmed DVT. RESULTS: Part 1: Because of the high overall incidence of DVT an interim analysis was done which showed 33/101 DVT (33%) among high risk patients in the enoxaparin 20 mg group and 33/107 (31%) in the dextran 70 group. The corresponding figures for patients at medium risk were 2/27 (7%) for enoxaparin 20 mg and 5/27 (19%) for dextran 70 (95% confidence interval (CI) for the difference--11.9 to 9.8). Part 2: the dose of enoxaparin was therefore increased to 40 mg and prophylaxis restricted to patients with cancer. There were 6/49 DVT (12%), which was compared with a random sample from the dextran 70 group from part 1 (historical controls) in which the incidence was 15/39 (38%, 95% CI of the difference 4.0 to 8.4). There were no pulmonary emboli, only 4 thrombi were above the knee and there were 4, 1 and 3 clinical DVT in the 20 mg and 40 mg enoxaparin, and dextran 70 groups, respectively. CONCLUSIONS: Enoxaparin 20 mg and dextran 70 are effective prophylaxis for patients at medium risk, but enoxaparin 40 mg is required for those at high risk.

Adult↗
PubMed1994

[Peroperative lavage].

Primary bowel anastomosis was performed after an on table lavage procedure in 29 patients who required surgery for colonic lesions. 13 patients were operated in the acute or subacute stage and 16 had inadequately prepared colons at the time of elective operations. The diagnoses were cancer of the colon in 23 patients, diverticulitis in three, stoma stricture in two and colonic bleeding in one. There were 26 left-sided colonic resections, two transverse colonic resections and one right-sided hemicolectomy. The procedure prolonged the operation time by 38 min. (median), range 16-80 min. The rate of complications was 14%, and there was no mortality. None of the patients presented clinical signs of anastomotic leakage. It is concluded that primary colonic anastomosis after on table lavage is a safe and reliable alternative to staged operations. It saves the patients the discomfort of a temporary stoma and possible morbidity from further operations.

Adult↗
PubMed1991

Association between DNA ploidy pattern and cellular atypia in colorectal carcinomas. A new clinical application of DNA flow cytometric study?

Fresh tissue specimens from 406 colorectal carcinomas were analyzed by DNA flow cytometric study, and the DNA ploidy pattern was compared with Dukes' stage, histologic grade, and degree of cellular atypia. Sixty-one percent of the carcinomas had a distinct aneuploid DNA pattern. The proportion of aneuploid carcinomas was significantly higher in the advanced Dukes' stages than in the localized ones. A highly significant association was found between DNA ploidy pattern and degree of cellular atypia, whereas no association was demonstrated between DNA ploidy pattern and histologic grade. This finding might indicate that cellular atypia has a stronger prognostic impact than the growth pattern of the tumor. The authors suggest that flow cytometric DNA quantification may replace assessment of cellular atypia in the histologic evaluation. Furthermore, together with earlier findings by others, these results indicate that the degree of cellular atypia may be conserved during the development from adenomas to carcinomas.

Adenocarcinoma↗
PubMed1990

[Peroperative ultrasonography in surgery of liver metastases in colorectal cancer. A obligatory examination].

It is not easy to evaluate the real actual benefit of resection of liver metastases from colo/rectal carcinoma. This is partly due to inaccurate preoperative imaging of the metastases. The given sensitivity of the various imaging techniques varies widely. Peroperative ultrasonography is more sensitive than the other techniques. It will influence the operation for metastases in 15-40% of the cases. This technique should therefore be compulsory in connection with surgery for liver metastases.

Colorectal Neoplasms↗
PubMed1990

[Surgeons opinion about cytostatic treatment of gastrointestinal cancer].

Surgeons' opinion on several aspects of the treatment of gastrointestinal cancer with cystostatic drugs was investigated by means of a questionnaire to 51 departments. 48 replied. The surgeons were generally critical of the use of chemotherapy for cancer in the oesophagus, pancreas and stomach. More than half of the surgeons considers that fluorouracil can be used to treat recurrent or metastatic disease of the colon/rectum. A few would use fluorouracil against the other kinds of cancer too. Psychological aspects are considered to be important both for the decision to use chemotherapy and for post-operative control.

Antineoplastic Agents↗