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Biomedical subjects

P H Chapuis

Publications and source records attributed to P H Chapuis.

At least 19 recordsLinked to original sources
PubMed2000

Prognostic significance of extensive microsatellite instability in sporadic clinicopathological stage C colorectal cancer.

BACKGROUND: Colorectal cancers exhibiting microsatellite instability (MSI) appear to have unique biological behaviour. This study analyses the association between extensive MSI (MSI-H), clinicopathological features and survival in an unselected group of patients with sporadic Australian Clinico-Pathological Stage (ACPS) C (tumour node metastasis stage III) colorectal cancer. METHODS: Some 255 patients who underwent resection for sporadic ACPS C colorectal cancer between 1986 and 1992 were studied. No patient had received chemotherapy. Minimum follow-up for all patients was 5 years. Archival normal and tumour DNA was extracted and amplified by polymerase chain reaction using a radioactive labelling technique. MSI-H was defined as instability in 40 per cent or more of seven markers. RESULTS: Twenty-one patients showed MSI-H. No association was found between MSI and age or sex. Tumours exhibiting MSI-H were more commonly right sided (P<0.00001), larger (P = 0.002) and more likely to be high grade (P = 0.049). After adjustment for age, sex and other pathological variables, patients whose cancers exhibited MSI-H had improved survival (P = 0.015). CONCLUSION: Recognition of MSI-H in sporadic ACPS C tumours identifies a subset of cancers with improved prognosis. Such stratification should be considered in trials of adjuvant therapy and may be relevant to therapeutic decision making.

Adult↗
PubMed1999

Immobiline-based two-dimensional gel electrophoresis: an optimised protocol for resolution of human colonic mucosal proteins.

An optimised protocol for the production of two-dimensional protein patterns of human colonic mucosal cells using immobilised pH gradients in the first dimension is presented. We tested a wide variety of solubilising agents and electrophoretic parameters, separately and in combination. Protein solubilisation was found to be best using a lysis solution containing 9 M urea, 2% Triton X-100, 2% 2-mercaptoethanol, 0.8% Pharmalyte pH 3-10 and 8 mM phenylmethylsulfonyl fluoride (PMSF). Horizontal streaking of basic proteins in the first dimension was virtually eliminated by a combination of washing Immobiline strips in 100 mM asorbic acid, pH 4.5, for 24 h before use and isoelectric focusing samples at 40 degrees C. The presence of 2% glycerol in the first dimension resulted in tighter resolution throughout the entire pH range. The use of these conditions may prove to have broad applicability to the generation of optimally resolved Immobiline-based two-dimensional protein patterns of many other tissues.

Acrylamides↗
PubMed1999

Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection.

BACKGROUND: The wide variability of reported local recurrence rates after curative resection of rectal cancer without adjuvant therapy may be a consequence of many different factors. However, few studies have investigated the potential effects of such factors on local recurrence by multivariate analysis. The present study examined clinical and tumour characteristics, operation type and operative technique as potential predictors of local recurrence in patients treated by surgery alone. METHODS: Prospective data were analysed by bivariate and multivariate methods including actuarial survival and proportional hazards regression. RESULTS: Local recurrence (pelvic or pelvic and systemic) was diagnosed in 59 of 596 patients. The 5-year actuarial local recurrence rate was 11.1 (95 per cent confidence interval 8.7-14.3) per cent. Independent predictive factors for local recurrence were: positive nodes (hazard ratio (HR) 5.5, P < 0.01); distal margin of 1 cm or less (HR 3.8, P < 0.01); venous invasion (HR 2.0, P = 0.02) and total anatomical dissection of the rectum (HR 2.0, P = 0.01). There was no difference in local recurrence between patients who had the mesorectum divided and those in whom it was totally excised. CONCLUSION: Nodal involvement is the most potent predictor of local recurrence. In patients in whom total anatomical dissection is performed, total mesorectal excision confers no additional protection against local recurrence.

Aged↗
PubMed1999

[Management of colorectal cancer in Australian hospitals. Twenty four years' experience].

This study analyses time trends in clinical features tumour pathology and treatment outcomes of patients with colorectal cancer (CRC) treated by surgery alone during the period 1971 to 1994 in a large Australian tertiary referral centre. Throughout this period, both surgical technique and pathology reporting were standardized and a specialized unit of colon and rectal surgery was established in 1980. Improvement in overall survival during this 24 year period reflects changes in tumour stage with an increasing proportion of stage A tumours, declining proportions of stage D tumours, and some improvement in survival for stages B and C colon cancer only.

Adult↗
PubMed1998

Quality of life in patients undergoing treatment for chronic radiation-induced rectal bleeding.

BACKGROUND: Laser and formalin therapy have recently been shown to be safe methods of haemostasis in patients with chronic radiation-induced rectal bleeding (CRRB). The effectiveness of this treatment in terms of improved quality of life remains to be determined. The aim of this study was to develop a questionnaire measure of self-perceived quality of life in patients with CRRB. METHODS: A self-completed Rectal Bleeding Quality of Life Scale (RBQOLS) based on the social and emotional problems experienced by patients with CRRB was developed using standard psychometric methods. Before laser and formalin therapy, 34 consecutive patients completed the questionnaire which was repeated 1 month after treatment and again 5 months later. The validity of the scale was assessed in relation to patient response to treatment. RESULTS: The RBQOLS had high reliability (alpha=0.89) and its concurrent validity was confirmed by a significant association with the pretreatment severity of CRRB assessed endoscopically. The mean RBQOLS score increased from 102 (95 per cent confidence interval 90-114) before treatment to 126 (111-141) after treatment (t=3.1, 33 d.f., P=0.004) and 136 (122-151) at follow-up attesting to its predictive validity. CONCLUSION: The RBQOLS is a reliable and valid device for assessing quality of life of patients with this uncommon, previously intractable and potentially life threatening complication of radiotherapy.

Aged↗
PubMed1997

Factors affecting survival after excision of the rectum for cancer: a multivariate analysis.

PURPOSE: The aim of this study was to identify and categorize the independent prognostic effects of patient, clinical, operative, and pathology variables on long-term survival after anterior resection or abdominoperineal excision of the rectum for cancer. METHODS: Proportional hazards regression analysis was used to analyze prospective data from 709 patients who underwent surgery at Concord Hospital during a 23-year period. No patient received adjuvant therapy. RESULTS AND CONCLUSIONS: After adjusting for age and clinicopathologic stage, significantly poorer survival was experienced by males, patients with extensive tumor adherent to other organ(s), those with a high-grade tumor or a tumor showing venous invasion, those who had a postoperative cardiovascular or respiratory complication, and those who did not undergo surgery by a colorectal surgeon specialist. The nature of the operation performed had no independent effect on survival.

Anastomosis, Surgical↗
PubMed1997

Cost of open versus laparoscopically assisted right hemicolectomy for cancer.

The aim of this study was to estimate and compare the costs of open right hemicolectomy (ORHC) versus laparoscopically assisted right hemicolectomy (LARHC) performed for cancer. A retrospective cost analysis of 61 consecutive patients operated on between January 1992 and August 1994 for right-sided colonic cancer by either LARHC (n = 28) or ORHC (n = 33) was performed. The analysis focused on the cost (in Australian dollars) incurred from the date of operation to the date of discharge. LARHC was significantly more expensive than ORHC (total cost LARHC $9064, ORHC $7881; p < 0.001). LARHC was associated with a significantly longer operating room utilization time (LARHC 261 minutes, ORHC 203 minutes; p < 0.001) and a greater cost of disposables (LARHC $854, ORHC $189; p < 0.001). This study demonstrates no cost benefit for LARHC compared to ORHC when performed for cancer.

Colectomy↗
PubMed1997

Laparoscopic resection of the colon and rectum for cancer.

BACKGROUND: Laparoscopically-assisted resection for large bowel cancer is technically feasible. Sixty-six patients who had resection of the colon or rectum for cancer have been audited prospectively. METHODS: Clinical and pathological data were collected prospectively as part of the ongoing Concord Hospital colorectal cancer project. Patients were followed up for a median of 29 months. RESULTS: In 57 of 66 patients in whom laparoscopic resection was attempted the operation was completed laparoscopically. Three patients died from perioperative myocardial infarction. The median postoperative stay was 14 days. There was a high incidence of postoperative respiratory and cardiac complications. One patient developed a port-site metastasis. CONCLUSION: There was no obvious benefit from laparoscopically-assisted resection of large bowel cancer in these patients.

Aged↗
PubMed1996

Morbidity and mortality following laparoscopic-assisted right hemicolectomy for cancer.

PURPOSE: This study was undertaken to compare morbidity, mortality, and pathology after laparoscopically assisted right hemicolectomy (LARHC) or open right hemicolectomy (ORHC) for cancer of the right colon. METHODS: Patients undergoing either LARHC or ORHC for invasive carcinoma of the right colon during a 30-month period were studied. Data were collected from two sources. All morbidity, mortality, and pathology data were collected prospectively in a form suitable for computer storage and analysis as part of the ongoing Concord Hospital Colorectal Cancer Registry. Data concerning in hospital course were obtained by casenote review. RESULTS: Twenty-eight patients underwent LARHC, and 33 had an ORHC during the study period. The two groups were well matched with respect to age, sex, weight, associated comorbidities, and tumor stage. Mean operating room use time was significantly higher for LARHC (LARHC = 261 minutes; ORHC = 203 minutes; P < 0.001). Mean hospital stay from date of resection was the same in both groups (LARHC = 12 days; ORHC = 12.2 days). There was no significant difference between procedures with respect to postoperative complications, return of gastrointestinal function, or narcotic analgesic requirements. There was a significant shorter distal margin of resection in the LARHC group (ORHC = 13.4 cm; LARHC = 10 cm; P = 0.03). Total cost was significantly greater for LARHC ($9,064 vs. $7,881 (Australian); P < 0.001). Median follow-up was 23.4 months for the LARHC group and 23.9 months for the ORHC group. To date, there have been no local or port site recurrences. CONCLUSION: Although there is no difference in morbidity and mortality following LARHC or ORHC, there is no apparent benefit for LARHC.

Aged↗
PubMed1996

Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum.

BACKGROUND: The optimal method of restoring intestinal continuity after rectal resection has been controversial. This study aims to compare the morbidity, mortality and survival of patients having either single-stapled (SS) or double-stapled (DS) colorectal anastomoses following resection of the rectum for cancer. METHODS: Peri-operative and long-term follow-up data were prospectively documented in all patients undergoing rectal resection for carcinoma with a stapled anastomosis at our institution over a 14-year period. Patients were stratified by anastomotic technique (SS or DS). Peri-operative mortality, complications potentially related to anastomotic technique and cancer-related outcome were compared. RESULTS: Two hundred and thirty-five patients had SS and 65 patients had DS anastomoses. The groups were well matched for age, sex, and tumour stage. Double-stapled anastomoses were used more frequently in the distal third of the rectum (P < 0.001). The distal margin of resection was not influenced by anastomotic technique. Major anastomotic leakage in 2.9% of SS cases was not significantly different from 6.1% of DS cases, and leakage was not influenced by anastomotic technique at any given level of the rectum. Two-year local recurrence rates were not significantly different between groups (SS 3.5%; DS 5.9%). CONCLUSIONS: These results suggest that the double-stapling technique is as safe as the single-stapling technique for constructing an anastomosis after excision of the rectum for cancer, in terms of the risk of leakage, the development of an anastomotic stricture, or local recurrence.

Aged↗
PubMed1996

Lymphovascular clearance in laparoscopically assisted right hemicolectomy is similar to open surgery.

BACKGROUND: The application of laparoscopic techniques to malignant colorectal disease has led to concerns regarding the adequacy of excision achieved. This study was performed to compare specimen histopathology following laparoscopically assisted right hemicolectomy (LARHC) with that following open right hemicolectomy (ORHC). METHODS: Data regarding patient details and tumour pathology were obtained by case-note review and from the Concord Hospital Colorectal Cancer Database. Thirty-two patients had LARHC for neoplastic lesions and 34 had ORHC for similar lesions over the same period. The two groups were well matched with respect to age, sex, weight and tumour characteristics. Early stage disease was more common in the LARHC group. RESULTS: There was no clinically significant difference between the groups in terms of margins of clearance or number of lymph nodes harvested. CONCLUSIONS: LARHC allows lymphovascular clearance indistinguishable from that afforded by open surgery. Long term outcome and survival data are required to confirm its role in the treatment of malignant colorectal disease.

Adenocarcinoma, Mucinous↗
PubMed1995

Survival after curative resection of lymph node negative colorectal carcinoma. A prospective study of 910 patients.

BACKGROUND: Approximately half of all patients treated for colorectal carcinoma by bowel resection have neither lymph node metastases nor known residual tumor (clinicopathologic Stages A and B). The aim of this study was to compare the survival of these patients with that of the general population and to explain any significant difference. METHODS: Prospectively collected data recorded for 910 patients from one institution during a period of 21.5 years were used in the analysis. Patient follow-up ranged from 6 months to 21.5 years. The "Survival" procedure, developed by the Finnish Cancer Registry, was used to compare the observed survival of patients with their expected survival, based on age- and sex-matched data from the population of New South Wales. Survival analysis was performed by the Kaplan-Meier method. Multivariate models were examined using Cox proportional hazards regression. RESULTS: Males with tumor spread beyond the muscularis propria (Stage B) was the only group with significantly poorer survival than expected. The reduced survival in this group was due to the effects of four clinical variables (cardiovascular complication, permanent stoma, urgent operation, respiratory complication) and one pathologic variable (direct spread involving a free serosal surface) acting independently. CONCLUSION: The survival of patients with clinicopathologic Stages A or B tumors closely matched their expected survival as predicted from the general population. Males with Stage B tumors were the only exception and their significantly reduced survival was largely due to clinical, as distinct from pathologic factors. These findings suggest that the risk of occult metastases is low for patients with Stages A and B tumors using this classification.

Adult↗
PubMed1995

Postoperative morbidity and mortality following resection of the colon and rectum for cancer.

PURPOSE: The aim of this study was to report the prevalence of postoperative complications and mortality of patients with colorectal cancer when treated by conventional surgery. METHODS: Morbidity and mortality following open resection for colorectal cancer were analyzed in 1,846 patients whose clinical, operative, and pathology data were prospectively documented over a 20-year period. RESULTS: Mortality following elective resection of the left and right colon was low, whereas overall morbidity was high (37.2 percent). Respiratory and cardiac complications were especially common. Incidence of clinically significant leakage was similar following right (0.5 percent) or left (1.1 percent) hemicolectomy. Incidence of anastomotic leakage was significantly higher after emergency right hemicolectomy (4.3 percent). Overall morbidity following excision of the rectum was high (40.2 percent). Respiratory and cardiac complications predominated. Incidence of clinically significant anastomotic leakage following anterior resection was low (2.9 percent). Over the years, there has been a decline in the number of patients with tumor demonstrated histologically in a line of resection, suggesting an improved local surgical clearance. CONCLUSIONS: These results following conventional surgery may be useful when evaluating new techniques.

Adenocarcinoma↗
PubMed1995

Transfusion does not influence patient survival after resection of colorectal cancer.

Two recent reviews reached opposing conclusions regarding the apparent detrimental effect of peri-operative blood transfusion on patient survival after resection of colorectal cancer. However, both sides agree that the influence of confounding variables has not been controlled adequately in most studies. The present study is based on 433 patients who had a curative resection for colorectal cancer between 1984 and 1989 and whose details and follow-up information were recorded in the Concord Hospital Colorectal Cancer Registry, Sydney. The association between peri-operative transfusion and patient survival after resection of colorectal cancer was examined taking into account 20 other prognostic variables. A proportional hazards regression model showed that transfusion did not have a statistically significant independent effect on survival after controlling for the patient's poor general condition, the complexity of the surgery and the occurrence of postoperative complications.

Blood Transfusion↗