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Background: Outcome after colorectal liver metastases (CRLM) resection has improved over time, despite increased resection rates. Hence, it's crucial to identify all patients possible to treat with curative intent. The objectives of this study were to map recurrence pattern, treatment strategy and survival depending on treatment and follow-up strategy.Methods: In the COLOFOL-trial, patients with radically resected stage II-III colorectal cancer were randomized to high-frequency (6, 12, 18, 24 and 36 months; HF) or low-frequency (12 and 36 months; LF) follow-up. In this study, all CRLM within 5 years were identified and medical files scrutinized. Overall survival (OS) was analysed in uni- and multivariable analyses. Primary endpoint was 5-year OS.Results: Of 2442 patients, 235 (9.6%) developed metachronous CRLM of which 123 (52.3%) underwent treatment with curative intent, resulting in 5-year OS of 58%. Five-year OS for patients with CRLM was 43% after HF versus 24% after LF. The survival benefit was confirmed for HF 8 years from resection of the primary tumour, HR 0.63 (CI 0.46-0.85).Conclusion: A high proportion of metachronous CRLM was possible to treat with curative intent, yielding high survival rates. More intense follow-up after colorectal cancer resection might be of value in high-risk patients. Background: Outcome after colorectal liver metastases (CRLM) resection has improved over time, despite increased resection rates. Hence, it's crucial to identify all patients possible to treat with curative intent. The objectives of this study were to map recurrence pattern, treatment strategy and survival depending on treatment and follow-up strategy.Methods: In the COLOFOL-trial, patients with radically resected stage II-III colorectal cancer were randomized to high-frequency (6, 12, 18, 24 and 36 months; HF) or low-frequency (12 and 36 months; LF) follow-up. In this study, all CRLM within 5 years were identified and medical files scrutinized. Overall survival (OS) was analysed in uni- and multivariable analyses. Primary endpoint was 5-year OS.Results: Of 2442 patients, 235 (9.6%) developed metachronous CRLM of which 123 (52.3%) underwent treatment with curative intent, resulting in 5-year OS of 58%. Five-year OS for patients with CRLM was 43% after HF versus 24% after LF. The survival benefit was confirmed for HF 8 years from resection of the primary tumour, HR 0.63 (CI 0.46-0.85).Conclusion: A high proportion of metachronous CRLM was possible to treat with curative intent, yielding high survival rates. More intense follow-up after colorectal cancer resection might be of value in high-risk patients.

To investigate the occurrence of synchronous colorectal cancer metastases (SCCM) confined to the lungs, risk factors for these metastases and their impact on survival.In a nationwide cohort study of 26,200 patients data were prospectively entered into the Danish Colorectal Cancer Group's (DCCG's) database between May 2001 and December 2011. The recorded data were merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable logistic- and extended Cox regression analyses were used to adjust for confounding variables.In total, 1970 patients (7.5%) had pulmonary SCCM of whom 736 (37%) had metastases exclusively in the lungs. Advanced age, recent years of diagnosis and a rectal index cancer were significantly associated with pulmonary SCCM. Adjustment for excess use of thoracic CT scans in rectal cancer patients did not alter this association (adjusted OR=1.81 (95% CI: 1.46-2.25, P0.001)). Patients subjected to pulmonary metastasectomy, resection of primary tumour and chemotherapy had a superior overall survival compared with non-treated patients, especially when these therapeutic modalities were combined.The occurrence of pulmonary SCCM was higher than previously reported and had a severe impact on survival. Our analyses suggest that pulmonary metastasectomy, resection of the primary tumour and chemotherapy may be a sound strategy in patients with confined pulmonary SCCM, but the risk of selection bias and consequent exaggeration of the treatment effect should be kept in mind. This study may serve as a reliable un-biased reference for future evaluation on detection strategies and potential therapeutic interventions.

Surgical site infection (SSI) is a common complication after abdominal surgery and the Centers for Disease Control and Prevention (CDC) criteria are commonly used for diagnosis and surveillance. The aim of this study was to evaluate whether SSI diagnosed according to CDC is clinically relevant (CRSSI) and whether there is agreement between evaluations according to the CDC criteria, the ASEPSIS score (Additional treatment, presence of Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, Isolation of bacteria and duration of Stay) and CRSSI. We included 54 patients diagnosed with SSI and a matched control group (N=46) without SSI according to the CDC criteria after laparotomy. Two blinded experienced surgeons evaluated the hospital records and determined whether patients had CRSSI, based on the following criteria: antibiotic treatment, surgical intervention, prolonged hospital stay or referral to an intensive care unit for SSI. The rate of CRSSI was 38 of 54 (70%) in patients with CDC-diagnosed SSI and none in patients without a CDC-diagnosed SSI. Sixty-one percent of the CDC-diagnosed SSIs were superficial, of which 48% were considered clinically relevant. There was substantial agreement between the CDC criteria and CRSSI [kappa=0.69; 95% confidence interval (CI): 0.55-0.83] and fair agreement between the ASEPSIS score and the CDC criteria (kappa=0.23; 95% CI: 0-0.49) and between the ASEPSIS score and CRSSI (kappa=0.39; 95% CI: 0.17-0.61). The CDC criteria represent a suitable standard definition for monitoring and identifying SSI, even if some cases of less clinically significant superficial SSI are included.

Objective: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on thromboprophylaxis. Methods: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on postoperative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol. Results: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%. Conclusion: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.

In a prospective randomized study heptest, thrombinantithrombin complexes (TAT), D-dimer, and t-PA:ag were analysed pre-and postoperatively in 206 consecutive patients undergoing hip arthroplasty during thromboprophylaxis with either a LMW heparin (Enoxaparin) or Dextran 70. Deep vein thrombosis (DVT) developed in 6 of 102 (6%) Enoxaparin and in 21 of 104 (20%) Dextran patients diagnosed by bilateral phlebography. In the Enoxaparin group heptest showed a significant increase from the pre- to the postoperative level opposed to a significant decrease in the Dextran group. Postoperative levels of TAT, D-dimer, and t-PA:ag were significantly increased in both groups, however, TAT was significantly higher in patients in the Dextran group than in the Enoxaparin patients. D-dimer was significantly higher in Dextran patients with DVT postoperatively compared with patients without DVT. No differences concerning TAT or t-PA:ag were observed between patients with and without DVT in any of the groups.

This retrospective study describes the cases of postoperative pulmonary embolism (PE) in a general surgical department during a 3-year period.To analyze the cases of PE, all patient data from the hospital central registry of diagnoses, pulmonary ventilation/perfusion scintigraphies (V/P scans), and autopsy records from a hospital in Denmark for the 3-year period from August 1986 to August 1989 were reviewed. Antithrombotic prophylaxis was applied routinely according to standard instructions. A total of 2,049 emergency and 2,832 elective operations were performed. The PEs were verified by autopsy or perfusion/ventilation scintigraphy.Postoperative PE was verified in 30 patients, which is equivalent to an incidence of 0.6% (95% confidence limits: 0.4% to 0.8%). With correction for autopsy rate (65%) the incidence is estimated to be 1.0% (0.6% to 1.3%). The incidence of fatal PE was 0.4% (0.2% to 0.5%). Fatal PE was found in 8.6% (5.0% to 13.5%) of the patients who had an autopsy performed. The incidence of fatal postoperative PE among patients who received thromboprophylaxis was 3.5%, compared with 11.2% in patients who did not receive prophylaxis, P0.05. Pulmonary embolism occurred in 3 patients younger than 40 years, and in 12 patients who had undergone minor surgery.The results of this retrospective study suggest that the incidence of fatal PE is reduced by low-dose heparin prophylaxis, and that the risk of developing PE is not limited to patients subjected to major surgery or older than 40 years of age. It is concluded that the indications for antithrombotic prophylaxis should also include minor surgery and patients aged less than 40 years. A standard instruction is strongly recommended for thromboprophylaxis in surgery, especially when dealing with emergency surgery.