Danish medical journal
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Danish medical journal · Feb 2017
ReviewComplete mesocolic excision an assessment of feasibility and outcome.
Surgery is the most important factor for radical treatment of colon cancer, and the long-term prognosis can be improved by improving the surgical treatment without increased risk of perioperative mortality. Complete mesocolic excision (CME), in which more extensive lymph node (LN) dissection is performed, has been shown in single-centre studies with historical controls to be associated with better oncological outcome. However, better evidence is needed. ⋯ For stage II the disease-free survivals were 91.9% (87.2-96.6%) in the CME group and 77.9% (71.6-84.1%) in the non-CME group (p = 0.0033), and for stage III 73.5% (63.6-83.5) and 67.5% (61.8-73.2) (p = 0.13) respectively. In the multivariable Cox regression models, CME was a significant predictive factor for higher dis-ease-free four-year survival for stage I-III patients with hazard ratios (HR) for CME of 0.59 (0.42-0.83, p = 0.0025). For stage II the HR was 0.44 (0.23-0.86, p = 0.018) and for stage III 0.64 (0.42-1.00, p = 0.048).
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Danish medical journal · Feb 2017
ReviewMultiparametric MRI in detection and staging of prostate cancer.
Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men in the Nordic countries. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies (TRUS-bx) lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging (mp-MRI) as the most sensitive and specific imaging tool for detection, lesion characterisation and staging of PCa. However, the experience with mp-MRI in PCa management in Denmark has been very limited. Therefore, we carried out this PhD project based on three original studies to evaluate the use of mp-MRI in detection, assessment of biological aggression and staging of PCa in a Danish setup with limited experience in mp-MRI prostate diagnostics. The aim was to assess whether mp-MRI could 1) improve the overall detection rate of clinically significant PCa previously missed by TRUS-bx, 2) identify patients with extracapsular tumour extension and 3) categorize the histopathological aggressiveness based on diffusion-weighted imaging. ⋯ Mp-MRI prior to repeated biopsies can improve the detection rate of clinically significant PCa and allow for a more accurate GS by combining standard TRUS-bx with mp-MRI-targeted biopsies under visual TRUS-guidance. Mp-MRI can provide valuable information about the histopathological aggressiveness of a PCa lesion and the tumour stage with possible ECE can be assessed in the pre-therapeutic setting providing important additional information for optimal patient-tailored treatment planning.