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Improved Outcomes in Colon and Rectal Surgery part 33

Improved Outcomes in Colon and Rectal Surgery part 33. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | IMPROVED OUTCOMES IN COLON AND RECTAL SURGERY Table 30.3 Preoperative neoadjuvant radiation studies. Study Open Closed Number of Pts Therapy Arms Local Pelvic Recurrence at 5 years Overall Survival at 5 years Comments Stockholm I 1 849 S 28 36 to L2 level no lateral 1980 to 1987 25Gy-S 14 p 0.001 36 beam Stockholm II 17 557 S 25 39 Patients older than 80 3 87 to 5 93 25Gy-S 12 p 0.001 46 p 0.03 excluded Pts having curative surg Swedish Rectal 18 1168 S 27 48 Patients older than 80 3 87 to 2 90 25Gy-S 11 p 0.001 58 p 0.001 excluded Dutch TME 19 1861 S 10.4 64 Patients older than 80 1 96 to12 99 25Gy-S 5.6 p 0.001 64 included Manchester 20 284 S 36 39 5Gy x 4 survival for 1981 to 1989 20Gy-S 13 p 0.001 46 p 0.03 those having curative resection MRC II 21 289 S 48 19 20x2Gy S four weeks 40Gy-S 32 p 0.04 26 p 0.09 after xrt Polish 22 312 25Gy-S 9 67.2 Mostly TME 1999 to 2002 50.4Gy C-S 14 p 0.17 66.2 T3 T4. Patients older than 75 excluded EORTC 23 1011 45Gy-S 17.1 63.2 no post op C Stage I and age over 80 4 93 to 5 03 45Gy C-S 9.6 vs. 67.2 with post excluded 45Gy-S-C 8.7 op C p 0.12 45Gy C-S-C 7.6 FFCD 9203 24 762 45Gy-S-C 16.5 67.2 Stage I and age over 75 1993 45Gy C-S-C 8.1 p 0.004 66.2 excluded Symbols as in Table 30.2. Table 30.4 Pre versus postoperative and chemotherapy studies. Study Open Closed Number of Pts random Therapy Arms Local Pelvic Recurrence at 5 years Overall Survival at 5 years Comments Upsala 25 471 25.5Gy-S 12 44 5.1x5Gy and 30x2Gy. 10 80 to 12 85 S-60Gy 21 p 0.02 39 p 0.43 German 26 823 50.4Gy C-S-C 6 74 TME exclude stage I 2 95 to 9 02 S-50.4G C-C 13 p 0.006 76 p 0.80 and age over 75 Symbols as in Table 30.2. significant improvement in overall survival and the incidence of local recurrence compared to surgery alone. Based on Gastrointestinal Tumor Study Group and North Central Cancer Treatment Group studies a U.S. National Institutes of Health Consensus Development Conference in 1990 recommended that postoperative radiation and chemotherapy be .