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Is the Surgeon's Experience an Independent Prognostic Factor in Rectal Cancer?

100%
Kładny J., Al-Amawi T., Kozłowski M., Wojtasik P., Świder-Al-Amawi M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
403-409
EN
The aim of the study was to evaluate the influence of the surgeons' caseload on the results of therapy in rectal cancer.Material and methods. 286 consecutive patients (155 males and 131 females) were enrolled and operated on for rectal cancer stage T2 (112 patients) and T3 (174 patients) in 8 surgical centers of Szczecin between January 1993 and December 1997. Studied group included about 79% of radically operated patients due were to rectal cancer in analyzed period.Results. The patients were assigned to one of two groups with regard to the surgeon's caseload. The first group was comprised of 116 patients (including 72 stage T3 and 54 stage T2 patients) operated on by surgeons more experienced in rectal surgery and the second group was comprised of 160 patients operated on by 36 surgeons with fewer caseloads. The surgeon's experience in rectal surgery was measured by the surgeon's caseload throughout the entire study period. We considered surgeons with greater than 25 cases over the study period experienced.Analysis of survival with regard to the managing center revealed significant differences for stage T3, with 5-year-survival rates ranging from 14% to 60%. Distinct differences were also noted for survival rates in stage T2 (5-year-survival rates ranged from 38% to 86%); however, these differences were not statistically significant. Analysis of the influence of surgeon's caseload on outcomes in rectal cancer revealed a significant influence in stage T3 and a lack of influence in stage T2.Conclusion. The surgeon's experience is an independent prognostic factor for stage T3 rectal cancer patients.
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Factors associated with increased pulse wave velocity in peritoneal dialysis patients

73%
Stróżecki P., Donderski R., Grajewska M., Marcinkowska E., Kozłowski M., Pollak J., Odrowąż-Sypniewska G., Manitius J.
Open Medicine
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2010
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vol. 5
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issue 3
381-386
EN
Elevated pulse wave velocity (PWV) reflects increased arterial stiffness. Several studies have investigated PWV in peritoneal dialysis (PD) patients, but direct comparisons with healthy controls were not done. The potential influence of peritoneal transport characteristics on arterial stiffness in PD patients was suggested in recent studies. The aims of this study were to compare PWV in PD patients and healthy volunteers, and to investigate factors associated with increased PWV. The carotid-femoral PWV was measured in 28 PD patients and 28 healthy controls, matched for age and gender. A peritoneal equilibration test (PET) was performed in all PD patients. Based on the PET, patients were classified as: high transporters (H) (n=8), high-average (HA) (n=12), low-average (LA) (n=6), and low transporters (L) (n=2). Six of the PD patients were diabetic. PWV was significantly higher in the PD patients than in the controls (9,9±2,4 vs. 8,0±0,9; p=0,0004). In the PD group, PWV was higher in H/HA than in L/LA patients (10,4 ± 2,5 vs. 8,6 ± 1,0; p=0,008), but all the diabetic patients were in the H/HA group. PWV was significantly higher in diabetic than in non-diabetic PD patients (12,8 ± 2,0 vs. 9,1 ± 1,7; p=0,004). In the PD patients, significant positive correlations were found between PWV and: age, pulse pressure, Kt/V, and duration of PD therapy. In conclusion, the carotid-femoral PWV is elevated in peritoneal dialysis patients. Increased PWV in PD patients is associated with age, diabetic status, and longer duration of PD therapy, but not with this type of peritoneal transport.
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