No abstract

Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is used in the palliative treatment of peritoneal metastasis. The combination of intraperitoneal and systemic chemotherapy seems rational, and the aim of this systematic review was to compare PIPAC directed monotherapy with a bidirectional treatment approach (PIPAC in combination with systemic chemotherapy). Main outcomes were survival and quality of life.Methods: A systematic literature search in Medline, Embase, Cochrane and the "Pleura and Peritoneum" was conducted and analyzed according to PRISMA guidelines. Studies in English reporting on bidirectional treatment with PIPAC and systemic chemotherapy and published before April 2019 were included.Results: Twelve studies with a total of 386 patients were included. None were specifically designed to compare mono-versus bidirectional treatment, but 44% of the patients received bidirectional treatment. This was more frequent in women (non-gynecological cancers) and one-third of the bidirectional treated patients had received no prior chemotherapy. Data from the included studies provided no conclusions regarding survival or quality of life.Conclusion: Bidirectional treatment with PIPAC and systemic chemotherapy is practised and feasible, and some patients are enrolled having received no prior systemic chemotherapy for their PM. The difficulty in drawing any conclusions based on this systematic review has highlighted the urgent need to improve and standardize reports on PIPAC directed therapy. We have, therefore, constructed a list of items to be considered when reporting on clinical PIPAC research.Trial registration: International Prospective Register of Systematic Reviews, PROSPERO. Registration number: 90352, March 5, 2018.

Anaemia and iron deficiency are common manifestations of colorectal cancer (CRC). The reported prevalence of anaemia at diagnosis of CRC is between 23% and 56%, with 70-80% due to iron deficiency [1][2][3][4][5][6][7]. Studies have shown that anaemia is associated with an increased risk of postoperative complications, mortality and cancer recurrence [8][9][10][11] following CRC surgery. Low iron stores have even been shown to be a significant risk factor for postoperative infections and increased length of hospital stay following gastrointestinal surgery [12]. Iron deficiency may adversely affect overall survival, relapse-free survival and postoperative complication rates after

The Danish national colorectal cancer (CRC) screening programme was initiated in 2014. Citizens aged 50-74 years were invited to submit a faecal immunochemical test (FIT) and FIT positive individuals (100 ng/ml haemoglobin per ml buffer -equivalent to 20 µg/g faeces) scheduled for colonoscopy within two weeks. Based on the adenoma findings, individuals are risk stratified, and their appropriate recall procedure and interval is determined [1]. If no adenomas are detected, an 8-year repeated FIT is scheduled while in the case of low-risk adenoma findings (less than three tubular adenomas, all smaller than 10 mm and all low-grade neoplasia), a repeated FIT is scheduled after 2 years instead [1]. Despite the described planned recall procedure, the first screening round was rolled out over 4 years, with all screening eligible individuals invited in that time span, and no re-invitations made in that period. This was done to

Background The diagnostic quality of screening colonoscopies has been found to differ between morning and afternoon. Specifically, the adenoma detection rate (ADR) is higher in the morning. Our aim was to assess if time-of-day dependent differences in colonoscopy quality exist in a Danish screening setting. Following national screening guidelines, an individual will be exempt from screening invitations for 8 years if the colonoscopy is without pathology. Therefore, it is of utmost importance to identify factors systematically affecting the detection of lesions. Methods This was a single-center study of screening colonoscopies performed between 2014 and 2018. Records were retrieved from the Danish Colorectal Cancer Screening Database and coupled with local data. The ADR and the cecal intubation rate were compared between morning (8-12 a.m.) and afternoon (12-4 p.m.) colonoscopies. Multivariate logistic regression analysis was performed. Results A total of 3659 screening colonoscopies were included. The ADR was 51% in the morning and 58% in the afternoon. Multivariate analysis found this statistically significant, with the “afternoon vs. morning” odds ratio for adenoma detection being 1.4 (95% confidence interval 1.17-1.68; P<0.001). The cecal intubation rate was 95.6% in the morning and 94.7%, a non-significant difference. Conclusions The ADR of screening colonoscopies was higher in the afternoon. Our study highlights the need for local/regional evaluation of factors affecting colonoscopy quality to address such issues. A clean colonoscopy exempts the patient from subsequent screening invitations for 8 years. Therefore, any observed systematic differences in quality must be addressed and eliminated.

No abstract

No abstract

We thank the editor for the opportunity to reply to the comments and worries brought forward by Larsen et al.