Surgical Treatment of Colorectal Cancer. Controversial Issues

Aims: This study was carried out to evaluate surgical treatment of colorectal cancer (CRC) with special interest in present status and controversial issues: stenting as a palliative procedure for metastasized CRC (I), duration of thromboprophylaxis after the surgical treatment of CRC (II), treatment of the increasing population of elderly people (III) and the quality of life (QoL) after surgery for rectal cancer with special reference to pelvic floor dysfunction (IV). Materials and methods: The material consisted of patients with CRC operated on at Turku University Hospital between 2003 and 2008. In study II the data was collected retrospectively from electronic archives. In other studies the follow-up data was collected at postoperative control visits. In study IV the RAND-36 standardized questionnaire and additional questions assessing urinary, sexual and anorectal dysfunction were used. Results: The results of the current study showed that self-expanding metallic stents provided an alternative to palliative surgery in the treatment of obstructive CRC. Low molecular heparin given s.c. for a median of 11 days until hospital discharge seemed to provide sufficient thromboprophylaxis after surgery. With preoperative selection elderly patients with rectal cancer were suitable for major surgery for rectal cancer with morbidity and mortality rates comparable to those in younger patients. There was no difference between preoperative and one year postoperative general QoL for operated rectal cancer patients. Postoperative pelvic dysfunction was associated with an impaired QoL in some dimensions. Conclusions: Many individual factors regarding the patient and the disease must be taken into account when making treatment decisions in CRC to ensure successful treatment of CRC, patient satisfaction and QoL.

Helsinki 14/7 36

Kirje 14.7.1936

Helsinki 17/7 36

Kirje 17.7.1936

[Berliini] [Olympisches Dorf, den] 4/8 36

Kirje 4.8.1936

Helsinki 8/7 36

Kirje 8.7.1936

Liikearvon arvonalentumistestaus IAS 36:n mukaan

The main object of this Master´s Thesis was to study the goodwill impairment testing under IAS 36. The aim was also to study the process of impairment testing in companies. The definition, treatment and impairment testing of goodwill were based on the interpretative literature of the standard, articles in trade papers and in international journals. Research methodology was descriptive, qualitative and normative. The empirical data was gathered from focused interviews of companies, consultant and auditor. In the impairment testing of goodwill under IAS 36 carrying amount of cash-generating unit is compared with unit´s recoverable amount, which is defined by either fair value less costs to sell or value in use. Value in use, which is based on unit´s net present value of the future cash flows, is clearly more generally used. The greatest black spots of testing are determination of cash-generating units and allocation of goodwill to them and determination of the discount rate. These black spots enable covering-up goodwill impairment. Companies testing processes differed, which makes comparison more difficult. The documentation of testing should also be invested more in companies.