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  • 1.
    Abbassi, Fariba
    et al.
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Gero, Daniel
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Muller, Xavier
    Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
    Bueno, Alba
    Kings Coll Hosp London, Inst Liver Studies, London, England..
    Figiel, Wojciech
    Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland..
    Robin, Fabien
    Univ Hosp Rennes, Dept HPB Surg & Transplantat, Rennes, France..
    Laroche, Sophie
    Hop Paul Brousse, Hepatobiliary Ctr, Dept Surg & Transplantat, Villejuif, France..
    Picard, Benjamin
    Hop Beaujon, APHP Nord, DMU PARABOL, Dept Anesthesiol Crit Care & Perioperat Med, Clichy, Nord, France..
    Shankar, Sadhana
    Leeds Teaching Hosp trust, Dept Abdominal Transplant & Hepatobiliary Surg, Leeds, W Yorkshire, England..
    Ivanics, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery. Univ Toronto, Univ Hlth Network, Multiorgan Transplant Program, Toronto, ON, Canada.;Henry Ford Hosp, Dept Surg, Detroit, MI USA..
    van Reeven, Marjolein
    Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Dept Surg, Div HPB & Transplant Surg, Rotterdam, Netherlands..
    van Leeuwen, Otto B.
    Univ Groningen, Univ Med Ctr Groningen, Div HPB Surg & Liver Transplantat, Groningen, Netherlands..
    Braun, Hillary J.
    Univ Calif San Francisco, Div Transplant Surg, San Francisco, CA USA..
    Monbaliu, Diethard
    Univ Hosp Leuven, Dept Abdominal Transplant Surg & Transplant Coord, Leuven, Belgium..
    Breton, Antoine
    Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
    Vachharajani, Neeta
    Washington Univ, St Louis Sch Med, Div Abdominal Transplantat, Dept Surg, St Louis, MO USA..
    Bonaccorsi Riani, Eliano
    Univ Hosp St Luc, Dept Abdominal & Transplant Surg, Brussels, Belgium..
    Nowak, Greg
    Karolinska Univ, Hosp Huddinge, Dept Transplantat Surg, Stockholm, Sweden..
    McMillan, Robert R.
    Houston Methodist Hosp, Weill Cornell Med Ctr, Houston, TX USA..
    Abu-Gazala, Samir
    Hosp Univ Penn, Penn Transplant Inst, Dept Surg, Philadelphia, PA USA..
    Nair, Amit
    Univ Rochester, Div Transplantat & Hepatobiliary Surg, Rochester, MN USA..
    Bruballa, Rocio
    Hosp Italiano Buenos Aires, HPB & Liver Transplant Unit, Buenos Aires, Argentina..
    Paterno, Flavio
    Univ Hosp, Rutgers New Jersey Med Sch, Div Liver Transplant, Newark, NJ USA..
    Weppler Sears, Deborah
    Cleveland Clin Florida, Dept Abdominal & Transplant Surg, Weston, FL USA..
    Pinna, Antonio D.
    Cleveland Clin Florida, Dept Abdominal & Transplant Surg, Weston, FL USA..
    Guarrera, James V.
    Univ Hosp, Rutgers New Jersey Med Sch, Div Liver Transplant, Newark, NJ USA..
    de Santibanes, Eduardo
    Hosp Italiano Buenos Aires, HPB & Liver Transplant Unit, Buenos Aires, Argentina..
    de Santibanes, Martin
    Hosp Italiano Buenos Aires, HPB & Liver Transplant Unit, Buenos Aires, Argentina..
    Hernandez-Alejandro, Roberto
    Univ Rochester, Div Transplantat & Hepatobiliary Surg, Rochester, MN USA..
    Olthoff, Kim
    Hosp Univ Penn, Penn Transplant Inst, Dept Surg, Philadelphia, PA USA..
    Ghobrial, R. Mark
    Houston Methodist Hosp, Weill Cornell Med Ctr, Houston, TX USA..
    Ericzon, Bo-Goran
    Karolinska Univ, Hosp Huddinge, Dept Transplantat Surg, Stockholm, Sweden..
    Ciccarelli, Olga
    Univ Hosp St Luc, Dept Abdominal & Transplant Surg, Brussels, Belgium..
    Chapman, William C.
    Washington Univ, St Louis Sch Med, Div Abdominal Transplantat, Dept Surg, St Louis, MO USA..
    Mabrut, Jean-Yves
    Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
    Pirenne, Jacques
    Univ Hosp Leuven, Dept Abdominal Transplant Surg & Transplant Coord, Leuven, Belgium..
    Mullhaupt, Beat
    Univ Hosp Zurich, Dept Gastroenterol & Hepatol, Zurich, Switzerland..
    Ascher, Nancy L.
    Univ Calif San Francisco, Div Transplant Surg, San Francisco, CA USA..
    Porte, Robert J.
    Univ Groningen, Univ Med Ctr Groningen, Div HPB Surg & Liver Transplantat, Groningen, Netherlands..
    de Meijer, Vincent E.
    Univ Groningen, Univ Med Ctr Groningen, Div HPB Surg & Liver Transplantat, Groningen, Netherlands..
    Polak, Wojciech G.
    Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Dept Surg, Div HPB & Transplant Surg, Rotterdam, Netherlands..
    Sapisochin, Gonzalo
    Univ Toronto, Univ Hlth Network, Multiorgan Transplant Program, Toronto, ON, Canada..
    Attia, Magdy
    Leeds Teaching Hosp trust, Dept Abdominal Transplant & Hepatobiliary Surg, Leeds, W Yorkshire, England..
    Soubrane, Olivier
    Hop Beaujon, APHP Nord, DMU DIGEST, Dept HPB Surg & Liver Transplantat, Clichy, France..
    Weiss, Emmanuel
    Hop Beaujon, APHP Nord, DMU PARABOL, Dept Anesthesiol Crit Care & Perioperat Med, Clichy, Nord, France..
    Adam, Rene A.
    Hop Paul Brousse, Hepatobiliary Ctr, Dept Surg & Transplantat, Villejuif, France..
    Cherqui, Daniel
    Hop Paul Brousse, Hepatobiliary Ctr, Dept Surg & Transplantat, Villejuif, France..
    Boudjema, Karim
    Univ Hosp Rennes, Dept HPB Surg & Transplantat, Rennes, France..
    Zieniewicz, Krzysztof
    Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland..
    Jassem, Wayel
    Kings Coll Hosp London, Inst Liver Studies, London, England..
    Dutkowski, Philipp
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Clavien, Pierre-Alain
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Novel Benchmark Values for Redo Liver Transplantation Does the Outcome Justify the Effort?2022In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 276, no 5, p. 860-867Article in journal (Refereed)
    Abstract [en]

    Objective: To define benchmark cutoffs for redo liver transplantation (redo-LT). Background: In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. Methods: We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score <= 25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. Results: Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI (R) at 1-year of <= 72, and in-hospital and 1-year mortality rates of <= 13% and <= 15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redoLT benchmarks. Conclusion: This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.

  • 2.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Fang, Xin
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Lindgren, Rickard
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes2020In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1, p. 140-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

    BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

    METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

    RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

    CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

  • 3.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. County Hospital Ryhov, Sweden.
    Letter: General Surgeon Supply and Appendiceal Rupture: Proportion of Perforation Is Not a Meaningful Measure of Quality of Care in ANNALS OF SURGERY, vol 261, issue 5, pp E132-E1322015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 5, p. E132-E132Article in journal (Other academic)
    Abstract [en]

    n/a

  • 4.
    Andersson, Roland E
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Letter: Resolving appendicitis is common2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 3, p. 553-553Article in journal (Other academic)
    Abstract [en]

    n/a

  • 5.
    Andersson, Roland
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Petzold, MG
    Nonsurgical treatment of appendiceal abscess or phlegmon: A systematic review and meta-analysis2007In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 246, no 5, p. 741-748Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A systematic review of the nonsurgical treatment of patients with appendiceal abscess or phlegmon, with emphasis on the success rate, need for drainage of abscesses, risk of undetected serious disease, and need for interval appendectomy to prevent recurrence. SUMMARY BACKGROUND DATA: Patients with appendiceal abscess or phlegmon are traditionally managed by nonsurgical treatment and interval appendectomy. This practice is controversial with proponents of immediate surgery and others questioning the need for interval appendectomy. METHODS: A Medline search identified 61 studies published between January 1964 and December 2005 reporting on the results of nonsurgical treatment of appendiceal abscess or phlegmon. The results were pooled taking the potential clustering on the study-level into account. A meta-analysis of the morbidity after immediate surgery compared with that after nonsurgical treatment was performed. RESULTS: Appendiceal abscess or phlegmon is found in 3.8% (95% confidence interval (CI), 2.6-4.9) of patients with appendicitis. Nonsurgical treatment fails in 7.2% (CI: 4.0-10.5). The need for drainage of an abscess is 19.7% (CI: 11.0-28.3). Immediate surgery is associated with a higher morbidity compared with nonsurgical treatment (odds ratio, 3.3, CI: 1.9-5.6, P < 0.001). After successful nonsurgical treatment, a malignant disease is detected in 1.2% (CI: 0.6-1.7) and an important benign disease in 0.7% (CI: 0.2-11.9) during follow-up. The risk of recurrence is 7.4% (CI: 3.7-11.1). CONCLUSIONS: The results of this review of mainly retrospective studies support the practice of nonsurgical treatment without interval appendectomy in patients with appendiceal abscess or phlegmon. © 2007 Lippincott Williams & Wilkins, Inc.

  • 6.
    Angenete, Eva
    et al.
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Thornell, Anders
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp östra, Univ Gothenburg, Gothenburg, Sweden.
    Burcharth, Jakob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Pommergaard, Hans-Christian
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Skullman, Stefan
    Dept Surg, Skaraborgs Hosp, Skövde, Sweden.
    Bisgaard, Thue
    Div Surg, GastroUnit, Hvidovre Hosp, Univ Copenhagen, Hvidovre, Denmark.
    Jess, Per
    Dept Surg, Roskilde Hosp, Roskilde, Denmark.
    Lackberg, Zoltan
    NAL Hosp Grp, Trollhättan, Sweden.
    Matthiessen, Peter
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Heath, Jane
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Rosenberg, Jacob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Haglind, Eva
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis The First Results From the Randomized Controlled Trial DILALA2016In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, no 1, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Objective:To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.

    Background:Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.

    Methods:Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.

    Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.

    Conclusions:In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.

  • 7.
    Annebäck, Matilda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Almquist, Martin
    Stålberg, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Norlén, Olov
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease: A Nationwide Population-based Cohort Study From Sweden2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 6, p. e1202-e1208Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence and risk factors for permanent hypoparathyroidism after total thyroidectomy for benign disease in a population-based setting with data independent of input of complication data.

    SUMMARY OF BACKGROUND DATA: The reported rate of permanent hypoparathyroidism is highly variable and mostly rely on reported complication data from national or institutional registries.

    METHODS: All patients who underwent total thyroidectomy in Sweden from 2005 to 2015 were identified through Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery and the Swedish National Patient Register. Patients were matched to outcome data from the Swedish Prescribed Drug Register. Permanent hypoparathyroidism was defined as treatment with calcium and/or active vitamin D more than 1 year after surgery.

    RESULTS: Seven thousand eight hundred fifty-two patients were included and 938 (12.5%) developed permanent hypoparathyroidism. The risk was lower in patients registered in the quality register (11.0% vs 16%, P < 0.001). In a multivariable analysis there was a higher risk of permanent hypoparathyroidism in patients with parathyroid autotransplantation [Odds ratio (OR) 1.72; 95% confidence interval 1.47-2.01], center-volume <100 thyroidectomies per year (OR 1.22; 1.03-1.44), age above 60 year (OR 1.64; 1.36-1.98) and female sex (OR 1.27; 1.05-1.54). Reported data from the quality register only identified 178 of all 938 patients with permanent hypoparathyroidism.

    CONCLUSION: The risk of permanent hypoparathyroidism after total thyroidectomy was high and associated with parathyroid autotransplantation, higher age, female sex and surgery at a low volume center. Reported follow-up data might underestimate the rate of permanent hypoparathyroidism.

  • 8. Arver, Brita
    et al.
    Isaksson, Karin
    Atterhem, Hans
    Baan, Annika
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Brandberg, Yvonne
    Ehrencrona, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Genetics.
    Emanuelsson, Monica
    Hellborg, Henrik
    Henriksson, Karin
    Karlsson, Per
    Loman, Niklas
    Lundberg, Jonas
    Ringberg, Anita
    Askmalm, Marie Stenmark
    Wickman, Marie
    Sandelin, Kerstin
    Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey2011In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 253, no 6, p. 1147-1154Article in journal (Refereed)
    Abstract [en]

    Background/Objective: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. Methods: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. Results: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low(3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1 unanticipated secondary operation.

  • 9. Arver, Brita
    et al.
    Isaksson, Karin
    Atterhem, Hans
    Baan, Annika
    Bergkvist, Leif
    Brandberg, Yvonne
    Ehrencrona, Hans
    Emanuelsson, Monica
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hellborg, Henrik
    Henriksson, Karin
    Karlsson, Per
    Loman, Niklas
    Lundberg, Jonas
    Ringberg, Anita
    Askmalm, Marie Stenmark
    Wickman, Marie
    Sandelin, Kerstin
    Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey2011In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 253, no 6, p. 1147-1154Article in journal (Refereed)
    Abstract [en]

    Background/Objective: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. Methods: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. Results: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low(3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1 unanticipated secondary operation.

  • 10.
    Asbun, H.J.
    et al.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Moekotte, A.L.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Vissers, F.L.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Kunzler, F.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Cipriani, F.
    Department of Surgery, San Raffaele Hospital, Milan, Italy.
    Alseidi, A.
    Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, VA, United States.
    DAngelica, M.I.
    Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States.
    Balduzzi, A.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Bassi, C.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Boggi, U.
    Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
    Callery, M.P.
    Department of General and Gastrointestinal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
    Del, Chiaro M.
    Department of Surgery, Division of Surgical Oncology, University of Colorado, Denver, CO, United States.
    Coimbra, F.J.
    Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
    Conrad, C.
    Department of Surgery, St. Elizabeths Medical Center, Boston, MA, United States.
    Cook, A.
    Wessex Institute, University of Southampton, United Kingdom.
    Coppola, A.
    General Surgery and Liver Transplant, Unit Department of General Surgery, Fondazione Policlinico, Universitario Agostino Gemelli, IRCCS, Rome, Italy.
    Dervenis, C.
    Department of Surgery, Medical School, University of Cyprus, Cyprus.
    Dokmak, S.
    Department of Surgery, Beaujon Hospital, Paris, France.
    Edil, B.H.
    Department of Surgery, University of Oklahoma, Oklahoma City, OK, United States.
    Edwin, B.
    Intervention Centre, Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Giulianotti, P.C.
    Division of Minimally Invasive, General Surgery and Robotic Surgery, University of Illinois, Chicago, IL, United States.
    Han, H.-S.
    Department of Surgery, Seoul National University Hospital, Seoul, South Korea.
    Hansen, P.D.
    Department of Surgery, Portland Providence Medical Center, Portland, OR, United States.
    Van, Der Heijde N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Van, Hilst J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Hester, C.A.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Hogg, M.E.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Jarufe, N.
    Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile.
    Jeyarajah, D.R.
    Department of HPB Surgery, Methodist Richardson Medical Center, Richardson, TX, United States.
    Keck, T.
    Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany.
    Kim, S.C.
    Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, South Korea.
    Khatkov, I.E.
    Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.
    Kokudo, N.
    Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
    Kooby, D.A.
    Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
    Korrel, M.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    De, Leon F.J.
    HPB and Transplant Unit, Regional Hospital, Málaga, Spain.
    Lluis, N.
    Department of Surgery, Bellvitge University Hospital, Barcelona, Spain.
    Lof, S.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Machado, M.A.
    Department of Surgery, University of São Paulo, São Paulo, Brazil.
    Demartines, N.
    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Martinie, J.B.
    Division of HPB Surgery, Department of Surgery, Carolinas Health Care Hospital, Charlotte, NC, United States.
    Merchant, N.B.
    Division of Surgical Oncology, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, United States.
    Molenaar, I.Q.
    Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
    Moravek, C.
    Pancreatic Cancer Action Network, Manhattan Beach, CA, United States.
    Mou, Y.-P.
    Department of Gastroenterology and Pancreatic Surgery, Zhengjiang Provincial Peoples Hospital, Peoples Hospital of Hangzhou Medical College, Zhejiang, China.
    Nakamura, M.
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
    Nealon, W.H.
    Department of Surgery, Northwell Health, Manhasset, NY, United States.
    Palanivelu, C.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Pessaux, P.
    Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France.
    Pitt, H.A.
    Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
    Polanco, P.M.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Primrose, J.N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Rawashdeh, A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Sanford, D.E.
    Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University, School of Medicine, St. Louis, MO, United States.
    Senthilnathan, P.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Shrikhande, S.V.
    Department of Surgery, Tata Memorial Center, Mumbai, India.
    Stauffer, J.A.
    Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL, United States.
    Takaori, K.
    Department of Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
    Talamonti, M.S.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Tang, C.N.
    Department of Surgery, Pamela Youde Nethersle Eastern Hospital, Chai Wan, Hong Kong, Hong Kong.
    Vollmer, C.M.
    Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
    Wakabayashi, G.
    Center for Advanced Treatment of HPB Diseases, Ageo Central General Hospital, Saitama, Japan.
    Walsh, R.M.
    Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
    Wang, S.-E.
    Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
    Zinner, M.J.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Wolfgang, C.L.
    Division of Surgical Oncology, Department of Surgery, John Hopkins University, School of Medicine, Baltimore, MD, United States.
    Zureikat, A.H.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Zwart, M.J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Conlon, K.C.
    Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland.
    Kendrick, M.L.
    Department of Surgery, Mayo Clinic, Rochester, MN, United States; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy.
    Zeh, H.J.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Hilal, M.A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Besselink, M.G.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection2020In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019).Summary Background Data: MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking. Methods: The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology. Results: After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety.Conclusion: The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery. © 2019 Wolters Kluwer Health, Inc. All rights reserved.

  • 11.
    Backman, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Bruze, Gustaf
    Naslund, Ingmar
    Ottosson, Johan
    Marsk, Richard
    Neovius, Martin
    Naslund, Erik
    Gastric Bypass Surgery Reduces De Novo Cases of Type 2 Diabetes to Population Levels A Nationwide Cohort Study From Sweden2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 5, p. 895-902Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to determine long-term changes in pharmacological treatment of type 2 diabetes after primary Roux-en-Y gastric bypass (RYGB) surgery, in patients with and without pharmacological treatment of diabetes preoperatively.

    Summary of Background Data: Several studies have shown that gastric bypass has good effect on diabetes, at least in the short-term. This study is a nationwide cohort study using Swedish registers, with basically no patients lost to follow-up during up to 7 years after surgery.

    Methods: The effect of RYGB on type 2 diabetes drug treatment was evaluated in this nationwide matched cohort study. Participants were 22,047 adults with BMI ≥30 identified in the nationwide Scandinavian Surgical Obesity Registry, who underwent primary RYGB between 2007 and 2012. For each individual, up to 10 general population comparators were matched on birth year, sex, and place of residence. Prescription data were retrieved from the nationwide Swedish Prescribed Drug Register through September 2015. Incident use of pharmacological treatment was analyzed using Cox regression.

    Results: Sixty-seven percent of patients with pharmacological treatment of type 2 diabetes before surgery were not using diabetes drugs 2 years after surgery and 61% of patients were not pharmacologically treated up to 7 years after surgery. In patients not using diabetes drugs at baseline, there were 189 new cases of pharmacological treatment of type 2 diabetes in the surgery group and 2319 in the matched general population comparators during a median follow-up of 4.6 years (incidence: 21.4 vs 27.9 per 10,000 person-years; adjusted hazard ratio 0.77, 95% confidence interval 0.67–0.89; P < 0.001).

    Conclusions: Gastric bypass surgery not only induces remission of pharmacological treatment of type 2 diabetesbut also protects from new onset of pharmacological diabetes treatment. The effect seems to persist in most, but not all, patients over 7 years of follow-up.

  • 12.
    Backman, Olof
    et al.
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Umeå University, Umeå, Sweden.
    Bruze, Gustaf
    Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Näslund, Ingmar
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ottosson, Johan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Marsk, Richard
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Neovius, Martin
    Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Näslund, Erik
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Gastric Bypass Surgery Reduces De Novo Cases of Type 2 Diabetes to Population Levels: A Nationwide Cohort Study From Sweden2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 5, p. 895-902Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to determine long-term changes in pharmacological treatment of type 2 diabetes after primary Roux-en-Y gastric bypass (RYGB) surgery, in patients with and without pharmacological treatment of diabetes preoperatively.

    SUMMARY OF BACKGROUND DATA: Several studies have shown that gastric bypass has good effect on diabetes, at least in the short-term. This study is a nationwide cohort study using Swedish registers, with basically no patients lost to follow-up during up to 7 years after surgery.

    METHODS: The effect of RYGB on type 2 diabetes drug treatment was evaluated in this nationwide matched cohort study. Participants were 22,047 adults with BMI ≥30 identified in the nationwide Scandinavian Surgical Obesity Registry, who underwent primary RYGB between 2007 and 2012. For each individual, up to 10 general population comparators were matched on birth year, sex, and place of residence. Prescription data were retrieved from the nationwide Swedish Prescribed Drug Register through September 2015. Incident use of pharmacological treatment was analyzed using Cox regression.

    RESULTS: Sixty-seven percent of patients with pharmacological treatment of type 2 diabetes before surgery were not using diabetes drugs 2 years after surgery and 61% of patients were not pharmacologically treated up to 7 years after surgery. In patients not using diabetes drugs at baseline, there were 189 new cases of pharmacological treatment of type 2 diabetes in the surgery group and 2319 in the matched general population comparators during a median follow-up of 4.6 years (incidence: 21.4 vs 27.9 per 10,000 person-years; adjusted hazard ratio 0.77, 95% confidence interval 0.67-0.89; P < 0.001).

    CONCLUSIONS: Gastric bypass surgery not only induces remission of pharmacological treatment of type 2 diabetes but also protects from new onset of pharmacological diabetes treatment. The effect seems to persist in most, but not all, patients over 7 years of follow-up.

  • 13.
    Bergkvist, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    de Boniface, Jana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Jönsson, Per-Ebbe
    Ingvar, Christian
    Liljegren, Göran
    Frisell, Jan
    Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 1, p. 150-156Article in journal (Refereed)
    Abstract [en]

    Background: Sentinel lymph node biopsy is an established staging method in early breast cancer. After a negative biopsy, most institutions will not perform a completion axillary dissection. The present study reports the current axillary recurrence (AR) rate, overall and disease-free survival in the Swedish Multicenter Cohort Study. Methods: From 3534 patients with primary breast cancer <= 3 cm prospectively enrolled in the Swedish multicenter cohort study, 2246 with a negative sentinel node biopsy and no further axillary surgery were selected. Follow-up consisted of annual clinical examination and mammography. Twenty-six hospitals and 131 surgeons contributed to patient accrual. Results: After a median follow-up time of 37 months (0-75), the axilla was the sole initial site of recurrence in 13 patients (13 of 2246, 0.6%). In another 7 patients, axillary relapse occurred after or concurrently with a local recurrence in the breast, and in a further 7 cases, it coincided with distant or extra-axillary lymphatic metastases. Thus, a total of 27 ARs were identified (27 of 2246, 1.2%). The overall 5-year survival was 91.6% and disease-free survival 92.1%. Conclusions: This is the first report from a national multicenter study that covers, not only highly specialized institutions but also small community hospitals with just a few procedures per year. Despite this heterogeneous background, the results lie well within the range of AR rates published internationally (0%-3.6%). The sentinel node biopsy procedure seems to be safe in a multicenter setting. Nevertheless, long-term follow-up data should be awaited before firm conclusions are drawn.

  • 14. Bergkvist, Leif
    et al.
    de Boniface, Jana
    Jönsson, Per-Ebbe
    Ingvar, Christian
    Liljegren, Göran
    Örebro University, School of Health and Medical Sciences.
    Frisell, Jan
    Axillary recurrence rate after negative sentinel node biopsy in breast cancer: three-year follow-up of the Swedish Multicenter Cohort Study2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 1, p. 150-156Article in journal (Refereed)
    Abstract [en]

    Background: Sentinel lymph node biopsy is an established staging method in early breast cancer. After a negative biopsy, most institutions will not perform a completion axillary dissection. The present study reports the current axillary recurrence (AR) rate, overall and disease-free survival in the Swedish Multicenter Cohort Study.

    Methods: From 3534 patients with primary breast cancer ≤3 cm prospectively enrolled in the Swedish multicenter cohort study, 2246 with a negative sentinel node biopsy and no further axillary surgery were selected. Follow-up consisted of annual clinical examination and mammography. Twenty-six hospitals and 131 surgeons contributed to patient accrual.

    Results: After a median follow-up time of 37 months (0-75), the axilla was the sole initial site of recurrence in 13 patients (13 of 2246, 0.6%). In another 7 patients, axillary relapse occurred after or concurrently with a local recurrence in the breast, and in a further 7 cases, it coincided with distant or extra-axillary lymphatic metastases. Thus, a total of 27 ARs were identified (27 of 2246, 1.2%). The overall 5-year survival was 91.6% and disease-free survival 92.1%.

    Conclusions: This is the first report from a national multicenter study that covers, not only highly specialized institutions but also small community hospitals with just a few procedures per year. Despite this heterogeneous background, the results lie well within the range of AR rates published internationally (0%-3.6%). The sentinel node biopsy procedure seems to be safe in a multicenter setting. Nevertheless, long-term follow-up data should be awaited before firm conclusions are drawn.

  • 15.
    Bergqvist, David
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Treatment of vascular Ehlers-Danlos syndrome: a systematic review2013In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 258, no 2, p. 257-261Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To provide the collected evidence from all literature reports.

    BACKGROUND:

    Vascular Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder with serious hemorrhagic consequences. Most experience on treatment is based on case reports and small case series.

    METHOD:

    A systematic literature review was performed. PubMed and reference lists were scrutinized.

    RESULTS:

    A total of 231 patients were identified with no gender preponderance. Aneurysms were present in 40%, often multiple. In 33%, there was an arterial rupture without an underlying aneurysm. Carotidocavernous fistula was seen in 18%. After open surgery the mortality was 30%; after endovascular procedures, it was 24%; in a group of miscellaneous cases, it was 60%; and the overall mortality was 39%. The median age of patients at death was 31 years. The median follow-up time was 12 months (5 days-7 years), but in 20% cases, it was not reported. In only 29 of the 119 recent patients (24%) the mutation was verified with molecular genetic testing.

    CONCLUSIONS:

    Vascular EDS is a serious disorder with high mortality, which does not seem to have been influenced by new treatment methods. Invasive methods should be used only when necessary, primarily to save the patients' life. Whenever possible, the genetic molecular defect should be identified. The results of this review may be affected by publications bias. Ideally, a prospective registry should be created.

  • 16.
    Biglarnia, Ali-Reza
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Bennet, William
    Nilsson, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Larsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular and Morphological Pathology.
    Magnusson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Yamamoto, Shinji
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Lorant, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Sedigh, Amir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    von Zur-Mühlen, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Bäckman, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Korsgren, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Tufveson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Utilization of Small Pediatric Donors Including Infants for Pancreas and Kidney Transplantation: Exemplification of the Surgical Technique and the Surveillance2014In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 260, no 2, p. e5-7Article in journal (Refereed)
  • 17.
    Borch, Kurt
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Ahrén, Bo
    Ahlman, Håkan
    Falkmer, Sture
    Granérus, Göran
    Grimelius, Lars
    Gastric carcinoids: Biologic behavior and prognosis after differentiated treatment in relation to type2005In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 242, no 1, p. 64-73Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze tumor biology and the outcome of differentiated treatment in relation to tumor subtype in patients with gastric carcinoid. Background: Gastric carcinoids may be subdivided into ECL cell carcinoids (type 1 associated with atrophic gastritis, type 2 associated with gastrinoma, type 3 without predisposing conditions) and miscellaneous types (type 4). The biologic behavior and prognosis vary considerably in relation to type. Methods: A total of 65 patients from 24 hospitals (51 type 1, 1 type 2, 4 type 3, and 9 type 4) were included. Management recommendations were issued for newly diagnosed cases, that is, endoscopic or surgical treatment of type 1 and 2 carcinoids (including antrectomy to abolish hypergastrinemia) and radical resection for type 3 and 4 carcinoids. Results: Infiltration beyond the submucosa occurred in 9 of 51 type 1, 4 of 4 type 3, and 7 of 9 type 4 carcinoids. Metastases occurred in 4 of 51 type 1 (3 regional lymph nodes, 1 liver), the single type 2 (regional lymph nodes), 3 of 4 type 3 (all liver), and 7 of 9 type 4 carcinoids (all liver). Of the patients with type 1 carcinoid, 3 had no specific treatment, 40 were treated with endoscopic or surgical excision (in 10 cases combined with antrectomy), 7 underwent total gastrectomy, and 1 underwent proximal gastric resection. Radical tumor removal was not possible in 2 of 4 patients with type 3 and 7 of 9 patients with type 4 carcinoid. Five- and 10-year crude survival rates were 96.1% and 73.9% for type 1 (not different from the general population), but only 33.3% and 22.2% for type 4 carcinoids. Conclusion: Subtyping of gastric carcinoids is helpful in the prediction of malignant potential and long-term survival and is a guide to management. Long-term survival did not differ from that of the general population regarding type 1 carcinoids but was poor regarding type 4 carcinoids. Copyright © 2005 by Lippincott Williams & Wilkins.

  • 18.
    Boström, Petrus
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Hultberg, Daniel Kverneng
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Häggström, Jenny
    Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
    Haapamäki, Markku M.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery.
    Rutegård, Jörgen
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Rutegård, Martin
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå, Sweden.
    Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer: A Nationwide Cohort Study2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 3, p. e236-e244Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to investigate the impact of tie level on oncological outcomes in rectal cancer surgery.

    SUMMARY BACKGROUND DATA: Theoretically, a high tie of the inferior mesenteric artery could facilitate removal of apical node metastases and improve tumor staging accuracy. However, no appropriately sized randomized controlled trial exists and results from observational studies are not consistent.

    METHODS: All stage I-III rectal cancer patients who underwent abdominal surgery with curative intention in 2007 to 2014 were identified and followed, using the Swedish Colorectal Cancer Registry. Primary outcome was cancer-specific survival, whereas overall and relative survival, locoregional and distant recurrence, and lymph node harvest were secondary outcomes, with high tie as exposure. We used propensity score matching to emulate a randomized controlled trial, and then performed Cox regression analyses to estimate hazard ratios (HRs) with confidence intervals (CIs).

    RESULTS: Some 8287 patients remained for analysis, of which 37% had high tie surgery. After propensity score matching, the 5-year cancer-specific survival rate was overall 86% and we found no association between the level of tie and cancer-specific (HR 0.92, 95% CI 0.79-1.07) or overall (HR 0.98, 95% CI 0.89-1.08) survival, nor to locoregional (HR 0.85, 95% CI 0.59-1.23) or distant (HR 1.01, 95% CI 0.88-1.15) recurrence, nor to relative survival (HR 1.05, 95% CI 0.85-1.28). Stratification and sensitivity analyses were similarly insignificant, after adjustment for confounding. Total lymph node harvest was, however, increased after high tie surgery (P < 0.01), but no differences were seen regarding positive nodes (P = 0.72).

    CONCLUSION: In this nationwide cohort study, the level of tie did not influence any patient-oriented oncological outcome, neither overall nor in node-positive patients. This would allow the patient's anatomical configuration and the surgeon's preferences to determine the level of tie.

  • 19.
    Boström, Petrus
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Kverneng Hultberg, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Häggström, Jenny
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Haapamäki, Markku M.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Matthiessen, Peter
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Rutegård, Jörgen
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer: A Nationwide Cohort Study2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 3, p. e236-e244Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to investigate the impact of tie level on oncological outcomes in rectal cancer surgery.

    Summary background data: Theoretically, a high tie of the inferior mesenteric artery could facilitate removal of apical node metastases and improve tumor staging accuracy. However, no appropriately sized randomized controlled trial exists and results from observational studies are not consistent.

    Methods: All stage I–III rectal cancer patients who underwent abdominal surgery with curative intention in 2007 to 2014 were identified and followed, using the Swedish Colorectal Cancer Registry. Primary outcome was cancer-specific survival, whereas overall and relative survival, locoregional and distant recurrence, and lymph node harvest were secondary outcomes, with high tie as exposure. We used propensity score matching to emulate a randomized controlled trial, and then performed Cox regression analyses to estimate hazard ratios (HRs) with confidence intervals (CIs).

    Results: Some 8287 patients remained for analysis, of which 37% had high tie surgery. After propensity score matching, the 5-year cancer-specific survival rate was overall 86% and we found no association between the level of tie and cancer-specific (HR 0.92, 95% CI 0.79–1.07) or overall (HR 0.98, 95% CI 0.89–1.08) survival, nor to locoregional (HR 0.85, 95% CI 0.59–1.23) or distant (HR 1.01, 95% CI 0.88–1.15) recurrence, nor to relative survival (HR 1.05, 95% CI 0.85–1.28). Stratification and sensitivity analyses were similarly insignificant, after adjustment for confounding. Total lymph node harvest was, however, increased after high tie surgery (P < 0.01), but no differences were seen regarding positive nodes (P = 0.72).

    Conclusion: In this nationwide cohort study, the level of tie did not influence any patient-oriented oncological outcome, neither overall nor in node-positive patients. This would allow the patient's anatomical configuration and the surgeon's preferences to determine the level of tie.

  • 20.
    Budtz-Lilly, Jacob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Aarhus Univ Hosp, Div Vasc Surg, Dept Cardiovasc Surg, Aarhus, Denmark..
    D'Oria, Mario
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Univ Hosp Trieste ASUGI, Div Vasc & Endovas Surg, Cardiovasc Dept, Trieste, Italy..
    Gallitto, Enrico
    Univ Bologna, IRCCS Univ Hosp Policlin S Orsola, Vasc Surg, DIMES, Bologna, Italy..
    Bertoglio, Luca
    Univ Vita Salute San Raffaele, Div Vasc Surg, IRCCS San Raffaele Inst, Milan, Italy..
    Koelbel, Tilo
    Univ Hosp Eppendorf, Dept Vasc Med, German Aort Ctr, Hamburg, Germany..
    Lindström, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Dias, Nuno
    Lund Univ, Skane Univ Hosp, Dept Thorac Surg & Vasc Dis, Vasc Ctr Malmö, Malmö, Sweden.;Lund Univ, Dept Clin Sci Malmö, Malmö, Sweden..
    Lundberg, Goran
    Karolinska Inst, Karolinska Univ Hosp, Dept Mol Med & Surg, Dept Vasc Surg, Stockholm, Sweden..
    Boeckler, Dittmar
    Univ Hosp Heidelberg, Dept Vasc & Endovasc Surg, Heidelberg, Germany..
    Parlani, Gianbattista
    Univ Perugia, Hosp S M Misericordia, Unit Vasc & Endovasc Surg, Perugia, Italy..
    Antonello, Michele
    Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Vasc & Endovasc Surg Sect, Padua, Italy..
    Veraldi, Gian F.
    Univ Hosp & Trust Verona, Dept Vasc Surg, Verona, Italy..
    Tsilimparis, Nikolaos
    Ludwig Maximilian Univ Hosp, Dept Vasc Surg, Munich, Germany..
    Kotelis, Drosos
    Univ Hosp RWTH Aachen, Dept Vasc Surg, Aachen, Germany.;Bern Univ Hosp, Dept Vasc Surg, Bern, Switzerland..
    Dueppers, Philip
    Zurich Univ Hosp, Dept Vasc Surg, Zurich, Switzerland..
    Tinelli, Giovanni
    Univ Cattolica Sacro Cuore, Unit Vasc Surg, Fdn Policlin Univ Gemelli IRCCS, Rome, Italy..
    Ippoliti, Arnaldo
    Tor Vergata Univ, Dept Biomed & Prevent, Vasc Surg Unit, Rome, Italy..
    Spath, Paolo
    Logiacco, Antonino
    Schurink, Geert Willem H.
    Maastricht Heart & Vasc Ctr, Div Vasc Surg, Maastricht, Netherlands..
    Chiesa, Roberto
    Univ Vita Salute San Raffaele, Div Vasc Surg, IRCCS San Raffaele Inst, Milan, Italy..
    Grandi, Alessandro
    Univ Vita Salute San Raffaele, Div Vasc Surg, IRCCS San Raffaele Inst, Milan, Italy..
    Panuccio, Giuseppe
    Univ Hosp Eppendorf, Dept Vasc Med, German Aort Ctr, Hamburg, Germany..
    Rohlffs, Fiona
    Univ Hosp Eppendorf, Dept Vasc Med, German Aort Ctr, Hamburg, Germany..
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Karelis, Angelos
    Lund Univ, Skane Univ Hosp, Dept Thorac Surg & Vasc Dis, Vasc Ctr Malmö, Malmö, Sweden..
    Sonesson, Bjorn
    Lund Univ, Skane Univ Hosp, Dept Thorac Surg & Vasc Dis, Vasc Ctr Malmö, Malmö, Sweden..
    Jonsson, Magnus
    Karolinska Inst, Karolinska Univ Hosp, Dept Mol Med & Surg, Dept Vasc Surg, Stockholm, Sweden..
    Bresler, Alina-Marilena
    Univ Hosp Heidelberg, Dept Vasc & Endovasc Surg, Heidelberg, Germany..
    Simonte, Gioele
    Univ Perugia, Hosp S M Misericordia, Unit Vasc & Endovasc Surg, Perugia, Italy..
    Isernia, Giacomo
    Univ Perugia, Hosp S M Misericordia, Unit Vasc & Endovasc Surg, Perugia, Italy..
    Xodo, Andrea
    Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Vasc & Endovasc Surg Sect, Padua, Italy..
    Mezzetto, Luca
    Univ Hosp & Trust Verona, Dept Vasc Surg, Verona, Italy..
    Mastrorilli, Davide
    Univ Hosp & Trust Verona, Dept Vasc Surg, Verona, Italy..
    Prendes, Carlota F.
    Ludwig Maximilian Univ Hosp, Dept Vasc Surg, Munich, Germany..
    Chaikhouni, Basel
    Univ Hosp RWTH Aachen, Dept Vasc Surg, Aachen, Germany.;Bern Univ Hosp, Dept Vasc Surg, Bern, Switzerland..
    Zimmermann, Alexander
    Zurich Univ Hosp, Dept Vasc Surg, Zurich, Switzerland..
    Lepidi, Sandro
    Univ Hosp Trieste ASUGI, Div Vasc & Endovas Surg, Cardiovasc Dept, Trieste, Italy..
    Gargiulo, Mauro
    Univ Bologna, IRCCS Univ Hosp Policlin S Orsola, Vasc Surg, DIMES, Bologna, Italy..
    Mees, Barend
    Maastricht Heart & Vasc Ctr, Div Vasc Surg, Maastricht, Netherlands..
    Unosson, Jon
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair The EU-FBENDO-FAIL Registry2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 278, no 2, p. E389-E395Article in journal (Refereed)
    Abstract [en]

    Objective:To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR).

    Methods:Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm.

    Background:Treatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes.

    Results:There were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4-12) years, 5 (3-8) for pEVAR, and 10 (6-14) for pOAR, P<0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P=0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P=0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P=0.03. Five-year estimates for freedom from type I/III endoleaks were similar between groups; freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), P=0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%).

    Conclusions:Repair of a failed pEVAR or pOARis safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.

  • 21.
    Cashin, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Graf, Wilhelm
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Mahteme, Haile
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Considerations on the Selection Process for Cytoreductive Surgery and Hyperthermic IntraPeritoneal Chemotherapy for Colorectal Carcinomatosis Reply2015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 262, no 2, p. e48-e49Article in journal (Refereed)
  • 22.
    Cashin, Peter H
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Graf, Wilhelm
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Mahteme, Haile
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Patient Selection for Cytoreductive Surgery in Colorectal Peritoneal Carcinomatosis using Serum Tumour Markers – an Observational Cohort Study2012In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 256, no 6, p. 1078-1083Article in journal (Refereed)
    Abstract [en]

    Objective: There were 2 objectives: first, to investigate how many patients were excluded from surgery on the basis of the radiological extent of the peritoneal carcinomatosis (PC) or the clinical examination; and second, to develop a score based primarily on serum tumor markers (STMs) that could predict short cancer-specific survival (<12 months). Background: Patient selection and prediction of prognosis is crucial for successful treatment of colorectal PC. Methods: All patients with colorectal PC referred for cytoreductive surgery and intraperitoneal chemotherapy (2005-2008) at Uppsala University hospital were included. Patients were divided into 2 groups-nonsurgery and surgery. Clinicopathological and laboratory parameters were collected in the surgery group. A Corep (COloREctal-Pc) score was developed using hazard ratios from histology, hematological status, serial serum tumor markers (STMs), and STM changes over time. Sensitivity, specificity, positive predicted value (PPV), and negative predicted value (NPV) were calculated in a second validating dataset (n = 24) with a survival cutoff of less than 12 months. Results: A total of 107 patients were included in the study, 42 in the nonsurgery group and 65 in the surgery group. In the nonsurgery group, 2 patients were excluded solely on the basis of the radiological extent of PC and 7 patients on clinical examination. The Corep score ranged from 0 to 18. A score of 6 or more showed a validated sensitivity of 80%, specificity 100%, PPV 1.0, and NPV 0.93. Conclusions: Radiological extent of PC was not a main deciding factor for treatment decisions and had less impact than the clinical examination. The Corep score identified patients with short cancer-specific survival that may not be suitable for treatment.

  • 23.
    Cavallaro, Paul
    et al.
    Massachusetts Gen Hosp, MA 02114 USA.
    Fearnhead, Nicola
    Cambridge Univ Hosp NHS Fdn Trust, England.
    Bissett, Ian
    Univ Auckland, New Zealand.
    Brar, Mantaj
    Univ Toronto, Canada.
    Cataldo, Thomas
    Harvard Med Sch, MA 02115 USA.
    Clarke, Rasheed
    Patient Advocate, Blogger.
    Denoya, Paula
    Stony Brook Univ Hosp, NY USA.
    Elder, Amber Lorraine
    Patient Advocate, Blogger.
    Gecse, Krisztina
    Univ Amsterdam, Netherlands.
    Hendren, Samantha
    Univ Michigan, MI 48109 USA.
    Holubar, Stefan
    Cleveland Clin, OH 44106 USA.
    Jeganathan, Nimalan
    Penn State Univ, PA USA.
    Myrelid, Pär
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Norton, Beth-Anne
    Brigham & Womens Hosp, MA 02115 USA.
    Wexner, Steven
    Cleveland Clin Florida, FL USA.
    Wilson, Lauren
    Dartmouth Hitchcock Med Ctr, NH 03766 USA.
    Zaghiyan, Karen
    Cedars Sinai Med Ctr, CA 90048 USA.
    Bordeianou, Liliana
    MGH Colorectal Surg Ctr, MA 02114 USA; Crohns & Colitis Ctr, MA 02114 USA.
    Patients Undergoing Ileoanal Pouch Surgery Experience a Constellation of Symptoms and Consequences Representing a Unique Syndrome: A Report From the Patient-Reported Outcomes After Pouch Surgery (PROPS) Delphi Consensus Study2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 1, p. 138-145Article in journal (Refereed)
    Abstract [en]

    Objective: The primary aim was to create a patient-centered definition of core symptoms that should be included in future studies of pouch function. Background: Functional outcomes after ileoanal pouch creation have been studied; however, there is great variability in how relevant outcomes are defined and reported. More importantly, the perspective of patients has not been represented in deciding which outcomes should be the focus of research. Methods: Expert stakeholders were chosen to correlate with the clinical scenario of the multidisciplinary team that cares for pouch patients: patients, colorectal surgeons, gastroenterologists/other clinicians. Three rounds of surveys were employed to select high-priority items. Survey voting was followed by a series of online patient consultation meetings used to clarify voting trends. A final online consensus meeting with representation from all 3 expert panels was held to finalize a consensus statement. Results: One hundred ninety-five patients, 62 colorectal surgeons, and 48 gastroenterologists/nurse specialists completed all 3 Delphi rounds. Fiftythree patients participated in online focus groups. One hundred sixty-one stakeholders participated in the final consensus meeting. On conclusion of the consensus meeting, 7 bowel symptoms and 7 consequences of undergoing ileoanal pouch surgery were included in the final consensus statement. Conclusions: This study is the first to identify key functional outcomes after pouch surgery with direct input from a large panel of ileoanal pouch patients. The inclusion of patients in all stages of the consensus process allowed for a true patient-centered approach in defining the core domains that should be focused on in future studies of pouch function.

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  • 24.
    Currie, Andrew
    et al.
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Burch, Jennifer
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Jenkins, John T.
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Faiz, Omar
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Kennedy, Robin H.
    Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Demartines, Nicolas
    CHUV Lausanne Surg, Lausanne, Switzerland.
    Hjern, Fredrik
    Danderyds Sjukhus, Danderyd, Sweden.
    Norderval, Stig
    University Hospital of North Norway, Tromsö, Norway.
    Lassen, Kristoffer
    University Hospital of North Norway, Tromsö, Norway.
    Revhaug, Andarthur
    University Hospital of North Norway, Tromsö, Norway.
    Koczkas, Tomas
    Östersunds Sjukhus, Östersund, Sweden.
    Nygren, Jonas
    Ersta Sjukhus, Stockholm, Sweden.
    Gustafsson, Ulf
    Ersta Sjukhus, Stockholm, Sweden.
    Kornfeld, Dan
    Kirurgkliniken St Göran, Stockholm, Sweden.
    Slim, Karem
    University Hospital, Clermont Ferrand, France.
    Hill, Andrew
    Middlemore Hospital, Auckland, New Zealand.
    Soop, Mattias
    North Shore Hospital, Auckland, New Zealand.
    Carlander, Johan
    Västerås Centrallasarett, Västerås, Sweden.
    Lundberg, Owe
    Kirurgkliniken Umeå, Umeå, Sweden.
    Fearon, Ken
    Western General Hospital, Edinburgh, United Kingdom.
    Kennedy, Robin
    St Marks Hospital, London, England..
    The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry2015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 6, p. 1153-1159Article in journal (Refereed)
    Abstract [en]

    Background: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.

    Objective: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.

    Methods: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.

    Findings: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR= 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).

    Conclusions: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.

  • 25.
    Dahlstrand, Ursula
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Sandblom, Gabriel
    CLINTEC, Karolinska Institutet.
    Nordin, Pär
    Insitutionen för kirurgisk och perioperativ vetenskap, Umeå Universitet.
    Wollert, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Gunnarsson, Ulf
    CLINTEC, Karolinska Institutet.
    Chronic Pain After Femoral Hernia Repair: A Cross-Sectional Study2011In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 254, no 6, p. 1017-1021Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To explore the prevalence of and to identify possible risk factors for chronic pain after surgery for femoral hernia.

    BACKGROUND:

    Chronic pain has become a very important outcome in quality assessment of inguinal hernia surgery. There are no studies on the risk for chronic pain after femoral hernia surgery.

    METHODS:

    The Inguinal Pain Questionnaire was sent to 1967 patients who had had a repair for primary unilateral femoral hernia between January 1, 1997 and December 31, 2006. A follow-up period of at least 18 months was chosen. Answers from 1461 patients were matched with data recorded in the Swedish Hernia Register and analyzed.

    RESULTS:

    Some degree of pain during the previous week was reported by 24.2% (354) of patients. Pain interfered with daily activities in 5.5% (81) of patients. Emergency surgery (OR = 0.54; 95% CI = 0.40-0.74) and longer time since surgery (OR = 0.93; 95% CI = 0.89-0.98 for each year added) were associated with lower risk for chronic postoperative pain, whereas a high level of preoperative pain was associated with a higher risk for chronic pain (OR = 1.17; 95% CI = 1.10-1.25). Surgical technique was not found to influence the risk for chronic pain in multivariate logistic regression analysis.

    CONCLUSIONS:

    Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. Further investigations into the role of preoperative pain are necessary.

  • 26. Dahlstrand, Ursula
    et al.
    Sandblom, Gabriel
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wollert, Staffan
    Gunnarsson, Ulf
    CLINTEC, Karolinska Institute, Stockholm, Sweden and Gastro Center Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Chronic pain after femoral hernia repair: a cross-sectional study2011In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 254, no 6, p. 1017-1021Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the prevalence of and to identify possible risk factors for chronic pain after surgery for femoral hernia.

    Background: Chronic pain has become a very important outcome in quality assessment of inguinal hernia surgery. There are no studies on the risk for chronic pain after femoral hernia surgery. Methods: The Inguinal Pain Questionnaire was sent to 1967 patients who had had a repair for primary unilateral femoral hernia between January 1, 1997 and December 31, 2006. A follow-up period of at least 18 months was chosen. Answers from 1461 patients were matched with data recorded in the Swedish Hernia Register and analyzed.

    Results: Some degree of pain during the previous week was reported by 24.2% (354) of patients. Pain interfered with daily activities in 5.5% (81) of patients. Emergency surgery (OR = 0.54; 95% CI = 0.40-0.74) and longer time since surgery (OR = 0.93; 95% CI = 0.89-0.98 for each year added) were associated with lower risk for chronic postoperative pain, whereas a high level of preoperative pain was associated with a higher risk for chronic pain (OR = 1.17; 95% CI = 1.10-1.25). Surgical technique was not found to influence the risk for chronic pain in multivariate logistic regression analysis.

    Conclusions: Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. Further investigations into the role of preoperative pain are necessary.

  • 27.
    Dahlstrand, Ursula
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wollert, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Nordin, Pär
    Sandblom, Gabriel
    Gunnarsson, Ulf
    Emergency Femoral Hernia Repair A Study Based on a National Register2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 4, p. 672-676Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. Background: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. Methods: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. Results: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. Conclusions: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operate with high priority to avoid incarceration and be repaired with a mesh.

  • 28.
    Dahlstrand, Ursula
    et al.
    Department of Surgery, Uppsala University, Uppsala University Hospital, 75185 Uppsala, Sweden.
    Wollert, Staffan
    Department of Surgery, Uppsala University, Uppsala, Sweden.
    Nordin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sandblom, Gabriel
    Division of Surgery, CLINTEC, Karolinska University Hospital Huddinge and Karolinska Institute, Stockholm, Sweden.
    Gunnarsson, Ulf
    Division of Surgery, CLINTEC, Karolinska University Hospital Huddinge and Karolinska Institute, Stockholm, Sweden.
    Emergency femoral hernia repair: a study based on a national register.2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 4, p. 672-676Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. BACKGROUND: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. METHODS: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. RESULTS: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. CONCLUSIONS: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.

  • 29. De Waele, Jan J.
    et al.
    Cheatham, Michael L.
    Balogh, Zsolt
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    D'Amours, Scott
    De Keulenaer, Bart
    Ivatury, Rao
    Kirkpatrick, Andrew W
    Leppaniemi, Ari
    Malbrain, Manu
    Sugrue, Michael
    Intra-abdominal pressure measurement using a U-tube technique: caveat emptor!2010In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 252, no 5, p. 890; author reply 890-891Article in journal (Refereed)
  • 30.
    Dias-Neto, Marina
    et al.
    Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA..
    Vacirca, Andrea
    Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA..
    Huang, Ying
    Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA..
    Baghbani-Oskouei, Aidin
    Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA..
    Jakimowicz, Tomasz
    Med Univ Warsaw, Warsaw, Poland..
    Mendes, Bernardo C.
    Mayo Clin, Div Vasc & Endovasc Surg, Rochester, MN USA..
    Kolbel, Tilo
    Univ Med Ctr Eppendorf UKE, Hamburg, Germany..
    Sobocinski, Jonathan
    Univ Lille, CHU Lille, Aort Ctr, Vasc Surg, Lille, France.;Univ Lille, CHU Lille, INSERM U1008, Lille, France..
    Bertoglio, Luca
    Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Dept Vasc Surg, Milan, Italy.;Univ & ASST Spedali Civili Hosp Brescia, Dept Sperimental & Clin Sci DSCS, Brescia, Italy..
    Mees, Barend
    Maastricht Univ, Med Ctr, Dept Vasc Surg, Maastricht, Netherlands..
    Gargiulo, Mauro
    Univ Bologna, Vasc Surg, DIMEC, Bologna, Italy.;IRCCS Univ Hosp Policlin S Orsola, Vasc Surg Unit, Bologna, Italy..
    Dias, Nuno
    Skane Univ Hosp, Vasc Ctr, Dept Thorac Surg & Vasc Dis, Malmö, Sweden.;Lund Univ, Dept Clin Sci, Malmö, Sweden..
    Schanzer, Andres
    Univ Massachusetts, Med Sch, Worcester, MA USA..
    Gasper, Warren
    Univ Calif San Francisco, San Francisco, CA USA..
    Beck, Adam W.
    Univ Alabama Birmingham, Birmingham, AL USA..
    Farber, Mark A.
    Univ N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA..
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Timaran, Carlos
    Univ Texas Southwestern, Clin Heart & Vasc Ctr, Dallas, TX USA..
    Schneider, Darren B.
    Univ Penn, Perelman Sch Med, Div Vasc Surg & Endovasc Therapy, Philadelphia, PA USA..
    Pedro, Luis Mendes
    Ctr Hosp Univ Lisboa Norte, Dept Vasc Surg, Lisbon, Portugal.;Univ Lisbon, Fac Med, Lisbon, Portugal.;Univ Lisboa CCULRISE, Ctr Cardiovasc, Lisbon, Portugal..
    Tsilimparis, Nikolaos
    Ludwig Maximilians Univ Hosp, Dept Vasc Surg, Munich, Germany..
    Haulon, Stephan
    Univ Paris Saclay, Hop Marie Lannelongue, Aort Ctr, Grp Hosp Paris St Joseph, Paris, France..
    Sweet, Matthew P.
    Univ Washington, Dept Surg, Div Vasc Surg, Seattle, WA USA..
    Ferreira, Emilia
    Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Dept Angiol & Vasc Surg, Lisbon, Portugal..
    Eagleton, Matthew
    Harvard Med Sch, Massachusetts Gen Hosp, Div Vasc & Endovasc Surg, Boston, MA USA..
    Yeung, Kak Khee
    Amsterdam UMC, VU Med Ctr, Amsterdam Cardiovasc Sci, Dept Vasc Surg, Amsterdam, Netherlands..
    Khashram, Manar
    Waikato Hosp, Dept Vasc Surg, Hamilton, New Zealand.;Univ Auckland, Dept Surg, Auckland, New Zealand..
    Jama, Katarzyna
    Med Univ Warsaw, Warsaw, Poland..
    Panuccio, Giuseppe
    Univ Med Ctr Eppendorf UKE, Hamburg, Germany..
    Rohlffs, Fiona
    Univ Med Ctr Eppendorf UKE, Hamburg, Germany..
    Mesnard, Thomas
    Univ Lille, CHU Lille, Aort Ctr, Vasc Surg, Lille, France.;Univ Lille, CHU Lille, INSERM U1008, Lille, France..
    Chiesa, Roberto
    Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Dept Vasc Surg, Milan, Italy.;Univ & ASST Spedali Civili Hosp Brescia, Dept Sperimental & Clin Sci DSCS, Brescia, Italy..
    Kahlberg, Andrea
    Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Dept Vasc Surg, Milan, Italy.;Univ & ASST Spedali Civili Hosp Brescia, Dept Sperimental & Clin Sci DSCS, Brescia, Italy..
    Schurink, Geert Willem
    Maastricht Univ, Med Ctr, Dept Vasc Surg, Maastricht, Netherlands..
    Lemmens, Charlotte
    Maastricht Univ, Med Ctr, Dept Vasc Surg, Maastricht, Netherlands..
    Gallitto, Enrico
    Univ Bologna, Vasc Surg, DIMEC, Bologna, Italy.;IRCCS Univ Hosp Policlin S Orsola, Vasc Surg Unit, Bologna, Italy..
    Faggioli, Gianluca
    Univ Bologna, Vasc Surg, DIMEC, Bologna, Italy.;IRCCS Univ Hosp Policlin S Orsola, Vasc Surg Unit, Bologna, Italy..
    Karelis, Angelos
    Skane Univ Hosp, Vasc Ctr, Dept Thorac Surg & Vasc Dis, Malmö, Sweden.;Lund Univ, Dept Clin Sci, Malmö, Sweden..
    Parodi, Ezequiel
    Univ N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA..
    Gomes, Vivian
    Univ N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA..
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Habib, Mohammed
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Colon, Jesus Porras
    Univ Texas Southwestern, Clin Heart & Vasc Ctr, Dallas, TX USA..
    Pavarino, Felipe
    Univ Texas Southwestern, Clin Heart & Vasc Ctr, Dallas, TX USA..
    Baig, Mirza S.
    Univ Texas Southwestern, Clin Heart & Vasc Ctr, Dallas, TX USA..
    Melo, Ryan Eduardo Costeloe De
    Ctr Hosp Univ Lisboa Norte, Dept Vasc Surg, Lisbon, Portugal.;Univ Lisbon, Fac Med, Lisbon, Portugal.;Univ Lisboa CCULRISE, Ctr Cardiovasc, Lisbon, Portugal.;Ludwig Maximilians Univ Hosp, Dept Vasc Surg, Munich, Germany..
    Crawford, Sean
    Univ Paris Saclay, Hop Marie Lannelongue, Aort Ctr, Grp Hosp Paris St Joseph, Paris, France..
    Zettervall, Sara L.
    Univ Washington, Dept Surg, Div Vasc Surg, Seattle, WA USA..
    Garcia, Rita
    Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Dept Angiol & Vasc Surg, Lisbon, Portugal..
    Ribeiro, Tiago
    Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Dept Angiol & Vasc Surg, Lisbon, Portugal..
    Alves, Goncalo
    Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Dept Angiol & Vasc Surg, Lisbon, Portugal..
    Goncalves, Frederico Bastos
    Ctr Hosp Univ Lisboa Cent, Hosp Santa Marta, Dept Angiol & Vasc Surg, Lisbon, Portugal..
    Kappe, Kaj Olav
    Amsterdam UMC, VU Med Ctr, Amsterdam Cardiovasc Sci, Dept Vasc Surg, Amsterdam, Netherlands..
    Mariko van Knippenberg, Samira Elize
    Amsterdam UMC, VU Med Ctr, Amsterdam Cardiovasc Sci, Dept Vasc Surg, Amsterdam, Netherlands..
    Tran, Bich Lan
    Amsterdam UMC, VU Med Ctr, Amsterdam Cardiovasc Sci, Dept Vasc Surg, Amsterdam, Netherlands..
    Gormley, Sinead
    Waikato Hosp, Dept Vasc Surg, Hamilton, New Zealand.;Univ Auckland, Dept Surg, Auckland, New Zealand..
    Oderich, Gustavo S.
    Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Adv Aort Res Program, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA..
    Grp, Int Multictr Aort Res
    Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 278, no 4, p. 568-577Article in journal (Refereed)
    Abstract [en]

    Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs).

    Background: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described.

    Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair.

    Results: A total of 2603 patients (69% males; mean age 72 +/- 10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P < 0.001) and rates of MAEs (34% vs 20%, P < 0.001). Median follow-up was 15 months ( interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50 +/- 4% vs 70 +/- 1% and 21 +/- 3% vs 7 +/- 1%, P < 0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality ( hazard ratio, 1.92; 95% CI] 1.50-2.44; P < 0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P < 0.001).

    Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

  • 31.
    Dijkstra, Esmee A.
    et al.
    Univ Groningen, Univ Med Ctr Groningen, Dept Med Oncol, Groningen, Netherlands..
    Nilsson, Per J.
    Karolinska Univ Hosp, Dept Surg, Stockholm, Sweden..
    Hospers, Geke A. P.
    Univ Groningen, Univ Med Ctr Groningen, Dept Med Oncol, Groningen, Netherlands..
    Bahadoer, Renu R.
    Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands..
    Meershoek-Klein Kranenbarg, Elma
    Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands..
    Roodvoets, Annet G. H.
    Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands..
    Putter, Hein
    Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands..
    Berglund, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Cervantes, Andres
    Univ Valencia, Biomed Res Inst Incl, Dept Med Oncol, Valencia, Spain..
    Crolla, Rogier M. P. H.
    Amphia Hosp, Dept Surg, Breda, Netherlands..
    Hendriks, Mathijs P.
    Northwest Clin, Dept Med Oncol, Alkmaar, Netherlands..
    Capdevila, Jaume
    Autonomous Univ Barcelona UAB, Vall Hebron Univ Hosp, Vall Hebron Inst Oncol VHIO, Dept Med Oncol, Barcelona, Spain..
    Edhemovic, Ibrahim
    Inst Oncol Ljubljana, Dept Surg Oncol, Ljubljana, Slovenia..
    Marijnen, Corrie A. M.
    Netherlands Canc Inst, Dept Radiat Oncol, Amsterdam, Netherlands.;Leiden Univ, Med Ctr, Dept Radiat Oncol, Leiden, Netherlands..
    van de Velde, Cornelis J. H.
    Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands..
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    van Etten, Boudewijn
    Univ Groningen, Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands..
    Locoregional Failure During and After Short-course Radiotherapy Followed by Chemotherapy and Surgery Compared With Long-course Chemoradiotherapy and Surgery2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 278, no 4, p. E766-E772Article in journal (Refereed)
    Abstract [en]

    Objective:To analyze risk and patterns of locoregional failure (LRF) in patients of the RAPIDO trial at 5 years.Background:Multimodality treatment improves local control in rectal cancer. Total neoadjuvant treatment (TNT) aims to improve systemic control while local control is maintained. At 3 years, LRF rate was comparable between TNT and chemoradiotherapy in the RAPIDO trial.

    Methods:A total of 920 patients were randomized between an experimental (EXP, short-course radiotherapy, chemotherapy, and surgery) and a standard-care group (STD, chemoradiotherapy, surgery, and optional postoperative chemotherapy). LRFs, including early LRF (no resection except for organ preservation/R2 resection) and locoregional recurrence (LRR) after an R0/R1 resection, were analyzed.

    Results:Totally, 460 EXP and 446 STD patients were eligible. At 5.6 years (median follow-up), LRF was detected in 54/460 (12%) and 36/446 (8%) patients in the EXP and STD groups, respectively (P=0.07), in which EXP patients were more often treated with 3-dimensional-conformed radiotherapy (P=0.029). In the EXP group, LRR was detected more often [44/431 (10%) vs. 26/428 (6%); P=0.027], with more often a breached mesorectum (9/44 (21%) vs. 1/26 (4); P=0.048). The EXP treatment, enlarged lateral lymph nodes, positive circumferential resection margin, tumor deposits, and node positivity at pathology were the significant predictors for developing LRR. Location of the LRRs was similar between groups. Overall survival after LRF was comparable [hazard ratio: 0.76 (95% CI, 0.46-1.26); P=0.29].

    Conclusions:The EXP treatment was associated with an increased risk of LRR, whereas the reduction in disease-related treatment failure and distant metastases remained after 5 years. Further refinement of the TNT in rectal cancer is mandated.

  • 32.
    D'Oria, Mario
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Gunnarsson, Kim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Long-term survival after repair of ruptured abdominal aortic aneurysms is improving over time: Nationwide analysis during twenty-four years in Sweden (1994-2017)2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. 670-677Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate long-term survival after ruptured abdominal aortic aneurysms (rAAA) repair in Sweden during twenty-four years (1994-2017).

    Summary Background Data: Management of rAAA has seen significant changes in the past decades, with the shifting from open (OAR) to endovascular (EVAR) being the most striking, thereby enabling treatment of elderly patients with multiple comorbidities.

    Methods: A registry-based nationwide cohort study was performed, and three 8-year periods (1994-2001, 2002-2009, 2010-2017) were compared for crude long-term survival with Kaplan-Meier and multivariable Cox proportional hazards analyses. Relative survival compared to matched general population referents was estimated.

    Results: Overall, 8,928 rAAA repair subjects were identified (1994-2001 N=3,368; 2002-2009 N=3,405; 2010-2017 N=2,155). The proportion of octogenarians (20.6%; 27.5%; 34.0%; p<.001), women (14.3%; 18.5%; 20.6%; p<.001), and EVAR procedures (1.5%; 14.9%; 35.5%; P<.001) increased over time. The crude 5-year survival was 36%; 44%; 43% (p<.0001). Multivariable Cox proportional hazard analysis displayed a decreasing mortality hazard ratio (HR) over time (1.00; 0.80; 0.72; p<.001). Use of EVAR was associated with reduced hazards of crude long-term mortality (HR=0.80, P<.001). Relative survival for patients surviving the perioperative period (i.e. 90 days) was lower than matched general population referents, and was stable over time (relative 5-year survival: 86% vs 88% , vs 86% p<.001).

    Conclusions: Nationwide analysis of long-term outcomes after repair of rAAA in Sweden during 24 years (1994-2017) has revealed that, despite changes in the baseline population characteristics as well as in the treatment strategy, long-term survival improved over time. 

  • 33.
    D'Oria, Mario
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste Medical School, Trieste, Italy.
    Scali, Salvatore
    Mao, Jialin
    Szeberin, Zoltán
    Thomson, Ian
    Beiles, Barry
    Stone, David
    Sedrakyan, Art
    Eldrup, Nikolaj
    Venermo, Maarit
    Cassar, Kevin
    Altreuther, Martin
    Boyle, Jonathan R
    Behrendt, Christian-Alexander
    Beck, Adam W
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Association Between Hospital Volume and Failure to Rescue After Open or Endovascular Repair of Intact Abdominal Aortic Aneurysms in the VASCUNET and International Consortium of Vascular Registries2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 5, p. 452-459Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between hospital volume and failure to rescue (FtR), after open repair (OAR), and endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries.

    Summary of Background Data: FtR (ie, in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death.

    Methods: Using data from 8 vascular registries, complication and mortality rates after intact AAA repair were examined (n = 60,273; EVAR-43,668; OAR-16,605). A restricted analysis using pooled data from 4 countries (Australia, Hungary, New Zealand, and USA) reporting data on all postoperative complications (bleeding, stroke, cardiac, respiratory, renal, colonic ischemia) was performed to identify risk-adjusted association between hospital volume and FtR.

    Results: The most frequently reported complications were cardiac (EVAR-3.0%, OAR-8.9%) and respiratory (EVAR-1.0%, OAR-5.7%). In adjusted analysis, 4.3% of EVARs and 18.5% of OARs had at least 1 complication. The overall FtR rate was 10.3% after EVAR and 15.7% after OAR. Subjects treated in the highest volume centers (Q4) had 46% and 80% lower odds of FtR after EVAR (OR = 0.54; 95% CI = 0.34-0.87; P = 0.04) and OAR (OR = 0.22; 95% CI = 0.11-0.44; P < 0.001) when compared to lowest volume centers (Q1), respectively. Colonic ischemia had the highest risk of FtR for both procedures (adjusted predicted risks, EVAR: 27%, 95% CI 14%-45%; OAR: 30%, 95% CI 17%-46%).

    Conclusions: In this multi-national dataset, FtR rate after intact AAA repair with EVAR and OAR is significantly associated with hospital volume. Hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred.

  • 34.
    D'Souza, Nigel
    et al.
    Croydon Univ Hosp, London, England;Royal Marsden NHS Fdn Trust, London, England;Imperial Coll, London, England.
    Babberich, Michael P. M. de Neree Tot
    Univ Amsterdam, Med Ctr, Amsterdam, Netherlands.
    d'Hoore, Andre
    Univ Clin Leuven, Leuven, Belgium.
    Tiret, Emmanuel
    Hosp St Antoine, Paris, France.
    Xynos, Evaghelos
    Interclin Hosp Heraklion, Iraklion, Greece.
    Beets-Tan, Regina G. H.
    Netherlands Canc Inst, Amsterdam, Netherlands.
    Nagtegaal, Iris D.
    Radboud Med Ctr, Nijmegen, Netherlands.
    Blomqvist, Lennart
    Karolinska Univ Hosp, Stockholm, Sweden.
    Holm, Torbjorn
    Karolinska Univ Hosp, Stockholm, Sweden.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Lacy, Antonio
    Hosp Clin Barcelona, Barcelona, Spain.
    Cervantes, Andres
    Univ Valencia, CIBERONC, Biomed Res Inst INCLIVA, Valencia, Spain.
    Glynne-Jones, Robert
    Mt Vernon Hosp, London, England.
    West, Nicholas P.
    Univ Leeds, Leeds, W Yorkshire, England.
    Perez, Rodrigo O.
    Univ Sao Paulo, Sch Med, Sao Paulo, SP, Brazil.
    Quadros, Claudio
    Aristides Maltez Hosp, Salvador, BA, Brazil.
    Lee, Kil Yeon
    Kyung Hee Univ, Med Ctr, Seoul, South Korea.
    Madiba, Thandinkosi E.
    Univ KwaZulu Natal, Durban, South Africa.
    Wexner, Steven D.
    Cleveland Clin Florida, Weston, FL USA.
    Garcia-Aguilar, Julio
    Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA.
    Sahani, Dushyant
    Massachusetts Gen Hosp, Boston, MA 02114 USA.
    Moran, Brendan
    Basingstoke Hosp, Basingstoke, Hants, England.
    Tekkis, Paris
    Royal Marsden NHS Fdn Trust, London, England;Imperial Coll, London, England.
    Rutten, Harm J.
    Catherina Ziekenhuis, Eindhoven, Netherlands;Maastricht Univ, GROW Sch Dev Biol & Oncol, Maastricht, Netherlands.
    Tanis, Pieter J.
    Univ Amsterdam, Med Ctr, Amsterdam, Netherlands.
    Wiggers, Theo
    Univ Med Ctr Groningen, Groningen, Netherlands.
    Brown, Gina
    Royal Marsden NHS Fdn Trust, London, England;Imperial Coll, London, England.
    Definition of the Rectum An International, Expert-based Delphi Consensus2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 270, no 6, p. 955-959Article in journal (Refereed)
    Abstract [en]

    Background: The wide global variation in the definition of the rectum has led to significant inconsistencies in trial recruitment, clinical management, and outcomes. Surgical technique and use of preoperative treatment for a cancer of the rectum and sigmoid colon are radically different and dependent on the local definitions employed by the clinical team. A consensus definition of the rectum is needed to standardise treatment. Methods: The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018. Results: Eleven different definitions for the rectum were used by participants in the consensus. Magnetic resonance imaging (MRI) was the most frequent modality used to define the rectum (67%), and the preferred modality for 72% of participants. The most agreed consensus landmark (56%) was "the sigmoid take-off,'' an anatomic, image-based definition of the junction of the mesorectum and mesocolon. In the second round, 81% of participants agreed that the sigmoid take-off as seen on computed tomography or MRI achieved consensus, and that it could be implemented in their institution. Also, 87% were satisfied with the sigmoid take-off as the consensus landmark. Conclusion: An international consensus definition for the rectumis the point of the sigmoid take-off as visualized on imaging. The sigmoid take-off can be identified as the mesocolon elongates as the ventral and horizontal course of the sigmoid on axial and sagittal views respectively on cross-sectional imaging. Routine application of this landmark during multidisciplinary team discussion for all patients will enable greater consistency in tumour localisation.

  • 35. Dueland, Svein
    et al.
    Guren, Tormod K.
    Hagness, Morten
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Line, Pal-Dag
    Pfeiffer, Per
    Foss, Aksel
    Tveit, Kjell M.
    Chemotherapy or Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer?2015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 5, p. 956-960Article in journal (Refereed)
    Abstract [en]

    Objective: The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy. Background: CRC is the third most common cancer worldwide. About 50% of patients will develop metastatic disease primarily to the liver and the lung. The majority of patients with liver metastases receive palliative chemotherapy, with a median OS of trial patients of about 2 years, and less than 10% are alive at 5 years. Methods: Patients with nonresectable liver-only CRC metastases underwent liver transplantation in the SECA study (n = 21). Disease-free survival (DFS) and OS of patients included in the SECA study were compared with progression-free survival (PFS) and OS in a similar cohort of CRC patients with liver-only disease included in a first-line chemotherapy study, the NORDIC VII study (n = 47). PFS/DFS and OS were estimated by the Kaplan-Meier method. Results: DFS/PFS in both groups were 8 to 10 months. However, a dramatic difference in OS was observed. The 5-year OS rate was 56% in patients undergoing liver transplantation compared with 9% in patients starting first-line chemotherapy. The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed in the chemotherapy group. Conclusions: Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases.

  • 36.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rudberg, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Montgomery, Agneta
    Rasmussen, Ib
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sandbu, Rune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Low Recurrence Rate After Laparoscopic (TEP) and Open (Lichtenstein) Inguinal Hernia Repair A Randomized, Multicenter Trial With 5-year Follow-up Reply2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 250, no 2, p. 355-355Article in journal (Refereed)
    Abstract
  • 37.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rudberg, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Montgomery, Agneta
    Rasmussen, Ib
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sandbue, Rune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Laparoscopic Versus Open Mesh Repair for Inguinal Hernia Reply2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 250, no 2, p. 354-354Article in journal (Refereed)
    Abstract
  • 38.
    Eklund, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Montgomery, Agneta K.
    Rasmussen, Ib C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sandbue, Rune P.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Bergkvist, Leif A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Rudberg, Claes R.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Low Recurrence Rate After Laparoscopic (TEP) and Open(Lichtenstein) Inguinal Hernia RepairA Randomized, Multicenter Trial With 5-Year Follow-Up2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 1, p. 33-38Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare a laparoscopic (totally extraperitoneal patch (TEP)) and an open technique (Lichtenstein) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence.

    Summary Background Data: Laparoscopic hernia repair has been introduced as an alternative to open repair. Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques; ie, less postoperative pain and a shorter convalescence period. Long-term results, however, are less well known.

    Methods: The study was conducted as a multicenter randomized trial with a 5-year follow-up. A total of 1512 men aged 30 to 70 years, with a primary unilateral inguinal hernia, were randomized to either TEP or Lichtenstein repair.

    Results: Overall, 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable. The cumulative recurrence rate was 3.5% in the TEP group and 1.2% in the Lichtenstein group (P = 0.008). Test for heterogeneity revealed significant differences between individual surgeons. The exclusion of 1 surgeon, who was responsible for 33% (7 of 21) of all recurrences in the TEP group, lowered the cumulative recurrence rate to 2.4% in this group, which was not statistically different from that of the Lichtenstein group.

    Conclusions: The recurrence rate for both TEP and Lichtenstein repair was low. A higher cumulative recurrence rate in the TEP group was seen at 5 years. Further analysis revealed that this could be attributable to incorrect surgical technique.

  • 39. Elliott, Jessie A
    et al.
    Markar, Sheraz R
    Klevebro, Fredrik
    Johar, Asif
    Goense, Lucas
    Lagergren, Pernilla
    Zaninotto, Giovanni
    van Hillegersberg, Richard
    van Berge Henegouwen, Mark I
    Nilsson, Magnus
    Hanna, George B
    Reynolds, John V
    An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE).2022In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the impact of surveillance on recurrence pattern, treatment, survival and health-related quality-of-life (HRQL) following curative-intent resection for esophageal cancer.

    SUMMARY BACKGROUND DATA: Although therapies for recurrent esophageal cancer may impact survival and HRQL, surveillance protocols after primary curative treatment are varied and inconsistent, reflecting a lack of evidence.

    METHODS: European iNvestigation of SUrveillance after Resection for Esophageal cancer was an international multicenter study of consecutive patients undergoing surgery for esophageal and esophagogastric junction cancers (2009-2015) across 20 centers (NCT03461341). Intensive surveillance (IS) was defined as annual computed tomography for 3 years postoperatively. The primary outcome measure was overall survival (OS), secondary outcomes included treatment, disease-specific survival, recurrence pattern, and HRQL. Multivariable linear, logistic, and Cox proportional hazards regression analyses were performed.

    RESULTS: Four thousand six hundred eighty-two patients were studied (72.6% adenocarcinoma, 69.1% neoadjuvant therapy, 45.5% IS). At median followup 60 months, 47.5% developed recurrence, oligometastatic in 39%. IS was associated with reduced symptomatic recurrence (OR 0.17 [0.12-0.25]) and increased tumor-directed therapy (OR 2.09 [1.58-2.77]). After adjusting for confounders, no OS benefit was observed among all patients (HR 1.01 [0.89-1.13]), but OS was improved following IS for those who underwent surgery alone (HR 0.60 [0.47-0.78]) and those with lower pathological (y)pT stages (Tis-2, HR 0.72 [0.58-0.89]). IS was associated with greater anxiety ( P =0.016), but similar overall HRQL.

    CONCLUSIONS: IS was associated with improved oncologic outcome in select cohorts, specifically patients with early-stage disease at presentation or favorable pathological stage post neoadjuvant therapy. This may inform guideline development, and enhance shared decision-making, at a time when therapeutic options for recurrence are expanding.

  • 40. ERAS, Compliance Group
    The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection: Results From an International Registry2015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 6, p. 1153-1159Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.

    OBJECTIVE: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.

    METHODS: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.

    FINDINGS: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR = 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).

    CONCLUSIONS: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.

  • 41.
    Essén, Pia
    et al.
    Depts. of Anesth. and Intensive Care, Huddinge University Hospital, Stockholm, Sweden; Depts. of Anesth. and Intensive Care, Karolinska Institute, Stockholm, Sweden.
    Thorell, Anders
    Department of Surgery, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
    McNurlan, Margaret A.
    Rowett Research Institute, Aberdeen, United Kingdom.
    Anderson, Susan
    Rowett Research Institute, Aberdeen, United Kingdom.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
    Wernerman, Jan
    Depts. of Anesth. and Intensive Care, Huddinge University Hospital, Stockholm, Sweden; Depts. of Anesth. and Intensive Care, Karolinska Institute, Stockholm, Sweden.
    Garlick, Peter J.
    Department of Surgery, State University of New York, Stony Brook NY, United States.
    Laparoscopic cholecystectomy does not prevent the postoperative protein catabolic response in muscle1995In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 222, no 1, p. 36-42Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The authors determined the effect of laparoscopic cholecystectomy on protein synthesis in skeletal muscle. In addition to a decrease in muscle protein synthesis, after open cholecystectomy, the authors previously demonstrated a decrease in insulin sensitivity. This study on patients undergoing laparoscopic and open surgery, therefore, included simultaneous measurements of protein synthesis and insulin sensitivity.

    SUMMARY BACKGROUND DATA:

    Laparoscopy has become a routine technique for several operations because of postoperative benefits that allow rapid recovery. However, its effect on postoperative protein catabolism has not been characterized. Conventional laparotomy induces a drop in muscle protein synthesis, whereas degradation is unaffected.

    METHODS:

    Patients were randomized to laparoscopic or open cholecystectomy, and the rate of protein synthesis in skeletal muscle was determined 24 hours postoperatively by the flooding technique using L-(2H5)phenylalanine, during a hyperinsulinemic normoglycemic clamp to assess insulin sensitivity.

    RESULTS:

    The protein synthesis rate decreased by 28% (1.77 +/- 0.11%/day vs. 1.26 +/- 0.08%/day, p < 0.01) in the laparoscopic group and by 20% (1.97 +/- 0.15%/day vs. 1.57 +/- 0.15%/day, p < 0.01) in the open cholecystectomy group. In contrast, the fall in insulin sensitivity after surgery was lower with laparoscopic (22 +/- 2%) compared with open surgery (49 +/- 5%).

    CONCLUSIONS:

    Laparoscopic cholecystectomy did not avoid a substantial decline in muscle protein synthesis, despite improved insulin sensitivity. The change in the two parameters occurred independently, indicating different mechanisms controlling insulin sensitivity and muscle protein synthesis.

  • 42.
    Franklin, Oskar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Jonsson, Pär
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Billing, Ola
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lundberg, Erik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Öhlund, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nyström, Hanna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lundin, Christina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Antti, Henrik
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Plasma micro-RNA alterations appear late in pancreatic cancer2018In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 267, no 4, p. 775-781Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this research was to study whether plasma microRNAs (miRNA) can be used for early detection of pancreatic cancer (PC) by analyzing prediagnostic plasma samples collected before a PC diagnosis. Background: PC has a poor prognosis due to late presenting symptoms and early metastasis. Circulating miRNAs are altered in PC at diagnosis but have not been evaluated in a prediagnostic setting. Methods: We first performed an initial screen using a panel of 372 miRNAs in a retrospective case-control cohort that included early-stage PC patients and healthy controls. Significantly altered miRNAs at diagnosis were then measured in an early detection case-control cohort wherein plasma samples in the cases are collected before a PC diagnosis. Carbohydrate antigen 19–9 (Ca 19–9) levels were measured in all samples for comparison. Results: Our initial screen, including 23 stage I-II PC cases and 22 controls, revealed 15 candidate miRNAs that were differentially expressed in plasma samples at PC diagnosis. We combined all 15 miRNAs into a multivariate statistical model, which outperformed Ca 19–9 in receiver-operating characteristics analysis. However, none of the candidate miRNAs, individually or in combination, were significantly altered in prediagnostic plasma samples from 67 future PC patients compared with 132 matched controls. In comparison, Ca 19–9 levels were significantly higher in the cases at <5 years before diagnosis. Conclusion: Plasma miRNAs are altered in PC patients at diagnosis, but the candidate miRNAs found in this study appear late in the course of the disease and cannot be used for early detection of the disease.

  • 43.
    Fränneby, Ulf
    et al.
    Department of Surgery, Södersjukhuset, Stockholm.
    Sandblom, Gabriel
    Department of Surgery, Akademiska Sjukhuset, Uppsala.
    Nordin, Pär
    Department of Surgery, östersunds Sjukhus, östersund.
    Nyrén, Olof
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Gunnarsson, Ulf
    Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden.
    Risk factors for long-term pain after hernia surgery2006In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 244, no 2, p. 212-219Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the prevalence of residual pain 2 to 3 years after hernia surgery, to identify factors associated with its occurrence, and to assess the consequences for the patient.

    SUMMARY BACKGROUND DATA: Iatrogenic chronic pain is a neglected problem that may totally annul the benefits from hernia repair.

    METHODS: From the population-based Swedish Hernia Register 3000 patients aged 15 to 85 years were sampled from the 9280 patients registered as having undergone a primary groin hernia operation in the year 2000. Of these, the 2853 patients still alive in 2003 were requested to fill in a postal questionnaire.

    RESULTS: After 2 reminders, 2456 patients (86%), 2299 men and 157 women responded. In response to a question about "worst perceived pain last week," 758 patients (31%) reported pain to some extent. In 144 cases (6%), the pain interfered with daily activities. Age below median, a high level of pain before the operation, and occurrence of any postoperative complication were found to significantly and independently predict long-term pain in multivariate logistic analysis when "worst pain last week" was used as outcome variable. The same variables, along with a repair technique using anterior approach, were found to predict long-term pain with "pain right now" as outcome variable.

    CONCLUSION: Pain that is at least partly disabling appears to occur more often than recurrences. The prevalence of long-term pain can be reduced by preventing postoperative complications. The impact of repair technique on the risk of long-term pain shown in our study should be further assessed in randomized controlled trials.

  • 44.
    Gero, Daniel
    et al.
    Univ Hosp Zurich, Switzerland.
    Raptis, Dimitri A.
    Univ Hosp Zurich, Switzerland; Royal Free Hosp, England.
    Vleeschouwers, Wouter
    AZ Sint Jan Brugge Oostende, Belgium.
    van Veldhuisen, Sophie L.
    Rijnstate Hosp, Netherlands.
    San Martin, Andres
    Dipreca Hosp, Chile.
    Xiao, Yao
    Varberg Hosp, Sweden; Univ Gothenburg, Sweden.
    Galvao, Manoela
    Adv Inst Bariatr and Metab Surg, Brazil.
    Giorgi, Marcoandrea
    Brown Univ, RI 02906 USA.
    Benois, Marine
    Univ Cote Azur, France.
    Espinoza, Felipe
    Clin Las Condes, Chile.
    Hollyman, Marianne
    Musgrove Pk Hosp, England.
    Lloyd, Aaron
    Fresno Heart and Surg Hosp, CA USA.
    Hosa, Hanna
    Univ Hosp Zurich, Switzerland.
    Schmidt, Henner
    Univ Hosp Zurich, Switzerland.
    Garcia-Galocha, Jose Luis
    Univ Complutense Madrid, Spain.
    van de Vrande, Simon
    AZ Sint Blasius Hosp, Belgium.
    Chiappetta, Sonja
    Sana Klinikum Offenbach, Germany.
    Lo Menzo, Emanuele
    Cleveland Clin Florida, FL USA.
    Aboud, Cristina Mamedio
    Oswaldo Cruz German Hosp, Brazil.
    Luthy, Sandra Gagliardo
    Clarunis St Clara Hosp, Switzerland; Univ Hosp Basel, Switzerland.
    Orchard, Philippa
    Southmead Hosp, England.
    Rothe, Steffi
    Vienna Med Univ, Austria.
    Prager, Gerhard
    Vienna Med Univ, Austria.
    Pournaras, Dimitri J.
    Southmead Hosp, England.
    Cohen, Ricardo
    Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
    Rosenthal, Raul
    Cleveland Clin Florida, FL USA.
    Weiner, Rudolf
    Sana Klinikum Offenbach, Germany.
    Himpens, Jacques
    AZ Sint Blasius Hosp, Belgium; Vienna Med Univ, Austria; St Pierre Univ Hosp, Belgium.
    Torres, Antonio
    Univ Complutense Madrid, Spain.
    Higa, Kelvin
    Fresno Heart and Surg Hosp, CA USA.
    Welbourn, Richard
    Musgrove Park Hospital, Taunton, UK.
    Berry, Marcos
    Clin Las Condes, Chile.
    Boza, Camilo
    Clin Las Condes, Chile.
    Iannelli, Antonio
    Univ Cote Azur, France.
    Vithiananthan, Sivamainthan
    Brown Univ, RI 02906 USA.
    Ramos, Almino
    Adv Inst Bariatr and Metab Surg, Brazil.
    Olbers, Torsten
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Univ Gothenburg, Sweden.
    Sepulveda, Matias
    Dipreca Hosp, Chile.
    Hazebroek, Eric J.
    Rijnstate Hosp, Netherlands.
    Dillemans, Bruno
    AZ Sint Jan Brugge Oostende, Belgium.
    Staiger, Roxane D.
    Univ Hosp Zurich, Switzerland.
    Puhan, Milo A.
    Univ Zurich, Switzerland.
    Peterli, Ralph
    Clarunis St Clara Hosp, Switzerland; Univ Hosp Basel, Switzerland.
    Bueter, Marco
    Univ Hosp Zurich, Switzerland.
    Defining Global Benchmarks in Bariatric Surgery A Retrospective Multicenter Analysis of Minimally Invasive Roux-en-Y Gastric Bypass and Sleeve Gastrectomy2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 270, no 5, p. 859-867Article in journal (Refereed)
    Abstract [en]

    Objective: To define “best possible” outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).

    Background: Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix.

    Methods: Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m2 and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers’ median values for respective quality indicators.

    Results: Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m2. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication.

    Conclusion: Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.

    ClinicalTrials.gov Identifier NCT03440138

  • 45.
    Ghaneh, Paula
    et al.
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England;Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England.
    Kleeff, Jorg
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England;Martin Luther Univ Halle Wittenberg, Univ Hosp Halle, Dept Surg, Halle, Germany.
    Halloran, Christopher M.
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England.
    Raraty, Michael
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England.
    Jackson, Richard
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England.
    Melling, James
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England.
    Jones, Owain
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England.
    Palmer, Daniel H.
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England.
    Cox, Trevor F.
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England.
    Smith, Chloe J.
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England.
    O'Reilly, Derek A.
    Manchester Royal Infirm, Dept Surg, Manchester, Lancs, England.
    Izbicki, Jakob R.
    Univ Hamburg, Dept Surg, Med Inst UKE, Hamburg, Germany.
    Scarfe, Andrew G.
    Univ Alberta, Dept Oncol, Div Med Oncol, Cross Canc Inst 2228, Edmonton, AB, Canada.
    Valle, Juan W.
    The Christie, Dept Med Oncol, Manchester, Lancs, England.
    McDonald, Alexander C.
    Beatson West Scotland Canc Ctr, Dept Med Oncol, Glasgow, Lanark, Scotland.
    Carter, Ross
    Glasgow Royal Infirm, Dept Surg, Glasgow, Lanark, Scotland.
    Tebbutt, Niall C.
    Austin Hlth, Dept Med Oncol, Melbourne, Vic, Australia.
    Goldstein, David
    Univ New South Wales, Prince Wales Hosp, Dept Med Oncol, Sydney, NSW, Australia;Univ New South Wales, Sch Clin, Sydney, NSW, Australia.
    Padbury, Robert
    Flinders Med Ctr, Dept Surg, Adelaide, SA, Australia.
    Shannon, Jennifer
    Nepean Canc Ctr, Dept Med Oncol, Nepean, ON, Australia;Univ Sydney, Sydney, NSW, Australia.
    Dervenis, Christos
    Agia Olga Hosp, Dept Surg, Athens, Greece.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Deakin, Mark
    Univ Hosp North Staffordshire, Dept Surg, Stoke On Trent, Staffs, England.
    Anthoney, Alan
    Univ Leeds, St Jamess Univ Hosp, Div Oncol, Leeds, W Yorkshire, England.
    Lerch, Markus M.
    Univ Med Greifswald, Dept Med A, Greifswald, Germany.
    Mayerle, Julia
    Univ Med Greifswald, Dept Med A, Greifswald, Germany.
    Olah, Attila
    Petz Aladar Hosp, Dept Surg, Gyor, Hungary.
    Rawcliffe, Charlotte L.
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England.
    Campbell, Fiona
    Heidelberg Univ, Dept Surg, Heidelberg, Germany.
    Strobel, Oliver
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Pathol, Liverpool, Merseyside, England.
    Buechler, Markus W.
    Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Pathol, Liverpool, Merseyside, England.
    Neoptolemos, John P.
    Univ Liverpool, Liverpool Canc Res, UK Canc Trials Unit, Liverpool, Merseyside, England;Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Dept Surg, Liverpool, Merseyside, England;Heidelberg Univ, Dept Surg, Heidelberg, Germany.
    The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 3, p. 520-529Article in journal (Refereed)
    Abstract [en]

    Objective and Background: Local and distant disease recurrence are frequently observed following pancreatic cancer resection, but an improved understanding of resection margin assessment is required to aid tailored therapies

    Methods: Analyses were carried out to assess the association between clinical characteristics and margin involvement as well as the effects of individual margin involvement on site of recurrence and overall and recurrence-free survival using individual patient data from the European Study Group for Pancreatic Cancer (ESPAC)-3 randomized controlled trial.

    Results: There were 1151 patients, of whom 505 (43.9%) had an RI resection. The median and 95% confidence interval (CI) overall survival was 24.9 (22.9-27.2) months for 646 (56.1%) patients with resection margin negative R0 >1 mm) tumors, 25.4 (21.6 30.4) months for 146 (12.7%) patients with RI <1 mm positive resection margins, and 18.7 (17.2-21.1) months for 359 (31.2%) patients with R1-direct positive margins (P < 0.001). In multivariable analysis, overall R 1-direct tumor margins, poor tumor differentiation, positive lymph node status, WHO performance status ≥ 1, maximum tumor size, and RI-direct posterior resection margin were all independently significantly associated with reduced overall and recurrence-free survival. Competing risks analysis showed that overall R1-direct positive resection margin status, positive lymph node status. WHO performance status 1, and R1-direct positive superior mesenteric/medial margin resection status were all significantly associated with local recurrence.

    Conclusions: RI-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.

  • 46. Glasbey, James
    Risk of Bowel Obstruction in Patients Undergoing Neoadjuvant Chemotherapy for High-risk Colon Cancer: A Nested Case-control Matched Analysis of an International, Multi-centre, Randomised Controlled Trial (FOxTROT).2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aimed to identify risk-criteria available before the point of treatment initiation that can be used to stratify risk of obstruction in patients undergoing neoadjuvant chemotherapy (NAC) for high-risk colon cancer.

    SUMMARY BACKGROUND DATA: Global implementation of neoadjuvant chemotherapy (NAC) for colon cancer, informed by the FOxTROT trial, may increase risk of bowel obstruction.

    METHODS: A case-control study, nested within an international randomised controlled trial (FOxTROT. ClinicalTrials.gov: NCT00647530). Patients with high-risk operable colon cancer (radiologically-staged T3-4 N0-2 M0) that were randomised to NAC and developed large bowel obstruction were identified. Firstly, clinical outcomes were compared between patients receiving NAC in FOxTROT that did and did not develop obstruction. Secondly, obstructed patients (cases) were age- and sex-matched with patients that did not develop obstruction (controls) in a 1:3 ratio using random sampling. Bayesian conditional mixed-effects logistic regression modelling was used to explore clinical, radiological, and pathological features associated with obstruction. Absolute risk of obstruction based on the presence or absence of risk criteria was estimated for all patients receiving NAC.

    RESULTS: Of 1053 patients randomised in FOxTROT, 699 received NAC, of whom 30 (4.3%) developed obstruction. Patients underwent care in European hospitals including 88 UK, 7 Danish and 3 Swedish centres. There was more open surgery (65.4% vs. 38.0%, P =0.01) and a higher pR1 rate in obstructed patients (12.0% vs. 3.8%, P =0.004), but otherwise comparable postoperative outcomes. In the case-control matched Bayesian model, two independent risk criteria were identified: (1) obstructing disease on endoscopy and/or being unable to pass through the tumour (adjusted odds ratio: 9.09, 95% credible interval: 2.34-39.66) and stricturing disease on radiology or endoscopy (OR: 7.18, 95% C.I.: 1.84-32.34). Three risk groups were defined according to the presence or absence of these criteria: 63.4% (443/698) of patients were at very low risk (<1%), 30.7% (214/698) at low risk (<10%), and 5.9% (41/698) at high risk (>10%).

    CONCLUSIONS: Safe selection for NAC for colon cancer can be informed by using two features that are available before treatment initiation and identify a small number of patients with high risk of preoperative obstruction.

  • 47.
    Gottlieb-Vedi, Eivind
    et al.
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
    Kauppila, Joonas H
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
    Mattsson, Fredrik
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
    Hedberg, Jakob
    Department of Surgical Sciences, Uppsala University, Sweden.
    Johansson, Jan
    Department of Surgery, Skåne University Hospital, Lund; Faculty of Medicine, Clinical Sciences, Lund University, Sweden.
    Edholm, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lagergren, Pernilla
    Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Department of Surgery & Cancer, Imperial College London, London, UK.
    Nilsson, Magnus
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Sweden.
    Lagergren, Jesper
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas’ NHS Foundation Trust, London, UK..
    Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. 429-436Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.

    SUMMARY BACKGROUND DATA: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.

    METHODS: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.

    RESULTS: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.

    CONCLUSION: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.

  • 48. Gottlieb-Vedi, Eivind
    et al.
    Kauppila, Joonas H
    Mattsson, Fredrik
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Johansson, Jan
    Edholm, David
    Lagergren, Pernilla
    Nilsson, Magnus
    Lagergren, Jesper
    Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. 429-436Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.

    Summary of Background Data: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.

    Methods: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.

    Results: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.

    Conclusion: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.

  • 49.
    Greijdanus, Nynke G.
    et al.
    Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
    Wienholts, Kiedo
    Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Netherlands; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands.
    Ubels, Sander
    Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
    Talboom, Kevin
    Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Netherlands; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands.
    Hannink, Gerjon
    Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
    Wolthuis, Albert
    Department of Surgery, Uz Leuven, Leuven, Belgium.
    De Lacy, Francisco B.
    Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
    Lefevre, Jérémie H.
    Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France.
    Solomon, Michael
    Department of Surgery, University of Sydney Central Clinical School, NSW, Camperdown, Australia.
    Frasson, Matteo
    Department of Surgery, Valencia University Hospital la Fe, Valencia, Spain.
    Rotholtz, Nicolas
    §§ Department of Surgery, Hospital Alemán, Buenos Aires, Argentina.
    Denost, Quentin
    Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France.
    Perez, Rodrigo O.
    Department of Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
    Konishi, Tsuyoshi
    Department of Colon and Rectal Surgery, Division of Surgery, The University of Texas Md Anderson Cancer Center, TX, Houston, United States.
    Panis, Yves
    Department of Colorectal Surgery, Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France.
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hompes, Roel
    Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Netherlands; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands.
    Rosman, Camiel
    Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
    Van Workum, Frans
    Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
    Tanis, Pieter J.
    Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Netherlands; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands; Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, Netherlands.
    De Wilt, Johannes H.W.
    Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
    Stoma-free survival after rectal cancer resection with anastomotic leakage: development and validation of a prediction model in a large international cohort2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 278, no 5, p. 772-780Article in journal (Refereed)
    Abstract [en]

    Objective: To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).

    Background: AL after RC resection often results in a permanent stoma.

    Methods: This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.

    Results: This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).

    Conclusions: The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.

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  • 50.
    Gunnarsson, Kim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Djavani, Khatereh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Nationwide Study of Ruptured Abdominal Aortic Aneurysms During Twenty Years (1994-2013)2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 2, p. e160-e166Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyze the epidemiology of ruptured abdominal aortic aneurysms (RAAA) in Sweden over 20 years, and assess the effect of endovascular repair (EVAR) on surgical treatment rate and outcome.

    METHODS: All Swedish citizens >50 years with RAAA 1994 to 2013 were extracted from 3 national (Cause of Death, Patient, and Vascular Surgical) registries. Incidence, proportion repaired, surgical techniques, and 90-day mortality were assessed based on sex and age groups, with regression analysis.

    RESULTS: 18,726 individuals with RAAA were identified, 74.0% men. The incidence of RAAA decreased from 33.1/100,000: 1994 to 21.3/100,000: 2013 (relative change -35.6%, P < 0.001). The proportion of men with RAAA undergoing repair was 44.5%: 1994-1998, 49.7%: 2009-2013 (+11.7%, P < 0.001). In women, 22.3% were repaired in 1994-1998, versus 28.2%: 2009-2013 (+26.4%, P < 0.001). The proportion undergoing repair increased in octogenarians (men: +44.3%, P < 0.001; women +49.3%, P = 0.001). EVAR increased from 0% initially to 42.3% in men and 41.2% in women 2013. Overall, mortality rate among all individuals with RAAA decreased, men 75.8%: 1994-1998, 64.8%: 2009-2013 (-14.5%, P < 0.001); women 88.5%: 1994-1998, 82.2%: 2009-2013 (-7.1%, P < 0.001). Among those who underwent repair, mortality was 47.0% in men: 1994-1998, 31.8%: 2009-2013 (-32.3%, P < 0.001); women 51.8%: 1994-1998, 41.4%: 2009-2013 (-20.1%, P = 0.010).

    CONCLUSION: RAAA mortality among men decreased, mainly attributed to falling incidence of RAAA. The mortality was further reduced by more patients being offered repair, increasingly often with EVAR, and improved survival after repair. Incidence of rupture remained unchanged among women, who had higher RAAA mortality. Focused efforts to reduce RAAA mortality among women are warranted.

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