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  • Bergkvist, L, et al. (författare)
  • Multicentre study of detection and false-negative rates in sentinel nodebiopsy for breast cancer
  • 2001
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 88:12, s. 1644-1648
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>BACKGROUND: Sentinel node biopsy has recently evolved as a means of staging the axilla in breast cancer with minimal surgical trauma. The aim of this prospective multicentre study was to identify factors that influenced the detection and false-negative rates during the learning phase.</p><p>METHODS: Data on all 498 sentinel node biopsies performed between August 1997 and December 1999 in Sweden were collected.</p><p>RESULTS: A sentinel node was found in 450 patients (90 per cent). Preoperative scintigraphy visualized 83 per cent of all sentinel nodes. The detection rate was higher with same-day injection of tracer than with injection the day before (96 versus 86 per cent; P &lt; 0.01). Dye injected less than 5 min or more than 30 min before the start of the operation lowered the detection rate (less than 60 per cent versus more than 65 per cent; P = 0.02). The detection rate varied from 61 to 100 per cent between surgeons. The false-negative rate was 11 per cent. The presence of multiple tumour foci and a high S-phase fraction increased the risk of a false-negative sentinel node, whereas the number of operations performed by each surgeon was less important.</p><p>CONCLUSION: Training of the individual surgeon influenced the detection rate, as did timing of tracer and dye injection. The false-negative rate seemed to be related to biological factors.</p>
  • Borch, Kurt, 1944-, et al. (författare)
  • Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma
  • 2000
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 87:5, s. 618-626
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: There are indications that some features of gastric carcinoma are changing, with a possible impact on prognosis. The aim of this study was to examine any changes in type, location, stage, resection rate, postoperative mortality rate or prognosis for patients with gastric carcinoma in a well defined population. Methods: During 1974-1991, 1161 new cases of gastric adenocarcinoma were diagnosed in Ostergotland County, Sweden. Tumour location, Lauren histological type, tumour node metastasis (TNM) stage, radicality of tumour resection and postoperative complications were recorded after histological re-evaluation of tissue specimens and examination of all patient records. Dates of death were obtained from the Swedish Central Bureau of Statistics. Time trends were studied by comparing the intervals 1974-1982 (period 1) and 1983-1991 (period 2). Results: The proportion of diffuse type of adenocarcinoma increased (from 27 to 35 per cent), while that of mixed type decreased (from 16 to 9 per cent) and that of intestinal type was unchanged. The proportion of tumours located in the proximal two-thirds of the stomach increased (from 32 to 42 per cent) and the proportion of patients with tumours in TNM stage IV decreased (from 32 to 25 per cent). Overall tumour resection rates were unchanged, although the proportion of radical total gastrectomies increased (from 36 to 50 per cent). Excluding tumours of the cardia or gastric remnant after previous ulcer surgery, the 5-year relative survival rate after radical resection increased from 25 to 36 per cent and the postoperative mortality rate decreased for both radical (from 11 to 4 per cent) and palliative (from 18 to 6 per cent) resection. Conclusion: The patterns of tumour histology, location and stage of gastric carcinoma have changed in the authors' region. These changes were paralleled by a significant improvement in survival and postoperative mortality rates.</p>
  • Franzén, Thomas, 1955-, et al. (författare)
  • Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication
  • 1999
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 86:7, s. 956-960
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background:</p><p>This was a prospective study of symptoms, and short-term and long-term reflux competence after partial fundoplication.</p><p>Methods:</p><p>Some 101 patients were operated consecutively with posterior partial (270°) fundoplication. Indications for surgery were reflux disease without erosive oesophagitis in 25 patients, moderate oesophagitis in 43, severe oesophagitis in 25 and paraoesophageal hernia in eight. Symptom score, manometry and pH tests were performed before operation, 6 months after operation and after 6–14 years.</p><p>Results:</p><p>All patients (<em>n</em> = 101) were free from heartburn and regurgitation at early follow-up. There was evidence of clinical recurrence at late follow-up (<em>n</em> = 87) in two of 22 patients without oesophagitis before operation, two of 39 with moderate oesophagitis before operation and three of 19 patients with severe oesophagitis before operation; 92 per cent had good reflux control at late follow-up.</p><p>Conclusion</p><p>Posterior partial fundoplication shows excellent reflux control at early follow-up. Ten years later fewer than 10 per cent of patients have recurrence, which is more common in patients who had severe oesophagitis before operation.</p>
  • Fredriksson, I, et al. (författare)
  • Consequences of axillary recurrence after conservative breast surgery
  • 2002
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 89:7, s. 902-908
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: The aim was to study the incidence, time course and prognosis of patients who developed axillary recurrence after breast-conserving surgery, and to evaluate possible risk factors for axillary recurrence and prognostic factors after axillary recurrence. Methods: In a population-based cohort of 6613 women with invasive breast cancer who had breast-conserving surgery between 1981 and 1990, 92 recurrences in the ipsilateral axilla were identified. Risk factors for axillary recurrence were studied in a case-control study nested in the cohort, and late survival was documented in the women with axillary recurrence. Results: The overall risk of axillary recurrence was 1.0 per cent at 5 years and 1.7 per cent at 10 years. The risk of axillary recurrence increased with tumour size (P = 0.033) and was highest in younger women (odds ratio (OR) 3.9 for women aged less than 40 years compared with those aged 50-59 years). Radiotherapy to the breast reduced the risk of axillary recurrence (OR 0.1 (95 per cent confidence interval 0.1 to 0.4)). The breast cancer-specific survival rate after axillary recurrence, as measured from primary treatment, was 78.0 per cent at 5 years and 52.3 per cent at 10 years. Tumour size and node status had a statistically significant effect on death from breast cancer. Conclusion: Axillary recurrence is rare, although more common in younger women with large tumours. Radiotherapy to the breast was protective. Tumour size and node status were the most important prognostic factors in women with axillary recurrence.</p>
  • Lundin, Erik, et al. (författare)
  • Outcome of segmental colonic resection for slow-transit constipation.
  • 2002
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 89:10
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong> The standard surgical treatment for slow-transit constipation (STC) is subtotal colectomy and ileorectal anastomosis. A segmental resection may serve the same purpose, but with a reduced risk of side-effects such as diarrhoea or incontinence. The aim of this study was to evaluate the functional results following segmental resection in a consecutive series of patients with STC.</p><p><strong>METHODS:</strong> Selection criteria included prolonged segmental transit on oral 111In-labelled diethylene triamine penta-acetic acid scintigraphic transit study, and disabling symptoms resistant to medical therapy and treatment of outlet obstruction. Twenty-eight patients (26 women, median age 52 years) were treated with segmental resection and followed prospectively with a validated questionnaire.</p><p><strong>RESULTS:</strong> After a median of 50 (range 16-78) months, 23 patients were pleased with the outcome. The median (range) stool frequency increased from 1 (0-7) to 7 (0-63) per week (P &lt; 0.001). The number of patients passing hard stools and straining excessively decreased (P = 0.016 and P = 0.041, respectively). The median incontinence score was unchanged. Rectal sensory thresholds were higher in patients in whom the treatment failed (P &lt; 0.001).</p><p><strong>CONCLUSION:</strong> With a symptomatic relief comparable to that after ileorectal anastomosis and less severe side-effects, segmental colectomy may be a better alternative for selected patients with STC. Thorough preoperative evaluation is important and impaired rectal sensation may predict a poor outcome.</p>
  • Morren, Geert, et al. (författare)
  • Anatomy of the anal canal and perianal structures as defined by phased-array magnetic resonance imaging
  • 2001
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 88:11, s. 1506-1512
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background:</p><p>The anatomy of the anal canal and perianal structures has been imaged using endoluminal magnetic resonance imaging (MRI). Phased-array MRI avoids the use of an endoluminal coil that may distort anatomy. The aim of this study was to describe the anatomy of the anal canal and perianal structures using phased-array MRI.</p><p>Methods:</p><p>Imaging was performed in 14 men and 19 nulliparous women. The dimensions of the anal canal, puborectalis, external anal sphincter, perineal body, superficial transverse perineal muscle, bulbospongiosus, ischiocavernosus and anococcygeal body were measured in different planes, and sex differences were calculated.</p><p>Results:</p><p>The lateral canal was significantly longer than its anterior and posterior part (<em>P</em> &lt; 0·001). The anterior external anal sphincter was shorter in women than in men (<em>P</em> = 0·01) and occupied, respectively, 30 and 38 per cent of the anal canal length (<em>P</em> = 0·001). The caudal ends of the external anal sphincter formed a double layer. The perineal body was thicker in women than in men (<em>P</em> &lt; 0·001) and easier to define. The superficial transverse muscles had a lateral and caudal extension to the ischiopubic bones. The bulbospongiosus was thicker in men than in women (<em>P</em> &lt; 0·001). The ischiocavernosus and anococcygeal body had the same dimensions in both sexes.</p><p>Conclusion:</p><p>Phased-array MRI is a non-invasive technique that allows an accurate description of the normal anatomy of the anal canal and perianal structures.</p>
  • Nilsson, E., et al. (författare)
  • Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996
  • 1998
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 85:12, s. 1686-1691
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Background</strong></p><p>Difficulties in obtaining and analysing outcome measures in hernia surgery may be an obstacle to necessary progress in non-specialized hospitals. Against this background a voluntary register was initiated in 1992 with the aim of describing and evaluating hernia surgery in participating units.</p><p><strong>Methods</strong></p><p>Prospective registration of all hernia operations carried out in participating hospitals was undertaken using identification codes specific for each individual. Repair technique, complications, day surgery, type of anaesthesia, and reoperation for recurrence were recorded. Actuarial analysis was used to determine the cumulative incidence of reoperation. Relative risk for reoperation was estimated by the Cox proportional hazards model.</p><p><strong>Results</strong></p><p>The number of participating hospitals and registered operations increased from eight and 1689 respectively in 1992 to 21 and 4056 in 1996. The use of mesh increased from 7 per cent of all operations in 1992 to 51 per cent in 1996. The proportion of operations done for recurrent hernia remained constant at 16–17 per cent throughout the 5-year study period. For all 12 542 herniorrhaphies registered, the cumulative incidence of reoperation at 2 years was 3 (95 per cent confidence interval 3–4) per cent. Postoperative complications, recurrent hernia, direct hernia and absorbable suture were associated with increased risk of reoperation for recurrence. An increased incidence of reoperation, although not statistically significant, was noted for conventional open repairs (Bassini, McVay, Marcy and others) <em>versus</em> the Shouldice technique.</p><p><strong>Conclusion</strong></p><p>In this prospective audit an increasing use of mesh was observed for open and laparoscopic surgery, especially for bilateral and recurrent hernia operations. Reoperation rates decreased significantly between 1992 and 1995.</p>
  • Nilsson, Gunilla, et al. (författare)
  • Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period.
  • 2000
  • Ingår i: British Journal of Surgery. - Wiley. - 0007-1323 .- 1365-2168. ; 87:7, s. 873-878
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background</p> <p>There is a widespread belief that introduction of the laparoscopic technique in antireflux surgery has led to easier postoperative recovery. To test this hypothesis a prospective randomized clinical trial with blind evaluation was conducted between laparoscopic and open fundoplication.</p> <p>Methods</p> <p>Sixty patients with gastro-oesophageal reflux disease were randomized to open or laparoscopic 360° fundoplication. The type of operation was unknown to the patient and the evaluating nurses after operation.</p> <p>Results</p> <p>The operating time was longer in the laparoscopy group, median 148 <em>versus</em> 109 min (<em>P</em> &lt; 0·0001). The need for analgesics was less in the laparoscopically operated patients, 33·9 <em>versus</em> 67·5 mg morphine per total hospital stay (<em>P</em> &lt; 0·001). There was no significant difference in postoperative nausea and vomiting. On the first day after operation patients in the laparoscopy group had better respiratory function: forced vital capacity 3·2 <em>versus</em> 2·2 litres (<em>P</em> = 0·004) and forced expiratory volume 2·6 <em>versus</em> 2·0 litres (<em>P</em> = 0·008). Postoperative hospital stay was shorter in the laparoscopic group, median (range) 3 (2–6) <em>versus</em> 3 (2–10) days (<em>P</em> = 0·021). No difference was found in the duration of sick leave.</p> <p>Conclusion</p> <p>Laparoscopic fundoplication was associated with a longer operating time, better respiratory function, less need for analgesics and a shorter hospital stay, while no reduction in the duration of postoperative sick leave was found compared with open surgery. © 2000 British Journal of Surgery Society Ltd</p>
  • Nordin, Pär, et al. (författare)
  • Randomized trial of Lichtenstein <em>versus</em> Shouldice hernia repair in general surgical practice
  • 2002
  • Ingår i: British Journal of Surgery. - 0007-1323 .- 1365-2168. ; 89:1, s. 45-49
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background:</p><p>The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres.</p><p>Methods:</p><p>Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension-free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow-up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor.</p><p>Results:</p><p>There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow-up of 36–77 months seven recurrences were found in the Shouldice group (95 per cent confidence interval (c.i.) 1·3 to 8·1) and one in the mesh group (95 per cent c.i. 0·0 to 2·0). Chronic groin pain was reported by 4·2 and 5·6 per cent in the Shouldice and Lichtenstein groups respectively. It was characterized as mild or moderate in all except two patients who had the Shouldice operation.</p><p>Conclusion: </p><p>Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit. © 2002 British Journal of Surgery Society Ltd</p>
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