| 1. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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A study of lymph node ratio in stage IV colorectal cancer.
- 2008
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Ingår i: World journal of surgical oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The finding of metastasis in colorectal cancer, stage IV disease, has a major impact on prognosis and treatment strategy. Known important factors include the extent of the metastasis and the patients' performance status. The lymph node factors are of known importance in earlier cancer stages but less described in metastatic disease. The aim of the study was to evaluate lymph node status and ratio as prognostic markers in stage IV colorectal cancer. METHOD: The study was retrospective and assessing all patients operated, with bowel resection, for an initial stage IV colorectal cancer during 1999-2003 (n=136). Basic demographic data as well as given treatment was assessed. The Lymph node ratio (LNR), the quota between the number of lymph node metastasis and assessed lymph nodes, was calculated. LNR groups were created by ratio thirds, 3 equally sized groups. The analysis was made by LNR group and by eligibility for chemotherapy with cancer specific survival as outcome parameter. RESULTS: The median survival (CSS) for the entire group was 431 days with great variability. For the patients eligible for chemotherapy it ranged from 791 days in LNR-group 1 to 433 days for the patients in group 3. For patients ineligible for chemotherapy the corresponding figures were 209 and 91 days. The eligibility for chemotherapy was a major prognostic factor which also takes co-morbidity, age and performance status into consideration. The LNR (p<0.01) and the tumour differentiation grade were also significant (p<0.05) factors regarding survival. The LNR group 3 was also associated with a higher frequency of multiple metastasis locations (p<0.05) and of more side effects with chemotherapy and thus of reductions in dosage or pre-emptive treatment ending (p<0.05). CONCLUSION: Stage IV colorectal cancer is a heterogeneous group regarding the survival prognosis. The lymph node ratio was found to be a significant marker for the survival prognosis (p<0.0049). High and low risk groups could be identified with a survival difference of up to one year. It could be of importance when planning a treatment strategy or evaluating clinical data materials. A pathology report should include a node assessment even at presence of synchronous metastasis.
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| 2. |
- Emland, Frans, et al.
(författare)
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Prolonged postoperative length of stay may be a valuable marker for susceptibility to relapse beyond established risk factors in patients with stage III colon cancer
- 2022
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Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Delay from surgery to adjuvant chemotherapy causes impaired survival among patients undergoing radical resection for stage III colon cancer, and the underlying mechanism for this is incompletely clarified. It is established that prolonged postoperative hospital length of stay (LOS) is associated with delayed initiation of the adjuvant treatment driving the assumption that prolonged LOS is prognostically unfavorable due to this fact and case mix factors. We hypothesize that prolonged LOS after surgery is a valuable marker for susceptibility to relapse that is not detected in established prognostic factors and, alone, associated with a shorter disease-free survival (DFS). Materials and methods: A total of 690 consecutive patients undergoing elective radical resection for stage III colon cancer in 2000–2015 were identified in a prospective detailed facility database. Univariate and multivariate analyses were performed using Cox proportional hazards model in the evaluation of LOS as an independent prognostic factor. Results: Short postoperative LOS, low comorbidity, and few complications were associated with longer DFS (p < 0.01). Fewer patients in the short and intermediate LOS groups had a relapse in their disease (28% and 33%, respectively), compared to the patients with longer LOS (40%, p < 0.05). LOS was a prognostic factor for DFS in the unadjusted univariate model (HR 1.04 per unit change) and remained statistically significant in the adjusted multivariate analysis, with a HR of 1.03 per hospital day (p < 0.01). Conclusions: Postoperative LOS independently correlates with the risk of recurrence and DFS, regardless of if adjuvant chemotherapy is given, along with the factors such as age, comorbidity, complications, and tumor features. We propose a further investigation into the causal mechanisms based on tumor and host biology linking LOS to DFS beyond established risk factors.
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| 3. |
- Hansson, Emma, 1981, et al.
(författare)
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A systematic review of the scientific evidence of venous supercharging in autologous breast reconstruction with abdominally based flaps.
- 2023
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Ingår i: World journal of surgical oncology. - 1477-7819. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Abdominally based free flaps are commonly used in breast reconstruction. A frequent complication is venous congestion, which might contribute to around 40% of flap failures. One way to deal with it is venous supercharging. The primary aim of this study was to investigate the scientific evidence for the effects of venous supercharging.A systematic literature search was conducted in PubMed, CINAHL, Embase, and Cochrane library. The included articles were critically appraised, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.Thirty-six studies were included. Most studies had serious study limitations and problems with directness. Three studies report 'routine' use of venous supercharging and performed it prophylactically in patients who did not have clinical signs of venous congestion. Seventeen studies report on flap complications, of which one is a randomised controlled trial demonstrating statistically significant lower complication rates in the intervention group. The overall certainty of evidence for the effect of a venous supercharging on flap complications, length of hospital stay and operative time, in patients without clinical signs of venous congestion, is very low (GRADE⊕⊕⊝⊝), and low on and surgical takebacks (GRADE⊕⊕⊝⊝). Twenty-one studies presented data on strategies and overall certainty of evidence for using radiological findings, preoperative measurements, and clinical risk factors to make decisions on venous supercharging is very low (GRADE⊕⊝⊝⊝).There is little scientific evidence for how to predict in which cases, without clinical signs of venous congestion, venous supercharging should be performed. The complication rate might be lower in patients in which a prophylactic venous anastomosis has been performed.PROSPERO (CRD42022353591).
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| 4. |
- Hansson, Emma, 1981, et al.
(författare)
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First‐year complications after immediate breast reconstruction with a biological and a synthetic mesh in the same patient: A randomized controlled study
- 2021
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Ingår i: World Journal of Surgical Oncology. - : Wiley. - 1477-7819 .- 0022-4790 .- 1096-9098. ; 123:1, s. 80-88
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Tidskriftsartikel (refereegranskat)abstract
- Background Even though meshes and matrices are widely used in breast reconstruction, there is little high‐quality scientific evidence for their risks and benefits. The aim of this study was to compare first‐year surgical complication rates in implant‐based immediate breast reconstruction with a biological mesh with that of a synthetic mesh, in the same patient. Methods This study is a clinical, randomized, prospective trial. Patients operated on with bilateral mastectomy and immediate breast reconstruction were randomized to biological mesh on one side and synthetic mesh on the other side. Results A total of 48 breasts were randomized. As the synthetically and the biologically reconstructed breasts that were compared belonged to the same woman, systemic factors were exactly the same in the two groups. The most common complication was seroma formation with a frequency of 38% in the biological group and 3.8% in the synthetical group (p=.011). A higher frequency of total implant loss could be seen in the biologic mesh group (8.5% vs. 2%), albeit not statistically significant (p=.083). Conclusions In the same patient, a synthetic mesh seems to yield a lower risk for serious complications, such as implant loss, than a biological mesh.
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| 5. |
- Holmberg, Carl Jacob, et al.
(författare)
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Surgery for gastrointestinal metastases of malignant melanoma - a retrospective exploratory study
- 2019
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Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCutaneous melanoma has a rapidly increasing incidence in Sweden, and it has more than doubled in the last two decades. In recent years, new systemic treatments for patients with metastatic disease have increased overall survival. The role of surgery in the metastatic setting has been unclear, and no randomized data exist. Many surgeons still perform metastasectomies; however, the exact role probably has to be redefined. The aim of this single-institution study was to retrospectively examine the safety and efficacy of surgery in abdominal melanoma metastases and to identify prognostic and predictive factors.MethodsRetrospective analysis of a consecutive series of all patients with stage IV melanoma with gastrointestinal metastases that underwent abdominal surgery at a single center between January 2010 and December 2018. Fifteen patients who underwent in total 18 abdominal procedures, both acute and elective, were identified and included in the study.ResultsOut of 18 laparotomies, six (33%) were emergency procedures due to ileus (n=4), small bowel perforation (n=1), and abdominal abscess (n=1). Twelve procedures (66%) were elective with the most common indication being persistent anemia (58%, n=7), abdominal pain and anemia (33%, n=4), and abdominal pain (8%, n=1). All procedures were performed by laparotomy. There were 19 small bowel resections, 3 partial colon resections, and 2 omental resections. Radical resection was possible in 56% (n=10) of cases and 67% (n=8) when only considering elective procedures. In 17 of 18 procedures (94%), there were mild or no surgical complications (Clavien-Dindo grades 0-I). The median overall survival was 14months with a 5-year survival of 23%.ConclusionsPatients with abdominal melanoma metastases can safely undergo resection with a high grade of radical procedures when performed in the elective setting.Trial registrationClinicalTrials.gov, NCT03879395. Registered 15 March 2019.
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| 6. |
- Normann, Maria, 1989, et al.
(författare)
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Mortality and morbidity after colorectal cancer resection surgery in elderly patients: a retrospective population-based study in Sweden
- 2024
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Ingår i: WORLD JOURNAL OF SURGICAL ONCOLOGY. - : BMC. - 1477-7819. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Colorectal cancer is primarily a condition of older adults, and surgery is the cornerstone of treatment. As life expectancy is increasing and surgical techniques and perioperative care are developing, curative surgery is often conducted even in ageing populations. However, the risk of morbidity, functional decline, and mortality following colorectal cancer resection surgery are known to increase with increasing age. This study aims to describe real-world data about postoperative mortality and morbidity after resection surgery for colorectal cancer in the elderly (>= 70 years) compared to younger patients (< 70 years), in a Swedish setting. Methods A cohort study including all patients diagnosed with colorectal cancer in a Swedish region of 1.7 million inhabitants between January 2016 and May 2020. Patients were identified through the Swedish Colorectal Cancer Registry, and all baseline and outcome variables were extracted from the registry. The following outcome measures were compared between the two age groups: 90-day mortality rates, postoperative complications, postoperative intensive care, reoperations, readmissions, and 1-year mortality. To adjust the analyses for baseline confounders in the comparison of the outcome variables, the following methods were used: marginal matching, calliper (ID matching), and logistic regression adjusted for baseline confounders. Results The cohort consisted of 5246 patients, of which 3849 (73%) underwent resection surgery. Patients that underwent resection surgery were significantly younger than those who did not (mean +/- SD, 70.9 +/- 11.4 years vs 73.7 +/- 12.8 years, p < 0.001). Multivariable analyses revealed that both 90-day and 1-year mortality rates were higher in older patients that underwent resection surgery (90-day mortality OR 2.12 [95% CI 1.26-3.59], p < 0.005). However, there were no significant differences in postoperative intensive care, postoperative complications, reoperations, or readmissions. Conclusion Elderly patients suffer increased postoperative mortality after resection surgery for colorectal cancer compared to younger individuals. Given the growing elderly population that will continue to require surgery for colorectal cancer, more efficient ways of determining and handling individual risk for older adults need to be implemented in clinical practice.
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