| 1. |
- Agger, Erik, et al.
(författare)
-
Cervical myoma causing colonic obstruction in the first trimester of pregnancy – a case report
- 2023
-
Ingår i: Case reports in women's health. - 2214-9112. ; 38
-
Tidskriftsartikel (refereegranskat)abstract
- A 39-year-old nulliparous woman with a previously known cervical myoma was admitted to the obstetrics department during the first trimester with complaints of severe abdominal pain, lack of bowel movements and the suspicion of a clinical bowel obstruction. Because no literature on this exact condition could be found, clinical decisions were based on reports and practice in similar situations. Ultrasound revealed the progression of a cervical myoma (previously 9 cm across), now 12 × 12 × 11 cm in size and a distended large bowel. Sigmoidoscopy excluded intraluminal obstruction. The patient was treated with oral laxatives and enema without success and her condition deteriorated. The myomatous cervix was examined vaginally (bimanual manoeuvre) with the patient under anaesthesia; however, attempts to dislodge the obstruction proved unsuccessful. After surgical consultation the patient was planned for an emergency laparoscopic sigmoidostomy. The post-operative course was uneventful and the patient discharged. She delivered a healthy child with caesarean section in gestation week 36. Bowel continuity was later laparoscopically restored in conjunction with a hysterectomy. This case illustrates the importance of active multidisciplinary management in a case of severe colonic obstruction caused by pregnancy-related obstruction in the small pelvis. In this case, colonic perforation and abortion of the fetus were both avoided.
|
|
| 2. |
- Agger, Erik, et al.
(författare)
-
Circumferential resection margin and local recurrence after rectal cancer surgery: a population-based study cohort
- 2019
-
Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 21:S3, s. 22-22
-
Konferensbidrag (refereegranskat)abstract
- Aim: Studies have suggested that there is a difference in risk of local recurrence(LR) with circumferential resection margins (CRM) less than 1.0 mm. We aimed toexamine how exact resection margins affect LR risk.Method: Data from the Swedish Colorectal Cancer Registry (SCRCR) were usedfor retrospective analysis of resected rectal cancers between 2005 and 2013. Primaryendpoint was LR.Results: 12146 cases were identified of which 8666 cases were analysed after exclusion. 388 cases had CRM < 1.0 mm and 8278 cases CRM ≥ 1.0 mm. There were 42LR (11.4%) when CRM < 1.0 mm and 280 LR (3.5%) when CRM ≥ 1.0 mm. LRrate was 17% (n = 27/159), 7.1% (n = 15/210), 5.5% (n = 26/473) and 3.4%(n = 254/7550) when CRM was 0.0 mm, 0.1–0.9 mm, 1.0–1.9 mm andCRM ≥ 2 mm respectively. LR risk at CRM 0.0 mm was significantly increased compared to all other groups. No significant difference in LR between CRM 1.0–1.9 mm and ≥ 2 mm was observed. LR was diagnosed earlier when CRM < 1.0 mm.Conclusion: LR risk is related with accuracy to the surgical circumferential resec-tion margin distance. There was no difference in LR risk above CRM 1.0 mm.Most LRs occurred within two years after surgery when CRM was below 1.0 mm
|
|
| 3. |
- Agger, Erik
(författare)
-
Factors predicting recurrence in rectal cancer
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Rectal cancer treatment has improved through important incremental surgical and oncological developments over the past decades. Localized disease is highly treatable with multimodal surgical and oncological therapy. Prognosis is dependent on several factors with tumour stage at diagnosis being the most important. Furthermore, curative treatment is highly dependent on radical surgical resection. Positive circumferential resection margin (CRM), lateral lymph node metastases and tumour deposits are examples of high-risk clinical situations associated with increased risk of recurrence and subsequently impaired long-term outcome and are investigated in this thesis.Aims: Paper I & II, to investigate CRM-positive resections in rectal cancer and effect on local recurrence and distant metastasis risk. Paper III, to describe MRI-positive lateral lymph nodes – investigating therapy and outcome in high-risk rectal cancer. Paper IV, to investigate the prognostic significance of tumour deposits as a risk factor and in comparison with lymph node involvement in rectal cancer.Method: Paper I-II & IV are retrospective national cohort studies. Paper III is a retrospective regional cohort study. Patient data was gathered from the Swedish ColoRectal Cancer Registry, medical records and the Swedish Cause of Death registry. Patients for paper I & II were between 2005 – 2013, for paper III between 2009 – 2014 and för paper IV between 2011 – 2014.Main outcome measures: Paper I, local recurrence. Paper II, distant metastasis. Paper III, descriptive tumour characteristics, overall survival, local recurrence and distant metastasis. Paper IV, local recurrence, distant metastasis, overall and relative survival.Results and conclusions: Exact CRM was associated with increased local recurrence risk. Neoadjuvant radiotherapy does not decrease risk of local recurrence in CRM-positive patients. Only a subset of patients with R1-resection (CRM 0.0 mm) suffered local recurrence during follow-up. Exact CRM equal to or less than 1.0 mm may be a risk factor for distant metastasis. However, several other factors likely contribute to increased risk of distant metastasis in CRM-positive patients. MRI-positive lateral lymph nodes were associated with synchrounous distant metastasis. Neoadjuvant (chemo)radiotherapy, abdominal rectal resection and selective lymph node dissection may be a useful approach in patients with MRI-positive lateral lymph nodes. Tumour deposits increased risk of both local recurrence and distant metastasis and decreased survival. The prognosis of patients with tumour deposits were comparable to pN1a-b stage mesorectal lymph node involvement.
|
|
| 4. |
- Agger, Erik, et al.
(författare)
-
Negative prognostic impact of tumor deposits in rectal cancer – a national study cohort
- 2023
-
Ingår i: Annals of Surgery. - 1528-1140. ; 273:3, s. 526-533
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether tumor deposits (TDs) in rectal cancer are associated withincreased recurrence risk and decreased survival.Summary background data: Tumor deposits (TDs) are considered a risk factor forrecurrence after colon cancer resection and presence of TDs prompts adjuvant chemotherapy.The prognostic relevance of TDs in rectal cancer requires further exploration.Methods: All patients treated with abdominal resection surgery for rectal cancer in Swedenbetween 2011 and 2014 were eligible for inclusion in this retrospective cohort-study based onprospectively collected data from the Swedish ColoRectal Cancer Registry. Primary endpointwas local recurrence or distant metastasis. Secondary outcomes were overall and relativesurvival.Results: 5455 patients were identified. 3769 patients were analysed after exclusion. TDs werefound in 404 (10.7%) patients including where 140 (3.7%) patients with had N1c-status. InTD-positive patients, local recurrence and distant metastasis rates at 5 years were 6.3% [95%CI 3.8-8.8%] and 38.9% [95% CI, 33.6-43.5%] compared to 2.7% [95% CI, 2.1-3.3%] and14.3% [95% CI, 13.1-15.5%] in TD-negative patients. In multivariable regression analysis,risk of local recurrence and distant metastasis were increased; HR 1.86 [95% CI, 1.09-3.19;P=0.024] and 1.87 [95% CI, 1.52-2.31; P=was 68.8% [95% CI, 64.4-73.4%] in TD-positive patients and 80.7% [95% CI, 79.4-82.1%] inTD-negative patients. pN1c-patients had similar outcomes regarding local recurrence, distantCopyright © 2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited.ACCEPTEDmetastasis and survival as pN1a-b stage patients. TD-positive pN1a-b patients hadsignificantly worse outcomes while TDs did not affect outcomes in pN2a-b patients.Conclusion: This study suggests that TDs have a negative impact on prognosis in rectalcancer. Thus, efforts should be made to diagnose TD-positive rectal cancer patientspreoperatively.
|
|
| 5. |
- Agger, Erik, et al.
(författare)
-
Rektalcancer: : Risk för lokalt recidiv är beroende av RESEKTIONSMARGINAL
- 2020
-
Ingår i: Onkologi i Sverige : den oberoende tidningen för svensk cancervård. - 1653-1582. ; 20:4, s. 27-32
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Rektalcancer är en sjukdom där behandlingsresultaten förbättrats kraftigt de senaste decennierna. Behandling för ändtarmscancer sker med antingen endast kirurgi eller kirurgi i kombination med onkologisk neoadjuvant behandling. Kirurgisk radikalitet, mikroskopisk marginal mellan tumörvävnad och frisk vävnad, är av stor betydelse för att minska risken för lokalrecidiv och öka överlevnaden
|
|
| 6. |
|
|
| 7. |
- Buchwald, Pamela
(creator_code:cre_t)
-
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
- 2024
-
Ingår i: British Journal of Surgery. - 1365-2168. ; 111:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
|
|
| 8. |
- Jörgren, Fredrik, et al.
(författare)
-
Tumour deposits in colon cancer predict recurrence and reduced survival in a nationwide population-based study
- 2023
-
Ingår i: BJS Open. - 2474-9842. ; 7:6
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Tumour deposits are suggested to impact prognosis in colon cancer negatively. This study assessed the impact of tumour deposits on oncological outcomes.Methods: Data from the Swedish Colorectal Cancer Registry for patients who underwent R0 abdominal surgery for TNM stage I-III colon cancer between 2011 and 2014 with 5-year follow-up were analysed with multivariable analysis. Patients were categorized for their tumour deposit status and compared for the local recurrence and distant metastasis rates and 5-year survivals (overall and relative). Subgroup analyses were performed according to the nodal disease status.Results: Of 8146 stage I-III colon cancer patients who underwent R0 resection, 8014 patients were analysed (808 tumour deposits positive, 7206 tumour deposits negative). Patients with tumour deposits positive tumours had increased local recurrence and distant metastasis rates (7.2 versus 3.0 per cent; P < 0.001 and 33.9 versus 12.0 per cent; P < 0.001 respectively) and reduced 5-year overall and relative survival (56.8 per cent versus 74.9 per cent; P < 0.001 and 68.5 versus 92.6 per cent; P < 0.001 respectively). In multivariable analysis, tumour deposits moderately increased the risks of local recurrence and distant metastasis (hazard ratio 1.50, 95 per cent c.i. 1.09 to 2.07; P = 0.013 and HR 1.91, 95 per cent c.i. 1.64 to 2.23; P < 0.001 respectively) and worse 5-year overall and relative survival (hazard ratio 1.60, 95 per cent c.i. 1.40 to 1.82; P < 0.001 and excess hazard ratio 2.24, 95 per cent c.i. 1.81 to 2.78; P < 0.001 respectively). Subgroup analysis of N stages found that N1c patients had worse outcomes than N0 for distant metastasis and relative survival. For patients with lymph node metastases tumour deposits increased the risks of distant metastasis and worse overall and relative survival, except for N2b patients.Conclusion: Tumour deposits negatively impact the prognosis in colon cancer and must be considered when discussing adjuvant chemotherapy.
|
|
| 9. |
- Lundström, Simon, et al.
(författare)
-
A retrospective cohort study on renal morbidity related to stoma type in inflammatory bowel disease patients following colectomy and ileal pouch-anal anastomosis surgery
-
Ingår i: Scandinavian Journal of Surgery. - 1799-7267.
-
Tidskriftsartikel (refereegranskat)abstract
- AbstractBackground and objective:Defunctioning loop ileostomy (DLI) is frequently used to decrease the consequences of anastomotic leak after ileal pouch-anal anastomosis (IPAA) surgery but is controversial because of stoma-associated morbidity. The aim of this study was to describe stoma-associated morbidity in IPAA–DLI patients compared with terminal ileostomy patients.Methods:Patients treated with colectomy for inflammatory bowel disease at Skåne University Hospital, Sweden, between 2005 and 2021 were eligible for inclusion. Terminal stoma-related morbidity was measured until 12 months after colectomy, IPAA surgery, or conversion to ileorectal anastomosis, whichever occurred first. DLI-related morbidity was measured until 12 months after IPAA surgery or stoma closure, whichever occurred first. Laboratory data were reviewed up to 18 months after surgery since patients without complications were rarely subjected to blood sampling. Data on patient characteristics, renal function, surgical complications, and readmissions were collected retrospectively. Primary outcomes were DLI- and terminal ileostomy-related renal morbidity, whereas secondary outcomes focused on stoma-related complications.Results:The study cohort consisted of 165 patients with terminal ileostomy after colectomy (median (interquartile range (IQR)): stoma time 30 (15–74) months) and 42 patients with IPAA–DLI (median (IQR): stoma time 4 (3–5) months). One case of anastomotic IPAA leakage was observed. IPAA–DLI patients more often required hospital care due to high-volume stoma output immediately after surgery (0–30 days, 29%) compared with terminal ileostomy patients (4%, p < 0.001). There were no significant differences in acute renal injury (p = 0.073) or chronic renal failure (p = 0.936) incidences between the groups. DLI closure was achieved in 95% of IPAA–DLI patients, with 5% suffering Clavien–Dindo complications > 2.Conclusions:IPAA–DLI patients exhibited higher incidence of short-term high-volume stoma output without higher rates of acute renal injury or chronic renal failure compared with terminal ileostomy patients in this small single-center retrospective study suggesting that the risk of renal morbidity in IPAA–DLI patients may have been overestimated.
|
|
| 10. |
- Lundström, Simon, et al.
(författare)
-
Adverse impact of tumor deposits in lymph node negative rectal cancer — a national cohort study
- 2023
-
Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 1432-1262. ; 38, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aimed to investigate the prognostic effect of tumor deposits (TDs) in lymph node negative rectal cancer. Methods Patients who had undergone surgery for rectal cancer with curative intention between 2011 and 2014 were extracted from the Swedish Colorectal Cancer Registry. Patients with positive lymph nodes, undisclosed TD status, stage IV disease, non-radical resections, or any outcome (local recurrence (LR), distant metastasis (DM) or mortality) within 90 days after surgery were excluded. TDs status was based on histopathological reports. Cox-regression analyses were used to examine the prognostic impact of TDs on LR, DM, and overall survival (OS) in lymph node–negative rectal cancer. Results A total of 5455 patients were assessed for inclusion of which 2667 patients were analyzed, with TDs present in 158 patients. TD-positive patients had a lower 5-year DM-free survival (72.8%, p < 0.0001) and 5-year overall survival (75.9%, p = 0.016), but not 5-year LR-free survival (97.6%) compared to TD-negative patients (90.2%, 83.1% and 95.6%, respectively). In multivariable regression analysis, TDs increased the risk of DM [HR 4.06, 95% CI 2.72–6.06, p < 0.001] and reduced the OS [HR 1.83, 95% CI 1.35–2.48, p < 0.001]. For LR, only univariable regression analysis was performed which showed no increased risk of LR [HR 1.88, 95% CI 0.86–4.11, p = 0.11]. Conclusion TDs are a negative predictor of DM and OS in lymph node–negative rectal cancer and could be taken into consideration when planning adjuvant treatment.
|
|
