| 1. |
- Karlson, Britt-Marie, et al.
(författare)
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Intraarterial chemoembolisation with lipiodol and epirubicin in hepatocellular cancer : improved survival in some patients?
- 1999
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Ingår i: Annales Chirurgiae et Gynaecologiae. - 0355-9521. ; 88:4, s. 264-268
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Arterial chemoembolisation with lipiodol and a cytotoxic drug is reported to give equivocal results in irresectable primary hepatocellular cancer (HCC). In order to further elucidate the possible response to this treatment, we analysed the results of all patients with irresectable HCC treated with chemoembolisation at our hospital. MATERIAL AND METHODS: 58 consecutive patients with HCC were treated with lipiodolepirubicin chemoembolisation between February 1988 - October 1994 and followed until death or October 1998. RESULTS: The average survival was 11.7 months and median survival was 6 months. 17 patients had only one treatment mostly due to death within 6 weeks after the first treatment. Patients with an open portal system at inclusion (50% of all) were found to have significantly increased survival after 6 and 12 months compared to those with portal obstruction. The subgroup of patients displaying a decrease in tumour size as judged by repeated CT scan 6 months after inclusion had significantly increased survival; all survived more than 12 months (median survival 30 months). CONCLUSIONS: Chemoembolisation with lipiodol-epirubicin may have an impact on survival on selected patients with irresectable hepatocellular cancer. The treatment may justifiably be offered patients with an open portal venous system and without liver failure.
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| 2. |
- Rasmussen, Ib Christian, et al.
(författare)
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Biliary pancreatic portal fistula as a complication of chronic pancreatitis. A case report with review of the literature
- 2006
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Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 111:3, s. 329-338
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Tidskriftsartikel (refereegranskat)abstract
- In this study we describe an unusual complication in a patient suffering from chronic calcifying pancreatitis. The patient had a fistula between the common bile duct, the pancreatic duct, and the portal vein. He received supportive medical treatment and achieved long-term survival. A review of the literature including diagnosis, treatment and outcome of this rare complication is presented.
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| 3. |
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| 4. |
- Langerth, Ann
(författare)
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Endoscopic retrograde cholangiopancreatography : Perforation and long-term outcomes after endoscopic sphincterotomy
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Endoscopic retrograde cholangio pancreatography (ERCP) is a commonly used procedure in various disorders of the pancreatobiliary tract. When extracting common bile duct stones (CBDS), the major duodenal papilla is divided using a papillotome to perform an endoscopic sphincterotomy (ES). Adverse events occurring shortly after ES are well-known and include perforation which, however, is difficult to investigate due to its low frequency. ES is often used in elderly and/or infirm patients with gallstone pancreatitis and cholangitis, to prevent relapse in biliary events linked to CBDS. Subsequent cholecystectomy in these patients remains controversial. What happens in the long term after ES is still partially unknown.In Paper I, we found an increased risk for both cholangitis and pancreatitis after ES for CBDS, without synchronic relapse of CBDS and when compared with the general population was found. In Paper II, we retained the ES group, but replaced the control group with controls with a history of gallstone disease. The increased risk for both cholangitis and pancreatitis without relapse of CBDS still remains but, no higher risk for malignancy in the pancreatobiliary tract was noted.We conducted study III, a prospective follow-up after ES, to evaluate to what extent ES prevents relapse into biliary events after cholangitis and pancreatitis caused by bile duct stones. We included 100 patients who did not have earlier gallbladder surgery and who were treated for pancreatitis and/or cholangitis. The patients then underwent ES but not cholecystectomy and were followed for a mean of 42 months. None of the patients had recurrent pancreatitis and one had cholangitis. This indicates that ES alone is an alternative to cholecystectomy in the prevention of further attacks of acute pancreatitis and cholangitis.Paper IV consists of 52,140 ERCPs that were registered with GallRiks, a Swedish population based register. A total of 376 cases were registered as perforations and 75 patients had a fatal outcome. These data showed that sphincterotomy in the pancreatic duct increased the risk of death from perforation but the risk of death was reduced when ERCP was performed at a Q4 centre.
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| 5. |
- Langerth, Ann, et al.
(författare)
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ERCP‑related perforations : a population‑based study of incidence,mortality, and risk factors
- 2020
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 34, s. 1939-1947
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study.Methods: Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1-3) groups. Furthermore, fatal group patients' records were reviewed.Results: Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8-21.6), age over 80 years (OR 3.8, 95% CI 2.0-7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1-7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%, p = 1.0), but in Q1-3 centers mortality was higher (45% vs. 21%, p = 0.024).Conclusions: ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.
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| 6. |
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| 7. |
- Månsson, Christopher, et al.
(författare)
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An unusual presentation of a solid pseudopapillary pancreatic tumor
- 2012
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Ingår i: Journal of Surgical Case Reports. - : Oxford University Press (OUP). - 2042-8812. ; :12
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Solid pseudopapillary pancreatic tumor (SPPT) is a rare tumor that constitutes 1–2% of all pancreatic tumors and most of the patients are young females. SPPT has low malignancy potential and radical resection is associated with good results and a high survival rate, even in cases with large tumors: the 5-year survival rate is estimated as 95%. This paper describes an unusual presentation of an SPPT discovered after blunt trauma to the abdomen during a basketball game. Computed tomography revealed a large tumor in the pancreatic head and the patient was operated by pylorus-preseving pancreaticoduodenectomy. The histopathologic examination indicated an SPPT with R0-resection and after 4 years there were no signs of recurrence.
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| 8. |
- Månsson, Christopher
(författare)
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Irreversible electroporation of pancreatic adenocarcinoma
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pancreatic cancer (PC) is a severe diagnosis with poor prognosis. Radical surgery is the only treatment that can possibly lead to a cure, and even with surgery, the 5-year survival is only 20%–25%. The majority of patients cannot be resected due to metastases or having a tumour that is too advanced locally (LAPC) with encasement of blood-vessels.Short electrical pulses can change the cell membrane, creating reversible pores in it. With a higher current, the pores become permanent, resulting in irreversible electroporation (IRE). This leads to specific cell death, with the chance to save surrounding scaffold material, such as the walls of blood vessels and bile ducts. This led to the theory that IRE might be suitable for treating LAPC.In Paper I, we found that IRE can be safely performed percutaneously with ultrasound guidance in humans with PC, with promising efficacy, since one of the five patients included was downstaged due to the IRE and could be surgically resected. In Paper II, which is an extension of Paper I, we treated 24 patients with LAPC (3 were also included in Paper I) who had received chemotherapy and, after IRE, stable disease was seen. Median overall survival was 17.9 months. Eleven patients had some form of complication, but we still concluded that IRE is reasonably safe in LAPC patients, with promising efficacy. In Paper III, we chose to treat LAPC with IRE followed by adjuvant chemotherapy. We compared the overall survival of our patients with those with LAPC in the National Quality Registry for Pancreatic and Periampullary Cancer. No significant survival gain could be seen in the group that received IRE compared to the registry group (13.3 months versus 9.9 months, p=0.511). In the IRE group, there were six major complications and we found no support for using IRE in this setting. Paper IV examines the response on the tumour marker CA19-9 in PC treated with IRE. We found 35 patients suitable for this analysis. The hypothesis that IRE would lower the CA19-9 value could not be proven. In fact, the CA19-9 was slightly higher one month after IRE (282 U/ml versus 315 U/ml). However, the 25th percentile of patients with the best CA19-9 response had a better survival (p=0.01) compared to the 25th percentile with the worst response, indicating that CA19-9 can be used as a prognostic marker after IRE in PC.
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| 9. |
- Månsson, Christopher, Läkarexamen, 1977-, et al.
(författare)
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Percutaneous Irreversible Electroporation as First Line Treatment of Locally Advanced Pancreatic Cancer
- 2019
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Ingår i: Anticancer Research. - : Anticancer Research USA Inc.. - 0250-7005 .- 1791-7530. ; 39:5, s. 2509-2512
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim:Irreversible electroporation (IRE) has recently been used as an experimental ablation treatment following systemic chemotherapy in locally advanced pancreatic cancer (LAPC). The primary aim of this study was to evaluate survival of LAPC patients after IRE prior to chemotherapy. The secondary aim was to examine the complication rates.Patients and Methods:Twenty-four patients with LAPC were included and treated with percutaneous ultrasound-guided IRE under general anesthesia. Survival data from the National Quality Registry for Pancreatic and Periampullary Cancer for LAPC during the same period were used for comparison.Results:The median survival after diagnosis was 13.3 months in the IRE group compared to 9.9 months in the registry group (p=0.511). Six patients had a severe complication after IRE treatment.Conclusion:No obvious gain in survival was observed with IRE as the first line treatment of LAPC and IRE was associated with severe complications. This study does not support percutaneous IRE in this setting.
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| 10. |
- Månsson, Christopher, et al.
(författare)
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Percutaneous irreversible electroporation for treatment of locally advanced pancreatic cancer following chemotherapy or radiochemotherapy
- 2016
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 42:9, s. 1401-1406
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Tidskriftsartikel (refereegranskat)abstract
- Background: Irreversible electroporation (IRE) is a non-thermal based tumor ablation method used close to vessels and ducts and has the potential of treating locally advanced pancreatic cancer (LAPC). The aim of this study was to evaluate the efficacy and safety of IRE in patients with LAPC after chemo- and/or radio-chemotherapy.Method: Twenty-four patients with biopsy proven LAPC and who had received chemo- and/or radio-chemotherapy with no signs of metastases were included and treated with ultrasound guided percutaneous IRE under general anesthesia.Results: The median overall survival from diagnosis of LAPC was 17.9 months; this included 7.0 months after IRE. Median time from IRE was 6.1 months to local progression and 2.7 months to observation of metastases. Local control was observed in nine patients. IRE related complications were observed in 11 patients, three of which were serious complications. There was no IRE related mortality.Conclusion: Percutaneous IRE is reasonably safe in LAPC after chemo-/radio-chemotherapy and with promising results regarding efficacy.
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