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- Segelman, J., et al.
(författare)
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Risk factors for anastomotic leakage following ileosigmoid or ileorectal anastomosis
- 2018
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Ingår i: Colorectal Disease. - : Wiley-Blackwell Publishing Inc.. - 1462-8910 .- 1463-1318. ; 20:4, s. 304-311
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Tidskriftsartikel (refereegranskat)abstract
- AimReconstruction with an ileosigmoidal anastomosis (ISA) or ileorectal anastomosis (IRA) is a surgical option after a subtotal colectomy. Anastomotic leakage (AL) is a problematic complication and high rates have been reported, but there is limited understanding of the risk factors involved. The aim of this study was to assess the established and potential predictors of AL following ISA and IRA.MethodThis was a retrospective cohort study including all patients who had undergone ISA or IRA at three Swedish referral centres for colorectal surgery between January 2007 and March 2015. Data regarding clinical characteristics, treatment and outcome were collected from medical records. Univariate and multivariate logistic regression models were used to determine the association between patient and treatment related factors and the cumulative incidence of AL.ResultsIn total, 227 patients were included. Overall, AL was detected amongst 30 patients (13.2%). Amongst patients undergoing colectomy with synchronous ISA or IRA (one‐stage procedure), AL occurred in 23 out of 120 (19.2%) compared with seven out of 107 (6.5%) after stoma reversal with ISA or IRA (two‐stage procedure) (P = 0.004). In addition, the multivariate analyses revealed a statistically significantly lower odds ratio for AL following a two‐stage procedure (OR 0.10, 95% CI 0.03–0.41, P = 0.001).ConclusionsThis study confirms high rates of AL following ISA and IRA. In particular, a synchronous procedure with colectomy and ISA/IRA carries a high risk of AL.
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- Styrud, J, et al.
(författare)
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Diagnostic accuracy in 2,351 patients undergoing appendicectomy for suspected acute appendicitis: A retrospective study 1986-1993
- 1999
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Ingår i: Digestive surgery. - : S. Karger AG. - 0253-4886 .- 1421-9883. ; 16:1, s. 39-44
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Tidskriftsartikel (refereegranskat)abstract
- <i>Aims: </i>To investigate the pre-operative findings, accuracy, perforation rate and complication rate in 2,351 patients who underwent appendicectomy during 1986–1993. <i>Method: </i>The 2,351 records from patients who underwent surgery were analysed to determine whether the pre-operative investigations introduced can improve the diagnostic accuracy when analysed in total. <i>Results: </i>The total diagnostic accuracy which was 70.9% in 1986 increased to a statistically significant figure of 87.1% in 1993. In female patients, the figure increased from 61.7 to 82.4% and in males from 82.0 to 91.2% during the studied period. The complication rate was in total 10.4% including a mortality of 0.21% (5 patients). <i>Conclusion: </i>We believe that with a combination of increased interest in patients with acute appendicitis, a wider use of active in-hospital observation, a more standardised pre-operative laboratory investigation and the use of ultrasonography, a high diagnostic accuracy could be reached without an increased rate of complications and perforations.
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- Golshani, P., et al.
(författare)
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The modified Glasgow Prognostic Score indicates an increased risk of anastomotic leakage after anterior resection for rectal cancer
- 2023
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 38:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPreoperative inflammation might cause and also be a marker for anastomotic leakage after anterior resection for rectal cancer. Available biomarker indices such as the modified Glasgow Prognostic Score (mGPS) or the C-reactive protein-to-albumin ratio (CAR) may be clinically useful for leakage assessment.MethodsPatients who underwent anterior resection for rectal cancer during 2014-2018 from a multicentre retrospective cohort were included. Data from the Swedish Colorectal Cancer registry and chart review at each hospital were collected. In a subset of patients, preoperative laboratory assessments were available, constituting the exposures mGPS and CAR. Anastomotic leakage within 12 months was the outcome. Causally oriented analyses were conducted with adjustment for confounding, as well as predictive models.ResultsA total of 418 patients were eligible for analysis. Most patients had mGPS = 0 (84.7%), while mGPS = 1 (10.8%) and mGPS = 2 (4.5%) were less common. mGPS = 2 (OR: 4.11; 95% CI: 1.69-10.03) seemed to confer anastomotic leakage, while this was not seen for mGPS = 1 (OR 1.09; 95% CI: 0.53-2.25). A cut off point of CAR > 0.36 might be indicative of leakage (OR 2.25; 95% CI: 1.21-4.19). Predictive modelling using mGPS rendered an area-under-the-curve of 0.73 (95% CI: 0.67-0.79) at most.DiscussionPreoperative inflammation seems to be involved in the development of anastomotic leakage after anterior resection for cancer. Inclusion into prediction models did not result in accurate leakage prediction, but high degrees of systemic inflammation might still be important in clinical decision-making.
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- Segelman, J., et al.
(författare)
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Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer
- 2012
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 99:5, s. 699-705
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Tidskriftsartikel (refereegranskat)abstract
- Background: This was a population-based cohort study to determine the incidence, prevalence and risk factors for peritoneal carcinomatosis (PC) from colorectal cancer. Methods: Prospectively collected data were obtained from the Regional Quality Registry. The Cox proportional hazards regression model was used for multivariable analysis of clinicopathological factors to determine independent predictors of PC. Results: All 11 124 patients with colorectal cancer in Stockholm County during 1995-2007 were included and followed until 2010. In total, 924 patients (8.3 per cent) had synchronous or metachronous PC. PC was the first and only localization of metastases in 535 patients (4.8 per cent). The prevalence of synchronous PC was 4.3 per cent (477 of 11 124). The cumulative incidence of metachronous PC was 4.2 per cent (447 of 10 646). Independent predictors for metachronous PC were colonic cancer (hazard ratio (HR) 1.77, 95 per cent confidence interval 1.31 to 2.39; P = 0.002 for right-sided colonic cancer), advanced tumour (T) status (HR 9.98, 3.10 to 32.11; P < 0.001 for T4), advanced node (N) status (HR 7.41, 4.78 to 11.51; P < 0.001 for N2 with fewer than 12 lymph nodes examined), emergency surgery (HR 2.11, 1.66 to 2.69; P < 0.001) and non-radical resection of the primary tumour (HR 2.75, 2.10 to 3.61; P < 0.001 for R2 resection). Patients aged > 70 years had a decreased risk of metachronous PC (HR 0.69, 0.55 to 0.87; P = 0.003). Conclusion: PC is common in patients with colorectal cancer and is associated with identifiable risk factors.
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- Segelman, J., et al.
(författare)
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Preoperative sexual function in women with rectal cancer
- 2013
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983. ; 39:10, s. 1079-1086
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Tidskriftsartikel (refereegranskat)abstract
- Background: Even though sexual dysfunction has been reported after rectal cancer treatment, information on preoperative sexual function is scarce, particularly in female patients. Aims: To describe preoperative sexual function in women with rectal cancer, and to analyse potential sources of bias. Methods: The Female Sexual Function Index (FSFI) was administered to women with newly diagnosed non-metastatic rectal cancer, irrespective of whether they were sexually active or not. FSFI total and domain scores were calculated for women with complete responses to the corresponding items. Data were compared for those who did and did not complete all the FSFI domains, and for women in the study cohort, and those who were eligible for inclusion but not included. Results: Sexual inactivity was common. Mean FSFI total score was low (16.4 +/- 10.6 SD) among the women who completed all six FSFI domains. The proportion of women who had a partner was higher in this group compared with those who did not complete all the domains (49 of 57 vs 7 of 25, p < 0.001). Eighty-two of the 157 women eligible for inclusion were included. Included women were younger (p = 0.002) and had less co-morbidity than those who were not included (p = 0.025). Conclusions: The low FSFI total score indicates sexual dysfunction. However, the use of FSFI in both women who are and who are not sexually active complicates interpretation of the data and may result in an information bias hampering internal validity. External validity may be limited by selection bias. (c) 2013 Elsevier Ltd. All rights reserved.
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