| 1. |
- Kauppila, Joonas H, et al.
(författare)
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The surgical management of esophago-gastric junctional cancer
- 2016
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Ingår i: Surgical Oncology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0960-7404 .- 1879-3320.
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Tidskriftsartikel (refereegranskat)abstract
- The best available surgical strategy in the treatment of resectable esophago-gastric junctional (EGJ) cancer is a controversial topic. In this review we evaluate the current literature and scientific evidence examining the surgical treatment of locally advanced EGJ cancer by comparing esophagectomy with gastrectomy, transhiatal with transthoracic esophagectomy, minimally invasive with open esophagectomy, and less extensive with more extensive lymphadenectomy. We also assess endoscopic procedures increasingly used for early EGJ cancer. The current evidence does not favor any of the techniques over the others in terms of oncological outcomes. Health-related quality of life may be better following gastrectomy compared to esophagectomy. Minimally invasive procedures might be less prone to surgical complications. Endoscopic techniques are safe and effective alternatives for early-stage EGJ cancer in the short term, but surgical treatment is the mainstay in fit patients due to the risk of lymph node metastasis. Any benefit of lymphadenectomy extending beyond local or regional nodes is uncertain. This review demonstrates the great need for well-designed clinical studies to improve the knowledge in how to optimize and standardize the surgical treatment of EGJ cancer.
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| 2. |
- Afshari, Kevin, et al.
(författare)
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Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case–control study
- 2019
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Ingår i: Surgical Oncology. - : Elsevier BV. - 0960-7404 .- 1879-3320. ; 29, s. 102-106
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim was to identify patient-, tumor- and treatment-related prognostic factors for five-year survival in rectal cancer patients with synchronous stage IV disease. Material and methods: This nationwide case-control study was based on the Swedish Colorectal Cancer Registry with supplementary information from medical records and the Swedish Inpatient Registry during the period 2000–2008. All resected rectal cancer patients with synchronous metastases that survived more than five years were included as cases. The control group consisted of corresponding patients who lived less than five years, matched in a 1:2 based on gender, age, resection of the rectal tumor, and the study period. Results: A total of 405 patients were identified; 99 long-term survivors (LTS) and 182 short-term survivors (STS). Patient-related factors of symptoms and comorbidity did not differ between LTS and STS. Among the treatment-related factors, multiple site metastases (p = 0.007), bilobar liver metastasis (p = 0.002), and increasing number of liver metastasis (p < 0.001) were associated with STS. Prognostic treatment-related factors were preoperative radiotherapy (p = 0.001), metastasectomy (p < 0.001), and radical resection of the primary tumor (p = 0.014). In the multivariable analysis, the single most important factor for becoming a LTS was a metastasectomy (hazard ratio: 8.474, 95% confidence interval: 4.098–17.543). Conclusions: The most important prognostic factor for long-term survival in patients with stage IV rectal cancer was metastasectomy, especially liver surgery. With thorough selection of patients for metastasectomy more patients with metastasized rectal cancer may survive beyond five years. © 2019 Elsevier Ltd
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| 3. |
- Faisal, Mohammed, et al.
(författare)
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Effects of analgesic and surgical modality on immune response in colorectal cancer surgery
- 2021
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Ingår i: Surgial oncology. - : ELSEVIER SCI LTD. - 0960-7404 .- 1879-3320. ; 38
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Different surgical methods, anesthesia, and analgesia are known to modify the surgical stress response, especially in patients with malignancy. We compared the impact of patient-controlled intravenous (PCA) versus epidural analgesia (EDA) on tumor-related mucosal immune response in patients undergoing open or laparoscopic surgery for colorectal cancer. Methods: In a University Hospital subgroup (n = 43) of a larger cohort (n = 235) of patients undergoing open or laparoscopic surgery for colorectal carcinoma randomized to PCA or EDA, colorectal tissues were stained for interleukin-10 (IL-10), tumor necrosis factor (TNF), and mast cell tryptase and then examined by immunofluorescence microscopy. Results: More IL-10+-cells were found in patients undergoing open compared to laparoscopic surgery in the PCA (P < 0.05) and EDA group (P < 0.0005), respectively, and numbers of TNF+-cells were higher in the open surgery group who received PCA (P < 0.05). No differences in IL-10 or TNF expressions were detected between EDA/PCA within the open or laparoscopic surgery groups, respectively. Fewer mast cells were observed in patients undergoing laparoscopic compared to open surgery combined with PCA (P < 0.05). Within the open surgery group, EDA resulted in fewer mucosal mast cells compared to the PCA group (P < 0.05). Conclusions: The surgical method, rather than type of analgesia, may have higher impact on peri-operative inflammation. Laparoscopic surgery when combined with EDA for colorectal cancer caused a decrease in the TNF and IL-10 expression and mast cells. EDA seems to have an anti-inflammatory effect on cancer-related inflammation during open surgery.
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| 6. |
- Lundqvist, Erik, et al.
(författare)
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Hereditary evaluation and genetic counselling in young individuals with colorectal cancer in a population-based cohort
- 2022
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Ingår i: Surgial oncology. - : Elsevier Science Ltd. - 0960-7404 .- 1879-3320. ; 41
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Early-onset colorectal cancer should raise suspicions of a hereditary colorectal cancer (CRC) syndrome, including Lynch syndrome (LS) and Familial Adenomatous Polyposis (FAP). Collection of family history and genetic counselling (GC) is mandatory but previous studies have revealed low awareness of hereditary CRC among clinicians why there has been an incentive to implement universal LS screening. In this population-based cohort study, we aimed to observe the uptake of GC in the Swedish South-Eastern medical care region for young CRC patients and to investigate the frequency of patients diagnosed with LS.& nbsp;Methods: Patients below 50 years of age diagnosed with CRC between 2008 and 2017 were identified from the national Swedish Colorectal Cancer Registry. Medical records were reviewed regarding family history, co-morbidity and referral for GC, with a follow-up time of at least three years.& nbsp;Results: The analysis included 278 patients with 287 tumours, 108 (38%) located in rectum and 179 (62%) in colon. One hundred sixteen (42%) individuals were referred to the Regional Clinical Genetics service, whereof 74 (27%) underwent complete investigation. Thirteen (18%) patients were identified with a mutation, eleven (15%) had LS and two (3%) FAP. The remaining 61 (82%), without proven mutation, were considered as familial CRC. Younger age correlated with a higher chance of referral for GC.& nbsp;Conclusion: The study found that only a minority of young CRC patients underwent genetic counselling, contrary to clinical guidelines. Hereditary CRC is therefore probably underdiagnosed even among young individuals.
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| 7. |
- Ratasvuori, Maire, et al.
(författare)
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Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis
- 2013
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Ingår i: Surgical Oncology. - : Elsevier BV. - 0960-7404 .- 1879-3320. ; 22:2, s. 132-138
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Forskningsöversikt (refereegranskat)abstract
- The number of cancer patients living with metastatic disease is growing. The increased survival has led to an increase in the number of cancer-induced complications, such as pathologic fractures due to bone metastases. Surgery is most commonly needed for mechanical complications, such as fractures and intractable pain. We determined survival, disease free interval and complications in surgically treated bone metastasis. Data were collected from the Scandinavian Skeletal Metastasis Registry for patients with extremity skeletal metastases surgically treated at eight major Scandinavian referral centres between 1999 and 2009 covering a total of 1195 skeletal metastases in 1107 patients. Primary breast, prostate, renal, lung, and myeloma tumors make up 78% of the tumors. Number of complications is tolerable and is affected by methods of surgery as well as preoperative radiation therapy. Overall 1-year patient survival was 36%; however, mean survival was influenced by the primary tumor type and the presence of additional visceral metastases. Patients with impending fracture had more systemic complications than those with complete fracture. Although surgery is usually only a palliative treatment, patients can survive for years after surgery. We developed a simple, useful and reliable scoring system to predict survival among these patients. This scoring system gives good aid in predicting the prognosis when selecting the surgical method. While it is important to avoid unnecessary operations, operating when necessary can provide benefit. (C) 2013 Elsevier Ltd. All rights reserved.
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| 10. |
- Grabau, Dorthe
(författare)
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Breast cancer patients with micrometastases only: Is a basis provided for tailored treatment?
- 2008
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Ingår i: Surgical Oncology. - : Elsevier BV. - 0960-7404. ; 17, s. 211-217
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Tidskriftsartikel (refereegranskat)abstract
- Women with breast cancer and micrometastases only constitute a treatment dilemma. If only a micrometastasis is found in a sentinel lymph node, an axillary lymph node dissection may be considered to be overtreatment and perhaps could be avoided. However, studies have shown decreased survival in patients with micrometastases only. This paper focuses on the pathological work-up behind the classification of breast cancer patients having micrometastases only and on the most recent literature concerning prognosis for breast cancer patients with micrometastases. The goal was to determine if studies to date have been able to define a population of breast cancer patients with micrometastases where the size of the metastasis could indicate whether an axillary lymph node dissection should be undertaken. Tailored surgical treatment of breast cancer patients with micrometastases only is not possible at the present time, due to lack of standardization in the pathological work-up of lymph nodes, which implies that this group of breast cancer patients cannot be delimited with sufficient precision. Tailored systemic therapy is also impossible due to lack of a precisely defined target for a feasible therapy.
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| 11. |
- Hafström, Lars-Olof, 1936, et al.
(författare)
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Isolated hyperthermic liver perfusion with chemotherapy for liver malignancy.
- 1994
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Ingår i: Surgical oncology. - 0960-7404. ; 3:2, s. 103-8
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Tidskriftsartikel (refereegranskat)abstract
- In an open study of unresectable liver tumours, isolated regional perfusion with hyperthermia and cytotoxic drugs has been tested in 29 patients. Four patients had primary hepatocellular cancer, 10 patients had metastases from malignant melanoma, remaining from breast cancer, colorectal cancer, midgut carcinoids and miscellaneous primaries. At laparotomy the proper hepatic artery and portal vein were canulated and connected to a pump oxygenator. The inferior vena cava was canulated with a triple lumen catheter (Perfufix) allowing for porto-caval shunting, drainage of lower body and renal veins to the heart and separate drainage of liver veins to the pump oxygenator. Liver perfusion was performed with a mean flow of 900 ml per min. Melphalan and cis-platinum 0.5 mg/kg body-weight were added to the perfusate for 1 h after liver temperature reached 40 degrees C. Four patients died within 30 days of perfusion due to multiple organ failure. These patients had more than 50% of liver volume occupied by cancer. All surviving patients developed reversible hepato- and renal toxicity. Partial tumour regression was registered in 20% of the patients. Five patients have survived more than three years. Hyperthermic liver perfusion is feasible but in patients with massive liver tumour, there is a significant risk of developing multiple organ failure.
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| 12. |
- Lindnér, Per, 1956, et al.
(författare)
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Regional lymphatic drug exposure following intraperitoneal administration of 5-fluorouracil, carboplatin, and etoposide.
- 1993
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Ingår i: Surgical oncology. - 0960-7404. ; 2:2, s. 105-12
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Tidskriftsartikel (refereegranskat)abstract
- Intraperitoneal (i.p.) administration of chemoterapeutic agents results in greater total drug exposures in the peritoneal cavity than in plasma. A study on the drug exposure for i.p. lymphatics of pigs, receiving 5-fluorouracil (5-FU), etoposide (VP-16) and carboplatin (CBDCA) by the i.p. route was conducted. Drug concentrations in peritoneal fluid, plasma, and thoracic duct lymph were monitored over the ensuing 3 h. 5-FU appeared rapidly in thoracic duct, lymph and plasma. The lymph concentration declined after 20 min while the plasma concentration remained stable. CBDCA reached a stable concentration in lymph and plasma after 60 min. VP-16 peaked in the lymph after 20 min, whereas the plasma concentration continued to rise for 150 min; the peritoneal half-life for VP-16 was too long for clearance to be defined. Total drug exposure (AUC) was for 5-FU 5.7-fold greater for lymph than for plasma and for CBDCA equal in both compartments. VP-16 had a 2.1-fold higher AUC for lymph than for plasma. The results indicate that the i.p. route of administration results in a greater exposure of the lower thoracic duct lymph than the plasma to 5-FU, produces only a marginally increased exposure to VP-16, and results in no difference for CBDCA. The efficacy of 5-FU is a function of total drug exposure. The results reported provide a strong rationale for evaluating the adjuvant use of i.p. 5-FU in colorectal and gastric carcinoma.
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| 15. |
- Naredi, Peter, 1955, et al.
(författare)
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Why do we need a core curriculum in surgical oncology in Europe?
- 2008
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Ingår i: Surgical oncology. - 0960-7404. ; 17:4, s. 267-9
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Tidskriftsartikel (refereegranskat)abstract
- Patients with cancer are often treated by multidisciplinary collaboration between many specialities where thorough knowledge about cancer, and surgical expertise is necessary. Most European surgeons with an interest in surgical oncology were trained according to their local organisations and national regulations. Formal education as per a national training programme is rare and little collaborative effort has taken place within Europe to standardize training between the relevant national surgical societies. The outcome measure of completion of training is vague. Surgical oncology is at present only recognised by a few European countries. Training in surgical oncology has been guided by tradition and common sense rather than by specific aims within the framework of a recognised internationally established core curriculum. Any educational initiative has to be delivered during restricted working hours as determined by European regulation. Accordingly, the actual number of surgical procedures that each trainee will perform under supervision is limited. A modern core curriculum necessitates an evidence-based approach, rather than common sense medicine.
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| 16. |
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| 17. |
- Sandblom, Viktor, 1987, et al.
(författare)
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Local treatment of liver metastases by administration of 177Lu-octreotate via isolated hepatic perfusion – A preclinical simulation of a novel treatment strategy
- 2019
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Ingår i: Surgical Oncology. - : Elsevier BV. - 0960-7404. ; 29, s. 148-156
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Systemic 177Lu-octreotate treatment for metastatic neuroendocrine tumours is restricted by organs at risk. By administering 177Lu-octreotate during isolated hepatic perfusion (IHP), the uptake in organs at risk might be strongly reduced. The aim of this study was to investigate the feasibility to use the combination of IHP and radionuclide therapy. Methods. To simulate IHP, the liver of a pig was prepared for ex vivo perfusion. Blood containing 490 MBq 177Lu-octreotate was circulated through the liver for 60min, after which the liver was rinsed. After IHP, the liver was examined by SPECT/CT. Lastly, an intraoperative gamma detector (IGD) was used to determine 177Lu activity concentration in the liver and results were compared with the activity concentration in corresponding liver biopsies. Results. Detector measurements over the liver during the IHP showed a fast increase with a maximum after approximately 10–15min. After IHP, about 75% of the 177Lu in the liver could be washed out. The SPECT/CT images revealed a relatively inhomogeneous distribution. Nevertheless, the IGD values of 177Lu activity concentration showed acceptable agreement with the biopsy values. Conclusions. Our results in pig show that it could be feasible to treat patients with liver metastases from NETs with 177Lu-octreotate via IHP 177. However, an inhomogeneous distribution of 177Lu-octreotate in normal liver tissue is expected, and in order to determine the activity concentration with satisfactory accuracy using an IGD, measurements need to be performed at several positions over the liver.
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| 18. |
- Papareddy, Praveen, et al.
(författare)
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An antimicrobial helix A-derived peptide of heparin cofactor II blocks endotoxin responses in vivo
- 2014
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Ingår i: Biochimica et Biophysica Acta - Biomembranes. - : Elsevier BV. - 0005-2736 .- 1879-2642 .- 0006-3002. ; 1838:5, s. 1225-1234
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Tidskriftsartikel (refereegranskat)abstract
- Host defense peptides are key components of the innate immune system, providing multi-facetted responses to invading pathogens. Here, we describe that the peptide GKS26 (GKSRIQRLNILNAKFAFNLYRVLICDQ), corresponding to the A domain of heparin cofactor II (HCII), ameliorates experimental septic shock. The peptide displays antimicrobial effects through direct membrane disruption, also at physiological salt concentration and in the presence of plasma and serum. Biophysical investigations of model lipid membranes showed the antimicrobial action of GKS26 to be mirrored by peptide incorporation into, and disordering of, bacterial lipid membranes. GKS26 furthermore binds extensively to bacterial lipopolysaccharide (LPS), as well as its endotoxic lipid A moiety, and displays potent anti-inflammatory effects, both in vitro and in vivo. Thus, for mice challenged with ip injection of LPS, GKS26 suppresses pro-inflammatory cytokines, reduces vascular leakage and infiltration in lung tissue, and normalizes coagulation. Together, these findings suggest that GKS26 may be of interest for further investigations as therapeutic against severe infections and septic shock.
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