| 1. |
- Buunen, M, et al.
(författare)
-
COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer.
- 2009
-
Ingår i: Danish medical bulletin. - 1603-9629 .- 0907-8916. ; 56:2, s. 89-91
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial. METHODS: The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy analysis. RESULTS: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the mid-rectum (41%). CONCLUSION: Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial. Completion of inclusion is expected by the end of 2009. Trial registration: Clinicaltrials.gov, identifier: NCT00297791 (www.clinicaltrials.gov).
|
|
| 2. |
- Siegel, R., et al.
(författare)
-
Laparoscopic extraperitoneal rectal cancer surgery : the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)
- 2011
-
Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 25:8, s. 2423-2440
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline. METHODS: An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference. RESULTS: Laparoscopic surgery for extraperitoneal (mid- and low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not inferior to the open in terms of disease-free survival, overall survival or local recurrence. Laparoscopic pelvic dissection may impair genitourinary and sexual function after rectal resection, like in open surgery. CONCLUSIONS: Laparoscopic surgery for mid- and low-rectal cancer can be recommended under optimal conditions. Still, most level 1 evidence is for colon cancer surgery rather than rectal cancer. Upcoming results from large randomised trials are awaited to strengthen the evidence for improved short-term results and equal long-term results in comparison with the open approach.
|
|
| 3. |
|
|
| 4. |
- Veldkamp, R., et al.
(författare)
-
Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES)
- 2004
-
Ingår i: Surgical endoscopy. - : Springer Science and Business Media LLC. - 1432-2218 .- 0930-2794. ; 18:8, s. 1163-85
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on the laparoscopic resection of colon cancer during the annual congress in Lisbon, Portugal, in June 2002. METHODS: A systematic review of the current literature was combined with the opinions, of experts in the field of colon cancer surgery to formulate evidence-based statements and recommendations on the laparoscopic resection of colon cancer. RESULTS: Advanced age, obesity, and previous abdominal operations are not considered absolute contraindications for laparoscopic colon cancer surgery. The most common cause for conversion is the presence of bulky or invasive tumors. Laparoscopic operation takes longer to perform than the open counterpart, but the outcome is similar in terms of specimen size and pathological examination. Immediate postoperative morbidity and mortality are comparable for laparoscopic and open colonic cancer surgery. The laparoscopically operated patients had less postoperative pain, better-preserved pulmonary function, earlier restoration of gastrointestinal function, and an earlier discharge from the hospital. The postoperative stress response is lower after laparoscopic colectomy. The incidence of port site metastases is <1%. Survival after laparoscopic resection of colon cancer appears to be at least equal to survival after open resection. The costs of laparoscopic surgery for colon cancer are higher than those for open surgery. CONCLUSION: Laparoscopic resection of colon cancer is a safe and feasible procedure that improves short-term outcome. Results regarding the long-term survival of patients enrolled in large multicenter trials will determine its role in general surgery.
|
|
| 5. |
- Bonjer, H Jaap, et al.
(författare)
-
A randomized trial of laparoscopic versus open surgery for rectal cancer.
- 2015
-
Ingår i: The New England journal of medicine. - 1533-4406. ; 372:14, s. 1324-32
-
Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was designed to compare 3-year rates of cancer recurrence in the pelvic or perineal area (locoregional recurrence) and survival after laparoscopic and open resection of rectal cancer.
|
|
| 6. |
- Veldkamp, R., et al.
(författare)
-
Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial
- 2005
-
Ingår i: The lancet oncology. - 1470-2045. ; 6:7, s. 477-84
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The safety and short-term benefits of laparoscopic colectomy for cancer remain debatable. The multicentre COLOR (COlon cancer Laparoscopic or Open Resection) trial was done to assess the safety and benefit of laparoscopic resection compared with open resection for curative treatment of patients with cancer of the right or left colon. METHODS: 627 patients were randomly assigned to laparoscopic surgery and 621 patients to open surgery. The primary endpoint was cancer-free survival 3 years after surgery. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, metastasis, overall survival, and blood loss during surgery. Analysis was by intention to treat. Here, clinical characteristics, operative findings, and postoperative outcome are reported. FINDINGS: Patients assigned laparoscopic resection had less blood loss compared with those assigned open resection (median 100 mL [range 0-2700] vs 175 mL [0-2000], p<0.0001), although laparoscopic surgery lasted 30 min longer than did open surgery (p<0.0001). Conversion to open surgery was needed for 91 (17%) patients undergoing the laparoscopic procedure. Radicality of resection as assessed by number of removed lymph nodes and length of resected oral and aboral bowel did not differ between groups. Laparoscopic colectomy was associated with earlier recovery of bowel function (p<0.0001), need for fewer analgesics, and with a shorter hospital stay (p<0.0001) compared with open colectomy. Morbidity and mortality 28 days after colectomy did not differ between groups. INTERPRETATION: Laparoscopic surgery can be used for safe and radical resection of cancer in the right, left, and sigmoid colon.
|
|
| 7. |
- Deijen, Charlotte L., et al.
(författare)
-
Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer
- 2017
-
Ingår i: Surgical Endoscopy. - : SPRINGER. - 0930-2794 .- 1432-2218. ; 31:6, s. 2607-2615
-
Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up. Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842). In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) -10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI -10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI -11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n = 3 vs. open n = 4). Laparoscopic surgery for non-metastatic colon cancer is associated with similar rates of disease-free survival, overall survival and recurrences as open surgery at 10-year follow-up.
|
|
| 8. |
- Kuhry, E., et al.
(författare)
-
Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer
- 2005
-
Ingår i: Surgical endoscopy. - 1432-2218. ; 19:5, s. 687-92
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: High hospital case volume has been associated with improved outcome after open operation for colorectal malignancies. METHODS: To assess the impact of hospital case volume on short-term outcome after laparoscopic operation for colon cancer, we conducted an analysis of patients who underwent laparoscopic colon resection within the COlon Cancer Laparoscopic or Open Resection (COLOR) trial. RESULTS: A total of 536 patients with adenocarcinoma of the colon were included in the analysis. Median operating time was 240, 210 and 188 min in centers with low, medium, and high case volumes, respectively (p < 0.001). A significant difference in conversion rate was observed among low, medium, and high case volume hospitals (24% vs 24% vs 9%; p < 0.001). A higher number of lymph nodes were harvested at high case volume hospitals (p < 0.001). After operation, fewer complications (p = 0.006) and a shorter hospital stay (p < 0.001) were observed in patients treated at hospitals with high caseloads. CONCLUSIONS: Laparoscopic operation for colon cancer at hospitals with high caseloads appears to be associated with improved short-term results.
|
|
| 9. |
- Mondejar, M. E., et al.
(författare)
-
A review of the use of organic Rankine cycle power systems for maritime applications
- 2018
-
Ingår i: Renewable and Sustainable Energy Reviews. - : Elsevier BV. - 1879-0690 .- 1364-0321. ; 91, s. 126-151
-
Forskningsöversikt (refereegranskat)abstract
- Diesel engines are by far the most common means of propulsion aboard ships. It is estimated that around half of their fuel energy consumption is dissipated as low-grade heat. The organic Rankine cycle technology is a well-established solution for the energy conversion of thermal power from biomass combustion, geothermal reservoirs, and waste heat from industrial processes. However, its economic feasibility has not yet been demonstrated for marine applications. This paper aims at evaluating the potential of using organic Rankine cycle systems for waste heat recovery aboard ships. The suitable vessels and engine heat sources are identified by estimating the total recoverable energy. Different cycle architectures, working fluids, components, and control strategies are analyzed. The economic feasibility and integration on board are also evaluated. A number of research and development areas are identified in order to tackle the challenges limiting a widespread use of this technology in currently operating vessels and new-buildings. The results indicate that organic Rankine cycle units recovering heat from the exhaust gases of engines using low-sulfur fuels could yield fuel savings between 10% and 15%.
|
|
| 10. |
|
|
| 11. |
|
|
| 12. |
- Andreasen, J. G., et al.
(författare)
-
Multi-objective optimization of organic Rankine ycle power plants using pure and mixed working fluids
- 2015
-
Ingår i: Proceedings of ASME ORC 2015. ; , s. 11-
-
Konferensbidrag (refereegranskat)abstract
- For zeotropic mixtures, the temperature varies during phase change, which is opposed to the isothermalphase change of pure fluids. The use of such mixtures as working fluids in organic Rankine cyclepower plants enables a minimization of the mean temperature difference of the heat exchangers whenthe minimum pinch point temperature difference is kept fixed. A low mean temperature differencemeans low heat transfer irreversibilities, which is beneficial for cycle performance, but it also results inlarger heat transfer surface areas. Moreover, the two-phase heat transfer coefficients for zeotropic mixturesare usually degraded compared to an ideal mixture heat transfer coefficient linearly interpolatedbetween the pure fluid values. This entails a need for larger and more expensive heat exchangers. Previousstudies primarily focus on the thermodynamic benefits of zeotropic mixtures by employing firstand second law analyses. In order to assess the feasibility of using zeotropic mixtures, it is, however,important to consider the additional costs of the heat exchangers. In this study, we aim at evaluatingthe economic feasibility of zeotropic mixtures compared to pure fluids. We carry out a multi-objectiveoptimization of the net power output and the component costs for organic Rankine cycle power plantsusing low-temperature heat at 90 ◦C to produce electrical power at around 500 kW. The primary outcomesof the study are Pareto fronts, illustrating the power/cost relations for R32, R134a and R32/R134a(0.65/0.35mole). The results indicate that R32/134a is the best of these fluids, with 3.4 % higher net powerthan R32 at the same total cost of 1200 k$.
|
|
| 13. |
|
|
| 14. |
|
|
| 15. |
- Balasubramanian, Ishwarya, et al.
(författare)
-
Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review
- 2017
-
Ingår i: Digestive Surgery. - : S. Karger AG. - 0253-4886 .- 1421-9883. ; 34, s. 151-160
-
Forskningsöversikt (refereegranskat)abstract
- © 2016 S. Karger AG, Basel. Background: Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice. Aim: To assess outcomes of out-patient management of acute UD. Methods: A comprehensive search for published studies using the search terms 'uncomplicated diverticulitis', 'mild diverticulitis' and 'out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings. Results: The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria. Conclusion: Ambulatory management of acute UD is reasonable in selected patients.
|
|
| 16. |
- Baldasso, Enrico, et al.
(författare)
-
Prediction of the annual performance of marine organic Rankine cycle power systems
- 2018
-
Ingår i: ECOS 2018 - Proceedings of the 31st International Conference on Efficiency, Cost, Optimization, Simulation and Environmental Impact of Energy Systems.
-
Konferensbidrag (refereegranskat)abstract
- The increasing awareness about the environmental impact of shipping and the increasingly stricter regulations introduced by the International Maritime Organization are driving the development of solutions to reduce the pollutant emissions from ships. While some previous studies focused on the implementation of a specific technology, others considered a wider perspective and investigated the feasibility of the integration of various technologies on board vessels. Among the screened technologies, organic Rankine cycle (ORC) power systems represent a viable solution to utilize the waste heat contained in the main engine exhaust gases to produce additional power for on board use. The installation of ORC power systems on board ships could result in a reduction of the CO 2 emissions by 5 – 10 %. Although a number of methods to derive the optimal design of ORC units in marine applications have been proposed, these methods are complex, computationally expensive and require specialist knowledge to be included as part of a general optimization procedure to define the optimal set of technologies to be implemented on board a vessel. This study presents a novel method to predict the performance of ORC units installed on board vessels, based upon the characteristics of the main engine exhaust gases and the ship sailing profile. The method is not computationally intensive, and is therefore suitable to be used in the context of large optimization problems, such as holistic optimization and evaluation of a ship performance given the operational profile, weather and route. The model predicted the annual energy production of two case studies with an accuracy within 4 %.
|
|
| 17. |
- Baldasso, Enrico, et al.
(författare)
-
Technical and economic feasibility of organic Rankine cycle-based waste heat recovery systems on feeder ships: Impact of nitrogen oxides emission abatement technologies
- 2019
-
Ingår i: Energy Conversion and Management. - : Elsevier BV. - 0196-8904. ; 183, s. 577-589
-
Tidskriftsartikel (refereegranskat)abstract
- The International Maritime Organization recently revised the regulations concerning nitrogen and sulphur oxides emissions from commercial ships. In this context, it is important to investigate how emission abatement technologies capable of meeting the updated regulation on nitrogen oxides emissions affect the performance of waste heat recovery units to be installed on board new vessels. The objective of this paper is to assess the potential fuel savings of installing an organic Rankine cycle unit on board a hypothetical liquefied natural gas-fuelled feeder ship operating inside emission control areas. The vessel complies with the updated legislation on sulphur oxides emissions by using a dual fuel engine. Compliance with the nitrogen oxides emission regulation is reached by employing either a high or low-pressure selective catalytic reactor, or an exhaust gas recirculation unit. A multi-objective optimization was carried out where the objective functions were the organic Rankine cycle unit annual electricity production, the volume of the heat exchangers, and the net present value of the investment. The results indicate that the prospects for attaining a cost-effective installation of an organic Rankine unit are larger if the vessel is equipped with a low-pressure selective catalytic reactor or an exhaust gas recirculation unit. Moreover, the results suggest that the cost-effectiveness of the organic Rankine cycle units is highly affected by fuel price and the waste heat recovery boiler design constraints.
|
|
| 18. |
- Björholt, Ingela, 1954, et al.
(författare)
-
Principles for the design of the economic evaluation of COLOR II: an international clinical trial in surgery comparing laparoscopic and open surgery in rectal cancer
- 2006
-
Ingår i: International journal of technology assessment in health care. - : Cambridge University Press (CUP). - 0266-4623 .- 1471-6348. ; 22:1, s. 130-5
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objective is to describe the principles for the design of the economic evaluation of COLOR II, a randomized, multi-country study comparing laparoscopic and open surgery for rectal cancer. METHODS: By using the experiences gained in a recent economic evaluation in colon cancer, where the same surgical techniques were compared, we could improve the method for identifying and measuring resource use items and also accommodate the use of data from the global study population. RESULTS: In the design of the study, the uncertainty in the resource-use variables was reduced by considering (i) what aspects drive each variable, (ii) what resource use is related to the intervention, (iii) how data from different countries affects the variable. CONCLUSIONS: The aim was to refine the data collection so that the economic research question could be answered in the best possible way, given the circumstances in the clinical study. Thus, (i) some variables were treated as stochastic variables and others as deterministic variables, (ii) aggregate key cost-driving resource items were developed that corresponded to clinical events, and (iii) a surrogate variable was selected, instead of the "obvious variable", to reduce the impact of confounding factors for one particular resource unit.
|
|
| 19. |
- Bonjer, H. Jacob, et al.
(författare)
-
Laparoscopically assisted vs open colectomy for colon cancer : a meta-analysis
- 2007
-
Ingår i: Archives of surgery (Chicago. 1960). - 0004-0010 .- 1538-3644. ; 142:3, s. 298-303
-
Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: To perform a meta-analysis of trials randomizing patients with colon cancer to laparoscopically assisted or open colectomy to enhance the power in determining whether laparoscopic colectomy for cancer is oncologically safe. DATA SOURCES: The databases of the Barcelona, Clinical Outcomes of Surgical Therapy (COST), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs Laparoscopic-Assisted Surgery in Patients With Colorectal Cancer (CLASICC) trials were the data sources for the study. STUDY SELECTION: Patients who had at least 3 years of complete follow-up data were selected. DATA EXTRACTION: Patients who had undergone curative surgery before March 1, 2000, were studied. Three-year disease-free survival and overall survival were the primary outcomes of this analysis. DATA SYNTHESIS: Of 1765 patients, 229 were excluded, leaving 796 patients in the laparoscopically assisted arm and 740 patients in the open arm for analysis. Three-year disease-free survival rates in the laparoscopically assisted and open arms were 75.8% and 75.3%, respectively (95% confidence interval [CI] of the difference, -5% to 4%). The associated common hazard ratio (laparoscopically assisted vs open surgery with adjustment for sex, age, and stage) was 0.99 (95% CI, 0.80-1.22; P = .92). The 3-year overall survival rate after laparoscopic surgery was 82.2% and after open surgery was 83.5% (95% CI of the difference, -3% to 5%). The associated hazard ratio was 1.07 (95% CI, 0.83-1.37; P = .61). Disease-free and overall survival rates for stages I, II, and III evaluated separately did not differ between the 2 treatments. CONCLUSION: Laparoscopically assisted colectomy for cancer is oncologically safe.
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
- Janson, M., et al.
(författare)
-
Data validation in an economic evaluation of surgery for colon cancer
- 2005
-
Ingår i: International journal of technology assessment in health care. - 0266-4623 .- 1471-6348. ; 21:2, s. 246-52
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study aimed to validate the accuracy of data retrieved in a prospective multicenter trial, the purpose of which was an economic evaluation of two techniques of surgery for colon cancer. METHODS: Within the Swedish contribution of the COLOR trial (Colon Cancer Open or Laparoscopic Resection), an economic evaluation of open versus laparoscopic surgical techniques was conducted. Data were collected by case record forms (CRF), patient diaries, and telephone surveys every 2 weeks. The study period was 12 weeks, and the perspective was societal. Data from the first consecutive forty patients to complete the health economic study protocol were validated. Retrieved data were compared with data from medical records and data from local social security offices for agreement. RESULTS: Statistically significant differences were found for duration of anesthesia, length of surgery, number of outpatient consultations by doctors and district nurses, complication rate, and the use of central venous lines. No significant differences were observed concerning length of hospital stay, disposable instruments cost, and time off work, all of which heavily influence total costs. CONCLUSIONS: The present method of data collection regarding resources used in this setting seems to produce accurate data for economic evaluation; however, relative to complication rates, the method did not retrieve accurate data.
|
|
| 23. |
- Janson, M., et al.
(författare)
-
Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer
- 2004
-
Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 91:4, s. 409-17
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There has been no randomized clinical trial of the costs of laparoscopic colonic resection (LCR) compared with those of open colonic resection (OCR) in the treatment of colonic cancer. METHODS: A subset of Swedish patients included in the Colon Cancer Open Or Laparoscopic Resection (COLOR) trial was included in a prospective cost analysis; costs were calculated up to 12 weeks after surgery. All relevant costs to society were included. No effects of the procedures, such as quality of life or survival, were taken into account. RESULTS: Two hundred and ten patients were included in the primary analysis, 98 of whom had LCR and 112 OCR. Total costs to society did not differ significantly between groups (difference in means for LCR versus OCR euro1846; P = 0.104). The cost of operation was significantly higher for LCR than for OCR (difference in means euro1171; P < 0.001), as was the cost of the first admission (difference in means euro1556; P = 0.015) and the total cost to the healthcare system (difference in means euro2244; P = 0.018). CONCLUSION: Within 12 weeks of surgery for colonic cancer, there was no difference in total costs to society incurred by LCR and OCR. The LCR procedure, however, was more costly to the healthcare system.
|
|
| 24. |
- Janson, M., et al.
(författare)
-
Randomized trial of health-related quality of life after open and laparoscopic surgery for colon cancer
- 2007
-
Ingår i: Surgical endoscopy. - 1432-2218. ; 21:5, s. 747-53
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Randomized controlled trials (RCTs) have reported improved or unchanged three-year survival following laparoscopic colon resection (LCR) for colon cancer compared with that following open resection (OCR). The aim of this study was to determine health-related quality of life (HRQL) in patients randomized to laparoscopic or open resection for colon cancer. METHODS: In total, 285 patients (130 LCR, 155 OCR) from seven Swedish centers were included. HRQL was assessed preoperatively and at 2, 4, and 12 weeks postoperatively with the EQ-5D and EORTC QLQ-C30 instruments. RESULTS: The LCR patients did significantly better on the social function component of the EORTC QLQ-C30 at two and four weeks and on the role function component at two weeks. CONCLUSION: Laparoscopic resection for colon cancer improved quality of life during the first postoperative month.
|
|
| 25. |
|
|
| 26. |
- Nilsson, Stefan, 1972, et al.
(författare)
-
Evaluating pictorial support in person-centred care for children (PicPecc) : A protocol for a crossover design study
- 2021
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:5
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5-17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison.Methods and analysis Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child's perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology.Ethics and dissemination Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council's guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals.Trial registration ClinicalTrials.gov; NCT04433650.
|
|
| 27. |
|
|
| 28. |
- Petersson, Josefin, et al.
(författare)
-
Bowel Obstruction and Ventral Hernia After Laparoscopic Versus Open Surgery for Rectal Cancer in A Randomized Trial (COLOR II).
- 2019
-
Ingår i: Annals of surgery. - 1528-1140. ; 269:1, s. 53-57
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the risk of bowel obstruction, incisional, and parastomal hernia following laparoscopic versus open surgery for rectal cancer.Laparoscopic surgery for rectal cancer has been adopted worldwide, after trials reported similar oncological outcomes compared with open surgery. Little is known about long-term morbidity, including bowel obstruction, incisional, and parastomal hernia following surgery.Patients included in the international, multicenter, noninferior, open-label, randomized COLOR II trial were followed for five years. Primary endpoint was local recurrence at 3-year follow-up. Secondary endpoints included bowel obstruction, incisional and parastomal hernia within 5 years, and the current article reports on these secondary endpoints.All 1044 patients included in the COLOR II trial were analyzed. There was no difference in risk of bowel obstruction, incisional, or parastomal hernia following laparoscopic or open surgery for rectal cancer.Based on long-term morbidity outcomes, laparoscopic surgery for rectal cancer could be considered a routine technique as there are no differences with open surgery.
|
|
| 29. |
- Pierobon, L., et al.
(författare)
-
Thermodynamic analysis of an integrated gasification solid oxide fuel cell plant combined with an organic Rankine cycle
- 2013
-
Ingår i: Renewable Energy. - 0960-1481 .- 1879-0682. ; 60, s. 226-234
-
Tidskriftsartikel (refereegranskat)abstract
- A 100 kWe hybrid plant consisting of gasification system, solid oxide fuel cells and organic Rankine cycle is presented. The nominal power is selected based on cultivation area requirement. For the considered output a land of around 0.5 km2 needs to be utilized. Woodchips are introduced into a fixed bed gasification plant to produce syngas which fuels the combined solid oxide fuel cells e organic Rankine cycle system to produce electricity. More than a hundred fluids are considered as possible alternative for the organic cycle using non-ideal equations of state (or state-of-the-art equations of state). A genetic algorithm is employed to select the optimal working fluid and the maximum pressure for the bottoming cycle. Thermodynamic and physical properties, environmental impacts and hazard specifications are also considered in the screening process. The results suggest that efficiencies in the region of 54e56% can be achieved. The highest thermal efficiency (56.4%) is achieved with propylcyclohexane at 15.9 bar. A comparison with the available and future technologies for biomass to electricity conversion is carried out. It is shown that the proposed system presents twice the thermal efficiency achieved by simple and double stage organic Rankine cycle plants and around the same efficiency of a combined gasification, solid oxide fuel cells and micro gas turbine plant.
|
|
| 30. |
- Samuelsson, Andreas, 1977, et al.
(författare)
-
Laparoscopic lavage for perforated diverticulitis in the LapLav study: population-based registry study.
- 2021
-
Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 108:10, s. 1236-1242
-
Tidskriftsartikel (refereegranskat)abstract
- The standard treatment for Hinchey III perforated diverticulitis with peritonitis was resection with or without a stoma, but recent trials have shown that laparoscopic lavage is a reasonable alternative. This registry-based Swedish study investigated results at a national level to assess safety in real-world scenarios.Patients in Sweden who underwent emergency surgery for perforated diverticulitis between 2016 and 2018 were studied. Inverse probability weighting by propensity score was used to adjust for confounding factors.A total of 499 patients were included in this study. Laparoscopic lavage was associated with a significantly lower 90-day Comprehensive Complication Index (20.9 versus 32.0; odds ratio 0.77, 95 per cent compatibility interval (c.i.) 0.61 to 0.97) and overall duration of hospital stay (9 versus 15days; ratio of means 0.84, 95 per cent c.i. 0.74 to 0.96) compared with resection. Patients had 82 (95 per cent c.i. 39 to 140) per cent more readmissions following lavage than resection (27.2 versus 21.0 per cent), but similar reoperation rates. More co-morbidity was noted among patients who underwent resection than those who had laparoscopic lavage.Laparoscopic lavage is safe in routine care beyond trial evaluations.
|
|
| 31. |
- W A Koedam, Thomas, et al.
(författare)
-
Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence
- 2020
-
Ingår i: National Center for Biotechnology information.
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate oncological outcome for patients with and without anastomotic leakage after colon or rectal cancer surgery. Summary of background data: The role of anastomotic leakage in oncological outcome after colorectal cancer surgery is still topic of debate and impact on follow-up and consideration for further treatment remains unclear. Methods: Patients included in the international, multicenter, non-inferior, open label, randomized, controlled trials COLOR and COLOR II, comparing laparoscopic surgery for curable colon (COLOR) and rectal (COLOR II) cancer with open surgery, were analyzed. Patients operated by abdominoperineal excision were excluded. Both univariate and multivariate analyses were performed to investigate the impact of leakage on overall survival, disease-free survival, local and distant recurrences, adjusted for possible confounders. Primary endpoints in the COLOR and COLOR II trial were disease-free survival and local recurrence at 3-year follow-up, respectively, and secondary endpoints included anastomotic leakage rate. Results: For colon cancer, anastomotic leakage was not associated with increased percentage of local recurrence or decreased disease-free-survival. For rectal cancer, an increase of local recurrences (13.3% vs 4.6%; hazard ratio 2.96; 95% confidence interval 1.38-6.34; P = 0.005) and a decrease of disease-free survival (53.6% vs 70.9%; hazard ratio 1.67; 95% confidence interval 1.16-2.41; P = 0.006) at 5-year follow-up were found in patients with anastomotic leakage. Conclusion: Short-term morbidity, mortality, and long-term oncological outcomes are negatively influenced by the occurrence of anastomotic leakage after rectal cancer surgery. For colon cancer, no significant effect was observed; however, due to low power, no conclusions on the influence of anastomotic leakage on outcomes after colon surgery could be reached. Clinical awareness of increased risk of local recurrence after anastomotic leakage throughout the follow-up is mandatory. Trial registration: Registered with ClinicalTrials.gov, number NCT00387842 and NCT00297791.
|
|
