| 1. |
- Agger, Erik, et al.
(författare)
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Circumferential resection margin and local recurrence after rectal cancer surgery: a population-based study cohort
- 2019
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 21:S3, s. 22-22
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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
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| 2. |
- Buchwald, Fredrik, et al.
(författare)
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Atrial Fibrillation in Transient Ischemic Attack Versus Ischemic Stroke : A Swedish Stroke Register (Riksstroke) Study
- 2016
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Ingår i: Stroke: a journal of cerebral circulation. - 0039-2499. ; 47:10, s. 2456-2461
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE—: Compared with ischemic stroke (IS), the association of atrial fibrillation (AF) with transient ischemic attack (TIA) is less well established. We aimed to assess the proportion of AF in patients with TIA, and these patients’ characteristics and secondary preventive treatment in comparison to patients with IS. METHODS—: Hospital-based data on TIA and IS events, registered from July 2011 to June 2013, were obtained from the Swedish Stroke Register (Riksstroke). A time-based TIA definition (duration of symptoms <24 hours) was applied. AF was registered as present when previously known or diagnosed at the time of assessment. RESULTS—: AF was present in 2779 of 14 980 (18.6%) patients with TIA and 13 258 of 44 173 (30.0%) patients with IS. The proportion of AF increased with age, reaching 32.9% in TIA and 46.6% in IS patients ≥85 years. Both in TIA and IS, age, hypertension, a history of stroke, and TIA, and being a nonsmoker were associated with the presence of AF. In contrast to IS, AF was less common in female than in male patients with TIA. At discharge, 64.2% of TIA and 50.0% of IS patients with AF were treated with oral anticoagulants. Proportions of AF patients treated with oral anticoagulants decreased substantially with increasing age. CONCLUSIONS—: AF is highly prevalent not only in IS but also in TIA patients, with proportions steeply increasing with age. In both TIA and IS, a substantial proportion of patients with AF were discharged without anticoagulant therapy.
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| 3. |
- Buchwald, Fredrik
(författare)
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TIA in the Swedish Stroke Register (Riksstroke). Aspects on diagnostic validation, risk factors, investigations, and therapies
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Transient ischemic attacks (TIA) indicate an increased risk of stroke, one of the leading causes of death and disability worldwide. In order to prevent stroke, our knowledge of diagnosis, demographics, risk factors, investigations, and treatment of patients with TIA needs to be improved.Aims: The aims of this thesis were to validate data and diagnoses in the Riksstroke TIA module (Riksstroke-TIA), to clarify the role of atrial fibrillation (AF) in TIA and the extent of oral anticoagulant (OAC) treatment in patients with AF, to assess characteristics, risk factors, and secondary preventive treatment in TIA patients with a history of stroke in comparison to those without, and evaluate the degree of carotid imaging and determinants for its non-use in patients with TIA.Methods: Paper I was based on a study sample of 180 patients from 6 different hospitals, extracted from the cohort of patients registered in Riksstroke-TIA between 1/7/2011 to 30/6/2012 (n=7825). Medical files were retrieved from each hospital. Paper II – IV were based on data from patients registered in Riksstroke-TIA between 1/7/2011 to 30/6/2013 (n=15064). For comparison, data on patients with ischemic stroke (IS) registered in Riksstroke during the corresponding period of time were included in paper II – IV (n=44416).ResultsPaper I: Two independent assessors agreed on a likely or possible diagnosis of TIA in 77% (137/180), in 3% (5/180) on a diagnosis of IS, and in 2% (3/180) that a diagnosis of TIA was unlikely. The quality of documentation was fair.Paper II: AF was present in 19% (2779/14980) of patients with TIA compared to 30% (13258/44173) in those with IS. Proportions of AF increased markedly with age. At discharge, 64% (1778/2771) of patients with TIA and AF and 50% (5502/10899) of patients with IS and AF were treated with OACs.Paper III: Patients with TIA and a history of stroke were older, more likely to be male, and they had higher proportions of AF, hypertension, and diabetes mellitus than those without a history of stroke. In TIA patients with prior stroke aged ≥85 years, AF was present in 41% (300/724) compared to 30% (604/2028) in those without prior stroke. At discharge, levels of OAC treatment in TIA patients with AF and prior stroke were lower than in those without prior stroke.Paper IV: Carotid imaging was performed in 70% (10545/15023) of patients with TIA. Determinants for its non-use were age ≥85 years, age 74-84 years, female sex, AF, a history of stroke, and care at a non-university hospital. There were substantial regional variations regarding proportions of carotid imaging, especially in the very elderly.Conclusions: There was interobserver agreement on TIA diagnoses in a majority of cases. More systematic documentation aided by a guide or checklist might improve diagnostic certainty. Data registered in Riksstroke-TIA was valid and suited for scientific evaluation. AF was a common but insufficiently treated risk factor in TIA. Certain patient groups appeared neglected with regard to carotid imaging and secondary preventive treatment, namely the very elderly, women, those with AF, and a history of stroke. Opportunities of secondary prevention were likely missed in a substantial number of patients.
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| 4. |
- Buchwald, Fredrik, et al.
(författare)
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Validation of Diagnoses of Transient Ischemic Attack in the Swedish Stroke Register (Riksstroke) TIA-Module
- 2015
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Ingår i: Neuroepidemiology. - : S. Karger. - 0251-5350 .- 1423-0208. ; 45:1, s. 40-43
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2010, the Swedish Stroke Register (Riksstroke; RS) established a module for transient ischemic attacks (RS-TIA). We report a diagnostic validation study of patients included in RS-TIA.Methods: During the first year, 7,825 patients were registered at 59 out of 74 Swedish hospitals. A time-based TIA definition was applied. A sample of 180 patients (30 patients each from 6 hospitals), with a similar distribution of age and sex as in RS-TIA, was prepared. Two independent observers assessed medical records for quality of documentation and assigned a diagnosis of likely, possible, unlikely TIA or ischennic stroke, according to pre-specified criteria.Results:The 2 observers agreed in 77% of cases that the event was a likely or possible TIA, in 3% that the event was an ischemic stroke, and in 2% that the event was an unlikely TIA. The observers disagreed in 8% of patients on TIA vs. ischennic stroke, and in 11% on a vascular vs. non-vascular cause. Quality of documentation was fair.Conclusions: There was interobserver agreement on diagnosis of TIA in the majority of patients included in RS-TIA. Diagnostic accuracy may be further improved by more systematic documentation of symptoms and signs.
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| 5. |
- Olofsson, Fredrik, et al.
(författare)
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No benefit of extended mesenteric resection with central vascular ligation in right-sided colon cancer.
- 2016
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910.
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Tidskriftsartikel (refereegranskat)abstract
- The optimal extent of mesenteric resection in colon cancer surgery is not known. We have previously shown an increased mortality associated with wider mesenteric resection in right hemicolectomy. This study compares the short and long-term outcome in three variations of right hemicolectomy based on the position of the vascular ligature in the mesentery.
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| 6. |
- Schultz, Johannes Kurt, et al.
(författare)
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Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis : The SCANDIV Randomized Clinical Trial
- 2015
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 314:13, s. 1364-1375
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Perforated colonic diverticulitis usually requires surgical resection, which is associated with significant morbidity. Cohort studies have suggested that laparoscopic lavage may treat perforated diverticulitis with less morbidity than resection procedures.OBJECTIVE: To compare the outcomes from laparoscopic lavage with those for colon resection for perforated diverticulitis.DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized clinical superiority trial recruiting participants from 21 centers in Sweden and Norway from February 2010 to June 2014. The last patient follow-up was in December 2014 and final review and verification of the medical records was assessed in March 2015. Patients with suspected perforated diverticulitis, a clinical indication for emergency surgery, and free air on an abdominal computed tomography scan were eligible. Of 509 patients screened, 415 were eligible and 199 were enrolled.INTERVENTIONS: Patients were assigned to undergo laparoscopic peritoneal lavage (n = 101) or colon resection (n = 98) based on a computer-generated, center-stratified block randomization. All patients with fecal peritonitis (15 patients in the laparoscopic peritoneal lavage group vs 13 in the colon resection group) underwent colon resection. Patients with a pathology requiring treatment beyond that necessary for perforated diverticulitis (12 in the laparoscopic lavage group vs 13 in the colon resection group) were also excluded from the protocol operations and treated as required for the pathology encountered.MAIN OUTCOMES AND MEASURES: The primary outcome was severe postoperative complications (Clavien-Dindo score >IIIa) within 90 days. Secondary outcomes included other postoperative complications, reoperations, length of operating time, length of postoperative hospital stay, and quality of life.RESULTS: The primary outcome was observed in 31 of 101 patients (30.7%) in the laparoscopic lavage group and 25 of 96 patients (26.0%) in the colon resection group (difference, 4.7% [95% CI, -7.9% to 17.0%]; P = .53). Mortality at 90 days did not significantly differ between the laparoscopic lavage group (14 patients [13.9%]) and the colon resection group (11 patients [11.5%]; difference, 2.4% [95% CI, -7.2% to 11.9%]; P = .67). The reoperation rate was significantly higher in the laparoscopic lavage group (15 of 74 patients [20.3%]) than in the colon resection group (4 of 70 patients [5.7%]; difference, 14.6% [95% CI, 3.5% to 25.6%]; P = .01) for patients who did not have fecal peritonitis. The length of operating time was significantly shorter in the laparoscopic lavage group; whereas, length of postoperative hospital stay and quality of life did not differ significantly between groups. Four sigmoid carcinomas were missed with laparoscopic lavage.CONCLUSIONS AND RELEVANCE: Among patients with likely perforated diverticulitis and undergoing emergency surgery, the use of laparoscopic lavage vs primary resection did not reduce severe postoperative complications and led to worse outcomes in secondary end points. These findings do not support laparoscopic lavage for treatment of perforated diverticulitis.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01047462.
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| 7. |
- Svensson Neufert, Rebecca, et al.
(författare)
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Rectal washout in rectal cancer surgery : A survey of Swedish practice – Questionnaire: Rectal washout in Swedish rectal cancer surgery
- 2018
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Ingår i: International Journal of Surgery Open. - : Elsevier BV. - 2405-8572. ; 15, s. 32-36
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: To reduce local recurrence rates when performing anterior resection in rectal cancer surgery Swedish national guidelines recommend rectal washout. This study aimed to describe current Swedish practice of rectal washout. Methods: Questionnaires were sent to Swedish surgical departments performing rectal cancer surgery. Results: Thirty-five units performed open rectal cancer surgery, and 91% (32/35) performed minimally invasive surgery. Forty percent (14/35) had a protocol on rectal washout. Rectal washout was most commonly performed using sterile water or an alcohol based solution and with a minimum volume of 100–499 ml. A catheter was used at most units, prior to transection of the rectum and with the bowel clamped. Routine use of rectal washout varied with the type of surgical procedure, with no differences between open and minimally invasive surgery: low anterior resection (97% (34/35) vs 94% (30/32); p = 0.60), high anterior resection (94% (33/35) vs 97% (31/32); p = 1.00), Hartmann's procedure (80% (28/35) vs 84% (27/32); p = 0.75), abdominoperineal resection (6% (2/35) vs 16% (5/32); p = 0.25). Conclusion: Swedish colorectal units perform rectal washout routinely with no differences between open and minimally invasive procedures. A minority have a procedure protocol.
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