| 1. |
- Thomas, HS, et al.
(författare)
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- 2019
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swepub:Mat__t
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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. |
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| 4. |
- Chabok, Abbas, 1964-, et al.
(författare)
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Low risk of complications in patients with first-time acute uncomplicated diverticulitis
- 2017
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 32:12, s. 1699-1702
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Tidskriftsartikel (refereegranskat)abstract
- First-time acute uncomplicated diverticulitis (AUD) has been considered to have an increased risk of complication, but the level of evidence is low. The aim of the present study was to evaluate the risk of complications in patients with first-time AUD and in patients with a history of diverticulitis. This paper is a population-based retrospective study at Vastmanland's Hospital, VasterAs, Sweden, where all patients were identified with a diagnosis of colonic diverticular disease ICD-10 K57.0-9 from January 2010 to December 2014. The records of all patients were surveyed and patients with a computed tomography (CT)-verified AUD were included. Complications defined as CT-verified abscess, perforation, colonic obstruction, fistula, or sepsis within 1 month from the diagnosis of AUD were registered. Of 809 patients with AUD, 642 (79%) had first-time AUD and 167 (21%) had a previous history of AUD with no differences in demographic or clinical characteristics. In total, 16 (2%) patients developed a complication within 1 month irrespective of whether they had a previous history of diverticulitis (P = 0.345). In the binary logistic regression analysis, first-time diverticulitis was not associated with increased risk of complications (OR 1.58; CI 0.52-4.81). The rate of antibiotic therapy was about 7-10% during the time period and outpatient management increased from 7% in 2010 to 61% in 2014. The risk for development of complications is low in AUD with no difference between patients with first-time or recurrent diverticulitis. This result strengthens existing evidence on the benign disease course of AUD.
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| 5. |
- Hosseinali Khani, Maziar, 1975-, et al.
(författare)
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Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997-2012
- 2017
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Ingår i: International Journal of Colorectal Disease. - : SPRINGER. - 0179-1958 .- 1432-1262. ; 32:11, s. 1591-1596
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to evaluate the association of socioeconomic status and comorbidities with uncomplicated and complicated diverticular disease (DD) in Sweden.Methods: We identified all individuals aged >= 30 years in Sweden diagnosed with DD between 1997 and 2012 using the Swedish National Population and Housing Census and the Hospital Discharge Register. Data were analyzed by multivariable logistic regression, with individual-level characteristics as covariates.Results: A total of 79,481 patients (median age 66 [range 3086] years) were hospitalized for DD, 15,878 (20%) of whom for complicated DD. Admissions for both uncomplicated and complicated DD were more common in women (p < 0.001). A low education level was identified as a risk factor for uncomplicated (unadjusted hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.75-1.82; adjusted HR 1.22, 95% CI 1.19-1.24) and complicated DD(unadjusted HR 1.84, 95% CI 1.77-1.92; adjusted HR 1.26, 95% CI 1.21-1.32). Patients with the lowest income had a lower risk of hospitalization for uncomplicated (adjusted HR 0.94, 95% CI 0.91-0.96) and complicated DD (adjusted HR 0.87, 95% CI 0.83-0.92) than those with the highest income. The correlation coefficient between income and education was 0.25. Diabetes and cardiovascular disease were identified as protective factors against uncomplicated DD (adjusted HR 0.68, 95% CI 0.66-0.69 and HR 0.79, 95% CI 0.74-0.84, respectively).Conclusions: Patients with the lowest education level had an increased risk of hospitalization for DD. Further studies are needed to explore the association of diabetes and cardiovascular disease with uncomplicated DD.
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| 6. |
- Isacson, Daniel, et al.
(författare)
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Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis
- 2019
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Ingår i: British Journal of Surgery. - : WILEY. - 0007-1323 .- 1365-2168. ; 106:11, s. 1542-1548
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to assess the long-term results in patients with uncomplicated diverticulitis who had participated in the Antibiotics in Acute Uncomplicated Diverticulitis (AVOD) RCT, which randomized patients with CT-verified left-sided acute uncomplicated diverticulitis to management without or with antibiotics.Methods: The medical records of patients who had participated in the AVOD trial were reviewed for long-term results such as recurrences, complications and surgery. Quality-of-life questionnaires (EQ-5D (TM)) were sent to patients, who were also contacted by telephone. Descriptive statistics were used for the analysis of clinical outcomes.Results: A total of 556 of the 623 patients (89 center dot 2 per cent) were followed up for a median of 11 years. There were no differences between the no-antibiotic and antibiotic group in recurrences (both 31 center dot 3 per cent; P = 0 center dot 986), complications (4 center dot 4 versus 5 center dot 0 per cent; P = 0 center dot 737), surgery for diverticulitis (6 center dot 2 versus 7 center dot 1 per cent; P = 0 center dot 719) or colorectal cancer (0 center dot 4 versus 2 center dot 1 per cent; P = 0 center dot 061). The response rate for the EQ-5D (TM) was 52 center dot 8 versus 45 center dot 2 per cent respectively (P = 0 center dot 030), and no differences were found between the two groups in any of the measured dimensions.Conclusion: Antibiotic avoidance for uncomplicated diverticulitis is safe in the long term.
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| 7. |
- Isacson, Daniel, et al.
(författare)
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Outpatient management of acute uncomplicated diverticulitis results in health-care cost savings
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:4, s. 449-452
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:Outpatient management without antibiotics has been shown to be safe for selected patients diagnosed with acute uncomplicated diverticulitis (AUD). The aim of this study was to evaluate the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics.Methods:The medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics in Vastmanland County were reviewed. Health-care cost analysis was performed using the Swedish cost-per-patient model.Results:In total, 494 episodes of AUD were identified, 254 in 2011 and 240 in 2014. The proportion of patients managed as outpatients was 20% in 2011 compared with 60% in 2014 (p<.001). There were 203 hospital admissions and a total length of stay of 677 days in 2011 compared with 95 admissions and 344 days in 2014 (both p<.001). The total health-care cost was Euro558,679 in 2011 compared with Euro370,370 in 2014 (p<.001). Three patients developed complications in 2011 and four in 2014 (p=.469).Conclusions:The new policy of outpatient management without antibiotics in routine health care almost halved the total health-care cost without an increase in the complication rate.
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| 8. |
- Isacson, Daniel, et al.
(författare)
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Outpatient, non-antibiotic management in acute uncomplicated diverticulitis : a prospective study
- 2015
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 30:9, s. 1229-1234
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period. A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months. In total, 155 patients were included, of which 54 were men; the mean age of the patients was 57.4 years. At the time of diagnosis, the mean C-reactive protein and white blood cell count were 73 mg/l and 10.5 x 10(9), respectively, and normalized in the vast majority of patients within the first week. The majority of the patients (97.4 %) were managed successfully as outpatients without antibiotics, admissions, or complications. In only four (2.6 %) patients, the management failed because of complications in three and deterioration in one. These patients were all treated successfully as inpatients without surgery. Five patients had recurrences and were treated as outpatients without antibiotics. Follow-up colonic investigations revealed cancer in two patients and polyps in 13 patients. Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.
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| 9. |
- Isacson, Daniel
(författare)
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Treatment of Acute Uncomplicated Colonic Diverticulitis
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate the clinical management of AUD with regard to the no-antibiotic policy and its long-term effect, treatment on an outpatient basis and the potential health-care cost savingsStudy I: a retrospective study at Västmanlands Hospital that evaluated and confirmed the adherence to the no-antibiotic policy in patients with AUD and its safety regarding complications and recurrences. A total of 246 patients with acute diverticulitis were identified, of which 195 had computed tomography (CT) confirmed AUD. In total, 91.3% of these patients did not receive any antibiotics and only two developed complications.Study II: a retrospective study with the aim to conduct a long-term follow-up of all Swedish patients who participated in the AVOD trial in terms of recurrences, complications, surgery and quality of life. The medical records of 96% of the patients were reviewed with a mean follow up of 11 years. Quality of life questionnaires were sent out to all patients. There were no differences regarding the rates of recurrence, complications or surgery for diverticulitis. There were no differences in the quality of life between groups according to the EQ-5D questionnaire.Study III: a prospective study where 155 patients with CT-verified AUD as were treated as outpatients without antibiotics. On day 3, patients reported an average pain score of 1.8 of 10 on the VAS scale and only 30% of patients were using analgesia. Four patients returned to hospital because of treatment failure.Study IV: a retrospective cohort study at Västmanland’s Hospital evaluated the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics. Medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics were reviewed. Overall 494 episodes of AUD were identified: 254 in 2011 and 240 in 2014. Three patients developed complications in 2011 and four in 2014. The proportion of patients managed as outpatients was 20% in 2011 compared with 61% in 2014. The hospital admissions, total length of stay of and total health-care costs were almost halved.In conclusion, these studies confirm the low complication and recurrence rates of AUD and strengthens findings that antibiotics have no benefit in the treatment of this disease. The no-antibiotic policy had no impact on short- or long-term outcomes regarding the rates of recurrence, complications, surgery or quality of life. Outpatient management was found to be feasible and safe, and significantly reduced admissions, which led to large health-care cost savings.
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| 10. |
- Kindler, Csaba, et al.
(författare)
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Detection of Free Cancer Cells in Pelvic Lavage with Double Immunocytochemistry at Rectal Cancer Surgery
- 2017
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Ingår i: Anticancer Research. - : International Institute of Anticancer Research. - 0250-7005 .- 1791-7530. ; 37:4, s. 1563-1568
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: The aim of the present study was to describe a double immunocytochemical staining method for detecting free cancer cells after rectal cancer surgery and to evaluate their extent and prognostic role. Materials and Methods: Immunocytochemistry was performed using antibodies against cytokeratin 20/caudal-typehomeobox transcription factor 2 (CDX2) and mucin glycoprotein-2 (MUC2)/p53 protein. The study included 29 patients with infraperitoneal rectal cancer who underwent bowel resection and four controls. The pelvic lavage was retrieved at the start of laparotomy, after total mesorectal excision and after abdominal lavage with sterile water. Results: Free cancer cells were detected with the double immunocytochemical method in the two controls with carcinomatosis and one control with sigmoidal cancer. None of the patients with rectal tumours had presence of free cancer cells. Conclusion: Immunocytochemical analysis of peritoneal lavage was feasible and negative in patients with infraperitoneal rectal cancer. Further studies are encouraged to investigate the clinical relevance in cases with free cancer cells after incomplete total mesorectal excision.
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| 11. |
- Nikberg, Maziar, et al.
(författare)
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Circumferential Resection Margin as a Prognostic Marker in the Modern Multidisciplinary Management of Rectal Cancer
- 2015
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Ingår i: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 58:3, s. 275-282
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A positive circumferential resection margin has been associated with a high risk of local recurrence and a decrease in survival in patients who have rectal cancer.OBJECTIVE: The purpose of this study was to analyze the involvement of circumferential resection margin in local recurrence and survival in a multidisciplinary population-based setting by using tailored oncological therapy and surgery with total mesorectal excision.DESIGN: Data were collected in a prospective database and retrospectively analyzed. Between 1996 and 2009, 448 patients with rectal cancer underwent a curative bowel resection.SETTINGS: Population-based data were collected at a single institution in the county of Vastmanland, Sweden.RESULTS: Preoperative radiotherapy was delivered to 334 patients (74%); it was delivered to 35 patients (8%) concomitantly with preoperative chemotherapy. In 70 patients (16%), en bloc resections of the prostate and vagina were performed. Intraoperative perforations were seen in 7 patients (1.6%). The mesorectal fascia was assessed as complete in 117/118 cases. In 32 cases (7%), the circumferential resection margin was 1 mm or less. After a median follow-up of 68 months, 5 (1.1%) patients developed a local recurrence; one of them had circumferential resection margin involvement. The 5-year overall survival was 77%. In the multivariate analysis, the circumferential resection margin was not an independent factor for disease-free survival.LIMITATIONS: Mesorectal fascia was not assessed before 2007. The findings might be explained by a type II error but, from a clinical perspective, enough patients were included to motivate the conclusion of the study.CONCLUSIONS: Circumferential resection margin is an important measurement in rectal cancer pathology, but the correlation to local recurrence is much less than previously stated, probably because of oncological treatment and surgery that respects the mesorectal fascia and, when required, en bloc resections. Circumferential resection margin should not be used as a prognostic marker in the modern multidisciplinary management of rectal cancer.
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| 12. |
- Nikberg, Maziar, et al.
(författare)
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Lymphovascular and perineural invasion in stage II rectal cancer : a report from the Swedish colorectal cancer registry
- 2016
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 55:12, s. 1418-1424
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level. Materials and methods: Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012. Results: Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p = .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence. Conclusions: Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.
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| 13. |
- Nikberg, Maziar, et al.
(författare)
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Prophylactic stoma mesh did not prevent parastomal hernias
- 2015
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 30:9, s. 1217-1222
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Tidskriftsartikel (refereegranskat)abstract
- Parastomal herniation is reported in up to 50 % of patients with a colostomy. A prophylactic stoma mesh has been reported to reduce parastomal hernia rates. The aim of the study was to evaluate the rate of parastomal hernias in a population-based cohort of patients, operated with and without a prophylactic mesh at two different time periods. All rectal cancer patients operated with an abdominoperineal excision or Hartmann's procedure between 1996 and 2012 were included. From 2007, a prophylactic stoma mesh was placed in the retro-muscular plane. Patients were followed prospectively with clinical and computed tomography examinations. There were no differences with regard to age, gender, pre-operative albumin levels, ASA score, body mass index (BMI), smoking or type of surgical resection between patients with (n = 71) and without a stoma mesh (n = 135). After a minimum follow-up of 1 year, 187 (91 %) of the patients were alive and available for analysis. At clinical and computed tomography examinations, exactly the same parastomal hernia rates were found in the two groups, viz, 25 and 53 %, respectively (p = 0.95 and p = 0.18). The hernia sac contained omentum or intestinal loops in 26 (81 %) versus 26 (60 %) patients with and without a mesh, respectively (p = 0.155). In the multivariate analyses, high BMI was associated with parastomal hernia formation. A prophylactic stoma mesh did not reduce the rate of clinically or computed tomography-verified parastomal hernias. High BMI was associated with an increased risk of parastomal hernia formation regardless of prophylactic stoma mesh.
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| 14. |
- 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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| 15. |
- Smedh, Kenneth, et al.
(författare)
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Hartmann's procedure vs abdominoperineal resection with intersphincteric dissection in patients with rectal cancer : a randomized multicentre trial (HAPIrect)
- 2016
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of Hartmann's procedure in the old and frail and/or in patients with fecal incontinence is increasing, even though some data have reported high postoperative rates of pelvic abscesses. Abdominoperineal excision with intersphincteric dissection has been proposed as a better alternative and is performed increasingly both nationally and internationally. However, no studies have been performed to support this. The aim of this study is to randomize patients between Hartmann's procedure and abdominoperineal excision with intersphincteric dissection and compare post-operative surgical morbidity and quality of life. The hypothesis is that intersphincteric abdominoperineal excision provides less pelvic and perineal morbidity. Methods/design: In this multicentre randomized controlled study, Hartmann's procedure will be compared with intersphincteric abdominoperineal excision in patients with rectal cancer unsuitable for an anterior resection. The patients are operated in different ways around the ano-rectum, otherwise the same procedure is performed with total mesorectal excision and all will receive a colostomy. The one-month postoperative control will focus on post-operative surgical complications, especially the perineal-pelvic, reoperations and other interventions. After one year, late complications such as pain in the perineal or pelvic area or disorders such as secretion or bleeding from the anorectal stump will be recorded and a follow-up of quality of life performed. Histological and oncological data will also be recorded, the latter up to 5 years post-operatively. Discussion: The HAPIrect trial is the first randomized controlled trial comparing standard low Hartmann's procedure with intersphincteric abdominoperineal excision in patients with rectal cancer with the aim of categorizing the post-operative surgical morbidity.
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| 16. |
- Sverrisson, Ingvar, et al.
(författare)
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Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer
- 2019
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 45:3, s. 341-346
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients.Methods:All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed.Results:In total, 13299 men had undergone a bowel resection for rectal cancer, 188 of whom had previously received radiotherapy for prostate cancer. Among those who had received radiation therapy, 59 men (31%) had an AR: 50 men (85%) received a diverting ileostomy, 42 men (71%) had an American Society of Anesthesiologists score of 1-2 and 36 men (61%) had tumour stage 1-2. AL was found in 12/59 men (20%), one of whom had a re-laparotomy. There was no 90-day mortality.Conclusions:In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.
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| 17. |
- Sverrisson, Ingvar, et al.
(författare)
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Hartmann's procedure in rectal cancer : a population-based study of postoperative complications
- 2015
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 30:2, s. 181-186
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Tidskriftsartikel (refereegranskat)abstract
- Hartmann's procedure for rectal cancer patients is increasingly performed but few studies have reported the postoperative outcome. The purpose was to report postoperative complications and analyse risk factors in rectal cancer patients operated with Hartmann's procedure. To describe the selection and postoperative complication patterns, all bowel-resected rectal cancer patients were included. Population-based data were from the county of Vastmanland, Sweden. All rectal cancer patients operated with an elective bowel resection between 1996 and 2012 were included. Demographics and postoperative complications were prospectively registered and data retrospectively analysed. Of the 624 patients included, 396 (64 %) were operated with an anterior resection, 159 (25 %) with an abdominoperineal excision and 69 (11 %) a Hartmann's procedure of which 90 % were low Hartmann's. Patients operated with a Hartmann's procedure were significantly older, had higher ASA-score, poorer WHO performance score and lower serum albumin levels. Operative time for Hartmann's procedure was a median of 49 and 99 min shorter than after anterior resection and abdominoperineal excision, respectively, and entailed less bleeding. Complications related to the pelvic and perineal dissections were more common after abdominoperineal excision compared with anterior resection and Hartmann's procedure (32 vs. 9 and 13 %, p < 0.001). Few rectal cancer patients, operated with Hartmann's procedure, developed pelvic complications despite a higher age, more co-morbidities, metastases in different localities and functional inferiority when compared with the patients operated with anterior resection or abdominoperineal excision. Hartmann's procedure is a valid alternative procedure in the old and frail rectal cancer patient.
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| 18. |
- Sverrisson, Ingvar, et al.
(författare)
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Low risk of intra-abdominal infections in rectal cancer patients treated with Hartmann's procedure : a report from a national registry
- 2018
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Ingår i: International Journal of Colorectal Disease. - : SPRINGER. - 0179-1958 .- 1432-1262. ; 33:3, s. 327-332
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Tidskriftsartikel (refereegranskat)abstract
- To describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann's procedure (HP). Data were retrieved from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007-2014. A retrospective analysis was performed using prospectively recorded data. Characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy were analysed. Of 10,940 patients resected for rectal cancer, 1452 (13%) underwent HP (median age, 77 years). The American Society of Anesthesiologists (ASA) score was 3-4 in 43% of patients; 15% had distant metastases and 62% underwent a low HP. The intra-abdominal infection rate was 8% and re-laparotomy rate was 10%. Multivariable logistic regression analysis identified preoperative radiotherapy (OR, 1.78; 95% CI, 1.14-2.77), intra-operative bowel perforation (OR, 1.99; 95% CI, 1.08-3.67), T4 tumours (OR, 1.68; 95% CI 1.04-2.69) and female gender (OR, 1.73; 95% CI, 1.15-2.61) as risk factors for intra-abdominal infection. ASA score 3-4 (OR, 1.62; 95% CI, 1.12-2.34), elevated BMI (OR, 1.05; 95% CI, 1.02-1.09) and female gender (OR, 2.06; CI, 1.41-3.00) were risk factors for re-laparotomy after HP. The rate of intra-abdominal infection was not increased after a low HP. Despite older age and co-morbidities including more advanced cancer, patients undergoing Hartmann's procedure had low rates of serious postoperative complications and re-laparotomy. A low HP was not associated with a higher rate of intra-abdominal infection. HP seems to be appropriate for old and frail patients with rectal cancer.
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| 19. |
- Sverrisson, Ingvar
(författare)
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Rectal cancer : Aspects of post-operative complications
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to study post-operative complications in patients with rectal cancer.Methods: Post-operative complications in patients operated for rectal cancer was retrospectively analyzed in three prospective registers; the local rectal cancer registry in the Västmanland County, Sweden, the Swedish Colorectal Cancer Registry (SCRCR) and the National Prostate Cancer Registry (NPCR). In Papers I and II, the focus was on the complication pattern after Hartmann’s procedure (HP). In Paper III, the incidence of parastomal hernia was assessed during a period when no prophylactic mesh was used (1996-2006) compared with a period when a prophylactic mesh was routinely used (2007-2012). In Paper IV, the anastomotic leakage (AL) rate after anterior resection (AR) for rectal cancer patients who had previously received RT for prostate cancer was assessed with combined data from the SCRCR and the NPCR.Results: In Paper I, patients operated with a HP were significantly older, had a higher ASA-score, a poorer WHO performance score and lower serum albumin levels. Few developed pelvic complications. In Paper II, the intra-abdominal infection rate was 8% and the re-laparotomy rate was 10%. Multi-variable logistic regression analysis identified pre-operative radiotherapy as a risk factor for intra-abdominal infections. In Paper III, we found no difference in the rate of parastomal hernia between patients with and without a prophylactic stoma mesh. In Paper IV, we identified 59 out of 188 patients who had undergone previous radiation therapy for prostate cancer who had been operated with AR. Twelve (20%) developed an AL, of whom only one underwent re-laparotomy and there was no 90-day mortality.Conclusion: The rate of serious post-operative complications was low after HP and it seems to be a safe and appropriate alternative in old and frail patients. Pre-operative radiotherapy was a risk factor for intra-abdominal infections in rectal cancer patients operated with a HP. A prophylactic stoma mesh did not reduce the rate of parastomal hernias. In patients that had previously been irradiated for prostate cancer, a minority underwent an AR. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than previously reported.
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| 20. |
- Thorisson, Arnar, 1979-
(författare)
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Acute Colonic Diverticulitis : The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to expand the current knowledge regarding the advantages and limitations of computed tomography (CT) for patients with acute diverticulitis and evaluate outpatient treatment for uncomplicated diverticulitis.Paper I: A retrospective evaluation of 602 patients with reported uncomplicated diverticulitis. Scans were re-evaluated and the degree of inflammation was graded. Signs of complications or other diseases were also noted. No radiological findings on CT could predict the development of complications or recurrence in patients with uncomplicated diverticulitis. However, 44 patients (7.3%) had signs of complicated diverticulitis that had been overlooked on the initial assessment. Despite small complications and a non-antibiotic treatment, the majority of patients recovered without incident, further strengthening the non-antibiotic treatment strategy.Paper II: A retrospective analysis of conservative treatment for perforated diverticulitis (n = 136) during a 5-year period. Twenty-nine of 136 patients were operated on within 24 h and not candidates for conservative management. Patients more than 75 years old, immunosuppressed patients, patients with free intraperitoneal air or free fluid in the abdominal cavity were at higher risk for emergency surgery within the first 24 h. Conservative treatment was successful in 101 of 107 patients (94%) when attempted. The presence of simultaneous abscess increased the risk for conservative treatment failure.Paper III: The aim of this prospective study was to determine if a non-enhanced low-dose CT was as sensitive as standard CT with intravenous (IV) contrast for patients with suspected acute diverticulitis. The included patients underwent both types of CT examinations. CT images were graded by three independent radiologists for the presence of diverticulitis, complications or other findings that could explain the patient’s symptoms. Sensitivity, specificity and both intra- and inter-reader agreement for low-dose CT were very high. Therefore, we recommend this examination for suspected diverticulitis.Paper IV: In this prospective study, 155 consecutive patients with CT-verified acute uncomplicated diverticulitis were treated as outpatients without antibiotics. Overall, only four patients (2.6%) returned to the hospital because of treatment failure, all of whom were hospitalized and received antibiotics. Outpatient treatment of uncomplicated diverticulitis is safe and recommended in selected patients.
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| 21. |
- Thorisson, Arnar, et al.
(författare)
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CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis
- 2016
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 31:2, s. 451-457
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The first randomized clinical trial of antibiotics in uncomplicated diverticulitis (the AVOD study) showed no benefit of antibiotics. The aim of this study was to re-evaluate the computed tomography (CT) scans of the patients in the AVOD study to find out whether there were CT findings that were missed and to study whether CT signs in uncomplicated diverticulitis could predict complications or recurrence.METHODS: The CT scan images from patients included in the AVOD study were re-evaluated and graded by two independent reviewers for different signs of diverticulitis, including complications, such as extraluminal gas or the presence of an abscess.RESULTS: Of the 623 patients included in the study, 602 CT scans were obtained and re-evaluated. Forty-four (7 %) patients were found to have complications on the admitting CT scan that had been overlooked. Twenty-seven had extraluminal gas and 17 had an abscess. Four of these patients deteriorated and required surgery, but the remaining patients improved without complications. Of the 18 patients in the no-antibiotic group, in whom signs of complications on CT were overlooked, 15 recovered without antibiotics. No CT findings in patients with uncomplicated diverticulitis could predict complications or recurrence.CONCLUSION: No CT findings that could predict complications or recurrence were found. A weakness in the initial assessment of the CT scans to detect extraluminal gas and abscess was found but, despite this, the majority of patients recovered without antibiotics. This further supports the non-antibiotic strategy in uncomplicated diverticulitis.
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| 22. |
- Thorisson, Arnar, et al.
(författare)
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Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:10-11, s. 1298-1303
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to describe patient characteristics and results of non-operative management for patients presenting with computed tomography (CT) verified perforated diverticulitis with extraluminal or free air.Methods: All patients treated for diverticulitis (ICD-10: K-57) during 2010–2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis and extraluminal or free air on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.Results: Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.Conclusions: Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.
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