| 21. |
- Ringborg, Cecilia, et al.
(författare)
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Health‑related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma
- 2017
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Ingår i: Gastric Cancer. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1436-3291 .- 1436-3305.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The postoperative health-related quality of life (HRQOL) outcomes in patients with gastroesophageal junction (GEJ) adenocarcinoma after gastrectomy and esophagectomy are unclear. The aim was to evaluate HRQOL outcomes 6 months after extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy. METHODS: Patients who underwent surgery for GEJ adenocarcinoma of Siewert type 2 or 3 in 2001-2005 were identified from a nationwide Swedish prospective and population-based cohort. Three surgical strategies, i.e., gastrectomy, esophagectomy, or esophagogastrectomy, were analyzed in relationship to HRQOL measured at 6 months after surgery (main outcome). HRQOL was assessed using well-validated questionnaires for general (EORTC QLQ-C30) and esophageal cancer-specific (EORTC QLQ-OES18) symptoms. Mean score differences (MSD) and 95% confidence intervals (CI) were analyzed using ANCOVA and adjusted for age, sex, tumor stage, comorbidity, education level, hospital volume, and postoperative complications. MSDs > 10 were regarded as clinically relevant. RESULTS: Among 176 patients with complete information on HRQOL and covariates, none of the MSDs for HRQOL among the three surgery groups were clinically and statistically significant. MSDs comparing esophagectomy and gastrectomy showed no major differences in global quality of life (MSD, +8, 95% CI, 0 to +16), physical function (MSD, +2, 95% CI, -5 to +9), pain (MSD, -3, 95% CI, -12 to +7), or reflux (MSD, +5, 95% CI, -4 to +14). Also, complication rates and 5-year survival rates were similar comparing esophagectomy and gastrectomy. CONCLUSIONS: Extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy seemed to yield similar 6-month postoperative HRQOL outcomes for patients with GEJ adenocarcinoma.
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| 22. |
- Rutegård, Martin, 1982-, et al.
(författare)
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Population-based esophageal cancer survival after resection without neoadjuvant therapy : an update
- 2012
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Ingår i: Surgery. - : Mosby Inc.. - 0039-6060 .- 1532-7361. ; 152:5, s. 903-910
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There are few population-based studies addressing the survival after resection for esophageal cancer. This study represents an update of a nationwide Swedish cohort initiated in 1987.METHODS: Based on data from the Swedish Patient Register, Swedish Cancer Register, and histopathologic records, 1,008 patients who had undergone esophageal resection as the only treatment for esophageal cancer were identified between January 1, 1987 and December 31, 2005. These were followed until death or emigration through linkage to the Swedish Total Population Register until January 1, 2009. Tumor stage, location, and histology were assessed from histopathologic reports, and comorbidities were assessed from the Patient Register. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) regarding survival. The results were adjusted for age, sex, comorbidity, tumor stage, location, histology, surgical radicality, and hospital volume.RESULTS: The proportion of patients surviving for 5 years increased from 19.7% in 1987-1991 to 30.7% in 1997-2000, but remained at 30.5% between 2001 and 2005. No difference in overall adjusted survival was found between the periods of 2001-2005 and 1997-2000 (adjusted HR, 0.89; 95% CI, 0.70-1.13). Thirty-day mortality decreased from 4.9% in 1997-2000 to 2.0% in 2001-2005, rendering an adjusted HR of 0.26 (95% CI, 0.08-0.87).CONCLUSION: After adjusting for relevant prognostic factors, long-term population-based survival after resection for esophageal cancer was unchanged between 2001 and 2005 compared to 1997-2000, while the corresponding 30-day mortality improved.
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| 23. |
- Rutegård, Martin, et al.
(författare)
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The prognostic role of coeliac node metastasis after resection for distal oesophageal cancer
- 2017
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- It is uncertain whether coeliac node metastasis precludes long-term survival in distal oesophageal cancer. This nationwide population-based cohort study included patients who underwent surgical resection for stage III or IV distal oesophageal cancer in 1987-2010 with follow-up until 2014. A minority (17.0%) had neoadjuvant therapy. The prognosis in patients with coeliac node metastasis was compared with patients with no such metastasis and patients with more distant metastasis. Multivariable Cox proportional-hazards regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of disease-specific and overall mortality. Among 446 patients, 346 (77.6%) had no coeliac node metastasis, 56 (12.6%) had coeliac node metastasis, and 44 (9.9%) had more distant metastasis. Compared to coeliac node negative patients, coeliac node positive patients were at a 52% increased risk of disease-specific mortality (HR = 1.52, 95% CI 1.10-2.10), while patients with more distant metastasis had a 27% statistically non-significant increase (HR = 1.27, 95% CI 0.88-1.83). Patients with distant metastasis had no increase in disease-specific mortality compared to those with coeliac node metastasis (HR 0.71, 95% CI 0.40-1.27). Thus, patients with distal oesophageal cancer with coeliac node metastasis seem to have a similarly poor survival as patients with more distant metastasis, and thus may not benefit from surgery.
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| 24. |
- Rutegård, Martin, et al.
(författare)
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Time Shift in Early Postoperative Mortality After Oesophagectomy for Cancer
- 2015
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Ingår i: Annals of Surgical Oncology. - : Springer Science and Business Media LLC. - 1068-9265 .- 1534-4681. ; 22:9, s. 3144-3149
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPostoperative mortality is traditionally defined as death within 30 days of surgery. We hypothesised that the declining 30-day mortality after oesophageal cancer resection is, at least partly, explained by a shift towards increased 90-day mortality.MethodsThis population-based cohort study included 95 % of all patients who underwent surgical resection for oesophageal cancer in Sweden in 1987–2010. Cox proportional-hazards regression models were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) of 30-day and 31–90 days postoperative mortality in three calendar periods (1987–1994, 1995–2002, and 2003–2010). Adjustments were made for age, sex, comorbidity, tumour stage, tumour histology, surgical radicality, neoadjuvant therapy, and hospital volume of oesophagectomy.ResultsAmong 1,822 patients, the 30-day postoperative mortality decreased from 9.3 % in 1987–1994 to 3.0 % in 2003–2010, while the corresponding 31–90 days mortality decreased from 8.4 to 4.6 %. The adjusted HR of 30-day mortality in the earliest period was markedly increased compared to the latest period (HR 3.26; 95 % CI 1.96–5.45), whereas the corresponding HR of 31–90 days mortality was weaker (HR 2.16; 95 % CI 1.34–3.46). Among patients who died within 90 days of surgery, the proportion of 31–90 days mortality increased from 47 to 61 % during the study period.ConclusionsThis population-based study indicates a shift of postoperative mortality following surgery for oesophageal cancer from 30 days to 31–90 days with more recent calendar periods. Reporting of 90-day mortality rates might replace 30-day mortality rates in assessing early postoperative mortality in oesophageal cancer patients.
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| 25. |
- van der Schaaf, Maartje, et al.
(författare)
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Reoperation after oesophageal cancer surgery in relation to long-term survival : a population-based cohort study
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The influence of reoperation on long-term prognosis is unknown. In this large population-based cohort study, it was aimed to investigate the influence of a reoperation within 30 days of oesophageal cancer resection on survival even after excluding the initial postoperative period.DESIGN: This was a nationwide population-based retrospective cohort study.SETTING: All hospitals performing oesophageal cancer resections during the study period (1987-2010) in Sweden.PARTICIPANTS: Patients operated for oesophageal cancer with curative intent in 1987-2010.PRIMARY AND SECONDARY OUTCOMES: Adjusted HRs of all cause, early and late mortality up to 5 years after reoperation following oesophageal cancer resection.RESULTS: Among 1822 included patients, the 200 (11%) who were reoperated had a 27% increased HR of all-cause mortality (adjusted HR 1.27, 95% CI 1.05 to 1.53) and 28% increased HR of disease-specific mortality (adjusted HR 1.28, 95% CI 1.04 to 1.59), compared to those not reoperated. Reoperation for anastomotic insufficiency in particular was followed by an increased mortality (adjusted HR 1.82, 95% CI 1.19 to 2.76).CONCLUSIONS: This large and population-based nationwide cohort study shows that reoperation within 30 days after primary oesophageal resection was associated with increased mortality, even after excluding the initial 3 months after surgery. This finding stresses the need to consider any actions that might prevent complications and reoperation after oesophageal cancer resection.
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| 26. |
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| 27. |
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| 28. |
- Andersson, Tina, et al.
(författare)
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Utvärdering av projektet Senior Sports School : hösten 2009
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det insamlade materialet ger ett entydigt resultat. En sällan skådad samstämmighet i omdömena råder, vilka också styrkts vid observationer under projektets gång. Samstämmigheten gäller även mellan projektets olika aktörer, ledare, deltagare och förenings-/företagsrepresentanter, var och en utifrån sitt perspektiv. Projektet Senior Sport School har haft ett dubbelt syfte, nämligen att: Tillsammans med Region Skåne, idrottsföreningar och Hushållningssällskapet vill Hässleholms kommun, Simrishamns kommun och Skåneidrotten genom Senior Sport School informera och inspirera äldre om möjligheterna till en aktiv roll inom idrotten såväl som (1) aktiv som (2) ledare. Projektet kan beskrivas i termer av succé – deltagarna har verkligen uppskattat kursen. Det talas genomgående om gemenskap, nya vänner, roligt att pröva på, komma igång, vara aktiv, etc. Denna sida kan sägas motsvara att vara aktiv i meningen aktivitet för deltagarens eget välbefinnande. Om projektets främsta mål däremot hade varit att rekrytera ledare till idrotten blir bilden en helt annan. Detta mål förblev på sin höjd halvt uttalad kursen igenom och resultatet kan i skrivande stund inte annat än beskrivas som ytterst magert. Tilläggas bör att om projektet anlagt ett uttalat fokus på att rekrytera ledare hade sannolikt gruppen intresserade minskat avsevärt. Poängteras bör att deltagarna i stor utsträckning uppfattar sig som ”redan frälsta” när det gäller att leva ett aktivt liv, dvs. projektet har inte nått nya grupper av seniora medborgare vilka är ovana vid aktivitet och idrott. De föreningar som besvarat enkäten säger att kontakten med projektledarna fungerat bra, men att de, med något undantag, inte såg att projektet skulle innebär en medlemsökning för den egna föreningen.
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| 29. |
- Bodén, Robert, et al.
(författare)
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Antidopaminergic drugs and acute pancreatitis : a population-based study
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:3, s. e000914-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the suggested association between antidopaminergic drugs and acute pancreatitis.DESIGN: A large population-based nested case-control study.SETTING: Swedish nationwide study from 2006 to 2008.PARTICIPANTS: The Patient Register was used to identify 6161 cases of acute pancreatitis. The 61 637 control subjects were randomly selected from the Register of the Total Population by frequency-based density sampling, matched for age, sex and calendar year.EXPOSURE: Exposure data were extracted from the Prescribed Drug Register. Antidopaminergic drugs were grouped into antiemetic/anxiolytic and other antipsychotics. Current use of antidopaminergic drugs was defined as filling a prescription 1-114 days before index date, while previous use was 115 days to 3.5 years before index date.MAIN OUTCOME MEASURES: Cases were defined as being diagnosed as having acute pancreatitis. ORs and 95% CIs were calculated using unconditional logistic regression.RESULTS: The unadjusted OR indicated an increased risk of acute pancreatitis among current users of antiemetic/anxiolytics (OR 1.9, 95% CI 1.4 to 2.6), but not in the multivariable model adjusting for alcohol-related comorbidity, chronic obstructive lung disease, ischaemic heart disease, obesity, diabetes, opioid use, gallstone disease, educational level, marital status and number of concomitant medications (OR 0.9, 95% CI 0.6 to 1.2). Similarly, among current users of other antipsychotics, the unadjusted OR was 1.4 (95% CI 1.1 to 1.6), while the adjusted OR was 0.8 (95% CI 0.6 to 0.9). Results regarding previous use of antidopaminergic drugs followed a similar risk pattern as for current use.CONCLUSIONS: The lack of association between antidopaminergic drugs and acute pancreatitis after adjustment for confounding factors in this study suggests that the previously reported positive associations might be explained by confounding.
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| 30. |
- Brusselaers, Nele, et al.
(författare)
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Hospital and surgical volume in relation to long-term survival after oesophagectomy : systematic review and meta-analysis
- 2014
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Ingår i: Gut. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1468-3288 .- 0017-5749.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Centralisation of healthcare, especially for advanced cancer surgery, has been a matter of debate. Clear short-term mortality benefits have been described for oesophageal cancer surgery conducted at high-volume hospitals and by high-volume surgeons. OBJECTIVE: To clarify the association between hospital volume, surgeon volume and hospital type in relation to long-term survival after oesophagectomy for cancer, by a meta-analysis. DESIGN: The systematic literature search included PubMed, Web of Science, Cochrane library, EMBASE and Science Citation Index, for the period 1990-2013. Eligible articles were those which reported survival (time to death) as HRs after oesophagectomy for cancer by hospital volume, surgeon volume or hospital type. Fully adjusted HRs for the longest follow-up were the main outcomes. Results were pooled by a meta-analysis, and reported as HRs and 95% CIs. RESULTS: Sixteen studies from seven countries met the inclusion criteria. These studies reported hospital volume (N=13), surgeon volume (N=4) or hospital type (N=4). A survival benefit was found for high-volume hospitals (HR=0.82, 95% CI 0.75 to 0.90), and possibly also, for high-volume surgeons (HR=0.87, 95% CI 0.74 to 1.02) compared with their low-volume counterparts. No association with survival remained for hospital volume after adjustment for surgeon volume (HR=1.01, 95% CI 0.97 to 1.06; N=2), while a survival benefit was found in favour of high-volume surgeons after adjustment for hospital volume (HR=0.91, 95% CI 0.85 to 0.98; N=2). CONCLUSIONS: This meta-analysis demonstrated better long-term survival (even after excluding early deaths) after oesophagectomy with high-volume surgery, and surgeon volume might be more important than hospital volume. These findings support centralisation with fewer surgeons working at large centres. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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