| 51. |
- Kauppila, Joonas H, et al.
(författare)
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Gastrectomy compared to oesophagectomy for Siewert II and III gastro-oesophageal junctional cancer in relation to resection margins, lymphadenectomy and survival
- 2017
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Ingår i: Scientific Reports. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2045-2322.
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Tidskriftsartikel (refereegranskat)abstract
- It is unclear whether gastrectomy or oesophagectomy offer better outcomes for gastro-oesophageal junction (GOJ) cancer. A total of 240 patients undergoing total gastrectomy (n = 85) or oesophagectomy (n = 155) for Siewert II-III GOJ adenocarcinoma were identified from a Swedish prospective population-based nationwide cohort. The surgical approaches were compared in relation to non-radical resection margins (main outcome) using multivariable logistic regression, providing odds ratios (ORs) and 95% confidence intervals (CIs), mean number of removed lymph nodes with standard deviation (SD) using ANCOVA, assessing mean differences and 95% CIs, and 5-year mortality using Cox regression estimating hazard ratios (HRs) and 95% CIs. The models were adjusted for age, sex, comorbidity, tumour stage, and surgeon volume. The non-radical resection rate was 15% for gastrectomy and 14% for oesophagectomy, and the adjusted OR was 1.61 (95% CI 0.68-3.83). The mean number of lymph nodes removed was 14.2 (SD +/- 9.6) for gastrectomy and 14.2 (SD +/- 10.4) for oesophagectomy, with adjusted mean difference of 2.4 (95% CI-0.2-5.0). The 5-year mortality was 76% following gastrectomy and 75% following oesophagectomy, with adjusted HR = 1.07 (95% CI 0.78-1.47). Gastrectomy and oesophagectomy for Siewert II or III GOJ cancer seem comparable regarding tumour-free resection margins, lymph nodes removal, and 5-year survival.
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| 52. |
- Kauppila, Joonas H., et al.
(författare)
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Risk Factors for Suicide After Bariatric Surgery in a Population-based Nationwide Study in Five Nordic Countries
- 2022
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 275:2, s. E410-E414
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To identify risk factors for suicide after bariatric surgery.Summary background data:Bariatric surgery reduces obesity-related mortality. However, it is for unclear reasons is associated with an increased risk of suicide.Methods:This population-based cohort study included patients having undergone bariatric surgery in 1982 to 2012 in any of the 5 Nordic countries, with follow-up through 2012. Eleven potential risk factors of suicide (sex, age, comorbidity, surgery type, surgical approach, calendar year of surgery, history of depression or anxiety, psychosis, schizophrenia, mania, or bipolar disorder, personality disorder, substance use, and number of previously documented psychiatric diagnoses) were analyzed using Cox regression.Results:Of 49,977 bariatric surgery patients, 98 (0.2%) committed suicide during follow-up. Women had a decreased risk of suicide compared to men (hazard ratio [HR] = 0.48, 95% confidence interval [CI] 0.33-0.77), although age and comorbidity did not influence this risk. Compared to gastric bypass, other types of bariatric surgery had lower risk of suicide (HR = 0.44, 95%CI 0.27-0.99). There was no difference in suicide risk between laparoscopic and open surgical approach. A history of depression or anxiety (HR = 6.87, 95%CI 3.97-11.90); mania, bipolar disorder, psychosis, or schizophrenia (HR = 2.70, 95%CI 1.14-6.37); and substance use (HR = 2.28, 95%CI 1.08-4.80), increased the risk of suicide. More of the above psychiatric diagnoses increased the risk of suicide (HR = 22.59, 95%CI 12.96-39.38 for ≥2 compared to 0 diagnoses).Conclusions:Although the risk of suicide is low, psychiatric disorders, male sex, and gastric bypass procedure seem to increase the risk of suicide after bariatric surgery, indicating a role for tailored preoperative psychiatric evaluation and postoperative surveillance.
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| 53. |
- Kauppila, Joonas H, et al.
(författare)
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The surgical management of esophago-gastric junctional cancer
- 2016
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Ingår i: Surgical Oncology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0960-7404 .- 1879-3320.
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Tidskriftsartikel (refereegranskat)abstract
- The best available surgical strategy in the treatment of resectable esophago-gastric junctional (EGJ) cancer is a controversial topic. In this review we evaluate the current literature and scientific evidence examining the surgical treatment of locally advanced EGJ cancer by comparing esophagectomy with gastrectomy, transhiatal with transthoracic esophagectomy, minimally invasive with open esophagectomy, and less extensive with more extensive lymphadenectomy. We also assess endoscopic procedures increasingly used for early EGJ cancer. The current evidence does not favor any of the techniques over the others in terms of oncological outcomes. Health-related quality of life may be better following gastrectomy compared to esophagectomy. Minimally invasive procedures might be less prone to surgical complications. Endoscopic techniques are safe and effective alternatives for early-stage EGJ cancer in the short term, but surgical treatment is the mainstay in fit patients due to the risk of lymph node metastasis. Any benefit of lymphadenectomy extending beyond local or regional nodes is uncertain. This review demonstrates the great need for well-designed clinical studies to improve the knowledge in how to optimize and standardize the surgical treatment of EGJ cancer.
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| 54. |
- Kilander, Carl, et al.
(författare)
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Exogenous estrogen and the risk of biliary tract cancer : a population-based study in a cohort of Swedish men treated for prostate cancer
- 2016
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 55:7, s. 846-850
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Tidskriftsartikel (refereegranskat)abstract
- Background: To assess the role of exogenous estrogen in the etiology of biliary tract cancer, a nationwide population-based cohort study in Sweden was performed. Methods: The study included all men in Sweden with prostate cancer diagnosed in 1961-2008. Due to treatment standards, patients diagnosed in 1961-1980 were considered more exposed to estrogen, while those diagnosed in 1981-2008 were regarded less exposed. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated to estimate the risk of biliary tract cancer in cohort members compared to the corresponding Swedish male population. Results: After 849 307 person-years of follow-up in 203 131 prostate cancer patients, there were 41 incident gallbladder cancers and 36 cancers of the extra-hepatic bile ducts. In overall, there were no apparent differences in the risk of gallbladder cancer or bile duct cancer between patients diagnosed in 1961-1980 and patients diagnosed in 1981-2008. However, in patients diagnosed in 1961-1980, there was a statistically non-significant increased risk of gallbladder cancer (SIR 1.34; 95% CI 0.71-2.29) and extra-hepatic bile duct cancer (SIR 1.20; 95% CI 0.55-2.28)>5 years of follow-up after the prostate cancer diagnosis. No such association was found for patients diagnosed in 1981-2008. Sensitivity analyses excluding prostate cancer patients exposed to potential confounding factors did not change the SIRs. Conclusions: Long exposure to high doses of exogenous estrogen might increase the risk of biliary tract cancer. However, any potential excess risk of bile duct cancer resulted by prolonged exposure to high doses of exogenous estrogen seems to be small.
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| 55. |
- Kilander, Carl, et al.
(författare)
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The population-based incidence and mortality of biliary tract cancer in Sweden
- 2018
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Ingår i: Cancer Epidemiology. - : Elsevier BV. - 1877-7821 .- 1877-783X. ; 56, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- Background: The incidence trends of biliary tract cancer need to be established. This study investigated the incidence and mortality of biliary tract cancer in Sweden in 1970-2010. Methods: Sex-specific biliary tract cancer incidence and mortality rates were evaluated using data from the Swedish Cancer Register, Patient Register and Causes of Death Register. Case registration was separate for each register. Gallbladder cancer and cancers of the extra-hepatic bile ducts were analyzed separately. Standardized incidence rates were calculated and joinpoint regression was used to calculate annual percent changes (APC) with 95% Confidence Intervals (CIs). Results: The incidence of non-gallbladder extra-hepatic cancers assessed from the Cancer Register decreased in men and women from the mid 1980's (APC: -4.0, 95% CI -5.3 - -2.7 and APC -6.3, 95% CI -7.7 - -4.8, respectively), whereas the mortality of non-gallbladder extra-hepatic cancers rather increased until 1990 (APC: 2.1, 95% CI 1.4-2.8 and APC 2.7, 95% CI 1.3-4.1, in men and women respectively). Notably, the mortality rate was greater than the incidence rate as assessed from the Cancer Register from the early 1990's and onwards. The incidence of non-gallbladder extra-hepatic cancers derived from the Patient Register also increased over time. Gallbladder cancer incidence and mortality rates generally decreased. However, incidence rates assessed from the Patient Register decreased to a lesser extent. Conclusions: The incidence of gallbladder cancer seems to have decreased over the past decades in Sweden. The incidence trends for extra-hepatic tumors other than gallbladder cancer may however be obscured by under-reporting.
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| 56. |
- Lagergren, Jesper
(författare)
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Cancer of the esophagus and gastric cardia : etiological aspects
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Esophageal cancer is one of the most lethal forms of cancer and the prognosis has not improved substantially during recent decades despite new treatments and diagnostic methods. In view of these discouraging results it is important to identify risk factors that might make primary prevention possible. The major risk factors for esophageal squamous cell carcinoma are tobacco smoking and alcohol use. Infection with human papillomavirus type 16 has also been claimed to be associated with the risk. While the incidence of squamous cell carcinoma of the esophagus is stable, that of adenocarcinoma of the esophagus and gastric cardia has increased dramatically in several Western countries. The reasons for this increase are unknown, and there is a paucity of known risk factors. To identify risk factors for esophageal and gastric cardia cancer, and to estimate the magnitude of their influence in the Swedish population, a nationwide population-based case-control study was performed. The study base was the entire Swedish population born in Sweden and aged below 80 years in 1995 through 1997. Collaboration between all Swedish hospital departments involved in the diagnosis or treatment of esophageal or cardia tumors ensured that incident cases were uniformly classified and reported to the study. Cases and population-based control subjects were interviewed face to-face about various exposures. Blood samples were collected for serological analyses of human papillomavirus. Gastroesophageal reflux symptoms were strongly associated with the risk of esophageal adenocarcinoma and moderately with the risk of gastric cardia adenocarcinoma. Increasing frequency, severity, and duration of symptoms increased the risk dose-dependently. Presence of Barrett s esophagus or obesity did not affect the association. Esophageal squamous cell carcinoma was not associated with reflux symptoms. There was a strong and dose-dependent relation between increasing body mass index (BMI) and risk of esophageal adenocarcinoma through the entire range ol BMI values. The risk was independent of reflux symptoms. BMI showed a weak association with adenocarcinoma of the gastric cardia, but not with esophageal squamous cell carcinoma. The risk of esophageal adenocarcinoma was not importantly associated with smoking, snuff dipping, or alcohol use. Gastric cardia adenocarcinoma was dose-dependently associated with smoking, but not with alcohol or snuff use. Esophageal squamous cell carcinoma was strongly associated with tobacco, and moderately with alcohol, but not with snuff use. The combined use of tobacco and alcohol entailed a strongly increased risk of squamous cell carcinoma. There was no serological evidence of a positive association between human papillomavirus infection types 16 or 18 and either form of esophageal cancer. The striking male predominance in patients with esophageal adenocarcinoma is unexplained. We hypothesized that female sex hormones may be protective. In a retrospective population-based cohort study among all patients given a diagnosis of prostate cancer in Sweden between 1958 and 1992, and thus heavily exposed to estrogen, we tested this hypothesis. There was no evidence of a role of sex hormones in the etiology of esophageal adenocarcinoma.
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| 57. |
- Lagergren, Jesper, et al.
(författare)
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Gastroesophageal reflux does not alter effects of body mass index on risk of esophageal adenocarcinoma
- 2014
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Ingår i: Clinical Gastroenterology and Hepatology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1542-3565. ; 12:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: A history of high body mass index (BMI) is strongly associated with risk of esophageal adenocarcinoma (EAC). We investigated whether gastroesophageal reflux is involved in this association. Methods: We analyzed data from a population-based Swedish nationwide study of patients with a new diagnosis of EAC (n=189) or gastroesophageal junction adenocarcinoma (n= 262), and matched controls (n=816), from 1995 through 1997. Our analysis included data on BMI 20 y before study inclusion; maximum adult BMI; frequency, severity and duration of gastroesophageal reflux symptoms; tumor features; and covariates (sex, age, smoking, alcohol, fruit and vegetables intake, and socio-economic status). We conducted stratified analyses and synergy tests, adjusting for covariates. Results: Odds ratios (ORs) for EAC among subjects with BMI ≥25 20 y before inclusion, compared with those with BMI <25, did not differ significantly, without or with adjustment for gastroesophageal reflux frequency (OR, 3.1; 95% confidence interval [CI], 2.2–4.4 and OR, 3.3; 95% CI, 2.2–4.8), severity (OR, 3.3; 95% CI, 2.2–4.8), or duration (OR, 3.2; 95% CI, 2.2–4.7). However, there were strong interactions and synergisms between BMI and gastroesophageal reflux categories. BMI appeared to have the largest effect on gastroesophageal reflux frequency (synergy index 8.9; 95% CI, 2.3–34.1 for maximum BMI and gastroesophageal reflux >3 times weekly). Conclusions: Based on a population-based study, the association between BMI and EAC does not appear to be affected by symptomatic gastroesophageal reflux, although BMI and reflux act synergistically.
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| 58. |
- Lagergren, Jesper, et al.
(författare)
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Marital status, education, and income in relation to the risk of esophaegal and gastric cancer by histological type and site
- 2016
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Ingår i: Cancer. - Stockholm : Wiley. - 0008-543X .- 1097-0142. ; 122:2, s. 207-212
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDMarital status, income, and education might influence the risk of esophageal and gastric cancer, but the literature is limited. A large study addressing subtypes of these tumors was used to clarify these associations.METHODSA nationwide, Swedish population–based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders.RESULTSAmong 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women.CONCLUSIONSDivorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified.
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| 59. |
- Lagergren, Lars, et al.
(författare)
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Ett liv i förening : om integrationsarbete i Skåne
- 2012
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Ingår i: Vem platsar i laget? En antologi om idrott och etnisk mångfald. - : Centrum för Idrottsforskning. - 9789197956260 ; , s. 103-120
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 60. |
- Lagergren, Lars, et al.
(författare)
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Integration i förening : kritiska reflektioner kring ett projekt
- 2009
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Ingår i: Educare. - : Malmö högskola, Lärarutbildningen. - 1653-1868 .- 2004-5190. ; :1, s. 43-59
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Tidskriftsartikel (refereegranskat)abstract
- This article discusses integration as a process rather than as a result or as a system of distribution, and takes its cue from Lave & Wenger’s concepts of “situated learning” and “legitimate peripheral participation”. By using integration as a process related concept the article analyzes both the intentions of an integration project as well as its consequences. The intention of the project was to simplify the integration of new members of the Swedish society by funnelling them into existing associations and clubs of their own choice in order to open up the considerable amount of social net works connections to these associations and clubs through their members. By becoming members of Swedish associations and clubs newcomers would also become aware of the importance of representation in Swedish society. The authors too see this result as an important step in the process of integration from a legitimate peripheral position towards the ever changing centre, e.g. integration as a result of various situated learning.
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