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Sökning: L773:2044 6055 > Lagergren Pernilla

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1.
  • Brusselaers, Nele, et al. (författare)
  • Education level and survival after esophageal cancer surgery : a prospective population-based cohort study
  • 2013
  • Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.
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2.
  • Brusselaers, Nele, et al. (författare)
  • Education level influences long-term survival after esophageal cancer surgery in a nationwide Swedish cohort study
  • 2013
  • Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures: The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse longterm survival after oesophagectomy for cancer.
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3.
  • Brusselaers, Nele, et al. (författare)
  • Marital status and survival after oesophageal cancer surgery : a population-based nationwide cohort study in Sweden
  • 2014
  • Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives A beneficial effect of being married on survival has been shown for several cancer types, but is unclear for oesophageal cancer. The objective of this study was to clarify the potential influence of the marital status on the overall and disease-specific survival after curatively intended treatment of oesophageal cancer using a nationwide population-based design, taking into account the known major prognostic variables. Design Prospective, population-based cohort. Setting All Swedish hospitals performing surgery for oesophageal cancer during 2001–2005. Participants This study included 90% of all patients with oesophageal or junctional cancer who underwent surgical resection in Sweden in 2001–2005, with follow-up until death or the end of the study period (2012). Primary and secondary outcome measures Cox regression was used to estimate associations between the marital status and the 5-year overall and disease-specific mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. Results Of all 606 included patients (80.4% men), 55.1% were married, 9.2% were remarried, 22.6% were previously married and 13% were never married. Compared with the married patients, the never married (HR 1.02, 95% CI 0.77 to 1.35), previously married (HR 0.90, 95% CI 0.71 to 1.15) and remarried patients (HR 0.79, 95% CI 0.55 to 1.13) had no increased overall 5-year mortality. The corresponding HRs for disease-specific survival, and after excluding the initial 90 days of surgery, were similar to the HRs for the overall survival. Conclusions This study showed no evidence of a better 5-year survival in married patients compared with non-married patients undergoing surgery for oesophageal cancer.
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4.
  • Lagergren, Jesper, et al. (författare)
  • Clinical implementation of a new antibiotic prophylaxis regimen for percutaneous endoscopic gastrostomy
  • 2013
  • Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: This study was undertaken to test the extent to which a new antibiotic prophylaxis regimen for percutaneous endoscopic gastrostomy (PEG), identified as a justified and simpler alternative to conventional regimen in a randomised clinical trial, has been adopted in clinical practice. DESIGN: A Swedish nationwide implementation survey, conducted in February 2013, assessed the level of clinical implementation of a 20 ml dose of oral solution of sulfamethoxazole and trimethoprim deposited in the PEG catheter immediately after insertion. All hospitals inserting at least five PEGs annually were identified from the Swedish Patient Registry. A clinician involved in the PEG insertions at each hospital participated in a structured telephone interview addressing their routine use of antibiotic prophylaxis. SETTING: All Swedish hospitals inserting PEGs (n=60). PARTICIPANTS: Representatives of PEG insertions at each of the 60 eligible hospitals participated (100% participation). MAIN OUTCOME MEASURES: Use of routine antibiotic prophylaxis for PEG. RESULTS: A total of 32 (53%) of the 60 hospitals had adopted the new regimen. It was more frequently adopted in university hospitals (67%) than in community hospitals (41%). An annual total of 1813 (70%) of 2573 patients received the new regimen. Higher annual hospital volume was associated with a higher level of adoption of the new regimen (80% in the highest vs 31% in the lowest). CONCLUSIONS: The clinical implementation of the new antibiotic prophylaxis regimen for PEG was high and rapid (70% of all patients within 3 years), particularly in large hospitals.
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5.
  • Lagergren, Jesper, et al. (författare)
  • Weekday of oesophageal cancer surgery in relation to early postoperative outcomes in a nationwide Swedish cohort study
  • 2016
  • Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Later weekday of surgery for oesophageal cancer seems to increase 5-year mortality, but the mechanisms are unclear. We hypothesised that early postoperative reoperations and mortality might explain this association, since reoperation after oesophagectomy decreases long-term prognosis, and later weekday of elective surgery increases 30-day mortality. Design: This was a population-based cohort study during the study period 1987–2014. Setting: All Swedish hospitals conducting elective surgery for oesophageal cancer in Sweden. Participants: Included were 1748 patients, representing almost all (98%) patients who underwent elective surgery for oesophageal cancer in Sweden during 1987–2010, with follow-up until 2014. Primary and secondary outcome measures: The risk of reoperation or mortality within 30 days of oesophageal cancer surgery was assessed in relation to weekday of surgery by calculating ORs with 95% CIs using multivariable logistic regression. ORs were adjusted for age, comorbidity, tumour stage, histology, neoadjuvant therapy and surgeon volume. Results: Surgery Wednesday to Friday did not increase the risk of reoperation or mortality compared with surgery Monday to Tuesday (OR=0.99, 95% CI 0.75 to 1.31). A decreased point estimate of reoperation (OR=0.88, 95% CI 0.64 to 1.21) was counteracted by an increased point estimate of mortality (OR=1.28, 95% CI 0.83 to 1.99). ORs did not increase from Monday to Friday when each weekday was analysed separately. There was no association between weekday of surgery and reoperation specifically for anastomotic leak, laparotomy or wound infection. Stratification for surgeon volume did not reveal any clear associations between weekday of surgery and risk of 30-day reoperation or mortality. Conclusions: Weekday of oesophageal cancer surgery does not seem to influence the risk of reoperation or mortality within 30 days of surgery, and thus cannot explain the association between weekday of surgery and long-term prognosis.
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7.
  • van der Schaaf, Maartje, et al. (författare)
  • Reoperation after oesophageal cancer surgery in relation to long-term survival : a population-based cohort study
  • 2014
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:3
  • 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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