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- Engström, Cecilia, 1965, et al.
(author)
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An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial
- 2007
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In: World journal of surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 31:6
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Journal article (peer-reviewed)abstract
- BACKGROUND: Partial fundoplications have been popularized by their lower risk of mechanical side effects. The question then emerges whether a similar partial wrap should be done posterior or anterior to the distal esophagus? We therefore conducted a study to compare the long-term outcome of laparoscopic partial fundoplications constructed either as anterior (AF) or posterior (PF) repairs. PATIENTS AND METHODS: Ninety-five patients were enrolled in a randomized clinical trial. After a mean follow up of 65 months, 43 AF and 45 PF patients remained in the study. The levels of reflux control and postfundoplication complaints were assessed by use of validated instruments. RESULTS: A posterior fundoplication was found to provide significantly better control of reflux related symptoms (heartburn p < 0.0001, acid regurgitation p < 0.0001). This was also reflected in a significantly lower number of reoperations and need for antisecretory drug therapy. The earlier postoperative difference in postfundoplication symptoms had disappeared. CONCLUSIONS: A laparoscopic posterior partial fundoplication offers a high and durable level of disease control with few side effects. The current anterior type of repair cannot be recommended due to insufficient reflux control.
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- Engström, Cecilia, 1965, et al.
(author)
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Manometric characteristics of the gastroesophageal junction after anterior versus posterior partial fundoplication
- 2005
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In: Diseases of the esophagus. - 1120-8694. ; 18:1, s. 31-6
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Journal article (peer-reviewed)abstract
- How best to surgically treat GERD is an unresolved issue. To increase our insights into the fundoplication procedures, functional consequences for the gastroesophageal junction of an anterior or a posterior partial fundoplication were studied by manometry. Patients were randomly selected from a larger study in a randomised comparison between posterior and anterior partial fundoplications. The manometric studies were done 12 months after respective procedures in 24 patients. The motor characteristics of the esophagus and lower esophageal sphincter (LES) function were determined by use of sleeve catheter manometry. The manometric characteristics of the esophageal body were similar in the study groups except for the ramp pressure. This was significantly higher in patients with posterior partial fundoplications. The posterior group had significantly longer total length (P < 0.02) as well as longer intra-abdominal portions (P = 0.07) of the LES while the basal tone, albeit numerically higher, did not reach statistical significance. Water-swallow induced LES relaxations reached lower nadir values in the anterior group (1.7 vs 2.7 mmHg). Gas distension triggered few transient LES relaxations in both study groups while common cavities were more frequently observed in those having an anterior partial wrap (P < 0.01). A posterior partial fundoplication is followed by manometric characteristics suggesting a well functioning antireflux barrier with some obstruction to bolus passage as well as restricted venting of air from the stomach. The manometric mechanisms behind the inferior reflux control achieved by a Watson type of anterior partial wrap has now been further elucidated.
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- Engström, Cecilia, 1965
(author)
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Operations for gastro-esophageal reflux disease. Studies on mode of action and how to improve functional outcomes
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Fundoplication operations have gained wide acceptance as an effective and durable treatment for chronic gastro-esophageal reflux disease (GERD). However, further valid data are required on the long-term efficacy and above all the corresponding profile of operation specific side effects. Depending on the magnitude of the postfundoplication problems, there is an obvious need for well-controlled data on how the design of a fundoplication procedure should be further developed in order to minimise the side effects without compromising with the level of reflux control.Patients and methodsThe present investigation incorporates three series of chronic GERD patients who were found suitable of antireflux surgery. Originally 137 patients were randomised to be either on open total fundoplication (Nissen-Rossetti) or a posterior partial wrap (Toupet). This group was subsequently followed during a median period of almost 12 years. Secondly 99 chronic GERD patients were randomly allocated to have a laparoscopic total fundoplication with or without a complete mobilisation of the fundus by division of all short gastric vessels. Finally 95 patients had either a Toupet partial fundoplication or an anterior partial wrap according to Watson. These operations were done laparoscopically. In the pre and postoperative evaluation all the patients were investigated by standardised questionnaire to assess symptoms, manometry and ambulatory 24-hour pH monitoring as well as endoscopy. In the postoperative setting endoscopy was only regularly used in study I. In a subset of patients a more extensive manometric protocol was followed, incorporating the use of sleeve sensor and gasdistension of the stomach.ResultsA posterior partial fundoplication was found to be equally effective in controlling GERD as a total fundic wrap. The downside of the latter procedure was, however, that gasbloat like complaints were more frequent and remained fairly stable even after 12 years. The most frequent complain was from rectal flatus. When doing a laparoscopic total fundoplication no major clinical differences emerged between the two operative approaches. However, in patients with intact short gastric vessels data were obtained to suggest better abilities to vent air from the stomach (more TLESRs on distension). An anterior partial fundoplication was clearly inferior to a laparoscopic Toupet procedure in terms of reflux control without major differences in the profile of post fundoplication complaints.ConclusionA posterior fundoplication has obvious advantages over a total fundoplication with fewer associated postfundoplication symptoms with maintained high level of reflux control. An anterior partial wrap does not correct the physiology of the gastroesophageal junction nor the gastroesophageal reflux. When doing a total fundoplication there seems to be no advantage by mobilising the fundus through division of all short gastric vessels.
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- Fagman, Johan Bourghardt, 1980, et al.
(author)
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EGFR, but not COX-2, protein in resected pancreatic ductal adenocarcinoma is associated with poor survival.
- 2019
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In: Oncology letters. - : Spandidos Publications. - 1792-1074 .- 1792-1082. ; 17:6, s. 5361-5368
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Journal article (peer-reviewed)abstract
- The effects of EGFR and COX-2 protein overexpression on clinical outcomes in pancreatic ductal adenocarcinoma (PDAC) patients remains unclear. Therefore, the aim of the present study was to evaluate the protein expression of epithelial growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) in tumor cells in surgically resected PDAC, in comparison with clinicopathological characteristics and clinical outcomes. Immunohistochemical staining of formalin-fixed paraffin-embedded tissue derived from surgically resected tumors was performed. Tissue slides were evaluated for membrane wild-type EGFR and cytoplasmic COX-2 staining using a histoscore system. Statistical associations between EGFR and COX-2 staining and clinicopathological characteristics were examined to predict survival. In a cohort of 32 resected PDAC patients, high EGFR protein expression in tumor cells was significantly associated with shorter median overall survival (7.9 vs. 39.2 months, P=0.0038). The corresponding hazard ratio (HR) for patients with high EGFR protein expression in tumor cells was 3.12 [95% confidence interval (CI): 1.39-7.00, P=0.006]. COX-2 protein expression was not associated with survival (22.6 vs. 24.5 months P=0.60; HR 1.22 95% CI: 0.59-2.51, P=0.60). Following multivariate Cox regression analysis, high EGFR protein expression in tumor cells (P=0.043) remained as significant independent prognostic factor for survival. In conclusion, high wild-type EGFR protein expression, but not COX-2 protein expression, in tumor cells is a prognostic factor for reduced overall survival following pancreatic tumor resection, supporting a role for EGFR in identifying resected patients that may benefit from EGFR-targeted therapy.
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