| 1. |
- Hansdotter, P., et al.
(författare)
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Patterns and resectability of colorectal cancer recurrences: outcome study within the COLOFOL trial
- 2021
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Ingår i: BJS open. - : Oxford University Press (OUP). - 2474-9842. ; 5:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Improvements in surgery, imaging, adjuvant treatment, and management of metastatic disease have led to modification of previous approaches regarding the risk of recurrence and prognosis in colorectal cancer. The aims of this study were to map patterns, risk factors, and the possibility of curative treatment of recurrent colorectal cancer in a multimodal setting. METHODS: This was a cohort study based on the COLOFOL trial population of patients who underwent radical resection of stage II or III colorectal cancer. The medical files of all patients with recurrence within 5years after resection of the primary tumour were scrutinized. Follow-up time was 5years after the first recurrence. Primary endpoints were cumulative incidence, site, timing, and risk factors for recurrence, and rate of potentially curative treatment. A secondary endpoint was survival. RESULTS: Of 2442 patients, 471 developed recurrences. The 5-year cumulative incidence was 21.4 (95 per cent c.i. 19.5 to 23.3) per cent. The median time to detection was 1.1years after surgery and 87.3 per cent were detected within 3years. Some 98.2 per cent of patients who had potentially curative treatment were assessed by a multidisciplinary tumour board. A total of 47.8 per cent of the recurrences were potentially curatively treated. The 5-year overall survival rate after detection was 32.0 (95 per cent c.i. 27.9 to 36.3) per cent for all patients with recurrence, 58.6 (51.9 to 64.7) per cent in the potentially curatively treated group and 7.7 (4.8 to 11.5) per cent in the palliatively treated group. CONCLUSION: Time to recurrence was similar to previous results, whereas the 21.4 per cent risk of recurrence was somewhat lower. The high proportion of patients who received potentially curative treatment, linked to a 5-year overall survival rate of 58.6 per cent, indicates that it is possible to achieve good results in recurrent colorectal cancer following multidisciplinary assessment.
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| 2. |
- Hansdotter, Pernilla, et al.
(författare)
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Treatment and survival of patients with metachronous colorectal lung metastases
- 2023
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Ingår i: Journal of Surgical Oncology. - : John Wiley & Sons. - 0022-4790 .- 1096-9098. ; 127:5, s. 806-814
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The lungs are the second most common site for metachronous metastases in colorectal cancer. No treatment algorithm is established, and the role of adjuvant chemotherapy is unclear. This study aimed to map pulmonary recurrences in a modern multimodal treated population, and to evaluate survival depending on management.Methods: Retrospective study based on the COLOFOL-trial population of 2442 patients, radically resected for colorectal cancer stage II-III. All recurrences within 5 years were identified and medical records were scrutinized.Results: Of 165 (6.8%) patients developing lung metastases as first recurrence, 89 (54%) were confined to the lungs. Potentially curative treatment was possible in 62 (37%) cases, of which 33 with surgery only and 29 with surgery and chemotherapy combined. The 5-year overall survival (5-year OS) for all lung recurrences was 28%. In patients treated with chemotherapy only the 5-year OS was 7.5%, compared with 55% in patients treated with surgery, and 72% when surgery was combined with chemotherapy. Hazard ratio for mortality was 2.9 (95% confidence interval 1.40-6.10) for chemotherapy only compared to surgery.Conclusion: A high proportion of metachronous lung metastases after colorectal surgery were possible to resect, yielding good survival. The combination of surgery and chemotherapy might be advantageous for survival.
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| 3. |
- Scherman, Peter, et al.
(författare)
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Cross-Sectional Area and Strength Differences of Fiberwire, Prolene, and Ticron Sutures.
- 2010
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 35A, s. 780-784
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Flexor tendons should be repaired with suture material strong enough to permit early motion and small enough for the resulting knot to allow unimpeded tendon glide and healing. This study sought to define differences in cross-sectional area and knotted tensile strength among Fiberwire, Prolene, and Ticron sutures. METHODS: Five strands, each of 3-0 and 4-0 Prolene, Ticron, and Fiberwire sutures, were embedded in polymethylmethacrylate and sectioned in a linear precision saw to obtain 10 cross-sections of each material and size. These were examined by scanning electron microscopy and digitally analyzed for cross-sectional areas. Ten strands of each suture material and size had a single throw knot placed, and they were loaded to failure in a micromechanical tester. RESULTS: Prolene and Ticron cross-sections were circular. Fiberwire was noncircular. The 3-0 Fiberwire sutures had greater cross-sectional area than the 3-0 Ticron sutures (p < .001), which in turn were larger than 3-0 Prolene (p < .05). The 4-0 Fiberwire cross-sectional area was also greater than that of 3-0 Ticron and Prolene (p < .05). After relating knotted tensile strength to cross-sectional area, Fiberwire was 10% stronger than Prolene, and 25% stronger than Ticron. CONCLUSIONS: Fiberwire is not only stronger, but also larger than other sutures in the same or even higher suture size category. Failure to meet the United States Pharmacopeia standards for suture diameter is declared in the product information sheet, although surgeons may not be aware of these size variations. Suture size definitions are currently based on diameter, a consistent measure for circular monofilament sutures, but not for braided or noncircular sutures.
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| 4. |
- Scherman, Peter, et al.
(författare)
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High resection rates of colorectal liver metastases after standardized follow-up and multimodal management: an outcome study within the COLOFOL trial
- 2023
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Ingår i: Hpb. - : Elsevier BV. - 1365-182X. ; 25:7, s. 766-774
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Tidskriftsartikel (refereegranskat)abstract
- Background: Outcome after colorectal liver metastases (CRLM) resection has improved over time, despite increased resection rates. Hence, it's crucial to identify all patients possible to treat with curative intent. The objectives of this study were to map recurrence pattern, treatment strategy and survival depending on treatment and follow-up strategy.Methods: In the COLOFOL-trial, patients with radically resected stage II-III colorectal cancer were randomized to high-frequency (6, 12, 18, 24 and 36 months; HF) or low-frequency (12 and 36 months; LF) follow-up. In this study, all CRLM within 5 years were identified and medical files scrutinized. Overall survival (OS) was analysed in uni- and multivariable analyses. Primary endpoint was 5-year OS. Results: Of 2442 patients, 235 (9.6%) developed metachronous CRLM of which 123 (52.3%) underwent treatment with curative intent, resulting in 5-year OS of 58%. Five-year OS for patients with CRLM was 43% after HF versus 24% after LF. The survival benefit was confirmed for HF 8 years from resection of the primary tumour, HR 0.63 (CI 0.46-0.85).Conclusion: A high proportion of metachronous CRLM was possible to treat with curative intent, yielding high survival rates. More intense follow-up after colorectal cancer resection might be of value in high-risk patients.
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| 5. |
- Scherman, Peter, et al.
(författare)
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Impact of patient, primary tumor and metastatic pattern including tumor location on survival in patients undergoing ablation or resection for colorectal liver metastases: A population-based national cohort study
- 2021
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 47:2, s. 375-383
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Selecting the optimal treatment strategy for patients with colorectal liver metastases (CRLM) aim to improve survival for the total cohort. Following the introduction of laparoscopic resections and ablation, localization may direct choice of method. The aim with this study was to re-evaluate prognostic factors that should be considered at the preoperative multidisciplinary tumor board, based on a national population cohort. Materials and methods A national cohort with radically operated colorectal cancer in 2009-2013, also treated for CRLM was identified in Swedish national registries. Prognostic factors were identified and evaluated in multivariable analyses. Results 1200 patients treated with resection and 125 with ablation only were included in the study cohort. Relative five-year survival was 54.7% (50.9%-58.4%) and 32.0% (22.4%-41.9%), respectively). High age, acute surgery and complications at time of primary tumor resection remained important risk factors at liver surgery, as well as the primary tumor characteristics; vascular invasion and high lymph node ratio. As for metastatic pattern; tumor size, location in segment 4, 6, 7 or 8, multiple metastatic sites and progress after preoperative chemotherapy were significant risk factors. In multivariate analyses, ablation therapy doubled the risk of death within 5 years. This strong negative impact was confirmed in a weighted propensity score analysis (HR = 2.1 (95 % CI 1.5 -3.0)). Conclusion Segmental localization and tumor size were prognostic factors but also patient and primary tumor factors significantly impacted survival after intervention for CRLM. Long-term survival was significantly lower after ablation therapy compared to surgical resection.
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| 6. |
- Scherman, Peter, et al.
(författare)
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Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer
- 2020
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Ingår i: Bjs Open. - : Oxford University Press (OUP). - 2474-9842. ; 4:1, s. 118-132
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Tidskriftsartikel (refereegranskat)abstract
- Background Resection of the primary tumour is a prerequisite for cure in patients with colorectal cancer, but hepatic metastasectomy has been used increasingly with curative intent. This national registry study examined prognostic factors for radically treated primary tumours, including the subgroup of patients undergoing liver metastasectomy. Methods Patients who had radical resection of primary colorectal cancer in 2009-2013 were identified in a population-based Swedish colorectal registry and cross-checked in a registry of liver tumours. Data on primary tumour and patient characteristics were extracted and prognostic impact was analysed. Results Radical resection was registered in 20 853 patients; in 38 center dot 7 per cent of those registered with liver metastases, surgery or ablation was performed. The age-standardized relative 5-year survival rate after radical resection of colorectal cancer was 80 center dot 9 (95 per cent c.i. 80 center dot 2 to 81 center dot 6) per cent, and the rate after surgery for colorectal liver metastases was 49 center dot 6 (46 center dot 0 to 53 center dot 2) per cent. Multivariable analysis identified lymph node status, multiple sites of metastasis, high ASA grade and postoperative complications after resection of the primary tumour as strong risk factors after primary resection and following subsequent liver resection or ablation. Age, sex and primary tumour location had no prognostic impact on mortality after liver resection. Conclusion Lymph node status and complications have a negative impact on outcome after both primary resection and liver surgery. Older age and female sex were underrepresented in the liver surgical cohort, but these factors did not influence prognosis significantly.
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| 7. |
- Scherman, Peter, et al.
(författare)
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Risk Factors for Postoperative Complications Following Resection of Colorectal Liver Metastases and the Impact on Long-Term Survival: A Population-Based National Cohort Study
- 2023
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Ingår i: World Journal of Surgery. - 0364-2313. ; 47:9, s. 2230-2240
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPostoperative complications (POCs) following resection of colorectal liver metastases (CRLM) are common. The objective of this study was to evaluate risk factors for developing complications and their impact on survival considering prognostic factors of the primary tumor, metastatic pattern and treatment in a well-defined national cohort.MethodsPatients treated with resection for CRLM that was also radically resected for their primary colorectal cancer (diagnosed in 2009-2013) were identified in Swedish national registers. Liver resections were categorized according to extent of surgery (Category I-IV). Risk factors for developing POCs as well as prognostic impact of POCs were evaluated in multivariable analyses. A subgroup analysis of minor resections was performed to evaluate POCs after laparoscopic surgery.ResultsPOCs were registered for 24% (276/1144) of all patients after CRLM resection. Major resection was a risk factor for POCs in multivariable analysis (IRR 1.76; P = 0.001). Comparing laparoscopic and open resections in the subgroup analysis of small resections, 6% (4/68) in the laparoscopic group developed POCs compared to 18% (51/289) after open resection (IRR 0.32; P = 0.024). POCs were associated with a 27% increased excess mortality rate (EMRR 1.27; P = 0.044). However, primary tumor characteristics, tumor burden in the liver, extrahepatic spread, extent of liver resection and radicality had higher impact on survival.ConclusionMinimal invasive resections were associated with a decreased risk of POCs following resection of CRLM which should be considered in surgical strategy. Postoperative complications were associated with a moderate risk for inferior survival.
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| 8. |
- Dahlin, Lars B., et al.
(författare)
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Intraneural glomus tumor of "uncertain malignant potential" and with BRAF mutation in the median nerve - an unusual case
- 2017
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Ingår i: Clinical Neuropathology. - 0722-5091. ; 36:7, s. 164-170
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Tidskriftsartikel (refereegranskat)abstract
- A glomus tumor of uncertain malignant potential is defined as a glomus tumor with some, but not all, criteria for malignancy and without a known metastasis. Here, we present a rare example presenting in the median nerve in a 40-year-old woman with a long history of severely impaired left median nerve function. A large panel of immunohistochemical stains excluded other diagnoses, and the designation of a "uncertain malignant potential" was based on the high proliferative activity, the tumor size and location, and the lack of WHO malignancy criteria such as marked nuclear atypia, necrosis, or atypical mitoses. A BRAF mutation was found in the tumor. Although extremely rare, both benign and malignant glomus tumors may present in large peripheral nerves and should therefore be considered in the differential diagnosis.
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| 9. |
- Haddad, Roger, et al.
(författare)
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A Biomechanical Assessment of Repair Versus Nonrepair of Sheep Flexor Tendons Lacerated to 75 Percent
- 2010
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Ingår i: The Journal of Hand Surgery. - : Elsevier BV. - 1531-6564 .- 0363-5023. ; 35A:4, s. 546-551
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The benefit of repairing a 75% partial flexor tendon laceration remains controversial. The purpose of this study was to assess the degree of gap formation with and without repair when the 75% lacerated tendon is subjected to cyclic loading. Repair with only a peripheral suture was compared to that using a core and peripheral repair technique. Methods Sixteen deep flexor tendons from sheep hind limbs were lacerated to 75% of the tendon diameter. The cut tendons were loaded for 100 cycles from 3 N up to 30 N and then back to 3 N, at a rate of 0.2 Hz. Gap formation was measured at 0 and 100 cycles. Tendons were then randomized into 2 repair groups of 8 each: group 1 was repaired with only a simple, running peripheral suture (6-0 polypropylene monofilament), whereas group 2 was repaired with a modified Kessler core suture (4-0 silicone-coated braided polyester) plus a peripheral suture (6-0 polypropylene monofilament). Repaired tendons were tested for 500 cycles, and the gap was measured at 0, 100, and 500 cycles. After cycling, gap was measured at 100 N load, and the peak loads were determined on static failure testing. Results The 75% partially lacerated tendons had >2 mm gap at 100 cycles. This gap was significantly reduced by peripheral or peripheral plus core repairs (p < .001). There was no difference in gap formation between tendons with peripheral repair only and those with both peripheral and core repairs. Gap formation in repaired tendons remained <= 1 mm at 500 cycles. After cycling, neither gap formation at 100 N load or the peak loads on failure testing differed between the 2 repair groups. Conclusions There is a large gap when an unrepaired 75% partial laceration is cyclically loaded. This gap is significantly reduced with a peripheral repair whether or not a core suture is used. (J Hand Surg 2010;35A:546-551. (C) 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)
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| 10. |
- Hall, Mats, et al.
(författare)
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Intestinal metaplasia at the gastroesophageal junction is associated with gastroesophageal reflux but not with Helicobacter pylori infection
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 53:10-11, s. 1179-1185
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Studies of the etiology of intestinal metaplasia (IM) at a normal appearing gastroesophageal junction (GEJ) are conflicting as associations with both H. Pylori (HP) infection and gastroesophageal reflux has been reported. The aim of this study was to investigate whether IM at the GEJ is associated with gastroesophageal reflux or HP infection. Material and methods: Fifty asymptomatic volunteers and 149 patients with reflux symptoms underwent endoscopy with biopsies obtained from the gastric antrum and the squamocolumnar junction (SCJ). All subjects underwent wireless 48 h pH monitoring with the electrode placed immediately above the SCJ and a fecal antigen test for HP infection. Clinical characteristics and the pattern of reflux were compared in subjects with and without IM. Results: Three asymptomatic volunteers and 35 patients who had clearly irregular SCJs with short extensions of columnar mucosa were excluded from the study. In the remaining 47 asymptomatic volunteers and 114 patients, variables that reached a significance level of 0.1 or less on univariate analyses were used in a binomial regression analysis to assess their relative importance for the finding of IM. IM at the GEJ was significantly associated with abnormal distal esophageal acid exposure (5.5 (1.2–24.6), p =.026), the frequency of reflux episodes/hour (1.5 (1.1–2.2), p =.031), and an endoscopic appearance of the SCJ corresponding to ZAP grade I (4.6 (1.4–15.6), p =.013). There was no association with HP infection. Conclusion: The finding of IM at an endoscopically normal-appearing GEJ is associated with gastroesophageal reflux but not with HP infection.
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