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Wijk, Lena
Publications (10 of 13) Show all publications
Wijk, L., Pache, B., Altman, A. D., Williams, L. L., Elias, K. M., McGee, J., . . . Nelson, G. (2019). ERAS interactive audit system (EIAS) gynecologic oncology project: Audit of international surgical practice informs perioperative care. In: : . Paper presented at SGO 50th Annual Meeting, Honolulu, Hawaii, March 16-19, 2019.
Open this publication in new window or tab >>ERAS interactive audit system (EIAS) gynecologic oncology project: Audit of international surgical practice informs perioperative care
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-73819 (URN)
Conference
SGO 50th Annual Meeting, Honolulu, Hawaii, March 16-19, 2019
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16Bibliographically approved
Wijk, L., Ljungqvist, O. & Nilsson, K. (2019). Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study. Clinical Nutrition, 38(6), 2721-2726
Open this publication in new window or tab >>Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study
2019 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 6, p. 2721-2726Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIM: Surgery causes development of insulin resistance. Women undergoing hysterectomy have different female sex hormonal status, ranging from premenopausal to postmenopausal. The aim of the study was to explore the relation between the female sex hormones and insulin resistance (IR%) after hysterectomy.

METHODS: A secondary analysis from a randomised controlled single-centre study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women were randomised to robot-assisted laparoscopic or abdominal hysterectomy. Blood were drawn before and after surgery for measurement of oestrogens, progesterone, and gonadotropins alongside determination of insulin sensitivity using the hyperinsulinemic normolycaemic clamp.

RESULTS: Female sex hormonal status was not correlated to insulin sensitivity before operation. Premenopausal women developed more IR% than postmenopausal women (p = 0.012). Premenopausal women also showed a significant decrease in absolute levels of oestradiol (E2) (p = 0.016), and the relative decrease in E2 from preoperative to postoperative values (E2%) was significantly higher (p = 0.001). There was a significant positive correlation in the entire study population between E2% and IR% (r = 0.72, p = 0.001, r2 0.51) that remained when adjusted for age (p = 0.028), BMI (p = 0.001), and preoperative insulin sensitivity (p = 0.011) separately.

CONCLUSIONS: Premenopausal women developed a higher degree of postoperative insulin resistance that was associated with a parallel relative change in oestradiol levels compared with the postmenopausal women. It remains unclear whether these are independent phenomena in the overall stress response or whether a causal relationship exists.

Place, publisher, year, edition, pages
Churchill Livingstone, 2019
Keywords
Female sex hormones, Hysterectomy, Insulin resistance, Oestrogen
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-71432 (URN)10.1016/j.clnu.2018.11.027 (DOI)000501650600029 ()30573354 (PubMedID)2-s2.0-85058499475 (Scopus ID)
Note

Funding agencies:

Stiftelsen för Gynekologisk Onkologi

Nyckelfonden

Lisa och Johan Grönbergs Stiftelse

Available from: 2019-01-12 Created: 2019-01-12 Last updated: 2020-01-14Bibliographically approved
Nelson, G., Bakkum-Gamez, J., Kalogera, E., Glaser, G., Altman, A., Meyer, L. A., . . . Dowdy, S. C. (2019). Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. International Journal of Gynecological Cancer, 29(4), 651-668
Open this publication in new window or tab >>Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update
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2019 (English)In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 29, no 4, p. 651-668Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.

METHODS: A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

RESULTS: All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.

CONCLUSIONS: The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Cancer and Oncology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-73189 (URN)10.1136/ijgc-2019-000356 (DOI)000469455500002 ()30877144 (PubMedID)2-s2.0-85066972075 (Scopus ID)
Available from: 2019-03-19 Created: 2019-03-19 Last updated: 2019-08-12Bibliographically approved
Wijk, L., Udumyan, R., Pache, B., Altman, A. D., Williams, L. L., Elias, K. M., . . . Nelson, G. (2019). International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery. American Journal of Obstetrics and Gynecology, 221(3), 237.e1-237.e11
Open this publication in new window or tab >>International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery
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2019 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 221, no 3, p. 237.e1-237.e11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Enhanced Recovery After Surgery (ERAS) Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively.

OBJECTIVES: To evaluate the association between compliance to ERAS Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort.

STUDY DESIGN: The study was comprised of 2,101 patients undergoing elective gynecologic/oncology surgery between January 2011 - November 2017 in 10 hospitals across Canada, the United States and Europe. Patient demographics, surgical/anesthesia details and ERAS protocol compliance elements (pre-, intra- and post-operative phases) were entered into the ERAS Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low versus medium/high). The following covariates were accounted for in the analysis: age, Body Mass Index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open versus minimally invasive), intra-operative blood loss, hospital and ERAS implementation status. The primary end-points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates.

RESULTS: Patient demographics: median age 56 years, 35.5% obese,15% smokers, 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤ 3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in ERAS guideline score was associated with 8% (IRR: 0.92 (95% CI: 0.90 - 0.95; p<0.001)) decrease in days in hospital among low-complexity, and 12% (IRR: 0.88 (95% CI: 0.82 - 0.93; p<0.001) decrease among patients with medium/high complexity scores. For every unit increase in ERAS guideline score, the odds of total complications were estimated to be 12% lower (p<0.05) among low-complexity patients.

CONCLUSION: Audit of surgical practices demonstrates that improved compliance with ERAS Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of ERAS implementation.

Place, publisher, year, edition, pages
Harcourt International Publishers, 2019
Keywords
ERAS, compliance, gynecologic oncology, gynecologic surgery, length of stay, perioperative care
National Category
Obstetrics, Gynecology and Reproductive Medicine Surgery
Identifiers
urn:nbn:se:oru:diva-74194 (URN)10.1016/j.ajog.2019.04.028 (DOI)000484395000012 ()31051119 (PubMedID)2-s2.0-85067447508 (Scopus ID)
Note

Funding Agencies:

Research Committee of Örebro County Council  

Reproductive Scientist Development Program  NICHD K12HD00849

Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-11-13Bibliographically approved
Falconer, H., Palsdottir, K., Stalberg, K., Dahm-Kähler, P., Ottander, U., Lundin, E. S., . . . Salehi, S. (2019). Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. International Journal of Gynecological Cancer, 29(6), 1072-1076
Open this publication in new window or tab >>Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial
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2019 (English)In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 29, no 6, p. 1072-1076Article in journal (Refereed) Published
Abstract [en]

Background: Radical hysterectomy with pelvic lymphadenectomy represents the standard treatment for early-stage cervical cancer. Results from a recent randomized controlled trial demonstrate that minimally invasive surgery is inferior to laparotomy with regards to disease-free and overall survival.

Primary Objective: To investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy.

Study Hypothesis: Robot-assisted laparoscopic radical hysterectomy is non-inferior to laparotomy in regards to recurrence-free survival with the advantage of fewer post-operative complications and superior patient-reported outcomes.

Trial Design: Prospective, multi-institutional, international, open-label randomized clinical trial. Consecutive women with early-stage cervical cancer will be assessed for eligibility and subsequently randomized 1:1 to either robot-assisted laparoscopic surgery or laparotomy. Institutional review board approval will be required from all participating institutions. The trial is coordinated from Karolinska University Hospital, Sweden.

Major Inclusion/Exclusion Criteria: Women over 18 with cervical cancer FIGO (2018) stages IB1, IB2, and IIA1 squamous, adenocarcinoma, or adenosquamous will be included. Women are not eligible if they have evidence of metastatic disease, serious co-morbidity, or a secondary invasive neoplasm in the past 5 years.

Primary Endpoint: Recurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer.

Sample Size: The clinical non-inferiority margin in this study is defined as a 5-year recurrence-free survival not worsened by >7.5%. With an expected recurrence-free survival of 85%, the study needs to observe 127 events with a one-sided level of significance (alpha) of 5% and a power (1-beta) of 80%. With 5 years of recruitment and 3 years of follow-up, the necessary number of events will be reached if the study can recruit a total of 768 patients.

Estimated Dates for Completing Accrual and Presenting Results: Trial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
cervical cancer, surgical oncology
National Category
Cancer and Oncology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-75730 (URN)10.1136/ijgc-2019-000558 (DOI)000477657600014 ()31203203 (PubMedID)2-s2.0-85068344066 (Scopus ID)
Funder
Stockholm County Council
Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13Bibliographically approved
Wijk, L., Nilsson, K. & Ljungqvist, O. (2018). Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study. Clinical Nutrition, 37(1), 99-106
Open this publication in new window or tab >>Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study
2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 99-106Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques.

METHODS: A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered.

RESULTS: There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values.

CONCLUSIONS: Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.

CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier no NCT02291406.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Robotic-assisted hysterectomy; Insulin resistance; Hysterectomy; Inflammatory response
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-58062 (URN)10.1016/j.clnu.2016.12.015 (DOI)000425564200010 ()28043722 (PubMedID)
Note

Funding Agencies:

Research Committee of Örebro County Council

Nyckelfonden

Stiftelsen Gynekologisk Onkologi

Lisa och Göran Grönbergs Stiftelse

Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2018-08-16Bibliographically approved
Wijk, L. (2017). Enhanced Recovery After Hysterectomy. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Enhanced Recovery After Hysterectomy
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To study recovery after hysterectomy under Enhanced Recovery After Surgery (ERAS) care, and in relation to different operation techniques.

Materials and Methods: An observational study was conducted comparing 85 patients undergoing hysterectomy with ERAS care to 120 patients immediately before establishing ERAS. In a prospective cohort study of 121 consecutive patients undergoing hysterectomy, the outcome was compared for patients with malignant versus benign indications. The main outcome measure was length of stay (LOS). A randomised controlled trial (RCT) of 20 women scheduled for hysterectomy compared robot-assisted laparoscopic with abdominal hysterectomy in terms of the development of insulin resistance, inflammatory reactions, and clinical recovery, and examined the relation to hormonal status. All studies were conducted in 2011--2015, at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden.

Results: Implementation of a structured ERAS protocol significantly reduced LOS compared to non-ERAS care. The effect was similar between patients with malignant and benign indications for surgery. No difference in complications was found. There was no difference in development of insulin resistance between robotic and abdominal technique, but clinical outcomes and inflammatory responses significantly favoured robot-assisted hysterectomy. Female sex hormone status was associated with the development of insulin resistance.

Conclusions: Recovery after hysterectomy can be influenced. ERAS care seems to be effective and safe. Clinical outcome can also be influenced by operational technique. Hysterectomy triggers a stress reaction in both the metabolic and the inflammatory system. It remains unclear why the reduced inflammatory reaction and favourable clinical outcome in robotic surgery were not mirrored by less insulin resistance. This could not be explained by female sex hormone status.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 164
Keywords
Hysterectomy, ERAS, Insulin Resistance, Female Sex hormones
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-58057 (URN)978-91-7529-203-8 (ISBN)
Public defence
2017-09-22, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-06-15 Created: 2017-06-15 Last updated: 2017-10-18Bibliographically approved
Wijk, L., Franzén, K., Ljungqvist, O. & Nilsson, K. (2016). Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease. Gynecologic and Obstetric Investigation, 81(5), 461-467
Open this publication in new window or tab >>Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease
2016 (English)In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, p. 461-467Article in journal (Refereed) Published
Abstract [en]

Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

Place, publisher, year, edition, pages
Basel: S. Karger, 2016
Keywords
ERAS, Fast-track, Hysterectomy, Length of stay, Perioperative care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-53181 (URN)10.1159/000443396 (DOI)000384034700012 ()26799328 (PubMedID)2-s2.0-84955604181 (Scopus ID)
Note

Funding Agencies:

Research Committee of Örebro County Council

Nyckelfonden, Örebro, Sweden

Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2018-07-17Bibliographically approved
Nelson, G., Altman, A. D., Nick, A., Meyer, L. A., Ramirez, P. T., Achtari, C., . . . Dowdy, S. C. (2016). Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations - Part II. Gynecologic Oncology, 140(2), 323-332
Open this publication in new window or tab >>Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations - Part II
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2016 (English)In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 140, no 2, p. 323-332Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Enhanced recovery after surgery, Gynecologic/oncology, Evidence based postoperative care
National Category
Cancer and Oncology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Oncology
Identifiers
urn:nbn:se:oru:diva-48759 (URN)10.1016/j.ygyno.2015.12.019 (DOI)000369678900023 ()26757238 (PubMedID)
Note

Funding Agency:

Baxter UK Ltd.

Available from: 2016-02-29 Created: 2016-02-29 Last updated: 2018-07-10Bibliographically approved
Nelson, G., Altman, A. D., Nick, A., Meyer, L. A., Ramirez, P. T., Achtari, C., . . . Dowdy, S. C. (2016). Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations - Part I. Gynecologic Oncology, 140(2), 313-322
Open this publication in new window or tab >>Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations - Part I
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2016 (English)In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 140, no 2, p. 313-322Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Enhanced Recovery After Surgery, Gynecologic/oncology, Evidence based perioperative care
National Category
Cancer and Oncology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Oncology
Identifiers
urn:nbn:se:oru:diva-48758 (URN)10.1016/j.ygyno.2015.11.015 (DOI)000369678900022 ()26603969 (PubMedID)
Note

Funding Agency:

Baxter UK Ltd.

Available from: 2016-02-29 Created: 2016-02-29 Last updated: 2018-09-12Bibliographically approved
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