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  • 1.
    Floodeen, Hannah
    et al.
    Örebro University Hospital.
    Hallböök, Olof
    Linköping University Hospital, Linköping, Sweden.
    Rutegård, J.
    Umeå University Hospital, Umeå, Sweden.
    Sjödahl, R.
    Linköping University Hospital, Linköping, Sweden.
    Matthiessen, Peter
    Örebro University Hospital.
    Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?2013In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 15, no 3, p. 334-340Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to compare patients with symptomatic anastomotic leakage following low anterior resection of the rectum (LAR) for cancer diagnosed during the initial hospital stay with those in whom leakage was diagnosed after hospital discharge.

    Method: Forty-five patients undergoing LAR (n=234) entered into a randomized multicentre trial (NCT 00636948), who developed symptomatic anastomotic leakage, were identified. A comparison was made between patients diagnosed during the initial hospital stay on median postoperative day 8 (early leakage, EL; n=27) and patients diagnosed after hospital discharge at median postoperative day 22 (late leakage, LL; n=18). Patient characteristics, operative details, postoperative course and anatomical localization of the leakage were analysed.

    Results: Leakage from the circular stapler line of an end-to-end anastomosis was more common in EL, while leakage from the stapler line of the efferent limb of the J-pouch or side-to-end anastomosis tended to be more frequent in LL (P=0.057). Intra-operative blood loss (P=0.006) and operation time (P=0.071) were increased in EL compared with LL. On postoperative day 5, EL performed worse than LL with regard to temperature (P=0.021), oral intake (P=0.006) and recovery of bowel activity (P=0.054). Anastomotic leakage was diagnosed most often by a rectal contrast study in EL and by CT scan in LL. The median initial hospital stay was 28days for EL and 10days for LL (P<0.001).

    Conclusion: The present study has demonstrated that symptomatic anastomotic leakage can present before and after hospital discharge and raises the question of whether early and late leakage after LAR may be different entities.

  • 2. Liljegren, Göran
    et al.
    Chabok, A.
    Wickbom, M.
    Smedh, K.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Acute colonic diverticulitis: a systematic review of diagnostic accuracy2007In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 9, no 6, p. 480-488Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To appraise the literature on the diagnosis of acute colonic diverticulitis by ultrasound (US), computed tomography (CT), barium enema (BE) and magnetic resonance imaging (MRI). METHOD: The databases of Pub Med, the Cochrane Library and EMBASE were searched for articles on the diagnosis of diverticulitis published up to November 2005. Studies where US, CT, BE, or MRI were compared with a reference standard on consecutive or randomly selected patients were included. Three examiners independently read the articles according to a prespecified protocol. In case of disagreement consensus was sought. The level of evidence of each article was classified according to the criteria of the Centre for Evidence-Based Medicine (CEBM), Oxford, UK. RESULTS: Forty-nine articles relevant to the subject were found and read in full. Twenty-nine of these were excluded. Among the remaining 20 articles, only one study, evaluating both US and CT reached level of evidence 1b according to the CEBM criteria. Two US studies and one MRI study reached level 2b. The remaining studies were level 4. CONCLUSION: The best evidence for diagnosis of diverticulitis in the literature is on US. Only one small study of good quality was found for CT and for MRI-colonoscopy.

  • 3. Matthiessen, Peter
    et al.
    Lindgren, Rickard
    Örebro University, School of Health and Medical Sciences.
    Hallböök, Olof
    Rutegård, Jörgen
    Sjödahl, Rune
    Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection for rectal cancer2010In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 12, no 7 Online, p. e82-e87Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate patients with symptomatic anastomotic leakage diagnosed after hospital discharge.METHOD: Patients (n = 234) undergoing low anterior resection of the rectum for cancer who were included in a prospective multicentre trial (NCT 00636948) and who developed symptomatic anastomotic leakage diagnosed after hospital discharge (late leakage, LL; n = 18) were identified. Patient characteristics, operative details, recovery on postoperative day 5, length of hospital stay, and how the leakage was diagnosed were recorded. A comparison with those who did not develop symptomatic leakage (no leakage, NL; n = 189) was made. The minimum follow up was 24 months.RESULTS: In the LL patients the median age was 69 years, 61% were female patients, and 6% had stage IV cancer disease. On postoperative day 5, the LL group had a postoperative course similar to the NL group regarding temperature, oral intake and bowel function. The proportion of patients on antibiotic treatment on postoperative day 5, regardless of indication, was 28% in the LL compared with 4% in the NL group (P < 0.001). The median initial hospital stay was 10 days for both groups. When readmission for any reason was added, the hospital stay rose to a median of 21.5 and 13 days in the LL and the NL groups respectively (P < 0.001).CONCLUSION: Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection of the rectum for cancer is not uncommon and has an immediate clinical postoperative course which may appear uneventful.

  • 4.
    Rutegård, M.
    et al.
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Haapamäki, M.
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Rutegård, Jörgen
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
    Early postoperative mortality after surgery for rectal cancer in Sweden, 2000-20112014In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 16, no 6, p. 426-432Article in journal (Refereed)
    Abstract [en]

    Aim: Postoperative mortality has traditionally been defined as death within 30 days of surgery. Such mortality after rectal cancer resection has declined significantly during the last decades. However, it is possible that this decline can be explained merely by a shift towards an increase in 90-day mortality.

    Method: A nationwide cohort study was based on data from the Swedish Colorectal Cancer Registry and the Swedish Patient Registry concerning patients who had undergone surgical resection for rectal cancer in 2000-2011. Unconditional logistic regression was used to calculate ORs with 95% CIs regarding mortality in different calendar periods (2000-2003, 2004-2007 and 2008-2011) in two different postoperative time periods (0-30 days and 31-90 days).

    Results: Some 15,437 patients were included in this surgical cohort. Mortality within 30 days of surgery decreased from 2.1% in 2000-2003 to 1.6% in 2008-2011, whilst the corresponding mortality within the 31- to 90-day time window decreased from 2.1% to 1.4%. The adjusted risk of 30-day mortality in 2008-2011 was statistically significantly decreased compared with that in 2000-2003 (OR = 0.67; 95% CI: 0.48-0.93) and mortality in the 31- to 90-day time window was also reduced for 2008-2011 compared with 2000-2003 (OR = 0.71; 95% CI: 0.51-0.99).

    Conclusion: This population-based, nationwide Swedish study indicates that postoperative mortality, as measured within 30 days and 31-90 days after surgery, has decreased with time. However, no relevant shift from earlier to later postoperative mortality was discerned.

  • 5.
    Siekmann, Wiebke
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Eintrei, Christina
    Department of Anesthesiology and Intensive care, County Council of Östergötland, Linköping, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sjölander, Anita
    Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Malmö, Sweden.
    Matthiessen, Peter
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Council of Östergötland, Linköping, Sweden.
    Gupta, Anil
    Örebro University, School of Medical Sciences. Karolinska University Hospital, Stockholm, Sweden.
    Surgical and not analgesic technique affects postoperative inflammation following colorectal cancer surgery: a prospective, randomized study2017In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 6, p. O186-O195Article in journal (Refereed)
    Abstract [en]

    AIM: Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery.

    METHODS: 96 patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient controlled intravenous analgesia (group P). Surgery and anaesthesia were standardized in both groups. Plasma cortisol, insulin and serum cytokines (IL-1β,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-13,TNFα,IFNγ,GM-CSF,PGE2 and VEGF) were measured preoperatively (T0), 1-6 hours postoperatively (T1) and 3-5 days postoperatively (T2). Mixed model analysis was used, after logarithmic transformation when appropriate, for analyses of cytokines and stress markers.

    RESULTS: There were no significant differences in any serum cytokine concentration between groups P and E at any time point except in IL-10 which was 87% higher in group P (median and range 4.1 (2.3-9.2) pg/ml,) compared to group E (2.6 (1.3-4.7) pg/ml) (p=0.002) at T1. There was no difference in plasma cortisol and insulin between the groups at any time point after surgery. Significant difference in median serum cytokine concentration was found between open and laparoscopic surgery with higher levels of IL-6,IL-8 and IL-10 at T1 in patients undergoing open surgery compared to laparoscopic surgery. No difference in serum cytokine concentration was detected between the groups or between the surgical technique at T2.

    CONCLUSIONS: Open surgery, compared to laparoscopic surgery, has greater impact on these inflammatory mediators than epidural analgesia vs. intravenous analgesia. This article is protected by copyright. All rights reserved.

  • 6.
    Slim, K.
    et al.
    Department of Digestive Surgery, CHU Estaing, Clermont-Ferrand, France.
    Demartines, N.
    Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
    Fearon, K. C.
    Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, Royal Infirmary, Edinburgh, UK.
    Lobo, D. N.
    Biomedical Research Unit, Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
    Ramirez, J.
    Department of Surgery, University Hospital, Zaragoza, Spain.
    Scott, M.
    Department of Anaesthesia, Royal Surrey County Hospital, Guildford, UK.
    Ljungqvist, Olle
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    ERAS® Society (all authors are members of ERAS® Society, Kista, Sweden), Group author
    Beyond ERAS?2014In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 16, no 3, p. 219-220Article in journal (Refereed)
  • 7.
    Tiefenthal, M.
    et al.
    Dept Surg, Ersta Hosp, Stockholm, Sweden; Dept Mol Med & Surg, Karolinska Institute, Stockholm, Sweden.
    Asklid, D.
    Dept Surg, Danderyd Hosp, Karolinska Inst, Stockholm, Sweden; Dept Clin Sci, Danderyd Hosp, Karolinska Inst, Stockholm, Sweden.
    Hjern, F.
    Dept Surg, Danderyd Hosp, Karolinska Inst, Stockholm, Sweden.; Dept Clin Sci, Danderyd Hosp, Karolinska Inst, Stockholm, Sweden.
    Matthiessen, Peter
    Deptartment of Surgery, Örebro University Hospital, Örebro, Sweden.
    Gustafsson, U. O.
    Dept Surg, Danderyd Hosp, Karolinska Inst, Stockholm, Sweden; Dept Clin Sci, Danderyd Hosp, Karolinska Inst, Stockholm, Sweden.
    Laparoscopic and open right-sided colonic resection in daily routine practice. A prospective multicentre study within an Enhanced Recovery After Surgery (ERAS) protocol2016In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 18, no 2, p. 187-194Article in journal (Refereed)
    Abstract [en]

    AimThe study compared the outcome of laparoscopic and open surgery in daily practice when performed in a strict Enhanced Recovery After Surgery (ERAS) environment. MethodTwo-hundred and ninety-two consecutive patients who received elective surgery, in three Swedish ERAS centres, for cancer or adenoma in the right colon in the period 1 January 2011 to 31 December 2012, were prospectively registered in a Web-based ERAS database. Peri-operative data were collected from the database and patient charts. The primary end-points included postoperative recovery and morbidity. The secondary objective was to identify preoperative variables that influenced the selection of patients for laparoscopic or open surgery. ResultsOne-hundred and twenty-three (42%) patients were selected for laparoscopic surgery. The overall preoperative ERAS-compliance rate was 87% and no significant difference was seen between the surgical techniques. In multivariate analysis, patients treated with laparoscopy had significantly earlier pain control (2.43.2days vs 4.2 +/- 5.9days; P=0.016) and a shorter length of hospital stay (LOS) (4days vs 6days; P=0.002) compared with open surgery. There was no significant difference in the complication rate [18.7% vs 21.3%; OR=1.0 (95% CI: 0.5-2.0)], the number of lymph nodes removed or the rate of R0 resection between laparoscopic and open surgery. Tumours selected for laparoscopy weregenerally smaller, had a lower T-stage and were predominantly situated in the caecum and the ascending colon compared with those of patients selected for open surgery. ConclusionThe use of laparoscopy in routine right-sided colectomy in an ERAS environment, with data on outcome corrected for selection bias, may result in faster recovery compared with open surgery.

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