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Wallin, Göran
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Publications (10 of 43) Show all publications
Lind, P., Nordenström, E., Johansson, L., Wallin, G. & Daskalakis, K. (2024). Impact of fine-needle aspiration cytology in thyroidectomy extent and associated surgical morbidity in thyroid cancer. Langenbeck's archives of surgery (Print), 409(1), Article ID 68.
Open this publication in new window or tab >>Impact of fine-needle aspiration cytology in thyroidectomy extent and associated surgical morbidity in thyroid cancer
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2024 (English)In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 409, no 1, article id 68Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To assess the impact of fine-needle aspiration cytology (FNAC) in the extent of surgery in patients with thyroid cancer (TC) and the associated surgical morbidity in primary and completion setting.

METHODS: A Swedish nationwide cohort of patients having surgery for TC (n = 2519) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal surgery between 2004 and 2013 was obtained. Data was validated through scrutinizing FNAC and histology reports.

RESULTS: Among the 2519 cases operated for TC, the diagnosis was substantiated and validated through the histology report in 2332 cases (92.6%). Among these, 1679 patients (72%) were female, and the median age at TC diagnosis was 52.3 years (range 18-94.6). Less than total thyroidectomy (LTT) was undertaken in 944 whereas total thyroidectomy (TT) in 1388 cases. The intermediate FNAC categories of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), as well as suspicion for follicular neoplasm (SFN) lesions were more often encountered in LTT (n = 314, 33.3%) than TT (n = 63, 4.6%), whereas FNACs suspicion for malignancy and/or malignancy were overrepresented in TT (n = 963, 69.4%). Completion thyroidectomies were undertaken in 553 patients out of 944 that initially had LTT. In 201 cases with cancer lesions > 1 cm, other than FTC (Follicular TC)/ HTC (Hürthle cell TC) subjected to primary LTT, inadequate procedures were undertaken in 81 due to absent, Bethesda I or II FNAC categories, preoperatively. Complications at completion of surgery in this particular setting were 0.5% for RLN palsy (n = 1) and 1% (n = 2) for hypoparathyroidism 6 months postoperatively. The overall postoperative complication rate was higher in primary TT vs. LTT for RLN palsy (4.8% [n = 67] vs. 2.4% [n = 23]; p = 0.003) and permanent hypoparathyroidism (6.8% [n = 95] vs. 0.8% [n = 8]; p < 0.0001).

CONCLUSIONS: FNAC results appear to affect surgical planning in TC as intermediate FNAC categories lead more often to LTT. Overall, inadequate procedures necessitating completion surgery are encountered in up to 15% of TC patients subjected to LTT due to absent, inconclusive, or misleading FNAC, preoperatively. However, completion of thyroidectomy in this setting did not yield significant surgical morbidity. Primary LTT is a safer primary approach compared to TT in respect of RLN palsy and permanent hypoparathyroidism complication rates; therefore, primary TT should probably be reserved for lesions > 1 cm or even larger with suspicion for malignancy or malignant FNAC.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Fine-needle aspiration cytology, Surgical morbidity, Thyroid cancer
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-111799 (URN)10.1007/s00423-024-03258-3 (DOI)001165650100001 ()38374242 (PubMedID)
Funder
Örebro University
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-03-11Bibliographically approved
Daskalakis, K., Tsoli, M., Wallin, G., Kogut, A., Srirajaskanthan, R., Giovos, G., . . . Kaltsas, G. (2024). MODIFIED HISTOPATHOLOGICAL GRADING OPTIMIZES PREDICTION OF SURVIVAL OUTCOMES IN SMALL INTESTINAL NEUROENDOCRINE TUMOURS. Paper presented at 10th Conference of European-Society-of-Endocrine-Surgeons (ESES), Rome, Italy, May 23-25, 2024. British Journal of Surgery, 111(Suppl. 4), Article ID znae104002.
Open this publication in new window or tab >>MODIFIED HISTOPATHOLOGICAL GRADING OPTIMIZES PREDICTION OF SURVIVAL OUTCOMES IN SMALL INTESTINAL NEUROENDOCRINE TUMOURS
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2024 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 111, no Suppl. 4, article id znae104002Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: We aimed to identify optimal grading Ki-67 cut-offs to delineate differences in prognosis of patients with small intestinal neuroendocrine tumours (SI-NETs) in terms of overall- and event-free survival rates.

Methods: We included 551 patients with SI-NETs diagnosed from June 15th, 1993, through March 8th, 2021, identified using the SI-NET databases from five European referral centers.

Results: Median age at baseline was 62.3(17-90) years; 252 patients were women (45.7%). All tumours were well-differentiated; 326 were G1 tumours (59.2%), 169 G2(30.7%), only 8 G3(1.5%), while 48 tumourswere of unspecified grade (8.7%). The median Ki67 was 2%(1-70%). 247 patients(44.8%) had distant metastases at baseline (stage IV), 217locoregional disease (41.1%; stage III), whereas 29(7.1%) and 25(4.5%) presented at stages II and I, respectively. Within a mean(SD) follow-up of 51.5(52.9) months, 94 patients(17.1%) died, whereas overall 188 experienced disease recurrence, progression and/or death(34.1%). The median OS was 214.7(95%CI: 152.7-276.6) months and the median EFS was 79.8(95%CI: 68.2-91.5) months, respectively. In multivariable Cox-regression OS analysis, age (HR=1.07, 95%CI: 1.04-1.09; p<0.001), Charlson Comorbidity Index(HR=1.1, 95%CI: 1.03-1.17; p=0.006) and the proposed modified histopathological Ki67 grading system(K67:5-10% group: HR=2.4, 95%CI: 1.3-4.5; p=0.007 and K67≥10% group: HR=5.1, 95%CI: 2.9-9.2; p<0.001) were independent predictors for death. Pertinent EFS analysis, confirmed age(HR=1.04, 95%CI: 1.02-1.05;p<0.001) and the proposed modified histopathological Ki67 grading system(K67≥10% group: HR=4; 95%CI:2.5-6.2;p<0.001) as independent predictors for recurrence, progression and/or death.

Conclusions: Ki-67 proliferation index is an independent predictor of EFS and OS. A modified site-specific histopathological grading system applying Ki-67 cut-offs of 5% and 10% seems more optimal to predict differences in SI-NET patient prognosis

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-114139 (URN)10.1093/bjs/znae104.002 (DOI)001233800000030 ()
Conference
10th Conference of European-Society-of-Endocrine-Surgeons (ESES), Rome, Italy, May 23-25, 2024
Available from: 2024-06-12 Created: 2024-06-12 Last updated: 2024-06-12Bibliographically approved
Wedin, M., Janson, E. T., Wallin, G., Sundin, A. & Daskalakis, K. (2024). Prevalence of metastases outside the liver and abdominal lymph nodes on 68Ga-DOTATOC-PET/CT in patients with small intestinal and pancreatic neuroendocrine tumours. Journal of neuroendocrinology, 36(5), Article ID e13391.
Open this publication in new window or tab >>Prevalence of metastases outside the liver and abdominal lymph nodes on 68Ga-DOTATOC-PET/CT in patients with small intestinal and pancreatic neuroendocrine tumours
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2024 (English)In: Journal of neuroendocrinology, ISSN 0953-8194, E-ISSN 1365-2826, Vol. 36, no 5, article id e13391Article, review/survey (Refereed) Published
Abstract [en]

Metastases outside the liver and abdominal/retroperitoneal lymph nodes are nowadays detected frequently in patients with neuroendocrine tumours (NETs), owing to the high sensitivity of positron emission tomography (PET) with Gallium-68-DOTA-somatostatin analogues (68Ga-SSA) and concomitant diagnostic computed tomography (CT). Our aim was to determine the prevalence of extra-abdominal metastases on 68Ga-DOTATOC-PET/CT in a cohort of patients with small intestinal (Si-NET) and pancreatic NET (Pan-NET), as well as that of pancreatic metastasis in patients with Si-NET. Among 2090 patients examined by 68Ga-DOTATOC-PET/CT at two tertiary referral centres, a total of 1177 patients with a history of Si- or Pan-NET, were identified. The most recent 68Ga-DOTATOC-PET/CT report for each patient was reviewed, and the location and number of metastases of interest were recorded. Lesions outside the liver and abdominal nodes were found in 26% of patients (n = 310/1177), of whom 21.5% (255/1177) were diagnosed with Si-NET and 4.5% (55/1177) Pan-NET. Bone metastases were found in 18.4% (215/1177), metastases to Virchow's lymph node in 7.1% (83/1177), and lung/pleura in 4.8% (56/1177). In the subset of 255 Si-NET patients, 5.4% (41/255) manifested lesions in the pancreas, 1.5% in the breast (18/255), 1.3% in the heart (15/255) and 1% in the orbita (12/255). In Si-NET patients, the Ki-67 proliferation index was higher in those with ≥2 metastatic sites of interest, than with 1 metastatic site, (p <0.001). Overall, extra-abdominal or pancreatic metastases were more often found in patients with Si-NET (34%) than in those with Pan-NET (13%) (p <0.001). Bone metastases were 2.6 times more frequent in patients with Si-NET compared to Pan-NET patients (p <0.001). Lesions to the breast and orbita were encountered in almost only Si-NET patients. In conclusion, lesions outside the liver and abdominal nodes were detected in as many as 26% of the patients, with different prevalence and metastatic patterns in patients with Si-NET compared to Pan-NET. The impact of such metastases on overall survival and clinical decision-making needs further evaluation.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2024
Keywords
68Ga‐DOTATOC‐PET/CT, bone metastases, heart metastases, neuroendocrine neoplasms, orbita metastases
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-113050 (URN)10.1111/jne.13391 (DOI)001198607800001 ()38590270 (PubMedID)2-s2.0-85190407655 (Scopus ID)
Available from: 2024-04-10 Created: 2024-04-10 Last updated: 2024-06-10Bibliographically approved
Ali, F., Sandblom, G., Fathalla, B. & Wallin, G. (2023). Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden: a register-based study. Hernia, 27(5), 1103-1108
Open this publication in new window or tab >>Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden: a register-based study
2023 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 27, no 5, p. 1103-1108Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The COVID-19 has had a profound impact on the health care delivery in Sweden, including deprioritization of benign surgeries during the COVID-19 pandemic. The aim of this study was to assess the effect of COVID-19 pandemic on emergency and planned hernia repair in Sweden.

METHODS: Data on hernia repairs from January 2016 to December 2021 were retrieved from the Swedish Patient Register using procedural codes. Two groups were formed: COVID-19 group (January 2020-December 2021) and control group (January 2016-December 2019). Demographic data on mean age, gender, and type of hernia were collected.

RESULTS: This study showed a weak negative correlation between the number of elective hernia repairs performed each month during the pandemic and the number of emergency repairs carried out during the following 3 months for inguinal hernia repair (p = 0.114) and incisional hernia repair (p = 0.193), whereas there was no correlation for femoral or umbilical hernia repairs.

CONCLUSION: The COVID-19 pandemic had a great impact on planned hernia surgeries in Sweden, but our hypothesis that postponing planned repairs would increase the risk of emergency events was not supported.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Acute hernia repair, COVID-19 pandemic, Delayed hernia repair, Delayed surgery, Planned hernia repair, Postponed hernia repair
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-107063 (URN)10.1007/s10029-023-02828-6 (DOI)001020750100001 ()37418049 (PubMedID)2-s2.0-85164114066 (Scopus ID)
Available from: 2023-07-10 Created: 2023-07-10 Last updated: 2023-10-16Bibliographically approved
Khamisi, S., Udumyan, R., Sjölin, G., Calissendorff, J., Filipsson Nyström, H., Holmberg, M., . . . Ljunggren, Ö. (2023). Fracture incidence in Graves' disease: A population-based study. Thyroid, 33(11), 1349-1357
Open this publication in new window or tab >>Fracture incidence in Graves' disease: A population-based study
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2023 (English)In: Thyroid, ISSN 1050-7256, E-ISSN 1557-9077, Vol. 33, no 11, p. 1349-1357Article in journal (Refereed) Published
Abstract [en]

Background Population-based studies have indicated an increase in bone turnover in hyperthyroidism with a subsequent decrease in bone mineral density and an increased risk of fractures, especially in postmenopausal women. However, heterogeneity between studies prevents a definitive conclusion. Graves' disease (GD) is an autoimmune disease, and it is the most common cause of hyperthyroidism. The aim of this study was to investigate fracture risk in patients with GD. Methods A total of 2134 patients with incident GD and 21261 age, sex- and county-matched controls were included 16-18 years after diagnosis in a retrospective cohort study. Drug and patient national registries in Sweden were used to assess the risk of developing skeletal complications. Up to ten age, sex- and county-matched controls per patient were selected from databases from The National Board of Health and Welfare and Statistics Sweden. Cox proportional hazards models were fitted to estimate hazard ratios (HR) and 95% confidence intervals. Results There were no significant differences in fracture rates between GD and controls but after adjustment for co-morbidities, the data showed higher vertebral fracture rates in male GD patients aged >52 years compared to male controls, HR=2.83 (1.05-7.64). The rates of osteoporosis treatments as well as treatment with corticosteroids were higher in patients with GD. However, HR for the association between GD and fractures remained largely unchanged after adjustment for osteoporosis treatments and treatments with corticosteroids. Conclusions There were no significant differences in total fracture rate between GD and the general population. However, men older than 52 years had a higher vertebral fracture rate. This study also shows that patients with treated GD receive more osteoporosis treatments compared to the general population.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-108380 (URN)10.1089/thy.2023.0162 (DOI)37725590 (PubMedID)2-s2.0-85175449682 (Scopus ID)
Available from: 2023-09-20 Created: 2023-09-20 Last updated: 2024-01-12Bibliographically approved
Ali, F., Sandblom, G., Forgo, B. & Wallin, G. (2023). Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair. Annals of Surgery Open, 4(1), Article ID e257.
Open this publication in new window or tab >>Peritoneal Bridging Versus Nonclosure in Laparoscopic Ventral Hernia Repair
2023 (English)In: Annals of Surgery Open, E-ISSN 2691-3593, Vol. 4, no 1, article id e257Article in journal (Refereed) Published
Abstract [en]

Introduction: Postoperative seroma and pain are common problems following laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernias. These advers outcomes may be avoided by dissecting and using the peritoneum in the hernial sac to bridge the hernia defect.

Methods: This was a patient- an and outcome assesor-blinded, parallel-design, randomized controlled trial compairing nonclosure and peritoeal bridging approaches in patients schedueled for elective midline ventral hernia repair. The primary end point was seroma volume on ultrasonography. The secondary end points were postoperative pain, recurrence, and complications.

Results: Between November 2018 and December 2020, 112 patients were randomized of whom 60 were in the nonclosure group and 52 were in the peritoneal bridging group. The seroma volume in the nonclosure and peritoneal bridging groups were 17cm3(6-53cm3) versus 0cm3(0-26cm3) at 1-moth follow-up (P=0.013). The median volume was zero at 3-, 6-, and 12-month follow-ups in both groups. No significant differences were observed in early postoperative pain (P=0.447) and in recurrencerate (P=0.684). There were 4(7%) and 1(2%) perioperative complictions that lead to reoperations in simple IPOM(sIPOM) and IPOM with peritoneal bridging (IPOM-pb), respectively.

Conclusion: Seroma was less prevalent after IPOM-pb at 1-month follow-up compaired with sIPOM, with simillar posoperative pain 1 week after index of surgery in both groups. At subsequent follow-ups, the differences in seroma were not statiscally significant. Further studies are required to confirm these results. Trial registration (NCT04229940)

Keywords: epigastric hernia, incisional hernia, IPOM with fascia closure, IPOM with peritoneal bridging, laparoscopic hernia repair, simple IPOM, umblical hernia, ventral hernia

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-105903 (URN)10.1097/as9.0000000000000257 (DOI)37600866 (PubMedID)
Available from: 2023-05-10 Created: 2023-05-10 Last updated: 2024-01-02Bibliographically approved
Wedin, M., Daskalakis, K., Wallin, G., Sundin, A. & Janson, T. E. (2023). Rare metastases diagnosed on 68Ga-DOTATOC-PET/CT in small intestinal and pancreatic NETs. Paper presented at 20th Annual ENETs Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease (ENETS 2023), Electronic Network, March 22-24, 2023. Journal of neuroendocrinology, 35(Suppl. 1), 116-116, Article ID D58.
Open this publication in new window or tab >>Rare metastases diagnosed on 68Ga-DOTATOC-PET/CT in small intestinal and pancreatic NETs
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2023 (English)In: Journal of neuroendocrinology, ISSN 0953-8194, E-ISSN 1365-2826, Vol. 35, no Suppl. 1, p. 116-116, article id D58Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Neuroendocrine metastases to the orbita, heart, breast, bone, Virchow's lymph node, and pancreas are rarely encountered in small intestinal (SI-NETs) and pancreatic NETs (P-NETs).

Aim(s): We aimed to assessthe prevalence of rare metastatic locations in patients with well-differentiated SI-NETs and P-NETs, who had undergone 68Ga-DOTATOC-PET/CT at diagnosis and/or follow-up.

Materials and methods: In this retrospective analysis of 753 SI-NET patients and 418 P-NET patients treated at two tertiary referral centers, rare metastases were evident in 26.5% (310/1171) of the patient cohort.

Results: Among patients with rare metastases (n=310), 45 % were women and median age at metastases diagnosis was 70 years (43-90). Median Ki-67 was 7% (1-70); 106 were G1 tumors, 142 G2, 11 G3 and 51 of unknown grade. Rare metastatic sites were present in bone 18 % (215/1171), Virchow's lymph node 6 % (75/1171) and 4 % (42/1171) in the lung/pleura. Metastases to the pancreas, breast, heart and orbita were only encountered in SI-NET primaries with a frequency of 5 % (41/753), 2 % (17/753), 2 % (14/753) and 2 % (12/753) respectively. Concomitant liver metastases were present in 86 %. Uncommon metastases were more frequent in SI-NET as compared with P-NET primaries, 255/753 [34%] vs. 55/418 [13%], p ˂0.00001. Bone metastases were present in 23 % (175/753) of SI-NET and 10 % (40/418) of p-NET primaries.

Conclusion: In conclusion, rare metastases are more frequent in SI-NET than p-NETs. The variety and pattern of rare metastases seems different between SI-NETs and P-NET primaries, as orbita, heart, breast and Virchow's lymph node deposits were only encountered in SI-NETs patients; and bone metastases were approximately twice more often inthis group. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
neuroendocrine neoplasm, rare metastases, bone metastases, breast metastases, orbita metastases, heart metastases, lung and pleural metastases, pancreatic metastases
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-109401 (URN)001058866300102 ()
Conference
20th Annual ENETs Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease (ENETS 2023), Electronic Network, March 22-24, 2023
Available from: 2023-10-25 Created: 2023-10-25 Last updated: 2023-10-25Bibliographically approved
Katawazai, A., Sandblom, G. & Wallin, G. (2022). BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY. Paper presented at European Hernia Society 44th Annual International Congress, Manchester, UK, October 18-21, 2022. British Journal of Surgery, 109(Suppl. 7)
Open this publication in new window or tab >>BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY
2022 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 109, no Suppl. 7Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim: The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.

Methods: The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair.

Results: Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) afteropen sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134).

Conclusions: All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

Place, publisher, year, edition, pages
Oxford University Press, 2022
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-102099 (URN)10.1093/bjs/znac308.002 (DOI)000869064500101 ()
Conference
European Hernia Society 44th Annual International Congress, Manchester, UK, October 18-21, 2022
Available from: 2022-11-09 Created: 2022-11-09 Last updated: 2022-11-09Bibliographically approved
Wedin, M., Tsoli, M., Wallin, G., Janson, E. T., Koumarianou, A., Kaltsas, G. & Daskalakis, K. (2022). Heterogeneity of Small Intestinal Neuroendocrine Tumors Metastasis: Biologic Patterns of a Series with Virchow's Node Involvement. Cancers, 14(4), Article ID 913.
Open this publication in new window or tab >>Heterogeneity of Small Intestinal Neuroendocrine Tumors Metastasis: Biologic Patterns of a Series with Virchow's Node Involvement
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2022 (English)In: Cancers, ISSN 2072-6694, Vol. 14, no 4, article id 913Article in journal (Refereed) Published
Abstract [en]

Small intestinal neuroendocrine tumors (SI-NETs) may rarely metastasize to the left supraclavicular lymph nodes, also known as Virchow's node metastasis (VM). Data on prevalence, prognostic significance, and clinical course of disease for SI-NET patients with VM is limited. In this retrospective analysis of 230 SI-NET patients treated at two tertiary referral centers, we found nine patients with VM (prevalence 3.9%). Among those, there were 5 females and median age at SI-NET and VM diagnosis was 61 and 65 years, respectively. Two patients had G1 tumors and five G2, while two tumors were of unspecified grade (median Ki67: 7%, range 2-15%). Four patients presented with synchronous VM, whereas five developed metachronous VM after a median of twenty-four months (range: 4.8-117.6 months). Hepatic metastases were present in seven patients, extrahepatic metastases (EM) in eight (six para-aortic distant lymph node metastases, one lung and one pancreatic metastasis), whereas peritoneal carcinomatosis (PC) in two patients. We used a control group of 18 age- and sex-matched SI-NET patients from the same cohort with stage IV disease but no extra-abdominal metastases. There was no difference in best-recorded response to first line treatment according to RECIST 1.1 as well as progression-free survival (PFS) between patients with VM and those in the control group (Chi-square test p = 0.516; PFS 71.7 vs. 106.9 months [95% CI 38.1-175.8]; log-rank p = 0.855). In addition, median overall survival (OS) of SI-NET patients with VM did not differ from those in the control group (138.6 [95% CI 17.2-260] vs. 109.9 [95% CI 91.7-128] months; log-rank p = 0.533). In conclusion, VM, although relatively rare in patients with SI-NETs, is more often encountered in patients with G2 tumors and established distant para-aortic lymph node metastases. The presence of VM in SI-NET patients does not seem to impact patients' survival outcomes and treatment responses, when compared to age- and sex-matched SI-NET patients with stage IV disease confined in the abdomen.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
Virchow’s node metastasis, small intestinal neuroendocrine neoplasm
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-97694 (URN)10.3390/cancers14040913 (DOI)000763736500001 ()35205660 (PubMedID)2-s2.0-85124342823 (Scopus ID)
Available from: 2022-02-28 Created: 2022-02-28 Last updated: 2022-03-16Bibliographically approved
Ali, F., Sandblom, G., Wikner, A. & Wallin, G. (2022). Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging. Hernia, 26(2), 635-646
Open this publication in new window or tab >>Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging
2022 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 26, no 2, p. 635-646Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure.

Method: A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared.

Results: From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 +/- 1.8 cm and 3.6 +/- 1.4 cm, respectively, and the mean BMI was 30.1 +/- 5.2 kg/m(2). The mean operating time was 67 +/- 28 min and was longer for IPOM-pb (71 +/- 27 min), less for IPOM-plus (63 +/- 28 min), and least for sIPOM (61 +/- 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21).

Conclusion: IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Laparoscopic surgery, Ventral hernia, IPOM, Peritoneal bridging, Defect closure
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-94884 (URN)10.1007/s10029-021-02502-9 (DOI)000698877800001 ()34559335 (PubMedID)2-s2.0-85115622527 (Scopus ID)
Note

Funding agency:

Örebro University

Available from: 2021-10-13 Created: 2021-10-13 Last updated: 2024-01-02Bibliographically approved
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