To Örebro University

oru.seÖrebro University Publications
Change search
Refine search result
1 - 18 of 18
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Dehlaghi Jadid, Kaveh
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Petersson, Josefin
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer: a population based nationwide non-inferiority study2022In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, no 11, p. 1308-1317Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to compare five-year overall survival in a national cohort of patients undergoing curative abdominal resection for rectal cancer by laparoscopic (LAP) or open (OPEN) technique.

    METHODS: All patients diagnosed with clinical stage I-III rectal cancer and who underwent LAP or OPEN abdominal curative surgery between 2010 and 2016 in Sweden were retrieved from the Swedish Colorectal Cancer Registry. A non-inferiority study design was employed with a statistical power of 90%, a one-side type I error of 2.5%, and a non-inferiority margin of 2%. The analyses were performed as intention-to-treat and the relationship between surgical technique and overall mortality within five years was analyzed. Multilevel regression models with the patients matched by propensity scores adjusted for patient and tumour related variables.

    RESULTS: A total of 8410 cancer stage I-III patients were included whereof 2094 LAP (24.9%) and 6316 underwent OPEN (74.9%) and were followed until December 31, 2020. Multivariable Cox regression demonstrated that five-year overall survival was higher in LAP; Hazard Ratio (HR): 0.877;(95% CI: 0.877-0.993). Outcome was similar when employing multiple imputation and propensity score matching. When excluding cT4 there was no difference; HR: 0.885;(95% CI: 0.790-1.033). At five years follow up, local recurrence was not different, 2.9% in LAP and 3.6% in OPEN (P=0.075), while metastatic disease was more frequent in OPEN, 19.6% compared with 15.6% in LAP (P<0.001).

    CONCLUSIONS: This study demonstrated that LAP was not inferior to OPEN with regard to overall five-year survival. These results support the use of laparoscopic surgery.

  • 2.
    Dehlaghi Jadid, Kaveh
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics.
    Petersson, Josefin
    SSORG - Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sjövall, Annika
    Department of Pelvic Cancer, Gastrointestinal Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden.
    Angenete, Eva
    SSORG - Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Long term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer: A population-based nationwide study with a non-inferiority design2023In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 25, no 5, p. 954-963Article in journal (Refereed)
    Abstract [en]

    AIM: The study aimed to compare five-year overall survival in a national cohort of patients undergoing curative abdominal resection for colon cancer by minimally invasive surgery (MIS) or open (OPEN) technique.

    METHODS: All patients diagnosed between 2010 and 2016 in Sweden with pathological UICC stage I-III colon cancer localized in the cecum, ascending colon, hepatic flexure or sigmoid colon, and those who underwent curative right sided hemicolectomy, sigmoid resection or high anterior resection by MIS or OPEN were included. Patients were identified in the Swedish Colorectal Cancer Registry from which all data was retrieved. The analyses were performed as intention-to-treat and the relationship between surgical technique (MIS or OPEN) and overall mortality within five years was analysed. For the primary research question a non-inferiority hypothesis was assumed with a statistical power of 90%, a one-side type I error of 2.5%, and a non-inferiority margin of 2%. For the secondary analyses, multilevel survival regression models with the patients matched by propensity scores were employed, adjusted for patient- and tumuor-related variables.

    RESULTS: A total of 11605 pathological UICC cancer stage I-III patients were included with 3297 MIS (28.4%) and 8308 OPEN (71.6%) and were followed until December 31, 2020. The primary analysis demonstrated superiority for MIS compared to OPEN. The multilevel survival regression analyses confirmed that five-year overall survival was higher in MIS with a hazard ratio (HR) of 0.874 (95% confidence interval (CI): 0.791-0.965), and if excluding pT4, outcome was similar, with a HR of 0.847 (95% CI: 0.756-0.948).

    CONCLUSION: This observational study demonstrated that MIS was favourable to OPEN with regard to five-year overall survival. These results support the use of laparoscopic colon cancer surgery in routine practise.

  • 3.
    Eberhardson, Michael
    et al.
    Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Myrelid, Pär
    Division of Surgery, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Surgery, University Hospital, Linköping, Sweden.
    Söderling, Jonas K.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Everhov, Åsa H.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hedin, Charlotte R. H.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Swede; Division of Gastroenterology, Medical Unit Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Neovius, Martin
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Olén, Ola
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates2022In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, no 4, p. 470-483Article in journal (Refereed)
    Abstract [en]

    Aim: Surgery is an important therapeutic option for Crohn's disease. The need for first bowel surgery seems to have decreased with the introduction of tumour necrosis factor inhibitors (TNFi; adalimumab or infliximab). However, the impact of TNFi on the need for intestinal surgery in Crohn's disease patients irrespective of prior bowel resection is not known. The aim of this work is to compare the incidence of bowel surgery in Crohn's disease patients who remain on TNFi treatment versus those who discontinue it.

    Method: We performed a nationwide register-based observational cohort study in Sweden of all incident and prevalent cases of Crohn's disease who started first-line TNFi treatment between 2006 and 2017. Patients were categorized according to TNFi treatment retention less than or beyond 1 year. The study cohort was evaluated with regard to incidence of bowel surgery from 12 months after the first ever TNFi dispensation.

    Results: We identified 5003 Crohn's disease patients with TNFi exposure: 3748 surgery naive and 1255 with bowel surgery prior to TNFi initiation. Of these patients, 7% (n = 353) were subjected to abdominal surgery during the first 12 months after the start of TNFi and were subsequently excluded from the main analysis. A majority (62%) continued TNFi for 12 months or more. Treatment with TNFi for less than 12 months was associated with a significantly higher surgery rate compared with patients who continued on TNFi for 12 months or more (hazard ratio 1.26, 95% CI 1.09-1.46; p = 0.002).

    Conclusion: Treatment with TNFi for less than 12 months was associated with a higher risk of bowel surgery in Crohn's disease patients compared with those who continued TNFi for 12 months or more.

  • 4.
    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.

  • 5.
    Gerdin, Anders
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Park, Jennifer
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Häggström, Jenny
    Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
    Segelman, Josefin
    Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Surgery, Ersta Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lydrup, Marie-Louise
    Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
    Rutegård, Martin
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
    Preoperative beta blockers and other drugs in relation to anastomotic leakage after anterior resection for rectal cancer2024In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 26, no 5, p. 974-986Article in journal (Refereed)
    Abstract [en]

    AIM: Previous research has indicated that preoperative beta blocker therapy is associated with a decreased risk of complications after surgery for rectal cancer. This is thought to arise because of the anti-inflammatory activity of the drug. These results need to be reproduced and analyses extended to other drugs with such properties, as this information might be useful in clinical decision-making. The main aim of this work was to replicate previous findings of beta blocker use as a prognostic marker for postoperative leakage. We also investigated whether drug exposure might induce anastomotic leaks.

    METHOD: This is a retrospective multicentre cohort study, comprising 1126 patients who underwent anterior resection for rectal cancer between 2014 and 2018. The use of any preoperative beta blocker was treated as the primary exposure, while anastomotic leakage within 12 months of surgery was the outcome. Secondary exposures comprised angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins and metformin. Using multivariable regression, we performed a replication analysis with a predictive aim for beta blockers only, while adjustment for confounding was done in more causally oriented analyses for all drugs. We estimated incidence rate ratio (IRR) and relative risk (RR) with 95% confidence intervals (CIs).

    RESULTS: Anastomotic leakage occurred in 20.6% of patients. Preoperative beta blockers were used by 22.7% of the cohort, while the leak distribution was almost identical between exposure groups. In the main replication analysis, no association could be detected (IRR 0.95, 95% CI 0.68-1.33). In the causally oriented analyses, only metformin affected the risk of leakage (RR 1.59, 95% Cl 1.31-1.92).

    CONCLUSION: While previous research has suggested that preoperative beta blocker use could be prognostic of anastomotic leakage, this study could not detect any such association. On the contrary, our results indicate that preoperative beta blocker use neither predicts nor causes anastomotic leakage after anterior resection for rectal cancer.

  • 6.
    Grahn, Oskar
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Lundin, Mathias
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.
    Chapman, Stephen J.
    Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
    Rutegård, Jörgen
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery.
    Rutegård, Martin
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
    Concerning our paper on the possible relation of postoperative non-steroidal anti-inflammatory drugs to anastomotic leakage and cancer recurrence2022In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, no 10, p. 1245-1245Article in journal (Other academic)
  • 7.
    Grahn, Oskar
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Lundin, Mathias
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.
    Chapman, Stephen J.
    Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
    Rutegård, Jörgen
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery.
    Rutegård, Martin
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Postoperative non-steroidal anti-inflammatory drugs in relation to recurrence, survival and anastomotic leakage after surgery for colorectal cancer2022In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, no 8, p. 933-942Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate whether non-steroidal anti-inflammatory drugs (NSAIDs) could be beneficial or harmful when used perioperatively for colorectal cancer patients, as inflammation may affect occult disease and anastomotic healing.

    METHODS: This is a protocol-based retrospective cohort study on colorectal cancer patients operated between 2007 and 2012 at 21 hospitals in Sweden. The NSAID exposure was retrieved from postoperative analgesia protocols, while outcomes and patient data were retrieved from the Swedish Colorectal Cancer Registry. Older or severely comorbid patients, as well as those with disseminated or non-radically operated tumours were excluded. Multivariable regression with adjustment for confounders was performed, estimating hazard ratios (HRs) for long-term and odds ratios (ORs) for short-term outcomes, including 95% confidence intervals (CIs).

    RESULTS: Some 6945 patients remained after exclusion, of which 3996 were treated at hospitals where an NSAID protocol was in place. No association was seen between NSAIDs and recurrence-free survival (HR 0.97; 95% CI 0.87-1.09). However, a reduction in cancer recurrence was detected (HR 0.83; 95% 0.72-0.95), which remained significant when stratifying into locoregional (HR 0.68; 95% CI 0.48-0.97) and distant recurrences (HR 0.85; 95% CI 0.74-0.98). Anastomotic leakage was less frequent (HR 0.69%; 95% CI 0.51-0.94) in the NSAID-exposed, mainly due to a risk reduction in colo- and ileo-rectal anastomoses (HR 0.47; 95% CI 0.33-0.68).

    CONCLUSION: There was no association between NSAID exposure and recurrence-free survival, but an association with improved cancer recurrence and the rate of anastomotic leakage was detected, which may depend on tumour site and anastomotic location.

  • 8.
    Holmgren, Klas
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Häggström, Jenny
    Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
    Haapamäki, Markku M.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery.
    Rutegård, Jörgen
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Rutegård, Martin
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
    Defunctioning stomas may reduce chances of a stoma-free outcome after anterior resection for rectal cancer2021In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 23, no 11, p. 2859-2869Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the conflicting consequences of faecal diversion on stoma outcomes and anastomotic leakage in anterior resection for rectal cancer, including interaction effects determined by the extent of mesorectal excision.

    METHOD: Anterior resections between 2007 and 2016 were identified using the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine stoma outcome 2 years after surgery. Tumour distance from the anal verge constituted a proxy for extent of mesorectal excision [total mesorectal excision (TME): ≤10 cm; partial mesorectal excision (PME): 13-15 cm]. With confounder-adjusted probit regression, the total effect of defunctioning stoma on permanent stoma, and the interaction effect of extent of mesorectal excision, were estimated together with the indirect effect through anastomotic leakage. Baseline risks, risk differences (RDs) and relative risks (RRs) were reported.

    RESULTS: The main study cohort included 4529 patients. Defunctioning stomas influenced the absolute permanent stoma risk (TME: RD 0.11 [95% CI 0.09-0.13]; PME: RD 0.15 [95% CI 0.13-0.16]). The baseline risk was higher in TME, with a resulting greater RR in PME (2.23 [95% CI 1.43-3.02] vs 4.36 [95% CI 3.05-5.68]). The indirect reduction in permanent stoma rates, due to the alleviating effect of faecal diversion on anastomotic leakage, was small (TME: 0.89 [95% CI 0.81-0.96]; PME: 0.96 [95% CI 0.91-1.00]).

    CONCLUSION: In anterior resection for rectal cancer, defunctioning stomas may reduce chances of a stoma-free outcome. Considering leakage reduction benefits, consequences of routine diversion in TME might be fairly balanced, while this seems questionable in PME.

  • 9.
    Jutesten, H.
    et al.
    Department of Surgery, Skåne University Hospital, Malmö, Sweden; Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Draus, J
    Department of Surgery, Hallands Hospital, Halmstad, Sweden.
    Janusz, Frey
    Department of Surgery, Blekinge Hospital, Karlskrona, Sweden.
    Neovius, G.
    Department of Surgery, Central Hospital, Kristianstad, Sweden.
    Lindmark, G.
    Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Buchwald, P.
    Department of Surgery, Skåne University Hospital, Malmö, Sweden; Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Lydrup, M. L.
    Department of Surgery, Skåne University Hospital, Malmö, Sweden; Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer2019In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 21, no 2, p. 174-182Article in journal (Refereed)
    Abstract [en]

    AIM: This study investigates how often bowel continuity was restored after anastomotic leakage in anterior resection for rectal cancer and assesses the clinical factors associated with permanent stoma.

    METHOD: The Swedish Colorectal Cancer Registry was used to identify cases of anastomotic leakage registered in southern Sweden between January 2001 and December 2011. Patient characteristics, surgical details and clinical information about the anastomotic leakages were retrieved from medical records.

    RESULTS: Of the 1442 patients operated on with anterior resection in 11 hospitals, 144 (10%) were diagnosed with anastomotic leakage after anterior resection for rectal cancer. After a median follow-up of 87 months (range 21-165), the overall rate of permanent stoma among patients with anastomotic leakage was 65%. Age ≥ 70 years (P = 0.02) and re-laparotomy (P < 0.001) were independently related to permanent stoma. Compared with nondefunctioned patients with anastomotic leakage, defunctioned patients with anastomotic leakage at the index procedure less often required re-laparotomy at some point during the entire clinical course (P < 0.001), but nondefunctioned and defunctioned patients with anastomotic leakage both had permanent stoma to the same extent (67% and 62%, respectively).

    CONCLUSION: Anastomotic leakage is highly associated with permanent stoma after anterior resection, especially in patients aged ≥ 70 years. In this cohort of patients with anastomotic leakage, 65% had permanent stoma at long-term follow-up. A defunctioning stoma ameliorates the clinical course but does not affect the end result of bowel continuity in established anastomotic leakage after anterior resection.

  • 10. 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, review/survey (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.

  • 11. 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.

  • 12.
    Pourlotfi, Arvid
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ahl, Rebecka
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Forssten, Maximilian Peter
    Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Bass, G. A.
    Örebro University, School of Medical Sciences. Surgical Critical Care & Emergency Surgery, Penn Medicine, Penn Presbyterian Medical Center, Philadelphia, USA.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Matthiessen, Peter
    Department of Surgery, Örebro University Hospital, Örebro, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Statin Therapy and Postoperative Short-Term Mortality after Rectal Cancer Surgery2021In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 23, no 4, p. 875-881Article in journal (Refereed)
    Abstract [en]

    AIM: The study aimed to assess the correlation between regular statin therapy and postoperative mortality following resection surgery for rectal cancer.

    METHOD: This retrospective cohort included all adult patients undergoing abdominal rectal cancer surgery in Sweden between January 2007 and September 2016. Data was gathered from the Swedish Colorectal Cancer Registry, a large population-based prospectively collected registry. Statin users were defined as patients with one or more collected prescriptions of a statin within 12 months before the date of surgery. The statin-positive and statin-negative cohorts were matched by propensity scores based on baseline demographics.

    RESULTS: 11,966 patients underwent resection surgery for rectal cancer, of whom 3,019 (25%) were identified as statin users. After applying propensity score matching (1:1), 3,017 pairs were available for comparison. In the matched groups, statin users demonstrated reduced 90-day all-cause mortality (0.7% versus 5.5%, p < 0.001), additionally displaying significantly reduced cause-specific mortality due to cardiovascular and respiratory events, as well as sepsis and multiorgan failure. The significant postoperative survival benefit of statin users was seen despite a higher rate of cardiovascular comorbidity.

    CONCLUSION: Preoperative statin therapy displays a strong association with reduced postoperative mortality following resectional surgery for rectal cancer. The results from the current study warrant further investigation to determine whether a causal relationship exists.

  • 13.
    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
    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.

  • 14.
    Rutegård, Martin
    et al.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
    Holmgren, Klas
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Häggström, Jenny
    Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
    Haapamäki, Markku M.
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery.
    Rutegård, Jörgen
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Correspondence: The right kind of rectal cancer operation for the right patient requires information on all relevant outcomes2022In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, no 1, p. 136-137Article in journal (Other academic)
  • 15.
    Rutegård, Martin
    et al.
    Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
    Matthiessen, Peter
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Glimelius, Bengt
    Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Blomqvist, Lennart
    Department of Radiation Physics/Nuclear Medicine, Karolinska University Hospital, Stockhom, Sweden.
    Implications of pretreatment extramural venous invasion in rectal cancer patients: A population-based study2024In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318Article in journal (Refereed)
    Abstract [en]

    AIM: Extramural venous invasion detected by MRI (mrEMVI) has in several expert centre studies been identified as an important prognostic factor in rectal cancer, and in guiding neoadjuvant therapy. However, population-based evidence for mrEMVI as a predictor for recurrent disease is lacking.

    METHOD: This was a multicentre retrospective study based on the Swedish Colorectal Cancer Registry. The study period encompassed patients operated with abdominal resection for rectal cancer 2017-2021, with follow-up until January 2023. Patients diagnosed at hospitals with radiological registry data coverage <90% or with metastatic disease were excluded. Pretreatment mrEMVI constituted exposure, while recurrence-free survival was the main outcome. Distant and local recurrence, and overall survival were secondary outcomes, and pretreatment and postoperative scenarios were explored using multivariable Cox regression with multiple imputation. Hazard ratios (HRs) with 95% confidence intervals (CIs) were reported.

    RESULTS: A total of 2737 patients from 13 hospitals were eligible for analysis. Pretreatment mrEMVI was reported in 14.5% of patients, while 71.9% had negative findings and 13.6% had missing data. In the pretreatment scenario, mrEMVI was an independent predictor for worse recurrence-free survival with an adjusted HR of 1.64 (95% CI: 1.31-2.06). In the postoperative MDT setting, the influence of mrEMVI on recurrence-free survival decreased with an adjusted HR of 1.27 (95% CI: 1.00-1.61).

    CONCLUSION: mrEMVI at diagnosis is an independent predictor of recurrence-free survival in an unselected population of rectal cancer patients undergoing abdominal resection.

  • 16.
    Siekmann, Wiebke
    et al.
    Örebro University, School of Medical Sciences. 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.

  • 17.
    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)
  • 18.
    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.

1 - 18 of 18
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf