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  • 1.
    Dehlaghi Jadid, Kaveh
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Long-term outcome, socioeconomic aspects and postoperative inflammatory response in minimally invasive rectal cancer surgery2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In Sweden, more than 2,200 individuals are diagnosed with rectal cancer each year and surgical resection is the cornerstone of treatment. Minimally invasive surgery (MIS) was introduced for abdominal rectal cancer resection in the 1990s. Proven advantages of MIS in the short term include less intraoperative bleeding, less postoperative pain, faster postoperative mobilization, and shorter hospital stay. Large randomized studies have also shown that MIS is not inferior to OPEN with regard to the oncological short-term or long-term outcome.

    The aim of this thesis was to increase the knowledge of MIS from a Swedish perspective regarding long-term oncological outcome, socioeconomic aspects, and the postoperative inflammatory response in curative abdominal rectal cancer surgery.

    Study I included all patients who were diagnosed with clinical stage I-III rectal cancer during 2010-2016. More than 8,300 patients were identified via the Swedish Colorectal Cancer Registry (SCRCR). The study had a so-called non-inferiority design and investigated overall 5-year survival. The results showed that survival was not worse in patients who underwent minimally invasive surgery in comparison to patients who underwent open surgery.

    Study II included all patients who were diagnosed with pathological stage I-III cancer of the colon 2010-2016. More than 11,000 patients were identified via the SCRCR. The study was designed in the same way as Study I. The results demonstrated that minimally invasive surgery was not inferior to open surgery.

    Study III analysed the potential impact of socioeconomic status, measured as level of education and household income, regarding the likelihood of receiving minimally invasive surgery. All patients who underwent curative abdominal rectal resection surgery during 2010-2016 were included. More than 8,000 patients were identified. The results showed that patients with the highest level of education and those in the highest income quartile were more likely to be operated on with minimally invasive technique.

    Study IV analysed the inflammatory response, measured as serum C-reactive protein during postoperative days 1-5, in all 520 patients undergoing abdominal rectal resection in Örebro between 2011 and 2021. Following exclusions based on postoperative adverse events, 382 patients remained for final analysis. The study demonstrated a trend for a less pronounced inflammatory response in patients operated with robot-assisted laparoscopy compared with conventional laparoscopy.

    Delarbeten
    1. Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer: a population based nationwide non-inferiority study
    Öppna denna publikation i ny flik eller fönster >>Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer: a population based nationwide non-inferiority study
    Visa övriga...
    2022 (Engelska)Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, nr 11, s. 1308-1317Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    Blackwell Publishing, 2022
    Nyckelord
    Rectal cancer, laparoscopy, minimally invasive surgery, multiple imputation, non-inferiority, oncological outcome, population based, propensity score, survival
    Nationell ämneskategori
    Cancer och onkologi Kirurgi
    Identifikatorer
    urn:nbn:se:oru:diva-99524 (URN)10.1111/codi.16204 (DOI)000822846800001 ()35656573 (PubMedID)2-s2.0-85133674068 (Scopus ID)
    Anmärkning

    Funding agency:

    Research Committee, Region Örebro County, Örebro OLL-964736

    Tillgänglig från: 2022-06-15 Skapad: 2022-06-15 Senast uppdaterad: 2024-01-12Bibliografiskt granskad
    2. Long term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer: A population-based nationwide study with a non-inferiority design
    Öppna denna publikation i ny flik eller fönster >>Long term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer: A population-based nationwide study with a non-inferiority design
    Visa övriga...
    2023 (Engelska)Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 25, nr 5, s. 954-963Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    Blackwell Publishing, 2023
    Nyckelord
    colon cancer, LAP, laparoscopy, long term outcome, minimally invasive surgery, MIS, non-inferiority, oncological outcome, overall survival, population based, propensity score
    Nationell ämneskategori
    Cancer och onkologi
    Identifikatorer
    urn:nbn:se:oru:diva-104137 (URN)10.1111/codi.16512 (DOI)000947019500001 ()36762443 (PubMedID)2-s2.0-85150627454 (Scopus ID)
    Anmärkning

    Funding agency:

    Research Committee, Region Örebro County, Örebro

    Tillgänglig från: 2023-02-13 Skapad: 2023-02-13 Senast uppdaterad: 2024-02-08Bibliografiskt granskad
    3. Does socio-economic status influence the choice of surgical techniquein abdominal rectal cancer surgery?
    Öppna denna publikation i ny flik eller fönster >>Does socio-economic status influence the choice of surgical techniquein abdominal rectal cancer surgery?
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Kirurgi
    Identifikatorer
    urn:nbn:se:oru:diva-110694 (URN)
    Tillgänglig från: 2024-01-12 Skapad: 2024-01-12 Senast uppdaterad: 2024-01-12Bibliografiskt granskad
    4. Postoperative inflammatory response in patients undergoinglaparoscopic and robotic rectal cancer resection
    Öppna denna publikation i ny flik eller fönster >>Postoperative inflammatory response in patients undergoinglaparoscopic and robotic rectal cancer resection
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Kirurgi
    Identifikatorer
    urn:nbn:se:oru:diva-110695 (URN)
    Tillgänglig från: 2024-01-12 Skapad: 2024-01-12 Senast uppdaterad: 2024-01-12Bibliografiskt granskad
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  • 2.
    Dehlaghi Jadid, Kaveh
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    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 universitet, Institutionen för medicinska vetenskaper. 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 study2022Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, nr 11, s. 1308-1317Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    Dehlaghi Jadid, Kaveh
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. 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 universitet, Institutionen för medicinska vetenskaper. 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 design2023Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 25, nr 5, s. 954-963Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Dehlaghi Jadid, Kaveh
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Gadan, Soran
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Matthiessen, Peter
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Postoperative inflammatory response in patients undergoinglaparoscopic and robotic rectal cancer resectionManuskript (preprint) (Övrigt vetenskapligt)
  • 5.
    Dehlaghi Jadid, Kaveh
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Gadan, Soran
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Nordenwall, Caroline
    Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden .
    Boman, Sol Erika
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Hed Myrberg, Ida
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Matthiessen, Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Does socio-economic status influence the choice of surgical techniquein abdominal rectal cancer surgery?Manuskript (preprint) (Övrigt vetenskapligt)
  • 6.
    Petersson, Josefin
    et al.
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
    Matthiessen, Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dehlaghi Jadid, Kaveh
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Bock, David
    School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Angenete, Eva
    Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
    Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open2023Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 13, nr 1, artikel-id 4335Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to compare LAP with OPEN regarding short-term mortality, morbidity and completeness of the cancer resection for colon cancer in a routine health care setting using population based register data. All 13,683 patients who were diagnosed 2012-2018 and underwent elective surgery for right-sided or sigmoid colon cancer were included from the Swedish Colorectal Cancer Registry and the National Patient Registry. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, length of hospital stay, reoperation, readmission and positive resection margin (R1). Weighted and unweighted multi regression analyses were performed. There were no difference in 30-day mortality: LAP (0.9%) and OPEN (1.3%) (OR 0.89, 95% CI 0.62-1.29, P = 0.545). The weighted analyses showed an increased 90-day mortality following OPEN, P < 0.001. Re-operations and re-admission were more frequent after OPEN and length of hospital stay was 2.9 days shorter following LAP (P < 0.001). R1 resections were significantly more common in the OPEN group in the unweighted and weighted analysis with P = 0.004 and P < 0.001 respectively. Therefore, the favourable short-term outcomes following elective LAP versus OPEN resection for colon cancer in routine health care indicate an advantage of laparoscopic surgery.

  • 7.
    Petersson, Josefin
    et al.
    Department of Surgery, SSORG Sahlgrenska University Hospital/Östra, 416 85, Göteborg, Sweden; Sunshine Coast University Hospital, Britinya, QLD, Australia.
    Matthiessen, Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, Örebro, Sweden.
    Dehlaghi Jadid, Kaveh
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, Örebro, Sweden.
    Bock, David
    Department of Surgery, SSORG Sahlgrenska University Hospital/Östra, 416 85, Göteborg, Sweden.
    Angenete, Eva
    Department of Surgery, SSORG Sahlgrenska University Hospital/Östra, 416 85, Göteborg, Sweden; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Göteborg, Sweden.
    Short-term results in a population based study indicate advantage for minimally invasive rectal cancer surgery versus open2024Ingår i: BMC Surgery, E-ISSN 1471-2482, Vol. 24, nr 1, artikel-id 52Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this study was to determine if minimally invasive surgery (MIS) for rectal cancer is non-inferior to open surgery (OPEN) regarding adequacy of cancer resection in a population based setting.

    METHODS: All 9,464 patients diagnosed with rectal cancer 2012-2018 who underwent curative surgery were included from the Swedish Colorectal Cancer Registry.

    PRIMARY OUTCOMES: Positive circumferential resection margin (CRM < 1 mm) and positive resection margin (R1). Non-inferiority margins used were 2.4% and 4%. SECONDARY OUTCOMES: 30- and 90-day mortality, clinical anastomotic leak, re-operation < 30 days, 30- and 90-day re-admission, length of stay (LOS), distal resection margin < 1 mm and < 12 resected lymph nodes. Analyses were performed by intention-to-treat using unweighted and weighted multiple regression analyses.

    RESULTS: The CRM was positive in 3.8% of the MIS group and 5.4% of the OPEN group, risk difference -1.6% (95% CI -1.623, -1.622). R1 was recorded in 2.8% of patients in the MIS group and in 4.4% of patients in the OPEN group, risk difference -1.6% (95% CI -1.649, -1.633). There were no differences between the groups in adjusted unweighted and weighted analyses. All analyses demonstrated decreased mortality and re-admissions at 30 and 90 days as well as shorter LOS following MIS.

    CONCLUSIONS: In this population based setting MIS for rectal cancer was non-inferior to OPEN regarding adequacy of cancer resection with favorable short-term outcomes.

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