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Graf, Wilhelm
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Publications (10 of 73) Show all publications
Danielson, J., Karlbom, U., Wester, T. & Graf, W. (2019). Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations. European journal of pediatric surgery, 29(3), 276-281
Open this publication in new window or tab >>Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations
2019 (English)In: European journal of pediatric surgery, ISSN 0939-7248, E-ISSN 1439-359X, Vol. 29, no 3, p. 276-281Article in journal (Refereed) Published
Abstract [en]

Purpose Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions. Materials and Methods Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5-17). Results Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant. Conclusion This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

Place, publisher, year, edition, pages
GEORG THIEME VERLAG KG, 2019
Keywords
anorectal malformation, fecal incontinence, dynamic graciloplasty, long-term outcome
National Category
Surgery Pediatrics
Identifiers
urn:nbn:se:uu:diva-385957 (URN)10.1055/s-0038-1641599 (DOI)000468783700009 ()29653440 (PubMedID)
Available from: 2019-06-19 Created: 2019-06-19 Last updated: 2019-06-19Bibliographically approved
Tsimogiannis, K., Karlbom, U., Lundin, E. & Graf, W. (2019). Long-term outcome after segmental colonic resection for slow transit constipation. International Journal of Colorectal Disease, 34(6), 1013-1019
Open this publication in new window or tab >>Long-term outcome after segmental colonic resection for slow transit constipation
2019 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 34, no 6, p. 1013-1019Article in journal (Refereed) Published
Abstract [en]

PurposeColectomy with ileorectal anastomosis (IRA) is the most common surgical procedure for slow transit constipation (STC). A hemicolectomy has been suggested as an alternative to IRA with good short-term results. However, long-term results are unknown. The aim of this study was to evaluate the long-term results after hemicolectomy as a treatment for STC.MethodsFifty patients with STC were selected for right- or left-sided hemicolectomy after evaluation with colonic scintigraphy from 1993 to 2008. Living patients (n=43) received a bowel function questionnaire and a questionnaire about patient-reported outcome.ResultsAfter a median follow-up of 19.8years, 13 patients had undergone rescue surgery (n=12) or used irrigation (n=1) and were classified as failures. In all, 30 were evaluable for functional outcome and questionnaire data for 19 patients (due to 11 non-responding) could be analysed. Two reported deterioration after several years and were also classified as failures. Median stool frequency remained increased from 1 per week at baseline to 5 per week at long-term follow-up (p=0.001). Preoperatively, all patients used laxatives, whereas 12 managed without laxatives at long-term follow-up (p=0.002). There was some reduction in other constipation symptoms but not statically significant. In the patients' global assessment, 10 stated a very good result, seven a good result and two a poor result.ConclusionsHemicolectomy for STC increases stool frequency and reduces laxative use. Long-term success rate could range between 17/50 (34%) and 35/50 (70%) depending on outcome among non-responders.

Place, publisher, year, edition, pages
SPRINGER, 2019
Keywords
Slow transit constipation, Segmental resection, Colonic functional disorders, Long-term follow-up
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-385967 (URN)10.1007/s00384-019-03283-5 (DOI)000468269800007 ()30937526 (PubMedID)
Available from: 2019-06-19 Created: 2019-06-19 Last updated: 2019-06-19Bibliographically approved
Danielson, J., Karlbom, U., Graf, W. & Wester, T. (2019). Persistent fecal incontinence into adulthood after repair of anorectal malformations. International Journal of Colorectal Disease, 34(3), 551-554
Open this publication in new window or tab >>Persistent fecal incontinence into adulthood after repair of anorectal malformations
2019 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 34, no 3, p. 551-554Article in journal (Refereed) Published
Abstract [en]

Purpose: Persistent fecal incontinence beyond childhood is common in ARM patients. The aim of this study was to analyze a consecutive series of adult patients with persistent incontinence, establish the causes, and evaluate whether further treatment could be offered. Methods: Forty-four adult ARM patients with reported incontinence were invited. Eighteen patients (11 males, median age 40.5 years, range 18-50 years) accepted and underwent clinical examination, rectoscopy, and 3D-ultrasound. Five had previously been treated with secondary surgery to improve continence. Results: Seventeen of the 18 patients had abnormal findings at examination. Eight patients had obstruction of the reconstructed anus. Eleven patients had sacral deformities. Nine patients had a defect in the external anal sphincter and nine patients could not contract the sphincter on demand. Five patients had significant prolapse of mucosa. In one patient, the neoanus was totally misplaced, one patient had a rectovaginal fistula, and one patient had short bowel syndrome due to several small bowel resections. Ten patients were offered conservative and five surgical treatment. Conclusions: This case series of adults shows that a majority of the patients can be offered further treatment. This indicates a need for structured follow-up of ARM patients into adulthood.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
ARM, Fecal incontinence, Rectoscopy, Adult outcome
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-382462 (URN)10.1007/s00384-018-3220-6 (DOI)000463742500022 ()30593590 (PubMedID)
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved
Elias, K., Bekhali, Z., Hedberg, J., Graf, W. & Sundbom, M. (2018). Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. Surgery for Obesity and Related Diseases, 14(2), 144-149
Open this publication in new window or tab >>Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch
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2018 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 2, p. 144-149Article in journal (Refereed) Published
Abstract [en]

Background: Bariatric procedures are increasingly being used, but data on bowel habits are scarce.

Objectives: To assess changes in gastrointestinal function and patient-scored symptoms after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS).

Setting: University hospital in Sweden.

Methods: We recruited 268 adult patients (mean age of 42.5 yr, body mass index 44.8, 67.9% female) listed for RYGB and BPD/DS. Patients answered validated questionnaires prospectively concerning bowel function, the Fecal Incontinence Quality of Life Scale, and the 36-Item Short Form Health Survey before and after their operation.

Results: Postoperatively, 208 patients (78.2% of 266 eligible patients) answered the questionnaires. RYGB patients had fewer bowel motions per week (8 versus 10) and more abdominal pain postoperatively (P<.001). Postoperatively, the 35 BPD/DS patients (69% versus 23%) needed to empty their bowel twice or more than twice daily, reported more flatus and urgency, and increased need for keeping a diet (P<.001). Concerning Fecal Incontinence Quality of Life Scale, coping and behavior was slightly reduced while depression and self-perception scores were improved after RYGB. Lifestyle, coping and behavior, and embarrassment were reduced after BPD/DS (P<.05). In the 36-Item Short Form Health Survey, physical scores were markedly improved, while mental scores were largely unaffected.

Conclusion: RYGB resulted in a reduced number of bowel movements but increased problems with abdominal pain. In contrast, BPD/DS-patients reported higher frequency of bowel movements, more troubles with flatus and urgency, and increased need for keeping a diet. These symptoms affected quality of life negatively, however, general quality of life was markedly improved after both procedures. These results will be of great value for preoperative counseling.

Keywords
Bowel habits, Duodenal switch, Fecal incontinence, Gastric bypass, Obesity
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-333263 (URN)10.1016/j.soard.2017.09.529 (DOI)000427662500005 ()29108895 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-01-25Bibliographically approved
Cashin, P., Mahteme, H., Syk, I., Frodin, J. E., Glimelius, B. & Graf, W. (2018). Quality of life and cost effectiveness in a randomized trial of patients with colorectal cancer and peritoneal metastases. European Journal of Surgical Oncology, 44(7), 983-990
Open this publication in new window or tab >>Quality of life and cost effectiveness in a randomized trial of patients with colorectal cancer and peritoneal metastases
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2018 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 44, no 7, p. 983-990Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to compare health-related quality-of-life (HRQOL) and cost-effectiveness between cytoreductive surgery with intraperitoneal chemotherapy (CRS + IPC) and systemic chemotherapy for patients with colorectal peritoneal metastases. Methods: Patients included in the Swedish Peritoneal Trial comparing CRS + IPC and systemic chemotherapy completed the EORTC QLQ-C30 and SF-36 questionnaires at baseline, 2, 4, 6, 12, 18, and 24 months. HRQOL at 24 months was the primary endpoint. EORTC sum score, SF-36 physical and mental component scores at 24 months were calculated and compared for each arm and then referenced against general population values. Two quality-adjusted life-year (QALY) indices were applied (EORTC-8D and SF-6D) and an incremental cost-effectiveness ratio (ICER) per QALY gained was calculated. A projected life-time ICER per QALY gained was calculated using predicted survival according to Swedish population statistics. Results: No statistical differences in HRQOL between the arms were noted at 24 months. Descriptively, survivors in the surgery arm had higher summary scores than the general population at 24 months, whereas survivors in the chemotherapy arm had lower scores. The projected life-time QALY benefit was 3.8 QALYs in favor of the surgery arm (p=0.06) with an ICER per QALY gained at 310,000 SEK (EORTC-8D) or 362,000 SEK (SF-6D) corresponding to 26,700-31,200 GBP. Conclusion: The HRQOL in patients with colorectal peritoneal metastases undergoing CRS + IPC appear similar to those receiving systemic chemotherapy. Two-year survivors in the CRS + IPC arm have comparable HRQOL to a general population reference. The treatment is cost-effective according to NICE guidelines.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
Keywords
Colorectal cancer, Peritoneal metastases, Cytoreductive surgery, Intraperitoneal chemotherapy, Quality of life, Cost-effectiveness
National Category
Nursing Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-361107 (URN)10.1016/j.ejso.2018.02.012 (DOI)000437391100010 ()29530346 (PubMedID)
Funder
Swedish Cancer Society, 150767
Available from: 2018-09-21 Created: 2018-09-21 Last updated: 2018-09-21Bibliographically approved
Enblad, M., Graf, W. & Birgisson, H. (2018). Risk factors for appendiceal and colorectal peritoneal metastases. European Journal of Surgical Oncology, 44(7), 997-1005
Open this publication in new window or tab >>Risk factors for appendiceal and colorectal peritoneal metastases
2018 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 44, no 7, p. 997-1005Article in journal (Refereed) Published
Abstract [en]

Background

Early diagnosis to target minimal volume disease has received increased attention in the management of appendiceal and colorectal peritoneal metastases (PM). This study aimed to identify risk factors for appendiceal, colon and rectal PM.

Methods

Data were retrieved from the Swedish Colorectal Cancer Registry for all patients undergoing bowel resection of appendiceal and colorectal tumours, in Sweden, 2007–2015. Risk factors for synchronous and metachronous PM were analysed with multivariate logistic and Cox proportional hazard regression models.

Results

Synchronous PM was most common in appendiceal cancer (23.5%), followed by colon (3.1%) and rectal (0.6%) cancer. The 5-year cumulative incidence was 9.0% for appendiceal, 2.5% for right colon, 1.8% for left colon and 1.2% for rectal cancer. In appendiceal cancer (n = 327), T4, N2, mucinous tumour, and non-radical surgery were associated with PM. In colon cancer (n = 24,399), synchronous PM were primarily associated with T4 (OR 18.37, 95% CI 8.12–41.53), T3 and N2 but also with N1, right-sided tumour, mucinous tumour, vascular and perineural invasion, female gender, age <60 and emergency surgery. These factors were also associated with metachronous PM. In rectal cancer (n = 10,394), T4 (OR 19.12, 95% CI 5.52–66.24), proximal tumour and mucinous tumour were associated with synchronous PM and T4 and mucinous tumour with metachronous PM.

Conclusions

This study shows that appendiceal cancer, right-sided colon cancer, advanced tumour and node stages and mucinous histopathology are the main high-risk features for PM and should increase the awareness of current or future PM.

Keywords
Peritoneal metastases, Appendiceal cancer, Colorectal cancer, Risk factors
National Category
Surgery Cancer and Oncology
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-340054 (URN)10.1016/j.ejso.2018.02.245 (DOI)000437391100012000437391100012 ()29576463 (PubMedID)
Funder
Swedish Cancer Society, 160411
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2019-07-02Bibliographically approved
Enblad, M., Birgisson, H., Ekbom, A., Sandin, F. & Graf, W. (2017). Increased incidence of bowel cancer after non-surgical treatment of appendicitis. European Journal of Surgical Oncology, 43(11), 2067-2075
Open this publication in new window or tab >>Increased incidence of bowel cancer after non-surgical treatment of appendicitis
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2017 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 43, no 11, p. 2067-2075Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is an ongoing debate on the use of antibiotics instead of appendectomy for treating appendicitis but diagnostic difficulties and longstanding inflammation might lead to increased incidence of bowel cancer in these patients. The aim of this population-based study was to investigate the incidence of bowel cancer after non-surgical treatment of appendicitis.

PATIENTS AND METHODS: Patients diagnosed with appendicitis but lacking the surgical procedure code for appendix removal were retrieved from the Swedish National Inpatient Register 1987-2013. The cohort was matched with the Swedish Cancer Registry and the standardised incidence ratios (SIR) with 95% confidence interval (95% CI) for appendiceal, colorectal and small bowel cancers were calculated.

RESULTS: Of 13 595 patients with non-surgical treatment of appendicitis, 352 (2.6%) were diagnosed with appendiceal, colorectal or small bowel cancer (SIR 4.1, 95% CI 3.7-4.6). The largest incidence increase was found for appendiceal (SIR 35, 95% CI 26-46) and right-sided colon cancer (SIR 7.5, 95% CI 6.6-8.6). SIR was still elevated when excluding patients with less than 12 months since appendicitis and the incidence of right-sided colon cancer was elevated five years after appendicitis (SIR 3.5, 95% CI 2.1-5.4). An increased incidence of bowel cancer was found after appendicitis with abscess (SIR 4.6, 95% CI 4.0-5.2), and without abscess (SIR 3.5, 95% CI 2.9-4.1).

CONCLUSION: Patients with non-surgical treatment of appendicitis have an increased short and long-term incidence of bowel cancer. This should be considered in the discussion about optimal management of patients with appendicitis.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Appendiceal cancer, Appendicitis, Colorectal cancer, Non-surgical treatment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333277 (URN)10.1016/j.ejso.2017.08.016 (DOI)000418107200012 ()28942236 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-03-09Bibliographically approved
Danielson, J., Karlbom, U., Graf, W. & Wester, T. (2017). Outcome in adults with anorectal malformations in relation to modern classification – Which patients do we need to follow beyond childhood?. Journal of Pediatric Surgery, 52(3), 463-468
Open this publication in new window or tab >>Outcome in adults with anorectal malformations in relation to modern classification – Which patients do we need to follow beyond childhood?
2017 (English)In: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, Vol. 52, no 3, p. 463-468Article in journal (Refereed) Published
Abstract [en]

Background/purpose

Knowledge about the functional outcome in adults with anorectal malformations is essential to organize structured transition to adult care for this patient group. The aim of this study was to investigate the functional outcome and quality of life in adults with anorectal malformations characterized according to the Krickenbeck classification.

Methods

Of 256 patients diagnosed with anorectal malformations at our institution in 1961–1993, 203 patients could be traced and were invited to participate in the study. One hundred and thirty-six patients replied (67%) and were compared with one hundred and thirty-six population based sex and age-matched controls. Patients and controls were evaluated with both a validated questionnaire as well as a study-specific questionnaire to assess bowel function. SF-36 was used for quality of life. Outcome in nine incontinence-related parameters, 10 constipation-related, 6 urogenital function-related, and 13 quality of life parameters were assessed in the patients and compared to the outcome of controls as well as to the type of anorectal malformations according to the Krickenbeck classification.

Results

The ARM-patients had an inferior outcome (P < 0.05) for all incontinence parameters, 8 of 10 parameters for constipation, 2 of 6 for urogenital function and 7 of 13 quality of life parameters. Patients with rectobulbar and vestibular fistulas had the worst statistical outcome but patients with cloaca and rectoprostatic/bladder-neck fistula had worse outcome in absolute numbers. Forty-four patients (32%) reported incontinence of stool at least once a week and 16 (12%) had a permanent colostomy.

Conclusions

The functional outcome and quality of life in adults with anorectal malformations are closely related to the type of malformation. A large proportion of the patients have persistent fecal incontinence, constipation and sexual problems that have a negative influence on their quality of life. Structured multidisciplinary follow-up of adults with anorectal malformations by pediatric and colorectal surgeons, as well as urologists and gynecologists is therefore advocated.

Keywords
Anorectal malformations, Long term outcome, Functional outcome, Sexual outcome, Quality of life, Transition to adult care
National Category
Surgery
Research subject
Pediatric Surgery
Identifiers
urn:nbn:se:uu:diva-241240 (URN)10.1016/j.jpedsurg.2016.10.051 (DOI)000397964100019 ()27894765 (PubMedID)
Available from: 2015-01-09 Created: 2015-01-09 Last updated: 2017-04-26Bibliographically approved
Cashin, P. H., Mahteme, H., Spang, N., Syk, I., Frodin, J. E., Torkzad, M., . . . Graf, W. (2016). Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial. European Journal of Cancer, 53, 155-162
Open this publication in new window or tab >>Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial
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2016 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 53, p. 155-162Article in journal (Refereed) Published
Abstract [en]

Background: First-line treatment of isolated resectable colorectal peritoneal metastases remains unclear. This study (the Swedish peritoneal study) compares cytoreductive surgery and intraperitoneal chemotherapy (surgery arm) with systemic chemotherapy (chemotherapy arm). Methods: Patients deemed resectable preoperatively were randomised to surgery and intraperitoneal 5-fluorouracil 550 mg/m(2) /d for 6 d with repeated courses every month or to systemic oxaliplatin and 5-fluorouracil regimen every second week. Both treatments continued for 6 months. Primary end-point was overall survival (OS) and secondary end-points were progression-free survival (PFS), and morbidity. Results: The study terminated prematurely when 48 eligible patients (24/arm) were included due to recruitment difficulties. Two-year OS was 54% in the surgery arm and 38% in the chemotherapy arm (p = 0.04). After 5 years, 8 versus 1 patient were alive, respectively (p = 0.02). Median OS was 25 months versus 18 months, respectively, hazard ratio 0.51 (95% confidence interval: 0.27-0.96, p = 0.04). PFS in the surgery arm was 12 months versus 11 months in the chemotherapy arm (p = 0.16) with 17% versus 0% 5-year PFS. Grade III-IV morbidity was seen in 42% and 50% of the patients, respectively. No mortalities. Conclusions: Cytoreductive surgery with intraperitoneal chemotherapy may be superior to systemic oxaliplatin-based treatment of colorectal cancer with resectable isolated peritoneal metastases.(ClinicalTrials. gov nr: NCT01524094).

Keywords
Cytoreductive surgery, Intraperitoneal chemotherapy, Colorectal cancer, Systemic chemotherapy, Peritoneal metastases, Peritoneal carcinomatosis
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-280096 (URN)10.1016/j.ejca.2015.09.017 (DOI)000368789100017 ()26751236 (PubMedID)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-11-30Bibliographically approved
Enblad, M., Birgisson, H., Wanders, A., Sköldberg, F., Ghanipour, L. & Graf, W. (2016). Importance of Absent Neoplastic Epithelium in Patients Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Annals of Surgical Oncology, 23(4), 1149-1156
Open this publication in new window or tab >>Importance of Absent Neoplastic Epithelium in Patients Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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2016 (English)In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 23, no 4, p. 1149-1156Article in journal (Refereed) Published
Abstract [en]

The importance of absent neoplastic epithelium in specimens from cytoreductive surgery (CRS) is unknown. This study aimed to investigate the prevalence and prognostic value of histopathology without neoplastic epithelium in patients treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). Data were extracted from medical records and histopathology reports for patients treated with initial CRS and HIPEC at Uppsala University Hospital, Sweden, between 2004 and 2012. Patients with inoperable disease and patients undergoing palliative non-CRS surgery were excluded from the study. Patients lacking neoplastic epithelium in surgical specimens from CRS, with or without mucin, were classified as "neoplastic epithelium absent" (NEA), and patients with neoplastic epithelium were classified as "neoplastic epithelium present" (NEP). The study observed NEA in 78 of 353 patients (22 %). Mucin was found in 28 of the patients with NEA. For low-grade appendiceal mucinous neoplasms and adenomas, the 5-year overall survival rate was 100 % for NEA and 84 % for NEP, and the 5-year recurrence-free survival rate was 100 % for NEA and 59 % for NEP. For appendiceal/colorectal adenocarcinomas (including tumors of the small intestine), the 5-year overall survival rate was 61 % for NEA and 38 % for NEP, and the 5-year recurrence-free survival rate was 60 % for NEA and 14 % for NEP. Carcinoembryonic antigen level, peritoneal cancer index, and completeness of the cytoreduction score were lower in patients with NEA. A substantial proportion of patients undergoing CRS and HIPEC have NEA. These patients have a favorable prognosis and a decreased risk of recurrence. Differences in patient selection can affect the proportion of NEA and hence explain differences in survival rates between reported series.

National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:uu:diva-282455 (URN)10.1245/s10434-015-4989-y (DOI)000371333200015 ()26577120 (PubMedID)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-03-09Bibliographically approved
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