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Påhlman, Lars
Alternative names
Publications (10 of 151) Show all publications
Ghanipour, L., Jirström, K., Sundström, M., Glimelius, B., Påhlman, L. & Birgisson, H. (2017). Associations of defect mismatch repair genes with prognosis and heredity in sporadic colorectal cancer. European Journal of Surgical Oncology, 43(2), 311-321.
Open this publication in new window or tab >>Associations of defect mismatch repair genes with prognosis and heredity in sporadic colorectal cancer
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2017 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 43, no 2, 311-321 p.Article in journal (Refereed) Published
Abstract [en]

Background: Microsatellite instability arises due to defect mismatch repair (MMR) and occurs in 10-20% of sporadic colorectal cancer. The purpose was to investigate correlations between defect MMR, prognosis and heredity for colorectal cancer in first-degree relatives.

Material and methods: Tumour tissues from 320 patients consecutively operated for colorectal cancer were analysed for immunohistochemical expression of MLH1, MSH2 and MSH6 on tissue microarrays. Information on KRAS and BRAF mutation status was available for selected cases.

Results: Forty-seven (15%) tumours displayed MSI. No correlation was seen between patients exhibiting MSI in the tumour and heredity (p= 1.000). Patients with proximal colon cancer and MSI had an improved cancer-specific survival (p= 0.006) and prolonged time to recurrence (p= 0.040). In a multivariate analysis including MSI status, gender, CEA, vascular and neural invasion, patients with MSS and proximal colon cancer had an impaired cancer-specific survival compared with patients with MSI (HR, 3.87; CI, 1.36-11.01). The same prognostic information was potentially also in distal colon cancer; no recurrences seen in the 8 patients with stages II and III distal colon cancer and MSI, but the difference was not statistically significant.  Conclusion:No correlation between MSI and heredity was seen. Patients with MSI tumours had improved survival.

 

Keyword
colorectal cancer, MSI, heredity, prognosis
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:uu:diva-224695 (URN)10.1016/j.ejso.2016.10.013 (DOI)000394072300011 ()27836416 (PubMedID)
Available from: 2014-05-19 Created: 2014-05-19 Last updated: 2017-04-25Bibliographically approved
Deijen, C. L., Vasmel, J. E., de Lange-de Klerk, E. S. M., Cuesta, M. A., Coene, P.-P. L. O., Lange, J. F., . . . Bonjer, H. J. (2017). Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surgical Endoscopy, 31(6), 2607-2615.
Open this publication in new window or tab >>Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer
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2017 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 31, no 6, 2607-2615 p.Article in journal (Refereed) Published
Abstract [en]

Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up. Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842). In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) -10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI -10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI -11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n = 3 vs. open n = 4). Laparoscopic surgery for non-metastatic colon cancer is associated with similar rates of disease-free survival, overall survival and recurrences as open surgery at 10-year follow-up.

Place, publisher, year, edition, pages
SPRINGER, 2017
Keyword
Colon cancer, Surgery, Laparoscopic, Treatment, Randomised clinical trial
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-327144 (URN)10.1007/s00464-016-5270-6 (DOI)000402134300030 ()27734203 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2017-08-28 Created: 2017-08-28 Last updated: 2017-08-28Bibliographically approved
Thorisson, A., Smedh, K., Torkzad, M. R., Påhlman, L. & Chabok, A. (2016). CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis. International Journal of Colorectal Disease, 31(2), 451-457.
Open this publication in new window or tab >>CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis
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2016 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 31, no 2, 451-457 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The first randomized clinical trial of antibiotics in uncomplicated diverticulitis (the AVOD study) showed no benefit of antibiotics. The aim of this study was to re-evaluate the computed tomography (CT) scans of the patients in the AVOD study to find out whether there were CT findings that were missed and to study whether CT signs in uncomplicated diverticulitis could predict complications or recurrence.

METHODS: The CT scan images from patients included in the AVOD study were re-evaluated and graded by two independent reviewers for different signs of diverticulitis, including complications, such as extraluminal gas or the presence of an abscess.

RESULTS: Of the 623 patients included in the study, 602 CT scans were obtained and re-evaluated. Forty-four (7 %) patients were found to have complications on the admitting CT scan that had been overlooked. Twenty-seven had extraluminal gas and 17 had an abscess. Four of these patients deteriorated and required surgery, but the remaining patients improved without complications. Of the 18 patients in the no-antibiotic group, in whom signs of complications on CT were overlooked, 15 recovered without antibiotics. No CT findings in patients with uncomplicated diverticulitis could predict complications or recurrence.

CONCLUSION: No CT findings that could predict complications or recurrence were found. A weakness in the initial assessment of the CT scans to detect extraluminal gas and abscess was found but, despite this, the majority of patients recovered without antibiotics. This further supports the non-antibiotic strategy in uncomplicated diverticulitis.

Keyword
Colonic diverticulitis; Complications; CT scan; Prediction
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-269592 (URN)10.1007/s00384-015-2423-3 (DOI)000369537500034 ()26490053 (PubMedID)
Available from: 2015-12-17 Created: 2015-12-17 Last updated: 2017-12-01Bibliographically approved
Ghanipour, L., Darmanis, S., Landegren, U., Glimelius, B., Påhlman, L. & Birgisson, H. (2016). Detection of prognostic biomarkers with solid-phase proximity ligation assay in patients with colorectal cancer. Translational Oncology, 9(3), 251-255.
Open this publication in new window or tab >>Detection of prognostic biomarkers with solid-phase proximity ligation assay in patients with colorectal cancer
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2016 (English)In: Translational Oncology, ISSN 1944-7124, E-ISSN 1936-5233, Vol. 9, no 3, 251-255 p.Article in journal (Refereed) Published
Abstract [en]

Background: In the search for prognostic biomarkers a significant amount of precious biobanked blood samples is needed if conventional analyses are used. Solid-phase proximity ligation assay (SP-PLA) is an analytic method with the ability to analyse many proteins at the same time in small amounts of plasma. The aim of this study was to explore the potential use of  SP-PLA in patients with colorectal cancer (CRC).

Material and methods: Plasma from patients with stage I-IV CRC, with (n=31) and without (n=29) disease dissemination at diagnosis or later, was analysed with SP-PLA using 35 antibodies targeting an equal number of proteins in 5 ml plasma. Carcinoembryonic antigen (CEA), analysed earlier on this cohort, was used as a reference.

Results: A total of 21 of the 35 proteins were detectable with SP-PLA. Patients in stage II-III with disseminated disease had lower plasma concentrations of HCC-4 (p=0.025). Low plasma levels of TIMP-1 were seen in patients with disseminated disease stage II (p=0.003). The level of CEA was higher in patients with disease dissemination compared to those without (p=0.007).

Conclusion: SP-PLA has the ability to analyse many tumour markers simultaneously in a small amount of blood. However, none of the markers selected for the present SP-PLA analyses gave better prognostic information compared with CEA. 

Keyword
colorectal cancer, biomarkers, SP-PLA, recurrence, prognosis
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-224696 (URN)10.1016/j.tranon.2016.04.001 (DOI)000378028300014 ()27267845 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme, 294409; 259796
Available from: 2014-05-19 Created: 2014-05-19 Last updated: 2017-12-05Bibliographically approved
Breugom, A. J., van Gijn, W., Muller, E. W., Berglund, Å., van den Broek, C. B., Fokstuen, T., . . . van de Velde, C. J. (2015). Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Annals of Oncology, 26(4), 696-701.
Open this publication in new window or tab >>Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial
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2015 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 26, no 4, 696-701 p.Article in journal (Refereed) Published
Abstract [en]

Background: The discussion on the role of adjuvant chemotherapy for rectal cancer patients treated according to current guidelines is still ongoing. A multicentre, randomized phase III trial, PROCTOR-SCRIPT, was conducted to compare adjuvant chemotherapy with observation for rectal cancer patients treated with preoperative (chemo) radiotherapy and total mesorectal excision (TME). Patients and methods: The PROCTOR-SCRIPT trial recruited patients from 52 hospitals. Patients with histologically proven stage II or III rectal adenocarcinoma were randomly assigned (1: 1) to observation or adjuvant chemotherapy after preoperative (chemo) radiotherapy and TME. Radiotherapy consisted of 5 x 5 Gy. Chemoradiotherapy consisted of 25 x 1.8-2 Gy combined with 5-FU-based chemotherapy. Adjuvant chemotherapy consisted of 5-FU/LV (PROCTOR) or eight courses capecitabine (SCRIPT). Randomization was based on permuted blocks of six, stratified according to centre, residual tumour, time between last irradiation and surgery, and preoperative treatment. The primary end point was overall survival. Results: Of 470 enrolled patients, 437 were eligible. The trial closed prematurely because of slow patient accrual. Patients were randomly assigned to observation (n = 221) or adjuvant chemotherapy (n = 216). After a median follow-up of 5.0 years, 5-year overall survival was 79.2% in the observation group and 80.4% in the chemotherapy group [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.62-1.39; P = 0.73]. The HR for disease-free survival was 0.80 (95% CI 0.60-1.07; P = 0.13). Five-year cumulative incidence for locoregional recurrences was 7.8% in both groups. Five-year cumulative incidence for distant recurrences was 38.5% and 34.7%, respectively (P = 0.39). Conclusion: The PROCTOR-SCRIPT trial could not demonstrate a significant benefit of adjuvant chemotherapy with fluoropyrimidine monotherapy after preoperative (chemo) radiotherapy and TME on overall survival, disease-free survival, and recurrence rate. However, this trial did not complete planned accrual.

Keyword
rectal adenocarcinoma, adjuvant chemotherapy, total mesorectal excision, preoperative radiotherapy, preoperative chemoradiotherapy
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-253259 (URN)10.1093/annonc/mdu560 (DOI)000353828700013 ()25480874 (PubMedID)
Available from: 2015-05-26 Created: 2015-05-25 Last updated: 2017-12-04Bibliographically approved
Torkzad, M., Casta, N., Bergman, A., Ahlström, H., Påhlman, L. & Mahteme, H. (2015). Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist. Journal of Surgical Oncology, 111(6), 746-751.
Open this publication in new window or tab >>Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist
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2015 (English)In: Journal of Surgical Oncology, ISSN 0022-4790, E-ISSN 1096-9098, Vol. 111, no 6, 746-751 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

To compare CT and MRI for peritoneal carcinomatosis index (PCI) assessment and to compare assessments made by the radiologist based on their experiences.

METHOD AND MATERIALS:

MRI and CT of abdomen and pelvis were performed on 39 prospectively followed by surgery directly. Two blinded radiologists with different experience levels evaluated PCI separately on different occasions on 19 cases initially and later on the remaining 20. The agreement between the radiologists' assessment and surgical findings in total and per site were recorded.

RESULTS:

Total PCI: The experienced radiologist was able to assess total tumor burden correctly on both CT and MRI (kappa = 1.0). For the inexperienced radiologist the assessment was better on CT (kappa = 0.73) compared to MRI (kappa = 0.58). Different sites: The experienced radiologist showed high agreement with kappa = 0.77 for MRI and 0.80 for CT. Corresponding figures were 0.39 and 0.60 for the inexperienced radiologist. For the second phase the agreement levels increased for the inexperienced radiologist increased to 0.80 and 0.70, respectively.

CONCLUSION:

CT and MRI are equal when read by experienced radiologist. CT shows better results when read by an inexperienced radiologist compared to MRI, however the results of the latter can easily be improved.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-244159 (URN)10.1002/jso.23878 (DOI)000353417700014 ()25580825 (PubMedID)
Available from: 2015-02-12 Created: 2015-02-12 Last updated: 2017-12-04Bibliographically approved
D'Hoore, A., Albert, M. R., Cohen, S. M., Herbst, F., Matter, I., Van der Speeten, K., . . . Wexner, S. D. (2015). COMPRES: a prospective postmarketing evaluation of the compression anastomosis ring CAR 27/ColonRing. Colorectal Disease, 17(6), 522-529.
Open this publication in new window or tab >>COMPRES: a prospective postmarketing evaluation of the compression anastomosis ring CAR 27/ColonRing
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2015 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 17, no 6, 522-529 p.Article in journal (Refereed) Published
Abstract [en]

AimPreclinical studies have suggested that nitinol-based compression anastomosis might be a viable solution to anastomotic leak following low anterior resection. A prospective multicentre open label study was therefore designed to evaluate the performance of the ColonRing in (low) colorectal anastomosis. MethodThe primary outcome measure was anastomotic leakage. Patients were recruited at 13 different colorectal surgical units in Europe, the United States and Israel. Institutional review board approval was obtained. ResultsBetween 21 March 2010 and 3 August 2011, 266 patients completed the study protocol. The overall anastomotic leakage rate was 5.3% for all anastomoses, including a rate of 3.1% for low anastomoses. Septic anastomotic complications occurred in 8.3% of all anastomoses and 8.2% of low anastomoses. ConclusionNitinol compression anastomosis is safe, effective and easy to use and may offer an advantage for low colorectal anastomosis. A prospective randomized trial comparing ColonRing with conventional stapling is needed.

Keyword
Compression anastomosis, anastomotic leakage, low anterior resection
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-256212 (URN)10.1111/codi.12884 (DOI)000354813200012 ()25537083 (PubMedID)
Available from: 2015-07-06 Created: 2015-06-22 Last updated: 2017-12-04Bibliographically approved
Breugom, A. J., Bastiaannet, E., Boelens, P. G., Van Eycken, E., Vandendael, T., Iversen, L. H., . . . Van de Velde, C. J. (2015). Differences in proportion adjuvant chemotherapy are not associated with relative survival for stage II colon cancer patients aged 75 years and older - a EURECCA international comparison. Paper presented at European Cancer Congress, 25 Sep - 29 Sep, 2015, Vienna, AUSTRIA. European Journal of Cancer, 51(S3), S195-S195.
Open this publication in new window or tab >>Differences in proportion adjuvant chemotherapy are not associated with relative survival for stage II colon cancer patients aged 75 years and older - a EURECCA international comparison
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2015 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, no S3, S195-S195 p.Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-267497 (URN)000361887400585 ()
Conference
European Cancer Congress, 25 Sep - 29 Sep, 2015, Vienna, AUSTRIA
Note

Meeting Abstract: 1323

Available from: 2015-12-09 Created: 2015-11-24 Last updated: 2017-12-01Bibliographically approved
Walters, S., Benitez-Majano, S., Muller, P., Coleman, M. P., Allemani, C., Butler, J., . . . Rachet, B. (2015). Is England closing the international gap in cancer survival?. British Journal of Cancer, 113(5), 848-860.
Open this publication in new window or tab >>Is England closing the international gap in cancer survival?
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2015 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 113, no 5, 848-860 p.Article in journal (Refereed) Published
Abstract [en]

Background: We provide an up-to-date international comparison of cancer survival, assessing whether England is 'closing the gap' compared with other high-income countries. Methods: Net survival was estimated using national, population-based, cancer registrations for 1.9 million patients diagnosed with a cancer of the stomach, colon, rectum, lung, breast (women) or ovary in England during 1995-2012. Trends during 1995-2009 were compared with estimates for Australia, Canada, Denmark, Norway and Sweden. Clinicians were interviewed to help interpret trends. Results: Survival from all cancers remained lower in England than in Australia, Canada, Norway and Sweden by 2005-2009. For some cancers, survival improved more in England than in other countries between 1995-1999 and 2005-2009; for example, 1-year survival from stomach, rectal, lung, breast and ovarian cancers improved more than in Australia and Canada. There has been acceleration in lung cancer survival improvement in England recently, with average annual improvement in 1-year survival rising to 2% during 2010-2012. Survival improved more in Denmark than in England for rectal and lung cancers between 1995-1999 and 2005-2009. Conclusions: Survival has increased in England since the mid-1990s in the context of strategic reform in cancer control, however, survival remains lower than in comparable developed countries and continued investment is needed to close the international survival gap.

Keyword
cancer survival, international comparison, population-based, cancer registries
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-264058 (URN)10.1038/bjc.2015.265 (DOI)000360727200020 ()26241817 (PubMedID)
Available from: 2015-10-05 Created: 2015-10-05 Last updated: 2017-12-01Bibliographically approved
Adam, R., de Gramont, A., Figueras, J., Kokudo, N., Kunstlinger, F., Loyer, E., . . . Påhlman, L. (2015). Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus. Cancer Treatment Reviews, 41(9), 729-741.
Open this publication in new window or tab >>Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus
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2015 (English)In: Cancer Treatment Reviews, ISSN 0305-7372, E-ISSN 1532-1967, Vol. 41, no 9, 729-741 p.Article in journal (Refereed) Published
Abstract [en]

An international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected ⩽12months and >12months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

Keyword
Colorectal cancer; Multidisciplinary team management; Surgery; Synchronous colorectal liver metastases; Systemic therapy
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-266453 (URN)10.1016/j.ctrv.2015.06.006 (DOI)000364897300001 ()26417845 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
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