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Sverrisson, I., Folkvaljon, F., Chabok, A., Stattin, P., Smedh, K. & Nikberg, M. (2019). Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer. European Journal of Surgical Oncology, 45(3), 341-346
Open this publication in new window or tab >>Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer
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2019 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, no 3, p. 341-346Article in journal (Refereed) Published
Abstract [en]

Introduction:

There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients.

Methods:

All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed.

Results:

In total, 13299 men had undergone a bowel resection for rectal cancer, 188 of whom had previously received radiotherapy for prostate cancer. Among those who had received radiation therapy, 59 men (31%) had an AR: 50 men (85%) received a diverting ileostomy, 42 men (71%) had an American Society of Anesthesiologists score of 1-2 and 36 men (61%) had tumour stage 1-2. AL was found in 12/59 men (20%), one of whom had a re-laparotomy. There was no 90-day mortality.

Conclusions:

In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.

Keywords
Rectal cancer, Prostate cancer, Complications, Anastomotic leakage, Radiation therapy
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-381093 (URN)10.1016/j.ejso.2018.11.015 (DOI)000461411100008 ()30503046 (PubMedID)
Available from: 2019-04-15 Created: 2019-04-15 Last updated: 2019-04-15Bibliographically approved
Tiselius, C., Kindler, C., Rosenblad, A. & Smedh, K. (2019). Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery. European Journal of Surgical Oncology, 45(6), 989-994
Open this publication in new window or tab >>Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery
2019 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, no 6, p. 989-994Article in journal (Refereed) Published
Abstract [en]

Introduction: For oncological reasons, central arterial ligation of the inferior mesenteric artery (IMA) is suggested in rectal cancer surgery although no conclusive evidence support this. We have therefore investigated the localization of lymph node metastases and compared central ligation of the IMA versus peripheral arterial ligation, in rectal cancer specimens. Methods: This was a cross-sectional population-based study of consecutive recruited patients who underwent resection for rectal cancer in 2012-2015. Multiple linear regression analysis was used to explore the relationship between lymph node count and age, sex, body mass index, preoperative oncological treatment, type of surgery, tumour stage, and vessel and specimen length. Results: 151 patients (54 women) were included, with median (range) age 70 (45-87) years. The median (range) number of lymph nodes retrieved was 25 (3-70), which was associated with body mass index, type of surgery and vessel length. Vessel length, median (range) 9.6 (5-14) and 9.2 (5-15) cm for reported central and peripheral arterial ligation, respectively, was associated with body mass index. In 39 of 42 samples, metastatic lymph nodes were located in the mesorectum, and 13 of 42 samples also had metastatic lymph nodes in the sigmoid mesentery. None were found around the ligated artery. Conclusion: To recruit all metastatic lymph nodes in rectal cancer surgery, it is important to include the sigmoid mesentery in the specimen, but not to perform a central ligation of the IMA compared with ligation of the SRA close to the left colic artery (LCA). (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Lymph node, Arterial ligation, Rectal cancer
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-389814 (URN)10.1016/j.ejso.2019.01.183 (DOI)000470941000010 ()30744943 (PubMedID)
Available from: 2019-07-30 Created: 2019-07-30 Last updated: 2020-02-04Bibliographically approved
Isacson, D., Smedh, K., Hosseinali Khani, M. & Chabok, A. (2019). Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis. British Journal of Surgery, 106(11), 1542-1548
Open this publication in new window or tab >>Long-term follow-up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis
2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 11, p. 1542-1548Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to assess the long-term results in patients with uncomplicated diverticulitis who had participated in the Antibiotics in Acute Uncomplicated Diverticulitis (AVOD) RCT, which randomized patients with CT-verified left-sided acute uncomplicated diverticulitis to management without or with antibiotics.

Methods: The medical records of patients who had participated in the AVOD trial were reviewed for long-term results such as recurrences, complications and surgery. Quality-of-life questionnaires (EQ-5D (TM)) were sent to patients, who were also contacted by telephone. Descriptive statistics were used for the analysis of clinical outcomes.

Results: A total of 556 of the 623 patients (89 center dot 2 per cent) were followed up for a median of 11 years. There were no differences between the no-antibiotic and antibiotic group in recurrences (both 31 center dot 3 per cent; P = 0 center dot 986), complications (4 center dot 4 versus 5 center dot 0 per cent; P = 0 center dot 737), surgery for diverticulitis (6 center dot 2 versus 7 center dot 1 per cent; P = 0 center dot 719) or colorectal cancer (0 center dot 4 versus 2 center dot 1 per cent; P = 0 center dot 061). The response rate for the EQ-5D (TM) was 52 center dot 8 versus 45 center dot 2 per cent respectively (P = 0 center dot 030), and no differences were found between the two groups in any of the measured dimensions.

Conclusion: Antibiotic avoidance for uncomplicated diverticulitis is safe in the long term.

Place, publisher, year, edition, pages
WILEY, 2019
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-396118 (URN)10.1002/bjs.11239 (DOI)000480058800001 ()31386199 (PubMedID)
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-10-31Bibliographically approved
Afshari, K., Chabok, A., Naredi, P., Smedh, K. & Nikberg, M. (2019). Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case-control study. Surgial oncology, 29, 102-106
Open this publication in new window or tab >>Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case-control study
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2019 (English)In: Surgial oncology, ISSN 0960-7404, E-ISSN 1879-3320, Vol. 29, p. 102-106Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim was to identify patient-, tumor- and treatment-related prognostic factors for five-year survival in rectal cancer patients with synchronous stage IV disease. Material and methods: This nationwide case-control study was based on the Swedish Colorectal Cancer Registry with supplementary information from medical records and the Swedish Inpatient Registry during the period 2000-2008. All resected rectal cancer patients with synchronous metastases that survived more than five years were included as cases. The control group consisted of corresponding patients who lived less than five years, matched in a 1:2 based on gender, age, resection of the rectal tumor, and the study period. Results: A total of 405 patients were identified; 99 long-term survivors (LTS) and 182 short-term survivors (STS). Patient-related factors of symptoms and comorbidity did not differ between LTS and STS. Among the treatment-related factors, multiple site metastases (p = 0.007), bilobar liver metastasis (p = 0.002), and increasing number of liver metastasis (p < 0.001) were associated with STS. Prognostic treatment-related factors were preoperative radiotherapy (p = 0.001), metastasectomy (p < 0.001), and radical resection of the primary tumor (p = 0.014). In the multivariable analysis, the single most important factor for becoming a LTS was a metastasectomy (hazard ratio: 8.474, 95% confidence interval: 4.098-17.543). Conclusions: The most important prognostic factor for long-term survival in patients with stage IV rectal cancer was metastasectomy, especially liver surgery. With thorough selection of patients for metastasectomy more patients with metastasized rectal cancer may survive beyond five years.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Rectal cancer, Stage IV, Prognostic factor, Metastases
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-389816 (URN)10.1016/j.suronc.2019.04.005 (DOI)000470833100016 ()31196471 (PubMedID)
Available from: 2019-07-30 Created: 2019-07-30 Last updated: 2019-07-30Bibliographically approved
Thorisson, A., Nikberg, M., Torkzad, M. R., Laurell, H., Smedh, K. & Chabok, A. (2018). Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT.
Open this publication in new window or tab >>Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT
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2018 (English)In: Article in journal (Other academic) Submitted
Abstract [en]

Purpose: To evaluate the diagnostic accuracy of non-enhanced low-dose computed tomography (LDCT) in acute colonic diverticulitis with contrast-enhanced standard-dose CT (SDCT) as the reference method.

Materials and Methods: Consecutive patients with clinically suspected diverticulitis were included from two hospitals between January and October 2017. All patients underwent LDCT followed by SDCT. All CT examinations were assessed for signs of diverticulitis, complications, and other diagnoses by three independent radiologists (two radiology consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity, specificity, and agreement were calculated.

Results: In total, 149 patients (median age 68, 107 women) were included; 107 had diverticulitis on standard CT. Sensitivity for diverticulitis using LDCT was 100%; the values were 99% for consulting radiologists and 92% for the radiology resident. Specificity was 100% for both consultants and 84% for the resident. Sensitivity for identification of complications was 74%, 60%, and 54%, respectively. Twenty-six patients had other causes of abdominal symptoms on standard CT, 23 (88%) of whom were diagnosed correctly on LDCT. One case of splenic infarction and two cases of segment colitis were missed on LDCT.

Conclusion: The diagnostic accuracy of LDCT was high for acute diverticulitis. Therefore, it is recommended as a standard method that should help to reduce radiation dose and cost. LDCT had lower sensitivity for complications, although discrimination between an inflamed diverticulum and small pericolic abscess accounted for a proportion of the discrepancies.

National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology; Surgery
Identifiers
urn:nbn:se:uu:diva-356709 (URN)
Available from: 2018-08-03 Created: 2018-08-03 Last updated: 2018-08-06Bibliographically approved
Sverrisson, I., Hosseinali Khani, M., Chabok, A. & Smedh, K. (2018). Low risk of intra-abdominal infections in rectal cancer patients treated with Hartmann's procedure: a report from a national registry. Paper presented at Meeting of the European-Society-of-ColoProctology (ESCP), SEP 23-25, 2015, Dublin, IRELAND. International Journal of Colorectal Disease, 33(3), 327-332
Open this publication in new window or tab >>Low risk of intra-abdominal infections in rectal cancer patients treated with Hartmann's procedure: a report from a national registry
2018 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 33, no 3, p. 327-332Article in journal (Refereed) Published
Abstract [en]

To describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann's procedure (HP). Data were retrieved from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007-2014. A retrospective analysis was performed using prospectively recorded data. Characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy were analysed. Of 10,940 patients resected for rectal cancer, 1452 (13%) underwent HP (median age, 77 years). The American Society of Anesthesiologists (ASA) score was 3-4 in 43% of patients; 15% had distant metastases and 62% underwent a low HP. The intra-abdominal infection rate was 8% and re-laparotomy rate was 10%. Multivariable logistic regression analysis identified preoperative radiotherapy (OR, 1.78; 95% CI, 1.14-2.77), intra-operative bowel perforation (OR, 1.99; 95% CI, 1.08-3.67), T4 tumours (OR, 1.68; 95% CI 1.04-2.69) and female gender (OR, 1.73; 95% CI, 1.15-2.61) as risk factors for intra-abdominal infection. ASA score 3-4 (OR, 1.62; 95% CI, 1.12-2.34), elevated BMI (OR, 1.05; 95% CI, 1.02-1.09) and female gender (OR, 2.06; CI, 1.41-3.00) were risk factors for re-laparotomy after HP. The rate of intra-abdominal infection was not increased after a low HP. Despite older age and co-morbidities including more advanced cancer, patients undergoing Hartmann's procedure had low rates of serious postoperative complications and re-laparotomy. A low HP was not associated with a higher rate of intra-abdominal infection. HP seems to be appropriate for old and frail patients with rectal cancer.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Rectal cancer, Surgery, Hartmann's procedure, Postoperative complications, Intra-abdominal infections
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-347541 (URN)10.1007/s00384-018-2967-0 (DOI)000425354700010 ()29354849 (PubMedID)
Conference
Meeting of the European-Society-of-ColoProctology (ESCP), SEP 23-25, 2015, Dublin, IRELAND
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2018-10-08Bibliographically approved
Thorisson, A., Hosseinali Khani, M., Andreasson, K., Smedh, K. & Chabok, A. (2018). Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study. Scandinavian Journal of Gastroenterology, 53(10-11), 1298-1303
Open this publication in new window or tab >>Non-operative management of perforated diverticulitis with extraluminal or free air - a retrospective single center cohort study
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1298-1303Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to describe patient characteristics and results of non-operative management for patients presenting with computed tomography (CT) verified perforated diverticulitis with extraluminal or free air.

Methods: All patients treated for diverticulitis (ICD-10: K-57) during 2010–2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis and extraluminal or free air on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described.

Results: Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity.

Conclusions: Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.

Keywords
Colonic diverticulitis, perforated diverticulitis, computed tomography, surgery
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-377721 (URN)10.1080/00365521.2018.1520291 (DOI)000457980900022 ()30353758 (PubMedID)
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-03-08Bibliographically approved
Isacson, D., Andreasson, K., Nikberg, M., Smedh, K. & Chabok, A. (2018). Outpatient management of acute uncomplicated diverticulitis results in health-care cost savings. Scandinavian Journal of Gastroenterology, 53(4), 449-452
Open this publication in new window or tab >>Outpatient management of acute uncomplicated diverticulitis results in health-care cost savings
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 4, p. 449-452Article in journal (Refereed) Published
Abstract [en]

Purpose:

Outpatient management without antibiotics has been shown to be safe for selected patients diagnosed with acute uncomplicated diverticulitis (AUD). The aim of this study was to evaluate the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics.

Methods:

The medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics in Vastmanland County were reviewed. Health-care cost analysis was performed using the Swedish cost-per-patient model.

Results:

In total, 494 episodes of AUD were identified, 254 in 2011 and 240 in 2014. The proportion of patients managed as outpatients was 20% in 2011 compared with 60% in 2014 (p<.001). There were 203 hospital admissions and a total length of stay of 677 days in 2011 compared with 95 admissions and 344 days in 2014 (both p<.001). The total health-care cost was Euro558,679 in 2011 compared with Euro370,370 in 2014 (p<.001). Three patients developed complications in 2011 and four in 2014 (p=.469).

Conclusions:

The new policy of outpatient management without antibiotics in routine health care almost halved the total health-care cost without an increase in the complication rate.

Keywords
Diverticulitis, outpatient management, antibiotics, health-care costs
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-354262 (URN)10.1080/00365521.2018.1448887 (DOI)000430726600011 ()29543100 (PubMedID)
Available from: 2018-06-28 Created: 2018-06-28 Last updated: 2018-12-10Bibliographically approved
Tiselius, C., Kindler, C., Shetye, J., Letocha, H. & Smedh, K. (2017). Computed Tomography Follow-Up Assessment of Patients with Low-Grade Appendiceal Mucinous Neoplasms: Evaluation of Risk for Pseudomyxoma Peritonei. Annals of Surgical Oncology, 24(7), 1778-1782
Open this publication in new window or tab >>Computed Tomography Follow-Up Assessment of Patients with Low-Grade Appendiceal Mucinous Neoplasms: Evaluation of Risk for Pseudomyxoma Peritonei
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2017 (English)In: Annals of Surgical Oncology, ISSN 1068-9265, E-ISSN 1534-4681, Vol. 24, no 7, p. 1778-1782Article in journal (Refereed) Published
Abstract [en]

Low-grade appendiceal mucinous neoplasms are rare. Both classification and management vary. This study aimed to follow up on patients with a diagnosis of LAMN after primary surgery with computer tomography (CT) scans to examine the risk for the development of pseudomyxoma peritonei (PMP).

This population-based prospective study investigated patients who underwent appendectomy between 2007 and 2013 and had histology results demonstrating the presence of LAMN. The patients were followed up with a CT scan every 6 months for 2 years, until December 2015.

The study investigated 41 patients (20 females) with a median age of 65 years (range 20-87 years). The entire appendix was processed and examined, with results showing that 12 were perforated, and 3 had a positive margin. Extra-appendiceal mucin on the surface of the appendix was found in ten cases, and in two cases, extra-mucinous epithelial cells were detected. During a median follow-up period of 5.1 years (range 2-8.6 years), none of the patients experienced the development of PMP.

These data suggest that for patients with LAMN confined to the appendix, involvement of the appendectomy margin or perforation with mucin locally, even with epithelial cells, did not predict the development of PMP, and a conservative approach seems justified. No reoperation was needed, and regular follow-up evaluation with CT scans was sufficient.

National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:uu:diva-326486 (URN)10.1245/s10434-016-5623-3 (DOI)000402459000005 ()28474197 (PubMedID)
Available from: 2017-09-15 Created: 2017-09-15 Last updated: 2017-09-15Bibliographically approved
Kindler, C., Smedh, K., Chabok, A., Shetye, J., Dafnis, G. & Nikberg, M. (2017). Detection of Free Cancer Cells in Pelvic Lavage with Double Immunocytochemistry at Rectal Cancer Surgery. Anticancer Research, 37(4), 1563-1568
Open this publication in new window or tab >>Detection of Free Cancer Cells in Pelvic Lavage with Double Immunocytochemistry at Rectal Cancer Surgery
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2017 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 4, p. 1563-1568Article in journal (Refereed) Published
Abstract [en]

Background/Aim: The aim of the present study was to describe a double immunocytochemical staining method for detecting free cancer cells after rectal cancer surgery and to evaluate their extent and prognostic role. Materials and Methods: Immunocytochemistry was performed using antibodies against cytokeratin 20/caudal-typehomeobox transcription factor 2 (CDX2) and mucin glycoprotein-2 (MUC2)/p53 protein. The study included 29 patients with infraperitoneal rectal cancer who underwent bowel resection and four controls. The pelvic lavage was retrieved at the start of laparotomy, after total mesorectal excision and after abdominal lavage with sterile water. Results: Free cancer cells were detected with the double immunocytochemical method in the two controls with carcinomatosis and one control with sigmoidal cancer. None of the patients with rectal tumours had presence of free cancer cells. Conclusion: Immunocytochemical analysis of peritoneal lavage was feasible and negative in patients with infraperitoneal rectal cancer. Further studies are encouraged to investigate the clinical relevance in cases with free cancer cells after incomplete total mesorectal excision.

Place, publisher, year, edition, pages
International Institute of Anticancer Research, 2017
Keywords
Rectal cancer, peritoneal cancer cells, immuno cytochemistry, immunocytology recurrence
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-327067 (URN)10.21873/anticanres.11485 (DOI)000402167700003 ()28373415 (PubMedID)
Available from: 2017-08-01 Created: 2017-08-01 Last updated: 2017-08-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7056-670x

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