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Halldestam, Ingvar
Alternative names
Publications (10 of 13) Show all publications
Griffiths, E. A. (2024). Predictors of anastomotic leak and conduit necrosis after oesophagectomy: Results from the oesophago-gastric anastomosis audit (OGAA). European Journal of Surgical Oncology, 50(6), Article ID 107983.
Open this publication in new window or tab >>Predictors of anastomotic leak and conduit necrosis after oesophagectomy: Results from the oesophago-gastric anastomosis audit (OGAA)
2024 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 50, no 6, article id 107983Article in journal (Refereed) Published
Abstract [en]

Background: Both anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy.

Methods: Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018-December 2018. Definitions for AL and CN were those set out by the Oesophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set.

Results: This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% and CN rate was 2.7%. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity and chronic obstructive pulmonary disease. The risk scoring model showed insufficient predictive ability in internal validation (area under the receiver-operating-characteristic curve [AUROC] = 0.618). Preoperative factors that were independent predictors of CN were: body mass index, Eastern Cooperative Oncology Group performance status, previous myocardial infarction and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an AUROC of 0.775.

Conclusion: Despite a large dataset, AL proves difficult to predict using preoperative factors. The risk-scoring model for CN provides an internally validated tool to estimate a patient's risk preoperatively.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Anastomotic leak; Conduit necrosis; Oesophagectomy; Outcomes
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-211978 (URN)10.1016/j.ejso.2024.107983 (DOI)001230573200001 ()38613995 (PubMedID)2-s2.0-85190281598 (Scopus ID)
Available from: 2025-03-01 Created: 2025-03-01 Last updated: 2025-03-01
Hollertz, P., Lindblad, M., Sandström, P., Halldestam, I. & Edholm, D. (2021). Outcome of microscopically non-radical oesophagectomy for oesophageal and oesophagogastric junctional cancer: nationwide cohort study. BJS Open, 5(3), Article ID zrab038.
Open this publication in new window or tab >>Outcome of microscopically non-radical oesophagectomy for oesophageal and oesophagogastric junctional cancer: nationwide cohort study
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2021 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 5, no 3, article id zrab038Article in journal (Refereed) Published
Abstract [en]

Background: Microscopically non-radical (R1) oesophageal cancer resection has been associated with worse survival. The aim of this study was to identify risk factors for R1 resection and to investigate how this affects long-term survival. Methods: The Swedish National Register for Oesophageal and Gastric Cancer was used to identify all patients who underwent oesophageal cancer resection with curative intent between 2006 and 2017. Risk factors for R1 resection were assessed by multivariable logistic regression analysis, and factors predicting 5-year survival identified by multivariable Cox regression. Results: The study included 1460 patients. Surgical margins were involved microscopically in 142 patients (9.7 per cent). The circumferential resection margin was involved in 114 (7.8 per cent), the proximal margin in 53 (3.6 per cent), and the distal margin in 29 (2.0 per cent). In 30 specimens (2.1 per cent), two or all three margins were involved. Independent risk factors for R1 resection were male sex, low BMI, absence of neoadjuvant treatments, and clinical T4 disease. The 5-year survival rate for the entire cohort was 42.2 per cent, but only 18.0 per cent for those who had an R1 resection. Independent risk factors for death within 5 years of resection were male sex, age above 60 years, normal BMI, ASA fitness grade III, intermediate-level education, R1 resection (hazard ratio 1.80, 95 per cent c.i. 1.40 to 2.32), clinical T3 disease, and clinical lymph node metastasis. Conclusion: R1 resection is common and predicts poor 5-year survival. Absence of neoadjuvant treatment is a risk factor for R1 resection.

Place, publisher, year, edition, pages
Oxford University Press, 2021
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-180037 (URN)10.1093/bjsopen/zrab038 (DOI)000758042000017 ()33972990 (PubMedID)
Note

Funding Agencies|Swedish Cancer SocietySwedish Cancer Society [180787]

Available from: 2021-10-11 Created: 2021-10-11 Last updated: 2022-05-26
Bahlmann, H., Halldestam, I. & Nilsson, L. (2019). Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial. European Journal of Anaesthesiology, 36(2), 153-161
Open this publication in new window or tab >>Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial
2019 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 2, p. 153-161Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications.

OBJECTIVES: The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care.

DESIGN: A randomised controlled study.

SETTING: Two Swedish university hospitals, between October 2011 and October 2015.

PATIENTS: Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency.

INTERVENTION: A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min m and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg.

MAIN OUTCOME MEASURE: The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list.

RESULTS: Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P < 0.01) and dobutamine more frequently (27/30 vs. 9/29, P < 0.01). The median [interquartile range, IQR] incidence of complications per patient 5 days after surgery was 2 [0 to 3] in the intervention group and 1 [0 to 2] in the control group (P = 0.10), and after 30 days 4 [2 to 6] in the intervention group and 2 [1 to 4] in the control group (P = 0.10).

CONCLUSION: Goal-directed therapy during oesophageal resection did not result in a reduction of the incidence of postoperative complications.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01416077.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-156264 (URN)10.1097/EJA.0000000000000908 (DOI)000462763800010 ()30431499 (PubMedID)2-s2.0-85059795456 (Scopus ID)
Note

Funding agencies: Linkoping Medical Society

Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2024-01-10Bibliographically approved
Halldestam, I. (2010). Incidensen av gallsten: symtom och riskfaktorer. Läkartidningen, 107(7), 425
Open this publication in new window or tab >>Incidensen av gallsten: symtom och riskfaktorer
2010 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 7, p. 425-Article in journal (Refereed) Published
Abstract [en]

[No abstract available]

Place, publisher, year, edition, pages
Lakartidningen, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-57025 (URN)
Available from: 2010-06-14 Created: 2010-06-09 Last updated: 2017-12-12
Halldestam, I., Kullman, E. & Borch, K. (2009). Incidence of and potential risk factors for gallstone disease in a general population sample. BRITISH JOURNAL OF SURGERY, 96(11), 1315-1322
Open this publication in new window or tab >>Incidence of and potential risk factors for gallstone disease in a general population sample
2009 (English)In: BRITISH JOURNAL OF SURGERY, ISSN 0007-1323, Vol. 96, no 11, p. 1315-1322Article in journal (Refereed) Published
Abstract [en]

Background: Several epidemiological studies have been published, but there are few reports on relations between gallstone incidence, symptomatology and risk factors. Methods: Of 621 randomly selected individuals aged 35-85 years in a general population who been screened previously, with ultrasonography and found to have no gallbladder stones, 503 (81.0 per cent) were re-examined after a minimum interval of 5 years. At baseline and re-examination, heredity for gallstone disease was explored and body mass index, digestive symptoms including abdominal pain, quality of life, alcohol and smoking habits, use of non-steroidal anti-inflammatory drugs and oestrogen, parity and blood lipid levels were recorded. Results: Forty-two (8.3 per cent) of the 503 subjects developed stones. Subjects were followed for a total of 3025.8 person-years, yielding an incidence for newly developed gallstones of 1.39 per 100 person-years. A positive association for gallstone development,was found only for length of follow-up and plasma low-density lipoprotein-cholesterol levels at baseline. Weekly alcohol consumption was inversely related to gallstone development. Conclusion: The incidence of gallstones in this population was 1.39 per 100 person-years. Gallstone development was related to length of follow-up and LDL-cholesterol levels, and inversely related to alcohol consumption.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51895 (URN)10.1002/bjs.6687 (DOI)
Available from: 2009-11-23 Created: 2009-11-23 Last updated: 2009-11-23
Halldestam, I., Kullman, E. & Borch, K. (2008). Defined indications for elective cholcystectomy for gallstone disease. British Journal of Surgery, 95(5), 620-626
Open this publication in new window or tab >>Defined indications for elective cholcystectomy for gallstone disease
2008 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, no 5, p. 620-626Article in journal (Refereed) Published
Abstract [en]

Background: This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery.

Methods: In this prospective study of 200 consecutive patients (161 women; median age 46·5 (range 24-79) years), strict indications for elective cholecystectomy were stipulated. Digestive symptoms and quality of life were recorded with a self-administered questionnaire before and at 3 and 12 months after surgery.

Results: Of 149 patients who experienced abdominal pain with typical location before surgery, 136 (91·3 per cent) reported total remission or reduced frequency of that type of pain 12 months later. Of 35 patients who reported atypical or multiple pain location before operation, 27 (77 per cent) experienced reduced frequency or disappearance of that type of pain. Frequency of pain episodes, atypical or multiple pain location, specific food intolerance and frequency of disturbing abdominal gas at baseline correlated positively with the frequency of abdominal pain episodes at 12 months after surgery. There was a tendency towards an inverse relation to age.

Conclusion: The frequency of persistent abdominal pain after elective cholecystectomy was low among patients with typical pain location before surgery. Atypical pain location, and frequent pain episodes before operation significantly reduced the chance of becoming pain-free.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13294 (URN)10.1002/bjs.6020 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2017-12-13Bibliographically approved
Halldestam, I. (2008). Gallstone disease: Population based studies on risk factors, symptomatology and complications. (Doctoral dissertation). Linköping University Electronic Press
Open this publication in new window or tab >>Gallstone disease: Population based studies on risk factors, symptomatology and complications
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background & aims: Gallstone disease is common, costly and its complications are sometimes life threatening. The aim of this thesis is to determine the prevalence and incidence in relation to putative risk factors in the general population. Furthermore, to identify individuals with asymptomatic gallstones who are at risk of developing complications and, finally, to identify those who are at risk of an unsatisfactory outcome after cholecystectomy.

Material & methods: A sample of the adult (35-85 y.) general population was screened with ultrasound examination, blood tests and a questionnaire regarding digestive symptoms, life-style and quality of life. After excluding 115 subjects, who previously had a cholecystectomy, 739 participated. The examination was repeated after a minimum of five years. The individuals who were shown to have gallstones were followed in order to identify risk factors for developing complications. 200 consecutive symptomatic patients were operated with cholecystectomy on defined indications. They completed a questionnaire regarding digestive symptoms, life-style and quality of life before and three and twelve months after surgery.

Results: The crude prevalence of gallstone disease was 17.2 % for women and 12.4% for men. It increased with age and was higher among women. Symptoms did not differ between subjects with and without gallstones, but those previously operated with cholecystectomy did worse both regarding symptoms and quality of life. The estimated crude annual gallstone incidence was 1.5%. This increased with age, but did not differ between the sexes. Gallstone development was positively related to elevated blood lipids and negatively related to alcohol consumption. Fourteen of 120 subjects with gallstones at the primary screening developed a complication demanding treatment during a follow-up interval of 87 (3-146) months. In the patient series operated on strict indications, 91.3 % of those who had reported typical gallstone related pain preoperatively, experienced total or partial pain relief 3 months postoperatively. With atypical pain preoperatively, the corresponding figure was 77.1 %. The findings 12 months postoperatively were similar. In the logistic regression analysis, young age, frequency of pain episodes, atypical pain, specific food intolerance and disturbing abdominal gas were positively related to the frequency of abdominal pain 12 months after surgery.

Conclusion: The prevalence of gallstones was positively related to age and female gender. Previous cholecystectomy was associated with more symptoms and worse quality of life. The annual gallstone incidence of 1.5 % was high in comparison with other studies, but our population was older. In general, neither prevalent nor incident gallstones in the general population were associated with specific symptoms. The cumulative risk of developing a complication to gallstone disease during a 5-year followup interval was 7.6 % with no tendency to level off.

Patients with typical pain had a better outcome after cholecystectomy. Young age, atypical pain and frequent pain episodes before surgery were major risk factors for a worse outcome in terms of persistent pain.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008. p. 69
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1065
Keywords
Epidemiology, gallstone disease, symptomatology, complications, risk factors
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-11801 (URN)978-91-7393-896-9 (ISBN)
Public defence
2008-05-28, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2020-03-29
Halldestam, I., Kullman, E. & Borch, K. (2008). Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors.
Open this publication in new window or tab >>Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors
2008 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13293 (URN)
Available from: 2008-05-13 Created: 2008-05-13
Redéen, S., Engström, H., Erikson, S., Haldestam, I., Leinsköld, T. & Johansson, K.-E. (2005). Abdominell tuberkulos - en nygammal diagnostisk utmaning. Läkartidningen, 102(30-31), 2151-2153
Open this publication in new window or tab >>Abdominell tuberkulos - en nygammal diagnostisk utmaning
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2005 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 30-31, p. 2151-2153Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33243 (URN)19242 (Local ID)19242 (Archive number)19242 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Halldestam, I., Enell, E.-L., Kullman, E. & Borch, K. (2004). Development of symptoms and complications in individuals with asymptomatic gallstones. British Journal of Surgery, 91(6), 734-738
Open this publication in new window or tab >>Development of symptoms and complications in individuals with asymptomatic gallstones
2004 (English)In: British Journal of Surgery, ISSN 0007-1323, Vol. 91, no 6, p. 734-738Article in journal (Refereed) Published
Abstract [en]

Background: Gallbladder stones are common in the developed world. Complications of gallstones contribute substantially to healthcare costs and may be life threatening. The identification of individuals likely to develop complications would be of benefit in clinical practice as elective cholecystectomy could then be performed.

Methods: Seven hundred and thirty-nine subjects aged 35-85 years from the general population were screened for gallbladder problems by ultrasonography and questionnaire assessment of putative risk factors and digestive symptoms. Gallstones, cholesterolosis or sludge in the gallbladder were diagnosed in 123 (16·3 per cent) of 739 subjects, 120 of whom were followed for a median of 87 (range 3-146) months to May 2003 or until treatment was required.

Results: Fourteen patients were admitted to hospital and treated for gallstone-related complications or symptoms. The cumulative risk of being treated during the first 5 years after detection of asymptomatic gallstones was 7·6 per cent and there was no indication of this risk levelling off. There were no significant differences between treated and untreated subjects with regard to digestive symptoms or any of the risk factors monitored at the initial screening, although treated subjects were significantly younger than those who were not treated.

Conclusion: Nearly one in ten individuals with asymptomatic gallbladder stones in the general population may be expected to develop symptoms or complications that require treatment within 5 years. Age may be inversely related to the incidence of complications.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13292 (URN)10.1002/bjs.4547 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18
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