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Sandström, Per A
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Publications (10 of 55) Show all publications
Sandström, P. A. & Björnsson, B. (2019). Bile spillage should be avoided in elective cholecystectomy. Hepatobiliary surgery and nutrition, 8(6), 640-642
Open this publication in new window or tab >>Bile spillage should be avoided in elective cholecystectomy
2019 (English)In: Hepatobiliary surgery and nutrition, ISSN 2304-3881, E-ISSN 2304-389X, Vol. 8, no 6, p. 640-642Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
AME PUBL CO, 2019
National Category
Physical Sciences
Identifiers
urn:nbn:se:liu:diva-162952 (URN)10.21037/hbsn.2019.07.14 (DOI)000502952600012 ()
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-02-25
Hasselgren, K., Sandström, P. A., Røsok, B. I., Sparrelid, E., Lindell, G., Larsen, P. N., . . . Björnsson, B. (2019). Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion: FLR Increase in Patients with CRLM Is Highest the First Week After PVO.. Journal of Gastrointestinal Surgery, 23(3), 556-562
Open this publication in new window or tab >>Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion: FLR Increase in Patients with CRLM Is Highest the First Week After PVO.
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2019 (English)In: Journal of Gastrointestinal Surgery, ISSN 1091-255X, E-ISSN 1873-4626, Vol. 23, no 3, p. 556-562Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Portal vein occlusion (PVO) is an established method to increase the volume of the future liver remnant (FLR). The main reasons for not proceeding to radical hepatectomy are lack of volume increase and tumor progression due to a wait-time interval of up to 8 weeks. The hypothesis was that the increase in FLR volume is not linear and is largest during the first weeks.

METHODS: Patients with colorectal liver metastases (CRLM) and standardized future liver remnant (sFLR) < 30% treated with PVO were prospectively included. All patients had at least one CT evaluation before radical hepatectomy.

RESULTS: Forty-eight patients were included. During the first week after PVO, the kinetic growth rate (KGR) was 5.4 (± 4), compared to 1.5 (± 2) between the first and second CT (p < 0.05). For patients reaching adequate FLR and therefore treated with radical hepatectomy, the KGR was 7 (± 4) the first week, compared to 4.3 (± 2) for patients who failed to reach a sufficient volume (p = 0.4). During the interval between the first and second CT, the KGR was 2.2 (± 2), respectively (± 0.1) (p = 0.017).

DISCUSSION: The increase in liver volume after PVO is largest during the first week. As KGR decreases over time, it is important to shorten the interval between PVO and the first volume evaluation; this may aid in decision-making and reduce unnecessary waiting time.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Colorectal liver metastases, Future liver remnant, Liver surgery, Portal vein embolization, Portal vein ligation
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-163892 (URN)10.1007/s11605-018-4031-3 (DOI)30465187 (PubMedID)
Note

Funding Agencies|LIO-534891, FORSS-560521, FORSS-660121, and FORSS-753-621

Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-02-25
Ibrahim, F., Sandström, P. A., Björnsson, B., Lindhoff Larsson, A. & Drott, J. (2019). 'I want to know why and need to be involved in my own care…': a qualitative interview study with liver, bile duct or pancreatic cancer patients about their experiences with involvement in care.. Supportive Care in Cancer, 27(7), 2561-2567
Open this publication in new window or tab >>'I want to know why and need to be involved in my own care…': a qualitative interview study with liver, bile duct or pancreatic cancer patients about their experiences with involvement in care.
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2019 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 27, no 7, p. 2561-2567Article in journal (Refereed) Published
Abstract [en]

Purpose

Patients’ involvement in their own care is important for those with upper abdominal tumours. Care is often conducted according to standardized fast-track care programs (FTCP), and a shorter hospital stay is one of the goals. However, there is no research providing an in-depth perspective on patients’ experiences of involvement in care. In this qualitative study, we explored experiences of involvement among patients who had surgery for upper abdominal tumours and were cared for according to an FTCP.

Methods

Qualitative in-depth face-to-face interviews about patient involvement in care were conducted with 20 patients who had surgery for the liver, bile duct, or pancreatic cancer using an open-interview guide.

Results

The most important findings are that customized information and active dialogue about care decisions stimulate patient involvement. We identified three themes from the analysed data: involvement depended on the quality of information, communication and involvement during the care period, and safety at discharge.

Conclusions

Individualized care and continuous information about treatment and care goals in the FTCP during the care process create trust between patients and healthcare professionals and increase patient experiences of involvement.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Upper abdominal cancer; Involvement Qualitative research; Surgery; Fast-track care programme
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-154882 (URN)10.1007/s00520-018-4548-8 (DOI)000469516100025 ()30430301 (PubMedID)2-s2.0-85056480153 (Scopus ID)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-07-03Bibliographically approved
Larnebratt, A., Fomichov, V., Björnsson, B., Sandström, P. A., Lindhoff Larsson, A. & Drott, J. (2019). Information is the key to successful participation for patients receiving surgery for upper gastrointestinal cancer. European Journal of Cancer Care (2), Article ID e12959.
Open this publication in new window or tab >>Information is the key to successful participation for patients receiving surgery for upper gastrointestinal cancer
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2019 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, no 2, article id e12959Article in journal (Refereed) Published
Abstract [en]

Fast-track programmes are aimed at improving perioperative care. The purpose of this study was to identify and explore patient participation among patients who had surgery for liver, bile duct or pancreatic cancer and followed a fast-track programme. A total of 116 questionnaires to investigate patient participation were analysed. Information was important for the patients, as was having the opportunity to ask questions and express personal views. The results showed differences by sex; men responded to a greater extent that they did not want to make decisions as a patient (p = 0.044) and that they had been motivated to take more responsibility for their future health (p = 0.011). Patients with pancreatic cancer discussed treatment goals with doctors to a greater extent than did patients with liver cancer (p = 0.041). Half of the patients perceived that they had not been involved in their care planning after discharge but had a desired to be involved. This seems to be an important point to improve in future care, and also that professionals should be aware of patients' needs for information and participation, especially at discharge.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
cancer, fast-track surgery, patient involvement, patient participation, recovery
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-154636 (URN)10.1111/ecc.12959 (DOI)000461076700027 ()30408839 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden

Available from: 2019-02-24 Created: 2019-02-24 Last updated: 2020-02-24
Lundgren, L., Muszynska, C., Rosa, A., Persson, G., Gimm, O., Andersson, B. & Sandström, P. A. (2019). Management of incidental gallbladder cancer in a national cohort. British Journal of Surgery, 106(9), 1216-1227
Open this publication in new window or tab >>Management of incidental gallbladder cancer in a national cohort
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2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 9, p. 1216-1227Article in journal (Refereed) Published
Abstract [en]

Background Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade. Methods Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross-linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease-specific survival. The study was divided into two intervals (2007-2011 and 2012-2016) to evaluate changes over time. Results In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36 center dot 9 per cent) underwent re-resection with curative intent. For patients with pT2 and pT3 disease, median disease-specific survival improved after re-resection (12 center dot 4 versus 44 center dot 1 months for pT2, and 9 center dot 7 versus 23 center dot 0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re-resection; these patients had a median disease-specific survival of 32 center dot 2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0 center dot 030). Conclusion Re-resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re-resection rate and more R0 resections in the later time period may have been associated with improved survival.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-159068 (URN)10.1002/bjs.11205 (DOI)000474059700001 ()31259388 (PubMedID)
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-08-23
Sandström, P. A., Rosok, B. I., Sparrelid, E., Lindell, G., Larsen, P. N., Lindhoff Larsson, A., . . . Björnsson, B. (2019). Response to the Comment on "Should We Have a Little More Patience With the Conventional 2-Stage Hepatectomy?". Annals of Surgery, 269(3), E33-E34
Open this publication in new window or tab >>Response to the Comment on "Should We Have a Little More Patience With the Conventional 2-Stage Hepatectomy?"
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2019 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 3, p. E33-E34Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-157565 (URN)10.1097/SLA.0000000000002739 (DOI)000467458600006 ()29557882 (PubMedID)2-s2.0-85061136050 (Scopus ID)
Available from: 2019-06-22 Created: 2019-06-22 Last updated: 2019-06-25Bibliographically approved
Sternby Eilard, M., Lundgren, L., Cahlin, C., Strandell, A., Svanberg, T. & Sandström, P. A. (2017). Surgical treatment for gallbladder cancer - a systematic literature review. Scandinavian Journal of Gastroenterology, 52(5), 505-514
Open this publication in new window or tab >>Surgical treatment for gallbladder cancer - a systematic literature review
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 5, p. 505-514Article, review/survey (Refereed) Published
Abstract [en]

Objective: To evaluate existing evidence regarding surgical treatments for gallbladder cancer in a Health Technology Assessment. A specific aim was to evaluate whether extended surgery regarding liver, lymph nodes, bile duct, and adjacent organs compared with cholecystectomy alone in the adult patient with gallbladder cancer in early and late stages implies improved survival. Methods: In April 2015 and updated in June 2016, a systematic literature search was conducted in PubMed, Embase, and the Cochrane Library. Two authors independently screened titles, abstracts, and full-text articles. The certainty of evidence was evaluated according to GRADE. Main results: Forty-four observational studies (non-randomised, controlled studies) and seven case series were included. Radical resection, including liver and lymph node resection, compared with cholecystectomy alone showed significantly better survival for patients with stages T1b and above. All studies had serious study limitations and the certainty of evidence was very low (GRADE circle plus(ooo)). A survival benefit seen in patients with stage T1b or higher with lymph node resection, was most evident in stage T2, but the certainty of evidence was low (GRADE circle plus circle plus(oo)). It is uncertain whether routine bile duct resections improve overall survival in patients with gallbladder cancer stage T2-T4 (GRADE circle plus(ooo)). Conclusion: Data indicate that prognosis can be improved if liver resection and lymph node resection is performed in patients with tumour stage T1b or higher. There is no evidence supporting resection of the bile duct or adjacent organs if it is not necessary in order to achieve radicality.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Bile duct resection; gallbladder cancer; liver resection; lymph node dissection; surgery
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-136232 (URN)10.1080/00365521.2017.1284895 (DOI)000395746800003 ()28270039 (PubMedID)
Note

Funding Agencies|HTA - centrum in Region Vastra Gotaland in Sweden

Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2018-05-03
Björnsson, B., Sparrelid, E., Rosok, B., Pomianowska, E., Hasselgren, K., Gasslander, T., . . . Sandström, P. (2016). Associating liver partition and portal vein ligation for staged hepatectomy in patients with colorectal liver metastases - Intermediate oncological results. European Journal of Surgical Oncology, 42(4), 531-537
Open this publication in new window or tab >>Associating liver partition and portal vein ligation for staged hepatectomy in patients with colorectal liver metastases - Intermediate oncological results
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2016 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 42, no 4, p. 531-537Article in journal (Refereed) Published
Abstract [en]

Background: Colorectal liver metastases (CRLM) not amenable for resection have grave prognosis. One limiting factor for surgery is a small future liver remnant (FLR). Early data suggests that associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) effectively increases the volume of the FLR allowing for resection in a larger fraction of patients than conventional two-stage hepatectomy (TSH) with portal vein occlusion (PVO). Oncological results of the treatment are lacking. The aim of this study was to assess the intermediate oncological outcomes after ALPPS in patients with CRLM. Material and methods: Retrospective analysis of all patients with CRLM operated with ALPPS at the participating centres between December 2012 and May 2014. Results: Twenty-three patients (16 male, 7 female), age 67 years (28-80) were operated for 6.5 (1-38) metastases of which the largest was 40 nun (14-130). Six (27.3%) patients had extra-hepatic metastases, 16 (72.7%) synchronous presentation. All patients received chemotherapy, 6 cycles (3-25) preoperatively and 16 (70%) postoperatively. Ten patients (43%) were rescue ALPPS after failed PVO. Severe complications occurred in 13.6% and one (4.5%) patient died within 90 days of surgery. After a median follow-up of 22.5 months from surgery and 33.5 months from diagnosis of liver metastases estimated 2 year overall survival was 59% (from surgery) and 73% (from diagnosis). Liver only recurrences (n = 8), were treated with reresection/ablation (n = 7) while lung recurrences were treated with chemotherapy. Conclusion: The overall survival, rate of severe complications and perioperative mortality associated with ALPPS for patients with CRLM is comparable to TSH. (C) 2016 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2016
Keywords
ALPPS; CRLM; Survival; Oncological results
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127748 (URN)10.1016/j.ejso.2015.12.013 (DOI)000374074800011 ()26830731 (PubMedID)
Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2017-05-03
Kuninty, P. R., Bojmar, L., Tjomsland, V., Larsson, M., Storm, G., Östman, A., . . . Prakash, J. (2016). MicroRNA-199a and -214 as potential therapeutic targets in pancreatic stellate cells in pancreatic tumor. OncoTarget, 7(13), 16396-16408
Open this publication in new window or tab >>MicroRNA-199a and -214 as potential therapeutic targets in pancreatic stellate cells in pancreatic tumor
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2016 (English)In: OncoTarget, ISSN 1949-2553, E-ISSN 1949-2553, Vol. 7, no 13, p. 16396-16408Article in journal (Refereed) Published
Abstract [en]

Pancreatic stellate cells (PSCs) are the key precursor cells for cancer-associated fibroblasts (CAFs) in pancreatic tumor stroma. Although depletion of tumor stroma is debatable, attenuation of PSC activity is still an interesting strategy to treat pancreatic cancer. In this study, we explored miRNA as therapeutic targets in tumor stroma and found miR-199a-3p and miR-214-3p induced in patient-derived pancreatic CAFs as well as in TGF-β-activated human PSCs (hPSCs). Inhibition of miR-199a or miR-214 using their hairpin inhibitors in hPSCs significantly inhibited their TGFβ-induced differentiation (gene and protein levels of α-SMA, Collagen, PDGFβR), migration and proliferation. Furthermore, heterospheroids of Panc-1 and hPSCs were prepared, which attained smaller size when hPSCs were transfected with anti-miR-199a or -214 than those transfected with control anti-miR. The conditioned medium obtained from TGFβ-activated hPSCs induced tumor cell proliferation and endothelial cell tube formation, but these effects were abrogated when hPSCs were transfected with anti-miR-199a or miR-214. Moreover, IPA analyses revealed signaling pathways related to miR-199a (TP53, mTOR, Smad1) and miR-214 (PTEN, Bax, ING4). Taken together, this study reveals miR-199a-3p and miR-214-3p as major regulators of PSC activation and PSC-induced pro-tumoral effects, representing them as key therapeutic targets in PSCs in pancreatic cancer.

Place, publisher, year, edition, pages
Impact press, 2016
National Category
Cancer and Oncology Cell and Molecular Biology Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:liu:diva-122828 (URN)10.18632/oncotarget.7651 (DOI)000375692900085 ()
Note

Funding agencies: Swedish Research Council, Stockholm, Sweden [K7/60501283]

Vid tiden för disputationen förelåg publikationen endast som manuskript

Available from: 2015-11-26 Created: 2015-11-26 Last updated: 2018-01-10
Røsok, B. I., Björnsson, B., Sparrelid, E., Hasselgren, K., Pomianowska, E., Gasslander, T., . . . Sandström, P. (2016). Scandinavian multicenter study on the safety and feasibility of the associating liver partition and portal vein ligation for staged hepatectomy procedure.. Surgery, 159(5), 1279-1286
Open this publication in new window or tab >>Scandinavian multicenter study on the safety and feasibility of the associating liver partition and portal vein ligation for staged hepatectomy procedure.
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2016 (English)In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 159, no 5, p. 1279-1286Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged as an additional tool to increase the size of the future liver remnant (FLR) in the settings of advanced tumor burden in the liver. Initial reports have indicated high feasibility but also high mortality and morbidity. The aim of this study was to assess the initial experience with ALPPS in Scandinavia regarding feasibility, morbidity, and mortality.

MATERIALS AND METHODS: We conducted a retrospective analysis of all patients who underwent ALPPS since its introduction at 3 Scandinavian hepatobiliary centers.

RESULTS: Thirty-six patients were identified, 21 male and 15 female. Median age was 67 years (22-83). Colorectal liver metastases (n = 25) were the most common indication for ALPPS followed by hepatocellular carcinoma (n = 4), cholangiocarcinoma (n = 4), and other (n = 3). Median growth of the FLR between the operations was 67% (-17 to 238) in 6 (5-13) days. All patients completed the second operation, and 71% of the resections were R0. Although the total percentage of patients with complication(s) was 92%, only 4 patients (11%) had a grade 3b complication according to the Clavien-Dindo classification, and no other severe complications were noted. There was no in-hospital mortality, but 1 (2.8%) patient died within 90 days of operation.

CONCLUSION: ALPPS is a highly feasible method to stimulate FLR growth in patients with colorectal liver metastases as well as primary hepatobiliary malignancies. The treatment can be carried out with relative safety.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-126633 (URN)10.1016/j.surg.2015.10.004 (DOI)000374208400005 ()26606881 (PubMedID)
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2018-03-21Bibliographically approved
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