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Björnsson, Bergthor
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Publications (10 of 24) Show all publications
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
Björnsson, B. & Sandström, P. (2019). Increasing evidence for minimally invasive approach to distal pancreatectomy. Laparoscopic Surgery, 3
Open this publication in new window or tab >>Increasing evidence for minimally invasive approach to distal pancreatectomy
2019 (English)In: Laparoscopic Surgery, E-ISSN 2616-4221, Vol. 3Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
AME Publishing Company, 2019
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-163889 (URN)10.21037/ls.2019.08.04 (DOI)
Available from: 2020-02-24 Created: 2020-02-24 Last updated: 2020-03-02Bibliographically 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
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
Åkerberg, D., Björnsson, B. & Ansari, D. (2017). Factors influencing receipt of adjuvant chemotherapy after surgery for pancreatic cancer: a two-center retrospective cohort study. Scandinavian Journal of Gastroenterology, 52(1), 56-60
Open this publication in new window or tab >>Factors influencing receipt of adjuvant chemotherapy after surgery for pancreatic cancer: a two-center retrospective cohort study
2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 1, p. 56-60Article in journal (Refereed) Published
Abstract [en]

Objective: The addition of adjuvant chemotherapy after surgical resection has improved survival rates for patients with pancreatic ductal adenocarcinoma (PDAC). However, outside clinical trials, many operated patients still do not receive adjuvant chemotherapy due to clinical and tumor-related factors. The aim of this study was to investigate factors that may influence the receipt of adjuvant chemotherapy and the effect on long-term survival. Materials and methods: Patients undergoing macroscopically curative resection for PDAC at the University Hospitals in Lund and Linkoping, Sweden, between 1 January 2007 and 31 December 2015, were retrospectively reviewed. Clinical and pathological data were compared between adjuvant and non-adjuvant chemotherapy groups and factors affecting chemotherapy receipt were analyzed by multiple logistic regression. Multivariable Cox regression analysis was performed to select predictive variables for survival. Results: A total of 233 patients were analyzed. Adjuvant chemotherapy was administered to 167 patients (71.7%). The likelihood of receiving adjuvant chemotherapy decreased with age, OR 0.91, 95% CI 0.86-0.95, pamp;lt;.001. Moreover, patients with severe postoperative complications (Clavien-Dindo grade amp;gt;= III) were less likely to receive adjuvant chemotherapy, OR 0.31, 95% CI 0.14-0.71, p=.005. The presence of lymph node metastases on histopathological reporting was associated with increased likelihood of initiating adjuvant chemotherapy, OR 2.19, 95% CI 1.09-4.40, p=.028. Adjuvant chemotherapy was an independent factor for prolonged survival on multivariable Cox regression analysis, HR 0.45 (95% CI 0.31-0.65), pamp;lt;.001. Conclusions: Age, postoperative complications and the presence of lymph node metastases affect the likelihood of receiving adjuvant chemotherapy after PDAC surgery.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Pancreatic cancer; surgery; age; postoperative complications; lymph node metastases; adjuvant chemotherapy; survival
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-134616 (URN)10.1080/00365521.2016.1228118 (DOI)000392486600011 ()27598522 (PubMedID)
Available from: 2017-02-21 Created: 2017-02-21 Last updated: 2018-05-02
Linecker, M., Kambakamba, P., Reiner, C. S., Linh, T.-K. D., Stavrou, G. A., Jenner, R. M., . . . Petrowsky, H. (2017). How much liver needs to be transected in ALPPS? A translational study investigating the concept of less invasiveness. Surgery, 161(2), 453-464
Open this publication in new window or tab >>How much liver needs to be transected in ALPPS? A translational study investigating the concept of less invasiveness
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2017 (English)In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 161, no 2, p. 453-464Article in journal (Refereed) Published
Abstract [en]

Background. ALPPS induces rapid liver hypertrophy after stage-1 operation, enabling safe, extended resections (stage-2) after a short period. Recent studies have suggested that partial transection at stage-1 might be associated with a better safety profile. The aim of this study was to assess the amount of liver parenchyma that needs to be divided to achieve sufficient liver hypertrophy in ALPPS. Methods. In a bi-institutional, prospective cohort study, nonfibrotic patients who underwent ALPPS with complete (n = 22) or partial (n = 23) transection for colorectal liver metastases were analyzed and compared with an external ALPPS cohort (n = 23). A radiologic tool was developed to quantify the amount of parenchymal transection. Liver hypertrophy and clinical outcome were compared between both techniques. The relationship of partial transection and hypertrophy was investigated further in an experimental murine model of partial ALPPS. Result. The median amount of parenchymal transection in partial ALPPS was 61 % (range, 34-86%). The radiologic method correlated poorly with the intraoperative surgeons estimation (r(s) = 0.258). Liver hypertrophy was equivalent for the partial ALPPS, ALPPS, and external ALPPS cohort (64% vs 60% vs. 64%). Experimental data demonstrated that partial transection of at least 50% induced comparable hypertrophy (137% vs 156%) and hepatocyte proliferation compared to complete transection. Conclusion. The study provides clinical and experimental evidence that partial liver partition of at least 50% seems to be equally effective in triggering volume hypertrophy as observed with complete transection and can be re recommended as less invasive alternative to ALPPS.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2017
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135396 (URN)10.1016/j.surg.2016.08.004 (DOI)000392904400022 ()27814957 (PubMedID)
Note

Funding Agencies|Clinical Research Priority Program of the University of Zurich; Liver and Gastrointestinal Disease Foundation (LGID)

Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-05-02
Björnsson, B. & Lundgren, L. (2016). A Personal Computer Freeware as a Tool for Surgeons to Plan Liver Resections.. Scandinavian Journal of Surgery, 105(3), 153-157
Open this publication in new window or tab >>A Personal Computer Freeware as a Tool for Surgeons to Plan Liver Resections.
2016 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 105, no 3, p. 153-157Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: The increase in liver surgery and the proportion of resections done on the margin to postoperative liver failure make preoperative calculations regarding liver volume important. Earlier studies have shown good correlation between calculations done with ImageJ and specimen weight as well as volume calculations done with more robust systems. The correlation to actual volumes of resected liver tissue has not been investigated, and this was the aim of this study.

MATERIAL AND METHODS: A total of 30 patients undergoing well-defined liver resections were included in this study. Volumes calculated with ImageJ were compared to volume measurements done after the retrieval of resected liver tissue.

RESULTS AND CONCLUSIONS: A strong correlation between calculated and measured liver volume was found with sample concordance correlation coefficient (ρc) = 0.9950. The knowledge on the nature of liver resections sets liver surgeons in a unique position to be able to accurately predict the volumes to be resected and, therefore, also the volume that will remain after surgery. This becomes increasingly important with the evolvement of methods to extend the boundaries of liver surgery. ImageJ is a reliable tool to preoperatively assess liver volume.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Liver; future liver remnant; liver resection
National Category
Surgery Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-126631 (URN)10.1177/1457496915607802 (DOI)000382586200003 ()26420775 (PubMedID)
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2018-03-23
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
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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