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  • 1.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. County Hospital Ryhov, Sweden.
    Letter: General Surgeon Supply and Appendiceal Rupture: Proportion of Perforation Is Not a Meaningful Measure of Quality of Care in ANNALS OF SURGERY, vol 261, issue 5, pp E132-E1322015In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 5, p. E132-E132Article in journal (Other academic)
    Abstract [en]

    n/a

  • 2.
    Andersson, Roland E
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Letter: Resolving appendicitis is common2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 3, p. 553-553Article in journal (Other academic)
    Abstract [en]

    n/a

  • 3.
    Andersson, Roland
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Petzold, MG
    Nonsurgical treatment of appendiceal abscess or phlegmon: A systematic review and meta-analysis2007In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 246, no 5, p. 741-748Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A systematic review of the nonsurgical treatment of patients with appendiceal abscess or phlegmon, with emphasis on the success rate, need for drainage of abscesses, risk of undetected serious disease, and need for interval appendectomy to prevent recurrence. SUMMARY BACKGROUND DATA: Patients with appendiceal abscess or phlegmon are traditionally managed by nonsurgical treatment and interval appendectomy. This practice is controversial with proponents of immediate surgery and others questioning the need for interval appendectomy. METHODS: A Medline search identified 61 studies published between January 1964 and December 2005 reporting on the results of nonsurgical treatment of appendiceal abscess or phlegmon. The results were pooled taking the potential clustering on the study-level into account. A meta-analysis of the morbidity after immediate surgery compared with that after nonsurgical treatment was performed. RESULTS: Appendiceal abscess or phlegmon is found in 3.8% (95% confidence interval (CI), 2.6-4.9) of patients with appendicitis. Nonsurgical treatment fails in 7.2% (CI: 4.0-10.5). The need for drainage of an abscess is 19.7% (CI: 11.0-28.3). Immediate surgery is associated with a higher morbidity compared with nonsurgical treatment (odds ratio, 3.3, CI: 1.9-5.6, P < 0.001). After successful nonsurgical treatment, a malignant disease is detected in 1.2% (CI: 0.6-1.7) and an important benign disease in 0.7% (CI: 0.2-11.9) during follow-up. The risk of recurrence is 7.4% (CI: 3.7-11.1). CONCLUSIONS: The results of this review of mainly retrospective studies support the practice of nonsurgical treatment without interval appendectomy in patients with appendiceal abscess or phlegmon. © 2007 Lippincott Williams & Wilkins, Inc.

  • 4.
    Asbun, H.J.
    et al.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Moekotte, A.L.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Vissers, F.L.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Kunzler, F.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Cipriani, F.
    Department of Surgery, San Raffaele Hospital, Milan, Italy.
    Alseidi, A.
    Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, VA, United States.
    DAngelica, M.I.
    Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States.
    Balduzzi, A.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Bassi, C.
    Division of Pancreatic Surgery, University Hospital of Verona, Verona, Italy.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Boggi, U.
    Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
    Callery, M.P.
    Department of General and Gastrointestinal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
    Del, Chiaro M.
    Department of Surgery, Division of Surgical Oncology, University of Colorado, Denver, CO, United States.
    Coimbra, F.J.
    Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
    Conrad, C.
    Department of Surgery, St. Elizabeths Medical Center, Boston, MA, United States.
    Cook, A.
    Wessex Institute, University of Southampton, United Kingdom.
    Coppola, A.
    General Surgery and Liver Transplant, Unit Department of General Surgery, Fondazione Policlinico, Universitario Agostino Gemelli, IRCCS, Rome, Italy.
    Dervenis, C.
    Department of Surgery, Medical School, University of Cyprus, Cyprus.
    Dokmak, S.
    Department of Surgery, Beaujon Hospital, Paris, France.
    Edil, B.H.
    Department of Surgery, University of Oklahoma, Oklahoma City, OK, United States.
    Edwin, B.
    Intervention Centre, Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Giulianotti, P.C.
    Division of Minimally Invasive, General Surgery and Robotic Surgery, University of Illinois, Chicago, IL, United States.
    Han, H.-S.
    Department of Surgery, Seoul National University Hospital, Seoul, South Korea.
    Hansen, P.D.
    Department of Surgery, Portland Providence Medical Center, Portland, OR, United States.
    Van, Der Heijde N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Van, Hilst J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Hester, C.A.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Hogg, M.E.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Jarufe, N.
    Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile.
    Jeyarajah, D.R.
    Department of HPB Surgery, Methodist Richardson Medical Center, Richardson, TX, United States.
    Keck, T.
    Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany.
    Kim, S.C.
    Department of Surgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, South Korea.
    Khatkov, I.E.
    Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.
    Kokudo, N.
    Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
    Kooby, D.A.
    Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
    Korrel, M.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    De, Leon F.J.
    HPB and Transplant Unit, Regional Hospital, Málaga, Spain.
    Lluis, N.
    Department of Surgery, Bellvitge University Hospital, Barcelona, Spain.
    Lof, S.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Machado, M.A.
    Department of Surgery, University of São Paulo, São Paulo, Brazil.
    Demartines, N.
    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Martinie, J.B.
    Division of HPB Surgery, Department of Surgery, Carolinas Health Care Hospital, Charlotte, NC, United States.
    Merchant, N.B.
    Division of Surgical Oncology, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, United States.
    Molenaar, I.Q.
    Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
    Moravek, C.
    Pancreatic Cancer Action Network, Manhattan Beach, CA, United States.
    Mou, Y.-P.
    Department of Gastroenterology and Pancreatic Surgery, Zhengjiang Provincial Peoples Hospital, Peoples Hospital of Hangzhou Medical College, Zhejiang, China.
    Nakamura, M.
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
    Nealon, W.H.
    Department of Surgery, Northwell Health, Manhasset, NY, United States.
    Palanivelu, C.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Pessaux, P.
    Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France.
    Pitt, H.A.
    Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
    Polanco, P.M.
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, United States.
    Primrose, J.N.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Rawashdeh, A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Sanford, D.E.
    Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University, School of Medicine, St. Louis, MO, United States.
    Senthilnathan, P.
    Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
    Shrikhande, S.V.
    Department of Surgery, Tata Memorial Center, Mumbai, India.
    Stauffer, J.A.
    Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL, United States.
    Takaori, K.
    Department of Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
    Talamonti, M.S.
    Department of Surgery, NorthShore University Health System, Evanston, IL, United States.
    Tang, C.N.
    Department of Surgery, Pamela Youde Nethersle Eastern Hospital, Chai Wan, Hong Kong, Hong Kong.
    Vollmer, C.M.
    Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
    Wakabayashi, G.
    Center for Advanced Treatment of HPB Diseases, Ageo Central General Hospital, Saitama, Japan.
    Walsh, R.M.
    Department of General Surgery, Cleveland Clinic, Cleveland, OH, United States.
    Wang, S.-E.
    Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
    Zinner, M.J.
    Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States.
    Wolfgang, C.L.
    Division of Surgical Oncology, Department of Surgery, John Hopkins University, School of Medicine, Baltimore, MD, United States.
    Zureikat, A.H.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Zwart, M.J.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Conlon, K.C.
    Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland.
    Kendrick, M.L.
    Department of Surgery, Mayo Clinic, Rochester, MN, United States; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy.
    Zeh, H.J.
    Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
    Hilal, M.A.
    Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
    Besselink, M.G.
    Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection2020In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019).Summary Background Data: MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking. Methods: The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology. Results: After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety.Conclusion: The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery. © 2019 Wolters Kluwer Health, Inc. All rights reserved.

  • 5.
    Borch, Kurt
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Ahrén, Bo
    Ahlman, Håkan
    Falkmer, Sture
    Granérus, Göran
    Grimelius, Lars
    Gastric carcinoids: Biologic behavior and prognosis after differentiated treatment in relation to type2005In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 242, no 1, p. 64-73Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze tumor biology and the outcome of differentiated treatment in relation to tumor subtype in patients with gastric carcinoid. Background: Gastric carcinoids may be subdivided into ECL cell carcinoids (type 1 associated with atrophic gastritis, type 2 associated with gastrinoma, type 3 without predisposing conditions) and miscellaneous types (type 4). The biologic behavior and prognosis vary considerably in relation to type. Methods: A total of 65 patients from 24 hospitals (51 type 1, 1 type 2, 4 type 3, and 9 type 4) were included. Management recommendations were issued for newly diagnosed cases, that is, endoscopic or surgical treatment of type 1 and 2 carcinoids (including antrectomy to abolish hypergastrinemia) and radical resection for type 3 and 4 carcinoids. Results: Infiltration beyond the submucosa occurred in 9 of 51 type 1, 4 of 4 type 3, and 7 of 9 type 4 carcinoids. Metastases occurred in 4 of 51 type 1 (3 regional lymph nodes, 1 liver), the single type 2 (regional lymph nodes), 3 of 4 type 3 (all liver), and 7 of 9 type 4 carcinoids (all liver). Of the patients with type 1 carcinoid, 3 had no specific treatment, 40 were treated with endoscopic or surgical excision (in 10 cases combined with antrectomy), 7 underwent total gastrectomy, and 1 underwent proximal gastric resection. Radical tumor removal was not possible in 2 of 4 patients with type 3 and 7 of 9 patients with type 4 carcinoid. Five- and 10-year crude survival rates were 96.1% and 73.9% for type 1 (not different from the general population), but only 33.3% and 22.2% for type 4 carcinoids. Conclusion: Subtyping of gastric carcinoids is helpful in the prediction of malignant potential and long-term survival and is a guide to management. Long-term survival did not differ from that of the general population regarding type 1 carcinoids but was poor regarding type 4 carcinoids. Copyright © 2005 by Lippincott Williams & Wilkins.

  • 6.
    Cavallaro, Paul
    et al.
    Massachusetts Gen Hosp, MA 02114 USA.
    Fearnhead, Nicola
    Cambridge Univ Hosp NHS Fdn Trust, England.
    Bissett, Ian
    Univ Auckland, New Zealand.
    Brar, Mantaj
    Univ Toronto, Canada.
    Cataldo, Thomas
    Harvard Med Sch, MA 02115 USA.
    Clarke, Rasheed
    Patient Advocate, Blogger.
    Denoya, Paula
    Stony Brook Univ Hosp, NY USA.
    Elder, Amber Lorraine
    Patient Advocate, Blogger.
    Gecse, Krisztina
    Univ Amsterdam, Netherlands.
    Hendren, Samantha
    Univ Michigan, MI 48109 USA.
    Holubar, Stefan
    Cleveland Clin, OH 44106 USA.
    Jeganathan, Nimalan
    Penn State Univ, PA USA.
    Myrelid, Pär
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Norton, Beth-Anne
    Brigham & Womens Hosp, MA 02115 USA.
    Wexner, Steven
    Cleveland Clin Florida, FL USA.
    Wilson, Lauren
    Dartmouth Hitchcock Med Ctr, NH 03766 USA.
    Zaghiyan, Karen
    Cedars Sinai Med Ctr, CA 90048 USA.
    Bordeianou, Liliana
    MGH Colorectal Surg Ctr, MA 02114 USA; Crohns & Colitis Ctr, MA 02114 USA.
    Patients Undergoing Ileoanal Pouch Surgery Experience a Constellation of Symptoms and Consequences Representing a Unique Syndrome: A Report From the Patient-Reported Outcomes After Pouch Surgery (PROPS) Delphi Consensus Study2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 1, p. 138-145Article in journal (Refereed)
    Abstract [en]

    Objective: The primary aim was to create a patient-centered definition of core symptoms that should be included in future studies of pouch function. Background: Functional outcomes after ileoanal pouch creation have been studied; however, there is great variability in how relevant outcomes are defined and reported. More importantly, the perspective of patients has not been represented in deciding which outcomes should be the focus of research. Methods: Expert stakeholders were chosen to correlate with the clinical scenario of the multidisciplinary team that cares for pouch patients: patients, colorectal surgeons, gastroenterologists/other clinicians. Three rounds of surveys were employed to select high-priority items. Survey voting was followed by a series of online patient consultation meetings used to clarify voting trends. A final online consensus meeting with representation from all 3 expert panels was held to finalize a consensus statement. Results: One hundred ninety-five patients, 62 colorectal surgeons, and 48 gastroenterologists/nurse specialists completed all 3 Delphi rounds. Fiftythree patients participated in online focus groups. One hundred sixty-one stakeholders participated in the final consensus meeting. On conclusion of the consensus meeting, 7 bowel symptoms and 7 consequences of undergoing ileoanal pouch surgery were included in the final consensus statement. Conclusions: This study is the first to identify key functional outcomes after pouch surgery with direct input from a large panel of ileoanal pouch patients. The inclusion of patients in all stages of the consensus process allowed for a true patient-centered approach in defining the core domains that should be focused on in future studies of pouch function.

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  • 7.
    Gero, Daniel
    et al.
    Univ Hosp Zurich, Switzerland.
    Raptis, Dimitri A.
    Univ Hosp Zurich, Switzerland; Royal Free Hosp, England.
    Vleeschouwers, Wouter
    AZ Sint Jan Brugge Oostende, Belgium.
    van Veldhuisen, Sophie L.
    Rijnstate Hosp, Netherlands.
    San Martin, Andres
    Dipreca Hosp, Chile.
    Xiao, Yao
    Varberg Hosp, Sweden; Univ Gothenburg, Sweden.
    Galvao, Manoela
    Adv Inst Bariatr and Metab Surg, Brazil.
    Giorgi, Marcoandrea
    Brown Univ, RI 02906 USA.
    Benois, Marine
    Univ Cote Azur, France.
    Espinoza, Felipe
    Clin Las Condes, Chile.
    Hollyman, Marianne
    Musgrove Pk Hosp, England.
    Lloyd, Aaron
    Fresno Heart and Surg Hosp, CA USA.
    Hosa, Hanna
    Univ Hosp Zurich, Switzerland.
    Schmidt, Henner
    Univ Hosp Zurich, Switzerland.
    Garcia-Galocha, Jose Luis
    Univ Complutense Madrid, Spain.
    van de Vrande, Simon
    AZ Sint Blasius Hosp, Belgium.
    Chiappetta, Sonja
    Sana Klinikum Offenbach, Germany.
    Lo Menzo, Emanuele
    Cleveland Clin Florida, FL USA.
    Aboud, Cristina Mamedio
    Oswaldo Cruz German Hosp, Brazil.
    Luthy, Sandra Gagliardo
    Clarunis St Clara Hosp, Switzerland; Univ Hosp Basel, Switzerland.
    Orchard, Philippa
    Southmead Hosp, England.
    Rothe, Steffi
    Vienna Med Univ, Austria.
    Prager, Gerhard
    Vienna Med Univ, Austria.
    Pournaras, Dimitri J.
    Southmead Hosp, England.
    Cohen, Ricardo
    Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
    Rosenthal, Raul
    Cleveland Clin Florida, FL USA.
    Weiner, Rudolf
    Sana Klinikum Offenbach, Germany.
    Himpens, Jacques
    AZ Sint Blasius Hosp, Belgium; Vienna Med Univ, Austria; St Pierre Univ Hosp, Belgium.
    Torres, Antonio
    Univ Complutense Madrid, Spain.
    Higa, Kelvin
    Fresno Heart and Surg Hosp, CA USA.
    Welbourn, Richard
    Musgrove Park Hospital, Taunton, UK.
    Berry, Marcos
    Clin Las Condes, Chile.
    Boza, Camilo
    Clin Las Condes, Chile.
    Iannelli, Antonio
    Univ Cote Azur, France.
    Vithiananthan, Sivamainthan
    Brown Univ, RI 02906 USA.
    Ramos, Almino
    Adv Inst Bariatr and Metab Surg, Brazil.
    Olbers, Torsten
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping. Univ Gothenburg, Sweden.
    Sepulveda, Matias
    Dipreca Hosp, Chile.
    Hazebroek, Eric J.
    Rijnstate Hosp, Netherlands.
    Dillemans, Bruno
    AZ Sint Jan Brugge Oostende, Belgium.
    Staiger, Roxane D.
    Univ Hosp Zurich, Switzerland.
    Puhan, Milo A.
    Univ Zurich, Switzerland.
    Peterli, Ralph
    Clarunis St Clara Hosp, Switzerland; Univ Hosp Basel, Switzerland.
    Bueter, Marco
    Univ Hosp Zurich, Switzerland.
    Defining Global Benchmarks in Bariatric Surgery A Retrospective Multicenter Analysis of Minimally Invasive Roux-en-Y Gastric Bypass and Sleeve Gastrectomy2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 270, no 5, p. 859-867Article in journal (Refereed)
    Abstract [en]

    Objective: To define “best possible” outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).

    Background: Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix.

    Methods: Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m2 and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers’ median values for respective quality indicators.

    Results: Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m2. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication.

    Conclusion: Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.

    ClinicalTrials.gov Identifier NCT03440138

  • 8.
    Gottlieb-Vedi, Eivind
    et al.
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
    Kauppila, Joonas H
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
    Mattsson, Fredrik
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
    Hedberg, Jakob
    Department of Surgical Sciences, Uppsala University, Sweden.
    Johansson, Jan
    Department of Surgery, Skåne University Hospital, Lund; Faculty of Medicine, Clinical Sciences, Lund University, Sweden.
    Edholm, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lagergren, Pernilla
    Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Department of Surgery & Cancer, Imperial College London, London, UK.
    Nilsson, Magnus
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Sweden.
    Lagergren, Jesper
    Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas’ NHS Foundation Trust, London, UK..
    Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. 429-436Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.

    SUMMARY BACKGROUND DATA: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.

    METHODS: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.

    RESULTS: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.

    CONCLUSION: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.

  • 9.
    Haapaniemi, Staffan
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Gunnarsson, Ulf
    Mora Hospital, Mora, and Akademiska Sjukhuset, Uppsala, Sweden.
    Nordin, Pär
    Östersunds Hospital, Östersund, Sweden.
    Nilsson, Erik
    Motala Hospital, Motala, Sweden.
    Reoperation after recurrent groin hernia repair2001In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 234, no 1, p. 122-126Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998, and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia.

    Methods: Data were retrieved for all groin hernia repairs prospectively recorded in the Swedish Hernia register from 1996 to 1998. Actuarial analysis adjusted for patients' death was used for calculating the cumulative incidence of reoperation. Relative risk for reoperation was estimated using the Cox proportional hazards model.

    Results: From 1996 to 1998, 17,985 groin hernia operations were recorded in the Swedish Hernia Register, 15% for recurrent hernia and 85% for primary hernia. At 24 months the risk for having had a reoperation was 4.6% after recurrent hernia repair and 1.7% after primary hernia repair. The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques. Postoperative complications and direct hernia were associated with an increased relative risk for reoperation. Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia.

    Conclusions: Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community. This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations.

  • 10.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Larsen, Peter N.
    Univ Copenhagen, Denmark.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Lindell, Gert
    Skane Univ Hosp, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Akad Univ Hosp, Sweden.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM Survival Analysis From the Randomized Controlled Trial LIGRO2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 273, no 3, p. 442-448Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the oncological outcome for patients with colorectal liver metastases (CRLM) randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH). Background: TSH with portal vein occlusion is an established method for patients with CRLM and a low volume of the future liver remnant (FLR). ALPPS is a less established method. The oncological outcome of these methods has not been previously compared in a randomized controlled trial. Methods: One hundred patients with CRLM and standardized FLR (sFLR) &lt;30% were included and randomized to resection by ALPPS or TSH, with the option of rescue ALPPS in the TSH group, if the criteria for volume increase was not met. The first radiological follow-up was performed approximately 4 weeks postoperatively and then after 4, 8, 12, 18, and 24 months. At all the follow-ups, the remaining/recurrent tumor was noted. After the first follow-up, chemotherapy was administered, if indicated. Results: The resection rate, according to the intention-to-treat principle, was 92% (44 patients) for patients randomized to ALPPS compared with 80% (39 patients) for patients randomized to TSH (P = 0.091), including rescue ALPPS. At the first postoperative follow-up, 37 patients randomized to ALPPS were assessed as tumor free in the liver, and also 28 patients randomized to TSH (P = 0.028). The estimated median survival for patients randomized to ALPPS was 46 months compared with 26 months for patients randomized to TSH (P = 0.028). Conclusions: ALPPS seems to improve survival in patients with CRLM and sFLR &lt;30% compared with TSH.

  • 11.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Larsen, Peter N.
    Univ Copenhagen, Denmark.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Lindell, Gert
    Skane Univ Hosp, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Akad Univ Hosp, Sweden.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response to Comment on "ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM - It Is Time to Entry the IDEAL Stage 4?"2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 6, p. E731-E732Article in journal (Other academic)
    Abstract [en]

    n/a

  • 12.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Larsen, Peter N.
    Univ Copenhagen, Denmark.
    Sparrelid, Ernesto
    Karolinska Inst, Sweden.
    Lindell, Gert
    Skane Univ Hosp, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Akad Univ Hosp, Sweden.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response to Comment on: Hasselgren K, et al ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM: Survival Analysis From the Randomized Controlled Trial LIGRO. Ann Surg. 2021;273(3):442-4482022In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 276, no 5, p. E632-E633Article in journal (Other academic)
  • 13.
    Hasselgren, Kristina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Larsen, Peter N.
    Nivers Copenhagen, Denmark.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Lindell, Gert
    Skane Univ Hosp, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Akad Univ Hosp, Sweden.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response to the Comment on "ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM: Survival Analysis From the Randomized Controlled Trial LIGRO-Metastatic Tumor Burden in the Future Liver Remnant for Decisionmaking of Staged Hepatectomy" Reply2021In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 274, no 6, p. E750-E751Article in journal (Other academic)
    Abstract [en]

    n/a

  • 14.
    Korrel, Maarten
    et al.
    Univ Amsterdam, Netherlands; Fdn Poliambulanza Hosp, Italy.
    Lof, Sanne
    Univ Amsterdam, Netherlands; Fdn Poliambulanza Hosp, Italy.
    Al Sarireh, Bilal
    Morriston Hosp, Wales.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Boggi, Ugo
    Univ Pisa, Italy.
    Butturini, Giovanni
    Pederzoli Hosp, Italy.
    Casadei, Riccardo
    St Orsola Marcello Malpighi Hosp, Italy.
    De Pastena, Matteo
    Verona Univ Hosp, Italy.
    Esposito, Alessandro
    Verona Univ Hosp, Italy.
    Fabre, Jean Michel
    Univ Hosp St Eloi, France.
    Ferrari, Giovanni
    Osped Niguarda Ca Granda, Italy.
    Fteriche, Fadhel Samir
    Hosp Beaujon, France.
    Fusai, Giuseppe
    Royal Free Hosp NHS Fdn Trust, England.
    Koerkamp, Bas Groot
    Erasmus MC Canc Inst, Netherlands.
    Hackert, Thilo
    Heidelberg Univ Hosp, Germany.
    DHondt, Mathieu
    Groeninge Hosp, Belgium.
    Jah, Asif
    Addenbrookes Hosp, England.
    Keck, Tobias
    Univ Hosp Schleswig Holstein, Germany.
    Marino, Marco V
    Hosp Osped Riuniti Villa Sofia Cervello, Italy; Abano Terme Gen Hosp, Italy.
    Molenaar, I. Quintus
    Univ Utrecht, Netherlands; Univ Utrecht, Netherlands.
    Pessaux, Patrick
    Univ Hosp Strasbourg, France.
    Pietrabissa, Andrea
    Univ Hosp Pavia, Italy.
    Rosso, Edoardo
    Fdn Poliambulanza Hosp, Italy; Univ Hosp Strasbourg, France.
    Sahakyan, Mushegh
    Univ Oslo, Norway; Univ Oslo, Norway; Oslo Univ Hosp, Norway.
    Soonawalla, Zahir
    Oxford Univ Hosp NHS Fdn Trust, England.
    Souche, Francois Regis
    Univ Hosp St Eloi, France.
    White, Steve
    Univ Hosp St Eloi, France.
    Zerbi, Alessandro
    Humanitas Univ, Italy; Humanitas Res Hosp, Italy.
    Dokmak, Safi
    Hosp Beaujon, France.
    Edwin, Bjorn
    Univ Oslo, Norway; Univ Oslo, Norway.
    Abu Hilal, Mohammad
    Fdn Poliambulanza Hosp, Italy; Southampton Univ Hosp NHS Fdn Trust, England.
    Besselink, Marc
    Univ Amsterdam, Netherlands.
    Short-term Outcomes After Spleen-preserving Minimally Invasive Distal Pancreatectomy With or Without Preservation of Splenic Vessels A Pan-European Retrospective Study in High-volume Centers2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 1, p. E119-E125Article in journal (Refereed)
    Abstract [en]

    Objective:To compare short-term clinical outcomes after Kimura and Warshaw MIDP. Background:Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce. Methods:Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (&gt;= 15 distal pancreatectomies annually) in 8 European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade &gt;= III) complications. Sensitivity analysis assessed the impact of excluding ("rescue") Warshaw procedures which were performed in centers that typically (&gt;75%) performed Kimura MIDP. Results:Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs 1.6%, P = 0.127) and major complications (11.5% vs 14.4%, P = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs 1.2%, P = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, P = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 minutes, P = 0.033) and less blood loss (100 vs 150 mL, P &lt; 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, P &lt; 0.001). Conclusions:Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.

  • 15.
    Lang, Hauke
    et al.
    Univ Med Mainz, Germany.
    de Santibanes, Eduardo
    Italian Hosp Buenos Aires, Argentina.
    Schlitt, Hans J.
    Univ Regensburg, Germany.
    Malago, Massimo
    UCL, England.
    van Gulik, Thomas
    Univ Amsterdam, Netherlands.
    Machado, Marcel A.
    Univ Sao Paulo, Brazil.
    Jovine, Elio
    Maggiore Hosp, Italy.
    Heinrich, Stefan
    Univ Med Mainz, Germany.
    Ettorre, Giuseppe Maria
    Camillo Hosp, Italy.
    Chan, Albert
    Univ Hong Kong, Peoples R China.
    Hernandez-Alejandro, Roberto
    Univ Rochester, NY USA.
    Campos, Ricardo Robles
    Virgen de la Arrixaca Clin and Univ Hosp, Spain.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Linecker, Michael
    Univ Hosp Zurich, Switzerland.
    Clavien, Pierre-Alain
    Univ Hosp Zurich, Switzerland.
    10th Anniversary of ALPPS-Lessons Learned and quo Vadis2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 1, p. 114-119Article in journal (Refereed)
    Abstract [en]

    Objective: Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been tested in various indications and clinical scenarios, leading to steady improvements in safety. This report presents the current status of ALPPS. Summary Background Data: ALPPS offers improved resectability, but drawbacks are regularly pointed out regarding safety and oncologic benefits. Methods: During the 12th biennial congress of the European African-Hepato-Pancreato-Biliary Association (Mainz, Germany, May 23-26, 2017) an expert meeting "10th anniversary of ALPP" was held to discuss indications, management, mechanisms of regeneration, as well as pitfalls of this novel technique. The aim of the meeting was to make an inventory of what has been achieved and what remains unclear in ALPPS. Results: Precise knowledge of liver anatomy and its variations is paramount for success in ALPPS. Technical modifications, mainly less invasive approaches like partial, mini- or laparoscopic ALPPS, mostly aiming at minimizing the extensiveness of the first-stage procedure, are associated with improved safety. In fibrotic/cirrhotic livers the degree of future liver remnant hypertrophy after ALPPS appears some less than that in noncirrhotic. Recent data from the only prospective randomized controlled trial confirmed significant higher resection rates in ALPPS with similar peri-operative morbidity and mortality rates compared with conventional 2-stage hepatectomy including portal vein embolization. ALPPS is effective reliably even after failure of portal vein embolization. Conclusions: Although ALPPS is now an established 2-stage hepatectomy additional data are warranted to further refine indication and technical aspects. Long-term oncological outcome results are needed to establish the place of ALPPS in patients with initially nonresectable liver tumors.

  • 16.
    Latenstein, Anouk E. J.
    et al.
    Univ Amsterdam, Netherlands.
    Scholten, Lianne
    Univ Amsterdam, Netherlands.
    Al-Saffar, Hasan Ahmad
    Karolinska Univ Hosp, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Butturini, Giovanni
    Pederzoli Hosp, Italy.
    Capretti, Giovanni
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ Dept Biomed Sci, Italy.
    Chatzizacharias, Nikolaos A.
    Univ Hosp Birmingham NHS Trust, England.
    Dervenis, Chris
    Univ Cyprus, Cyprus.
    Frigerio, Isabella
    Pederzoli Hosp, Italy.
    Gallagher, Tom K.
    St Vincents Univ Hosp, Ireland.
    Gasteiger, Silvia
    Med Univ Innsbruck, Austria.
    Halimi, Asif
    Karolinska Univ Hosp, Sweden.
    Labori, Knut J.
    Oslo Univ Hosp, Norway.
    Montagnini, Greta
    Univ & Hosp Trust Verona, Italy.
    Munoz-Bellvis, Luis
    Univ Salamanca, Spain.
    Nappo, Gennaro
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ Dept Biomed Sci, Italy.
    Nikov, Andrej
    Cent Mil Hosp Prague, Czech Republic.
    Pando, Elizabeth
    Hosp Valle De Hebron, Spain.
    de Pastena, Matteo
    Univ & Hosp Trust Verona, Italy.
    De La Pena-Moral, Jesus M.
    Hosp Clin Univ Virgen Arrixaca, Spain.
    Radenkovic, Dejan
    Univ Belgrade, Serbia.
    Roberts, Keith J.
    Univ Hosp Birmingham NHS Trust, England.
    Salvia, Roberto
    Univ & Hosp Trust Verona, Italy.
    Sanchez-Bueno, Francisco
    Hosp Clin Univ Virgen Arrixaca, Spain.
    Scandavini, Chiara
    Karolinska Univ Hosp, Sweden.
    Serradilla-Martin, Mario
    Miguel Servet Univ Hosp, Spain.
    Stattner, Stefan
    Med Univ Innsbruck, Austria; Salzkammergut Klinikum, Austria.
    Tomazic, Ales
    Univ Med Ctr Ljubljana, Slovenia.
    Varga, Martin
    Paracelsus Med Univ, Austria.
    Zavrtanik, Hana
    Univ Med Ctr Ljubljana, Slovenia.
    Zerbi, Alessandro
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ Dept Biomed Sci, Italy.
    Erkan, Mert
    Koc Univ, Turkey.
    Kleeff, Jorg
    Martin Luther Univ Halle Wittenberg, Germany.
    Lesurtel, Mickael
    Univ Lyon 1, France.
    Besselink, Marc G.
    Univ Amsterdam, Netherlands.
    Ramia-Angel, Jose M.
    Univ Hosp Guadalajara, Spain.
    Clinical Outcomes After Total Pancreatectomy A Prospective Multicenter Pan-European Snapshot Study2022In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 276, no 5, p. E536-E543Article in journal (Refereed)
    Abstract [en]

    Objective: To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. Background: Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. Methods: This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (&lt;60 vs &gt;= 60). Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. Results: In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with &gt;= 60 pancreatoduodenectomies compared &lt;60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume &lt;60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss &gt;= 2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA &gt;= 3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss &gt;= 2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications. Conclusion: This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.

  • 17.
    Linecker, Michael
    et al.
    University Hospital Zurich, Switzerland.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Stavrou, Gregor A.
    Asklepios Hospital Barmbek, Germany; Semmelweis University of Budapest, Germany.
    Oldhafer, Karl J.
    Asklepios Hospital Barmbek, Germany; Semmelweis University of Budapest, Germany.
    Lurje, Georg
    University Hospital Aachen, Germany.
    Neumann, Ulf
    University Hospital Aachen, Germany.
    Adam, Rene
    Hop Paul Brousse, France.
    Pruvot, Francois-Rene
    University Hospital, France.
    Topp, Stefan A.
    University Hospital Dusseldorf, Germany.
    Li, Jun
    University of Medical Centre Hamburg Eppendorf, Germany.
    Capobianco, Ivan
    University of Tubingen Hospital, Germany.
    Nadalin, Silvio
    University of Tubingen Hospital, Germany.
    Autran Machado, Marcel
    University of Sao Paulo, Brazil.
    Voskanyan, Sergey
    FMBA, Russia.
    Balci, Deniz
    Ankara University, Turkey.
    Hernandez-Alejandro, Roberto
    London Health Science Centre, Canada; University of Rochester, NY 14627 USA.
    Alvarez, Fernando A.
    Italian Hospital Buenos Aires, Argentina.
    De Santibanes, Eduardo
    Italian Hospital Buenos Aires, Argentina.
    Robles-Campos, Ricardo
    Virgen Arrixaca Clin, Spain; University Hospital, Spain.
    Malago, Massimo
    UCL, England.
    de Oliveira, Michelle L.
    University Hospital Zurich, Switzerland.
    Lesurtel, Mickael
    University Hospital Zurich, Switzerland.
    Clavien, Pierre-Alain
    University Hospital Zurich, Switzerland.
    Petrowsky, Henrik
    University Hospital Zurich, Switzerland.
    Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity2017In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 266, no 5, p. 779-786Article in journal (Refereed)
    Abstract [en]

    Objective: To longitudinally assess whether risk adjustment in Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) occurred over time and is associated with postoperative outcome. Background: ALPPS is a novel 2-stage hepatectomy enabling resection of extensive hepatic tumors. ALPPS has been criticized for its high mortality, which is reported beyond accepted standards in liver surgery. Therefore, adjustments in patient selection and technique have been performed but have not yet been studied over time in relation to outcome. Methods: ALPPS centers of the International ALPPS Registry having performed amp;gt;= 10 cases over a period of amp;gt;= 3 years were assessed for 90-day mortality and major interstage complications (amp;gt;= 3b) of the longitudinal study period from 2009 to 2015. The predicted prestage 1 and 2 mortality risks were calculated for each patient. In addition, questionnaires were sent to all centers exploring center-specific risk adjustment strategies. Results: Among 437 patients from 16 centers, a shift in indications toward colorectal liver metastases from 53% to 77% and a reverse trend in biliary tumors from 24% to 9% were observed. Over time, 90-day mortality decreased from initially 17% to 4% in 2015 (P = 0.002). Similarly, major interstage complications decreased from 10% to 3% (P = 0.011). The reduction of 90-day mortality was independently associated with a risk adjustment in patient selection (P amp;lt; 0.001; OR: 1.62; 95% CI: 1.36-1.93) and using less invasive techniques in stage-1 surgery (P = 0.019; OR: 0.39; 95% CI: 0.18-0.86). A survey indicated risk adjustment of patient selection in all centers and ALPPS technique in the majority (80%) of centers. Conclusions: Risk adjustment of patient selection and technique in ALPPS resulted in a continuous drop of early mortality and major postoperative morbidity, which has meanwhile reached standard outcome measures accepted for major liver surgery.

  • 18.
    Matthiessen, P.
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Hallböök, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Rutegard, J.
    Rutegård, J., Umeå University Hospital, Umeå, Sweden.
    Simert, G.
    Högland Hospital, Eksjö, Sweden.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial2008In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, no 4, p. 719-720Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 19.
    Matthiessen, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Rutegård, Jörgen
    Departments of Surgery, Örebro University Hospital, Örebro, Sweden.
    Simert, Göran
    Höglandssjukhuset, Eksjö, Sweden.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial2007In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 246, no 2, p. 207-214Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not.

    SUMMARY BACKGROUND DATA: The introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size.

    METHODS: From December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival >6 months, informed consent, anastomosis ≤7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events.

    RESULTS: The overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n = 116) had leakage in 10.3% (12 of 116) and those without stoma (n = 118) in 28.0% (33 of 118) (odds ratio = 3.4, 95% confidence interval, 1.6-6.9, P < 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P < 0.001). After a follow-up of median 42 months (range, 6-72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32-86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups.

    CONCLUSION: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.

  • 20.
    Nilsson, Klara
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Klevebro, Fredrik
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Rouvelas, Ioannis
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Lindblad, Mats
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Szabo, Eva
    Orebro Univ, Sweden.
    Halldestam, Ingvar
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Smedh, Ulrika
    Sahlgrens Univ Hosp, Sweden.
    Wallner, Bengt
    Umea Univ Hosp, Sweden.
    Johansson, Jan
    Skane Univ Hosp, Sweden.
    Johnsen, Gjermund
    Trondheim Reg & Univ Hosp, Norway.
    Aahlin, Eirik Kjus
    Univ Hosp Northern Norway, Norway.
    Johannessen, Hans-Olaf
    Oslo Univ Hosp, Norway.
    Hjortland, Geir Olav
    Oslo Univ Hosp, Norway.
    Bartella, Isabel
    Univ Cologne, Germany.
    Schroeder, Wolfgang
    Univ Cologne, Germany.
    Bruns, Christiane
    Univ Cologne, Germany.
    Nilsson, Magnus
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial Standard Versus Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer2020In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 272, no 5, p. 684-689Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate if prolonged TTS after completed nCRT improves postoperative outcomes for esophageal and esophagogastric junction cancer. Summary of Background Data: TTS has traditionally been 4-6 weeks after completed nCRT. However, the optimal timing is not known. Methods: A multicenter clinical trial was performed with randomized allocation of TTS of 4-6 or 10-12 weeks. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality, and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101). Results: In total 249 patients were randomized. There were no significant differences between standard TTS and prolonged TTS with regard to overall incidence of complications Clavien-Dindo grade II-V (63.2% vs 72.6%, P = 0.134) or regarding Clavien-Dindo grade IIIb-V complications (31.6% vs 34.9%, P = 0.603). There were no statistically significant differences between standard and prolonged TTS regarding anastomotic leak (P = 0.596), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548), and respiratory failure (P = 0.723). In the standard TTS arm 5 patients (4.3%) died within 90 days of surgery, compared to 4 patients (3.8%) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.234). Conclusion: The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction, is not of major importance with regard to short-term postoperative outcomes.

  • 21. Nordin, P
    et al.
    Haapaniemi, S
    van der Linden, W
    Nilsson, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Choice of anesthesia and risk of reoperation for recurrence in groin hernia repair2004In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 240, p. 187-192Article in journal (Refereed)
  • 22.
    Nordin, Pär
    et al.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Haapaniemi, S.
    Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden.
    Van Der Linden, W.
    Department of Surgery, Östersund Hospital, Östersund, Sweden.
    Nilsson, E.
    Department of Surgery, Motala Hospital, Motala, Sweden.
    Choice of anesthesia and risk of reooperation for recurrence in groin hernia repair2004In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 240, no 1, p. 187-192Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence.

    Background: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results.

    Methods: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis.

    Results: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation.

    Conclusions: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.

  • 23.
    Ros, Axel
    et al.
    Department of Surgery, County Hospital of Ryhov, Jönköping, Sweden.
    Gustafsson, Lennart
    Motala Hospital, Motala, Sweden.
    Krook, Hans
    Vrinnevi Hospital, Norrköping, Sweden.
    Nordgren, Carl-Eric
    County Hospital, Kalmar, Sweden.
    Thorell, Anders
    Karolinska Hospital, Stockholm, Sweden.
    Wallin, Göran
    Karolinska Hospital, Stockholm, Sweden.
    Nilsson, Erik
    Motala Hospital, Motala, Sweden.
    Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study2001In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 234, no 6, p. 741-749Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze outcomes after open small-incision surgery (minilaparotomy) and laparoscopic surgery for gallstone disease in general surgical practice.

    Methods: This study was a randomized, single-blind, multicenter trial comparing laparoscopic cholecystectomy (LC) to minilaparotomy cholecystectomy (MC). Both elective and acute patients were eligible for inclusion. All surgeons normally performing cholecystectomy, both trainees under supervision and consultants, operated on randomized patients. LC was a routine procedure at participating hospitals, whereas MC was introduced after a short training period. All nonrandomized cholecystectomies at participating units during the study period were also recorded to analyze the external validity of trial results. The randomization period was from March 1, 1997, to April 30, 1999.

    Results: Of 1,705 cholecystectomies performed at participating units during the randomization period, 724 entered the trial and 362 patients were randomized to each of the procedures. The groups were well matched for age and sex, but there were fewer acute operations in the LC group than the MC group. In the LC group 264 and in the MC group 150 operations were performed by surgeons who had done more than 25 operations of that type. Median operating times were 100 and 85 minutes for LC and MC, respectively. Median hospital stay was 2 days in each group, but in a nonparametric test it was significantly shorter after LC. Median sick leave and time for return to normal recreational activities were shorter after LC than MC. Intraoperative complications were less frequent in the MC group, but there was no difference in the postoperative complication rate between the groups. There was one serious bile duct injury in each group, but no deaths.

    Conclusions: Operating time was longer and convalescence was smoother for LC compared with MC. Further analyses of LC versus MC are necessary regarding surgical training, surgical outcome, and health economy.

  • 24.
    Sandström, Per A
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Lindell, Gert
    Lund Univ, Sweden.
    Larsen, Peter Norgaard
    Univ Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Uppsala Univ, Sweden.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response to the Comment on "Should We Have a Little More Patience With the Conventional 2-Stage Hepatectomy?"2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 3, p. E33-E34Article in journal (Other academic)
    Abstract [en]

    n/a

  • 25.
    Sandström, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard Ingvald
    Oslo Univ Hosp, Norway.
    Sparrelid, Ernesto
    Karolinska Univ Hosp, Sweden.
    Larsen, Peter Norgaard
    Univ Copenhagen, Denmark.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn Atle
    Univ Copenhagen, Denmark.
    Lindell, Gert
    Lund Univ, Sweden.
    Isaksson, Bengt
    Uppsala Univ, Sweden.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Response to Comment on "When Innovation Is Not Enough in ANNALS OF SURGERY, vol 270, issue 2, pp E36-E372019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 270, no 2, p. E36-E37Article in journal (Other academic)
    Abstract [en]

    n/a

  • 26.
    Sandström, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Sparrelid, Ernesto
    Karolinska Inst, Sweden.
    Larsen, Peter N.
    Univ Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindell, Gert
    Lund Univ, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Karolinska Inst, Sweden.
    Rizell, Magnus
    Univ Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)2018In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 267, no 5, p. 833-840Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCTwas conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome-RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [ 95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P amp;lt; 0.0001]. No differences in complications (Clavien- Dindo amp;gt;= 3a) [ 43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [ 1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short- term mortality.

  • 27.
    Sandström, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Sparrelid, Ernesto
    Karolinska Inst, Sweden.
    Larsen, Peter Norgaard
    Univ Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Lindell, Gert
    Lund Univ, Sweden.
    Schultz, Nicolai A.
    Univ Copenhagen, Denmark.
    Bjornbeth, Bjorn A.
    Oslo Univ Hosp, Norway.
    Isaksson, Bengt
    Uppsala Univ, Sweden.
    Rizell, M.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response to "ALPPS Versus Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastases"2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 1, p. E16-E17Article in journal (Other academic)
    Abstract [en]

    n/a

  • 28.
    Sandström, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Rosok, Bard I.
    Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
    Sparrelid, Ernesto
    Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Lindell, Gert
    Department of Surgery, Skane University Hospital, Lund University, Lund, Sweden.
    Larsen, Peter Norgaard
    Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Schultz, Nicolai A.
    Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Isaksson, Bengt
    Department of Surgery, Akademiska Hospital, University of Uppsala, Uppsala, Sweden.
    Rizell, Magnus
    Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Response: "Unresectable Colorectal Liver Metastases: When Definitions Matter to Appropriately Assess Extreme Liver Resection Techniques2018In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, no 6, p. E83-E85Article in journal (Other academic)
    Abstract [en]

    n/a

  • 29.
    van Hilst, Jony
    et al.
    Acad Med Ctr, Netherlands.
    de Rooij, Thijs
    Acad Med Ctr, Netherlands.
    Klompmaker, Sjors
    Acad Med Ctr, Netherlands.
    Rawashdeh, Majd
    Southampton Univ Hosp NHS Fdn Trust, England.
    Aleotti, Francesca
    Osped San Raffaele, Italy.
    Al-Sarireh, Bilal
    Morriston Hosp, Wales.
    Alseidi, Adnan
    Virginia Mason Med Ctr, WA 98101 USA.
    Ateeb, Zeeshan
    Karolinska Inst, Sweden.
    Balzano, Gianpaolo
    Osped San Raffaele, Italy.
    Berrevoet, Frederik
    Ghent Univ Hosp, Belgium.
    Björnsson, Bergthor
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Boggi, Ugo
    Univ Pisa, Italy.
    Busch, Olivier R.
    Acad Med Ctr, Netherlands.
    Butturini, Giovanni
    Pederzoli Hosp, Italy.
    Casadei, Riccardo
    St Orsola Marcello Malpighi Hosp, Italy.
    Del Chiaro, Marco
    Karolinska Inst, Sweden.
    Chikhladze, Sophia
    Univ Klinikum Freiburg, Germany.
    Cipriani, Federica
    Southampton Univ Hosp NHS Fdn Trust, England.
    van Dam, Ronald
    Maastricht Univ, Netherlands.
    Damoli, Isacco
    Verona Univ Hosp, Italy.
    van Dieren, Susan
    Acad Med Ctr, Netherlands.
    Dokmak, Safi
    Hosp Beaujon, France.
    Edwin, Bjorn
    Oslo Univ Hosp, Norway; Inst Clin Med, Norway.
    van Eijck, Casper
    Erasmus MC, Netherlands.
    Fabre, Jean-Marie
    Hop St Eloi, France.
    Falconi, Massimo
    Osped San Raffaele, Italy.
    Farges, Olivier
    Hosp Beaujon, France.
    Fernandez-Cruz, Laureano
    Hosp Clin Barcelona, Spain.
    Forgione, Antonello
    Osped Niguarda Ca Granda, Italy.
    Frigerio, Isabella
    Pederzoli Hosp, Italy.
    Fuks, David
    Inst Mutualiste Montsouris, France.
    Gavazzi, Francesca
    Humanitas Univ Hosp, Italy.
    Gayet, Brice
    Inst Mutualiste Montsouris, France.
    Giardino, Alessandro
    Pederzoli Hosp, Italy.
    Koerkamp, Bas Groot
    Erasmus MC, Netherlands.
    Hackert, Thilo
    Heidelberg Univ Hosp, Germany.
    Hassenpflug, Matthias
    Heidelberg Univ Hosp, Germany.
    Kabir, Irfan
    Oxford Univ Hosp NHS Fdn Trust, England.
    Keck, Tobias
    UKSH Campus Lubeck, Germany.
    Khatkov, Igor
    Moscow Clin Sci Ctr, Russia.
    Kusar, Masa
    Univ Med Ctr Ljubljana, Slovenia.
    Lombardo, Carlo
    Univ Pisa, Italy.
    Marchegiani, Giovanni
    Verona Univ Hosp, Italy.
    Marshall, Ryne
    Virginia Mason Med Ctr, WA 98101 USA.
    Menon, Krish V.
    Kings Coll Hosp NHS Fdn Trust, England.
    Montorsi, Marco
    Humanitas Univ Hosp, Italy.
    Orville, Marion
    Hosp Beaujon, France.
    de Pastena, Matteo
    Verona Univ Hosp, Italy.
    Pietrabissa, Andrea
    Univ Hosp Pavia, Italy.
    Poves, Ignaci
    Hosp del Mar, Spain.
    Primrose, John
    Southampton Univ Hosp NHS Fdn Trust, England.
    Pugliese, Raffaele
    Osped Niguarda Ca Granda, Italy.
    Ricci, Claudio
    St Orsola Marcello Malpighi Hosp, Italy.
    Roberts, Keith
    Univ Hosp Birmingham, England.
    Rosok, Bard
    Oslo Univ Hosp, Norway; Inst Clin Med, Norway.
    Sahakyan, Mushegh A.
    Oslo Univ Hosp, Norway; Inst Clin Med, Norway.
    Sanchez-Cabus, Santiago
    Hosp Clin Barcelona, Spain.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Scovel, Lauren
    Virginia Mason Med Ctr, WA 98101 USA.
    Solaini, Leonardo
    Univ Brescia, Italy.
    Soonawalla, Zahir
    Oxford Univ Hosp NHS Fdn Trust, England.
    Souche, F. Regis
    Hop St Eloi, France.
    Sutcliffe, Robert P.
    UKSH Campus Lubeck, Germany; Univ Hosp Birmingham, England.
    Tiberio, Guido A.
    Univ Brescia, Italy.
    Tomazic, Ales
    Univ Med Ctr Ljubljana, Slovenia.
    Troisi, Roberto
    Ghent Univ Hosp, Belgium.
    Wellner, Ulrich
    Hosp Clin Barcelona, Spain.
    White, Steven
    Freeman Hosp Newcastle Upon Tyne, England.
    Wittel, Uwe A.
    Univ Klinikum Freiburg, Germany.
    Zerbi, Alessandro
    Humanitas Univ Hosp, Italy.
    Bassi, Claudio
    Verona Univ Hosp, Italy.
    Besselink, Marc G.
    Academic Medical Centre, Amsterdam, The Netherlands.
    Abu Hilal, Mohammed
    Southampton Univ Hosp NHS Fdn Trust, England.
    Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)2019In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 1, p. 10-17Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC).

    Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC.

    Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival.

    Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60–400) vs 300 mL (150–500), P = 0.001] and hospital stay [8 (6–12) vs 9 (7–14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8–22) vs 22 (14–31), P< 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22–34] versus 31 (95% CI, 26–36) months (P = 0.929).

    Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

  • 30.
    Wallen, Stefan
    et al.
    Orebro Univ, Sweden; Univ Hosp Orebro, Sweden.
    Bruze, Gustaf
    Karolinska Inst, Sweden.
    Ottosson, Johan
    Orebro Univ, Sweden.
    Marcus, Claude
    Karolinska Inst, Sweden.
    Sundstrom, Johan
    Uppsala Univ, Sweden.
    Szabo, Eva
    Orebro Univ, Sweden.
    Olbers, Torsten
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
    Palmetun-Ekback, Maria
    Univ Hosp Orebro, Sweden.
    Naslund, Ingmar
    Orebro Univ, Sweden.
    Neovius, Martin
    Karolinska Inst, Sweden.
    Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention2023In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 3, p. E552-E560Article in journal (Refereed)
    Abstract [en]

    Objective: To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. Summary of Background Data: Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups. Methods: Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention. Results: During the 2-year period before treatment, prevalence of individuals receiving &gt;= 1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98). Conclusions: Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.

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