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  • 1.
    Andersson, Roland
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. 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-E1322015Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, nr 5, s. E132-E132Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 2.
    Andersson, Roland E
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Letter: Resolving appendicitis is common2008Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, nr 3, s. 553-553Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 3.
    Andersson, Roland
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi.
    Petzold, MG
    Nonsurgical treatment of appendiceal abscess or phlegmon: A systematic review and meta-analysis2007Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 246, nr 5, s. 741-748Artikel i tidskrift (Refereegranskat)
    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.
    Borch, Kurt
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Ahrén, Bo
    Ahlman, Håkan
    Falkmer, Sture
    Granérus, Göran
    Grimelius, Lars
    Gastric carcinoids: Biologic behavior and prognosis after differentiated treatment in relation to type2005Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 242, nr 1, s. 64-73Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Haapaniemi, Staffan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    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 repair2001Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 234, nr 1, s. 122-126Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Linecker, Michael
    Univ Hosp Zurich, Switzerland.
    Clavien, Pierre-Alain
    Univ Hosp Zurich, Switzerland.
    10th Anniversary of ALPPS-Lessons Learned and quo Vadis2019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 1, s. 114-119Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Linecker, Michael
    et al.
    University Hospital Zurich, Switzerland.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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 Morbidity2017Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 266, nr 5, s. 779-786Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Matthiessen, P.
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Hallböök, Olof
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Rutegard, J.
    Rutegård, J., Umeå University Hospital, Umeå, Sweden.
    Simert, G.
    Högland Hospital, Eksjö, Sweden.
    Sjödahl, Rune
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial2008Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 247, nr 4, s. 719-720Övrigt (Övrigt vetenskapligt)
    Abstract [en]

    [No abstract available]

  • 9.
    Matthiessen, Peter
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Hallböök, Olof
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Rutegård, Jörgen
    Departments of Surgery, Örebro University Hospital, Örebro, Sweden.
    Simert, Göran
    Höglandssjukhuset, Eksjö, Sweden.
    Sjödahl, Rune
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial2007Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 246, nr 2, s. 207-214Artikel i tidskrift (Refereegranskat)
    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.

  • 10. Nordin, P
    et al.
    Haapaniemi, S
    van der Linden, W
    Nilsson, Erik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Choice of anesthesia and risk of reoperation for recurrence in groin hernia repair2004Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 240, s. 187-192Artikel i tidskrift (Refereegranskat)
  • 11.
    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 repair2004Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 240, nr 1, s. 187-192Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    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 study2001Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 234, nr 6, s. 741-749Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Sandström, Per A
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Response to the Comment on "Should We Have a Little More Patience With the Conventional 2-Stage Hepatectomy?"2019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 3, s. E33-E34Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 14.
    Sandström, Per
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Lindhoff Larsson, Anna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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-E372019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 270, nr 2, s. E36-E37Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 15.
    Sandström, Per
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Sparrelid, Ernesto
    Karolinska Inst, Sweden.
    Larsen, Peter N.
    Univ Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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)2018Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 267, nr 5, s. 833-840Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Sandström, Per
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Rosok, Bard I.
    Oslo Univ Hosp, Norway.
    Sparrelid, Ernesto
    Karolinska Inst, Sweden.
    Larsen, Peter Norgaard
    Univ Copenhagen, Denmark.
    Lindhoff Larsson, Anna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Response to "ALPPS Versus Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastases"2019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 1, s. E16-E17Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 17.
    Sandström, Per
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Response: "Unresectable Colorectal Liver Metastases: When Definitions Matter to Appropriately Assess Extreme Liver Resection Techniques2018Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 6, s. E83-E85Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

  • 18.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    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)2019Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 1, s. 10-17Artikel i tidskrift (Refereegranskat)
    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.

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