100 results on '"Haglind, E."'
Search Results
2. P-366 Long-term quality of life in patients treated for anal cancer: Self-reported bother of symptoms
- Author
-
Axelsson, A., primary, Bock, D., additional, Haglind, E., additional, Johansson, M., additional, Nilsson, H., additional, Nilsson, P., additional, Staff, C., additional, and Angenete, E., additional
- Published
- 2020
- Full Text
- View/download PDF
3. Residual/recurrent disease and deaths at 6 years after open or robotic-assisted radical prostatectomy in the prospective, controlled trial LAPPRO
- Author
-
Nyberg, M.P., primary, Akre, O., additional, Bock, D., additional, Carlsson, S.V., additional, Carlsson, S., additional, Hugosson, J., additional, Steineck, G., additional, Stranne, J., additional, Tyritzis, S., additional, Wiklund, P., additional, Haglind, E., additional, and Bjartell, A.S., additional
- Published
- 2020
- Full Text
- View/download PDF
4. Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial)
- Author
-
Park, J, Danielsen, A K, Angenete, E, Bock, D, Marinez, A C, Haglind, E, Jansen, J E, Skullman, S, Wedin, A, and Rosenberg, J
- Subjects
Adult ,Aged, 80 and over ,Male ,Postoperative Complications/epidemiology ,Time Factors ,Ileostomy ,Middle Aged ,humanities ,Rectal Neoplasms/surgery ,Quality of Life ,Health Status Indicators ,Humans ,Female ,Rectum/surgery ,Aged ,Follow-Up Studies - Abstract
BACKGROUND: A temporary ileostomy may reduce symptoms from anastomotic leakage after rectal cancer resection. Earlier results of the EASY trial showed that early closure of the temporary ileostomy was associated with significantly fewer postoperative complications. The aim of the present study was to compare health-related quality of life (HRQOL) following early versus late closure of a temporary ileostomy.METHODS: Early closure of a temporary ileostomy (at 8-13 days) was compared with late closure (at more than 12 weeks) in a multicentre RCT (EASY) that included patients who underwent rectal resection for cancer. Inclusion of participants was made after index surgery. Exclusion criteria were signs of anastomotic leakage, diabetes mellitus, steroid treatment, and signs of postoperative complications at clinical evaluation 1-4 days after rectal resection. HRQOL was evaluated at 3, 6 and 12 months after resection using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29 and Short Form 36 (SF-36®).RESULTS: There were 112 patients available for analysis. Response rates of the questionnaires were 82-95 per cent, except for EORTC QLQ-C30 at 12 months, to which only 54-55 per cent of the patients responded owing to an error in questionnaire distribution. There were no clinically significant differences in any questionnaire scores between the groups at 3, 6 or 12 months.CONCLUSION: Although the randomized study found that early closure of the temporary ileostomy was associated with significantly fewer complications, this clinical advantage had no effect on the patients' HRQOL. Registration number: NCT01287637 (https://www.clinicaltrials.gov).
- Published
- 2018
5. Two-year results of the randomized clinical trial DILALA comparing laparoscopic lavage with resection as treatment for perforated diverticulitis
- Author
-
Kohl, A, Rosenberg, J, Bock, D, Bisgaard, T, Skullman, S, Thornell, A, Gehrman, J, Angenete, E, Haglind, E, Kohl, A, Rosenberg, J, Bock, D, Bisgaard, T, Skullman, S, Thornell, A, Gehrman, J, Angenete, E, and Haglind, E
- Abstract
BACKGROUND: Traditionally, perforated diverticulitis with purulent peritonitis was treated with resection and colostomy (Hartmann's procedure), with inherent complications and risk of a permanent stoma. The DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) and other randomized trials found laparoscopic lavage to be a feasible and safe alternative. The medium-term follow-up results of DILALA are reported here.METHODS: Patients were randomized during surgery after being diagnosed with Hinchey grade III perforated diverticulitis at diagnostic laparoscopy. The primary outcome was the proportion of patients with one or more secondary operations from 0 to 24 months after the index procedure in the laparoscopic lavage versus Hartmann's procedure groups. The trial was registered as ISRCTN82208287.RESULTS: Forty-three patients were randomized to laparoscopic lavage and 40 to Hartmann's procedure. Patients in the lavage group had a 45 per cent reduced risk of undergoing one or more operations within 24 months (relative risk 0·55, 95 per cent c.i. 0·36 to 0·84; P = 0·012) and had fewer operations (ratio 0·51, 95 per cent c.i. 0·31 to 0·87; P = 0·024) compared with those in the Hartmann's group. No difference was found in mean number of readmissions (1·37 versus 1·50; P = 0·221) or mortality between patients randomized to laparoscopic lavage or Hartmann's procedure. Three patients in the lavage group and nine in the Hartmann's group had a colostomy at 24 months.CONCLUSION: Laparoscopic lavage is a better option for perforated diverticulitis with purulent peritonitis than open resection and colostomy.
- Published
- 2018
6. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer
- Author
-
Deijen, C.L., Vasmel, J.E., Lange-de Klerk, E.S. de, Cuesta, M.A., Coene, P.L.O., Lange, J.F., Meijerink, W.J.H.J., Jakimowicz, J.J., Jeekel, J., Kazemier, G., Pahlman, L., Haglind, E., Bonjer, H.J., Deijen, C.L., Vasmel, J.E., Lange-de Klerk, E.S. de, Cuesta, M.A., Coene, P.L.O., Lange, J.F., Meijerink, W.J.H.J., Jakimowicz, J.J., Jeekel, J., Kazemier, G., Pahlman, L., Haglind, E., and Bonjer, H.J.
- Abstract
Contains fulltext : 174511.pdf (publisher's version ) (Open Access), BACKGROUND: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up. METHODS: Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842). RESULTS: In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) -10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI -10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI -11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n = 3 vs. open n = 4). CONCLUSIONS: Laparoscopic surgery for non-metastatic colon cancer is associated with similar rates of disease-free survival, overall survival and recurrences as open surgery at 1
- Published
- 2017
7. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer
- Author
-
Deijen, CL, Vasmel, JE, de Lange-de Klerk, ESM, Cuesta, MA, Coene, P, Lange, Johan, Meijerink, W, Jakimowicz, JJ, Jeekel, J (Hans), Kazemier, G, Janssen, IMC, Pahlman, L, Haglind, E, Bonjer, HJ, Deijen, CL, Vasmel, JE, de Lange-de Klerk, ESM, Cuesta, MA, Coene, P, Lange, Johan, Meijerink, W, Jakimowicz, JJ, Jeekel, J (Hans), Kazemier, G, Janssen, IMC, Pahlman, L, Haglind, E, and Bonjer, HJ
- Published
- 2017
8. Health economic analysis of laparoscopic lavage versus Hartmann's procedure for diverticulitis in the randomized DILALA trial
- Author
-
Gehrman, J., Angenete, E, Björholt, I., Bock, David, Rosenberg, J., and Haglind, E
- Abstract
Background: Open surgery with resection and colostomy (Hartmann's procedure) has been the standard treatment for perforated diverticulitis with purulent peritonitis. In recent years laparoscopic lavage has emerged as an alternative, with potential benefits for patients with purulent peritonitis, Hinchey grade III. The aim of this study was to compare laparoscopic lavage and Hartmann's procedure with health economic evaluation within the framework of the DILALA (DIverticulitis – LAparoscopic LAvage versus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) trial. Methods: Clinical effectiveness and resource use were derived from the DILALA trial and unit costs from Swedish sources. Costs were analysed from the perspective of the healthcare sector. The study period was divided into short-term analysis (base-case A), within 12 months, and long-term analysis (base-case B), from inclusion in the trial throughout the patient's expected life. Results: The study included 43 patients who underwent laparoscopic lavage and 40 who had Hartmann's procedure in Denmark and Sweden during 2010–2014. In base-case A, the difference in mean cost per patient between laparoscopic lavage and Hartmann's procedure was €–8983 (95 per cent c.i. –16 232 to –1735). The mean(s.d.) costs per patient in base-case B were €25 703(27 544) and €45 498(38 928) for laparoscopic lavage and Hartmann's procedure respectively, resulting in a difference of €–19 794 (95 per cent c.i. –34 657 to –4931). The results were robust as demonstrated in sensitivity analyses. Conclusion: The significant cost reduction in this study, together with results of safety and efficacy from RCTs, support the routine use of laparoscopic lavage as treatment for complicated diverticulitis with purulent peritonitis.
- Published
- 2016
9. Physical activity before radical prostatectomy reduces sick leave after surgery : results from a prospective, non-randomized controlled clinical trial (LAPPRO)
- Author
-
Angenete, E, Angerås, U, Börjesson, Mats, Ekelund, J, Gellerstedt, M, Thorsteinsdottir, T, Steineck, G, and Haglind, E
- Subjects
Prostatectomy ,Urology ,Omvårdnad ,Urologi och njurmedicin ,Urology and Nephrology ,Nursing ,Physical fitness ,Prostatic neoplasm - Abstract
BACKGROUND: Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery. The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications, sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial (LAParoscopic Prostatectomy Robot Open). METHODS: LAPPRO is a prospective controlled trial, comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011. 1569 patients aged 64 or less with an occupation were included in this sub-study. The Gleason score was CC BY 4.0Funders: Gothenburg Medical Society; Sahlgrenska University Hospital, 146201; Tornspiran Foundation; Mrs Mary von Sydow Foundation
- Published
- 2016
10. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer
- Author
-
Deijen, C.L. (Charlotte L.), Vasmel, J.E. (Jeanine E.), De Lange-De Klerk, E.S.M. (E. S M), Cuesta, M.A. (Miguel), Coene, P-P. (Peter Paul), Lange, J.F. (Johan), Meijerink, W.J.H.J. (Jeroen), Jakimowicz, J.J. (Jack), Jeekel, J. (Hans), Kazemier, G. (Geert), Janssen, I.M.C. (Ignace M. C.), Påhlman, L. (Lars), Haglind, E. (Eva), Bonjer, H.J. (H. Jaap), Deijen, C.L. (Charlotte L.), Vasmel, J.E. (Jeanine E.), De Lange-De Klerk, E.S.M. (E. S M), Cuesta, M.A. (Miguel), Coene, P-P. (Peter Paul), Lange, J.F. (Johan), Meijerink, W.J.H.J. (Jeroen), Jakimowicz, J.J. (Jack), Jeekel, J. (Hans), Kazemier, G. (Geert), Janssen, I.M.C. (Ignace M. C.), Påhlman, L. (Lars), Haglind, E. (Eva), and Bonjer, H.J. (H. Jaap)
- Abstract
Background: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up. Methods: Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842). Results: In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) −10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI −10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI −11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n =
- Published
- 2016
- Full Text
- View/download PDF
11. Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES)
- Author
-
Veldkamp, R, Gholghesaei, M, Bonjer, Hj, Meijer, Dw, Buunen, M, Jeekel, J, Anderberg, B, Cuesta, Ma, Cuschierl, A, Fingerhut, A, Fleshman, Jw, Guillou, Pj, Haglind, E, Himpens, J, Jacobi, Ca, Jakimowicz, Jj, Koeckerling, F, Lacy, Am, Lezoche, Emanuele, Monson, Jr, Morino, M, Neugebauer, E, Wexner, Sd, Whelan, Rl, EUROPEAN ASSOCIATION OF ENDOSCOPIC SURGERY EAES, Cardiology, Otorhinolaryngology and Head and Neck Surgery, and Surgery
- Subjects
medicine.medical_specialty ,Colorectal cancer ,port site metastasis ,Endoscopic surgery ,costs ,outcomes ,Metastasis ,SDG 3 - Good Health and Well-being ,medicine ,Laparoscopic resection ,colon cancer ,controindication ,conversion ,morbidity and mortality ,stress response ,Humans ,Laparoscopy ,Contraindication ,Colectomy ,Societies, Medical ,medicine.diagnostic_test ,Colonoscopes ,business.industry ,Contraindications ,Colonoscopy ,medicine.disease ,Surgery ,Endoscopy ,Europe ,Colonic Neoplasms ,business ,Abdominal surgery - Abstract
The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on the laparoscopic resection of colon cancer during the annual congress in Lisbon, Portugal, in June 2002.A systematic review of the current literature was combined with the opinions, of experts in the field of colon cancer surgery to formulate evidence-based statements and recommendations on the laparoscopic resection of colon cancer.Advanced age, obesity, and previous abdominal operations are not considered absolute contraindications for laparoscopic colon cancer surgery. The most common cause for conversion is the presence of bulky or invasive tumors. Laparoscopic operation takes longer to perform than the open counterpart, but the outcome is similar in terms of specimen size and pathological examination. Immediate postoperative morbidity and mortality are comparable for laparoscopic and open colonic cancer surgery. The laparoscopically operated patients had less postoperative pain, better-preserved pulmonary function, earlier restoration of gastrointestinal function, and an earlier discharge from the hospital. The postoperative stress response is lower after laparoscopic colectomy. The incidence of port site metastases is1%. Survival after laparoscopic resection of colon cancer appears to be at least equal to survival after open resection. The costs of laparoscopic surgery for colon cancer are higher than those for open surgery.Laparoscopic resection of colon cancer is a safe and feasible procedure that improves short-term outcome. Results regarding the long-term survival of patients enrolled in large multicenter trials will determine its role in general surgery.
- Published
- 2004
12. Physical activity before radical prostatectomy reduces sick leave after surgery - results from a prospective, non-randomized controlled clinical trial (LAPPRO)
- Author
-
Angenete, E., primary, Angerås, U., additional, Börjesson, M., additional, Ekelund, J., additional, Gellerstedt, M., additional, Thorsteinsdottir, T., additional, Steineck, G., additional, and Haglind, E., additional
- Published
- 2016
- Full Text
- View/download PDF
13. No consensus on restrictions on physical activity to prevent incisional hernias after surgery
- Author
-
Pommergaard, H-C, Burcharth, J, Danielsen, Anne Kjaergaard, Angenete, E, Haglind, E, Rosenberg, Jacob, Pommergaard, H-C, Burcharth, J, Danielsen, Anne Kjaergaard, Angenete, E, Haglind, E, and Rosenberg, Jacob
- Abstract
PURPOSE: In the postoperative phase after colorectal surgery, restrictions on physical activity are often recommended for patients to prevent incisional hernias. However, evidence does not support that restrictions may prevent such hernias. The purpose of this study was to evaluate the extent of restrictions on physical activity recommended for patients operated for colorectal cancer and to evaluate the agreement among surgical specialists.METHODS: A questionnaire was sent to 60 general surgeons (specialists) in Denmark and Sweden working in academic departments of surgery with a high volume of colorectal cancer resections. The questionnaire was case based and contained questions regarding possible restrictions on physical activity recommended for patients 0-2, 2-6 and >6 weeks after resection for colorectal cancer. Agreement among the surgeon on whether restrictions should be recommended was analyzed.RESULTS: Forty-one surgeons answered the questionnaire (68.3 %). The probability that two randomly chosen specialists agreed on whether restrictions should be given was generally low for the first two time periods (0-2 and 2-6 weeks); however, at >6 weeks there was a high level of agreement. Moreover, the number of restrictions recommended was different between the 41 surgeons (p < 0.0005) and more restrictions were recommended for open compared with laparoscopic surgery (p < 0.0005).CONCLUSIONS: Major disagreements exist on the degree of restrictions on physical activity that should be recommended for patients after colorectal surgery. As there is no evidence to support that specific restrictions prevent hernia formation, these are merely based on personal preferences. Clinical studies in this area are therefore highly warranted.
- Published
- 2014
14. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer:a systematic review and meta-analysis
- Author
-
Pommergaard, Hans-Christian, Gessler, B, Burcharth, Jakob, Angenete, E, Haglind, E, Rosenberg, J, Pommergaard, Hans-Christian, Gessler, B, Burcharth, Jakob, Angenete, E, Haglind, E, and Rosenberg, J
- Abstract
AIM: Colorectal anastomotic leakage is a serious complication. Despite extensive research, no consensus on the most important preoperative risk factors exists. The aim of this systematic review and meta-analysis was to evaluate risk factors for anastomotic leakage in patients operated with colorectal resection.METHOD: The databases MEDLINE, Embase and CINAHL were searched for prospective observational studies on preoperative risk factors for anastomotic leakage. Meta-analyses were performed on outcomes based on odds ratios (OR) from multivariate regression analyses. The Newcastle-Ottawa scale was used for bias assessment within studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels.RESULTS: This review included 23 studies evaluating 110,272 patients undergoing colorectal resection for cancer. The meta-analyses found that a low rectal anastomosis [OR = 3.26 (95% CI: 2.31-4.62)], male gender [OR = 1.48 (95% CI: 1.37-1.60)] and preoperative radiotherapy [OR = 1.65 (95% CI: 1.06-2.56)] may be risk factors for anastomotic leakage. Primarily as a result of observational design, the quality of evidence was regarded as moderate or low for these risk factors according to the GRADE approach.CONCLUSION: Based on the best available evidence, important preoperative risk factors for colorectal anastomotic leakage have been identified. Knowledge on risk factors may influence treatment and procedure-related decisions, and possibly reduce the leakage rate.
- Published
- 2014
15. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II)
- Author
-
Andersson, J, Abis, G, Gellerstedt, M, Angenete, E, Angerås, U, Cuesta, M A, Jess, P, Rosenberg, J, Bonjer, H J, Haglind, E, Andersson, J, Abis, G, Gellerstedt, M, Angenete, E, Angerås, U, Cuesta, M A, Jess, P, Rosenberg, J, Bonjer, H J, and Haglind, E
- Abstract
BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer.METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms.RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences between laparoscopic and open approaches. An improvement in sexual dysfunction was seen in the first year, but some male sexual problems persisted. Before operation 64·5 per cent of men in the laparoscopic group and 55·6 per cent in the open group reported some degree of erectile dysfunction. This increased to 81·1 and 80·5 per cent respectively 4 weeks after surgery, and 76·3 versus 75·5 per cent at 12 months, with no significant differences between groups. Micturition symptoms were less affected than sexual function and gradually improved to preoperative levels by 6 months. Adjusting for confounders, including radiotherapy, did not change these results.CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this.REGISTRATION NUMBER: NCT0029779 (http://www.clinicaltrials.gov).
- Published
- 2014
16. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial
- Author
-
colon cancer laparoscopic group,, Buunen, Mark, Veldkamp, R (Ruben), Hop, Kuhry, E, Jeekel, J (Hans), Haglind, E, Pahlman, L, Cuesta, MA, Msika, S, Morino, M, Lacy, A, Bonjer, HJ (Jaap), Surgery, and Epidemiology
- Subjects
Laparoscopic surgery ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,MEDLINE ,Disease-Free Survival ,law.invention ,Randomized controlled trial ,SDG 3 - Good Health and Well-being ,law ,medicine ,Humans ,Laparoscopy ,Colectomy ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Open surgery ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,Oncology ,Colonic Neoplasms ,Female ,business - Abstract
Laparoscopic surgery for colon cancer has been proven safe, but debate continues over whether the available long-term survival data justify implementation of laparoscopic techniques in surgery for colon cancer. The aim of the COlon cancer Laparoscopic or Open Resection (COLOR) trial was to compare 3-year disease-free survival and overall survival after laparoscopic and open resection of solitary colon cancer.Between March 7, 1997, and March 6, 2003, patients recruited from 29 European hospitals with a solitary cancer of the right or left colon and a body-mass index up to 30 kg/m(2) were randomly assigned to either laparoscopic or open surgery as curative treatment in this non-inferiority randomised trial. Disease-free survival at 3 years after surgery was the primary outcome, with a prespecified non-inferiority boundary at 7% difference between groups. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, and blood loss during surgery. Neither patients nor health-care providers were blinded to patient groupings. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00387842.During the recruitment period, 1248 patients were randomly assigned to either open surgery (n=621) or laparoscopic surgery (n=627). 172 were excluded after randomisation, mainly because of the presence of distant metastases or benign disease, leaving 1076 patients eligible for analysis (542 assigned open surgery and 534 assigned laparoscopic surgery). Median follow-up was 53 months (range 0.03-60). Positive resection margins, number of lymph nodes removed, and morbidity and mortality were similar in both groups. The combined 3-year disease-free survival for all stages was 74.2% (95% CI 70.4-78.0) in the laparoscopic group and 76.2% (72.6-79.8) in the open-surgery group (p=0.70 by log-rank test); the difference in disease-free survival after 3 years was 2.0% (95% CI -3.2 to 7.2). The hazard ratio (HR) for disease-free survival (open vs laparoscopic surgery) was 0.92 (95% CI 0.74-1.15). The combined 3-year overall survival for all stages was 81.8% (78.4-85.1) in the laparoscopic group and 84.2% (81.1-87.3) in the open-surgery group (p=0.45 by log-rank test); the difference in overall survival after 3 years was 2.4% (95% CI -2.1 to 7.0; HR 0.95 [0.74-1.22]).Our trial could not rule out a difference in disease-free survival at 3 years in favour of open colectomy because the upper limit of the 95% CI for the difference just exceeded the predetermined non-inferiority boundary of 7%. However, the difference in disease-free survival between groups was small and, we believe, clinically acceptable, justifying the implementation of laparoscopic surgery into daily practice. Further studies should address whether laparoscopic surgery is superior to open surgery in this setting.
- Published
- 2009
17. PCN165 - Cost-Minimization Analysis of Laparoscopic and Open Surgery for Rectal Cancer
- Author
-
Gehrman, J, Björholt, I, Angenete, E, Andersson, J, Bonjer, J, and Haglind, E
- Published
- 2016
- Full Text
- View/download PDF
18. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial
- Author
-
Andersson, J, Angenete, E, Gellerstedt, M, Angerås, U, Jess, Per, Rosenberg, J, Fürst, A, Bonjer, J, Haglind, E, Andersson, J, Angenete, E, Gellerstedt, M, Angerås, U, Jess, Per, Rosenberg, J, Fürst, A, Bonjer, J, and Haglind, E
- Abstract
Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12¿months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial.
- Published
- 2013
19. Current controversies in colorectal surgery: the way to resolve uncertainty and move forward
- Author
-
Rosenberg, J, Fischer, A, Haglind, E, Jess, Per, Rosenberg, J, Fischer, A, Haglind, E, and Jess, Per
- Abstract
The are currently a number of unsolved clinical questions in colorectal surgery with new surgical principles being introduced without proper scientific high-level evidence. These include complete mesocolic excision with central ligation for colonic cancer, extralevator abdominoperineal excision for low rectal cancer, robotic surgery for various colorectal procedures, laparoscopic lavage without resection for Hinchey Stage III perforated sigmoid diverticulitis, and the use of the single port technique for laparoscopic surgery. Before general implementation the new modalities should ideally be evalueted in randomized studies and meta-analyses. Many randomized studies, however, cannot give the final answer to the research question because they are underpowered and it is therefore important to perform well-designed studies that are large enough to provide the final answer. A way forward could therefore be to form multicenter and even multinational research groups in order to ensure accrual of sufficient sample sizes.
- Published
- 2012
20. Laparoscopic extraperitoneal rectal cancer surgery : the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)
- Author
-
Siegel, R., Cuesta, M. A., Targarona, E., Bader, F. G., Morino, M., Corcelles, R., Lacy, A. M., Påhlman, Lars, Haglind, E., Bujko, K., Bruch, H. P., Heiss, M. M., Eikermann, M., Neugebauer, E. A. M., Siegel, R., Cuesta, M. A., Targarona, E., Bader, F. G., Morino, M., Corcelles, R., Lacy, A. M., Påhlman, Lars, Haglind, E., Bujko, K., Bruch, H. P., Heiss, M. M., Eikermann, M., and Neugebauer, E. A. M.
- Abstract
BACKGROUND: The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline. METHODS: An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference. RESULTS: Laparoscopic surgery for extraperitoneal (mid- and low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not inferior to the open in terms of disease-free survival, overall survival or local recurrence. Laparoscopic pelvic dissection may impair genitourinary and sexual function after rectal resection, like in open surgery. CONCLUSIONS: Laparoscopic surgery for mid- and low-rectal cancer can be recommended under optimal conditions. Still, most level 1 evidence is for colon cancer surgery rather than rectal cancer. Upcoming results from large randomised trials are awaited to strengthen the evidence for improved short-term resu
- Published
- 2011
- Full Text
- View/download PDF
21. COLOR II - A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer
- Author
-
Bonjer, H. J., Cuesta, M. A., Lacy, A. M., Haglind, E., Fuerst, A., Lange, J. F., Hop, W. C. J., Buunen, M., D'Hoore, A., Inglis, K., Jess, P., Bulut, O., Rosenberg, J., Christensen, M. Mark, Isalnieks, I., Jaeger, C., Kreis, M., Jeekel, J., van der Harst, E., Coenen, P. P. L. O., Gerhards, M. F., Bemelman, W., Jakimowicz, J. J., van Riet, Y. E. A., Hansson, B. M. E., Rosman, C., Neijenhuis, P. A., den Outer, A. J., Targarona, E. M., Balague, C., Delgado, S., Lujan, J., Garcia Molina, F. J., Skullman, S., Kurlberg, G., Läckberg, Z., Påhlman, Lars, Kressner, U., Matthiessen, P., Kim, Seon-Hahn, Bonjer, H. J., Cuesta, M. A., Lacy, A. M., Haglind, E., Fuerst, A., Lange, J. F., Hop, W. C. J., Buunen, M., D'Hoore, A., Inglis, K., Jess, P., Bulut, O., Rosenberg, J., Christensen, M. Mark, Isalnieks, I., Jaeger, C., Kreis, M., Jeekel, J., van der Harst, E., Coenen, P. P. L. O., Gerhards, M. F., Bemelman, W., Jakimowicz, J. J., van Riet, Y. E. A., Hansson, B. M. E., Rosman, C., Neijenhuis, P. A., den Outer, A. J., Targarona, E. M., Balague, C., Delgado, S., Lujan, J., Garcia Molina, F. J., Skullman, S., Kurlberg, G., Läckberg, Z., Påhlman, Lars, Kressner, U., Matthiessen, P., and Kim, Seon-Hahn
- Abstract
Introduction: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial. Methods: The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy analysis. Results: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the mid-rectum (41%). Conclusion: Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial. Completion of inclusion is expected by the end of 2009. Trial registration: Clinicaltrials.gov, identifier: NCT00297791 (www.clinicaltrials.gov).
- Published
- 2009
22. COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer
- Author
-
Buunen, M, Bonjer, H J, Hop, W C J, Haglind, E, Kurlberg, G, Rosenberg, J, Lacy, A M, Cuesta, M A, D'Hoore, A, Fürst, A, Lange, J F, Jess, P, Bulut, O, Poornoroozy, P, Jensen, K Juul, Christensen, M Mark, Lundhus, E, Ovesen, H, Birch, D, Iesalnieks, I, Jäger, C, Kreis, M, van riet, Y, van der Harst, E, Gerhards, M F, Bemelman, W A, Hansson, B M E, Neijenhuis, P A, Prins, H A, Balague, C, Targarona, E, Luján Mompeán, J A, Franco Osorio, J D, Garcia Molina, F J, Skullman, S, Läckberg, Z, Kressner, U, Matthiessen, P, Kim, S H, Poza, A Alfredo, Buunen, M, Bonjer, H J, Hop, W C J, Haglind, E, Kurlberg, G, Rosenberg, J, Lacy, A M, Cuesta, M A, D'Hoore, A, Fürst, A, Lange, J F, Jess, P, Bulut, O, Poornoroozy, P, Jensen, K Juul, Christensen, M Mark, Lundhus, E, Ovesen, H, Birch, D, Iesalnieks, I, Jäger, C, Kreis, M, van riet, Y, van der Harst, E, Gerhards, M F, Bemelman, W A, Hansson, B M E, Neijenhuis, P A, Prins, H A, Balague, C, Targarona, E, Luján Mompeán, J A, Franco Osorio, J D, Garcia Molina, F J, Skullman, S, Läckberg, Z, Kressner, U, Matthiessen, P, Kim, S H, and Poza, A Alfredo
- Abstract
Udgivelsesdato: 2009-May, INTRODUCTION: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial. METHODS: The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy analysis. RESULTS: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the mid-rectum (41%). CONCLUSION: Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial. Completion of inclusion is expected by the end of 2009. Trial registration: Clinicaltrials.gov, identifier: NCT00297791 (www.clinicaltrials.gov).
- Published
- 2009
23. Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer.
- Author
-
Kuhry, E, Bonjer, H J, Haglind, E, Hop, W C J, Veldkamp, R, Cuesta, M A, Jeekel, J, Påhlman, Lars, Morino, M, Lacy, A, Delgado, S, Kuhry, E, Bonjer, H J, Haglind, E, Hop, W C J, Veldkamp, R, Cuesta, M A, Jeekel, J, Påhlman, Lars, Morino, M, Lacy, A, and Delgado, S
- Published
- 2005
24. Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study
- Author
-
Bringman, S., Ek, A., Haglind, E., Heikkinen, T., Kald, Anders, Kylberg, F., Ramel, S., Wallon, Conny, Anderberg, B., Bringman, S., Ek, A., Haglind, E., Heikkinen, T., Kald, Anders, Kylberg, F., Ramel, S., Wallon, Conny, and Anderberg, B.
- Abstract
Background: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. Methods: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. Results: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). Conclusion: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.
- Published
- 2001
- Full Text
- View/download PDF
25. Is a dissection balloon beneficial in bilateral, totally extraperitoneal, endoscopic hernioplasty? A randomized, prospective, multicenter study
- Author
-
Bringman, S, Ek, Anna-Christina, Haglind, E, Heikkinen, TJ, Kald, Anders, Kylberg, F, Ramel, S, Wallon, Conny, Anderberg, B, Bringman, S, Ek, Anna-Christina, Haglind, E, Heikkinen, TJ, Kald, Anders, Kylberg, F, Ramel, S, Wallon, Conny, and Anderberg, B
- Abstract
Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to gain the initial working space in totally extraperitoneal endoscopic (TEP) hernioplasty, but this increases its cost. Forty-four men with bilateral, primary or recurrent inguinal hernias were randomized to undergo TEP with or without dissection balloon, There were two conversions to transabdominal preperitoneal hernioplasty, or open herniorrhaphy, in the group with balloon and four in the group without balloon. There was no difference in the postoperative morbidity or operation time between the two groups, and there were no major complications in either group. The recurrence rate was 4.3% in the group with the balloon and 7.1% in the group without the balloon. There were no statistically significant differences between the groups, Although our study population is too small to detect small differences between the groups, it seems that the use of a dissection balloon is not beneficial in a bilateral TEP.
- Published
- 2001
26. GROWTH FACTORS AND CATECHOLAMINES IN TRAUMA PATIENTS.
- Author
-
Haglind, E., primary, Svanberg, E., additional, Gellerstedt, M., additional, and Lang, C., additional
- Published
- 2004
- Full Text
- View/download PDF
27. L-ARGININE IMPROVED SHORT-TERM SURVIVAL AFTER INTESTINAL ISCHEMIA-REPERFUSION.
- Author
-
Haglind, E., primary and Nilsson, B., additional
- Published
- 1998
- Full Text
- View/download PDF
28. TNF AND INTERLEUKIN-6 LEVELS AND TRANS-LOCATION 24 H AFTER SMALL INTESTINAL ISCHEMIA-REPERFUSION (SIIR).
- Author
-
Haglind, E., primary
- Published
- 1996
- Full Text
- View/download PDF
29. MET-ENKEPHALIN AND CATHECHOLAMINE RELEASE FROM THE SMALL INTESTINE IN ISCHEMIA-REPERFUSION.
- Author
-
Haglind, E., primary, Medhak, S., additional, Watson, J. D., additional, and Åneman, A., additional
- Published
- 1995
- Full Text
- View/download PDF
30. REDUCED NO-SYNTHESIS IN THE GUT BY ENDOGENOUS NO-SYNTHASE INHIBITION DURING CARDIAC TAMPONADE IN PIGS.
- Author
-
Åneman, A, primary, Fändriks, L, additional, Backman, V, additional, Holm, M, additional, Pettersson, A, additional, and Haglind, E, additional
- Published
- 1995
- Full Text
- View/download PDF
31. 127; HEPATIC RETICULOENDOTHELIAL SYSTEM DYSFUNCTION IN INTESTINAL SHOCK
- Author
-
Haglind, E., primary, Wang, D., additional, and Klein, A. S., additional
- Published
- 1994
- Full Text
- View/download PDF
32. The role of 5-hydroxytryptamine in the feline response to intravenous infusion of live E. coli
- Author
-
Haglund U, S. Arvidsson, Haglind E, and Falk A
- Subjects
Ketanserin ,Time Factors ,Haemodynamic response ,Premedication ,Hemodynamics ,Blood Pressure ,Piperidines ,medicine ,Animals ,Lung ,Escherichia coli Infections ,Pharmacology ,Septic shock ,business.industry ,Blood flow ,medicine.disease ,Pulmonary hypertension ,Shock, Septic ,Intestines ,medicine.anatomical_structure ,Regional Blood Flow ,Anesthesia ,Vascular resistance ,cardiovascular system ,Cats ,Arterial blood ,Vascular Resistance ,business ,medicine.drug ,Research Article - Abstract
A standardized septic shock was induced in cats by intravenous infusion of a live E. coli bacteria strain. The bacterial infusion induced a rapid haemodynamic response characterized mainly by a pulmonary arterial hypertension and a late phase characterized by systemic hypotension and hypodynamic circulation. Systemic arterial, pulmonary arterial, portal venous, left atrial pressures, max inspiratory-expiratory pressure difference in the trachea, aortic and intestinal blood flows were monitored. Arterial blood samples were taken for recording the number of circulating platelets and white blood cells and for determining the acid-base balance. The effect of pretreatment with ketanserin, a specific 5-hydroxytryptamine2 (5-HT2)-receptor blocker on these haemodynamic reactions was studied. In short term experiments on non-bacteriaemic control cats, ketanserin prevented the pulmonary hypertension induced by intravenous 5-HT infusions but not the increase in intestinal blood flow. Ketanserin induced a reduction of total peripheral (including intestinal) vascular resistance to blood flow but had no effect on aortic blood flow. After infusion of bacteria, ketanserin pretreated cats were more hypotensive due to a relative peripheral dilatation of the resistance vessels. Ketanserin pretreatment had no effect on the pulmonary vascular reactions, the tracheal pressure difference or the number of circulating platelets or white blood cells. Thus, except for a more pronounced hypotension early after bacterial infusion, ketanserin pretreatment did not influence the haemodynamic response. It is concluded that 5-HT is not of significant importance in the pathogenesis of the haemodynamic reactions following experimental bacteraemia.
- Published
- 1983
33. The role of 5-hydroxytryptamine in the feline response to intravenous infusion of live E. coli
- Author
-
Arvidsson, S., primary, Falk, A., additional, Haglind, E., additional, and Haglund, U., additional
- Published
- 1983
- Full Text
- View/download PDF
34. METENKEPHALIN and CATHECHOLAMINE RELEASE FROM THE SMALL INTESTINE IN ISCHEMIAREPERFUSION
- Author
-
Haglind, E., Medhak, S., Watson, J. D., and Åneman, A.
- Published
- 1995
35. Long-Term Results After Laparoscopic Lavage for Perforated Diverticulitis Purulent Peritonitis in Sweden: A Population-Based Observational Study.
- Author
-
Samuelsson A, Bock D, Prytz M, Ehrencrona C, Wedin A, Angenete E, and Haglind E
- Abstract
Objective: To compare long-term outcomes after laparoscopic lavage with resection surgery for perforated diverticulitis, Hinchey grade III as practiced in Sweden for 3 years., Background: Laparoscopic lavage has been studied in 3 randomized controlled trials. Long-term results indicate that additional surgery and a remaining stoma are less common after lavage compared with resection, but data from routine care and larger cohorts are needed to get a more complete picture., Methods: LapLav is a national cohort study with nearly complete coverage of all patients operated in Sweden between 2016 and 2018. The cohort was retrieved from the national patient register by a definition based on the Classification of Diseases and Related Health Problems-10 code plus the surgical procedural code. All medical records have been reviewed and data retrieved in addition to registry data. Propensity score with inverse probability weighting was used to balance the 2 groups, that is, laparoscopic lavage vs resection surgery., Results: Before the propensity score was applied, the cohort consisted of 499 patients. Additional surgery was more common in the resection group [odds ratio, 0.714; 95% confidence interval (CI) = 0.529-0.962; P = 0.0271]. Mortality did not differ between the groups (hazard ratio, 1.20; 95% CI = 0.69-2.07; P = 0.516). In the lavage group, 27% of patients went on to have resection surgery., Conclusions: In Swedish routine care, laparoscopic lavage was feasible and safe for the surgical treatment of perforated diverticulitis, Hinchey grade III. Our results indicate that laparoscopic lavage can be used as a first-choice treatment., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
- Full Text
- View/download PDF
36. Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? - An emulated trial.
- Author
-
Ehrencrona C, Li Y, Angenete E, Haglind E, Franzén S, Grimby-Ekman A, and Bock D
- Subjects
- Female, Humans, Male, Anxiety epidemiology, Anxiety etiology, Anxiety Disorders, Bayes Theorem, Quality of Life, Randomized Controlled Trials as Topic, Cancer Survivors, Neoplasms complications, Neoplasms drug therapy, Neoplasms epidemiology
- Abstract
Background: High rates of negative intrusive thoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors., Methods: Data on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1 year after diagnosis, trial 2 had follow-up 2 years after diagnosis, baseline in both trials was 12 months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression., Results: Trial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2., Conclusions: The emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group., Trial Registration: The three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229)., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
37. Salvage radiotherapy after radical prostatectomy: functional outcomes in the LAPPRO trial after 8-year follow-up.
- Author
-
Carlsson S, Bock D, Lantz A, Angenete E, Koss Modig K, Hugosson J, Bjartell A, Steineck G, Wiklund P, and Haglind E
- Subjects
- Male, Humans, Follow-Up Studies, Prospective Studies, Hematuria etiology, Prostatectomy adverse effects, Prostatectomy methods, Salvage Therapy adverse effects, Prostatic Neoplasms radiotherapy, Prostatic Neoplasms surgery, Urinary Incontinence epidemiology, Urinary Incontinence etiology
- Abstract
Objective: Radical prostatectomy reduces mortality among patients with localized prostate cancer, however up to 35% of patients will experience biochemical recurrence, often treated with salvage radiotherapy. The objective of the study was to investigate long-term effects of salvage radiotherapy., Methods: A prospective, controlled, non-randomized trial at 14 Swedish center's including 4,003 patients scheduled for radical prostatectomy 2008-2011. A target trial emulation approach was used to identify eligible patients that was treated with salvage radiotherapy. The control group received no salvage radiotherapy. Outcomes were assessed by patient questionnaires on ordinal scales and statistical group comparisons were made using ordered logit regression with adjustment for baseline outcome and confounding factors. The primary endpoints were bowel, urinary and sexual function and bothering due to dysfunction at 8 years., Results: Eleven percent (330/3,139) of the analyzed study population received salvage radiotherapy. Fecal leakage, leakage of mucus and hematochezia were more common after receiving salvage radiotherapy compared with the control group; 4.5% versus 2.6% odds ratio (95% confidence interval [CI]): (1.90 [1.38; 2.62]), 6.8% versus 1.5% 4.14 (2.98; 5.76) and 8.6% versus 1.2% 4.14 (2.98; 5.76), respectively. Urinary incontinence, erectile dysfunction and hematuria were more common after receiving salvage radiotherapy, 34% versus 23% 2.23 (2.65; 3.00), 65% versus 57% 1.65 (1.18; 2.29) and 16% versus 1.6% 11.17 (5.68; 21.99), respectively., Conclusion: Salvage radiotherapy was associated with increased risk for fecal leakage, hematochezia, urinary incontinence and hematuria. Our results emphasize the importance of selecting patients for salvage radiotherapy to avoid overtreatment and to give high quality pre-treatment information to ensure patients' preparedness for late side-effects.
- Published
- 2023
- Full Text
- View/download PDF
38. Learning curve for robot-assisted laparoscopic radical prostatectomy in a large prospective multicentre study.
- Author
-
Bock D, Nyberg M, Lantz A, Carlsson SV, Sjoberg DD, Carlsson S, Stranne J, Steineck G, Wiklund P, Haglind E, and Bjartell A
- Subjects
- Humans, Learning Curve, Male, Margins of Excision, Prospective Studies, Prostatectomy methods, Treatment Outcome, Erectile Dysfunction epidemiology, Erectile Dysfunction etiology, Laparoscopy methods, Prostatic Neoplasms surgery, Robotic Surgical Procedures methods, Robotics, Urinary Incontinence epidemiology, Urinary Incontinence etiology
- Abstract
Objective: Differences in outcome after radical prostatectomy for prostate cancer can partly be explained by intersurgeon differences, where degree of experience is one important aspect. This study aims to define the learning curve of robot-assisted laparoscopic prostatectomy (RALP) regarding oncological and functional outcomes., Materials and Methods: Out of 4003 enrolled patients in the LAPPRO trial, 3583 met the inclusion criteria, of whom 885 were operated on by an open technique. In total, 2672 patients with clinically localized prostate cancer from seven Swedish centres were operated on by RALP and followed for 8 years (LAPPRO trial). Oncological outcomes were pathology-reported surgical margins and biochemical recurrence at 8 years. Functional outcomes included patient-reported urinary incontinence and erectile dysfunction at 3, 12 and 24 months. Experience was surgeon-reported experience before and during the study. The relationship between surgeon experience and functional outcomes and surgical margin status was analysed by mixed-effects logistic regression. Biochemical recurrence was analysed by Cox regression, with robust standard errors., Results: The learning curve for positive surgical margins was relatively flat, with rates of 21% for surgeons who had performed 0-74 cases and 24% for surgeons with > 300 cases. Biochemical recurrence at 4 years was 11% (0-74 cases) and 13% (> 300 cases). Incontinence was stable over the learning curve, but erectile function improved at 2 years, from 38% (0-74 cases) to 53% (> 300 cases)., Conclusions: Analysis of the learning curve for surgeons performing RALP showed that erectile function improved with increasing number of procedures, which was not the case for oncological outcomes.
- Published
- 2022
- Full Text
- View/download PDF
39. Degree of Preservation of Neurovascular Bundles in Radical Prostatectomy and Recurrence of Prostate Cancer.
- Author
-
Axén E, Godtman RA, Bjartell A, Carlsson S, Haglind E, Hugosson J, Lantz A, Månsson M, Steineck G, Wiklund P, and Stranne J
- Abstract
Background: Reports on possible benefits for continence with nerve-sparing (NS) radical prostatectomy have expanded the indications beyond preservation of erectile function. It is unclear whether NS surgery affects oncological outcomes., Objective: To determine whether the degree of NS during radical prostatectomy influences oncological outcomes., Design Setting and Participants: Of 4003 patients enrolled in a prospective, controlled trial comparing open and robotic radical prostatectomy during 2008-2011, we evaluated 2401 patients who received robotic radical prostatectomy at seven Swedish centres. Patients were followed for 8 yr., Outcome Measurements and Statistical Analysis: Data for recurrence and positive surgical margin status were assessed using validated patient questionnaires, patient interviews, and clinical record forms before and at 3, 12, and 24 mo and 6 and 8 yr after surgery. Cox and logistic regressions were used to model the effect on recurrence and positive surgical margins (PSM), respectively., Results and Limitations: A total of 481 men had PSM and 467 experienced recurrence during follow-up. Median follow-up for men without recurrence was 6.6 yr. There were no statistically significant differences in recurrence rate between degrees of NS. The PSM rate was significantly higher with a higher degree of NS: interfascial NS, odds ratio (OR) 2.32 (95% confidence interval [CI] 1.69-3.16); intrafascial NS, OR 3.23 (95% CI 2.17-4.80). Recurrence rates were higher for patients with pT2 disease and PSM (hazard ratio [HR] 3.32, 95% CI 2.43-4.53) than for patients with pT3 disease without PSM (HR 2.08, 95% CI 1.66-2.62). The lack of central review of pathological specimens is a limitation., Conclusions: A higher degree of NS significantly increased the risk of PSM but did not significantly increase the risk of cancer recurrence. Combined with the known functional benefits of NS surgery, these results underscore the need to identify an individualised balance., Patient Summary: In this report we looked at the effect of a nerve-sparing approach during removal of the prostate on cancer outcomes for patients having robot-assisted surgery at seven Swedish hospitals. We found that a high degree of nerve-sparing increased the rate of cancer positivity at the margins of surgical specimens and that positive surgical margins increased the risk of recurrence of prostate cancer., (© 2021 The Authors.)
- Published
- 2021
- Full Text
- View/download PDF
40. The perceived benefit of intraoperative stress modifiers for surgeons: an experimental simulation study in volunteers.
- Author
-
Erestam S, Bock D, Andersson AE, Haglind E, Park J, and Angenete E
- Abstract
Background: During surgery, surgeons often work under stressful conditions, which could affect patient safety. Reducing intraoperative stress for surgeons could benefit surgeons and subsequently patients. It is difficult to study stress and stress relief in real life situations due to the multitude of confounding factors. The aim of this study was to evaluate simulated intraoperative stressors on surgeons' stress levels and the effect of an intervention (pause including a sugar-containing drink) during standardized experiments (simulated operations)., Methods: An experimental interventional study was conducted using a simulator. The healthy surgeon volunteers were randomized to intervention and control in a cross-over design. Primary endpoint was salivary cortisol difference between a pause including a sugar containing drink (intervention) and controls. Secondary endpoints were change in heart rate, change in self-perceived stress measured by the State Trait Anxiety Inventory (STAI), and experience of the intraoperative pause. Endpoints were calculated with a mixed effect analysis of covariance (ANCOVA) model., Results: Seventeen surgeons performed 32 experiments. There was no statistically significant difference in salivary cortisol between simulations with and without a pause including a sugar-containing drink; percent reduction, 8% (0.92 (95%CI:0.72;1.18)), p-value = 0.469. The surgeons' self-estimation of intervention was positive, but there was no statistically significant difference in heart rate or STAI., Conclusions: The surgeons' experience of a pause including a drink was positive but there were no differences in physiological outcomes of the intervention. Lessons learned from this study could contribute to optimizing design of future studies., Trial Registration: Clinicaltrials.gov NCT04626648 , Registered November 6, 2020, retrospectively registered.
- Published
- 2021
- Full Text
- View/download PDF
41. Correction to: The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial.
- Author
-
Onerup A, Angenete E, Bock D, Börjesson M, Olsén MF, Gillheimer EG, Skullman S, Thörn SE, Haglind E, and Nilsson H
- Published
- 2020
- Full Text
- View/download PDF
42. Risk of Recurrent Disease 6 Years After Open or Robotic-assisted Radical Prostatectomy in the Prospective Controlled Trial LAPPRO.
- Author
-
Nyberg M, Akre O, Bock D, Carlsson SV, Carlsson S, Hugosson J, Lantz A, Steineck G, Stranne J, Tyritzis S, Wiklund P, Haglind E, and Bjartell A
- Abstract
Background: Conclusive evidence of superiority in oncological outcome for robot-assisted laparoscopic prostatectomy (RALP) over retropubic radical prostatectomy (RRP) is lacking., Objective: To compare RALP and RRP regarding recurrent disease and to report the mortality rate 6 yr after surgery., Design Setting and Participants: A total of 4003 men with localized prostate cancer were enrolled between 2008 and 2011 in Laparoscopic Prostatectomy Robot Open (LAPPRO)- a prospective, controlled, nonrandomized trial performed at 14 Swedish centers., Outcome Measurements and Statistical Analysis: Data were collected at visits and by patient questionnaires at 3, 12, and 24 mo, and through a structured telephone interview at 6 yr. Cause of death was retrieved from the National Cause of Death Register in Sweden. The modified Poisson regression approach was used for analyses., Results and Limitations: After adjustment for patient-, tumor-, and surgeon-related confounders, no statistically significant difference was observed between RALP and RRP in biochemical recurrence rate (14 vs 16%, relative risk [RR] 0.77, 95% confidence interval [CI] 0.56-1.06) or in not cured endpoint (22% vs 23%, RR 0.82, 95% CI 0.6-1.11). Stratified by D'Amico risk group, a significant benefit for RALP existed for recurrent disease in high-risk patients (RR 0.47, 95% CI 0.26-0.86, p = 0.02). All-cause mortality was 3% ( n = 96). Prostate cancer-specific mortality was 0.6% ( n = 21) overall, 0.3% ( n = 8) after RALP, and 1.5% ( n = 13) after RRP. The nonrandomized design is a limitation., Conclusions: No significant difference was observed for cancer recurrence rate between RALP and RRP 6 yr after surgery. However, in a subgroup analysis, we found a significant benefit for RALP regarding recurrence rate in the high-risk group. Larger studies with longer follow-up are needed to make a firm conclusion and to evaluate a possible survival benefit., Patient Summary: In general, the oncological outcome is comparable between robotic and open radical prostatectomy 6 yr after surgery. For high-risk patients, our findings indicate that there is an advantage for robotics, but further studies with longer follow-up time is needed to make a firm conclusion., (© 2020 Published by Elsevier B.V. on behalf of European Association of Urology.)
- Published
- 2020
- Full Text
- View/download PDF
43. Do negative intrusive thoughts at diagnosis predict impaired quality of life, depressed mood and waking up with anxiety 3, 12 and 24 months after radical prostatectomy? - a longitudinal study.
- Author
-
Bock D, Angenete E, Asplund D, Bjartell A, Carlsson S, Hugosson J, Stinesen Kollberg K, Lantz A, Nilsson H, Prytz M, Steineck G, Thorsteinsdottir T, Wiklund P, and Haglind E
- Subjects
- Aged, Forecasting, Humans, Longitudinal Studies, Male, Middle Aged, Sleep, Time Factors, Anxiety etiology, Attitude to Health, Depression etiology, Postoperative Complications etiology, Postoperative Complications psychology, Prostatectomy psychology, Prostatic Neoplasms psychology, Prostatic Neoplasms surgery, Quality of Life psychology, Thinking
- Abstract
Objective: To evaluate the effect of intrusive thoughts at diagnosis on quality of life, depressed mood and waking up with anxiety up to two years after radical prostatectomy. Method: The Laparoscopic Prostatectomy Robot Open (LAPPRO) trial was a prospective, longitudinal multicenter study of 4003 patients undergoing radical prostatectomy. Questionnaire data were collected preoperatively, at 3, 12 and 24 months after surgery. Results: The group of patients with intrusive thoughts at diagnosis had a statistically significant higher postoperative prevalence of impaired quality of life, depressed mood and waking up with anxiety as compared with the group of patients with no or minor intrusive thoughts. The highest risk increase for impaired QoL, depressed mood and waking up with anxiety ≥1/week was at 12, 3 and 3 months, respectively, where the three outcomes increased by 38% (RR: 1.38; 95%CI: 1.27-1.49)), 136% (RR: 2.36; 95%CI: 1.74-3.19)) and 165% (RR: 2.65; 95%CI: 2.22-3.17)), respectively. Conclusions: The demonstrated link between intrusive thoughts and quality of life, depressed mood and waking up with anxiety deliver is further evidence to the idea that intrusive thoughts has potential as an endpoint for assessing and predicting psychological distress among men with prostate cancer diagnosis. Trial registration number: ISRCTN06393679 (www.isrctn.com). Date of registration: 07/02/2008. Retrospectively registered.
- Published
- 2020
- Full Text
- View/download PDF
44. Agreement between patient reported outcomes and clinical reports after radical prostatectomy - a prospective longitudinal study.
- Author
-
Bock D, Angenete E, Bjartell A, Hugosson J, Steineck G, Walming S, Wiklund P, and Haglind E
- Subjects
- Adult, Aged, Electronic Health Records trends, Humans, Longitudinal Studies, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications psychology, Prospective Studies, Prostatectomy psychology, Prostatectomy trends, Prostatic Neoplasms epidemiology, Prostatic Neoplasms psychology, Prostatic Neoplasms surgery, Surveys and Questionnaires standards, Sweden epidemiology, Treatment Outcome, Electronic Health Records standards, Patient Reported Outcome Measures, Patient Satisfaction, Postoperative Complications diagnosis, Prostatectomy adverse effects
- Abstract
Background: In clinical research information can be retrieved through various sources. The aim is to evaluate the agreement between answers in patient questionnaires and clinical reports in a study of patients after radical prostatectomy and patient characteristics associated with agreement between these two data sources., Methods: In the prospective non-randomized longitudinal trial LAParoscopic Prostatectomy Robot Open (LAPPRO) 4003 patients undergoing radical prostatectomy at 14 centers in Sweden were followed. Analysis of agreement is made using a variety of methods, including the recently proposed Gwet's AC1, which enables us to handle the limitations of Cohen's Kappa where agreement depends on the underlying prevalence., Results: The incidence of postoperative events was consistently reported higher by the patient compared with the clinical reports for all outcomes. Agreement regarding the absence of events (negative agreement) was consistently higher than agreement regarding events (positive agreement) for all outcome variables. Overall impression of agreement depends on which measure used for the assessment. The previously reported desirable properties of Gwet's AC1 as well as the patient characteristics associated with agreement were confirmed., Conclusion: The differences in incidence and agreement across the different variables and time points highlight the importance of carefully assessing which source of information to use in clinical research., Trial Registration: ISRCTN06393679 ( www.isrctn.com ). Date of registration: 07/02/2008. Retrospectively registered.
- Published
- 2019
- Full Text
- View/download PDF
45. Association between operative technique and intrusive thoughts on health-related Quality of Life 3 years after APE/ELAPE for rectal cancer: results from a national Swedish cohort with comparison with normative Swedish data.
- Author
-
Prytz M, Ledebo A, Angenete E, Bock D, and Haglind E
- Subjects
- Aged, Colectomy adverse effects, Colectomy methods, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Odds Ratio, Prognosis, Rectal Neoplasms diagnosis, Rectal Neoplasms surgery, Registries, Sweden epidemiology, Treatment Outcome, Quality of Life, Rectal Neoplasms epidemiology
- Abstract
The aim of this prospective registry-based population study was to investigate the association between QoL 3 years after surgery for rectal cancer and intrusive thoughts and to assess the association with the type of surgery (i.e., APE or ELAPE) in a population-based national cohort. ELAPE has been proposed as a superior surgical technique for distal rectal cancer, but long-term effects on QoL are not known. There are also no studies on the association of negative intrusive thoughts on patients' self-reported Quality of Life following surgery for distal rectal cancer. Negative intrusive thoughts are regarded as a marker of incomplete cognitive processing of the psychological trauma caused by, for example, a cancer diagnosis. Intrusive thoughts have been recognized as an important factor associated Quality of Life outcome following surgery for other malignancies. All Swedish patients operated with any kind of abdominoperineal resection in the years 2007-2009 were identified through the Swedish ColoRectal Cancer Registry (SCRCR)-the APER population. All patients alive 3 years after surgery and willing to participate were included. Data were collected from three different sources: the registry, the original operative notes, and a study-specific questionnaire regarding health-related QoL answered by the patients. Questions on QoL from a normative reference population were also collected for comparison. Fifty-six percent of the APER population reported a low overall Quality of Life. There was no significant difference between the sexes. Among men, there was a difference in overall QoL, with a higher level in the normative population (48%) compared with the male APER population (39%). Overall QoL was compared to a normative Swedish population. Almost half of the patients experienced negative intrusive thoughts, which was associated with a lower overall Quality of Life. The frequency and severity of negative intrusive thoughts were significantly associated with a low overall QoL. There was no difference in overall QoL after standard, compared with extralevator abdominoperineal excision. A large proportion of survivors after abdominoperineal excision for rectal cancer has a Quality of Life compared with a normative population, but many suffer from negative intrusive thoughts, a symptom of stress, which significantly decrease overall Quality of Life., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
- Published
- 2018
- Full Text
- View/download PDF
46. Assessing health, quality of life and urogenital function in a sample of the Swedish general population: a cross-sectional study.
- Author
-
Bock D, Angenete E, Gonzales E, Heath J, and Haglind E
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Coitus, Cross-Sectional Studies, Depression, Female, Health Status, Humans, Male, Middle Aged, Prevalence, Sexual Dysfunction, Physiological complications, Sexual Dysfunction, Physiological epidemiology, Sexual Dysfunction, Physiological psychology, Stress, Psychological epidemiology, Surveys and Questionnaires, Sweden epidemiology, Defecation, Intestines, Quality of Life, Sexual Health, Stress, Psychological etiology, Urination, Urogenital System
- Abstract
Objective: Evaluate the urinary, bowel and sexual function as well as stress symptoms and depression in a sample of the Swedish population., Design: A random sample of Swedish men and women in age groups from 30 to 89 years, a total of 3000 individuals, were contacted and after receiving informed consent, a questionnaire was sent., Main Outcome Measures: Measures of urinary, bowel, sexual function and quality of life., Results: The questionnaire was sent to 2094 individuals who gave informed consent. The questionnaire was answered by 1078 individuals. Quality of life, stress symptoms and depressed mood were relatively constant across age groups for both men and women. Urinary function differed significantly across gender and age groups, but bowel function was relatively unaffected by age. Overall bowel dysfunction was slightly more prevalent among women compared with men. For both men and women, the frequency of intercourse or other sexual activities decreased with age, whereas sexually associated distress increased by age in men, but decreased among women., Conclusions: In a general population, the urinary function varied across age and sex. Overall bowel dysfunction was slightly more prevalent among women compared with men. Sexually associated distress increased by age for men, but decreased for women., Trial Registration Number: NCT02392923; Results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2018
- Full Text
- View/download PDF
47. The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial.
- Author
-
Onerup A, Angenete E, Bock D, Börjesson M, Fagevik Olsén M, Grybäck Gillheimer E, Skullman S, Thörn SE, Haglind E, and Nilsson H
- Subjects
- Clinical Protocols, Cost-Benefit Analysis, Exercise Therapy adverse effects, Exercise Therapy economics, Health Care Costs, Health Status, Humans, Length of Stay, Postoperative Care adverse effects, Postoperative Care economics, Preoperative Care adverse effects, Preoperative Care economics, Recovery of Function, Research Design, Return to Work, Sick Leave, Sweden, Time Factors, Treatment Outcome, Breathing Exercises adverse effects, Breathing Exercises economics, Colorectal Neoplasms surgery, Exercise, Exercise Therapy methods, Inhalation, Postoperative Care methods, Preoperative Care methods
- Abstract
Background: Surgery for colorectal cancer is associated with a high risk of post-operative adverse events, re-operations and a prolonged post-operative recovery. Previously, the effect of prehabilitation (pre-operative physical activity) has been studied for different types of surgery, including colorectal surgery. However, the trials on colorectal surgery have been of limited methodological quality and size. The aim of this trial is to compare the effect of a combined pre- and post-operative intervention of moderate aerobic physical activity and inspiratory muscle training (IMT) with standard care on post-operative recovery after surgery for colorectal cancer., Methods/design: We are conducting a randomised, controlled, parallel-group, open-label, multi-centre trial with physical recovery within 4 weeks after cancer surgery as the primary endpoint. Some 640 patients planned for surgery for colorectal cancer will be enrolled. The intervention consists of pre- and post-operative physical activity with increased daily aerobic activity of moderate intensity as well as IMT. In the control group, patients will be advised to continue their normal daily exercise routine. The primary outcome is patient-reported physical recovery 4 weeks post-operatively. Secondary outcomes are length of sick leave, complication rate and severity, length of hospital stay, re-admittances, re-operations, post-operative mental recovery, quality of life and mortality, as well as changes in insulin-like growth factor 1 and insulin-like growth factor-binding protein 3, perception of pain and a health economic analysis., Discussion: An increase in moderate-intensity aerobic physical activity is a safe, cheap and feasible intervention that would be possible to implement in standard care for patients with colorectal cancer. If shown to be effective, this lifestyle intervention could be a clinical parallel to pre-operative smoke cessation that has already been implemented with good clinical results., Trial Registration: ClinicalTrials.gov identifier: NCT02299596 . Registered on 17 November 2014.
- Published
- 2017
- Full Text
- View/download PDF
48. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia.
- Author
-
Walming S, Angenete E, Block M, Bock D, Gessler B, and Haglind E
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Incidence, Incisional Hernia epidemiology, Laparotomy adverse effects, Male, Middle Aged, Retrospective Studies, Risk Factors, Surgical Wound, Surgical Wound Dehiscence epidemiology, Suture Techniques adverse effects, Sutures, Sweden, Young Adult, Incisional Hernia etiology, Postoperative Complications epidemiology, Surgical Wound Dehiscence etiology, Surgical Wound Infection complications
- Abstract
Background: Several factors and patient characteristics influence the risk of surgical wound dehiscence and incisional hernia after midline laparotomy. The purpose of this study was to investigate whether a specified, or not specified, suture quota in the operative report affects the incidence of surgical wound complications and to describe the previously known risk factors for these complications., Methods: Retrospective data collection from medical records of all vascular procedures and laparotomies engaging the small intestines, colon and rectum performed in 2010. Patients were enrolled from four hospitals in the region Västra Götaland, Sweden. Unadjusted and adjusted Cox regression analyses were used when calculating the impact of the risk factors for surgical wound dehiscence and incisional hernia., Results: A total of 1,621 patients were included in the study. Wound infection was a risk factor for both wound dehiscence and incisional hernia. BMI 25-30, 30-35 and >35 were risk factors for wound dehiscence and BMI 30-35 was a risk factor for incisional hernia. We did not find that documentation of the details of suture technique, regarding wound and suture length, influenced the rate of wound dehiscence or incisional hernia., Conclusions: These results support previous findings identifying wound infection and high BMI as risk factors for both wound dehiscence and incisional hernia. Our study indicates the importance of preventive measures against wound infection and a preoperative dietary regiment could be considered as a routine worth testing for patients with high BMI planned for abdominal surgical precedures.
- Published
- 2017
- Full Text
- View/download PDF
49. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study.
- Author
-
Erestam S, Haglind E, Bock D, Andersson AE, and Angenete E
- Abstract
Background: Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork., Methods: This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention., Results: At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure., Conclusions: There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed., Trial Registration: NCT02329691.
- Published
- 2017
- Full Text
- View/download PDF
50. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer.
- Author
-
Nilsson H, Angerås U, Bock D, Börjesson M, Onerup A, Fagevik Olsen M, Gellerstedt M, Haglind E, and Angenete E
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Length of Stay, Male, Middle Aged, Postoperative Period, Prospective Studies, Quality of Life, Sick Leave, Surveys and Questionnaires, Sweden, Breast Neoplasms surgery, Convalescence, Exercise, Health Status, Lymph Node Excision, Mastectomy, Preoperative Care
- Abstract
Objective: The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery., Design: A prospective cohort study., Setting: Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden., Participants: Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level Saltin-Grimby Physical Activity Level Scale (SGPALS)., Main Outcome Measure: Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery., Results: 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks., Conclusions: The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active patients., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.