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9. Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries

Author

Dickson, E. A., Penna, M., Cunningham, C., Ratcliffe, F. M., Chantler, J., Crabtree, N. A., Tuynman, J. B., Albert, M. R., Monson, J. R. T., Hompes, R., Abdelmoaty, W., Adamina, M., Aigner, F., Alavi, K., Albers, B., Al Furajii, H., Allison, A., Eduardo, S., Araujo, A., Apostolides, G. Y., Arezzo, A., Arnold, S. J., Aryal, K., Ashamalla, S., Ashraf, Sana, Attaluri, V., Austin, R., Barugo-La, G., Beggs, A., Belgers, H. J., Bell, S., Bemelman, W., Berti, S., Biebl, M., Blondeel, J., Binky, B., Baloyiannis, I. -N., Bandyopadhyay, D., Boni, L., Bordeianou, L., Box, B., Boyce, S., Brokelman, W., Brown, C. J., Bruegger, L., Buchli, C., Christian Buchs, N., Bulut, O., Burt, C., Bursics, A., Cahill, R. A., Pablo Campana, J., Caricato, M., Caro-Tar-Rago, A., Casans, F., Cassinotti, E., Caycedo-Marulan-Da, A., Chadi, S. A., Chandrasinghe, P., Chaudhri, S., Chaumont, N., Chitsabesan, P., Coget, J., Collera, P., Coleman, M., Courtney, E. D., Dagbert, F., Dalton, S. J., Daniel, G., Clark, D. A., De-Drye, L., De La Torre, J., Dapri, G., Dayal, S. P., De Chaisemartin, C., Borja De Lacy, F., Blasco Delgado, O., Di Candido, F., Diaz Del Gobbo, G., De Graaf, E. J. R., Delrio, P., De Pooter, K., D'Hooge, P., Doornebosch, P., Duff, S., Du Jardin, P., Dzhumabaev, K. E., Tom Edwards, M., Egenvall, I., Espin, E., Eugenio, M., Egenvall, M. -I., Ravn Eriksen, J., Faerden, A. E., Faes, S., Simo Fernandez, V., Fichera, A., Fierens, J., Fierens, K., Forgan, T., Francis, N., Francombe, J., Francone, E., Francone, T., Gamage, B., Perez Garcia, J. A., Ethem Gecim, I., Van Geluwe, B., Gin-Gert, C., George, V., Gloeckler, M., Gogenur, I., Goulart, A., Grolich, T., Haas, E., Hameed, U., Hahnloser, D., Harikrishnan, A., Harris, G., Haunold, I., Hendrickse, C., Hendrickx, T., Heyns, M., Horwood, J., Huerga, D., Ito, M., Jarimba, A., Joeng, H. K. M., Jones, O., Jutten, G., Kala, Z., Kita, Y., Knol, J., Thengugal Kochupapy, R., Kneist, W., Kok, A. S. Y., Kusters, M., Lacy, A. M., Laka-Tos, M., Lal, R., Lakkis, Z., Leao, P., Lambrechts, A., Lee, L., Lelong, B., Leung, E., Lezoche, E., Sender Liberman, A., Lidder, P., An-Drade Lima, M., Loganathan, A., Lombana, L. J., Lorenzon, Laura, Loriz, H., Lukas, M., Lutrin, D., Mackey, P., Mamedli, Z. Z., Mansfield, S., Marcello, P., Marcoen, S., Romero Marcos, J. M., Marcy, T., Marecik, S., Marks, J., Marsanic, P., Mattacheo, A., Maun, D., May, D., Maykel, J. A., Mcarthur, D., Mccallum, I., Mccarthy, K., Mclemore, E. C., Ramon Sil-Viera Mendes, C., Messaris, E., Michalopoulos, A., Mikalauskas, S., Miles, A., Millan, M., Mills, S., Miskovic, D., Montroni, I., Moore, E., Moore, T., Mori, Simona, Morino, M., Muratore, A., Mutafchiyski, V., Myers, A., Van Nieuwenhove, Y., Nishizawa, Y., Ng, P., John Nolan, G., Obias, V., Ochsner, A., Hwan Oh, J., Onghena, T., Oommen, S., Orkin, B. A., Osman, K., Ouro, S., Panis, Y., Papavramidis, T., Von Papen, M., Papp, G., Paquette, I., Paraoan, M. T., Paredes, J. P., Pastor, C., Pattyn, P. R. L., Karim Perdawood, S., Wan Pei, C. F., Piehslinger, J., Penchev, D., Oliva Perez, R., Persiani, Roberto, Pfeffer, F., Terry Phang, P., Pokela, V., Picchetto, A., Poskus, E., Prieto, D., Que-Reshy, F. A., Ramcharan, S., Rauch, S., Rega, D., Reyes, J. C., Ris, F., Delgado Rivilla, S., Alexander Rockall, T., Roquete, P., Rossi, G., Ruffo, G., Sakai, Y. -S., Sands, D., Sao Juliao, G. P., Scala, Alessandro, Scala, D., Estevez Schwarz, L., Edmond Seid, V., Seitinger, G., Shaikh, I. A., Sharma, A., Siet-Ses, C., Singh, B., Helmer Sjo, O., Kyung Sohn, D., Sora-Via, C., Sosef, M. N., Spinelli, A., Speakman, C., Steele, S., Stephan, V., Stevenson, A. R. L., Stotland, P., Studer, P., Strypstein, S., Sylla, P., Szyszkowitz, A., Talwar, A., Tanis, P., Tejedor, P., Pastor Teso, E., Tognelli, J., Torkington, J., Tschann, P., Tuech, J. -J., Tuerler, A., Tzovaras, G., Ugolini, G., Vallribera, F., Vansteenkiste, F., Vangenechten, E., Verdaasdonk, E. G. G., Vilela, N., Walter, B., Warren, O. J., Visser, T., Warrier, S., Warner, M., Waru-Savitarne, J., Whiteford, M. H., Andreas Wik, T., Witzig, J. -A., Wolff, T., Wolthuis, A. M., Wynn, G., Ashraf S., Lorenzon L. (ORCID:0000-0001-6736-0383), Mori S., Persiani R. (ORCID:0000-0002-1537-5097), Scala A., Dickson, E. A., Penna, M., Cunningham, C., Ratcliffe, F. M., Chantler, J., Crabtree, N. A., Tuynman, J. B., Albert, M. R., Monson, J. R. T., Hompes, R., Abdelmoaty, W., Adamina, M., Aigner, F., Alavi, K., Albers, B., Al Furajii, H., Allison, A., Eduardo, S., Araujo, A., Apostolides, G. Y., Arezzo, A., Arnold, S. J., Aryal, K., Ashamalla, S., Ashraf, Sana, Attaluri, V., Austin, R., Barugo-La, G., Beggs, A., Belgers, H. J., Bell, S., Bemelman, W., Berti, S., Biebl, M., Blondeel, J., Binky, B., Baloyiannis, I. -N., Bandyopadhyay, D., Boni, L., Bordeianou, L., Box, B., Boyce, S., Brokelman, W., Brown, C. J., Bruegger, L., Buchli, C., Christian Buchs, N., Bulut, O., Burt, C., Bursics, A., Cahill, R. A., Pablo Campana, J., Caricato, M., Caro-Tar-Rago, A., Casans, F., Cassinotti, E., Caycedo-Marulan-Da, A., Chadi, S. A., Chandrasinghe, P., Chaudhri, S., Chaumont, N., Chitsabesan, P., Coget, J., Collera, P., Coleman, M., Courtney, E. D., Dagbert, F., Dalton, S. J., Daniel, G., Clark, D. A., De-Drye, L., De La Torre, J., Dapri, G., Dayal, S. P., De Chaisemartin, C., Borja De Lacy, F., Blasco Delgado, O., Di Candido, F., Diaz Del Gobbo, G., De Graaf, E. J. R., Delrio, P., De Pooter, K., D'Hooge, P., Doornebosch, P., Duff, S., Du Jardin, P., Dzhumabaev, K. E., Tom Edwards, M., Egenvall, I., Espin, E., Eugenio, M., Egenvall, M. -I., Ravn Eriksen, J., Faerden, A. E., Faes, S., Simo Fernandez, V., Fichera, A., Fierens, J., Fierens, K., Forgan, T., Francis, N., Francombe, J., Francone, E., Francone, T., Gamage, B., Perez Garcia, J. A., Ethem Gecim, I., Van Geluwe, B., Gin-Gert, C., George, V., Gloeckler, M., Gogenur, I., Goulart, A., Grolich, T., Haas, E., Hameed, U., Hahnloser, D., Harikrishnan, A., Harris, G., Haunold, I., Hendrickse, C., Hendrickx, T., Heyns, M., Horwood, J., Huerga, D., Ito, M., Jarimba, A., Joeng, H. K. M., Jones, O., Jutten, G., Kala, Z., Kita, Y., Knol, J., Thengugal Kochupapy, R., Kneist, W., Kok, A. S. Y., Kusters, M., Lacy, A. M., Laka-Tos, M., Lal, R., Lakkis, Z., Leao, P., Lambrechts, A., Lee, L., Lelong, B., Leung, E., Lezoche, E., Sender Liberman, A., Lidder, P., An-Drade Lima, M., Loganathan, A., Lombana, L. J., Lorenzon, Laura, Loriz, H., Lukas, M., Lutrin, D., Mackey, P., Mamedli, Z. Z., Mansfield, S., Marcello, P., Marcoen, S., Romero Marcos, J. M., Marcy, T., Marecik, S., Marks, J., Marsanic, P., Mattacheo, A., Maun, D., May, D., Maykel, J. A., Mcarthur, D., Mccallum, I., Mccarthy, K., Mclemore, E. C., Ramon Sil-Viera Mendes, C., Messaris, E., Michalopoulos, A., Mikalauskas, S., Miles, A., Millan, M., Mills, S., Miskovic, D., Montroni, I., Moore, E., Moore, T., Mori, Simona, Morino, M., Muratore, A., Mutafchiyski, V., Myers, A., Van Nieuwenhove, Y., Nishizawa, Y., Ng, P., John Nolan, G., Obias, V., Ochsner, A., Hwan Oh, J., Onghena, T., Oommen, S., Orkin, B. A., Osman, K., Ouro, S., Panis, Y., Papavramidis, T., Von Papen, M., Papp, G., Paquette, I., Paraoan, M. T., Paredes, J. P., Pastor, C., Pattyn, P. R. L., Karim Perdawood, S., Wan Pei, C. F., Piehslinger, J., Penchev, D., Oliva Perez, R., Persiani, Roberto, Pfeffer, F., Terry Phang, P., Pokela, V., Picchetto, A., Poskus, E., Prieto, D., Que-Reshy, F. A., Ramcharan, S., Rauch, S., Rega, D., Reyes, J. C., Ris, F., Delgado Rivilla, S., Alexander Rockall, T., Roquete, P., Rossi, G., Ruffo, G., Sakai, Y. -S., Sands, D., Sao Juliao, G. P., Scala, Alessandro, Scala, D., Estevez Schwarz, L., Edmond Seid, V., Seitinger, G., Shaikh, I. A., Sharma, A., Siet-Ses, C., Singh, B., Helmer Sjo, O., Kyung Sohn, D., Sora-Via, C., Sosef, M. N., Spinelli, A., Speakman, C., Steele, S., Stephan, V., Stevenson, A. R. L., Stotland, P., Studer, P., Strypstein, S., Sylla, P., Szyszkowitz, A., Talwar, A., Tanis, P., Tejedor, P., Pastor Teso, E., Tognelli, J., Torkington, J., Tschann, P., Tuech, J. -J., Tuerler, A., Tzovaras, G., Ugolini, G., Vallribera, F., Vansteenkiste, F., Vangenechten, E., Verdaasdonk, E. G. G., Vilela, N., Walter, B., Warren, O. J., Visser, T., Warrier, S., Warner, M., Waru-Savitarne, J., Whiteford, M. H., Andreas Wik, T., Witzig, J. -A., Wolff, T., Wolthuis, A. M., Wynn, G., Ashraf S., Lorenzon L. (ORCID:0000-0001-6736-0383), Mori S., Persiani R. (ORCID:0000-0002-1537-5097), and Scala A.

Abstract

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying r

Published
2019

12. Risk factors for anastomotic leakage following ileosigmoid or ileorectal anastomosis

Author

Segelman, J., Mattsson, I., Jung, Bärbel, Nilsson, P. J., Palmer, G., Buchli, C., Segelman, J., Mattsson, I., Jung, Bärbel, Nilsson, P. J., Palmer, G., and Buchli, C.

Abstract

Aim Reconstruction with an ileosigmoidal anastomosis (ISA) or ileorectal anastomosis (IRA) is a surgical option after a subtotal colectomy. Anastomotic leakage (AL) is a problematic complication and high rates have been reported, but there is limited understanding of the risk factors involved. The aim of this study was to assess the established and potential predictors of AL following ISA and IRA. Method This was a retrospective cohort study including all patients who had undergone ISA or IRA at three Swedish referral centres for colorectal surgery between January 2007 and March 2015. Data regarding clinical characteristics, treatment and outcome were collected from medical records. Univariate and multivariate logistic regression models were used to determine the association between patient and treatment related factors and the cumulative incidence of AL. Results In total, 227 patients were included. Overall, AL was detected amongst 30 patients (13.2%). Amongst patients undergoing colectomy with synchronous ISA or IRA (one‐stage procedure), AL occurred in 23 out of 120 (19.2%) compared with seven out of 107 (6.5%) after stoma reversal with ISA or IRA (two‐stage procedure) (P = 0.004). In addition, the multivariate analyses revealed a statistically significantly lower odds ratio for AL following a two‐stage procedure (OR 0.10, 95% CI 0.03–0.41, P = 0.001). Conclusions This study confirms high rates of AL following ISA and IRA. In particular, a synchronous procedure with colectomy and ISA/IRA carries a high risk of AL., Funding Agencies|Stockholm Community Council; Karolinska Institutet; Bengt Ihre Foundation; Bengt Ihre Research Fellowship

Published
2018
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13. Effect of radiotherapy for rectal cancer on female sexual function: a prospective cohort study.

Author

Svanström Röjvall, A., Buchli, C., Bottai, M., Ahlberg, M., Flöter‐Rådestad, A., Martling, A., and Segelman, J.

Subjects
*RECTAL cancer, *OVARIAN function tests, *LONGITUDINAL method, *CANCER radiotherapy, *ANTI-Mullerian hormone, *OVARIAN reserve
Abstract

Antecedentes: La experiencia clínica y los datos limitados que han sido publicados indican que la radioterapia (RT) preoperatoria por cáncer rectal influye negativamente en la función sexual femenina. El obejtivo de este estudio fue investigar prospectivamente el impacto de la RT en la funcion sexual y en la reserva ovárica evaluada por el nivel de hormona antimülleriana (anti‐Müllerian hormone, AMH). Métodos: Las mujeres con cáncer rectal estadio I‐III en las que se planeaba un tratamiento quirúrgico con o sin (quimio)radioterapia ((chemo)radiotherapy (C)RT)) se incluyeron en el estudio y fueron seguidas durante 2 años. Se recogieron datos a nivel basal y durante el seguimiento del cuestionario del índice de función sexual femenina (Female Sexual Function Index, FSFI), así como se obtuvieron muestras de sangre para los análisis hormonales, incluyendo AMH en mujeres de ≤ 45 años de edad. Resultados: En el grupo expuesto a RT (n = 109), la mediana de las puntuaciones disminuyó a lo largo del tiempo en todos los dominios del FSFI y en la puntuación total del FSFI (de 18,5 (2,0‐36) a 10,8 (2,0‐34,8), P < 0,001). En el grupo no expuesto a RT (n = 30), solamente el grado de satosfacciòn disminuyó a lo largo del tiempo (de 3,2 (0,8‐6,0) a 1,8 (0,8‐6,0), P = 0,012). En el análisis longitudinal de regresión, la disminución media de la puntuación total del FSFI fue de ‐9,33 (i.c. del 95% ‐16,66; ‐1,99), P = 0,013) en el grupo expuesto a RT en comparacion con las mujeres no expuestas, durante los 2 años postoperatorios, ajustado por edad, índice de bienestar psicológico (Psychological General Well Being Index, PGWI) y vida en pareja. Se observó una asociación correspondiente con la exitación, lubricación, orgasmo y dolor. Cinco de seis mujeres de ≤ 45 años de edad con niveles séricos detectables de AMH en situación basal presentaron niveles indetectables tras la RT. Conclusión: La RT preoperatoria se asociaba con alteración de la función sexual en mujeres con cáncer rectal. Este aspecto debe ser considerado a la hora de discutir la eleccion del tratamiento y la rehabilitación. En mujeres jóvenes, los niveles indetectables de AMH tras la RT indican una pérdida irreversible de folículos ováricos. [ABSTRACT FROM AUTHOR]

Published
2020
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17. Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose–response study in young healthy men

Author

Tapper, J., primary, Arver, S., additional, Pencina, K. M., additional, Martling, A., additional, Blomqvist, L., additional, Buchli, C., additional, Li, Z., additional, Gagliano‐Jucá, T., additional, Travison, T. G., additional, Huang, G., additional, Storer, T. W., additional, Bhasin, S., additional, and Basaria, S., additional

Published
2017
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18. Low anterior resection syndrome after right‐ and left‐sided resections for colonic cancer.

Author

Buchli, C., Martling, A., and Sjövall, A.

Subjects
COLON cancer, SURGICAL excision, QUALITY of life
Abstract

Background: This population‐based cohort study aimed to evaluate occurrence of low anterior resection syndrome (LARS) and correlate this to health‐related quality of life in patients who had undergone segmental colonic resection for colonic cancer in the Stockholm–Gotland region. The hypothesis was that there is a difference in occurrence of LARS depending on whether a right‐ or a left‐sided resection was performed. Methods: Patients who underwent segmental colonic resection for colonic cancer stages I–III in the Stockholm–Gotland region in 2013–2015 received EORTC QLQ‐C30, QLQ‐CR29 and LARS score questionnaires 1 year after surgery. Clinical patient and tumour data were collected from the Swedish ColoRectal Cancer Registry. Patient‐reported outcome measures were analysed in relation to type of colonic resection. Results: Questionnaires were sent to 866 patients and complete responses were provided by 517 (59·7 per cent). After right‐sided resection 20·6 per cent reported major LARS. After left‐sided resection the proportion with major LARS was 15·6 per cent. The odds ratio (OR) for major LARS after right‐sided resection was 1·45 (95 per cent c.i. 1·02 to 2·06; P = 0·037) compared with left‐sided resection. After adjustment for age and sex, an increase in the risk of major LARS after right‐ versus left‐sided resection remained (OR 1·48, 1·03 to 2·13; P = 0·035). Major LARS correlated with impaired quality of life. Conclusion: Major LARS was more frequent after right‐sided than following left‐sided colonic resection. Major LARS reflected impaired quality of life. [ABSTRACT FROM AUTHOR]

Published
2019
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26. Survival after surgery beyond total mesorectal excision for primary locally advanced rectal cancer, a population-based study.

Author

Bolmstrand B, Nilsson PJ, Eloranta S, Martling A, Buchli C, and Palmer G

Abstract

Background: The aim of this study was to compare relative survival in non-metastatic rectal cancer clinically staged as T3-T4 requiring beyond total mesorectal excision (TME) to that after standard TME., Methods: This population-based study included all patients operated with anterior resection, abdominoperineal excision or Hartmann's procedure for non-metastatic rectal cancer clinically staged as T3-T4 in Sweden between 2009 and 2018. Relative survival was analysed in relation to surgery beyond TME (bTME), which was subcategorized as bTME- and bTME + to account for extent of resection. In all survival analyses, follow-up started at 90 days after surgery. Based on a causal model defined a priori excess mortality rate ratios (EMRR) were estimated using Poisson regression., Results: Of 8272 included patients 1220 (14.7 %) were operated bTME. In a model adjusted for age and sex bTME was associated with higher excess mortality compared to standard TME (EMRR: 1.76, 95%CI:1.52-2.04). This association persisted after additional adjustment for tumour characteristics, neoadjuvant therapy and hospital volume (EMRR: 1.32, 95%CI:1.11-1.56) and was mainly attributable to restricted relative survival after bTME- (EMRR: 1.42, 95%CI:1.18-1.72) as EMRR after bTME+ was 1.07 (95%CI:0.80-1.44)., Conclusion: This national population-based study showed inferior relative survival after bTME compared to standard TME in non-metastasized rectal cancer cT3-cT4. Unexpectedly this difference was mainly seen after bTME of limited extent., (Copyright © 2024. Published by Elsevier Ltd.)

Published
2024
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27. Bone turnover biomarkers reflect radiation-induced bone injuries in women with non-metastatic rectal cancer.

Author

Magnusson P, Sääf M, Martling A, Svanström Röjvall A, Atanasova D, Wilamowski F, Flöter Rådestad A, Buchli C, and Segelman J

Abstract

Preoperative radiotherapy (RT) for non-metastatic rectal cancer reduces local recurrence rates but can cause pelvic insufficiency fractures. Despite the high morbidity from RT-induced skeletal injuries, predictive and preventive measures are lacking. How these injuries are reflected by bone biomarkers are largely unknown. The aim was to assess longitudinal changes in bone biomarkers and their relation to RT-related bone injuries in women with rectal cancer. This longitudinal cohort study includes 47 women with non-metastatic rectal cancer treated with surgery ± preoperative RT with or without chemotherapy. Sclerostin, bioactive sclerostin, C-terminal telopeptide cross-links of collagen type I (CTX), bone-specific alkaline phosphatase (BALP), and type I procollagen intact N-terminal propeptide (PINP) were measured at baseline, after RT, and 1 yr postoperatively. Pelvic magnetic resonance imaging was used for detection of skeletal injury. Sixteen of 36 (44%) irradiated women had radiation-induced bone injuries and were compared to 11 women (RT-) and 20 women (RT+) without bone injuries. Serum CTX, BALP, and PINP increased during the first year after RT in women with radiation-induced bone injuries. The difference in mean change of CTX ( p =.037) and BALP ( p =.042) was conferred by longitudinal regression analyses adjusted for serum estradiol. Serum sclerostin and bioactive sclerostin remained stable over time. Taken together, bone markers may be of interest for future research on fracture prediction or preventive measures in women susceptible to radiation-induced bone injury. Due to few measure points, the full pattern cannot be captured regarding the relation over time between bone biomarkers and skeletal injury from irradiation., Competing Interests: P.M., M.S., A.M., A.S.R., D.A., F.W., A.F.R., C.B., and J.S. report no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)

Published
2024
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28. Preoperative use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diuretics increases the risk of dehydration after ileostomy formation: population-based cohort study.

Author

de la Motte L, Nordenvall C, Martling A, and Buchli C

Subjects
Humans, Male, Female, Aged, Sweden epidemiology, Middle Aged, Risk Factors, Rectal Neoplasms surgery, Postoperative Complications epidemiology, Postoperative Complications etiology, Cohort Studies, Aged, 80 and over, Incidence, Registries, Preoperative Care methods, Angiotensin Receptor Antagonists therapeutic use, Angiotensin Receptor Antagonists adverse effects, Angiotensin-Converting Enzyme Inhibitors adverse effects, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Ileostomy adverse effects, Dehydration epidemiology, Patient Readmission statistics & numerical data, Diuretics adverse effects, Diuretics therapeutic use
Abstract

Background: Readmission rates following ileostomy formation are high. Dehydration and consecutive renal failure are common causes of readmission, potentially pronounced by drugs affecting the homeostasis. The aim of the study was to assess the risk of dehydration after ileostomy formation in patients treated with angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) or diuretics., Method: This nationwide population-based cohort study used data derived from the Colorectal Cancer Data Base of several Swedish healthcare registers. The study included all patients operated on with elective anterior resection and temporary ileostomy for rectal cancer clinically staged I-III in Sweden in 2007-2016. Exposure was at least two dispensations of ACEI, ARB or diuretics within 1 year prior to surgery. Outcome was 90-day readmission due to dehydration including acute renal failure., Results: In total, 3252 patients were included with 1173 (36.1%) exposed to ACEI, ARB or diuretics. The cumulative incidence for 90-day readmission due to dehydration was 29.0% (151 of 520) for exposed versus 13.8% (98 of 712) for unexposed. The proportion of readmissions due to any reason was 44.3% (520 of 1173) for exposed compared to 34.2% (712 of 2079) for unexposed. The incidence rate ratio for readmission due to dehydration was 2.83 (95% c.i. 2.21 to 3.63, P < 0.001). The hazard rate ratio was 2.45 (95% c.i. 1.83 to 3.27, P < 0.001) after adjusting for age, gender and comorbidity., Conclusion: Medication with ACEI, ARB or diuretics defines a vulnerable patient group with increased risk of readmission due to dehydration after ileostomy formation., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)

Published
2024
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29. The augmented value of using clinical notes in semi-automated surveillance of deep surgical site infections after colorectal surgery.

Author

Verberk JDM, van der Werff SD, Weegar R, Henriksson A, Richir MC, Buchli C, van Mourik MSM, and Nauclér P

Subjects
Humans, Retrospective Studies, Cohort Studies, Predictive Value of Tests, Surgical Wound Infection diagnosis, Surgical Wound Infection prevention & control, Colorectal Surgery adverse effects
Abstract

Background: In patients who underwent colorectal surgery, an existing semi-automated surveillance algorithm based on structured data achieves high sensitivity in detecting deep surgical site infections (SSI), however, generates a significant number of false positives. The inclusion of unstructured, clinical narratives to the algorithm may decrease the number of patients requiring manual chart review. The aim of this study was to investigate the performance of this semi-automated surveillance algorithm augmented with a natural language processing (NLP) component to improve positive predictive value (PPV) and thus workload reduction (WR)., Methods: Retrospective, observational cohort study in patients who underwent colorectal surgery from January 1, 2015, through September 30, 2020. NLP was used to detect keyword counts in clinical notes. Several NLP-algorithms were developed with different count input types and classifiers, and added as component to the original semi-automated algorithm. Traditional manual surveillance was compared with the NLP-augmented surveillance algorithms and sensitivity, specificity, PPV and WR were calculated., Results: From the NLP-augmented models, the decision tree models with discretized counts or binary counts had the best performance (sensitivity 95.1% (95%CI 83.5-99.4%), WR 60.9%) and improved PPV and WR by only 2.6% and 3.6%, respectively, compared to the original algorithm., Conclusions: The addition of an NLP component to the existing algorithm had modest effect on WR (decrease of 1.4-12.5%), at the cost of sensitivity. For future implementation it will be a trade-off between optimal case-finding techniques versus practical considerations such as acceptability and availability of resources., (© 2023. The Author(s).)

Published
2023
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30. External validation of semi-automated surveillance algorithms for deep surgical site infections after colorectal surgery in an independent country.

Author

van der Werff SD, Verberk JDM, Buchli C, van Mourik MSM, and Nauclér P

Subjects
Humans, Surgical Wound Infection diagnosis, Algorithms, Anti-Bacterial Agents therapeutic use, Colorectal Surgery adverse effects, Digestive System Surgical Procedures adverse effects
Abstract

Background: Automated surveillance methods that re-use electronic health record data are considered an attractive alternative to traditional manual surveillance. However, surveillance algorithms need to be thoroughly validated before being implemented in a clinical setting. With semi-automated surveillance patients are classified as low or high probability of having developed infection, and only high probability patients subsequently undergo manual record review. The aim of this study was to externally validate two existing semi-automated surveillance algorithms for deep SSI after colorectal surgery, developed on Spanish and Dutch data, in a Swedish setting., Methods: The algorithms were validated in 225 randomly selected surgeries from Karolinska University Hospital from the period January 1, 2015 until August 31, 2020. Both algorithms were based on (re)admission and discharge data, mortality, reoperations, radiology orders, and antibiotic prescriptions, while one additionally used microbiology cultures. SSI was based on ECDC definitions. Sensitivity, specificity, positive predictive value, negative predictive value, and workload reduction were assessed compared to manual surveillance., Results: Both algorithms performed well, yet the algorithm not relying on microbiological culture data had highest sensitivity (97.6, 95%CI: 87.4-99.6), which was comparable to previously published results. The latter algorithm aligned best with clinical practice and would lead to 57% records less to review., Conclusions: The results highlight the importance of thorough validation before implementation in other clinical settings than in which algorithms were originally developed: the algorithm excluding microbiology cultures had highest sensitivity in this new setting and has the potential to support large-scale semi-automated surveillance of SSI after colorectal surgery., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Published
2023
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31. Quality of life and patient reported symptoms after colorectal cancer in a Swedish population.

Author

Sjövall A, Lagergren P, Johar A, and Buchli C

Subjects
Humans, Quality of Life, Sweden, Cohort Studies, Postoperative Complications epidemiology, Surveys and Questionnaires, Patient Reported Outcome Measures, Colorectal Neoplasms surgery, Rectal Neoplasms therapy
Abstract

Aim: A proportion of patients treated for colorectal cancer have impaired quality of life (QoL) but it is uncertain if the level of QoL differs from the corresponding background population. This population-based cohort study aimed to evaluate health-related QoL in colorectal cancer patients and compare their QoL with that of a Swedish reference population., Methods: Patients who underwent surgery for colorectal cancer Stages I-III in the Stockholm-Gotland region in 2013-2015 received the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the QLQ-CR29 questionnaires and the low anterior resection syndrome score, 1 year after surgery. Patient and tumour data were collected from the Swedish Colorectal Cancer Registry. The patient cohort was matched to a Swedish reference population regarding EORTC QLQ-C30. Global QoL was compared to the reference population and a patient group with impaired QoL was defined. Detailed patient-reported outcomes were analysed in relation to global QoL in the patient cohort., Results: A total of 925 patients returned the questionnaires and 358 patients (38.70%) reported a clinically relevant impaired global QoL compared to the reference population. Patients with impaired QoL reported clinically relevant and statistically significantly more complaints regarding bowel habits, pain and anxiety. After adjustment for sex, age and stoma, anxiety was the strongest predictor for impaired QoL, with OR 6.797 (95% CI 4.677-9.879)., Conclusion: A substantial proportion of patients treated for colorectal cancer have impaired global QoL. This impairment is strongly associated with several physical symptoms and anxiety., (© 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Published
2023
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32. Long-term opioid use following bicycle trauma: a register-based cohort study.

Author

Zibung E, von Oelreich E, Eriksson J, Buchli C, Nordenvall C, and Oldner A

Subjects
Humans, Cohort Studies, Bicycling, Logistic Models, Practice Patterns, Physicians', Retrospective Studies, Analgesics, Opioid therapeutic use, Opioid-Related Disorders drug therapy
Abstract

Purpose: Chronic opioid use is a significant public health burden. Orthopaedic trauma is one of the main indications for opioid prescription. We aimed to assess the risk for long-term opioid use in a healthy patient cohort., Methods: In this matched cohort study, bicycle trauma patients from a Swedish Level-I-Trauma Centre in 2006-2015 were matched with comparators on age, sex, and municipality. Information about dispensed opioids 6 months prior until 18 months following the trauma, data on injuries, comorbidity, and socioeconomic factors were received from national registers. Among bicycle trauma patients, the associations between two exposures (educational level and injury to the lower extremities) and the risk of long-term opioid use (> 3 months after the trauma) were assessed in multivariable logistic regression models., Results: Of 907 bicycle trauma patients, 419 (46%) received opioid prescriptions, whereof 74 (8%) became long-term users. In the first quarter after trauma, the mean opioid use was significantly higher in the trauma patients than in the comparators (253.2 mg vs 35.1 mg, p < 0.001) and fell thereafter to the same level as in the comparators. Severe injury to the lower extremities was associated with an increased risk of long-term opioid use [OR 4.88 (95% CI 2.34-10.15)], whereas high educational level had a protecting effect [OR 0.42 (95% CI 0.20-0.88)]., Conclusion: The risk of long-term opioid use after a bicycle trauma was low. However, opioids should be prescribed with caution, especially in those with injury to lower extremities or low educational level., (© 2022. The Author(s).)

Published
2023
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33. Impact of radiotherapy on bone health in women with rectal cancer - A prospective cohort study.

Author

Svanström Röjvall A, Buchli C, Sääf M, Magnusson P, Flöter Rådestad A, Martling A, and Segelman J

Subjects
Humans, Female, Prospective Studies, Bone Density, Cross-Sectional Studies, Biomarkers, Procollagen, Rectal Neoplasms radiotherapy
Abstract

Introduction: Pelvic radiotherapy (RT) increases the risk of pelvic insufficiency fractures. The aim was to investigate if RT is associated with changes in serum bone biomarkers in women with rectal cancer, and to examine the incidence of radiation-induced bone injuries and the association with bone biomarkers., Material and Methods: Women diagnosed with rectal cancer stage I-III, planned for abdominal surgery ± preoperative (chemo) RT, were prospectively included and followed one year. Serum bone biomarkers comprised sclerostin (regulatory of bone formation), CTX (resorption), BALP and PINP (formation). A subgroup was investigated with annual pelvic magnetic resonance imaging (MRI). The association between RT and bone biomarkers was explored in regression models., Results: Of 134 included women, 104 had surgery with preoperative RT. The formation markers BALP and PINP increased from baseline to one year in the RT-exposed group (p < 0.001, longitudinal comparison). In the adjusted regression analysis, the mean increase in PINP was higher in the RT-exposed than the unexposed group (17.6 (3.6-31.5) μg/L, p = 0.013). Sclerostin and CTX did not change within groups nor differed between groups. Radiation-induced injuries were detected in 16 (42%) of 38 women with available MRI. At one year, BALP was higher among women with than without bone injuries (p = 0.018, cross-sectional comparison)., Conclusions: Preoperative RT was associated with an increase in the formation marker PINP, which could represent bone recovery following RT-induced injuries, commonly observed in participants evaluated with MRI. These findings should be further explored in larger prospective studies on bone health in rectal cancer patients., Competing Interests: Declaration of interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2022
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34. Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study.

Author

Svanström Röjvall A, Buchli C, Flöter Rådestad A, Martling A, and Segelman J

Subjects
Female, Humans, Libido, Orgasm, Prospective Studies, Surveys and Questionnaires, Androgens, Rectal Neoplasms surgery
Abstract

Background: Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production., Aim: To investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer., Methods: Women diagnosed with stage I-III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography-mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women., Outcomes: The primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort., Results: In the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 - 36.0) to 16.4 (3.5 - 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 - 5.97) and 1.39 (0.46 - 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains., Strengths and Limitations: This is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations., Conclusion and Clinical Implication: Testosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors. Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study. J Sex Med 2021;18:1374-1382., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2021
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35. Oncological outcomes after complete mesocolic excision in right-sided colon cancer: a population-based study.

Author

Bernhoff R, Sjövall A, Granath F, Holm T, Martling A, and Buchli C

Subjects
Colectomy, Humans, Lymph Node Excision, Prospective Studies, Colonic Neoplasms surgery, Laparoscopy, Mesocolon surgery
Abstract

Aim: Complete mesocolic excision (CME) has been proposed as the preferred surgical technique for resection of colon cancer. This prospective cohort study evaluates the effect of CME surgery on colon cancer mortality after right-sided hemicolectomy on a population level., Methods: Data from the Swedish Colorectal Cancer Registry and the Cause of Death Registry on all patients treated with elective right-sided hemicolectomy for colon cancer Stages I-III in the Stockholm County 2008-2012 were analysed. Adherence to principles of CME surgery was determined by structured analysis of anonymized surgical reports regarding the presence of five essential features. The exposure to CME was graded as group 0 (not exposed to CME), group 1 (intermediate) and group 2 (exposed to CME)., Results: In total, 1171 patients were analysed with 234 (20.0%) patients in CME group 0, 453 (38.7%) patients in CME group 1 and 484 (41.3%) in CME group 2. The 5-year colon cancer mortality was 20.2% in CME group 0, 13.9% in CME group 1 and 13.1% in CME group 2 (P = 0.026). The adjusted hazard ratio for colon cancer mortality was 0.61 (95% CI 0.42-0.91; P = 0.014) for CME group 1 and 0.52 (95% CI 0.35-0.77; P = 0.001) for CME group 2., Discussion: The presence of predefined CME features in surgical reports was related to a graded benefit on cancer-specific mortality after right-sided hemicolectomy for colon cancer Stages I-III., (© 2021 The Association of Coloproctology of Great Britain and Ireland.)

Published
2021
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36. Differences in management and outcome for colon and rectal carcinoma with synchronous liver metastases: a population-based cohort study.

Author

Båverud Olsson L, Buchli C, Villard C, and Nilsson PJ

Subjects
Cohort Studies, Hepatectomy, Humans, Retrospective Studies, Carcinoma, Colorectal Neoplasms surgery, Liver Neoplasms surgery, Rectal Neoplasms surgery
Abstract

Aim: Surgical treatment of colorectal cancer with synchronous colorectal liver metastases (SCRLM) can follow three different strategies with regard to the timing of liver resection. The aim of this study was to describe the selection of surgical strategy, focusing on differences between colon and rectal cancer with SCRLM, postoperative morbidity/mortality and survival., Method: This was a retrospective population-based study of patients with SCRLM registered in the Swedish Colorectal Cancer Registry in the Stockholm/Gotland region during 2010-2017 and treated with surgical resection of the primary tumour and liver metastases (LM). Patients were followed for 5 years or censored at 22 November 2018., Results: A total of 238 patients met the inclusion criteria during the study period. Patients with rectal cancer were treated with the 'liver first' strategy in 70% of cases, whereas the main treatment strategies for colonic tumours were 'simultaneous resection' (44%) and 'primary first' (37%). Rectal cancer had a superior 5-year survival rate compared with colon tumours with SCRLM (62 vs. 47%; p = 0.033). There was no difference in survival between treatment strategies irrespective of primary tumour location. Postoperative complications occurred most commonly among rectal tumours treated with simultaneous resection (p = 0.024)., Conclusion: Patients with rectal cancer and SCRLM were more often treated with the 'liver first' strategy than patients with colon cancer. Patients with rectal cancer and SCRLM where both primary tumour and LM were operated on had significantly better survival than corresponding patients with colon cancer., (© 2020 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Published
2021
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37. Acute primary testicular failure due to radiotherapy increases risk of severe postoperative adverse events in rectal cancer patients.

Author

Tapper J, Arver S, Holm T, Bottai M, Machado M, Jasuja R, Martling A, and Buchli C

Subjects
Adult, Aged, Aged, 80 and over, Biomarkers blood, Combined Modality Therapy, Humans, Male, Middle Aged, Neoplasm Staging, Prospective Studies, Radiotherapy Dosage, Rectal Neoplasms pathology, Risk Factors, Testosterone blood, Postoperative Complications epidemiology, Rectal Neoplasms radiotherapy, Rectal Neoplasms surgery, Testis radiation effects
Abstract

Aim: The aim of this study is to analyze postoperative adverse events (AE) in relation to acute primary testicular failure after radiotherapy (RT) for rectal cancer., Method: This relation was assessed in 104 men, included in a previous prospective cohort study of men treated with surgical resection of the rectum for rectal cancer stage I-III. Postoperative AE were graded according to Clavien-Dindo (2004). Grade 3 or more was set as cut-off for severe postoperative AE. The impact of primary testicular failure on postoperative AE was related to the cumulative mean testicular dose (TD) and the change in Testosterone (T) and Luteinizing hormone (LH) sampled at baseline and after RT., Results: Twenty-six study participants (25%) had severe postoperative AE. Baseline characteristics and endocrine testicular function did not differ significantly between groups with (AE+) and without severe postoperative AE (AE-). After RT, the LH/T-ratio was higher in AE+, 0.603 (0.2-2.5) vs 0.452 (0.127-5.926) (p = 0.035). The longitudinal regression analysis showed that preoperative change in T (OR 0.844, 95% CI 0.720-0.990, p = 0.034), LH/T-ratio (OR 2.020, 95% CI 1.010-4.039, p = 0.047) and low T (<8 nmol/L, OR 2.605, 95 CI 0.951-7.139, p = 0.063) were related to severe postoperative AE., Conclusion: Preoperative decline in T due to primary testicular failure induced by preoperative RT could be a risk factor regarding short-term outcome of surgery in men with rectal cancer., (Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Published
2020
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38. The effects of testosterone administration on muscle areas of the trunk and pelvic floor in hysterectomized women with low testosterone levels: proof-of-concept study.

Author

Tapper J, Huang G, Pencina KM, Li Z, Arver S, Martling A, Blomqvist L, Buchli C, Travison TG, Storer TW, Bhasin S, and Basaria S

Subjects
Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Magnetic Resonance Imaging methods, Menopause, Premature, Pelvic Floor diagnostic imaging, Proof of Concept Study, Testosterone administration & dosage, Testosterone blood, Testosterone deficiency, Testosterone pharmacology, Androgens administration & dosage, Hysterectomy adverse effects, Muscle Strength drug effects, Testosterone analogs & derivatives
Abstract

Objective: The aim of this study was to determine the effect of testosterone administration on trunk and pelvic floor muscle area in women with low testosterone levels., Methods: Participants were hysterectomized women with total testosterone<31 ng/dL and/or free testosterone<3.5 pg/mL; participating in the Testosterone Dose Response in Surgically Menopausal Women (TDSM) trial. All participants received a standardized transdermal estradiol regimen during the 12-week run-in period, and were then randomized to receive weekly intramuscular injections of placebo, or 3, 6.25, 12.5, or 25 mg testosterone enanthate for 24 weeks. Muscle areas of the trunk and pelvis were measured at baseline and end of treatment using 1.5 Tesla magnetic resonance imaging. Total and free testosterone levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. Testosterone effect on muscle areas was analyzed using linear regression models., Results: A total of 24 women who had available baseline and posttreatment magnetic resonance imaging were included in the analysis. Increased cross-sectional areas of the paraspinal, psoas, and abdominal wall muscles were seen after testosterone administration. The estimated mean change (95% CI; P value) between treatment groups was 4.07 cm (1.26-6.88; P = 0.007) for paraspinal, 1.60 cm (0.10-3.09; P = 0.038) for psoas major, and 7.49 cm (1.96-13.02; P = 0.011) for abdominal wall muscles. Increases in psoas muscle area were significantly associated with changes in free testosterone concentrations. No significant changes in obturator internus and pelvic floor muscle areas were observed., Conclusion: Short-term testosterone administration in women with low testosterone levels was associated with increased trunk muscle area.

Published
2019
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39. Patterns of complications following urinary tract reconstruction after multivisceral surgery in colorectal and anal cancer.

Author

Bolmstrand B, Nilsson PJ, Holm T, Buchli C, and Palmer G

Subjects
Adult, Aged, Aged, 80 and over, Anastomosis, Surgical adverse effects, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoadjuvant Therapy adverse effects, Postoperative Complications etiology, Radiotherapy, Adjuvant adverse effects, Retrospective Studies, Surgically-Created Structures adverse effects, Urinary Diversion adverse effects, Young Adult, Anus Neoplasms surgery, Colorectal Neoplasms surgery, Cystectomy adverse effects, Intestines surgery, Ureter surgery, Urologic Diseases etiology
Abstract

Background: Multi-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications., Methods: All patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004-2015 were included in this retrospective cohort study. Data was collected from medical records with follow-up until at least one year after the index surgery. Complications were graded according to the Clavien-Dindo classification system of surgical complications., Results: The study included 189 patients; 121 underwent cystectomy and 68 partial ureter resection. The rate of high grade urological complications was 22%. The risk of major urological complications was significantly higher in patients subjected to ureter resection compared to after cystectomy (OR 2.60, 95% CI 1.23-5.49). Also, preoperative radiotherapy and intestinal anastomotic dehiscence significantly increased the risk of high grade urological complications., Conclusion: To achieve potentially curative resections with uninvolved margins in patients with locally advanced colorectal and anal cancer, multi-visceral resection including urinary tract reconstruction can be performed with reasonable morbidity., (Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Published
2018
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40. Changes in Clinical Practice Reduce the Rate of Anastomotic Leakage After Colorectal Resections.

Author

Iversen H, Ahlberg M, Lindqvist M, and Buchli C

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Anastomotic Leak etiology, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Clinical Protocols, Colectomy adverse effects, Female, Fluid Therapy, Humans, Incidence, Interrupted Time Series Analysis, Intraoperative Care, Male, Middle Aged, Retrospective Studies, Risk Factors, Young Adult, Anastomotic Leak epidemiology, Anastomotic Leak prevention & control, Colon surgery, Colonic Diseases surgery, Rectal Diseases surgery, Rectum surgery
Abstract

Background: Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections., Methods: Retrospective cohort study based on prospectively collected data. All 894 patients with primary anastomosis after colorectal resection at a tertiary referral center between 2006 and 2013 were analyzed. Changes in clinical practice aiming at reducing the rate of anastomotic leakages were introduced in January 2010 and were characterized by exclusion of perioperative nonsteroidal anti-inflammatory drugs, introduction of intra-operative goal-directed fluid therapy and avoidance of primary anastomoses in emergency resections. The study population was divided into two groups, one treated before and one after the introduction of changes in clinical practice. Groups were compared regarding patient characteristics and incidence of anastomotic leakage., Results: The cumulative incidence of anastomotic leakage after colorectal resections decreased from 10.0% (41 of 409) to 4.5% (22 of 485) after changing clinical practice, relative risk 0.45 (95% CI 0.27-0.75, p = 0.002). The adjusted odds ratio was 0.45 (0.26-0.78, p = 0.004). A separate analysis showed a decrease after colon resections from 9.1% (23 of 252) to 4.5% (14 of 310), relative risk 0.49 (0.26-0.94, p = 0.039), and from 11.5% (18 of 157) to 4.6% (8 of 175) after rectal resections, relative risk 0.40 (0.18-0.89, p = 0.024)., Conclusion: Implementing a structured change of clinical practice can significantly reduce the anastomotic leakage rate after colorectal resections., Trial Registration: Clinical trial registration number: ACTRN12617001497392.

Published
2018
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41. Risk of Acute Testicular Failure After Preoperative Radiotherapy for Rectal Cancer: A Prospective Cohort Study.

Author

Buchli C, Martling A, Abani MA, Frödin JE, Bottai M, Lax I, Arver S, and Holm T

Subjects
Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Prostatic Neoplasms surgery, Radiation Injuries diagnosis, Radiotherapy, Adjuvant, Rectal Neoplasms surgery, Risk Factors, Testicular Diseases diagnosis, Treatment Outcome, Adenocarcinoma radiotherapy, Neoadjuvant Therapy adverse effects, Proctectomy, Prostatic Neoplasms radiotherapy, Radiation Injuries etiology, Rectal Neoplasms radiotherapy, Testicular Diseases etiology
Abstract

Objective: The aim of this study was to assess the acute effect of preoperative RT for rectal cancer on endocrine testicular function., Background: Preoperative radiotherapy (RT) enhances local control and cancer-specific survival in patients treated for rectal cancer. In case series, a negative acute effect on Leydig cell function has been reported., Methods: This prospective cohort study included 168 males with rectal or prostate cancer stage I-III. Males treated with preoperative RT and surgery for rectal cancer formed the exposed group (n = 93). Males treated with surgery alone were assigned to the unexposed group (n = 75). The androgen levels were assessed at baseline and after preoperative RT. The exposure was quantified with the treatment planning system to estimate the cumulative testicular dose (TD). The risk of low T (serum T < below 8 nmol/L) was the primary endpoint. Secondary endpoints were serum testosterone (T), bioavailable T, luteinizing hormone (LH), and the LH-T ratio., Results: The baseline levels of androgens were not related to exposure status or type of cancer. The proportion of low T increased from 14.6% at baseline to 35.4% after RT, relative risk 2.41 (95% CI 1.57 to 3.71, P < 0.001). Preoperative RT resulted in a significant decrease of serum and bioavailable T and a significant increase of LH and LH-T ratio. The decline in serum and bioavailable T was related to the TD., Conclusions: Preoperative RT for rectal cancer results in dose-dependent primary testicular failure increasing the risk of hypogonadism at the time of surgery by 2.4 times (number needed to harm = 5).

Published
2018
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42. Assessment of testicular dose during preoperative radiotherapy for rectal cancer.

Author

Buchli C, Al Abani M, Ahlberg M, Holm T, Fokstuen T, Bottai M, Frödin JE, Lax I, and Martling A

Subjects
Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Organs at Risk radiation effects, Preoperative Period, Radiotherapy Planning, Computer-Assisted methods, Cone-Beam Computed Tomography methods, Radiotherapy Dosage, Rectal Neoplasms radiotherapy, Rectal Neoplasms surgery, Testis radiation effects
Abstract

Background: Radiotherapy (RT) for rectal cancer can have adverse effects on testicular function resulting in azoospermia and low testosterone levels. Variability of testicular dose (TD) due to differences in position of testes has been assessed with scrotal dosimeters and resulted in substantial variability of delivered TD. The aim of this study was to estimate planned and delivered TD using a treatment planning system (TPS)., Methods: In 101 men treated with RT for rectal cancer the cumulative mean TD (mTD) was calculated by TPS based on plan-computed tomography (CT) to evaluate the effect of different predictors on planned TD. The delivered TD was estimated by TPS based on repeated cone-beam CTs in 32 of 101 men to assess within-person variability of planned and delivered TD in a longitudinal analysis., Results: The median planned mTD for short course RT was 0.57 Gy (range 0.06-14.37 Gy) and 0.81 Gy (range 0.36-10.80 Gy) for long course RT. The median planned mTD was similar to the median delivered mTD in the 32 men analysed over the entire course of RT (p=0.84). The mTD did not change significantly over time of planning and delivering RT. The variation in proximity between testes and planning target volume (PTV) was related to within-person variability of mTD in men on the 50th and 75th percentile of mTD and as expected the absolute difference between planned and delivered mTD increased with higher mTD., Conclusion: Testicular doses calculated based on plan-CT are an accurate estimation of delivered TD based on repeated cone beam (CB)CT. The within-person variability of TD is related to variation in proximity between testes and PTV in men with moderate to high TD.

Published
2016
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43. Testosterone and body composition in men after treatment for rectal cancer.

Author

Buchli C, Tapper J, Bottai M, Holm T, Arver S, Blomqvist L, and Martling A

Subjects
Adult, Aged, Androgens blood, Androgens therapeutic use, Humans, Hypogonadism drug therapy, Leydig Cells physiology, Longitudinal Studies, Luteinizing Hormone blood, Male, Middle Aged, Prospective Studies, Sweden, Testis radiation effects, Testosterone deficiency, Testosterone radiation effects, Body Composition radiation effects, Hypogonadism chemically induced, Muscle, Skeletal radiation effects, Rectal Neoplasms radiotherapy, Testosterone blood
Abstract

Introduction: Preoperative radiotherapy for rectal cancer may affect Leydig cell function. However, the diagnosis of posttreatment hypogonadism is complicated as sexual symptoms associated to hypogonadism can rely on adverse events of pelvic radiation and surgery., Aim: The objective of this study was to investigate the association of testosterone levels and body composition. The clinical value of such an association is tested subsequently in the study population., Methods: This was a longitudinal study with prospective registration during 2010-2012 and 1-year follow up. Men with rectal cancer stage I-III, treated with radiotherapy and surgery, were eligible, and 40 of 53 men were available for analysis., Main Outcome Measures: The areas of skeletal muscle and adipose tissue were assessed on a defined section of a computed tomography at baseline and after 1 year. Androgen levels were recorded from morning blood samples., Results: The area of skeletal muscle was related to the level of bioavailable testosterone (P = 0.01) but not to the level of serum testosterone (P = 0.36). The subcutaneous adipose tissue was not related to testosterone levels. Men with posttreatment serum testosterone levels of 8-12 nmol/L and longitudinal loss of psoas muscle area had a significantly increased luteinizing hormone-testosterone ratio compared with those with longitudinal gain of psoas muscle., Conclusions: The area of psoas muscle is related to the unbound fraction of circulating testosterone in men treated for rectal cancer. The longitudinal loss of psoas muscle in men with borderline levels of serum testosterone seems to be an androgen-related symptom associated with compensatory activation of the pituitary-gonadal axis indicating a testicular failure in this group of patients., (© 2014 International Society for Sexual Medicine.)

Published
2015
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44. A multicenter randomized clinical trial of primary anastomosis or Hartmann's procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis.

Author

Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Villiger P, Buchli C, Grieder F, Gelpke H, Decurtins M, Tempia-Caliera AA, Demartines N, Hahnloser D, Clavien PA, and Breitenstein S

Subjects
Aged, Aged, 80 and over, Anastomosis, Surgical, Chi-Square Distribution, Female, Humans, Male, Middle Aged, Postoperative Complications, Statistics, Nonparametric, Switzerland, Treatment Outcome, Diverticulitis, Colonic surgery, Ileostomy methods, Intestinal Perforation surgery, Peritonitis surgery
Abstract

Objectives: To evaluate the outcome after Hartmann's procedure (HP) versus primary anastomosis (PA) with diverting ileostomy for perforated left-sided diverticulitis., Background: The surgical management of left-sided colonic perforation with purulent or fecal peritonitis remains controversial. PA with ileostomy seems to be superior to HP; however, results in the literature are affected by a significant selection bias. No randomized clinical trial has yet compared the 2 procedures., Methods: Sixty-two patients with acute left-sided colonic perforation (Hinchey III and IV) from 4 centers were randomized to HP (n = 30) and to PA (with diverting ileostomy, n = 32), with a planned stoma reversal operation after 3 months in both groups. Data were analyzed on an intention-to-treat basis. The primary end point was the overall complication rate. The study was discontinued following an interim analysis that found significant differences of relevant secondary end points as well as a decreasing accrual rate (NCT01233713)., Results: Patient demographics were equally distributed in both groups (Hinchey III: 76% vs 75% and Hinchey IV: 24% vs 25%, for HP vs PA, respectively). The overall complication rate for both resection and stoma reversal operations was comparable (80% vs 84%, P = 0.813). Although the outcome after the initial colon resection did not show any significant differences (mortality 13% vs 9% and morbidity 67% vs 75% in HP vs PA), the stoma reversal rate after PA with diverting ileostomy was higher (90% vs 57%, P = 0.005) and serious complications (Grades IIIb-IV: 0% vs 20%, P = 0.046), operating time (73 minutes vs 183 minutes, P < 0.001), hospital stay (6 days vs 9 days, P = 0.016), and lower in-hospital costs (US $16,717 vs US $24,014) were significantly reduced in the PA group., Conclusions: This is the first randomized clinical trial favoring PA with diverting ileostomy over HP in patients with perforated diverticulitis.

Published
2012
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45. Testicular function after radiotherapy for rectal cancer--a review.

Author

Buchli C, Martling A, Arver S, and Holm T

Subjects
Erectile Dysfunction etiology, Humans, Male, Radiation Dosage, Spermatogenesis radiation effects, Testis physiology, Testosterone blood, Rectal Neoplasms radiotherapy, Testis radiation effects
Abstract

Introduction: Eighty percent of all male rectal cancer patients are sexually active at the time of diagnosis. Because of modern multimodal therapy many can expect long-term survival. The testes can be exposed to scattered or direct radiation during radiotherapy, depending on their position in relation to the targeted volume., Aim: This review analyzes the current literature providing data on testicular exposure to radiation during radiotherapy for rectal cancer and the consequences on testicular function., Methods: A systematic search was conducted in PubMed, Embase, and Cochrane. Ten original articles providing data on testicular exposure to radiation and testicular function in men with primary rectal cancer were included for qualitative synthesis., Main Outcome Measures: Data on testicular exposure to radiation and testosterone levels in men with rectal cancer are reported., Results: On average, the testes were exposed to 0.24-8.4 Gy during long-course radiotherapy for rectal cancer. Testosterone levels after radiation were significantly lower compared with pretreatment levels or compared with patients treated with surgery alone. After radiotherapy, the absolute risk increase was 0.17-0.30 for posttreatment testosterone levels below 8 nmol/L. In the largest study, the relative risk was 2.7 for testosterone levels below 8 nmol/L for men treated with radiotherapy compared with men treated with surgery alone., Conclusion: Current data generate three hypotheses: (i) during long-course radiotherapy for rectal cancer, the testes can be exposed to direct and/or scattered radiation; (ii) men treated with radiotherapy seem at risk to develop testicular dysfunction with decreased serum testosterone levels compared with both pretreatment values and men treated with surgery alone; and (iii) a decrease in testosterone levels (<8 nmol/L) may precipitate specific symptoms caused by testosterone deficiency such as impaired physical, psychological, and sexual function after treatment., (© 2011 International Society for Sexual Medicine.)

Published
2011
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46. Re: prognostic reliability of the Hawkins sign in fractures of the talus.

Author

Buchli C

Subjects
Adolescent, Adult, Bone Nails, Child, Female, Fracture Fixation, Internal adverse effects, Fracture Healing, Hospitals, University, Humans, Male, Middle Aged, Osteonecrosis etiology, Postoperative Complications etiology, Prognosis, Radiography, Reproducibility of Results, Sensitivity and Specificity, Talus blood supply, Treatment Outcome, Ankle Injuries surgery, Fractures, Bone diagnosis, Fractures, Bone diagnostic imaging, Talus diagnostic imaging, Talus injuries
Published
2008
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47. Delayed referral and gram-negative organisms increase the conversion thoracotomy rate in patients undergoing video-assisted thoracoscopic surgery for empyema.

Author

Lardinois D, Gock M, Pezzetta E, Buchli C, Rousson V, Furrer M, and Ris HB

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Debridement methods, Female, Gram-Negative Bacterial Infections complications, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Empyema, Pleural microbiology, Empyema, Pleural surgery, Referral and Consultation statistics & numerical data, Thoracic Surgery, Video-Assisted, Thoracotomy
Abstract

Background: The role of video-assisted thoracoscopic surgery in the treatment of pleural empyema was assessed in a consecutive series of 328 patients between 1992 and 2002. An analysis of the predicting factors for conversion thoracotomy in presumed stage II empyema was performed., Methods: Empyema stage III with pleural thickening and signs of restriction on computer tomography imaging was treated by open decortication, whereas a thoracoscopic debridement was attempted in presumed stage II disease. Conversion thoracotomy was liberally used during thoracoscopy if stage III disease was found at surgery. Predictive factors for conversion thoracotomy were calculated in a multivariate analysis among several variables such as age, sex, time interval between onset of symptoms and surgery, involved microorganisms, and underlying cause of empyema., Results: Of the 328 patients surgically treated for stage II and III empyema, 150 underwent primary open decortication for presumed stage III disease. One hundred seventy-eight patients with presumed stage II empyema underwent a video-assisted thoracoscopic approach. Of these 178 patients, thoracoscopic debridement was successful in 99 of 178 patients (56%), and conversion thoracotomy and open decortication was judged necessary in 79 of 178 patients (44%). The conversion thoracotomy rate was higher in parapneumonic empyema (55%) as compared with posttraumatic (32%) or postoperative (29%) empyema; however, delayed referral (p < 0.0001) and gram-negative microorganisms (p < 0.01) were the only significant predictors for conversion thoracotomy in a multivariate analysis., Conclusions: Video-assisted thoracoscopic debridement offers an elegant, minimally invasive approach in a number of patients with presumed stage II empyema. However, to achieve a high success rate with the video-assisted thoracoscopic approach, early referral of the patients to surgery is required. Conversion thoracotomy should be liberally used in case of chronicity, especially after delayed referral (> 2 weeks) and in the presence of gram-negative organisms.

Published
2005
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