bluuebunny/crossref_metadata_2025 huggingface dataset:
71885 - Ultra-High Frequency Ultrasound Imaging of Bowel Wall in Hirschsprung’s Disease—Correlation and Agreement Analyses of Histoanatomy
Authors: Hawez Tebin , Graneli Christina , Erlöv Tobias , Gottberg Emilia , Mitev Rodrigo Munoz , Hagelsteen Kristine , Evertsson Maria , Jansson Tomas , Cinthio Magnus , Stenström Pernilla
Published: August 2024

Introduction

Hirschsprung’s disease (HD) is characterized by aganglionosis in the bowel wall, requiring resection. Ultra-high frequency ultrasound (UHFUS) imaging of the bowel wall has been suggested to be an instantaneous method of deciding resection length. The aim of this study was to validate UHFUS imaging of the bowel wall in children with HD by exploring the correlation and systematic differences between UHFUS and histopathology.

Method

Resected fresh bowel specimens of children 0–1 years old, operated on for rectosigmoid aganglionosis at a national HD center 2018–2021, were examined ex vivo with UHFUS center frequency 50 MHz. Aganglionosis and ganglionosis were confirmed by histopathological staining and immunohistochemistry. Histoanatomical layers of bowel wall in histopathological and UHFUS images, respectively, were outlined using MATLAB programs.

Result

Both histopathological and UHFUS images were available for 19 aganglionic and 18 ganglionic specimens. The thickness of muscularis interna correlated positively between histopathology and UHFUS in both aganglionosis (R = 0.651, p = 0.003) and ganglionosis (R = 0.534, p = 0.023). The muscularis interna was systematically thicker in histopathology than in UHFUS images in both aganglionosis (0.499 vs. 0.309 mm; p < 0.001) and ganglionosis (0.644 versus 0.556 mm; p = 0.003).

Discussion

Significant correlations and systematic differences between histopathological and UHFUS images support the hypothesis that UHFUS reproduces the histoanatomy of the bowel wall in HD accurately.
72220 - Catheter-related Superior Vena Cava Syndrome: A Hidden Threat in Pediatric patients
Authors: Borg Helena , Persson Sara
Published: August 2024

Introduction

Superior vena cava syndrome (SVCS) is caused by an obstruction of the thoracic central veins. SVCS is a rare but potentially life-threatening condition with malignancy as the most common cause. In children, SVCS is most commonly related to the use of a central venous catheter (CVC) or treatment of congenital heart defects. SVCS usually presents with swelling of the face, tounge, neck and hand, distended chest and neck veins, cyanosis, respiratory distress and watering eyes.

Method

One girl with duodenal atresia, gestational week (GW) 34+0, weight 2005g, and one boy with necrotizing enterocolitis, GW 32+ 5, weight 1720g developed catheter-related SVCS at two and four weeks of age. Both had been subjected to major intraabdominal surgery and received a CVC in the left subclavian vein, for parenteral nutrition. Presenting symptoms were, elevated body temperature, decreasing platelets, CRP elevation, discoloration of the upper body, swelling of the face and desaturation. The bloodcultures were positive. Ultrasound and contrast-enhanced CT for detection of catheter-related thrombosis were performed.

Result

CT scan, but not ultrasound, confirmed a SVC obstruction. The children were referred to the ICU for immediate treatment with heparin and the girl also received Actilyse. She developed chylothorax and required thoracic drainage for four months with additional somatostatin treatment, loop diuretics and anticoagulation with low molecular weight heparin and Rivaroxaban.

Discussion

SVCS is associated with potentially severe complications. The presenting symptoms are general and easily mistaken for other more common causes behind deranged vital signs. Early detection and intervention is important to minimize morbidity and mortality.
72232 - Renal and urinary tract malformations among children with esophageal atresia: a single-center retrospective cross-sectional study
Authors: Eriksson Freja , Omling Erik , Salö Martin , Svensson Emma
Published: August 2024

Introduction

Children with esophageal atresia (EA) may present with concomitant renal or urinary tract malformations, sometimes as part of a VACTERL association. The aim of this study was to map the burden of renal, urinary tract and genital anomalies, impaired kidney function, and micturition difficulties in children with EA, and to investigate the correlation between these anomalies and the type of EA.

Method

Children presenting with EA at Skåne University Hospital between 2012 and 2023 were identified. Patients deceased within five days of birth were excluded. Data were collected from medical records and included type of EA, concomitant malformations, renal or urinary tract related complications and surgical procedures, and most current serum creatinine. Data were analyzed using Chi2 and Fisher’s exact tests. The study was approved by the Swedish Ethical Review Authority (2010/49).

Result

93 patients were included. 18 (19.4%) presented with a renal or urinary tract malformation, most commonly vesicoureteral reflux (n=6). Seven (38.9%) of these patients required surgical intervention. Four (22.2%) and 14 (20.9%) of patients with and without renal or urinary tract malformations had impaired kidney function (p=1.0). Presence of a renal or urinary tract malformation was associated with additional genital anomalies (44.4% and 5.3%, p<0.001) and neurogenic bladder (22.2% and 2.7%, p=0.01). There was no correlation with the type of EA (p=0.62).

Discussion

The knowledge of concomitant renal and urinary tract malformations and potential complications in children with EA is scarce. This study contributes to the general understanding of comorbidities. Results can help better inform caregivers and direct postnatal care.
71606 - Comparison of short-term outcomes in robotic-assisted versus laparoscopic surgery for rectal cancer - a population-based study
Authors: Mertens Carl , Buchwald Pamela , Matthiessen Peter , Jutesten Henrik , Gadan Soran , Jörgren Fredrik
Published: August 2024

Introduction

In rectal cancer minimally invasive surgery (MIS) is recommended with either robotic-assisted or laparoscopic technique. Randomized controlled studies have shown similar outcomes between the techniques. This study aimed to compare population-based data on short-term outcomes between robotic-assisted and laparoscopic surgery for rectal cancer.

Method

Data from the Swedish Colorectal Cancer Registry for patients undergoing MIS for rectal cancer between 2014-2021 with 30-day follow-up were analysed. Primary outcome was positive circumferential resection margin (CRM+). Secondary outcomes were conversion to open surgery, total mesorectal excision (TME) specimen quality and overall or surgical complications. Analyses were conducted by intention-to-treat, with data grouped according to surgical technique. Multivariable analyses were performed.

Result

A total of 5874 patients were analysed (3578 robotic-assisted; 2296 laparoscopic). There was no difference in CRM+ between the groups (6.5 versus 5.9 per cent; P=0.291). Increased rates of conversion were found in the laparoscopic group (16.1 versus 9.1 per cent; P<0.001) and of incomplete TME specimen (4.9 versus 2.7 per cent; P=0.04) and surgical complications (21.5 versus 19.3 per cent; P=0.044) in the robotic-assisted group. In multivariable analysis (Table 1), neither of the techniques was an independent predictor of CRM+ (Odds ratio (OR) 0.99, 95 per cent c.i. 0.75 to 1.30; P=0.925). For secondary outcomes laparoscopic technique was a predictor of conversion (P<0.001) and robotic-assisted of incomplete TME specimen (P<0.001).

Discussion

This population-based study could not show superiority regarding short-term outcomes of any of MIS techniques. Findings regarding conversion rates and incomplete TME specimen warrant further investigation.
71776 - Gut wrenching decisions: Stoma or no stoma prior to long-course neoadjuvant therapy in rectal cancer?
Authors: Sandén Gustav , Vinnars Petrus , Ljuslinder Ingrid , Rutegård Martin
Published: August 2024

Introduction

Before and during neoadjuvant treatment for rectal cancer, complications might ensue. Some of those complications could be alleviated by a defunctioning stoma established before treatment initiation. This retrospective study examines complication rates among rectal cancer patients undergoing long-course neoadjuvant therapy, comparing those with and without a stoma.

Method

All rectal cancer patients undergoing neoadjuvant treatment during 2007–2022 in Region Västerbotten, Sweden, were identified using the Swedish Colorectal Cancer Registry. Data were obtained from this registry and patient charts. Patients not planned for curative long-course neoadjuvant therapy, those with recurrent disease, those with a pre-existing stoma, and those receiving a stoma due to urgent bowel-related issues before treatment, were excluded. The primary outcome was the incidence of complications between diagnosis and resectional surgery. Additionally, we investigated time to treatment and utilisation of pre-treatment stomas over time.

Result

Out of 482 identified patients, 105 remained after exclusion. Among these, 24/105 (23%) patients received a pre-treatment stoma, while 81/105 (77%) received upfront neoadjuvant therapy. The complication incidence in the stoma group was 18/24 (75%), significantly higher than 24/81 (30%) in the control group (p < 0.001). A considerable number of high-grade complications were directly caused by the stoma surgery. Time to neoadjuvant therapy was significantly longer in the stoma group (p < 0.001), and the use of pre-treatment stomas has decreased in recent years.

Discussion

Rectal cancer patients who receive a stoma before neoadjuvant treatment, in absence of urgent symptoms, experience more complications than those without a stoma. Pending further investigation, such prophylactic stomas should likely be avoided.
71848 - Microscopic vascular invasion is associated with non-radical resection of locally recurrent rectal cancer, and impaired disease-free survival
Authors: Iversen Henrik , Buchli Christian
Published: August 2024

Introduction

Negative resection margin (R0) is strongly associated with long term outcomes after surgical resection for locally recurrent rectal cancer (LRRC). The aim of this study was to evaluate the association of microscopic vascular invasion (V1) with probability of R0 resection and disease-free survival (DFS) when performing resection of LRRC with curative intent.

Method

Study design: Retrospective observational study. Participants: Patients operated with curative intent for LRRC at the Karolinska University Hospital from January 2003 until December 2017. Data were retrieved from medical records. Outcome measures were R status and DFS.

Result

Overall, 126 patients were operated for LRRC with curative intent. R0 resection was achieved in 96 patients (76%). The absence or presence of V1 was stated in the pathology report in 73 patients (58%). Of those 41 (56 %) were reported as V1 and 32 (44 %) as V0. The relative risk of R1 resection was 41 % when V1 was present and 0.0 % in the absence of V1 (P<0.001). Presence of V1 in the LRRC specimen was also associated with impaired DFS (P=0.05).

Discussion

Microscopic vascular invasion in LRRC is a significant risk factor for R1 resection and poor survival after resection with curative intent.
72238 - Major LARS in patients with rectal cancer following a Watch and Wait protocol – results from the Swedish national Wow study
Authors: Mijaljevic Lidija , Azhar Najia , Chabok Abbas , Folkesson Joakim , Gerdin Anders , Grönkvist Rode , Hermus Linda , Martling Anna , Matthiessen Peter , Rydbeck Daniel , Angenete Eva
Published: August 2024

Introduction

Rectal cancer has historically been treated with resection surgery. (Chemo)radiotherapy results in a clinical complete response (cCR) in some patients, which enables a nonoperative management; “watch and wait”. Low Anterior Resection Syndrome (LARS) is a consequence after sphincter-preserving surgery, however similar symptoms can occur after treatment with (chemo)radiotherapy. The aim of this study was to report the prevalence of LARS in Swedish patients treated as watch and wait within a research protocol and to identify trends over time.

Method

The WoW study is a multicenter prospective national cohort study including patients with cCR after (chemo)radiotherapy for rectal cancer. The study population consists of 211 patients with stage I-III rectal cancer and cCR included between January 2017 and February 2023. LARS-score was analyzed at baseline, six months and one year.

Result

Demography and clinical characteristics are presented in the table. Questionnaires were available for 182 patients in total. LARS-score was possible to analyze for 170 patients at baseline, 136 at six months and 118 at one year, patients reporting a stoma were excluded.

Major LARS was reported by 41 (24%) patients at baseline, 35 (26%) at 6 months and 26 (22%) at 12 months.

Discussion

One of four patients in this WoW-cohort reported major LARS and it is persistent after one year. Long-term follow-up is required to see if symptoms change over time to understand the functional outcome of the treatment offered to be able to provide adequate information about possible long-lasting life changes due to treatment.
72241 - Survival in Appendiceal adenocarcinoma in Sweden
Authors: Johansson Joel , Andersson Roland , Loftås Per , Redéen Stefan
Published: August 2024

Introduction

Appendiceal adenocarcinoma (AA) is a rare malignancy with increasing incidence that is associated with poor outcomes. Much of the existing knowledge is derived from registry-based studies, particularly the Surveillance, Epidemiology, and End Results (SEER) database in the US.

Method

This retrospective cohort study utilized data from the Swedish Cancer Registry, Swedish Cause of Death Registry and the National Patient Registry to analyse demographic characteristics and outcomes of AA patients diagnosed from 1970 to 2019. Kaplan-Meier survivor function, multivariable Cox regression analysis, standardized mortality ratio, relative survival and Poisson regression analysis was used to assess survival and factors that affect survival. Incidence was estimated by direct standardization and incidence rate ratio (IRR) from 2005 till 2019.

Result

A total of 2,436 AA patients were included, with a mean age at diagnosis of 64.2 years. Five-year survival improved over time. Increasing age and disease stage were associated with decreased survival, as well as not undergoing surgery or only exploration. Cytoreductive surgery with HIPEC and a mucinous histological subtypes were associated with improved survival. Seeking medical care for acute abdominal pain during the year prior to diagnosis did not affect mortality. Both in situ lesions and invasive AA increased from 2005 onwards. In situ lesions saw the largest increase (IRR 11,50 p<0,01).

Discussion

While survival increases over time excess mortality remains high and is increasing. Seeking medical care for acute abdominal pain during the year prior to diagnosis did not affect survival. This could have implications for conservative management of appendicitis.
71253 - Neither larger hospital caseload nor more endovascular repair improves the 90-day mortality after repair for intact abdominal aortic aneurysms
Authors: Lundgren Fredrik , Troëng Thomas
Published: August 2024

Introduction

The causal connection between hospital caseload and short-term mortality after complex surgery is controversial. Does a small minimum, say 10 cases yearly, suffice to secure good results or are substantially larger numbers necessary? Randomized studies are difficult, if not impossible, so these questions must be determined by observational studies which also can eliminate confounding.

We analysed intact abdominal aortic aneurysms (iAAA) from these aspects with patients from the Swedish vascular registry (Swedvasc). As endovascular abdominal aortic aneurysm repair (EVAR) was connected to caseload, this was also considered, simultaneously.

Method

Swedvasc comprised 4 868 iAAA 2013–2017 and age, sex, risk factors, and mortality were procured. Swedheart supplied information of previous cardiac insufficiency. Information of municipal homecare was available from the National Board of Health and Welfare and was coded as patient frailty. Mortality at 90-days was evaluated with Cox regression versus caseload of all AAA, proportion of EVAR, age, sex, heart disease, previous cardiac insufficiency, pulmonary disease, kidney disease, frailty, and urgency (no-urgency, unplanned-with-symptoms, emergency). Additionally, caseload and proportion of EVAR were plotted and analysed against unadjusted institutional mortality.

Result

Neither caseload, nor more EVAR reduced patient's 90-day mortality (HR 1.04 P=0.650 and 1.06 P=0.739, respectively). Male sex decreased 90-day mortality (0.56 P=0.006) while heart disease, pulmonary disease, and urgency (either unplanned-with-symptoms or emergency) increased mortality (1.47 P=0.049, 1.66 P=0.010, 2.23 P=0.022, 2.45 P=0.002, respectively). Caseload or proportion of EVAR were not connected to individual hospital mortality.

Discussion

We failed to show any causal relationship between caseload or proportion of EVAR versus 90-day mortality.
71552 - In-situ Laser Fenestrations of Visceral Endografts (InLoVE) Mid-term outcomes from a multicenter study
Authors: Jónsson Gísli Gunnar , Zielinski Alexander , Berczeli Marton , Resch Timothy , Dias Nuno , Wanhainen Anders , Mani Kevin , Ghulam Qasam , Karelis Angelos , Lindström David
Published: August 2024

Introduction

Emergent complex abdominal aortic diseases are challenging to treat. During In-situ laser fenestration (ISLF) aortic branches are covered and then restored with in-situ fenestration of the stentgraft with promising mid-term results1. The aim of this study was to examine our mid-term outcome of ISLF in visceral aortic pathology.

Method

Retrospective multicenter study on consecutive ISLF cases of visceral aortic stent-grafts 2018-2023 in three aortic centers. Technical success was defined as a successful vascularization with bridging stent without any type 3 endoleak.

Result

A total of 65 ISLFs were performed in 34 patients, mean age 74 years. The procedure was performed in an acute setting in 79%. Pre-stenting of all target vessels was performed on 29 patients (85%). Four patients (12%) died within 30 days, all presented with a rupture. Technical success was achieved in 61/65 ISLF (94%). All failed cannulations were in renals, three due to difficult angulation and one dissected during cannulation. Median follow up was 464 days. Cumulative survival at six months, one year and two years was 88%, 80% and 72%. There were in total six (9%) target vessel instability detected: Three (5%) type III endoleaks, and three (5%) stent stenosis, all requiring relining. Freedom from target vessel instability at six months till end of follow up was 90% (figure 1).

On latest follow-up scan, all successfully deployed ISLF bridging stents were patent without signs of endoleak type 3.

Discussion

ISLF is a promising tool for emergent endovascular procedures in complex anatomies.
72216 - Diagnostic reference level for endovascular abdominal aortic aneurysm repair in Sweden
Authors: Markusdottir Erna , Linden Alice , Holsti Mari , Cicek Catharina , Butt Talha , Strömberg Sofia , Smidfelt Kristian , Jonsson Magnus , Starck Joachim
Published: August 2024

Introduction

The 2023 ESVS guidelines on Radiation Safety recommends establishment of national diagnostic reference level (DRLs) for endovascular procedures. (1) Diagnostic reference level is a tool used for medical imaging procedures using ionizing radiation for optimization and reference. (2) (3) (4). The aim of this study was to propose a national DRL for Sweden for standard EVAR procedure.

Method

All standard EVAR procedures performed in Sweden 2021-2022 were identified in SwedVasc. The EVARs were then grouped into intact and ruptured cases and then further subgrouped. Radiation data was analysed for the whole cohort with subgroup analysis for ruptures and obesity (BMI>25). The preliminary national DRL for standard EVARs was determined as the third quartile of the DAP median values from all centers.

Result

A total of 1423 EVAR procedures performed at 26 centers in Sweden were identified. Twenty centers have agreed to participate, data from 13 centers were included in the preliminary data review. Remaining 7 centers are still collecting data. A total of 508 EVAR procedures were included into this preliminary analysis. The correlation between DAP value and individual center volume was non-significant, p=0.1 (Figure 2). The proposed preliminary DLR for standard EVAR (n=403) was 153 Gy cm2. Mean DAP for patients with BMI <25 and ≥25 was 75 and 148 respectively (p-<0.001). Mean DAP for ruptures (n=63) and intact AAA (n=462) was 187 and 131 respectively (p=0.002).

Discussion

An evaluation and further a continuous reassessment of the national DRLs are in order to keep the radiation doses as low as reasonably possible.
72296 - Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 1983
Authors: Matovu Alphons , Löfgren Jenny , Wladis Andreas , Nordin Pär , Pettersson Hans Järnbert , Sandblom Gabriel
Published: August 2024

Introduction

The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women.

Method

The study was based on two Swedish national registers, the Medical Birth Register (MBR) and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries.

Result

A total of 1, 535, 379 women were born between 1956 and 1983. Among these, 1,417, 237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100 000 person-year and 2.6 per 100 000 person-year respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23-1.40) among women registered for two deliveries, 1.70 (1.58 -1.82) among women registered for ≥3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14-1.49), 1.70 (1.49-1.95) for FHR among women with two and ≥3 registered deliveries respectively.

Discussion

In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.
72313 - A retrospective analysis of short-term clinical outcomes after the introduction of a robotic assisted ventral hernia program at Danderyds Hospital
Authors: Törnqvist Björn , Ohlsson Johan , Stillström David
Published: August 2024

Introduction

A robotic assisted surgery-program has been established at Danderyds Hospital in order to offer ventral hernia patients a minimal invasive approach.

Method

All patients undergoing either open Rives-Stoppa repair or robotic assisted minimal invasive repair for ventral hernias at Danderyds Hospital between January 2015 and April 2024 were retrospectively analyzed for short-term clinical outcomes, operation time and length of stay.

Result

A total of 91 consecutive open Rives-Stoppa repairs were compared to 200 consecutive robotically assisted repairs where the mesh was placed in the retrorectus compartment with minimal invasive methods. The patients in the two groups did not differ significantly regarding age, gender and hernia size. Operation time, adjusted by hernia size, was significantly longer in the robotic assisted group during the learning curve of the first 100 robotic assisted operations but did not differ from open surgery during the last 100 robotic assisted operations. Length of stay was significantly longer in the open repair group (mean 3.0 days) compared to the robotic assisted group (mean 1.3 days). Complications according to Clavien-Dindo were low in the robotically assisted group with a significan lower use of epidural anesthesia compared to open hernia surgery.

Discussion

Patients with ventral hernias can safely be operated using minimal invasive robotic assisted surgery. Short-term outcomes are promising with few complications and short hospital stay, indicating cost-effectiveness compared to open Rives-Stoppa repairs. Beyond the learning curve, robotic assisted ventral hernia surgery is also comparable to open surgery regarding operation time. For long-term results including recurrent hernias further studies are needed.
72314 - The FemRep Study. A Randomized Controlled Trial on Open Groin Hernia Repair in Women
Authors: Matovu Alphonsus , Nordin Pär , Sandblom Gabriel , Wladis Andreas , Lulu Francis , Elaju Moses , Okello Geoffrey , Castro Akena Dole , Bladin Olof , Löfgren Jenny
Published: August 2024

Introduction

The aim of the study was to compare patient outcomes after open anterior mesh repair versus a modified open anterior mesh repair for both inguinal and femoral hernias among women in low income settings.

Method

A double blinded Randomized Controlled Trial was conducted. In the intervention arm, we used a modified open anterior mesh technique where the posterior wall of the inguinal canal was incised, and a small flap of mesh positioned to cover the femoral canal. In the control arm we used the open anterior mesh technique according to Lichtenstein. The primary outcome was groin hernia recurrence one year postoperatively. The secondary outcomes were post operative complications at 14 days, inguinal pain, and patient satisfaction one year post operatively.

Result

Between October 2019 and March 2020, 200 women were included in the study. Of these, 82(41%) participants had femoral hernias. Thirty-five participants crossed from the control arm to the intervention arm due to the presence of a femoral hernia. The follow up rate at two weeks and one year was 100%. In an intention to treat analysis, the recurrence rate was 4 (4%) participants in the control arm and 7 (7%) participants in the intervention arm. Postoperative wound complications occurred in 4 (4%) participants in the control arm and none in the intervention arm.

Discussion

Femoral hernias were a common finding aided by Intraoperative inspection of the femoral canal. The modified open anterior mesh repair for groin hernias is a safe and effective option in the study setting.
71487 - The role of previous implant-based breast reconstruction and radiotherapy for surgical complications in DIEP breast reconstruction
Authors: Liu Y I hang , Jakobsson Stina , Edsander-Nord Åsa , Johansson Anna L V , Sackey Helena , de Boniface Jana , Halle Martin
Published: August 2024

Introduction

A deep inferior epigastric perforator (DIEP) flap breast reconstruction can be performed de novo or after a previous implant-based breast reconstruction (IBR). Fibrotic changes and capsule development after IBR may increase challenges in microvascular surgery especially in patients with previous radiotherapy. We aimed to evaluate whether previous IBR is associated with increased surgical complication rates in DIEP breast reconstruction.

Method

This study included all patients undergoing DIEP flap breast reconstruction at a university hospital 2005-2022. Patients were divided into those with or without previous IBR, and then further into those with or without a history of radiotherapy. Main outcomes were 1) microvascular re-anastomosis during surgery and 2) total or partial flap necrosis within 30 days. Multivariable logistic regression analyses were adjusted for Body Mass Index, smoking status, and age.

Result

Overall, 516 women had received 577 DIEP flap breast reconstructions. Partial necrosis occurred in 25 (4.3%) cases and total necrosis in 5 (0.9%) cases. Radiotherapy had been received prior to 446 reconstructions (77.3%) and in 213 (36.9%), an IBR had previously been performed. In irradiated patients, re-anastomosis and flap necrosis were significantly more common in those with a IBR (25/170 (14.7%) and 12/170 (7.1%), than those without a previous IBR (20/271 (7.4%) and 9/271 (3.3%); p=0.013 and 0.073, respectively).

Discussion

Previous IBR increased the risk of perioperative re-anastomosis but not of flap necrosis among previously irradiated patients. Although re-reconstruction using a DIEP flap can thus be considered safe despite previous radiotherapy and IBR, surgeons should acknowledge an increased perioperative complexity.
72285 - Trends in Head and neck reconstructions over three decades, a snapshot of the Örebro head and neck cancer registry (ÖHNCR)
Authors: Holm Sebastian , Landström Fredrik , Hanoon Dhafir , Tabrisi Reza , Zdolsek Johann
Published: August 2024

Introduction

In Sweden, approximately 1700 patients are diagnosed with head and neck cancer (HNC) every year. HNC is relatively rare (2,6 % of all cancers). Risk factors for HNC are smoking, high consumption of alcohol, human papilloma virus (HPV) infection and inflammation 1. The Örebro head and neck cancer registry (ÖHNCR) was founded 1988 to register amount of HNC patients, treatment, reconstruction and overall survival.

Method

We performed a retrospective review of all microvascular and local/regional reconstructions in ÖHNCR from 1988 to 2023. It includes in total 4111 patients in the registry to present day.

Result

The majority, approximately 71.8% of the patients, were judged to be tumour-free at the last check-up. The five-year survival rate for all HNC patients has increased from 49.8% in 1988 to 55.1% in 2023, an increase of 5.3%. Overall survival varies between types of cancer within HNC. The number of both free and local/regional flaps has increased over the past two decades. Of all reported patients in ÖHHCR, approximately 44 patients (34%) have been reconstructed each year. The most common free flap for soft tissue reconstruction were, radial free flap (n=331, 49%) and osteocutaneous reconstruction was the fibula free flap (n=210, 31%). The most common local/regional flap were pectoralis major flap (n=242, 33%).

Discussion

The registry data trends correspond with the current literature, with increased incidence of number of cases with HNC and following reconstruction. We speculate that the increased number of reconstructions, permits an increased number of radical HNC resections followed by improved oncological- and functional outcomes.
72312 - Accuracy of EU-TIRADS in Assessing Thyroid Nodule with Surgeon-performed ultrasound
Authors: Lundin Elias , Annebäck Matilda , Norlén Olov
Published: August 2024

Introduction

The aim of this study was to evaluate the accuracy of European Thyroid Imaging and Reporting Data System (EU-TIRADS) in an unselected cohort of thyroid nodule patients with surgeon-performed ultrasound.

Method

This retrospective cohort study included all patients who underwent thyroid ultrasound with EU-TIRADS classification at the Surgery Department at Uppsala University Hospital between 1 July 2019 and 31 December 2020. Medical charts were reviewed, and the nodules were analyzed by obtaining patient characteristics, EU-TIRADS classification and cytological and/or histological result. Patients without a diagnosis of cancer at the end of the observation period or with a benign pathology were considered benign.

Result

Some 482 patients fulfilled the inclusion criteria. After exclusion, 282 patients remained, with a total of 390 thyroid nodules. Patients were either operated on (n=122, 31.1%) or observed through the regional medical chart system for at least 37 months (median 43 months). The number of nodules in each EU-TIRADS category were as follows: TIRADS 2; 155 (39.7%), TIRADS 3; 153 (39.2%), TIRADS 4; 45 (11.5%) and TIRADS 5; 37 (9.5%). Risk of malignancy in TIRADS 2 was 2.6%, TIRADS 3; 5.2%, TIRADS 4; 13.3% and TIRADS 5; 32.4%. However, in asymptomatic patients, i.e., patients that were not operated on, none of the nodules classified as TIRADS 2 (n=123) had or developed a clinical malignancy during the observation period.

Discussion

In this study, surgeon-performed ultrasound with the use of EU-TIRADS classification, accurately identified potentially malignant nodules within a clinical context, with no missed cancer cases detected during follow-up.
72304 - Development of an Adapted Diabetes Diary for Patients Following Total Pancreatectomy: A Step Towards Improved Self-Management and Learning
Authors: Ackalin Simone Huayna , Toyama Mika , Otterbom Ingrid , Gustavell Tina
Published: August 2024

Introduction

After total pancreatectomy (TP), patients develop poorly controlled diabetes classified as type 3c diabetes. Consequently, there is a need for specific patient education to enable patients to manage insulin treatment independently upon discharge. Existing diabetes diaries designed for patients with diabetes are not tailored to this particular patient group. Therefore, the aim was to develop a diabetes diary adapted for type 3c diabetes patients who have undergone TP, to facilitate the patient's self-management and learning of insulin treatment during the initial postoperative period.

Method

Individual interviews with patients following TP (n=3), registered nurses (n=3), and assistant nurses (n=3) regarding experiences and understanding of insulin treatment, as well as the need for an adapted diabetes diary, followed by a literature review of existing diabetes diaries. Data were analysed qualitatively.

Result

The majority of patients were found to have inadequate understanding of insulin treatment and blood sugar monitoring. Nurses perceived that lack in patient knowledge could be supplemented through an adapted diary. Varying work routines among healthcare personnel hindered the use. An adapted diary could be formulated based on existing diabetes diaries with the addition of instructions and information specific to type 3c diabetes.

Discussion

The diary for type 3c diabetes patients has been implemented as clinical routine on the ward. Further validation of the diary and its usage is needed. Therefore, further evaluation through analysis of diary usage and interviews with patients both during hospitalization and at home is planned, to enhance understanding of how the diary can contribute to patient learning and self-management.
72374 - Assessment of resilience and social support in the context of colorectal surgery
Authors: Hallbert Rebecka
Published: August 2024

Introduction

Surgical advancements continue to progress, and the implementation of care programs such as checklists during the surgical procedure enhances nursing and medical care while reducing the risk of complications. However, in a strained work environment, standardized protocols might also overshadow patient-centered care, negatively impacting the patient’s wellbeing and chances of a fast recovery.

Method

This literature review investigates assessment tools for measuring resilience and social support in patients undergoing colorectal surgery to enhance postoperative outcomes. Using validated instruments such as MSPSS, CD-RISC, BRS, and SFQ, studies have identified the importance of social support and resilience in patient recovery.

Result

As a result of colorectal surgery patients often experience permanent physical changes, necessitating psychological resilience and social support for adaptation. Integrating prehabilitation programs into checklists such as ERAS protocols while providing person-centered care can optimize patient outcomes by addressing individual needs and promoting self-management strategies. Collaboration between patients, families, and healthcare providers is essential for comprehensive rehabilitation considering the patients' physical, psychological, cultural, social, and sexual needs.

Discussion

As addressing patients' resilience and social support needs during surgical processes is critical for successful postoperative recovery, existing preoperative checklists should include assessments of these factors to facilitate tailored interventions and support patient-centered care. By focusing on patients' individual resources and support systems, healthcare providers can empower patients to develop effective self-care strategies essential for optimal rehabilitation after colorectal surgery.
Optimal candidates and surrogate endpoints for HAIC versus Sorafenib in hepatocellular carcinoma: an updated systematic review and meta-analysis
Authors: Si Tengfei , Shao Qing , Jassem Wayel , Ma Yun , Heaton Nigel
Published: August 2024

Background and aims:

Hepatic artery infusion chemotherapy (HAIC) has been a long-standing intervention for hepatocellular carcinoma (HCC). Despite positive clinical outcomes, its inclusion in guidelines remains limited due to a lack of evidence-based support. This study aims to identify optimal target populations for HAIC and validate associations between intermediate endpoints with overall survival (OS).

Methods:

Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The primary search strategy was based on medical subject headings terms (MeSH) using ‘Hepatic arterial infusion chemotherapy’, ‘HAIC’, ‘Sorafenib’, ‘Nexavar’, ‘hepatocellular carcinoma’, ‘HCC’, ‘Liver cancer’, combined with free text words. Data extraction, quality assessment, and analysis were performed according to preregistered protocol.

Results:

A total of 26 studies, 6456 HCC patients were included for analysis (HAIC, n=2648; Sorafenib, n=3808). Pooled outcomes revealed that Sorafenib demonstrated better OS only in patients who were refractory to trans-arterial chemoembolization (TACE) (HR=1.32, 95% CI [1.01–1.73]), in other subgroups or overall HCC population HAIC consistently outperformed Sorafenib in patients’ survival. Radiologically, higher response rates in the HAIC group does not necessarily translate into survival improvement, but the hazard ratios (HRs) of 1-year-OS (R2=0.41, P=0.0044) and 1-year-progression free survival (1y-PFS) (R2=0.77, P=0.0002) strongly correlated with the patients OS. Meanwhile, larger tumour size (HR=1.86, 95% CI [1.12–3.1, 95%), heavier tumour burden (HR=2.32, 95% CI [1.33–4.02), existence of MVI or EHS (HR=1.65, 95% CI [1.36–2]; HR=1.60, 95% CI [1.19–2.14]), and AFP >400 ng/ml (HR=1.52, 95% CI [1.20–1.92]) were identified as independent risk factors for OS, while HAIC treatment (HR=0.54, 95% CI [0.35–0.82]) and lower BCLC stage (HR=0.44, 95% CI [0.28–0.69]) were potential protective factors for HCC patients.

Conclusion:

HAIC monotherapy appears noninferior to Sorafenib in HCC treatment, with potential benefits in specific subgroups. The robust correlation between 1y-OS/1y-PFS and OS, alongside identified risk and protective factors from the present study, offers valuable insights for designing future large prospective studies in this field.
Treatment patterns and prognosis of patients with clear cell adenocarcinoma of the cervix: a population-based cohort study
Authors: Li Jing , Qiao Huimin , Yang Yang , Wu Lan , Xu Dongdong , Lin Zhongqiu , Lu Huaiwu
Published: August 2024

Objectives:

To describe treatment patterns and prognoses for clear cell adenocarcinoma of the cervix (CCAC), a poorly understood rare tumor.

Methods:

A retrospective case–control study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database, focusing on females diagnosed with CCAC between 2000 and 2019. Kaplan–Meier analysis, propensity score matching, Cox regression analysis, and subgroup analysis were used to assess treatment outcomes and risk factors.

Results:

Of the 52 153 patients with cervical cancer in the SEER database, 528 had CCAC. Overall survival (OS) was worse for patients with early-stage and locally advanced CCAC disease, although no differences in survival were observed for patients with stage IVB disease compared to those with other histologies. In our investigation into treatment patterns, we have discovered that surgical treatment was the preferred choice for the majority of patients with locally advanced CCAC (58.5%). Further, Kaplan–Meier analysis revealed that surgery improved OS in CCAC patients (65.6 vs. 25.3%, P=0.000), with similar results in locally advanced-stage patients (57.9 vs. 26.7%, P=0.000). Moreover, multivariate Cox regression analysis revealed that surgery was significantly associated with a more favorable prognosis in CCAC patients with locally advanced disease (HR 0.299, 95% CI: 0.153–0.585, P=0.000). Consistent findings were observed following propensity score matching (HR 0.283, 95% CI: 0.106–0.751, P=0.011). According to the subgroup analyses, surgical intervention continued to show a beneficial effect on CCAC patients with locally advanced disease (HR=0.31, 95% CI: 0.21–0.46, P<0.001). In particular, we also found that compared to patients who received primary radiotherapy (RT), those who underwent radical surgery exhibited a significantly prolonged OS in locally advanced CCAC patients. Furthermore, multivariate Cox regression analysis revealed that surgery was associated with better outcomes in patients with stage IB3-IIA2 and locally resectable stage IIIC patients (HR 0.207, 95% CI=0.043–0.991, P=0.049). However, this trend was not observed for patients with stage IIB-IVA (except locally resectable stage IIIC) CCAC.

Conclusions:

Surgery should be considered the preferred treatment option for patients with locally advanced CCAC at stage IB3-IIA2 and locally resectable stage IIIC.
Galectin-3 as a Prognostic Biomarker of Left Ventricular Assist Device Implantation Outcomes
Authors: Hoang Ryan , Acosta Mary E. , Belkin Mark N. , Rasheed Nabeel F. , Siddiqi Umar , Cruz Jennifer M. , Lupo Sydney E. , Stonebraker Corinne R. , Kalantari Sara , Grinstein Jonathan
Published: August 2024

We assessed the prognostic potential of Galectin-3 in a sample of 159 heart failure patients who received a left ventricular assist device (LVAD) implant from 2012 to 2020. Clinical outcomes included hemodynamic data, right heart failure (RHF), hemocompatibility-related adverse events (HRAEs), and mortality. Galectin-3 was compounded into Michigan-RVF and EUROMACS-RHF risk scores and compared to the noncompounded risk scores. Right heart failure was significantly correlated with Galectin (p = 0.004) on a continuous spectrum. Inotrope duration was significantly correlated to Galectin-3 (interquartile range [IQR]: 7.58–8.65, p < 0.001) along with INTERMACS score (IQR: 2.14–1.90, p < 0.001). Intensive care unit length of stay (median 8 days, p = 0.02), blood urea nitrogen (p < 0.001), creatinine (p < 0.001), and pulmonary artery pulsatility index (p = 0.05) were also significantly correlated with Galectin-3. In our c-statistic analysis, the predictive value for RHF improved when Galectin-3 was included for both the Michigan-RVF (0.80–0.86) and EUROMACS-RHF (0.77–0.82) risk scores. When elevated over a binary cutoff of 18.2 ng/ml, Galectin-3 significantly correlated with HRAEs (p = 0.014) and mortality (p = 0.031). Galectin-3 shows great promise as a predictive biomarker in patients implanted with durable LVADs. In addition to significant correlation with key clinical outcomes, Galectin-3 enhanced the Michigan-RVF and EUROMACS-RHF risk scores in predicting progression to RHF.
Medications that Regulate Gastrointestinal Transit Influence Inpatient Blood Glucose
Authors: Momenzadeh Amanda , Cranney Caleb , Choi So Yung , Bresee Catherine , Tighiouart Mourad , Gianchandani Roma , Pevnick Joshua , Moore Jason H. , Meyer Jesse G.
Published: August 2024

Objective

A multitude of factors affect a hospitalized individual’s blood glucose (BG), making BG difficult to predict and manage. Beyond medications well established to alter BG, such as beta-blockers, there are likely many medications with undiscovered effects on BG variability. Identification of these medications and the strength and timing of these relationships has potential to improve glycemic management and patient safety.

Materials and Methods

EHR data from 103,871 inpatient encounters over 8 years within a large, urban health system was used to extract over 500 medications, laboratory measurements, and clinical predictors of BG. Feature selection was performed using an optimized Lasso model with repeated 5-fold cross-validation on the 80% training set, followed by a linear mixed regression model to evaluate statistical significance. Significant medication predictors were then evaluated for novelty against a comprehensive adverse drug event database.

Results

We found 29 statistically significant features associated with BG; 24 were medications including 10 medications not previously documented to alter BG. The remaining five factors were Black/African American race, history of type 2 diabetes mellitus, prior BG (mean and last) and creatinine.

Discussion

The unexpected medications, including several agents involved in gastrointestinal motility, found to affect BG were supported by available studies. This study may bring to light medications to use with caution in individuals with hyper- or hypoglycemia. Further investigation of these potential candidates is needed to enhance clinical utility of these findings.

Conclusion

This study uniquely identifies medications involved in gastrointestinal transit to be predictors of BG that may not well established and recognized in clinical practice.
IMPACT OF THE COVID-19 PANDEMIC ON ADHERENCE TO CARDIOVASCULAR MEDICATIONS AMONG CHRONICALLY TREATED PATIENTS IN ALBERTA
Authors: McAlister Finlay A. , Savu Anamaria , Chu Luan Manh , Dover Douglas C. , Kaul Padma
Published: August 2024

Background:

Some studies have suggested that the COVID-19 pandemic negatively impacted patient adherence with chronic therapies. We designed this study to explore whether cardiovascular drug adherence patterns changed in chronically treated patients during the COVID-19 pandemic.

Methods:

Retrospective cohort study examining drug dispensation data for all Alberta residents older than 18 years who were chronic users of at least one cardiovascular drug class, defined as receiving at least one prescription per annum for any agent in that drug class from March 15, 2017 to March 14, 2023 and 2 or more prescriptions within 365 days during either the pre-pandemic phase (March 15, 2018 to March 14, 2020) or the pandemic phase (March 15, 2020 to March 14, 2022). We calculated the proportion of days covered (PDC) for each drug class per patient and used generalized estimating equation logistic regression to estimate the effect of time period (pandemic versus pre-pandemic) on achievement of good adherence (PDC>0.8) after adjusting for age, sex, socioeconomic status, and comorbidities.

Results:

We evaluated 548,601 chronic users of at least one cardiovascular drug class between March 15, 2018 and March 14, 2022. The most frequently dispensed cardiovascular drug classes were ACEi/ARB (67.6%), statins (53.8%), beta-blockers (21.0%), and calcium channel blockers (20.7%); the most frequent diagnoses were hypertension (77.2%), diabetes mellitus (30.6%), and ischemic heart disease (19.6%), although 55.4% of the patients had Charlson Comorbidity Index scores of 0. The mean PDC for cardiovascular drug use in our cohort was 85.7% (median 93%) pre-pandemic and 87.0% (median 94%) during the pandemic. The proportion exhibiting good adherence (PDC>0.8) increased from 72.8% pre-pandemic to 75.4% during the pandemic (p<0.001). During the pandemic, users of cardiovascular drugs were more likely to exhibit good adherence (PDC>0.8) than they were in the pre-pandemic period: aOR ranged from 1.05 (95%CI 1.00-1.11) for mineralocorticoid receptor antagonists to 1.16 (1.15-1.17) for statins.

Conclusion:

Chronic users of cardiovascular drugs exhibited higher adherence measures during the COVID-19 pandemic than prior to the pandemic.