bluuebunny/crossref_metadata_2025_split huggingface dataset:
72302 - Don’t cry over spilled gallstones. Consequences of gallstones left in the abdominal cavity, a matched cohort study
Authors: Edergren Åsa , Sandblom Gabriel , Ali Omar , von Gerber Alva , Agustsson Thorhallur , Jaafar Gona 
Published: August 2024

Abstract

Introduction
In 2.4% of laparoscopic cholecystectomies, gallstones are left in the abdomen after surgery. Studies on the long-term effect of spilled gallstone are scarce, but complications such as abscesses are described in 7% of these cases. Are the rest of these patients symptom free? This study aimed to examine if gallstones left in the abdominal cavity increase the risk of surgical site infection (SSI), post-operative abscess and chronic abdominal pain.

Method
The study is based on GallRiks, the Swedish register of gallstone-surgery, and a retrospective review of patient records for patients undergoing laparoscopic cholecystectomy at Södersjukhuset in Stockholm 2008 – 2022. Patients with registered retained gallstones in the abdominal cavity were identified and matched with a control group without an intraoperatively perforated gallbladder based on age, gender, surgery indication, operation year and surgical approach. Preoperative, intraoperative, and postoperative variables were collected. The cases and controls were compared with chi-square test and data was analyzed using Cox regression with stone spillage as exposure, adjusted for ASA-classification and antibiotic treatment.

Result
76 cases with retained gallstones were matched with 152 cases without gallbladder perforation. No significant associations between retained gallstones and abdominal pain, nor abscess development, were found. There was however a significant association between retained gallstones and SSI with a hazard ratio of 6.18 [1.63 - 23.4]. There was no significant effect of antibiotics on the risk for any of the outcomes.

Discussion
Few patients seem to develop complications from retained gallstones, so maybe some gallstones left in the abdomen at the end of surgery is acceptable?
72325 - Centralisation of gastric cancer surgery- impact on treatment strategies and survival - a national population-based cohort study
Authors: Engborg Jonathan , Winbladh Anders , Lindblad Mats , Hedberg Jakob 
Published: August 2024

Abstract

Introduction
Centralised surgery care improves results of curative resection in rare malignancies. Less is known of secondary effects of such centralisation on all patients, including patients receiving palliative or no tumour treatment. This population-based cohort study aimed to evaluate effects of centralisation on survival and treatment decision in all gastric cancer patients in Sweden between 2006-2016.

Method
All patients diagnosed with non-cardia gastric cancer were identified using National Registry for Oesophageal and Gastric Cancer (NREV) in Sweden. Patients cared by a local hospital performing low-volume curative gastric cancer surgery before centralisation were compared to patients in the same communities after curative cases were referred elsewhere. Survival differences were plotted in logistic regression models.

Result
Of 49 hospitals, 28 stopped performing curative gastric cancer surgery during the study period. After centralisation, 8 hospitals remained performing curative gastric cancer surgery. 4562 patients were included, and the median overall survival increased from 7.9 to 9.2 months. Resection rates fell from 36% to 30%. Treatment recommendation made at multidisciplinary cancer conference increased from 36% to 87%, where active tumour treatment increased from 66% to 72%. No significant difference in treatment strategy or time to surgery was found between the groups. No difference in overall survival was found between the groups.

Discussion
During the centralisation of gastric cancer surgery, survival, multidisciplinary treatment decisions and active treatment increased, with no detrimental effects on populations outside the major centres’ primary uptake areas.
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

Abstract

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 &lt; 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

Abstract

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

Abstract

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&lt;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

Abstract

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&lt;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&lt;0.001) and robotic-assisted of incomplete TME specimen (P&lt;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

Abstract

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 &lt; 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 &lt; 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

Abstract

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&lt;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

Abstract

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

Abstract

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&lt;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

Abstract

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

Abstract

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.