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Kanani A, Veen T, Søreide K. Neoadjuvant immunotherapy in primary and metastatic colorectal cancer. Br J Surg 2021; 108:1417-1425. [PMID: 34694371 PMCID: PMC10364874 DOI: 10.1093/bjs/znab342] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/07/2021] [Accepted: 09/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common solid organ cancer. Traditional treatment is with surgery and chemotherapy. Immunotherapy has recently emerged as a neoadjuvant therapy that could change treatment strategy in both primary resectable and metastatic CRC. METHODS A literature review of PubMed with a focus on studies exploring upfront immunotherapy in operable CRC, either for primary resectable stage I-III cancers or for (potentially) operable liver metastasis. RESULTS Immune checkpoint blockade by the programmed cell death 1 (PD-1) receptor inhibitors nivolumab and pembrolizumab and the cytotoxic T cell-associated protein 4 (CTLA-4) inhibitor ipilimumab has shown good results in both early-stage and advanced CRC. The effects of immune checkpoint inhibitors have so far been demonstrated in small phase I/II studies and predominantly in treatment-refractory stage IV disease with defect Mismatch repair (dMMR). However, recent data from phase I/II (NICHE-1) studies suggest an upfront role for immunotherapy in operable stage I-III disease. By blocking crucial immune checkpoints, cytotoxic T cells are activated and release cytotoxic signals that initiate cancer cell destruction. The very high complete response rate in dMMR operable CRC with neoadjuvant immunotherapy with nivolumab and ipilimumab, and even partial pathological response in some patients with proficient MMR (pMMR) CRC, calls for further attention to patient selection for neoadjuvant treatment, beyond MMR status alone. CONCLUSION Early data on the effect of immunotherapy in CRC provide new strategic thinking of treatment options in CRC for both early-stage and advanced disease, with prospects for new trials.
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Affiliation(s)
- A Kanani
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Gastrointestinal Translational Research Unit, Stavanger University Hospital, Stavanger, Norway
| | - T Veen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Gastrointestinal Translational Research Unit, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Gastrointestinal Translational Research Unit, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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2
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Skjold-Ødegaard B, Hamid S, Lindeman RJ, Ersdal HL, Søreide K. Deciphering the inflection points to achieve proficiency for each procedure step during training in laparoscopic appendicectomy. BJS Open 2021; 5:6369778. [PMID: 34518871 PMCID: PMC8438264 DOI: 10.1093/bjsopen/zrab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/05/2021] [Indexed: 02/01/2023] Open
Abstract
Background Laparoscopic appendicectomy is a common procedure early in surgical training. A minimum number is usually required for certification in general surgery. However, data on proficiency are scarce. This study aimed to investigate steps towards proficiency in laparoscopic appendicectomy. Methods This was a prospective observational cohort study of laparoscopic appendicectomies performed by junior trainees under supervision scored on a six-point performance scale. Structured assessment was done within a defined programme. Procedures performed for uncomplicated appendicitis in adults were included. The procedures were evaluated with LOWESS graphs generated to investigate inflection points. Factors associated with proficiency rates were reported with odds ratios and 95 per cent confidence intervals. Results In total 142 laparoscopic procedures were included for 19 trainees (58 per cent female). The cumulative number of procedures during the study was a median of 20 (i.q.r. 8–33). For overall proficiency, an inflection point occurred at 30 procedures. Proficiency rate increased from 51 per cent for 30 or fewer procedures to 93 per cent for more than 30 procedures (odds ratio 11.9 (95 per cent c.i. 3.4 to 40.9); P < 0.001). Inflection points for proficiency for each procedure step varied considerably, with lowest numbers (fewer than 15 procedures) for removing the specimen, and highest for dividing the mesoappendix (more than 55 procedures). Operating time was significantly reduced by a median of 7 minutes after 30 procedures, from median 62 (i.q.r. 25–120) minutes to median 55 (i.q.r. 30–110) minutes for more than 30 procedures. Conclusion For junior trainees, variation in proficiency is related to specific procedure steps. Targeted training on specific procedure skills may reduce numbers needed to achieve proficiency in laparoscopic appendicectomy during training.
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Affiliation(s)
- B Skjold-Ødegaard
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Department of Surgery, Haugesund Hospital, Haugesund, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - S Hamid
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - R-J Lindeman
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H L Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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3
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Affiliation(s)
- B Skjold-Ødegaard
- Department of Surgery, Haugesund Hospital, Haugesund, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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4
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Bennett S, Søreide K, Gholami S, Pessaux P, Teh C, Segelov E, Kennecke H, Prenen H, Myrehaug S, Callegaro D, Hallet J. Strategies for the delay of surgery in the management of resectable hepatobiliary malignancies during the COVID-19 pandemic. Curr Oncol 2020; 27:e501-e511. [PMID: 33173390 PMCID: PMC7606047 DOI: 10.3747/co.27.6785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.
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Affiliation(s)
- S Bennett
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
| | - K Søreide
- Norway: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, and Department of Clinical Medicine, University of Bergen, Bergen
| | - S Gholami
- United States: Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA (Gholami); Virginia Mason Cancer Institute, Seattle, WA (Kennecke)
| | - P Pessaux
- France: Department of Surgery, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg
| | - C Teh
- Philippines: Institute of Surgery, St. Luke's Medical Center, Quezon City; Department of Surgery, Makati Medical Center, Makati; and Department of General Surgery, National Kidney and Transplant Institute, Quezon City
| | - E Segelov
- Australia: Monash University and Monash Health, Melbourne
| | - H Kennecke
- United States: Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA (Gholami); Virginia Mason Cancer Institute, Seattle, WA (Kennecke)
| | - H Prenen
- Belgium: Department of Oncology, University Hospital Antwerp, Antwerp
| | - S Myrehaug
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
| | - D Callegaro
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
- Italy: Department of Surgery, Fondazione irccs Istituto Nazionale Tumori, Milan
| | - J Hallet
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
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5
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Nymo LS, Kleive D, Waardal K, Bringeland EA, Søreide JA, Labori KJ, Mortensen KE, Søreide K, Lassen K. Centralizing a national pancreatoduodenectomy service: striking the right balance. BJS Open 2020; 4:904-913. [PMID: 32893988 PMCID: PMC7528527 DOI: 10.1002/bjs5.50342] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/23/2020] [Accepted: 07/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher‐volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study presents a volume–outcome analysis of a complete national cohort in a health system with long‐standing centralization. Methods Data for all pancreatoduodenectomies in Norway in 2015 and 2016 were identified through a national quality registry and completed through electronic patient journals. Hospitals were dichotomized (high‐volume (40 or more procedures/year) or medium–low‐volume). Results Some 394 procedures were performed (201 in high‐volume and 193 in medium–low‐volume units). Major postoperative complications occurred in 125 patients (31·7 per cent). A clinically relevant postoperative pancreatic fistula occurred in 66 patients (16·8 per cent). Some 17 patients (4·3 per cent) died within 90 days, and the failure‐to‐rescue rate was 13·6 per cent (17 of 125 patients). In multivariable comparison with the high‐volume centre, medium–low‐volume units had similar overall complication rates, lower 90‐day mortality (odds ratio 0·24, 95 per cent c.i. 0·07 to 0·82) and no tendency for a higher failure‐to‐rescue rate. Conclusion Centralization beyond medium volume will probably not improve on 90‐day mortality or failure‐to‐rescue rates after pancreatoduodenectomy.
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Affiliation(s)
- L S Nymo
- Department of Gastrointestinal Surgery, University Hospital of North, Tromsø, Norway.,Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - D Kleive
- Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K Waardal
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - E A Bringeland
- Department of Gastrointestinal Surgery, St Olav Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - J A Søreide
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K J Labori
- Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K E Mortensen
- Department of Gastrointestinal Surgery, University Hospital of North, Tromsø, Norway.,Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - K Søreide
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Lassen
- Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway.,Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway
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6
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Thorsen K, Vetrhus M, Narvestad JK, Reite A, Larsen JW, Vennesland J, Tjosevik KE, Søreide K. Performance and outcome evaluation of emergency resuscitative thoracotomy in a Norwegian trauma centre: a population-based consecutive series with survival benefits. Injury 2020; 51:1956-1960. [PMID: 32522355 DOI: 10.1016/j.injury.2020.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/08/2020] [Accepted: 05/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Emergency resuscitative thoracotomy (ERT) is a lifesaving procedure for select indications in severely injured patients. The main body of the literature stem from regions with a high prevalence of penetrating injuries, while data from European institutions remain scarce. We aimed to evaluate a decade of ERT in a Norwegian trauma centre. METHODS A prospectively collected series from the institutional trauma registry of all consecutive trauma patients who had an ERT at Stavanger University Hospital (SUH) from 2006 to 2018. Data were extracted using both registry and electronic patient record (EPR) data, including injury profile, demographics and outcomes. Comparison of groups were done by descriptive statistics. RESULTS A total of 26 ERTs were performed during the study period, of which 20 were men (75%) and 6 women (25%). Five patients (19%) survived to hospital discharge, of which 3 men and 2 women with a median age of 46 years (range 24-68). All survivors had thoracic injury as location of major injury (LOMI.). Of the five survivors, four suffered blunt injury and one patient penetrating injury. At one-year of follow-up of the survivors, three patients scored 8/8 on Glasgow outcome scale-extended, 1 patient scored 7/8 and one patient 5/8. CONCLUSION In this study, ERT conferred good outcome with survival in one of every five procedures. Performing ERT in severely injured patients presenting in extremis appears to be justified even in low-volume centres and in blunt trauma.
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Affiliation(s)
- K Thorsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
| | - M Vetrhus
- Department of Vascular Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J K Narvestad
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - A Reite
- Department of Vascular Surgery, Stavanger University Hospital, Stavanger, Norway
| | - J Wiik Larsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - J Vennesland
- Department of Vascular Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K E Tjosevik
- Department of Emergency Medicine, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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7
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Stormark K, Krarup PM, Sjövall A, Søreide K, Kvaløy JT, Nordholm-Carstensen A, Nedrebø BS, Kørner H. Anastomotic leak after surgery for colon cancer and effect on long-term survival. Colorectal Dis 2020; 22:1108-1118. [PMID: 32012414 DOI: 10.1111/codi.14999] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/15/2019] [Indexed: 02/08/2023]
Abstract
AIM An anastomotic leak after surgery for colon cancer is a recognized complication but how it may adversely affect long-term survival is less clear because data are scarce. The aim of the study was to investigate the long-term impact of Grade C anastomotic leak in a large, population-based cohort. METHOD Data on patients undergoing resection for Stage I-III colon cancer between 2008 and 2012 were collected from the Swedish, Norwegian and Danish Colorectal Cancer Registries. Overall relative survival and conditional 5-year relative survival, under the condition of surviving 1 year, were calculated for all patients and stratified by stage of disease. RESULTS A total of 22 985 patients were analysed. Anastomotic leak occurred in 849 patients (3.7%). Five-year relative survival in patients with anastomotic leak was 64.7% compared with 87.0% for patients with no leak (P < 0.001). Five-year relative survival among the patients who survived the first year was 88.6% vs 81.3% (P = 0.003). Stratification by cancer stage showed that anastomotic leak was significantly associated with decreased relative survival in patients with Stage III disease (P = 0.001), but not in patients with Stage I or II (P = 0.950 and 0.247, respectively). CONCLUSION Anastomotic leak after surgery for Stage III colon cancer was associated with significantly decreased long-term relative survival.
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Affiliation(s)
- K Stormark
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - A Sjövall
- Division of Coloproctology, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Clinical Surgery, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J T Kvaløy
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - A Nordholm-Carstensen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - B S Nedrebø
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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8
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Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBS, Otero J, Callegaro D, Warner SG, Baxter NN, Teh CSC, Ng-Kamstra J, Meara JG, Hagander L, Lorenzon L. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020; 107:1250-1261. [PMID: 32350857 PMCID: PMC7267363 DOI: 10.1002/bjs.11670] [Citation(s) in RCA: 473] [Impact Index Per Article: 118.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Background The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. Methods This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. Results Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. Conclusion Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - J Hallet
- Department of Surgery, Sunnybrook and University of Toronto, Toronto, Ontario, Canada
| | - J B Matthews
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A A Schnitzbauer
- Department for General, Visceral and Transplant Surgery, Frankfurt University Hospital, Goethe University, Frankfurt/Main, Germany
| | - P D Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P B S Lai
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - J Otero
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | - D Callegaro
- Department of Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milan, Spain
| | - S G Warner
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - N N Baxter
- Melbourne School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - C S C Teh
- Institute of Surgery, St Luke's Medical Centre, Metro Manila, Philippines.,Department of Surgery, Makati Medical Centre, Makati, Philippines.,Department of General Surgery, National Kidney and Transplant Institute, Quezon City, Philippines
| | - J Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - L Hagander
- Lund University WHO Collaborating Centre for Surgery and Public Health, Paediatric Surgery, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - L Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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Abstract
BACKGROUND AND AIMS Patients undergoing surgery are prone to infections, either at the site of surgery (superficial or organ-space) or at remote sites (e.g. pneumonia or urinary tract). Surgical site infections are associated with substantial morbidity and mortality, increased length of hospital stay and represent a huge burden to the health economy across all healthcare systems. Here we discuss recent advances and challenges in the field of surgical site infections. MATERIAL AND METHODS Review of pertinent English language literature. RESULTS Numerous guidelines and recommendations have been published in order to prevent surgical site infections. Compliance with these evidence-based guidelines vary and has not resulted in any major decrease in the surgical site infection rate. To date, most efforts to reduce surgical site infection have focused on the role of the surgeon, but a more comprehensive approach is necessary. CONCLUSION Surgical site infections need to be addressed in a structured way, including checklists, audits, monitoring, and measurements. All stakeholders, including the medical profession, the society, and the patient, need to work together to reduce surgical site infections. Most surgical site infections are preventable-and we need a paradigm shift to tackle the problem.
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Affiliation(s)
- R Andersson
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - D Ansari
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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10
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Abstract
BACKGROUND AND AIMS Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery. MATERIAL AND METHODS Review of the pertinent English-language literature. RESULTS There is a growing body of evidence showing a lack of benefit of prophylactic drainage after pancreatoduodenectomy. Randomized trials have reported similar outcomes with or without routine drains. If drains were used, early removal was found to be superior to late removal in patients with a low risk of postoperative pancreatic fistula. Consequently, criteria for early drain removal have been developed based on the measurement of drain amylase levels. On the contrary, there exists a subgroup of patients where drains may have a role. In patients with high risk of pancreatic fistula formation, such as those having a soft pancreatic texture, small pancreatic duct and high body mass index, the placement of drains may give sentinel information about future clinical deterioration. The drain may thus help reduce failure-to-rescue rates. CONCLUSION Despite much research, there are many unanswered questions regarding drains in pancreatic surgery. It is evident that routine drainage should be abandoned for a more selective strategy. Furthermore, what is needed is a postoperative warning score that early on can identify patients at risk of a pancreatic fistula, without the routine placement of drains.
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Affiliation(s)
- R Andersson
- Surgery, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - D Ansari
- Surgery, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
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11
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Affiliation(s)
- M Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12 631 East 17th Avenue, C-313, Aurora, Colorado 80045, USA
| | - K Søreide
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway
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12
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Søreide K, Guest RV, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg 2019; 106:32-45. [PMID: 30582640 DOI: 10.1002/bjs.11035] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. METHODS A systematic PubMed search of the English literature to May 2018 was conducted. RESULTS The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. CONCLUSION Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
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Affiliation(s)
- K Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R V Guest
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - T J Kendall
- Division of Pathology, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - O J Garden
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - S J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
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13
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Watson M, Kanani A, Lea D, Khajavi R, Søreide J, Kørner H, Hagland H, Søreide K. Association between elevated microsatellite alterations at selected tetranucleotides (EMAST) and clinicopathological features of colorectal cancer patients: a molecular trait of proximal colon cancer in the elderly? Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Holmer H, Bekele A, Hagander L, Harrison EM, Kamali P, Ng-Kamstra JS, Khan MA, Knowlton L, Leather AJM, Marks IH, Meara JG, Shrime MG, Smith M, Søreide K, Weiser TG, Davies J. Evaluating the collection, comparability and findings of six global surgery indicators. Br J Surg 2018; 106:e138-e150. [PMID: 30570764 PMCID: PMC6790969 DOI: 10.1002/bjs.11061] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/01/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023]
Abstract
Background In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates. Methods Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates. Results Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916–2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed. Conclusion Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.
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Affiliation(s)
- H Holmer
- WHO Collaborating Centre for Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Karolinska University Hospital, Solna, Stockholm, Sweden
| | - A Bekele
- Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,University of Global Health Equity, Kigali, Rwanda
| | - L Hagander
- WHO Collaborating Centre for Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Paediatric Surgery, Skåne University Hospital Children's Hospital, Lund, Sweden
| | - E M Harrison
- Department of Clinical Surgery, Royal Infirmary of Edinburgh and Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - P Kamali
- Division of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.,InciSioN, International Student Surgical Network, Leuven, Belgium
| | - J S Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M A Khan
- InciSioN, International Student Surgical Network, Leuven, Belgium.,CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - L Knowlton
- Department of Surgery, Stanford University, Stanford, California, USA
| | - A J M Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - I H Marks
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,InciSioN, International Student Surgical Network, Leuven, Belgium
| | - J G Meara
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA
| | - M G Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, USA
| | - M Smith
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of General Surgery, Chris Hani Baragwaneth Academic Hospital, Johannesburg, South Africa
| | - K Søreide
- Department of Clinical Surgery, Royal Infirmary of Edinburgh and Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T G Weiser
- Department of Clinical Surgery, Royal Infirmary of Edinburgh and Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.,Department of Surgery, Stanford University, Stanford, California, USA
| | - J Davies
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Institute for Applied Health Research, University of Birmingham, Birmingham, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Parktown, South Africa
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15
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Abstract
A call for action now
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, PO Box 8100, Stavanger University Hospital, N-4068 Stavanger, Norway
| | - D C Winter
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
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16
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Berg K, Sveen A, Høland M, Berg M, Hektoen M, Alagaratnam S, Nesbakken A, Søreide K, Lothe R. PO-325 Novel recurrent high-level amplifications in microsatellite stable colorectal cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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17
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Lassen K, Nymo LS, Olsen F, Søreide K. Benchmarking of aggregated length of stay after open and laparoscopic surgery for cancers of the digestive system. BJS Open 2018; 2:246-253. [PMID: 30079394 PMCID: PMC6069352 DOI: 10.1002/bjs5.67] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/07/2018] [Indexed: 12/15/2022] Open
Abstract
Background Length of hospital stay (LOS) may serve as a surrogate measure of healthcare quality and resource use, particularly when transfers of care and readmissions are accounted for. This study aimed to benchmark true hospital stay by measuring index, transfer and readmission stays across the range of digestive cancer surgery. Methods A cohort study of all patients undergoing resection for cancer of the oesophagus, stomach, liver, pancreas, colon or rectum in 2012–2016 was undertaken. Index LOS, transfer and readmission stays were merged into an ‘aggregated’ length of stay (a‐LOS), and compared between organ sites and between open and minimal‐access approaches. Results In total, 24 354 resections were reported (mean age of patients 68·3 years; 51·3 per cent were men). Resections were reported as laparoscopic for 9151 procedures (37·6 per cent), with a further 283 (3·0 per cent) described as converted to open surgery. Use of a‐LOS compared with standard LOS added a median of 5 days for pancreatoduodenectomy, 4 days for major liver resections, 3 days for oesophageal and gastric resections, and 2 days for minor liver, distal pancreatic and rectal resections. Conclusion Overall hospital stay across organ sites and procedures is better described by a‐LOS. The study benchmarks the use of total hospital days during the first 30 days in a universal healthcare system.
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Affiliation(s)
- K Lassen
- Department of Hepato-Pancreato-Biliary Surgery Oslo University Hospital Oslo Norway.,Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Norway.,Institute of Clinical Medicine University of Tromsø Tromsø Norway
| | - L S Nymo
- Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Norway.,Institute of Clinical Medicine University of Tromsø Tromsø Norway
| | - F Olsen
- Centre for Clinical Documentation and Evaluation Northern Norway Regional Health Authority Tromsø Norway
| | - K Søreide
- Department of Clinical Medicine University of Bergen Bergen Norway.,Department of Gastrointestinal Surgery Stavanger University Hospital Stavanger Norway.,Department of Clinical Surgery Royal Infirmary of Edinburgh, and University of Edinburgh Edinburgh UK
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18
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Nordgård O, Tjensvoll K, Gilje B, Søreide K. Circulating tumour cells and DNA as liquid biopsies in gastrointestinal cancer. Br J Surg 2018; 105:e110-e120. [DOI: 10.1002/bjs.10782] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/02/2017] [Accepted: 11/09/2017] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Blood is the most extensively studied body fluid and, because it contains circulating tumour cells (CTCs) and circulating tumour-derived cell-free DNA (ctDNA), it may represent a liquid biopsy for cancer. Methods for enrichment and detection of CTCs and ctDNA, their clinical applications and future opportunities in gastrointestinal cancers were the focus of this review.
Methods
The PubMed database was searched for literature up to 24 June 2017, with a focus on the past 10 years. Identified articles were further scrutinized for relevant references. Articles were those in English relating to colorectal, gastric and pancreatic cancer.
Results
Both CTCs and ctDNA are in low abundance compared with other cellular components of blood, but effective enrichment and highly sensitive techniques are available for their detection. Potential clinical applications of these liquid biopsies include screening, prognostic stratification, therapy administration, monitoring of treatment effect or resistance, and surveillance. Liquid biopsies provide opportunities to reduce the need for invasive tissue sampling, especially in the context of intratumoral heterogeneity and the need for tumour genotyping.
Conclusion
Liquid biopsies have applications in gastrointestinal cancers to improve clinical decision-making.
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Affiliation(s)
- O Nordgård
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
| | - K Tjensvoll
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - B Gilje
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
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19
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Thorsen K, Søreide JA, Søreide K. Long-Term Mortality in Patients Operated for Perforated Peptic Ulcer: Factors Limiting Longevity are Dominated by Older Age, Comorbidity Burden and Severe Postoperative Complications. World J Surg 2017; 41:410-418. [PMID: 27734076 DOI: 10.1007/s00268-016-3747-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is a surgical emergency associated with high short-term mortality. However, studies on long-term outcomes are scarce. Our aim was to investigate long-term survival after surgery for PPU. MATERIALS AND METHODS A population-based, consecutive cohort of patients who underwent surgery for PPU between 2001 and 2014 was reviewed, and the long-term mortality was assessed. Survival was investigated by univariate analysis (log-rank test) and displayed using Kaplan-Meier survival curves. Multivariable analysis of risk factors for long-term mortality was assessed by Cox proportional hazards regression and reported as hazard ratio (HR) with 95 % confidence intervals (CI). RESULTS A total of 234 patients were available for the calculation of ninety-day, one-year and two-year mortality, and the results showed rates of 19.2 % (45/234), 22.6 % (53/234) and 24.8 % (58/234), respectively. At the end of follow-up, a total of 109 of the 234 patients (46.6 %) had died. Excluding 37 (15.2 %) patients who died within 30 days of surgery, 197 patients had long-term follow-up (median 57 months, range 1-168) of which 36 % (71/197) died during the follow-up period. In multivariable analyses, age >60 years (HR 3.95, 95 % CI 1.81-8.65), active cancer (HR 3.49, 95 % CI 1.73-7.04), hypoalbuminemia (HR 1.65, 95 % CI 0.99-2.73), pulmonary disease (HR 2.06, 95 % CI 1.14-3.71), cardiovascular disease (HR 1.67, 95 % CI 1.01-2.79) and severe postoperative complications (HR 1.76, 95 % CI 1.07-2.89) during the initial stay for PPU were all independently associated with an increased risk of long-term mortality. Cause of long-term mortality was most frequently (18 of 71; 25 %) attributed to new onset sepsis and/or multiorgan failure. CONCLUSION The long-term mortality after surgery for PPU is high. One in every three patients died during follow-up. Older age, comorbidity and severe postoperative complications were risk factors for long-term mortality.
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Affiliation(s)
- K Thorsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway.
| | - J A Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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20
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Søreide K. Cancer biology of small gastrointestinal stromal tumors (<2 cm): What is the risk of malignancy? Eur J Surg Oncol 2017; 43:1344-1349. [DOI: 10.1016/j.ejso.2017.01.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 12/11/2022] Open
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21
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Hagland H, Lea D, Watson M, Søreide K. Correlation of circulating T-cells in pre-operative blood to intratumoral density and location of CD3+ and CD8+ T-cells in colorectal cancer: a potential for an immunoscore by liquid biopsy? Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30242-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Abstract
Surgeons need to get involved
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, and Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, N-4068 Stavanger, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - M Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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23
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Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, Ansaloni L, Bala M, Balogh ZJ, Beltrán MA, Ben-Ishay O, Biffl WL, Birindelli A, Cainzos MA, Catalini G, Ceresoli M, Che Jusoh A, Chiara O, Coccolini F, Coimbra R, Cortese F, Demetrashvili Z, Di Saverio S, Diaz J, Egiev VN, Ferrada P, Fraga GP, Ghnnam WM, Lee JG, Gomes CA, Hecker A, Herzog T, Kim JI, Inaba K, Isik A, Karamarkovic A, Kashuk J, Khokha V, Kirkpatrick AW, Kluger Y, Koike K, Kong VY, Leppaniemi A, Machain GM, Maier RV, Marwah S, McFarlane ME, Montori G, Moore EE, Negoi I, Olaoye I, Omari AH, Ordonez CA, Pereira BM, Pereira Júnior GA, Pupelis G, Reis T, Sakakushev B, Sato N, Segovia Lohse HA, Shelat VG, Søreide K, Uhl W, Ulrych J, Van Goor H, Velmahos G, Yuan KC, Wani I, Weber DG, Zachariah SK, Catena F. Erratum to: The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 2017; 12:36. [PMID: 28785302 PMCID: PMC5541743 DOI: 10.1186/s13017-017-0148-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
[This corrects the article DOI: 10.1186/s13017-017-0141-6.].
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Affiliation(s)
- M. Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - A. Chichom-Mefire
- Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
| | - F. M. Labricciosa
- 0000 0001 1017 3210grid.7010.6Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - T. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - F. M. Abu-Zidan
- 0000 0001 2193 6666grid.43519.3aDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - A. K. Adesunkanmi
- 0000 0001 2183 9444grid.10824.3fDepartment of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - L. Ansaloni
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M. Bala
- 0000 0001 2221 2926grid.17788.31Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Z. J. Balogh
- 0000 0004 0577 6676grid.414724.0Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - M. A. Beltrán
- Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - O. Ben-Ishay
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - W. L. Biffl
- 0000 0001 1482 1895grid.162346.4Acute Care Surgery at The Queen’s Medical Center, John A. Burns School of Medicine, University of Hawai’i, Honolulu, USA
| | - A. Birindelli
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - M. A. Cainzos
- 0000 0000 8816 6945grid.411048.8Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - G. Catalini
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - M. Ceresoli
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A. Che Jusoh
- Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
| | - O. Chiara
- grid.416200.1Emergency Department, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - F. Coccolini
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - R. Coimbra
- 0000 0001 2107 4242grid.266100.3Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | - F. Cortese
- Emergency Surgery Unit, San Filippo Neri’s Hospital, Rome, Italy
| | - Z. Demetrashvili
- 0000 0004 0428 8304grid.412274.6Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, T’bilisi, Georgia
| | - S. Di Saverio
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - J.J. Diaz
- 0000 0001 2175 4264grid.411024.2Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - V. N. Egiev
- 0000 0000 9559 0613grid.78028.35Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - P. Ferrada
- 0000 0004 0458 8737grid.224260.0Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - G. P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - W. M. Ghnnam
- 0000000103426662grid.10251.37Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - J. G. Lee
- 0000 0004 0470 5454grid.15444.30Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - C. A. Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - A. Hecker
- 0000 0000 8584 9230grid.411067.5Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - T. Herzog
- grid.416438.cDepartment of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - J. I. Kim
- 0000 0004 0470 5112grid.411612.1Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - K. Inaba
- 0000 0001 2156 6853grid.42505.36Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA USA
| | - A. Isik
- 0000 0001 1498 7262grid.412176.7Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - A. Karamarkovic
- 0000 0001 2166 9385grid.7149.bClinic for Emergency Surgery, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - J. Kashuk
- 0000 0004 1937 0546grid.12136.37Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - V. Khokha
- Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus
| | - A. W. Kirkpatrick
- 0000 0004 0469 2139grid.414959.4Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, Foothills Medical Centre, Calgary, AB Canada
| | - Y. Kluger
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - K. Koike
- 0000 0004 0372 2033grid.258799.8Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - V. Y. Kong
- 0000 0004 0576 7753grid.414386.cDepartment of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | - A. Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - G. M. Machain
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - R. V. Maier
- 0000000122986657grid.34477.33Department of Surgery, University of Washington, Seattle, WA USA
| | - S. Marwah
- 0000 0004 1771 1642grid.412572.7Department of Surgery, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - M. E. McFarlane
- 0000 0004 0500 5353grid.412963.bDepartment of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - G. Montori
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - E. E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - I. Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - I. Olaoye
- 0000 0000 8878 5287grid.412975.cDepartment of Surgery, University of Ilorin, Teaching Hospital, Ilorin, Nigeria
| | - A. H. Omari
- 0000 0004 0411 3985grid.460946.9Department of Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - C. A. Ordonez
- 0000 0001 2295 7397grid.8271.cDepartment of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia
| | - B. M. Pereira
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - G. A. Pereira Júnior
- Division of Emergency and Trauma Surgery, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - G. Pupelis
- Department of General and Emergency Surgery, Riga East University Hospital ‘Gailezers’, Riga, Latvia
| | - T. Reis
- Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil
| | - B. Sakakushev
- 0000 0001 0726 0380grid.35371.33General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - N. Sato
- 0000 0001 1011 3808grid.255464.4Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
| | - H. A. Segovia Lohse
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - V. G. Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - K. Søreide
- 0000 0004 0627 2891grid.412835.9Department of Gastrointestinal Surgery, Stavanger University Hospital, Stravenger, Norway
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, University of Bergen, Bergen, Norway
| | - W. Uhl
- grid.416438.cDepartment of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - J. Ulrych
- 0000 0000 9100 9940grid.411798.2First Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - H. Van Goor
- 0000 0004 0444 9382grid.10417.33Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G.C. Velmahos
- 0000 0004 0386 9924grid.32224.35Trauma, Emergency Surgery, and Surgical Critical Care Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - K. C. Yuan
- 0000 0004 1756 1461grid.454210.6Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - I. Wani
- 0000 0001 0174 2901grid.414739.cDepartment of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - D. G. Weber
- 0000 0004 0453 3875grid.416195.eDepartment of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - S. K. Zachariah
- Department of Surgery, Mosc Medical College, Kolenchery, Cochin India
| | - F. Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
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Abstract
The understanding of peptic ulcer disease (PUD) etiology, and improvements in treatment during the last two decades, has dramatically decreased the once so frequently performed procedures for PUD and its complications. Benign gastric outlet obstruction may, however, still require operative intervention when non-operative treatment fails. Today, surgeons in training, and even practicing surgeons, may have limited operative experience with procedures required to alleviate an obstructed pylorus. Our aim of this paper is to review the techniques (the Heineke-Mikulicz and Finney pyloroplasties, and modifications) and indications for pyloroplasty in the modern surgical era.
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Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, Norway
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25
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Aunan JR, Watson MM, Hagland HR, Søreide K. Molecular and biological hallmarks of ageing. Br J Surg 2016; 103:e29-46. [PMID: 26771470 DOI: 10.1002/bjs.10053] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ageing is the inevitable time-dependent decline in physiological organ function that eventually leads to death. Age is a major risk factor for many of the most common medical conditions, such as cardiovascular disease, cancer, diabetes and Alzheimer's disease. This study reviews currently known hallmarks of ageing and their clinical implications. METHODS A literature search of PubMed/MEDLINE was conducted covering the last decade. RESULTS Average life expectancy has increased dramatically over the past century and is estimated to increase even further. Maximum longevity, however, appears unchanged, suggesting a universal limitation to the human organism. Understanding the underlying molecular processes of ageing and health decline may suggest interventions that, if used at an early age, can prevent, delay, alleviate or even reverse age-related diseases. Hallmarks of ageing can be grouped into three main categories. The primary hallmarks cause damage to cellular functions: genomic instability, telomere attrition, epigenetic alterations and loss of proteostasis. These are followed by antagonistic responses to such damage: deregulated nutrient sensing, altered mitochondrial function and cellular senescence. Finally, integrative hallmarks are possible culprits of the clinical phenotype (stem cell exhaustion and altered intercellular communication), which ultimately contribute to the clinical effects of ageing as seen in physiological loss of reserve, organ decline and reduced function. CONCLUSION The sum of these molecular hallmarks produces the clinical picture of the elderly surgical patient: frailty, sarcopenia, anaemia, poor nutrition and a blunted immune response system. Improved understanding of the ageing processes may give rise to new biomarkers of risk or prognosis, novel treatment targets and translational approaches across disciplines that may improve outcomes.
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Affiliation(s)
- J R Aunan
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - M M Watson
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H R Hagland
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Centre for Organelle Research (CORE), Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - K Søreide
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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26
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Søreide K. The SSO/ESSO International Career Development Exchange Program: Experience from MD Anderson Cancer Center and Massachusetts General Hospital. Eur J Surg Oncol 2016; 42:3-6. [PMID: 27144256 DOI: 10.1016/j.ejso.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
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27
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Abstract
The greatest surgical challenge
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, PO Box 8100, Stavanger University Hospital, N-4068 Stavanger, Norway (e-mail: )
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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28
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Abstract
BACKGROUND Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. METHODS This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. RESULTS The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. CONCLUSION Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.
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Affiliation(s)
- K F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - T Veen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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29
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
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30
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Sandvik OM, Søreide K, Gudlaugsson E, Kvaløy JT, Søreide JA. Epidemiology and classification of gastroenteropancreatic neuroendocrine neoplasms using current coding criteria. Br J Surg 2015; 103:226-32. [PMID: 26511392 PMCID: PMC5061026 DOI: 10.1002/bjs.10034] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND The lack of uniform criteria for coding of gastroenteropancreatic neuroendocrine neoplasia (GEP-NEN) has hampered previous epidemiological studies. The epidemiology of GEP-NEN was investigated in this study using currently available criteria. METHODS All patients diagnosed with GEP-NEN between January 2003 and December 2013 in a well defined Norwegian population of approximately 350 000 people were included. Age- and sex-adjusted incidence rates were calculated. The current 2010 World Health Organization criteria, European Neuroendocrine Tumour Society classification and International Union Against Cancer (UICC) classification were used. RESULTS A total of 204 patients (114 male, 55.9 per cent) were identified. The median age at diagnosis was 61 (range 10-94) years. The annual overall crude incidence was 5.83 per 100,000 inhabitants, with an increasing trend (P = 0.033). The most frequent location was small intestine (60 patients, 29.4 per cent) followed by appendix (48 patients, 23.5 per cent) and pancreas (33 patients, 16.2 per cent). Grade 1 tumours were more common in gastrointestinal (100 patients, 58.5 per cent) than in pancreatic (9 patients, 27 per cent) NEN. According to the UICC classification, 77 patients (37.7 per cent) had stage I, 17 patients (8.3 per cent) stage II, 37 patients (18.1 per cent) stage III and 70 patients (34.3 per cent) had stage IV disease. No patient with stage I disease had grade 3 tumours; advanced tumour grade increased with stage. CONCLUSION A high crude incidence of GEP-NEN, at 5.83 per 100,000 inhabitants, was noted together with a significant increasing trend over time.
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Affiliation(s)
- O M Sandvik
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - J T Kvaløy
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway
| | - J A Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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31
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Søreide K, Thorsen K, Søreide JA. Predicting outcomes in patients with perforated gastroduodenal ulcers: artificial neural network modelling indicates a highly complex disease. Eur J Trauma Emerg Surg 2014; 41:91-8. [PMID: 25621078 PMCID: PMC4298653 DOI: 10.1007/s00068-014-0417-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/26/2014] [Indexed: 12/27/2022]
Abstract
Purpose Mortality prediction models for patients with perforated peptic ulcer (PPU) have not yielded consistent or highly accurate results. Given the complex nature of this disease, which has many non-linear associations with outcomes, we explored artificial neural networks (ANNs) to predict the complex interactions between the risk factors of PPU and death among patients with this condition. Methods ANN modelling using a standard feed-forward, back-propagation neural network with three layers (i.e., an input layer, a hidden layer and an output layer) was used to predict the 30-day mortality of consecutive patients from a population-based cohort undergoing surgery for PPU. A receiver-operating characteristic (ROC) analysis was used to assess model accuracy. Results Of the 172 patients, 168 had their data included in the model; the data of 117 (70 %) were used for the training set, and the data of 51 (39 %) were used for the test set. The accuracy, as evaluated by area under the ROC curve (AUC), was best for an inclusive, multifactorial ANN model (AUC 0.90, 95 % CIs 0.85–0.95; p < 0.001). This model outperformed standard predictive scores, including Boey and PULP. The importance of each variable decreased as the number of factors included in the ANN model increased. Conclusions The prediction of death was most accurate when using an ANN model with several univariate influences on the outcome. This finding demonstrates that PPU is a highly complex disease for which clinical prognoses are likely difficult. The incorporation of computerised learning systems might enhance clinical judgments to improve decision making and outcome prediction.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway ; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - K Thorsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway ; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - J A Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway ; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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32
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Søreide K. Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres (Br J Surg 2014; 101: 959–964). Br J Surg 2014; 101:964-5. [DOI: 10.1002/bjs.9500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway
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Søreide K. Clinical effect of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction (Br J Surg 2014; 101: 433-437). Br J Surg 2014; 101:438. [PMID: 24536014 DOI: 10.1002/bjs.9459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, N-40368 Stavanger, Norway.
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34
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Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg 2013; 101:e51-64. [PMID: 24338777 DOI: 10.1002/bjs.9368] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. METHODS PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred. RESULTS Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3.8-14 per 100,000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0.63 (95 per cent confidence interval (c.i.) 0.41 to 0.97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2.97, 95 per cent c.i. 1.06 to 8.29) and 1-year (RR 1.49, 1.10 to 2.03) risk of ulcer recurrence. CONCLUSION Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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35
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Abstract
Merits much greater attention by the surgical community
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Affiliation(s)
- A Bergenfelz
- Department of Surgery, Skåne University Hospital, Lund, Sweden.
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36
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Affiliation(s)
- K. Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
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37
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Nedrebø BS, Søreide K, Nesbakken A, Eriksen MT, Søreide JA, Kørner H. Risk factors associated with poor lymph node harvest after colon cancer surgery in a national cohort. Colorectal Dis 2013; 15:e301-8. [PMID: 23582027 DOI: 10.1111/codi.12245] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 11/15/2012] [Indexed: 12/26/2022]
Abstract
AIM Evaluation of ≥ 12 lymph nodes (LNs) is recommended after surgery for colon cancer. A harvest of ≤ 8 is considered poor, but few reports have evaluated risk factors associated with a poor harvest. This aims of this study were to analyse the clinical, surgical and pathological factors associated with poor LN harvest (LNH), the total number of examined nodes and the effect of LN number on stage. METHOD All patients reported to the Norwegian Colorectal Cancer Registry during 2007 and 2008 who underwent curative resection for Stage I-III colon cancer were studied. Risk factors for poor LNH and the proportion of Stage III disease were analysed by univariate and multivariate analyses. RESULTS A total of 2879 patients were included in the study. The median LNH was 14. Overall, 69.9% had ≥ 12 lymph nodes and 14.4% had ≤ 8 LN (poor harvest). Multivariate analysis showed that male sex, age > 75 years, sigmoid tumours, pT category 1-2, failure to use the pathology report template and distance of ≤ 5 cm from the bowel resection margin were all independent factors for poor LNH. Age < 65 years, pT category 3-4, and poor tumour differentiation were independent predictors of Stage III disease. An increased LNH did not increase the proportion of patients identified as being LN positive at the ≤ 8, 9-11 and ≥ 12 LN levels. CONCLUSION Adequate LNH was achieved in the majority of curative colon cancer resections in this national cohort. Elderly, male patients with sigmoid cancers, and a short distal margin were at increased risk of a poor LNH.
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Affiliation(s)
- B S Nedrebø
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
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Glomsaker T, Hoff G, Kvaløy JT, Søreide K, Aabakken L, Søreide JA. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg 2012; 100:373-80. [PMID: 23225493 DOI: 10.1002/bjs.8992] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND With an increased use of magnetic resonance imaging, the indications for endoscopic retrograde cholangiopancreatography (ERCP) have changed. Consequently, the patterns and factors predictive of complications after ERCP performed during current routine clinical practice are not well known. METHODS A prospective multicentre cohort study was undertaken in 11 Norwegian hospitals. Complications and mortality within 30 days after ERCP were analysed by univariable and multivariable regression analysis. RESULTS There were 2808 ERCP procedures, of which 2573 (91·6 per cent) were therapeutic. More than half of the patients were aged 70 years or more. Common bile duct cannulation was achieved in 2557 procedures (91·1 per cent). Complications occurred in 327 (11·6 per cent) of the procedures, including cholangitis in 100 (3·6 per cent), pancreatitis in 88 (3·1 per cent), bleeding in 66 (2·4 per cent), perforation in 25 (0·9 per cent) and cardiovascular-respiratory events in 32 (1·1 per cent). In the multivariable regression analysis, older age, increasing American Society of Anesthesiologists fitness score, centre ERCP volumes of more than 150 procedures annually and precut sphincterotomy were predictive factors for severe complications. The overall 30-day mortality rate was 2·2 per cent (63 patients), with a procedure-related mortality rate of 1·4 per cent (39 patients). Malignancy was diagnosed in 46 (73 per cent) of the patients who died. CONCLUSION ERCP is a procedure with considerable risk for complications. Morbidity and mortality are related to patient age and co-morbidity, as well as hospital volume of ERCP procedures and the type of intervention.
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Affiliation(s)
- T Glomsaker
- Department of Gastroenterological Surgery, Stavanger University Hospital, Stavanger, Norway
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39
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40
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Affiliation(s)
- K Harboe
- Department of Orthopaedic Surgery, Stavanger University Hospital, Stavanger, Norway
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41
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Søreide K, Træland JH, Stokkeland PJ, Glomsaker T, Søreide JA, Kørner H. Adherence to national guidelines for surveillance after curative resection of nonmetastatic colon and rectum cancer: a survey among Norwegian gastrointestinal surgeons. Colorectal Dis 2012; 14:320-4. [PMID: 21689321 DOI: 10.1111/j.1463-1318.2011.02631.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM National guidelines recommend enrollment of patients in surveillance programmes following curative resection of colorectal carcinoma (CRC) in order to detect recurrence or distant metastasis at an asymptomatic/early stage when secondary curative treatment can be offered. Little is known about surgeons' adherence to such guidelines. In this national survey we analyse adherence and attitudes to postoperative follow up among Norwegian gastrointestinal surgeons involved in the care of patients with CRC. METHOD We performed a nationwide survey of all hospitals performing surgery for colon and/or rectum cancer. The presence of a surveillance programme, the type of programme, adherence to national guidelines or report on any deviation thereof, location of follow up at the hospital or with a general practitioner (GPs) and the estimated annual volume of surgery were queried through mail and telephone. RESULTS All hospitals (n=41) performing colorectal surgery responded, of which 25 (61%) conducted postoperative follow up by surgeons in the hospital outpatient clinics, four (10%) carried out follow up with a combination of hospital outpatient visits and visits to GPs, and 12 (29%) referred surveillance to the GP alone. For total reported patient numbers, almost two-thirds (60%) received surveillance according to national recommendations through outpatient visits with the surgeon or GP, while one-third (37%) were subject to other alternative routines. A small number (2%) received informal 'ad hoc' surveillance only. More liberal use of imaging outside guideline recommendations was reported for rectal cancer patients, while colon cancer patients treated in larger hospitals were more likely to be referred for GP surveillance. CONCLUSION All hospitals reported having a strategy for surveillance after surgery for colon and rectal cancer, but there was considerable variance in strategy. A scientific audit of the true level of compliance, effectiveness and cost-benefit is warranted at a national level.
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Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
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42
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Søreide K. Snapshot Quiz 11/04 ( Br J Surg 2011; 98: 865, 888). Br J Surg 2011. [DOI: 10.1002/bjs.7697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway
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43
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Thorsen K, Ringdal KG, Strand K, Søreide E, Hagemo J, Søreide K. Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury. Br J Surg 2011; 98:894-907. [PMID: 21509749 DOI: 10.1002/bjs.7497] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypothermia, acidosis and coagulopathy have long been considered critical combinations after severe injury. The aim of this review was to give a clinical update on this triad in severely injured patients. METHODS A non-systematic literature search on hypothermia, acidosis and coagulopathy after major injury was undertaken, with a focus on clinical data from the past 5 years. RESULTS Hypothermia (less than 35 °C) is reported in 1·6-13·3 per cent of injured patients. The occurrence of acidosis is difficult to estimate, but usually follows other physiological disturbances. Trauma-induced coagulopathy (TIC) has both endogenous and exogenous components. Endogenous acute traumatic coagulopathy is associated with shock and hypoperfusion. Exogenous effects of dilution from fluid resuscitation and consumption through bleeding and loss of coagulation factors further add to TIC. TIC is present in 10-34 per cent of injured patients, depending on injury severity, acidosis, hypothermia and hypoperfusion. More expedient detection of coagulopathy is needed. Thromboelastography may be a useful point-of-care measurement. Management of TIC is controversial, with conflicting reports on blood component therapy in terms of both outcome and ratios of blood products to other fluids, particularly in the context of civilian trauma. CONCLUSION The triad of hypothermia, acidosis and coagulopathy after severe trauma appears to be fairly rare but does carry a poor prognosis. Future research should define modes of early detection and targeted therapy.
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Affiliation(s)
- K Thorsen
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway
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44
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Nedrebø BS, Søreide K, Eriksen MT, Dørum LM, Kvaløy JT, Søreide JA, Kørner H. Survival effect of implementing national treatment strategies for curatively resected colonic and rectal cancer. Br J Surg 2011; 98:716-23. [PMID: 21341253 DOI: 10.1002/bjs.7426] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND The surgical management of rectal cancer has changed substantially over the past decade. There are limited data on the long-term outcome of implementing systematic management strategies. METHODS Survival of a national cohort of patients treated surgically for colonic and rectal cancer over a 10-year interval was analysed. All 31 158 patients in Norway diagnosed with adenocarcinoma of the colon and rectum between 1994 and 2003 were identified from the Cancer Registry of Norway and the Norwegian Rectal Cancer Registry. Changes in 5-year relative survival were compared by age, stage and tumour location during the early and late years. RESULTS The study population included 19 053 patients who had a curative resection. The relative 5-year survival rate significantly improved for both colonic cancer (73·8 versus 78·0 per cent; P < 0·001) and rectal cancer (72·1 versus 79·6 per cent; P < 0·001). The 5-year relative survival was significantly better for rectal than colonic cancer during the late period (P = 0·030). Improved 5-year relative survival was related to better outcomes in patients with positive lymph nodes (67·2 and 62·1 per cent for rectal and colonic cancer respectively; each P < 0·001 versus early period), but not for the subgroup aged over 75 years with lymph node-positive colonic cancer. CONCLUSION In this national cohort, survival after curative surgery for colorectal cancer increased significantly after implementation of national management strategies. Improvements were most evident for rectal cancer and in lymph node-positive disease; they were less substantial for colonic cancer and elderly patients (over 75 years). Strategic treatment changes may be warranted for the latter group.
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Affiliation(s)
- B S Nedrebø
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Surgical Sciences, University of Bergen, Bergen, Norway
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Søreide K. Temporal Patterns of Death after Trauma: Evaluation of Circadian, Diurnal, Periodical and Seasonal Trends in 260 Fatal Injuries. Scand J Surg 2010; 99:235-239. [DOI: 10.1177/145749691009900411] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: Temporal patterns of trauma deaths may indicate potential for prevention or systems improvement, but have been poorly investigated in the Scandinavian trauma population. This study examines patterns in trauma deaths to the occurrence in hour and time of the day, day and time in the week, and month and season. Materials and Methods: Investigation of the temporal patterns of death in 260 fatalities undergoing autopsy. Time of death were explored according to time of the day (hour; day/night), time of the week (day of week; weekday/weekend) and time of the year (month; season) and analyzed for difference in gender, age, injury type and severity, and mechanisms of injury and death. Results: A total of 260 trauma deaths were included, of which 125 (48%) died in hospital and 194 (75%) were male. No particular peak-hour of the day when deaths occurred was found. One-third of deaths occurred during weekends. For inhospital deaths during weekends, significantly more patients had respiratory distress (RR > 20 or < 16 in 72.5% for weekends and 47.0% for weekdays; p = 0.008) and hypotension (SBP < 90mmHg in 61% vs 40%; p = 0.048) during weekends. Deaths occurred with some monthly variance demonstrated with two monthly peaks in February/March and July/August, respectively. Overall, no statistically different seasonal differences in the occurrence of traumatic deaths, nor any differences in cause of death, type or severity of injury, nor in physiological parameters was found. However, a higher number of inhospital deaths presented with reduced consciousness level (GCS < 8) and severe head injuries (AIS-head ≥ 4) during spring and summer (P = 0.045, chi-square for trend) compared to winter and fall. Conclusions: Trauma deaths in a Scandinavian population did not demonstrate statistically significant differences in overall circadian, weekly or seasonal patterns of trauma death occurrence. However, the impact of fatal head injuries during spring and summer warrants further investigation.
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Affiliation(s)
- K. Søreide
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Surgical Sciences, University of Bergen, Bergen, Norway
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46
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Abstract
First article of ‘Trauma Series’
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Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway.
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47
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Søreide K, Glomsaker T. Authors' reply: Surgical training and working time restriction ( Br J Surg 2009; 96: 329–330). Br J Surg 2009. [DOI: 10.1002/bjs.6713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
| | - T Glomsaker
- Department of Surgery, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
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48
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Abstract
Team–patient, not doctor–patient, relationship
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Affiliation(s)
- T B Glomsaker
- Department of Surgery, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
| | - K Søreide
- Department of Surgery, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
- Department of Surgical Sciences, University of Bergen, Bergen, Norway
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Abstract
Emergency department thoracotomy (EDT) may serve as a life-saving tool when performed for the right indications, in selected patients, and in the hands of a trained surgeon. Critically injured patients 'in extremis' arrive at an increasing rate in the trauma bay, as an effect of improved pre-hospital trauma systems and rapid transport. Any patient in near, or full cardiovascular shock prompts the trauma surgeon to rapidly perform a thoracotomy. The EDT procedure is managed best by surgeons familiar with, and experienced in, penetrating cardiothoracic injuries. However, the geographical differences in trauma epidemiology lends no, or only scarce, experience with this procedure in most European trauma centres. Consequently, mandatory training is imperative for success. The rationale for performing an EDT is to: (I) resuscitate the agonal patient with penetrating cardiothoracic injuries; (II) release cardiac tamponade by evacuation of pericardial blood; (III) immediately control hemorrhage and repair cardiac or pulmonary injury; (IV) perform open cardiac massage; and (V) place a thoracic aortic cross-clamp to redistribute the remaining blood volume, and perfuse the carotids and coronary arteries. The prevalence rates of blood-borne viruses reported in critically injured patients in the USA (10-20%) exceed the prevalence in the Nordic countries (HIV prevalence < 1% in general population). However, risk is not negligible and mandated universal precautions are needed. The literature is rich in series describing the use of EDT, however, the best evidence is derived from a few prospective trials. EDT saves about one in every five patients with isolated penetrating cardiac injury, while > 98% die after blunt injury. Based on an updated review of the current available literature, this paper presents the current evidence regarding the rationale, risk, and outcomes for employing EDT in the field of trauma surgery.
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Affiliation(s)
- K Søreide
- Department of Surgery, Stavanger University Hospital, Acute Care Medicine Research Network, Department of Health Studies, University of Stavanger, Norway.
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Søreide K. Seroprevalence of bloodborne viruses in Scandinavian trauma victims. Scand J Surg 2007; 96:88. [PMID: 17461320 DOI: 10.1177/145749690709600117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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