127 results on '"Bengt Isaksson"'
Search Results
2. Aspirin as secondary prevention in colorectal cancer liver metastasis (ASAC trial): study protocol for a multicentre randomized placebo-controlled trial
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Sheraz Yaqub, Bjørn Atle Bjørnbeth, Jon-Helge Angelsen, Claus Wilki Fristrup, Jon Erik Grønbech, Oskar Hemmingsson, Bengt Isaksson, Ingebjørg Soterud Juel, Peter Nørgaard Larsen, Gert Lindell, Frank Viborg Mortensen, Kim Erlend Mortensen, Magnus Rizell, Per Sandström, Oddvar Mathias Sandvik, Ernesto Sparrelid, Helena Taflin, Kjetil Taskén, and The ASAC study group
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Colorectal cancer ,Liver metastases ,Aspirin ,Acetylsalicylic acid ,Secondary prevention ,Medicine (General) ,R5-920 - Abstract
Abstract Background Colorectal cancer is one the most common cancers in the western world with increasing incidence. Approximately 50% of the patients develop liver metastases. Resection of liver metastases is the treatment of choice although almost half of the resected patients get recurrence in the liver. Methods The ASAC trial is a Scandinavian, multicentre, double-blinded, randomized, placebo-controlled study to determine whether adjuvant treatment with low-dose aspirin (acetylsalicylic acid (ASA)) can improve disease-free survival in patients treated for colorectal cancer liver metastases (CRCLM). Up to 800 patients operated for CRCLM will be randomized to Arm#1 ASA 160 mg once daily or Arm#2 Placebo, for a period of 3 years or until disease recurrence. The patients will be recruited at all major hepatobiliary surgical units in Norway, Sweden and Denmark and have follow-up according to standard of care and the National Guidelines. Discussion The ASAC trial will be the first clinical interventional trial to assess the potential beneficial role of ASA in recurrence of CRCLM and survival. ASA is an inexpensive, well-tolerated and easily accessible drug that will be highly potential as adjuvant drug in secondary prevention of CRCLM if the study shows a beneficial effect. We will also determine the effect of ASA as adjuvant treatment on Health-Related Quality of Life and the cost-effectiveness. Trial registration ClinicalTrials.gov NCT03326791 . Registered on 31 October 2017.
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- 2021
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3. Correction: Immunohistochemical Typing of Adenocarcinomas of the Pancreatobiliary System Improves Diagnosis and Prognostic Stratification.
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Carlos Fernández Moro, Alejandro Fernandez-Woodbridge, Melroy Alistair D'souza, Qianni Zhang, Benedek Bozoky, Senthil Kandaswamy Vasan, Piera Catalano, Rainer Heuchel, Sonia Shtembari, Marco Del Chiaro, Olof Danielsson, Mikael Björnstedt, J Matthias Löhr, Bengt Isaksson, Caroline Verbeke, and Béla Bozóky
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Medicine ,Science - Abstract
[This corrects the article DOI: 10.1371/journal.pone.0166067.].
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- 2017
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4. Immunohistochemical Typing of Adenocarcinomas of the Pancreatobiliary System Improves Diagnosis and Prognostic Stratification.
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Carlos Fernández Moro, Alejandro Fernandez-Woodbridge, Melroy Alistair D'souza, Qianni Zhang, Benedek Bozoky, Senthil Vasan Kandaswamy, Piera Catalano, Rainer Heuchel, Sonia Shtembari, Marco Del Chiaro, Olof Danielsson, Mikael Björnstedt, J Matthias Löhr, Bengt Isaksson, Caroline Verbeke, and Béla Bozóky
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Medicine ,Science - Abstract
Adenocarcinomas of the pancreatobiliary system are currently classified by their primary anatomical location. In particular, the pathological diagnosis of intrahepatic cholangiocarcinoma is still considered as a diagnosis of exclusion of metastatic adenocarcinoma. Periampullary cancers have been previously classified according to the histological type of differentiation (pancreatobiliary, intestinal), but overlapping morphological features hinder their differential diagnosis. We performed an integrative immunohistochemical analysis of pancreato-biliary tumors to improve their diagnosis and prediction of outcome.This was a retrospective observational cohort study on patients with adenocarcinoma of the pancreatobiliary system who underwent diagnostic core needle biopsy or surgical resection at a tertiary referral center. 409 tumor samples were analyzed with up to 27 conventional antibodies used in diagnostic pathology. Immunohistochemical scoring system was the percentage of stained tumor cells. Bioinformatic analysis, internal validation, and survival analysis were performed.Hierarchical clustering and differential expression analysis identified three immunohistochemical tumor types (extrahepatic pancreatobiliary, intestinal, and intrahepatic cholangiocarcinoma) and the discriminant markers between them. Among patients who underwent surgical resection of their primary tumor with curative intent, the intestinal type showed an adjusted hazard ratio of 0.19 for overall survival (95% confidence interval 0.05-0.72; p value = 0.014) compared to the extrahepatic pancreatobiliary type.Integrative immunohistochemical classification of adenocarcinomas of the pancreatobiliary system results in a characteristic immunohistochemical profile for intrahepatic cholangiocarcinoma and intestinal type adenocarcinoma, which helps in distinguishing them from metastatic and pancreatobiliary type adenocarcinoma, respectively. A diagnostic immunohistochemical panel and additional extended panels of discriminant markers are proposed as guidance for their pathological diagnosis.
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- 2016
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5. Strategies for Short-Term Storage of Hepatocytes for Repeated Clinical Infusions
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Carl Jorns M.D., Roberto Gramignoli, Mohammed Saliem, Helen Zemack, Lisa-Mari Mörk, Bengt Isaksson, Greg Nowak, Bo-Göran Ericzon, Stephen Strom, and Ewa Ellis
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Medicine - Abstract
Hepatocyte transplantation is an upcoming treatment for patients with metabolic liver diseases. Repeated cell infusions over 1–2 days improve clinical outcome. Isolated hepatocytes are usually cold stored in preservation solutions between repeated infusions. However, during cold storage isolated hepatocytes undergo cell death. We investigated if tissue preservation and repeated isolations are better than storage of isolated hepatocytes when cold preserving human hepatocytes. Liver tissue obtained from liver surgery or organ donors was divided into two pieces. Hepatocytes were isolated by collagenase digestion. Hepatocytes were analyzed directly after isolation (fresh) or after storage for 48 h at 4°C in University of Wisconsin solution (UW cells). Liver tissue from the same donor was stored at 4°C in UW and hepatocytes were isolated after 48 h (UW tissue cells). Hepatocyte viability and function was evaluated by trypan blue exclusion, plating efficiency, ammonia metabolism, CYP 1A1/2, 2C9, 3A7, and 3A4 activities, phase II conjugation, and apoptosis evaluation by TUNEL assay and caspase-3/7 activities. Hepatocytes stored in UW showed a significantly lower viability compared to fresh cells or hepatocytes isolated from tissue stored for 48 h (54% vs. 71% vs. 79%). Plating efficiency was significantly decreased for cells stored in UW (40%) compared to fresh and UW tissue cells (63% vs. 55%). No significant differences between UW cells and UW tissue cells could be shown for CYP activities or ammonia metabolism. Hepatocytes stored in UW showed a strong increase in TUNEL-positive cells, whereas TUNEL staining in cold-stored liver tissue and hepatocytes isolated after 48 h was unchanged. This observation was confirmed by increased caspase-3/7 activities in UW cells. Although preservation of isolated hepatocytes in UW maintains function, cold storage of liver tissue and repeated hepatocyte isolations is superior to cold storage of isolated hepatocytes in preserving hepatocyte viability and function.
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- 2014
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6. Intra Versus Extrahepatic Division of Right Hepatic Vein During Rightsided Hemihepatectomy
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Jansson, Anders, M.D., Bengt Isaksson, and Lars Lundell, Professor
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- 2017
7. Waterjet Versus Ultrasound Dissection During Hepatic Transection
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Bengt Isaksson, Jansson, Anders, M.D., and Lars Lundell, Professor
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- 2015
8. Response to Professor Siriwardena regarding our manuscript A comparison of the simultaneous, liver-first, and colorectal-first strategies for surgical treatment of synchronous colorectal liver metastases
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Petter Frühling, Jozef Urdzik, and Bengt Isaksson
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Hepatology ,Gastroenterology - Published
- 2023
9. Multimodal perioperative assessment of liver function and volume in patients undergoing hepatectomy for colorectal liver metastasis: a comparison of the indocyanine green retention test, 99mTc mebrofenin hepatobiliary scintigraphy and gadoxetic acid enhanced MRI
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Qiang Wang, Torkel B. Brismar, Stefan Gilg, Eduard Jonas, Henrik Nilsson, Antonios Tzortzakakis, Bengt Isaksson, Rimma Axelsson, and Ernesto Sparrelid
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Gastroenterologi ,Radiology, Nuclear Medicine and imaging ,Radiologi och bildbehandling ,Gastroenterology and Hepatology ,General Medicine ,Radiology, Nuclear Medicine and Medical Imaging - Abstract
Objectives: To compare the dynamic changes in future liver remnant (FLR) function and volume after hepatectomy and to evaluate the associations between three modalities in assessment of liver function. Methods: Liver function and volume were quantified pre-operatively, at post-operative day (POD) 7 and POD 28 in 10 patients with colorectal liver metastases undergoing hemihepatectomy using the indocyanine green retention (ICG) test, hepatobiliary scintigraphy (HBS) and gadoxetic acid-enhanced MRI. The 99mTc mebrofenin uptake rate in the FLR was applied as a reference of liver function. MRI-derived parameters including liver-to-muscle ratio (LMR), liver-to-spleen ratio (LSR) and hepatocellular uptake index (HUI) were used for liver function assessment. Spearman’s correlation analysis was used to evaluate the associations. Results: Increase in liver function ranged from 13 to 152% (median 92%) and in volume from 37 to 134% (median 79%). There was no significant discrepancy in increase between FLR function and volume during the first month following hepatectomy. LMR showed a significant correlation to ICG test (r = −0.66, p < 0.05) while LSR had an association with standardized FLR function obtained by HBS (r = −0.71, p < 0.05). During the first week after hepatectomy, pre-operative HUI and LMR showed the strongest correlation to the FLR growth in function and volume respectively (p < 0.05). Conclusion: The observed growth in FLR volume is closely related to the functional increase within 1 month after hepatectomy. Gadoxetic acid-enhanced MRI might substitute HBS for regional liver function assessment and provide an imaging tool for liver growth prediction. Advances in knowledge: Liver function growth was parallel with liver volume increase during the perioperative period. Liver function assessment with gadoxetic acid-enhanced MRI was comparable with that of HBS indicating that gadoxetic acid-enhanced MRI could substitute HBS for regional liver function evaluation.
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- 2022
10. Molecular adsorbent recirculating system treatment in patients with post-hepatectomy liver failure: Long-term results of a pilot study
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Stefan, Gilg, Ernesto, Sparrelid, Jennie, Engstrand, Ruth, Baumgartner, Greg, Nowak, Per, Stål, Melroy, D'Souza, Anders, Jansson, Bengt, Isaksson, Eduard, Jonas, and Cecilia, Stromberg
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Postoperative Complications ,Liver Neoplasms ,Hepatectomy ,Humans ,Pilot Projects ,Postoperative Period ,Prospective Studies ,Liver Failure ,Retrospective Studies - Abstract
Post-hepatectomy liver failure (PHLF) is the leading cause of postoperative mortality following major liver resection. Between December 2012 and May 2015, 10 consecutive patients with PHLF (according to the Balzan criteria) following major/extended hepatectomy were included in a prospective treatment study with the molecular adsorbent recirculating system (MARS). Sixty- and 90-day mortality rates were 0% and 10%, respectively. Of the nine survivors, four still had liver dysfunction at 90 days postoperatively. One-year overall survival (OS) of the MARS-PHLF cohort was 50%. The present study aims to assess long-term outcome of this cohort compared to a historical control cohort.To compare long-term outcome of the MARS-PHLF treatment cohort with PHLF patients not treated with MARS, the present study includes all 655 patients who underwent major hepatectomy at Karolinska University Hospital between 2010 and 2018. Patients with PHLF were identified according to the Balzan criteria.The cohort was split into three time periods: pre-MARS period (MARS treatment may contribute to improved outcome of patients with PHLF. Further studies are needed.The initial pilot study was registered at ClinicalTrials.gov (NCT03011424).
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- 2022
11. Efficiency in treatment discussions: A field study of time related aspects in multi-disciplinary team meetings.
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Kristina Groth, Oscar Frykholm, Ralf Segersvärd, Bengt Isaksson, and Johan Permert
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- 2009
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12. Survival and prognostic factors after transplantation, resection and ablation in a national cohort of early hepatocellular carcinoma
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Gert Lindell, Bengt Isaksson, Madeleine Helmersson, Oskar Hemmingsson, Peter Naredi, C. Strömberg, Magnus Rizell, Malin Sternby Eilard, and Per Sandström
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Adolescent ,medicine.medical_treatment ,Preoperative risk ,030230 surgery ,Resection ,National cohort ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Early Hepatocellular Carcinoma ,In patient ,Aged ,Retrospective Studies ,Hepatology ,business.industry ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,Prognosis ,Ablation ,Liver Transplantation ,Surgery ,Transplantation ,Treatment Outcome ,030220 oncology & carcinogenesis ,Catheter Ablation ,Female ,Liver function ,business - Abstract
Background In patients with early hepatocellular cancer (HCC) and preserved liver function, the choice between transplantation, resection and ablation and which factors to consider is not obvious and guidelines differ. In this national cohort study, we aimed to compare posttreatment survival in patients fulfilling predefined criteria, and to analyse preoperative risk factors that could influence decision. Methods We used data from HCC-patients registered with primary transplantation, resection or ablation 2008–2016 in the SweLiv-registry. In Child A-subgroups, 18–75 years, we compared survival after transplantation or resection, with different tumour criteria; either corresponding to our transplantation criteria (N = 257) or stricter with single tumours ≤50 mm (N = 159). A subgroup with single tumours ≤30 mm, compared all three treatments (N = 193). Results We included 1022 HCC-patients; transplantation n = 223, resection n = 438, ablation n = 361. In the transplant criteria subgroup, differences in five-year survival, adjusted for age and gender, were not significant, with 71.2% (CI 62.3–81.3) after transplantation (n = 109) and 63.5% (CI 54.9–73.5) after resection (n = 148). Good liver function (Child 5 vs. 6, Albumin ≥36), increased the risk after transplantation, but decreased the risk after resection and ablation. Conclusion Even within Child A, detailed liver function assessment is important before treatment decision, and for stratifying survival comparisons.
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- 2021
13. Response to Comment on: Hasselgren K, et al ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM: Survival Analysis From the Randomized Controlled Trial LIGRO. Ann Surg. 2021;273(3):442-448
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Bjørn Atle Bjørnbeth, Magnus Rizell, Bengt Isaksson, Bergthor Björnsson, Nicolai A. Schultz, Peter Nørgaard Larsen, Per Sandström, Bård I. Røsok, Kristina Hasselgren, Ernesto Sparrelid, Gert Lindell, and Anna Lindhoff Larsson
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medicine.medical_specialty ,business.industry ,Portal Vein ,Urology ,Thyrotropin ,Survival Analysis ,law.invention ,Randomized controlled trial ,law ,Medicine ,Hepatectomy ,Humans ,Surgery ,In patient ,business ,Survival analysis - Published
- 2022
14. Outcome of ERCP related to case-volume
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Eva-Lena Syrén, Gabriel Sandblom, Lars Enochsson, Arne Eklund, Bengt Isaksson, Johanna Österberg, and Staffan Eriksson
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Cholangiopancreatography, Endoscopic Retrograde ,Kirurgi ,Gallstones ,Procedure time ,Catheterization ,ERCP ,Postoperative Complications ,Case-volume ,Pancreatitis ,Cannulation rate ,Humans ,Post-ERCP pancreatitis ,Surgery ,Intra- and postoperative complication rates - Abstract
Background and aims In some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes. Methods Data were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor. Results In multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p p When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p p Conclusions The results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.
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- 2022
15. Cardiovascular complications after common bile duct stone extractions
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Gabriel Sandblom, Arne Eklund, Eva-Lena Syrén, Bengt Isaksson, Lars Enochsson, and Staffan Eriksson
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medicine.medical_specialty ,Cardiovascular Complication ,medicine.medical_treatment ,Gallstones ,Disease ,Article ,ERCP ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Aged ,Cholangiopancreatography, Endoscopic Retrograde ,Common Bile Duct ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Kirurgi ,General surgery ,Cardiovascular complication ,Hepatology ,medicine.disease ,Pulmonary embolism ,Choledocholithiasis ,Cholecystectomy, Laparoscopic ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Cholecystectomy ,business ,Abdominal surgery - Abstract
Background Common bile duct stone (CBDS) is a common condition the rate of which increases with age. Decision to treat in particular elderly and frail patients with CBDS is often complex and requires careful assessment of the risk for treatment-related cardiovascular complications. The aim of this study was to compare the rate of postoperative cardiovascular events in CBDS patients treated with the following: ERCP only; cholecystectomy only; cholecystectomy followed by delayed ERCP; cholecystectomy together with ERCP; or ERCP followed by delayed cholecystectomy. Methods The study was based on data from procedures for gallstone disease registered in the Swedish National Quality Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006–2014. ERCP and cholecystectomy procedures performed for confirmed or suspected CBDS were included. Postoperative events were registered by cross-matching GallRiks with the National Patient Register (NPR). A postoperative cardiovascular event was defined as an ICD-code in the discharge notes indicating myocardial infarct, pulmonary embolism or cerebrovascular disease within 30 days after surgery. In cases where a patient had undergone ERCP and cholecystectomy on separate occasions, the 30-day interval was timed from the first intervention. Results A total of 23,591 underwent ERCP or cholecystectomy for CBDS during the study period. A postoperative cardiovascular event was registered in 164 patients and death within 30 days in 225 patients. In univariable analysis, adverse cardiovascular event and death within 30 days were more frequent in patients who underwent primary ERCP (p Conclusions Primary ERCP as well as cholecystectomy may be performed for CBDS with acceptable safety. More studies are required to provide reliable guidelines for the management of CBDS.
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- 2020
16. A comparison of the simultaneous, liver-first, and colorectal-first strategies for surgical treatment of synchronous colorectal liver metastases at two major liver-surgery institutions in Sweden
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Petter Frühling, Cecilia Strömberg, Bengt Isaksson, and Jozef Urdzik
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Cancer och onkologi ,Hepatology ,Cancer and Oncology ,Gastroenterology - Abstract
Background The optimal treatment strategy for patients with synchronous colorectal liver metastases is unclear. The aim of this study was to compare the outcome of the simultaneous, liver-first, and colorectal-first surgical approaches. Methods All consecutive patients with synchronous colorectal liver metastases who underwent liver resection with curative intent were included. Data were collected from local databases. Patient and tumour specific characteristics were retrieved, and clinicopathological factors were analysed. A Cox regression model was constructed, and a subgroup intention-to-treat analysis was performed after propensity score matching. Results A total of 658 patients were included in the analysis. Ninety-two patients had a simultaneous resection, 163 patients had liver-first, and 403 patients had a colorectal-first approach. After matching, two balanced groups between the simultaneous and liver-first groups were created with 58 patients in each. There were no differences in post-operative complications defined as Clavien-Dindo 3a (p=0.992), and >3a (p=0.999). There were no differences in overall survival between the groups (stratified log rank p=0.455). The median overall survival for liver-first was 42.2 (26.3-58.2) months, and for the simultaneous groups, 56.2 (47.1-65.4). Conclusion The simultaneous approach was not associated with worse overall survival compared to a staged approach, and had comparable morbidity and mortality.
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- 2021
17. ERCP-related perforations: a population-based study of incidence, mortality, and risk factors
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Ann Langerth, Bengt Isaksson, S. Linder, Britt-Marie Karlson, and Jozef Urdzik
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Adverse event ,Male ,medicine.medical_specialty ,Perforation (oil well) ,Article ,03 medical and health sciences ,ERCP ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Adverse effect ,Aged ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Perforation ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Incidence (epidemiology) ,General surgery ,Kirurgi ,Incidence ,Hepatology ,Survival Analysis ,Population based study ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Abdominal surgery - Abstract
Background Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study. Methods Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1–3) groups. Furthermore, fatal group patients’ records were reviewed. Results Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8–21.6), age over 80 years (OR 3.8, 95% CI 2.0–7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1–7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%, p = 1.0), but in Q1–3 centers mortality was higher (45% vs. 21%, p = 0.024). Conclusions ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.
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- 2019
18. The impact of post-hepatectomy liver failure on mortality: a population-based study
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Bjarne Ardnor, C. Strömberg, Bengt Isaksson, Per Sandström, Gert Lindell, Stefan Gilg, and Magnus Rizell
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Gastroenterology and Hepatology ,Population based ,030230 surgery ,Severity of Illness Index ,Gastroenterology ,Cholangiocarcinoma ,03 medical and health sciences ,hepatectomy ,Postoperative Complications ,0302 clinical medicine ,Liver Function Tests ,Risk Factors ,Cause of Death ,Internal medicine ,Gastroenterologi ,Hepatectomy ,Humans ,Medicine ,Post operative mortality ,post-operative mortality ,Registries ,Aged ,Retrospective Studies ,Sweden ,liver dysfunction ,business.industry ,Liver failure ,Bilirubin ,Middle Aged ,population-based ,Population based study ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Female ,Liver dysfunction ,business ,Liver Failure ,Major hepatectomy ,Post-hepatectomy liver failure ,major hepatic resection - Abstract
Background: Post-hepatectomy liver failure (PHLF) is considered a main reason for death after major hepatectomy. The reported PHLF-related mortality differs largely and the data mainly originate from single centers. Aim: A retrospective, population-based register study was designed to evaluate the impact of PHLF on 90-day mortality after hepatectomy. Method: All patients who underwent liver resection in Sweden between 2005 and 2009 were retrospectively identified using the Swedish Hospital Discharge Registry. 30- and 90-day mortality were identified by linkage to the Registry of Causes of Death. Additional clinical data were obtained from the medical charts in all seven university hospitals in Sweden. PHLF was defined according to Balzan criteria (Bilirubin >50 µg/L and international normalized ratio >1.5) on postoperative day 5. Results: A total of 2461 liver resections were performed (2194 in university hospitals). 30- and 90-day mortality were 1.3% and 2.5%, respectively. 90-day mortality at university hospitals was 2.1% (n = 46). In 41% (n = 19) of these patients, PHLF alone or in combination with multi-organ failure was identified as cause of death. Between the PHLF and non-PHLF group, there was no significant difference regarding age, sex, American Society of Anesthesiologists-classification, or preoperative chemotherapy. Cholangiocarcinoma as indication for surgery, need for vascular reconstruction and an extended resection were significantly overrepresented in the PHLF-group. Between groups, the incidence of 50:50 criteria differed significantly already on postoperative day 3. Conclusion: Overall mortality is very low after hepatectomy in Sweden. PHLF represents the single most important cause of death even in a population-based setting.
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- 2018
19. The prognostic value of C-reactive protein and albumin in patients undergoing resection of colorectal liver metastases. A retrospective cohort study
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Bengt Isaksson, Jozef Urdzik, Patric Ejder, Katarina Hellberg, Petter Frühling, and C. Strömberg
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medicine.medical_specialty ,Gastroenterology ,Resection ,Prognostic score ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,Cancer och onkologi ,Hepatology ,biology ,Proportional hazards model ,business.industry ,Kirurgi ,C-reactive protein ,Liver Neoplasms ,Albumin ,Retrospective cohort study ,Prognosis ,C-Reactive Protein ,030220 oncology & carcinogenesis ,Cancer and Oncology ,biology.protein ,030211 gastroenterology & hepatology ,Surgery ,business ,Colorectal Neoplasms ,Median survival - Abstract
Background The systemic inflammation-based Glasgow Prognostic Score (GPS) and modified GPS (mGPS), as measured by preoperative C-reactive protein (CRP) and albumin, correlate with poor survival in several cancers. This study evaluates the prognostic value of these scores in patients with colorectal liver metastases (CRLM). Methods This retrospective study assessed the prognostic role of preoperatively measured GPS and mGPS in patients undergoing liver resection because of CRLM. Clinicopathological data were retrieved from local databases. The prognostic value of GPS and mGPS were compared and a Cox regression model was used to find independent predictors of overall survival. Results In total, 849 consecutive patients between January 2005 and December 2015 were included. Patients with GPS 0 had a median survival of 70 months compared to 49 months in patients with GPS 1, and 27 months in patients with GPS 2. Multivariable analyses showed that GPS 1 (HR = 1.51, 95%CI [1.14–2.01]) and GPS 2 (HR = 2.78, 95%CI [1.79–4.31]), after correction for age >70 years (HR = 1.75 [1.36–2.26]), and extended resection (HR = 2.53, 95%CI[1.79–3.58]), were associated with poor overall survival. Conclusion A preoperative GPS is an independent prognostic factor in patients with CRLM, and appears to be a better prognostic tool than mGPS.
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- 2021
20. Response to Comment on 'ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM - It Is Time to Entry the IDEAL Stage 4?'
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Bergthor Björnsson, Anna Lindhoff Larsson, Ernesto Sparrelid, Bård I. Røsok, Magnus Rizell, Bjørn Atle Bjørnbeth, Nicolai A. Schultz, Peter Nørgaard Larsen, Per Sandström, Bengt Isaksson, Kristina Hasselgren, and Gert Lindell
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Oncology ,medicine.medical_specialty ,Ideal (set theory) ,business.industry ,Liver Neoplasms ,MEDLINE ,Thyrotropin ,Text mining ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Surgery ,In patient ,Stage (cooking) ,business - Published
- 2020
21. The effect of glucose control in liver surgery on glucose kinetics and insulin resistance
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Olav Rooyackers, Olle Ljungqvist, Bengt Isaksson, Christina Blixt, and Mirjam Larsson
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0301 basic medicine ,Blood Glucose ,Male ,medicine.medical_treatment ,Stress hyperglycemia ,Critical Care and Intensive Care Medicine ,law.invention ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Insulin ,Postoperative Period ,Prospective Studies ,Glucose kinetics ,Nutrition and Dietetics ,Middle Aged ,Treatment Outcome ,Liver ,Endokrinologi och diabetes ,Arterial blood ,Female ,Analysis of variance ,medicine.medical_specialty ,030209 endocrinology & metabolism ,Glycemic Control ,Endocrinology and Diabetes ,Perioperative Care ,03 medical and health sciences ,Insulin resistance ,Internal medicine ,Glucose control ,medicine ,Hepatectomy ,Humans ,Hypoglycemic Agents ,Postoperative ,Aged ,030109 nutrition & dietetics ,business.industry ,Perioperative ,medicine.disease ,Kinetics ,Endocrinology ,Glucose ,Hyperglycemia ,Glucose Clamp Technique ,Insulin Resistance ,business - Abstract
Background & aims: Clinical outcome is negatively correlated to postoperative insulin resistance and hyperglycemia. The magnitude of insulin resistance can be modulated by glucose control, preoperative nutrition, adequate pain management and minimal invasive surgery. Effects of glucose control on perioperative glucose kinetics in liver surgery is less studied. Methods: 18 patients scheduled for open hepatectomy were studied per protocol in this prospective, randomized study. In the treatment group (n = 9), insulin was administered intravenously to keep arterial blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 9) received insulin if blood glucose >11.5 mmol/l. Insulin sensitivity was measured by an insulin clamp on the day before surgery and immediately postoperatively. Glucose kinetics were assessed during the clamp and surgery. Results: Mean intraoperative glucose was 7.0 mM (SD 0.7) vs 9.1 mM (SD 1.9) in the insulin and control group respectively (p < 0.001; ANOVA). Insulin sensitivity decreased in both groups but significantly (p = 0.03, ANOVA) more in the control group (M value: 4.6 (4.4-6.8) to 2.1 (1.2-2.6) and 4.6 (4.1-5.0) to 0.6 (0.1-1.8) mg/kg/min in the treatment and control group respectively). Endogenous glucose production (EGP) increased and glucose disposal (WGD) decreased significantly between the pre-and postoperative clamps in both groups, with no significant difference between the groups. Intraoperative kinetics demonstrated that glucose control decreased EGP (p = 0.02) while WGD remained unchanged (p = 0.67). Conclusion: Glucose control reduces postoperative insulin resistance in liver surgery. EGP increases and WGD is diminished immediately postoperatively. Insulin seems to modulate both reactions, but mostly the WGD is affected. Intraoperative EGP decreased while WGD remained unaltered. Registration number of clinical trial: ANZCTR 12614000278639.
- Published
- 2020
22. Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy: a single-center retrospective analysis of 46 consecutive patients
- Author
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Charlotte Ebeling Barbier, Bengt Isaksson, Marijela Moreno Berggren, and Rickard Nyman
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Single Center ,030218 nuclear medicine & medical imaging ,Muscle hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Preoperative Care ,Retrospective analysis ,medicine ,Hepatectomy ,Humans ,Radiology, Nuclear Medicine and imaging ,Local anesthesia ,In patient ,Aged ,Retrospective Studies ,Radiological and Ultrasound Technology ,business.industry ,Portal Vein ,N-butyl-cyanoacrylate ,Liver Neoplasms ,General Medicine ,Enbucrilate ,Middle Aged ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Portal vein embolization ,Female ,business - Abstract
Background Preoperative portal vein embolization (PVE) is performed to induce hypertrophy of the future liver remnant enabling major liver resection in patients with various types of liver tumors. Purpose To evaluate safety and effectiveness of PVE with n-butyl-cyanoacrylate (NBCA). Material and Methods All consecutive patients referred to our hospital for PVE between July 2006 and July 2017 were retrospectively reviewed. Volumetry was performed on computed tomography images before and after PVE, segmenting the total liver volume and the future liver remnant (FLR), i.e. liver segments I–III. Results PVE was performed in 46 patients (18 women, 28 men; mean age = 61 years) using local anesthesia. The ipsilateral technique was used in 45 patients. Adverse events were rare. The mean FLR volume increase was 56%, the degree of hypertrophy was 9.7%, and the kinetic growth rate was 2.1%/week. The median ± SD period between PVE and liver surgery was 7 ± 3 weeks. Forty-two patients (91%) had surgery; liver resection was performed in 37 (80%) patients. Three patients (7%) developed transient liver failure after surgery. There was no 90-day post-PVE or postoperative mortality. Conclusion PVE using NBCA through the ipsilateral approach in local anesthesia is safe and effective in inducing hypertrophy of the future liver remnant enabling surgery, and thereby increasing survival in patients with liver tumors.
- Published
- 2020
23. Liver resection is beneficial for patients with colorectal liver metastases and extrahepatic disease
- Author
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Kristina, Hasselgren, Bengt, Isaksson, Bjarne, Ardnor, Gert, Lindell, Magnus, Rizell, Cecilia, Strömberg, Per, Loftås, Bergthor, Björnsson, and Per, Sandström
- Subjects
extrahepatic disease (EHD) ,medicine.medical_specialty ,business.industry ,Kirurgi ,General Medicine ,Disease ,Gastroenterology and Hepatology ,Gastroenterology ,Colorectal liver metastases ,liver resection ,Resection ,Editorial ,Text mining ,Internal medicine ,medicine ,Gastroenterologi ,Surgery ,Original Article ,business - Abstract
Background: Liver metastases are the most common cause of death for patients with colorectal cancer and affect up to half of the patients. Liver resection is an established method that can potentially be curative. For patients with extrahepatic disease (EHD), the role of liver surgery is less established. Methods: This is a retrospective study based on data from the national quality registry SweLiv. Data were obtained between 2009 and 2015. SweLiv is a validated registry and has been in use since 2009, with coverage above 95%. Patients with liver metastases and EHD were analyzed and cross-checked against the national death cause registry for survival analysis. Results: During the study period, 2,174 patients underwent surgery for colorectal liver metastases (CRLM), and 277 patients with EHD were treated with resection or ablation. The estimated median survival time for the entire cohort from liver resection/ablation was 40 months (95% CI, 32-47). The survival time for patients treated with liver resection was 45 months compared to 26 months for patients treated with ablation (95% CI 38-53, 18-33, P=0.001). A subgroup analysis of resected patients revealed that the group with pulmonary metastases had a significantly longer estimated median survival (50 months; 95 % CI, 39-60) than the group with lymph node metastases (32 months; 95% CI, 7-58) or peritoneal carcinomatosis (28 months; 95% CI, 14-41) (P=0.022 and 0.012, respectively). Other negative prognostic factors were major liver resection and nonradical liver resection. Conclusions: For patients with liver metastases and limited EHD, liver resection results in prolonged survival compared to what can be expected from chemotherapy alone.
- Published
- 2020
24. Treatment patterns and survival in patients with hepatocellular carcinoma in the Swedish national registry SweLiv
- Author
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Bengt Isaksson, M. Sternby Eilard, Martin Henriksson, Oskar Hemmingsson, Per Sandström, Gert Lindell, C. Strömberg, Bergthor Björnsson, and Magnus Rizell
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Adolescent ,Databases, Factual ,lcsh:Surgery ,Young Adult ,Internal medicine ,medicine ,Hepatectomy ,Humans ,In patient ,Registries ,Chemoembolization, Therapeutic ,Aged ,Aged, 80 and over ,Sweden ,Hepatology ,business.industry ,Kirurgi ,Liver Neoplasms ,Gastroenterology ,lcsh:RD1-811 ,Original Articles ,Middle Aged ,Sorafenib ,medicine.disease ,Survival Analysis ,Liver Transplantation ,Treatment Outcome ,Hepatocellular carcinoma ,HPB ,Female ,Original Article ,Surgery ,National registry ,business - Abstract
Background Consistent data on clinical features, treatment modalities and long‐term survival in patients with hepatocellular carcinoma (HCC) using nationwide quality registers are lacking. This study aimed to describe treatment patterns and survival outcomes in patients diagnosed with HCC using a national maintained database. Methods Characteristics and treatment patterns in patients diagnosed with HCC and registered in the national register of liver and bile duct tumours (SweLiv) between 2009 and 2016 were reviewed. Overall survival (OS) was estimated using Kaplan–Meier analysis and the log rank test to compare subgroups for clinical features, treatment modalities and outcomes according to the year of treatment. Results A total of 3376 patients with HCC were registered over 8 years, 246 (7·3 per cent) of whom underwent transplantation. Some 501 (14·8 per cent) and 390 patients (11·6 per cent) had resection and ablation as primary treatment. Transarterial chemoembolization and systemic sorafenib treatment were intended in 476 (14·1 per cent) and 426 patients (12·6 per cent) respectively; the remaining 1337 (39·6 per cent) were registered but referred for best supportive care (BSC). The 5‐year survival rate was approximately 75 per cent in the transplantation group. Median OS was 4·6 (i.q.r. 2·0 to not reached) years after resection and 3·1 (2·3–6·7) years following ablation. In patients referred for palliative treatment, median survival was 1·4 (0·8–2·9), 0·5 (0·3–1·2) and 0·3 (0·1–1·0) years for the TACE, sorafenib and BSC groups respectively (P, Of 3376 patients diagnosed in contemporary clinical care with hepatocellular carcinoma in Sweden and registered in SweLiv between 1 January 2009 and 31 December 2016, 60 per cent were recommended to receive active treatment in a curative or palliative mode. Not surprisingly, owing to patient selection, survival varied substantially depending on the treatment provided. Importantly, explorative analyses showed that the initiation of national guidelines in Sweden may have improved survival outcomes in patients with hepatocellular carcinoma. Survival of HCC, registry based study
- Published
- 2020
25. Postoperative rendezvous endoscopic retrograde cholangiopancreaticography as an option in the management of choledocholithiasis
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Arne Eklund, Lars Enochsson, Bengt Isaksson, Gabriel Sandblom, Eva-Lena Syrén, and Staffan Eriksson
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,Complications ,medicine.medical_treatment ,digestive system ,Article ,Sphincterotomy, Endoscopic ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Postoperative Period ,Abscess ,Cholangiopancreatography, Endoscopic Retrograde ,business.industry ,Kirurgi ,Odds ratio ,Length of Stay ,Middle Aged ,Hepatology ,medicine.disease ,Confidence interval ,digestive system diseases ,Surgery ,Rendezvous ERCP ,Treatment Outcome ,surgical procedures, operative ,Choledocholithiasis ,030220 oncology & carcinogenesis ,Pancreatitis ,Female ,030211 gastroenterology & hepatology ,Cholecystectomy ,business ,Abdominal surgery - Abstract
Background Rendezvous endoscopic retrograde cholangiopancreaticography (ERCP) is a well-established method for treatment of choledocholithiasis. The primary aim of this study was to determine how different techniques for management of common bile duct stone (CBDS) clearance in patients undergoing cholecystectomy have changed over time at tertiary referral hospitals (TRH) and county/community hospitals (CH). The secondary aim was to see if postoperative rendezvous ERCP is a safe, effective and feasible alternative to intraoperative rendezvous ERCP in the management of CBDS. Methods Data were retrieved from the Swedish registry for cholecystectomy and ERCP (GallRiks) 2006–2016. All cholecystectomies, where CBDS were found at intraoperative cholangiography, and with complete 30-day follow-up (n = 10,386) were identified. Data concerning intraoperative and postoperative complications, readmission and reoperation within 30 days were retrieved for patients where intraoperative ERCP (n = 2290) and preparation for postoperative ERCP were performed (n = 2283). Results Intraoperative ERCP increased (7.5% 2006; 43.1% 2016) whereas preparation for postoperative ERCP decreased (21.2% 2006; 17.2% 2016) during 2006–2016. CBDS management differed between TRHs and CHs. Complications were higher in the postoperative rendezvous ERCP group: Odds Ratio [OR] 1.69 (95% confidence interval [CI] 1.16–2.45) for intraoperative complications and OR 1.50 (CI 1.29–1.75) for postoperative complications. Intraoperative bleeding OR 2.46 (CI 1.17–5.16), postoperative bile leakage OR 1.89 (CI 1.23–2.90) and postoperative infection with abscess OR 1.55 (CI 1.05–2.29) were higher in the postoperative group. Neither post-ERCP pancreatitis, postoperative bleeding, cholangitis, percutaneous drainage, antibiotic treatment, ICU stay, readmission/reoperation within 30 days nor 30-day mortality differed between groups. Conclusions Techniques for management of CBDS found at cholecystectomy have changed over time and differ between TRH and CH. Rendezvous ERCP is a safe and effective method. Even though intraoperative rendezvous ERCP is the preferred method, postoperative rendezvous ERCP constitutes an acceptable alternative where ERCP resources are lacking or limited.
- Published
- 2020
26. Outcomes of Simultaneous Resections and Classical Strategy for Synchronous Colorectal Liver Metastases in Sweden : A Nationwide Study with Special Reference to Major Liver Resections
- Author
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Per Sandström, Magnus Rizell, Bjarne Ardnor, Agneta Norén, Ingvar Syk, Bengt Isaksson, Christian Sturesson, Valentinus T. Valdimarsson, and Gert Lindell
- Subjects
Adult ,Male ,medicine.medical_specialty ,Original Scientific Report ,Colorectal cancer ,Cohort Studies ,Postoperative Complications ,medicine ,Hepatectomy ,Humans ,Registries ,Survival analysis ,Colectomy ,Aged ,Sweden ,Cancer och onkologi ,Proctectomy ,business.industry ,Kirurgi ,Liver Neoplasms ,Vascular surgery ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,Cardiac surgery ,Treatment Outcome ,Cardiothoracic surgery ,Cancer and Oncology ,Cohort ,Female ,business ,Colorectal Neoplasms ,Abdominal surgery ,Cohort study ,Follow-Up Studies - Abstract
Background About 20% of patients with colorectal cancer have liver metastases at the time of diagnosis, and surgical resection offers a chance for cure. The aim of the present study was to compare outcomes for patients that underwent simultaneous resection to those that underwent a staged procedure with the bowel-first (classical) strategy by using information from two national registries in Sweden. Methods In this prospectively registered cohort study, we analyzed clinical, pathological, and survival outcomes for patients operated in the period 2008–2015 and compared the two strategies. Results In total, 537 patients constituted the study cohort, where 160 were treated with the simultaneous strategy and 377 with the classical strategy. Patients managed with the simultaneous strategy had less often rectal primary tumors (22% vs. 31%, p = 0.046) and underwent to a lesser extent a major liver resection (16% vs. 41%, p p p p = 0.110) difference was detected. Twenty-five patients had a major liver resection in the simultaneous strategy group and 155 in the classical strategy group without difference in 5-year overall survival (p = 0.198). Conclusion Simultaneous resection of the colorectal primary cancer and liver metastases can possibly have more complications, with no difference in overall survival compared to the classical strategy.
- Published
- 2020
27. Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden
- Author
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Per Sandström, Christian Sturesson, Gert Lindell, Ingvar Syk, Magnus Rizell, Valentinus T. Valdimarsson, Bjarne Ardnor, Agneta Norén, and Bengt Isaksson
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Colorectal cancer ,Treatment outcome ,Adenocarcinoma ,Gastroenterology ,Time-to-Treatment ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Overall survival ,Hepatectomy ,Humans ,In patient ,Registries ,Pathological ,Colectomy ,Aged ,Sweden ,Hepatology ,business.industry ,Liver Neoplasms ,Cancer ,Middle Aged ,Primary cancer ,medicine.disease ,Outcome and Process Assessment, Health Care ,Treatment Outcome ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
Background: Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries. Methods: Clinical, pathological and survival outcomes were compared between the liver-first strategy and the classical strategy (2008-2015). Overall survival was calculated. Results: A total of 623 patients were identified, of which 246 were treated with the liver-first strategy and 377 with the classical strategy. The median follow-up was 40 months. Patients chosen for the classical strategy more often had T4 primary tumours (23% vs 14%, P = 0.012) and node-positive primaries (70 vs 61%, P = 0.015). The liver-first patients had a higher liver tumour burden score (4.1 (2.5-6.3) vs 3.6 (2.2-5.1), P = 0.003). No difference was seen in five-year overall survival between the groups (54% vs 49%, P = 0.344). A majority (59%) of patients with rectal cancer were treated with the liver-first strategy. Conclusion: The liver-first strategy is currently the dominant strategy for sCRLM in patients with rectal cancer in Sweden. No difference in overall survival was noted between strategies.
- Published
- 2018
28. High incidence of biliary stricture after associating liver partition and portal vein ligation for staged hepatectomy
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Bengt Isaksson, Srinivas Sanjeevi, Eduard Jonas, Stefan Gilg, and Ernesto Sparrelid
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Hilum (biology) ,Portal vein ligation ,General Medicine ,030230 surgery ,medicine.disease ,Comorbidity ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,030211 gastroenterology & hepatology ,Stage (cooking) ,Hepatectomy ,business ,Complication ,Left Hepatic Duct - Abstract
Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage procedure most frequently applied in the setting of an extended right-sided hemi-hepatectomy. Initial reports of high mortality have sparked debate regarding the safety and efficacy of the procedure. We describe a higher incidence of early post-operative bile duct strictures after ALPPS, a complication rarely seen after conventional liver resection. Methods An institutional review was conducted to assess the incidence of post-operative biliary strictures following conventional right-sided or extended right-sided hemi-hepatectomy and ALPPS. Patient demographics and operative data were obtained from the patient database of Karolinska University Hospital. Results Between 2010 and 2015, 528 hemi-hepatectomies or extended hemi-hepatectomies were performed, of which 500 were conventional liver resections and 28 were ALPPS. The incidence of post-operative biliary stricture was 10.7% (n = 3) following ALPPS, 1.4% (n = 2) following extended right-sided hepatectomy (P = 0.023; OR = 8.46; 95% CI 1.35-53.2) and 1.1% following formal right-sided hepatectomy (P = 0.004; OR = 11.0; 95% CI 2.11-57.6). All biliary strictures were at the level of the hilum affecting the left hepatic duct. Pre-operative comorbidity was less in the ALPPS group and post-operative complications were more severe following ALPPS. Conclusion Iatrogenic biliary strictures following conventional liver resection is an uncommon complication. It does, however, occur more frequently following ALPPS and is associated with an increased morbidity. Caution should therefore be exercised when dividing the right hilar pedicle at stage 2 of ALPPS.
- Published
- 2017
29. Morphological alterations and redox changes associated with hepatic warm ischemia-reperfusion injury
- Author
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Rim Jawad, Greg Nowak, Marita Wallenberg Lundgren, Melroy A D'souza, Bengt Isaksson, Lisa Arodin Selenius, Olof Danielsson, and Mikael Björnstedt
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,Warm ischemia-reperfusion injury ,medicine.disease_cause ,Redox ,03 medical and health sciences ,0302 clinical medicine ,Thioredoxins ,Glutaredoxin ,Hepatic ischemia-reperfusion injury ,Electron microscopy ,Medicine ,cardiovascular diseases ,skin and connective tissue diseases ,Glutaredoxins ,Hepatology ,business.industry ,Basic Study ,Warm ischemia ,medicine.disease ,030104 developmental biology ,Portal triad clamping ,Oxidative stress ,030211 gastroenterology & hepatology ,sense organs ,business ,Reperfusion injury ,Ischemia reperfusion injury - Abstract
AIM To study the effects of warm ischemia-reperfusion (I/R) injury on hepatic morphology at the ultrastructural level and to analyze the expression of the thioredoxin (TRX) and glutaredoxin (GRX) systems. METHODS Eleven patients undergoing liver resection were subjected to portal triad clamping (PTC). Liver biopsies were collected at three time points; first prior to PTC (baseline), 20 min after PTC (post-ischemia) and 20 min after reperfusion (post-reperfusion). Electron microscopy and morphometry were used to study and quantify ultrastructural changes, respectively. Additionally, gene expression analysis of TRX and GRX isoforms was performed by quantitative PCR. For further validation of redox protein status, immunogold staining was performed for the isoforms GRX1 and TRX1. RESULTS Post-ischemia, a significant loss of the liver sinusoidal endothelial cell (LSEC) lining was observed (P = 0.0003) accompanied by a decrease of hepatocyte microvilli in the space of Disse. Hepatocellular morphology was well preserved apart from the appearance of crystalline mitochondrial inclusions in 7 out of 11 patients. Post-reperfusion biopsies had similar features as post-ischemia with the exception of signs of a reactivation of the LSECs. No changes in the expression of redox-regulatory genes could be observed at mRNA level of the isoforms of the TRX family but immunoelectron microscopy indicated a redistribution of TRX1 within the cell. CONCLUSION At the ultrastructural level, the major impact of hepatic warm I/R injury after PTC was borne by the LSECs with detachment and reactivation at ischemia and reperfusion, respectively. Hepatocytes morphology were well preserved. Crystalline inclusions in mitochondria were observed in the hepatocyte after ischemia.
- Published
- 2017
30. A Composite Score to Predict Survival in Patients Undergoing Resection because of Colorectal Liver Metastases (CRLM)
- Author
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Jozef Urdzik, Bengt Isaksson, and Petter Frühling
- Subjects
medicine.medical_specialty ,Hepatology ,Composite score ,business.industry ,Gastroenterology ,Medicine ,In patient ,business ,Resection ,Surgery - Published
- 2021
31. ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis
- Author
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Bengt Isaksson, Bergthor Björnsson, Per Sandström, Magnus Rizell, Nicolai A. Schultz, Gert Lindell, Bjørn Atle Bjørnbeth, Ernesto Sparrelid, Anna Lindhoff Larsson, Peter Nørgaard Larsen, and Bård I. Røsok
- Subjects
Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,030230 surgery ,Scandinavian and Nordic Countries ,associating liver partition and portal vein ligation for staged hepatectomy ,Rate ratio ,Gastroenterology ,Metastasis ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Prospective Studies ,Prospective cohort study ,Ligation ,Aged ,Neoplasm Staging ,portal embolization ,Chemotherapy ,two-stage hepatectomy ,business.industry ,Liver Neoplasms ,Margins of Excision ,portal ligation ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,Randomized Controlled Trials ,Surgery ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,business ,Colorectal Neoplasms ,colorectal liver metastasis ,RCT ,Follow-Up Studies - Abstract
Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome - RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality. (Less)
- Published
- 2017
32. Dynamic Evaluation of Liver Volume and Function in Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy
- Author
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Rimma Axelsson, Eduard Jonas, Bengt Isaksson, Antonios Tzortzakakis, Torkel B. Brismar, Ernesto Sparrelid, Ulrika Dahlén, and Gustav Murquist
- Subjects
Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,030230 surgery ,Scintigraphy ,Gastroenterology ,Liver metastases ,03 medical and health sciences ,chemistry.chemical_compound ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Liver function tests ,Hepatectomy ,Humans ,Medicine ,Prospective Studies ,Stage (cooking) ,Ligation ,Aged ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Liver Neoplasms ,Organ Size ,Middle Aged ,medicine.disease ,Liver regeneration ,Liver Regeneration ,Treatment Outcome ,Liver ,chemistry ,030220 oncology & carcinogenesis ,Female ,Original Article ,Surgery ,ALPPS ,business ,Indocyanine green ,Liver Failure - Abstract
Background Despite a fast and potent growth of the future liver remnant (FLR), patients operated with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are at risk of developing posthepatectomy liver failure. In this study, the relation between liver volume and function in ALPPS was studied using a multimodal assessment. Methods Nine patients with colorectal liver metastases treated with neoadjuvant chemotherapy and operated with ALPPS were studied with hepatobiliary scintigraphy, computed tomography, indocyanine green clearance test, and serum liver function tests. A comparison between liver volume and function was conducted. Results The preoperative FLR volume of 19.5% underestimated the preoperative FLR function of 25.3% (p = 0.011). The increase in FLR volume exceeded the increase in function at day 6 after stage 1 (FLR volume increase 56.7% versus FLR function increase 28.2%, p = 0.021), meaning that the increase in function was 50% of the increase in volume. After stage 2, functional increase exceeded the volume increase, resulting in similar values 28 days after stage 2. Conclusions In the inter-stage period of ALPPS, the high volume increase is not paralleled by a corresponding functional increase. This may in part explain the high morbidity and mortality rates associated with ALPPS. Functional assessment of the FLR is advised.
- Published
- 2017
33. Response to the Comment on 'ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM: Survival Analysis From the Randomized Controlled Trial LIGRO—Metastatic Tumor Burden in the Future Liver Remnant for Decision-making of Staged Hepatectomy'
- Author
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Bergthor Björnsson, Nicolai A. Schultz, Bjørn Atle Bjørnbeth, Anna Lindhoff Larsson, Magnus Rizell, Ernesto Sparrelid, Per Sandström, Kristina Hasselgren, Bård I. Røsok, Peter Nørgaard Larsen, Bengt Isaksson, and Gert Lindell
- Subjects
Oncology ,medicine.medical_specialty ,Portal Vein ,business.industry ,medicine.medical_treatment ,MEDLINE ,Thyrotropin ,Metastatic tumor ,Survival Analysis ,Tumor Burden ,law.invention ,Liver ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Surgery ,In patient ,business ,Survival analysis - Published
- 2020
34. Colorectal liver metastases - comparisons of prognostic risk factors and overall survival
- Author
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C. Strömberg, Bengt Isaksson, C. Villard, and Katarina Hellberg
- Subjects
Oncology ,medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,Overall survival ,business - Published
- 2020
35. Rescue ALPPS is efficient and safe after failed portal vein occlusion in patients with colorectal liver metastases
- Author
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Torkel B. Brismar, Bengt Isaksson, Lars Lundell, Stefan Gilg, and Ernesto Sparrelid
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,PVO ,medicine.medical_treatment ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Occlusion ,medicine ,Hepatectomy ,Humans ,Treatment Failure ,Stage (cooking) ,Ligation ,Aged ,Retrospective Studies ,Chemotherapy ,Liver resection ,Portal Vein ,business.industry ,Liver Neoplasms ,Middle Aged ,Vascular surgery ,Embolization, Therapeutic ,Liver Regeneration ,Surgery ,Cardiac surgery ,Colorectal liver metastases ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Original Article ,Female ,ALPPS ,Colorectal Neoplasms ,business ,Abdominal surgery - Abstract
Purpose The aim of this study was to investigate whether associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can be used as an effective and safe rescue procedure in patients with colorectal liver metastases (CRLM) and insufficient effect on the future liver remnant (FLR) after previous portal vein occlusion (PVO). Methods Eleven patients with bilobar CRLM treated with neoadjuvant chemotherapy and previous PVO with insufficient effect on the FLR were analyzed retrospectively from a prospective database. FLR was evaluated with computed tomography volumetry 6 days after stage 1, and stage 2 was performed on day seven. Results Six days after stage 1, the median increase of the FLR was 209 ml (range 87–314, P 0.5 % in all patients and successful subsequent removal of the tumor bearing liver (segments IV–VIII) in all patients with no 90-day mortality. No patient had a 3b-complication or more according to Clavien-Dindo. No patient developed severe posthepatectomy liver failure. Conclusions The powerful hypertrophy of the FLR associated with ALPPS seems to be maintained in patients with CRLM and previous failed PVO.
- Published
- 2016
36. The prognostic role of systemic inflammation in patients undergoing resection of colorectal liver metastases: C-reactive protein (CRP) is a strong negative prognostic biomarker
- Author
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Ulf Gunnarsson, Christian Kersten, Helena Isoniemi, Thyra Löwenmark, Bengt Isaksson, Karin A. Ydsten, Anne Helene Kostner, Caj Haglund, and Reetta Peltonen
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,Colorectal cancer ,Disease ,Systemic inflammation ,Gastroenterology ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,In patient ,Prognostic biomarker ,biology ,business.industry ,C-reactive protein ,General Medicine ,medicine.disease ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,biology.protein ,Surgery ,medicine.symptom ,business - Abstract
BACKGROUND AND OBJECTIVES: Systemic inflammation has been associated with poor survival in several tumor types, but has been less extensively studied in resectable metastatic disease. The aim of th ...
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- 2016
37. Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion : FLR Increase in Patients with CRLM Is Highest the First Week After PVO
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Gert Lindell, Bengt Isaksson, Ernesto Sparrelid, Per Sandström, Nicolai A. Schultz, Magnus Rizell, Anna Lindhoff Larsson, Kristina Hasselgren, Bjørn Atle Bjørnbeth, Peter Nørgaard Larsen, Bård I. Røsok, and Bergthor Björnsson
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Liver surgery ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Portal vein ,Portal vein ligation ,Gastroenterology and Hepatology ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Portal vein embolization ,Occlusion ,medicine ,Gastroenterologi ,Hepatectomy ,Humans ,In patient ,Postoperative Period ,Neoplasm Metastasis ,Ligation ,Aged ,business.industry ,Portal Vein ,Kirurgi ,Liver Neoplasms ,Gastroenterology ,Surgery ,Liver Regeneration ,Colorectal liver metastases ,Future liver remnant ,030220 oncology & carcinogenesis ,Female ,Original Article ,business ,Colorectal Neoplasms ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
BACKGROUND: Portal vein occlusion (PVO) is an established method to increase the volume of the future liver remnant (FLR). The main reasons for not proceeding to radical hepatectomy are lack of volume increase and tumor progression due to a wait-time interval of up to 8 weeks. The hypothesis was that the increase in FLR volume is not linear and is largest during the first weeks. METHODS: Patients with colorectal liver metastases (CRLM) and standardized future liver remnant (sFLR) Funding Agencies|LIO-534891, FORSS-560521, FORSS-660121, and FORSS-753-621
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- 2019
38. Imbalance of Genes Encoding Natural Killer Immunoglobulin-Like Receptors and Human Leukocyte Antigen in Patients With Biliary Cancer
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Hannes Jansson, Lena Berglin, Martin Cornillet, Helene Johansson, Ernesto Sparrelid, Laura Hertwig, Bengt Isaksson, Karl-Johan Malmberg, Ewa Ellis, Faviel F. Gonzalez-Galarza, Derek Middleton, Christine L. Zimmer, Niklas K. Björkström, and Marie Schaffer
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0301 basic medicine ,Male ,Asia ,Time Factors ,chemical and pharmacologic phenomena ,Human leukocyte antigen ,Biology ,Ligands ,Linkage Disequilibrium ,Bile duct cancer ,Primary sclerosing cholangitis ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Lymphocytes, Tumor-Infiltrating ,Receptors, KIR ,HLA Antigens ,Risk Factors ,otorhinolaryngologic diseases ,medicine ,Humans ,Genetic Predisposition to Disease ,Receptor ,Genetic Association Studies ,Aged ,Aged, 80 and over ,Hepatology ,Bile duct ,Gastroenterology ,hemic and immune systems ,Middle Aged ,South America ,medicine.disease ,Prognosis ,Europe ,Killer Cells, Natural ,030104 developmental biology ,medicine.anatomical_structure ,Phenotype ,Bile Duct Neoplasms ,Receptors, KIR2DL3 ,Case-Control Studies ,Immunology ,North America ,biology.protein ,030211 gastroenterology & hepatology ,Female ,Antibody ,Liver cancer - Abstract
Background & Aims Bile duct tumors are rare and have poor prognoses. Natural killer (NK) cells are frequent in human liver and infiltrate these tumors but do not control their progression. Responses of NK cells are regulated by NK immunoglobulin-like receptors (KIRs), which interact with HLA class I ligands. We aimed to characterize the features of the KIR gene loci and their ligands in patients with bile duct cancer (BDC). Methods We performed combined multidimensional characterization of genes that encode KIRs and their ligands in blood samples from patients with BDC from Sweden, followed for up to 8 years after diagnosis (n = 148), in 2 geographically matched cohorts of healthy individuals from Northern Europe (n = 204 and n = 900), and in healthy individuals from 6 geographically unrelated populations (n = 2917). We used real-time polymerase chain reaction, RNA sequencing, immunohistochemistry, and flow cytometry to evaluate NK-cell presence, as well as KIR and KIR-ligand expression in bile duct tumors and control tissues. Results Patients with bile duct tumors had multiple alterations at the KIR gene loci. KIR loci are grouped into genotypes that encode more inhibitory (group A) and more activating (group B) receptors, which can be subdivided into centromeric and telomeric fragments. Patients with BDC had a lower prevalence of KIR2DL3, which was linked to disequilibrium in centromeric A/B and B/B genotypes, compared with control individuals. The associations between KIRs and KIR ligands differed between patients with BDC and control individuals; patients had an altered balance between activating and inhibitory KIRs. KIR-positive NK cells infiltrated biliary tumors that expressed matched KIR ligands. Conclusions In a multidimensional analysis of DNA from blood samples of patients with BDC in Europe, we found patients to have multiple alterations at the KIR and HLA gene loci compared with control individuals. These alterations might affect NK-cell tumor surveillance. NK cells from bile duct tumors expressed KIRs and were found in tumors that expressed cognate ligands. This should be considered in development of immune-based therapies for BDC.
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- 2018
39. Health Economic Evaluation of Patients with Colorectal Liver Metastases Randomized to ALPPS or TSH - Analysis from the LIGRO Trial
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B. Røsok, Martin Henriksson, Peter Nørgaard Larsen, Per Sandström, K. Hasselgren, Ernesto Sparrelid, Gert Lindell, Bengt Isaksson, and Bergthor Björnsson
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medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Economic evaluation ,Gastroenterology ,Medicine ,business - Published
- 2021
40. Associating Liver Partition and Portal Vein Ligation for Primary Hepatobiliary Malignancies and Non-Colorectal Liver Metastases
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Ernesto Sparrelid, Per Sandström, Bengt Isaksson, Bergthor Björnsson, Kristina Hasselgren, and Thomas Gasslander
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Portal vein ligation ,030230 surgery ,Malignancy ,Wilms Tumor ,Gastroenterology ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Perihilar Cholangiocarcinoma ,Ligation ,Melanoma ,Intrahepatic Cholangiocarcinoma ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatocellular cancer ,Portal Vein ,business.industry ,Eye Neoplasms ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Treatment Outcome ,Non colorectal ,030220 oncology & carcinogenesis ,Female ,Surgery ,Patient Safety ,Radical resection ,business ,Follow-Up Studies ,Klatskin Tumor - Abstract
Background and Aims: Associating liver partition and portal vein ligation for staged hepatectomy may increase the possibility of radical resection in the case of liver malignancy. Concerns have been raised about the high morbidity and mortality associated with the procedure, particularly when applied for diagnoses other than colorectal liver metastases. The aim of this study was to analyze the initial experience with associating liver partition and portal vein ligation for staged hepatectomy in cases of non-colorectal liver metastases and primary hepatobiliary malignancies in Scandinavia. Materials and Methods: A retrospective analysis of all associating liver partition and portal vein ligation for staged hepatectomy procedures performed at two Swedish university hospitals for non-colorectal liver metastases and primary hepatobiliary malignancies was performed. The primary focus was on the safety of the procedure. Results and Conclusion: Ten patients were included: four had hepatocellular cancer, three had intrahepatic cholangiocarcinoma, one had a Klatskin tumor, one had ocular melanoma metastasis, and one had a metastasis from a Wilms’ tumor. All patients completed both operations, and the highest grade of complication (according to the Clavien-Dindo classification) was 3A, which was observed in one patient. No 90-day mortality was observed. Radical resection (R0) was achieved in nine patients, while the resection was R2 in one patient. The low morbidity and mortality observed in this cohort compared with those of earlier reports on associating liver partition and portal vein ligation for staged hepatectomy for diagnoses other than colorectal liver metastases may be related to the selection of patients with limited comorbidity. In addition, procedures other than associating liver partition and portal vein ligation for staged hepatectomy had been avoided in most of the patients. In conclusion, associating liver partition and portal vein ligation for staged hepatectomy can be applied to primary hepatobiliary malignancies and non-colorectal liver metastases with acceptable rates of morbidity and mortality.
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- 2016
41. ALPPS improves survival compared with TSH in patients affected of CRLM – Survival analysis from the randomized controlled trial LIGRO
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Magnus Rizell, Nicolai A. Schultz, Bergthor Björnsson, Anna Lindhoff Larsson, Per Sandström, Ernesto Sparrelid, Kristina Hasselgren, Bjorn A. Bjørnbeth, Bengt Isaksson, Gert Lindell, Bård I. Røsok, and Peter N. Larsen
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medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Portal vein ligation ,General Medicine ,Surgery ,law.invention ,Randomized controlled trial ,law ,Occlusion ,Medicine ,In patient ,Hepatectomy ,business ,Median survival ,Survival analysis - Abstract
OBJECTIVE To evaluate the oncological outcome for patients with colorectal liver metastases (CRLM) randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH). BACKGROUND TSH with portal vein occlusion is an established method for patients with CRLM and a low volume of the future liver remnant (FLR). ALPPS is a less established method. The oncological outcome of these methods has not been previously compared in a randomized controlled trial. METHODS One hundred patients with CRLM and standardized FLR (sFLR)
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- 2020
42. Comparison of oncological outcome between ALPPS and TSH in a randomized controlled trial
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Bergthor Björnsson, Nicolai Aagaard Schultz, A. Lindhoff Larsson, Ernesto Sparrelid, B. Atle Björnbeth, K. Hasselgren, Bengt Isaksson, Per Sandström, Magnus Rizell, P. Norgaard Larsen, B. Ingvald Rosok, and Gert Lindell
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medicine.medical_specialty ,Hepatology ,Randomized controlled trial ,law ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,business ,Outcome (game theory) ,law.invention - Published
- 2020
43. Response to 'ALPPS Versus Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastases'
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Bård I. Røsok, Nicolai A. Schultz, Anna Lindhoff Larsson, Bergthor Björnsson, Bjørn Atle Bjørnbeth, Per Sandström, Magnus Rizell, Bengt Isaksson, Gert Lindell, Peter Nørgaard Larsen, and Ernesto Sparrelid
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medicine.medical_specialty ,business.industry ,Portal Vein ,medicine.medical_treatment ,Liver Neoplasms ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Medicine ,Hepatectomy ,Humans ,030211 gastroenterology & hepatology ,In patient ,business ,Colorectal Neoplasms - Abstract
Response to "ALPPS Versus Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastases"
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- 2018
44. Response to Comment on 'When Innovation Is Not Enough'
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Per Sandström, Anna Lindhoff Larsson, Ernesto Sparrelid, Bengt Isaksson, Magnus Rizell, Gert Lindell, Peter Nørgaard Larsen, Bergthor Björnsson, Bjørn Atle Bjørnbeth, Nicolai A. Schultz, and Bård I. Røsok
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,Liver Neoplasms ,MEDLINE ,Ethnic group ,Ethnicity ,Medicine ,Hepatectomy ,Humans ,Surgery ,business ,Colorectal Neoplasms ,Delivery of Health Care - Published
- 2018
45. Identification of Inequalities in the Selection of Liver Surgery for Colorectal Liver Metastases in Sweden
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Bjarne Ardnor, Agneta Norén, K. Gunnarsdottir, Per Sandström, Gert Lindell, Bengt Isaksson, and Magnus Rizell
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Liver surgery ,Oncology ,Adult ,Male ,medicine.medical_specialty ,Population based ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Hepatectomy ,Humans ,Survival rate ,Referral and Consultation ,Selection (genetic algorithm) ,Aged ,Aged, 80 and over ,Sweden ,business.industry ,Patient Selection ,Liver Neoplasms ,Middle Aged ,Survival Rate ,Socioeconomic Factors ,030220 oncology & carcinogenesis ,Surgery ,Identification (biology) ,Female ,business ,Colorectal Neoplasms - Abstract
Background: Liver resection for colorectal liver metastases offers a 5-year survival rate of 25%–58%. This study aimed to analyze whether patients with colorectal liver metastases undergo resection to an equal extent and whether selection factors play a role in the selection process. Material and Methods: Data were retrieved from the Swedish Colorectal Cancer Registry (2007–2011) for colorectal cancer and colorectal liver metastases. The patients identified were linked to the Swedish Registry of Liver and Bile surgery and the National Patient Registry to identify whether liver surgery or ablative treatment was performed. Analyses for age, sex, type of primary tumor and treating hospital (university, county, or district), American Society of Anesthesiologists class, and radiology for detection of metastatic disease were performed. Results: Of 28,355 patients with colorectal cancer, 21.6% (6127/28,355) presented with liver metastases. Of the patients with liver metastases, 18.5% (1134/6127) underwent liver resection or ablation. The cumulative proportion of liver resection/ablation was 4% (1134/28,355) of all colorectal cancer. If “not bowel resected” were excluded, the proportion slightly increased to 4.7% (1134/24,262). Around 15% of the patients with metastases were registered as referrals for liver surgery. In a multivariable analysis patients treated at a university hospital for primary tumor were more frequently surgically treated for liver metastases (p 70 years and those with American Society of Anesthesiologists class >2 underwent liver resection less frequently. Magnetic resonance imaging of the liver was more often used in diagnostic work-up in men. Conclusion: Patients with colorectal liver metastases are unequally treated in Sweden, as indicated by the low referral rate. The proximity to a hepatobiliary unit seems important to enhance the patient’s chances of being offered liver surgery.
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- 2018
46. Response: 'Unresectable Colorectal Liver Metastases: When Definitions Matter to Appropriately Assess Extreme Liver Resection Techniques'
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Per Sandström, Nicolai A. Schultz, Gert Lindell, Peter Nørgaard Larsen, Bård I. Røsok, Anna Lindhoff Larsson, Magnus Rizell, Bergthor Björnsson, Bengt Isaksson, and Ernesto Sparrelid
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Liver Neoplasms ,MEDLINE ,Leucovorin ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Hepatectomy ,Humans ,Surgery ,Radiology ,business ,Colorectal Neoplasms - Abstract
Response "Unresectable Colorectal Liver Metastases : When Definitions Matter to Appropriately Assess Extreme Liver Resection Techniques''
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- 2018
47. The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study
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Greg Nowak, Bengt Isaksson, Staffan Wahlin, Stefan Gilg, Ernesto Sparrelid, Lars Saraste, C. Strömberg, and Lars Lundell
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medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology and Hepatology ,Asymptomatic ,Extracorporeal ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Gastroenterologi ,Medicine ,Adverse effect ,Hepatology ,business.industry ,Mortality rate ,Kirurgi ,Original Articles ,Surgery ,Clinical trial ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Original Article ,Liver function ,Hepatectomy ,medicine.symptom ,business - Abstract
Posthepatectomy liver failure (PHLF) represents the single most important cause of postoperative mortality after major liver resection, yet no effective treatment option is available. Extracorporeal liver support devices might be helpful, but systematic studies are lacking. Accordingly, we aimed to assess the safety and feasibility of the Molecular Adsorbent Recirculating System (MARS) in patients with PHLF. Between December 2012 and May 2015, a total of 206 patients underwent major or extended hepatectomy, and 10 consecutive patients with PHLF (according to the Balzan 50:50 criteria) were enrolled into the study. MARS treatment was initiated on postoperative day 5-7, and five to seven consecutive treatment sessions were completed for each patient. In total, 59 MARS cycles were implemented, and MARS was initiated and completed without major complications in any patient. However, 1 patient developed an immense asymptomatic hyperbilirubinemia (without encephalopathy), 1 had repeated clotting problems in the MARS filter, and 2 patients experienced access problems with the central venous line. Otherwise, no adverse events were observed. In 9 patients, the bilirubin level and international normalized ratio decreased significantly (P < 0.05) during MARS treatment. The 60- and 90-day mortality was 0% and 10%, respectively. Among the 9 survivors, 4 still had liver dysfunction at 90 days postoperatively. Five patients were alive 1 year postoperatively without any signs of liver dysfunction or disease recurrence. Conclusion: The use of MARS in PHLF is feasible and safe and improves liver function in patients with PHLF. In the present study, 60- and 90-day mortality rates were unexpectedly low compared to a historical control group. The impact of MARS treatment on mortality in PHLF should be further evaluated in a randomized controlled clinical trial. (Hepatology Communications 2018;2:445-454).
- Published
- 2017
48. Serial Assessment of Growth Factors Associated with Liver Regeneration in Patients Operated with Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy
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Greg Nowak, Stefan Gilg, Ewa Ellis, Ernesto Sparrelid, Bengt Isaksson, and Helene Johansson
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Adult ,Male ,Vascular Endothelial Growth Factor A ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,030230 surgery ,Muscle hypertrophy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Epidermal growth factor ,medicine ,Hepatectomy ,Humans ,Prospective Studies ,RNA, Messenger ,Ligation ,Aged ,Epidermal Growth Factor ,business.industry ,Hepatocyte Growth Factor ,Interleukin-6 ,Portal Vein ,Interleukin ,Middle Aged ,Liver regeneration ,Liver Regeneration ,Vascular endothelial growth factor ,chemistry ,Liver Lobe ,030220 oncology & carcinogenesis ,Surgery ,Hepatocyte growth factor ,Female ,business ,medicine.drug - Abstract
Background: There is limited knowledge about the mechanisms behind the unparalleled growth of the future liver remnant (FLR) linked to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). In this study, liver regenerative markers were examined in patients subjected to ALPPS. Methods: Ten patients with colorectal liver metastases treated with neoadjuvant chemotherapy and ALPPS were included. Plasma was sampled at 6 time points and biopsies from both liver lobes were collected at both stages of ALPPS. The levels of interleukin (IL)-6, hepatocyte growth factor (HGF), tumor necrosis factor-α, epidermal growth factor, and vascular endothelial growth factor in plasma were measured at each time point. Expression of mRNA for markers of proliferation and apoptosis was studied in the biopsies from both liver lobes taken at both stages. Results: ALPPS resulted in a peak of IL-6 after stage 1 (p = 0.004), which decreased rapidly and did not increase again after stage 2. HGF also increased after stage 1 (p = 0.048), and the HGF levels correlated significantly with the degree of growth of the FLR before stage 2 (p = 0.02, r2 = 0.47). There was a correlation between peak levels of IL-6 and HGF (p = 0.03, r2 = 0.84). Conclusions: IL-6 and HGF seem to be early mediators of hypertrophy after stage 1 in the ALPPS procedure. The peak HGF plasma level correlates with the degree of FLR growth in patients subjected to ALPPS.
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- 2017
49. Tumour growth after portal vein embolization with pre-procedural chemotherapy for colorectal liver metastases
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Bengt Isaksson, Christian Sturesson, Roland Andersson, Ernesto Sparrelid, and Lidewij Spelt
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Male ,medicine.medical_specialty ,Time Factors ,Colorectal cancer ,medicine.medical_treatment ,Context (language use) ,Resection ,Risk Factors ,medicine ,Hepatectomy ,Humans ,Chemoembolization, Therapeutic ,Neoadjuvant therapy ,Aged ,Cell Proliferation ,Retrospective Studies ,Aged, 80 and over ,Sweden ,Chemotherapy ,Hepatology ,Portal Vein ,business.industry ,Liver Neoplasms ,Gastroenterology ,Retrospective cohort study ,Original Articles ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Tumor Burden ,Treatment Outcome ,Chemotherapy, Adjuvant ,Portal vein embolization ,Disease Progression ,Linear Models ,Female ,Radiology ,Colorectal Neoplasms ,Tomography, X-Ray Computed ,business - Abstract
BackgroundFor resection of colorectal cancer (CRC) liver metastases, pre-operative portal vein embolization (PVE) is used to increase the size of the future liver remnant (FLR) prior to advanced liver resection when indicated. PVE is speculated to cause tumour progression, but only a limited number of studies have analysed tumour growth after PVE in the context of pre-procedural chemotherapy, which was the aim of this retrospective study.MethodsPatients treated with stabilizing chemotherapy and PVE before liver resection for CRC metastases were included. Tumour progression according to RECIST guidelines and a change in tumour volume was analysed on computed tomography (CT) scans prior to chemotherapy, before PVE and after PVE, respectively.ResultsThirty-four patients were included, of whom 23 had bilobar disease. Of tumours in the embolized lobe, 3/34 showed progression after PVE as compared with 3/23 in the non-embolized lobe (P = 0.677). A decrease in tumour volume of 16% and 11% was noted in the embolized and non-embolized lobe, respectively (P = 0.368). Patients were off chemotherapy in a median of 16 days before PVE. There was a linear correlation between the growth of tumours and time between the end of chemotherapy and PVE (r = 0.25, P = 0.0005).ConclusionThe rate of progression of CRC liver metastases after PVE and pre-procedural chemotherapy was lower in the present study as compared with previous reports. This applies to tumours in both the embolized and non-embolized lobes and is associated with keeping the time between the end of chemotherapy and PVE short.
- Published
- 2015
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50. Liver parenchyma access and lesion marker via the endovascular route
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Staffan Holmin, Bengt Isaksson, Anton Razuvaev, Johan Lundberg, Stefan Jonsson, and Thorhallur Agustsson
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medicine.medical_specialty ,Pathology ,Catheters ,Swine ,business.industry ,Colorectal cancer ,Endovascular Procedures ,Local ablation ,food and beverages ,Antineoplastic Agents ,Signal-To-Noise Ratio ,medicine.disease ,Lesion ,Hepatic Artery ,Liver ,Animals ,Hepatectomy ,Medicine ,Female ,Surgery ,Radiology ,medicine.symptom ,business ,Liver parenchyma ,Ultrasonography - Abstract
Neoadjuvant chemotherapeutic regimens for metastatic colorectal cancer are now so effective that they can cause "vanishing" lesions. With new advances such as local ablation, intra-arterial treatments in bolus with pumps or with beads, and isolation of hepatic perfusion, the need for a working channel to the liver may be warranted, ideally reducing the risk of spreading neoplastic cells.The endovascular trans-vessel wall Extroducer device makes it possible to gain direct access to the liver parenchyma. The distal tip is then detached, to act as both a marker and a securing plug in the vessel defect. We used ex vivo and in vivo tests to evaluate the device as a working channel for local administration of substances to the parenchyma and as a marker for detection with both transabdominal and intraoperative ultrasonography.We could deploy the Extroducer device without any hemorrhagic or thromboembolic complications in vivo, and we were able to detect all markers ex vivo and in vivo using both transabdominal and intraoperative ultrasonography. Furthermore, we found that it is possible to administer substances to the liver parenchyma using the catheter.The trans-vessel wall technique can be used to establish a working channel to the liver parenchyma for administration of any substance, such as chemotherapeutic agents or cells. The detached device can also be used as a marker for ultrasound-guided partial liver resection in "vanishing lesions." The technique should have a low risk of seeding of neoplastic cells. This study in large animals forms a strong basis for translation to clinical studies.
- Published
- 2015
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