Scandinavian Journal of Surgery最新文献

Background and aims: The anti-inflammatory effects of dexamethasone may reduce the inflammatory response after pancreatoduodenectomy. The aim of this retrospective observational study was to evaluate the association between intraoperative dexamethasone and postoperative complications in patients undergoing pancreatoduodenectomy with a special focus on patients with pancreatic ductal adenocarcinoma (PDAC).

Methods: All eligible patients undergoing pancreatoduodenectomy in our hospital between January 2018 and December 2021 (n = 319) were included comparing the postoperative outcomes in patients who received intraoperative dexamethasone (n = 178) to patients not given any intraoperative glucocorticoids (n = 142).

Results: PDAC was the most common diagnosis (n = 166) and of these patients 92 received intraoperative dexamethasone and 74 no glucocorticoids. Patients with PDAC who received dexamethasone experienced fewer severe Clavien-Dindo complications than those not receiving glucocorticoids (n = 13/92 (14.1%) vs n = 21/74 (28.4%), P = 0.033). Multivariable analyses confirmed that a single dose of dexamethasone was associated with a reduced risk of severe complications in this patient group (odds ratio (OR) 0.40, 95% confidence interval [CI] 0.18-0.91, P = 0.030). When considering all pancreatoduodenectomy patients, no statistically significant differences in postoperative complications were observed. The incidence of postoperative infections was similar between the groups, although postoperative C-reactive protein (CRP) levels were lower in pancreatoduodenectomy patients who received dexamethasone (CRP on the second postoperative day: 102 (69-146) vs 159 (112-208) mg/l, P < 0.001). Patients who received dexamethasone experienced postoperative fever less frequently than those not given an intraoperative glucocorticoid (n = 68/178 (38.4%) vs n = 73/141 (51.8%), P = 0.023). Dexamethasone had no statistically significant influence on overall survival of PDAC patients.

Conclusion: A single dose of dexamethasone was not associated with decreased postoperative complications across all pancreatoduodenectomy patients. However, within the PDAC subgroup, there were fewer Clavien-Dindo ⩾ 3 complications after dexamethasone compared to no glucocorticoid administration.

Background and aims: The Fecal Incontinence Quality of Life Scale (FIQL) is a health-related questionnaire that measures the quality of life among patients with fecal incontinence. This questionnaire comprises 29 items divided into four subscales: Lifestyle, Coping/Behavior, Depression/Self-Perception, and Embarrassment. The aim of the study was to validate the FIQL questionnaire in the Finnish language.

Methods: A multiphase validation method was used consisting of a two-panel translation process followed by a psychometric evaluation process. The validation process was used to ensure the consistency and quality of the questionnaire through the test-retest process. The internal consistency between the four subscales was measured with Cronbach's alpha, and the stability over time was assessed by intra-class correlation coefficient (ICC) analysis. Spearman's correlations were used to examine the construct validity.

Results: A total of 82 patients with fecal incontinence and 10 reference participants were included in this study. The results for Finnish FIQL indicated that all four subscales had good internal consistency, except for the embarrassment subscale, which had a slightly lower Cronbach's alpha value for the test (0.68). Between subscales, ICC ranged from 0.83 to 0.90, indicating almost perfect stability over time. Correlations were moderate between the FIQL and the severity of fecal incontinence.

Conclusions: The Finnish version of the FIQL has been successfully validated and shown to be feasible. The questionnaire can be used for both research and clinical purposes in Finnish patients with fecal incontinence.

Background and aims: Whereas the value of endoscopic retrograde cholangiopancreatography (ERCP) training in clinical practice is well known, the impact on stress markers and performance in a virtual reality (VR) simulator is not. The primary aim of the study was to see how the number of clinical ERCPs performed during a 1-year period influenced VR-ERCP performance. A secondary aim was to compare differences in salivary stress marker levels, between the first and final simulator attempts.

Methods: Thirty-one endoscopists completed three VR-ERCP procedures of increasing difficulty. The times taken to complete the different steps of the procedures were recorded. Saliva chromogranin A, cortisol, and α-amylase were measured before and after each phase of the cystic leakage procedure. Participants then did 1 year of clinical ERCP training at their respective centers. The remaining cohort (26/31) was divided into two subgroups according to their level of clinical training. They then completed the same VR-ERCP procedures. Differences in time before and after each phase as well as stress marker levels during the cystic leakage procedure were assessed.

Results: Those with >100 ERCPs of clinical training improved times to completion of all 15 phases in the VR-ERCP procedures (p < 0.05) in contrast to the group with 20-50 ERCPs who only improved in 11/15. Differences in increases in salivary stress marker levels of chromogranin A before and after each phase of the cystic leakage procedure, adjusted for number of ERCPs, showed significant reductions in four of the five phases measured.

Conclusion: Clinical ERCP training enhances subsequent performance in terms of time to completion in a VR-ERCP simulator. Additional intended use of simulators could be used as a benchmark for clinical progress. Saliva markers may be feasible to use in measuring stress reactions in a training setting.

Background: The study aimed to analyze thyroid-stimulating hormone (TSH) levels quantitatively and investigate their potential correlation with the risk of incident atrial fibrillation (AF) in differentiated thyroid cancer (DTC) patients.

Methods: DTC cases diagnosed between 1995 and 2015 in Stockholm, Sweden, were identified from the Swedish Cancer Registry. Medical records were scrutinized, and follow-up began 9 months post-surgery with tracking data until the earliest AF record, censoring, or 31 August 2022. TSH values were classified as unsuppressed (TSH > 0.5 mE/L), mildly suppressed (TSH 0.1-0.5 mE/L), or suppressed (TSH < 0.1 mE/L), with graphical analysis spanning up to a 10-year follow-up period. In addition, a nested case-control study assessed the impact of TSH category on incident AF. Additional data on cardiovascular risk factors were gathered.

Results: Among 608 patients, approximately 78% maintained suppressed TSH levels for over half of their follow-up time. Notably, there was a decrease in the proportion of patients receiving long-term TSH suppression after 2013. Among 39 newly diagnosed AF cases, most were in the suppressed TSH category. Moreover, about half of these new AF patients had established cardiovascular risk factors prior to DTC diagnosis.

Conclusion: DTC patients generally adhered to TSH suppression guidelines, with a decline observed in the proportion of suppressed TSH values following the adoption of individualized treatment in 2013. The study could not establish a clear link between TSH suppression and the risk of incident AF, highlighting the need for further investigation.

Background and aims: To compare the clinical and oncological results of anatomical resection of primary non-small cell lung cancers performed by resident and specialist surgeons as the lead surgeon in a medium-volume, mixed-practice hospital.

Methods: We retrospectively collected individual patient record data. Between 1 January 2000 and 31 December 2020, a total of 959 primary lung cancer cases underwent intention-to-treat surgical resection at the Oulu University Hospital. Of these surgeries, 108 were performed by a resident surgeon as the lead surgeon. Propensity score matching was used to find similar unique resident-led cases to compare with unique specialist-led cases in a 1:2 ratio.

Results: After propensity score matching, 65 resident-led cases were eligible for comparison to 130 specialist-led cases. Intra-operative complications were similar in both groups; resident-led cases had a complication rate of 12.3%, whereas specialist-led cases had a complication rate of 8.5% (p = 0.445). The incidence of major Clavien-Dindo complications (>IIIa) was 12.3% and 15.4% (p = 0.668), respectively. In the Kaplan-Meier analysis, the overall survival rate at 1, 3, and 5 years was 90.0%, 71.3%, and 65.3%, respectively, in resident-led cases and 88.2%, 66.6%, and 54.5%, respectively, in specialist-led cases (p = 0.389). Disease-specific survival at 1, 3, and 5 years was 90.0%, 77.6%, and 71.1%, respectively, in resident-led cases and 91.4%, 76.3%, and 76.3%, respectively, in specialist-led cases (p = 0.931).

Conclusion: There was no difference in intra- and post-operative complication rate based on surgeon expertise. Both short-term and long-term results were comparable between resident- and specialist-led surgeries.

Background and objective: The optimal type of anastomosis for preventing anastomotic leakage (AL) and bowel dysfunction after colorectal surgery remains uncertain. The aim of the study was to evaluate anastomotic type after anterior resection (AR) in relation to AL and functional outcome in long-term follow-up.

Methods: This was a population-based study using data from the Swedish Colorectal Cancer Registry (SCRCR). The patients were categorized into two groups, based on anastomotic design ("J-pouch/side-to-end (STE) anastomosis" or "end-to-end (ETE) anastomosis"). AL was established using SCRCR and supplemented with review of medical records. The low anterior resection syndrome (LARS) score questionnaire and Cleveland Clinic Florida Fecal Incontinence score (CCFFIS) were used for the assessment of bowel function. The associations and the predefined confounders were adjusted for using logistic regression/linear mixed-effects models.

Results: A total of 710 patients who underwent curative rectal cancer surgery with AR between 2007 and 2013 were included. AL occurred in 87 (15.7%) patients in the STE group and 10 (10.2%) in the ETE group. After adjustment, the type of anastomosis (STE versus ETE) did not affect the odds of AL (odds ratio (OR) 0.80 (95% CI: 0.37-1.76)). There was no association between the anastomotic technique and bowel dysfunction (LARS score: OR 1.14 (95% CI: 0.58-2.27) and CCFFIS: OR -0.08 (95% CI: -1.63 to -1.46)).

Conclusions: This is the first study examining anastomotic type and the risk of AL and bowel dysfunction in a long-term perspective beyond 3 years among patients who underwent AR. The anastomosis type did not show any association for AL or bowel dysfunction.

Background: In recent years, as new strategies have been developed, there has been a reduction of invasive interventions for prevention or treatment of ischaemic cerebral events. Furthermore, surgical treatment has been centralized to major vascular centra.

Aim: This study analyzed registered malpractice claims to the insurance during two decades. Treatment policies (more pharmacological treatment, less intervention for asymptomatic carotid artery disease) and claiming patterns changed (Introduction of Patient Safety Act 2011).

Material and methods: During a 20-year period (2000-2019), 184 malpractice claims related to invasive treatment of carotid artery cerebral circulatory disorders were registered in the files of the Swedish National Insurance Company. These were analyzed in two 10-year cohorts regarding the indication for intervention, the intervention itself, and the sufferers' reasons motivating the claims and the final decision as judged by the Insurance Company's medical and juridical experts.

Results: The claim rate was on a 1% level (of all carotid artery interventions), no difference between the two decades. Between the first and second decade, claims concerning intervention for asymptomatic carotid artery disease decreased with 26%. In 51% of the claims, the damage was considered avoidable and the claimants were compensated for their financial losses. Motor nerve lesions were compensated for in 78% and stroke in 40%. Thrombolysis as a claimed procedure increased from 2 to 10 between the periods.

Conclusion: During a 20-year period, negligence claims after interventions for asymptomatic carotid artery disease or manifest carotid artery cerebral ischemia were stable at a 1% level of all interventions. The compensation rate was around 50%. Dominating injuries to be claimed and compensated for were perioperative motor cranial nerve injuries and postoperative stroke. Despite changes in treatment policy, the claim and compensation rate were stable.

Background: Superparamagnetic iron oxide (SPIO) nanoparticles are non-inferior as a tracer for sentinel lymph node biopsy (SLNB) detection in breast cancer patients compared to the standard radioactive tracer (technetium-99m, Tc^99m) with or without blue dye (Patent blue V^®, BD). Sentinel lymph node (SLN) detection has been successful using an ultra-low dose of 0.1 mL SPIO injected intradermally in patients with breast cancer, and this study aims to assess the potential reduction of SPIO-related skin discoloration and breast magnetic resonance imaging (MRI) artifacts at 6 and 12 months after breast-conserving surgery using the ultra-low dose of SPIO.

Method: Skin discoloration and MRI artifact were pre-planned endpoints in the prospective MAGSNOW feasibility study. MRI follow-ups were scheduled 6 and 12 months after surgery, and MRI artifacts were classified into six grades. SPIO-induced skin discoloration was assessed at baseline, 1, 6, and 12 months by photography.

Results: Thirty-six patients had 6- and 12-month MRI follow-up performed, revealing no MRI artifacts impairing breast assessment. At 12 months, 75.0% (27/36) of the patients had minimal MRI artifacts, primarily in the subcutaneous tissue, or <5 mm in the fibro-glandular tissue. At 12 months, 54% (27/50) of the patients had a skin discoloration with a median area of 0.79 cm² (interquartile range (IQR) 0.14-1.41).

Conclusion: An ultra-low dose of SPIO may offer a solution to the concerns of MRI artifacts and skin discoloration associated with the present recommended dose of 1-2 mL of SPIO.

Background and aims: The purpose of this study was to compare the incidence of and treatment methods for Achilles tendon ruptures (ATRs) in public and private healthcare in Finland between 1997 and 2019.

Methods: The Finnish National Hospital Discharge Register and the Finnish Register of Primary Health Care Visits were searched to identify all adults diagnosed with ATR in 1997-2019.

Results: In the study period, 91% of patients with ATR were treated in the public sector. In public healthcare, the majority of patients were treated nonoperatively (10,997; 40% operative vs 16,303; 60% nonoperative), whereas in the private sector, the majority of the patients were treated operatively (2088; 80% operative vs 514; 20% nonoperative) (P < 0.001).

Conclusion: The distribution of public and private treatment for ATRs remained consistent during the follow-up period from 1997 to 2019. In the public sector, treatment methods became significantly more nonoperative during the study period, while no such change was observed in the private sector.