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Strigård, Karin
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Publications (10 of 71) Show all publications
Gkekas, I., Novotny, J., Fabian, P., Nemecek, R., Palmqvist, R., Strigård, K., . . . Gunnarsson, U. (2019). Deficient mismatch repair as a prognostic marker in stage II colon cancer patients. European Journal of Surgical Oncology, 45(10), 1854-1861
Open this publication in new window or tab >>Deficient mismatch repair as a prognostic marker in stage II colon cancer patients
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2019 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 45, no 10, p. 1854-1861Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A number of reports have evaluated the relationship between deficient DNA mismatch repair (dMMR) and colorectal cancer prognosis. Unfortunately, the exact prognostic role of dMMR has not been clearly established due to contradictory results. This study aims to determine the prognostic impact of dMRR in stage II colon cancer patients only. The appropriate identification of high-risk stage II colon cancers is of paramount importance in the selection of patients who may benefit from adjuvant treatment after surgery.

METHODS: Four hundred and fifty-two patients with curative resection of stage II colon cancer were included. Hospital records were used as data source, providing clinical, surgical, pathology, oncology and follow-up information for statistical analysis focusing on overall survival (OS) and time to progression (TTP). Mismatch repair status was determined by immunohistochemistry. Patient survival was followed-up for a mean of 77·35 months.

RESULTS: dMMR was detected in 93 of 452 patients (20·6%). No impact on overall survival (Log-Rank, p = 0·583, 95% CI 0·76-1·67). However, the hazard ratio 0·50 for TTP was highly significant (Log-Rank, p = 0·012, 95% CI 0·28-0·87) in patients with dMMR compared with those with mismatch repair proficient tumours (pMMR).

CONCLUSIONS: Patients with dMMR tumours have a lower risk for recurrence compared to those with pMMR tumours, but this finding did not correlate to better overall survival.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Colon cancer, Prognostic factors, Stage II, dMMR
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-161631 (URN)10.1016/j.ejso.2019.05.023 (DOI)00491301600016 ()31186203 (PubMedID)
Funder
Cancerforskningsfonden i NorrlandVisare Norr
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2019-11-19Bibliographically approved
Näverlo, S., Strigård, K. & Gunnarsson, U. (2019). Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. International Journal of Colorectal Disease, 34(6), 993-1000
Open this publication in new window or tab >>Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma
2019 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 34, no 6, p. 993-1000Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma.

METHODS: Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden.

RESULTS: In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of non-reversal than those living farther away (OR 0.3; 95% CI 0.12-0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82-1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery.

CONCLUSIONS: Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Defunctioning stoma, Distance, Permanent stoma, Rectal cancer, Rural, Stoma reversal
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-156475 (URN)10.1007/s00384-019-03258-6 (DOI)30747282 (PubMedID)
Funder
Västerbotten County Council, VLL-675981
Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-06-11Bibliographically approved
Holmdahl, V., Stark, B., Clay, L., Gunnarsson, U. & Strigård, K. (2019). One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial. Hernia, 23(2), 355-361
Open this publication in new window or tab >>One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial
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2019 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 23, no 2, p. 355-361Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.

METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.

RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.

CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Abdominal muscle strength, Full-thickness skin, Incisional hernia, Recurrence rate, Ventral hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-156474 (URN)10.1007/s10029-019-01900-4 (DOI)000464888100022 ()30737622 (PubMedID)2-s2.0-85061249726 (Scopus ID)
Available from: 2019-02-18 Created: 2019-02-18 Last updated: 2019-06-13Bibliographically approved
Lindmark, M., Strigård, K., Nordin, P. & Gunnarsson, U. (2019). Patient Reported Injuries After Ventral Hernia Repair. Scandinavian Journal of Surgery, 108(1), 30-35
Open this publication in new window or tab >>Patient Reported Injuries After Ventral Hernia Repair
2019 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 108, no 1, p. 30-35Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: The Swedish National Patient Insurance Company (LÖF) can compensate patients who believe they have been exposed to an avoidable injury or malpractice in healthcare. Its register covers 95% of Swedish healthcare providers.

MATERIAL AND METHODS: Data on patients operated for primary or incisional ventral hernia in Sweden between 2010 and 2015 and who had filed a claim, were retrieved from LÖF. A total of 290 cases were identified and included. Files include a copy of records, relevant imaging, and an expert advisor's opinion.

RESULTS: Inadvertent enterotomy occurred during 25 repairs and in these cases, laparoscopic repair was clearly overrepresented ( p  < 0.001). Complications related to the surgical site (infection and ugly scar) were predominantly related to open repairs ( p  < 0.001). Twenty percentage (57/290) of the claims were directly related to an anesthetic mishap. Univariate ordinal regression showed that the odds of receiving a high reimbursement was significantly increased if laparoscopic repair was performed p  < 0.001 (odds ratio: 0.37; 95% confidence interval: 0.21-0.65). Sixty-three percentage of claims were filed by women.

CONCLUSION: Inadvertent enterotomy is overrepresented, and the probability that a claim filed for an avoidable injury leads to high reimbursement is greater if laparoscopic repair is performed rather than open ventral hernia repair. The high amount of injuries related to general anesthesia during umbilical hernia repair may be reduced with an increased proportion executed in local anesthesia.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Ventral hernia, enterotomy, hernia repair, iatrogenic patient injury, insurance, laparoscopic repair, local anesthesia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-150228 (URN)10.1177/1457496918783727 (DOI)000461561500005 ()29966500 (PubMedID)
Funder
Västerbotten County Council, VLL-675981
Available from: 2018-07-20 Created: 2018-07-20 Last updated: 2019-04-23Bibliographically approved
Näverlo, S., Gunnarsson, U., Strigård, K. & Näsvall, P. (2019). Quality of life after end colostomy without mesh and with prophylactic synthetic mesh in sublay position: one-year results of the STOMAMESH trial. International Journal of Colorectal Disease, 34(9), 1591-1599
Open this publication in new window or tab >>Quality of life after end colostomy without mesh and with prophylactic synthetic mesh in sublay position: one-year results of the STOMAMESH trial
2019 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 34, no 9, p. 1591-1599Article in journal (Refereed) Published
Abstract [en]

Purpose: To determine whether prophylactic mesh in a sublay position has an impact on the quality-of-life (QoL) of patients receiving an end colostomy.

Methods: One-year follow-up of patients from the STOMAMESH trial, a randomized controlled double-blinded multicenter study. Patients were randomized to either prophylactic synthetic mesh with a cruciform incision in the center, placed in sublay position, or no prophylactic mesh. Patients attended a 1-year visit and responded to the questionnaires EORTC QLQ C-30 and CR-38. The impact of having a mesh on QoL was determined by comparing a group of patients receiving a mesh with a group without. A subgroup analysis was made depending on whether a PSH was clinically present or not.

Results: Of the 232 randomized patients, 211 patients reached the 1-year clinical follow-up. The response rate of these 211 patients was 70%. No differences were seen in global QoL between the groups. Mesh patients reported significantly less stoma-related problems (p = 0.014) but more sexual problems in males (p = 0.022). When excluding patients with a clinical diagnosis of PSH, the difference in stoma-related problems remained while no significant difference was seen regarding sexual problems in males.

Conclusions: When forming an end colostomy, prophylactic synthetic mesh in a sublay position did not affect global QoL at 1-year follow-up, but stoma-related problems were fewer even in the presence of a clinically diagnosed PSH.

Place, publisher, year, edition, pages
SPRINGER, 2019
Keywords
Quality-of-life, Mesh, Parastomal hernia, Prophylaxis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-164507 (URN)10.1007/s00384-019-03359-2 (DOI)000483626600009 ()31392405 (PubMedID)
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-11-22Bibliographically approved
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2019). Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH. Annals of Surgery, 269(3), 427-431
Open this publication in new window or tab >>Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH
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2019 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 3, p. 427-431Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
Keywords
mesh, parastomal hernia, prophylaxis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-142585 (URN)10.1097/SLA.0000000000002542 (DOI)000467458600023 ()29064900 (PubMedID)
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2019-06-13Bibliographically approved
Carlstedt, A., Petersson, U., Stark, B., Strigård, K., Bringman, S., Egberth, M., . . . Theodorsson, E. (2018). Abdominell rektusdiastas kan ge funktionella besvär: Indikation för behandling måste förtydligas. Läkartidningen, 115, Article ID FCL4.
Open this publication in new window or tab >>Abdominell rektusdiastas kan ge funktionella besvär: Indikation för behandling måste förtydligas
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2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id FCL4Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-154180 (URN)30457664 (PubMedID)2-s2.0-85056718354 (Scopus ID)
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-17Bibliographically approved
Blind, N., Strigård, K., Gunnarsson, U. & Brännström, F. (2018). Distance to hospital is not a risk factor for emergency colon cancer surgery.. International Journal of Colorectal Disease, 33(9), 1195-1200
Open this publication in new window or tab >>Distance to hospital is not a risk factor for emergency colon cancer surgery.
2018 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 33, no 9, p. 1195-1200Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this study is to see if the distance to a hospital performing colon cancer surgery is a risk factor for emergency surgical intervention and to determine the variability between defined but demographically divergent catchment areas.

METHODS: Data on patients living in Västerbotten County who underwent colon cancer surgery between 2007 and 2010 were extracted from the Swedish Colorectal Cancer Register (SCRCR). Of the 436 registrations matching these criteria, 380 patients were used in the analysis, and their distance to the nearest hospital providing care for colorectal cancer (CRC) was estimated using Google Maps™. The correlations between the risk for emergency surgery and the distance to a hospital, gender, age, income level and hospital catchment area were analysed in uni- and multivariate models.

RESULTS: Distance to the nearest hospital had no significant effect on the proportion of emergency operations for colon cancer. There was significant variability in risk for emergency surgery between hospital catchment areas, where the catchment areas of the university hospital and the most rural hospital had a higher proportion than the other local hospital catchment area (OR, 2.00 (p = 0.038) and OR, 2.97 (p = 0.005)). These results were still significant when analysed with multivariate logistic regression (OR, 2.13 (p = 0.026) and OR, 3.05 (p = 0.013)).

CONCLUSION: Distance to a hospital performing colon cancer surgery had no effect on the proportion of emergency surgeries. However, a variability between defined catchment areas was seen. Future studies will focus on possible factors behind this variability.

Keywords
Colon cancer, Distance, Emergency surgery, Rural
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148535 (URN)10.1007/s00384-018-3074-y (DOI)000441102200006 ()29797050 (PubMedID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-09-11Bibliographically approved
Winsnes, A., Gunnarsson, U., Falk, P., Stark, B., Moskaug, J. Ø. & Strigård, K. (2018). Evaluating full-thickness skin grafts in intraperitoneal onlay mesh position versus onlay position in mice. Journal of Surgical Research, 230, 155-163
Open this publication in new window or tab >>Evaluating full-thickness skin grafts in intraperitoneal onlay mesh position versus onlay position in mice
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2018 (English)In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 230, p. 155-163Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Importance: Hernia surgery requires reinforcement material with few side effects when used in the intraperitoneal position. Autologous skin grafting may meet this requirement, but animal experiments are obligatory before being applied in humans.

OBJECTIVE: To compare survival and effects of isogeneic full-thickness skin grafts in the intraperitoneal onlay mesh (IPOM) position in mice, with a control group using the onlay position. Primary end point was graft survival and secondary end point adhesion formation and inflammation through NF-κB activity.

METHODS: Design: Intervention study with 8-week follow-up in accordance with ARRIVE criteria, performed between 2015 and 2016.

SETTING: Animal laboratory.

PARTICIPANTS: Transgenic C57BL/6 mice with isogeneic background were used. Recipients were female wild-type phenotype mice >3 mo (n = 24). Donors were male or female mice >7 mo, with phenotype-positive for the luciferase gene (n = 20) or positive for NF-κB-luciferase gene (n = 4).

INTERVENTION: Full-thickness skin was grafted in the IPOM position and compared with grafts in the onlay position as controls. Survival was evaluated by regular longitudinal postoperative luminescence imaging over 8 wk. Adherence formation was evaluated macroscopically after sacrifice. Inflammation of full-thickness skin grafts in IPOM position of NF-κB mice was evaluated in four additional mice. Main outcome and measure: Survival of grafts, evaluated by luminescence.

RESULTS: Ten animals received grafts in the IPOM position, and 10 in the onlay position as controls. Graft survival after 8 wk was 100% (20/20). Average luminescence at the end of the 8-week period was 999,597 flux (min 162,800, max 2,521,530) in the IPOM group (n = 10) and 769,708 flux (min 76,590, max 2,164,080) in the onlay control group (n = 10). No adhesions requiring sharp dissection (Jenkins' scale >2) were seen. Four animals with grafts in the IPOM position showed peak inflammation (NF-κB activity) 5 d after surgery subsiding toward the end of follow-up.

CONCLUSIONS: Full-thickness skin survives as well in the IPOM position as in the onlay control position, and few adherences develop. Further studies are required to fully characterize the tissue remodeling and repair processes associated with IPOM skin grafting. The result is relevant in the search for alternative reinforcement materials to be used in complex hernia surgery in humans.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Abdominal wall reinforcement, Acellular scaffold, Autologous full-thickness skin graft, Hernia repair, IPOM/onlay, Intraperitoneal, Isogeneic
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-151807 (URN)10.1016/j.jss.2018.04.041 (DOI)000441170900023 ()30100033 (PubMedID)2-s2.0-85047625025 (Scopus ID)
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-10-05Bibliographically approved
Clay, L., Stark, B., Gunnarsson, U. & Strigård, K. (2018). Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study. Hernia (2), 325-332
Open this publication in new window or tab >>Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized controlled multicenter study
2018 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, no 2, p. 325-332Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.

METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.

RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.

CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Abdominal wall reconstruction, Full-thickness skin, Hernia complication, Incisional hernia, Infection, Ventral hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-143226 (URN)10.1007/s10029-017-1712-x (DOI)000428248700014 ()29247365 (PubMedID)
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-08-07Bibliographically approved
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