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Rutegård, Jörgen
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Publications (10 of 70) Show all publications
Sörelius, K., Svensson, J., Matthiessen, P., Rutegård, J. & Rutegård, M. (2019). A nationwide study on the incidence of mesenteric ischaemia after surgery for rectal cancer demonstrates an association with high arterial ligation. Colorectal Disease, 21(8), 925-931
Open this publication in new window or tab >>A nationwide study on the incidence of mesenteric ischaemia after surgery for rectal cancer demonstrates an association with high arterial ligation
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2019 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 21, no 8, p. 925-931Article in journal (Refereed) Published
Abstract [en]

Aim: The incidence of mesenteric ischaemia after resection for rectal cancer has not been investigated in a population-based setting. The use of high ligation of the inferior mesenteric artery might cause such ischaemia, as the bowel left in situ depends on collateral blood supply after a high tie.

Method: The Swedish Colorectal Cancer Registry was used to identify all patients subjected to an abdominal resection for rectal cancer during the years 2007-2017 inclusive. Mesenteric ischaemia within the first 30 postoperative days was recorded, classified as either stoma necrosis or colonic necrosis. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for mesenteric ischaemia in relation to high tie, with adjustment for confounding.

Results: Some 14 657 patients were included, of whom 59 (0.40%) had a reoperation for any type of mesenteric ischaemia, divided into 34 and 25 cases of stoma necrosis and colonic necrosis, respectively. Compared with patients who did not require reoperation for mesenteric ischaemia following rectal cancer surgery, the proportion having high tie was greater (54.2% vs 38.5%; P = 0.032). The adjusted OR for reoperation due to any mesenteric ischaemia with high tie was 2.26 (95% CI 1.34-3.79), while the corresponding estimates for stoma and colonic necrosis, respectively, were 1.60 (95% CI 0.81-3.17) and 3.69 (95% CI 1.57-8.66).

Conclusion: The incidence of reoperation for mesenteric ischaemia after abdominal resection for rectal cancer is low, but the use of a high tie might increase the risk of colonic necrosis demanding surgery.

Keywords
Inferior mesenteric artery, high tie, low tie, stoma necrosis, bowel ischaemia, central ligation, proximal ligation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-162667 (URN)10.1111/codi.14674 (DOI)000478607100012 ()31062468 (PubMedID)
Available from: 2019-09-04 Created: 2019-09-04 Last updated: 2019-09-04Bibliographically approved
Rutegård, M., Rutegård, J. & Haapamäki, M. M. (2019). Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study. BMJ Open, 9(5), Article ID e027255.
Open this publication in new window or tab >>Multicentre, randomised trial comparing acellular porcine collagen implant versus gluteus maximus myocutaneous flap for reconstruction of the pelvic floor after extended abdominoperineal excision of rectum: study protocol for the Nordic Extended Abdominoperineal Excision (NEAPE) study
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027255Article in journal (Refereed) Published
Abstract [en]

Introduction: Different surgical techniques are used to cover the defect in the floor of the lesser pelvis after an ‘extralevator’ or ‘extended’ abdominoperineal excision for advanced rectal cancer. However, these operations are potentially mutilating, and the reconstruction method of the pelvic floor has been studied only sparsely. We aim to study whether a porcine-collagen implant is superior or equally beneficial to a gluteus maximus myocutaneous flap as a reconstruction method.

Methods and analysis: This is a multicentre non-blinded randomised controlled trial with the experimental arm using a porcine-collagen implant and the control arm using a gluteus maximus muscle and skin rotation flap. Considered for inclusion are patients with rectal cancer, who are operated on with a wide abdominoperineal rectal excision including most of the levator muscles and where the muscle remnants cannot be closed in the midline with sutures. Patients with a primary or recurrent rectal cancer with an estimated survival of more than a year are eligible. The randomisation is computer generated with a concealed sequence and stratified by participating hospital and preoperative radiotherapy regimen. The main outcome is physical performance 6 months after surgery measured with the timed-stands test. Secondary outcomes are perineal wound healing, surgical complications, quality of life, ability to sit and other outcomes measured at 3, 6 and 12 months after surgery. To be able to state experimental arm non-inferiority with a 10% margin of the primary outcome with 90% statistical power and assuming 10% attrition, we aim to enrol 85 patients from May 2011 onwards.

Ethics and dissemination: The study has been approved by the Regional Ethical Review board at Umeå University (protocol no: NEAPE-2010-335-31M). The results will be disseminated through patient associations and conventional scientific channels.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-161540 (URN)10.1136/bmjopen-2018-027255 (DOI)000471192800261 ()31147361 (PubMedID)
Funder
Västerbotten County Council, VLL-187711Västerbotten County Council, VLL-226241
Available from: 2019-07-11 Created: 2019-07-11 Last updated: 2019-07-11Bibliographically approved
Rutegård, M., Båtsman, M., Axelsson, J., Brynolfsson, P., Brännström, F., Rutegård, J., . . . Riklund, K. (2019). PET/MRI and PET/CT hybrid imaging of rectal cancer - description and initial observations from the RECTOPET (REctal Cancer trial on PET/MRI/CT) study. Cancer Imaging, 19, Article ID 52.
Open this publication in new window or tab >>PET/MRI and PET/CT hybrid imaging of rectal cancer - description and initial observations from the RECTOPET (REctal Cancer trial on PET/MRI/CT) study
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2019 (English)In: Cancer Imaging, ISSN 1740-5025, E-ISSN 1470-7330, Vol. 19, article id 52Article in journal (Refereed) Published
Abstract [en]

PurposeThe role of hybrid imaging using F-18-fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET), computed tomography (CT) and magnetic resonance imaging (MRI) to improve preoperative evaluation of rectal cancer is largely unknown. To investigate this, the RECTOPET (REctal Cancer Trial on PET/MRI/CT) study has been launched with the aim to assess staging and restaging of primary rectal cancer. This report presents the study workflow and the initial experiences of the impact of PET/CT on staging and management of the first patients included in the RECTOPET study.MethodsThis prospective cohort study, initiated in September 2016, is actively recruiting patients from Region Vasterbotten in Sweden. This pilot study includes patients recruited and followed up until December 2017. All patients had a biopsy-verified rectal adenocarcinoma and underwent a minimum of one preoperative FDG-PET/CT and FDG-PET/MRI examination. These patients were referred to the colorectal cancer multidisciplinary team meeting at Umea University Hospital. All available data were evaluated when making management recommendations. The clinical course was noted and changes consequent to PET imaging were described; surgical specimens underwent dedicated MRI for anatomical matching between imaging and histopathology.ResultsTwenty-four patients have so far been included in the study. Four patients were deemed unresectable, while 19 patients underwent or were scheduled for surgery; one patient was enrolled in a watch-and-wait programme after restaging. Consequent to taking part in the study, two patients were upstaged to M1 disease: one patient was diagnosed with a solitary hepatic metastasis detected using PET/CT and underwent metastasectomy prior to rectal cancer surgery, while one patient with a small, but metabolically active, lung nodulus experienced no change of management. PET/MRI did not contribute to any recorded change in patient management.ConclusionsThe RECTOPET study investigating the role of PET/CT and PET/MRI for preoperative staging of primary rectal cancer patients will provide novel data that clarify the value of adding hybrid to conventional imaging, and the role of PET/CT versus PET/MRI.Trial registrationNCT03846882.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Rectal neoplasm, Rectal tumour, Staging, Lymph nodes, Tumour deposits, PET, CT, FDG-PET, CT, PET
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-161991 (URN)10.1186/s40644-019-0237-1 (DOI)000477054900002 ()31337428 (PubMedID)
Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13Bibliographically approved
Boström, P., Haapamäki, M. M., Rutegård, J., Matthiessen, P. & Rutegård, M. (2019). Population‐based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer. BJS Open, 3(1), 106-111
Open this publication in new window or tab >>Population‐based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer
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2019 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 3, no 1, p. 106-111Article in journal (Refereed) Published
Abstract [en]

Background: Anastomotic leakage following anterior resection for rectal cancer may result in death. The aim of this study was to yield an updated, population‐based estimate of postoperative mortality and evaluate possible interacting factors.

Methods: This was a retrospective national cohort study of patients who underwent anterior resection between 2007 and 2016. Data were retrieved from a prospectively developed database. Anastomotic leakage constituted exposure, whereas outcome was defined as death within 90 days of surgery. Logistic regression analyses, using directed acyclic graphs to evaluate possible confounders, were performed, including interaction analyses.

Results: Of 6948 patients, 693 (10·0 per cent) experienced anastomotic leakage and 294 (4·2 per cent) underwent reintervention due to leakage. The mortality rate was 1·5 per cent in patients without leakage and 3·9 per cent in those with leakage. In multivariable analysis, leakage was associated with increased mortality only when a reintervention was performed (odds ratio (OR) 5·57, 95 per cent c.i. 3·29 to 9·44). Leaks not necessitating reintervention did not result in increased mortality (OR 0·70, 0·25 to 1·96). There was evidence of interaction between leakage and age on a multiplicative scale (P = 0·007), leading to a substantial mortality increase in elderly patients with leakage.

Conclusion: Anastomotic leakage, in particular severe leakage, led to a significant increase in 90‐day mortality, with a more pronounced risk of death in the elderly.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-154649 (URN)10.1002/bjs5.50106 (DOI)000457222900012 ()30734021 (PubMedID)
Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2019-02-22Bibliographically 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
Holmgren, K., Haapamäki, M. M., Matthiessen, P., Rutegård, J. & Rutegård, M. (2018). Anterior resection for rectal cancer in Sweden: validation of a registry-based method to determine long-term stoma outcome. Acta Oncologica, 57(12), 1631-1638
Open this publication in new window or tab >>Anterior resection for rectal cancer in Sweden: validation of a registry-based method to determine long-term stoma outcome
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2018 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, no 12, p. 1631-1638Article in journal (Refereed) Published
Abstract [en]

Background: A permanent stoma after anterior resection for rectal cancer is common. Nationwide registries provide sufficient power to evaluate factors influencing this phenomenon, but validation is required to ensure the quality of registry-based stoma outcomes.

Methods: Patients who underwent anterior resection for rectal cancer in the Northern healthcare region of Sweden between 1 January 2007 and 31 December 2013 were reviewed by medical records and followed until 31 December 2014 with regard to stoma outcome. A registry-based method to determine nationwide long-term stoma outcomes, using data from the National Patient Registry and the Swedish Colorectal Cancer Registry, was developed and internally validated using the chart reviewed reference cohort. Accuracy was evaluated with positive and negative predictive values and Kappa values. Following validation, the stoma outcome in all patients treated with an anterior resection for rectal cancer in Sweden during the study period was estimated. Possible regional differences in determined stoma outcomes between the six Swedish healthcare regions were subsequently evaluated with the χ2 test.

Results: With 312 chart reviewed patients as reference, stoma outcome was accurately predicted through the registry-based method in 299 cases (95.8%), with a positive predictive value of 85.1% (95% CI 75.8%-91.8%), and a negative predictive value of 100.0% (95% CI 98.4%-100.0%), while the Kappa value was 0.89 (95% CI 0.82-0.95). In Sweden, 4768 patients underwent anterior resection during the study period, of which 942 (19.8%) were determined to have a permanent stoma. The stoma rate varied regionally between 17.8-29.2%, to a statistically significant degree (p = .001).

Conclusion: Using data from two national registries to determine long-term stoma outcome after anterior resection for rectal cancer proved to be reliable in comparison to chart review. Permanent stoma prevalence after such surgery remains at a significant level, while stoma outcomes vary substantially between different healthcare regions in Sweden.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-152765 (URN)10.1080/0284186X.2018.1521988 (DOI)30306825 (PubMedID)2-s2.0-85054883319 (Scopus ID)
Available from: 2018-10-22 Created: 2018-10-22 Last updated: 2019-11-12Bibliographically approved
Holmgren, K., Kverneng Hultberg, D., Haapamäki, M. M., Rutegård, J., Matthiessen, P. & Rutegård, M. (2018). Reply to: 'High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study' [Letter to the editor]. Colorectal Disease, 20(4), 342-343
Open this publication in new window or tab >>Reply to: 'High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study'
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2018 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 20, no 4, p. 342-343Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-146720 (URN)10.1111/codi.14035 (DOI)000428991400015 ()29377501 (PubMedID)
Available from: 2018-04-18 Created: 2018-04-18 Last updated: 2018-06-09Bibliographically approved
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2018). Response to: "Follow-up of the STOMAMESH Cohort" [Letter to the editor]. Annals of Surgery, 268(2), e31-e31
Open this publication in new window or tab >>Response to: "Follow-up of the STOMAMESH Cohort"
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2018 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, no 2, p. e31-e31Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148347 (URN)10.1097/SLA.0000000000002787 (DOI)000452663200006 ()29985812 (PubMedID)2-s2.0-85050122389 (Scopus ID)
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2019-01-22Bibliographically approved
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2018). Response to: "Prophylactic Mesh for the Prevention of Parastomal Hernias: Need for a Deep Dive" [Letter to the editor]. Annals of Surgery, 268(2), E30-E30
Open this publication in new window or tab >>Response to: "Prophylactic Mesh for the Prevention of Parastomal Hernias: Need for a Deep Dive"
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2018 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, no 2, p. E30-E30Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-154653 (URN)10.1097/SLA.0000000000002807 (DOI)000452663200004 ()29742528 (PubMedID)
Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2019-01-22Bibliographically approved
Eklöf, V., Löfgren-Burström, A., Zingmark, C., Edin, S., Larsson, P., Karling, P., . . . Palmqvist, R. (2017). Cancer-associated fecal microbial markers in colorectal cancer detection. International Journal of Cancer, 141(12), 2528-2536
Open this publication in new window or tab >>Cancer-associated fecal microbial markers in colorectal cancer detection
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2017 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 141, no 12, p. 2528-2536Article in journal (Refereed) Published
Abstract [en]

Colorectal cancer (CRC) is the second most common cause of cancer death in the western world. An effective screening program leading to early detection of disease would severely reduce the mortality of CRC. Alterations in the gut microbiota have been linked to CRC, but the potential of microbial markers for use in CRC screening has been largely unstudied. We used a nested case-control study of 238 study subjects to explore the use of microbial markers for clbA+ bacteria harboring the pks pathogenicity island, afa-C+ diffusely adherent Escherichia coli harboring the afa-1 operon, and Fusobacterium nucleatum in stool as potential screening markers for CRC. We found that individual markers for clbA+ bacteria and F. nucleatum were more abundant in stool of patients with CRC, and could predict cancer with a relatively high specificity (81.5% and 76.9%, respectively) and with a sensitivity of 56.4% and 69.2%, respectively. In a combined test of clbA+ bacteria and F. nucleatum, CRC was detected with a specificity of 63.1% and a sensitivity of 84.6%. Our findings support a potential value of microbial factors in stool as putative noninvasive biomarkers for CRC detection. We propose that microbial markers may represent an important future screening strategy for CRC, selecting patients with a "high-risk" microbial pattern to other further diagnostic procedures such as colonoscopy.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
F. nucleatum, clbA, colorectal cancer, gut microbiota, screening, stool
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-142380 (URN)10.1002/ijc.31011 (DOI)000413549900019 ()28833079 (PubMedID)
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2019-01-02Bibliographically approved
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