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Kverneng Hultberg, Daniel
Publications (5 of 5) Show all publications
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
Holmgren, K., Kverneng Hultberg, D., Haapamäki, M. M., Matthiessen, P., Rutegård, J. & Rutegård, M. (2017). High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study. Colorectal Disease, 19(12), 1067-1075
Open this publication in new window or tab >>High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study
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2017 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 12, p. 1067-1075Article in journal (Refereed) Published
Abstract [en]

AIM: Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.

METHOD: Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.

RESULTS: A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.

CONCLUSION: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.

Keywords
Defunctioning stoma, diverting stoma, faecal diversion, permanent stoma
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-142563 (URN)10.1111/codi.13771 (DOI)000416856200006 ()28612478 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2019-11-12Bibliographically approved
Kverneng Hultberg, D., Afshar, A. A., Rutegård, J., Lange, M., Haapamäki, M. M., Matthiessen, P. & Rutegård, M. (2017). Level of vascular tie and its effect on functional outcome 2 years after anterior resection for rectal cancer. Colorectal Disease, 19(11), 987-995
Open this publication in new window or tab >>Level of vascular tie and its effect on functional outcome 2 years after anterior resection for rectal cancer
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2017 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, no 11, p. 987-995Article in journal (Refereed) Published
Abstract [en]

Aim Previous research indicates that high tie of the inferior mesenteric artery during anterior resection for rectal cancer might be associated with an increased risk of postoperative functional disturbances. The goal of this population-based retrospective cohort study was to further investigate that association.

Method Patients who underwent anterior resection for rectal cancer from April 2011 to September 2012 were identified through the Swedish Colorectal Cancer Registry. Bowel and urogenital function were assessed by a postal questionnaire 2 years after surgery. Information on the level of mesenteric tie and clinical variables was retrieved from the registry. The outcome was defined as any defaecatory, urinary or sexual dysfunction as reported by the patient. The association between high tie and the outcome was evaluated with multivariable logistic and linear regression with adjustment for confounders, such as sex, body mass index, comorbidity and preoperative radiation.

Results With a response rate of 86%, 805 patients were included in the study. Of these, 46% were operated with high tie. After adjustment for confounders, high tie did not affect the risk of faecal incontinence (OR 0.85; 95% CI 0.59-1.22), urinary incontinence (OR 0.94; 95% CI 0.63-1.41) or various aspects of sexual dysfunction (erectile dysfunction, anejaculation, dyspareunia and coital vaginal dryness). However, an association between high tie and defaecation at night was detected (OR 1.44; 95% CI 1.02-2.03).

Conclusion This study does not support that the level of vascular tie influences the risk of major defaecatory, urinary or sexual disturbances 2 years after anterior resection for rectal cancer.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Autonomic function, ligation level, faecal incontinence, urinary incontinence, sexual function
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-141980 (URN)10.1111/codi.13745 (DOI)000414180900010 ()28544473 (PubMedID)
Available from: 2017-12-06 Created: 2017-12-06 Last updated: 2018-06-09Bibliographically approved
Kverneng Hultberg, D., Angenete, E., Lydrup, M.-L. -., Rutegård, J., Matthiessen, P. & Rutegård, M. (2017). Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer. European Journal of Surgical Oncology, 43(10), 1908-1914
Open this publication in new window or tab >>Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer
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2017 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 43, no 10, p. 1908-1914Article in journal (Refereed) Published
Abstract [en]

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used in colorectal surgery due to their opioid-sparing effect. However, several studies have indicated an increased risk of anastomotic leakage following NSAID treatment, although conflicting results exist. The primary goal of this study was to further examine whether postoperative NSAIDs are independently associated with anastomotic leakage after anterior resection for rectal cancer. Methods: Patients who underwent anterior resection for rectal cancer during 2007-2013 in 15 different hospitals in three healthcare regions in Sweden were included in the study. Registry data and information from patient records were retrieved. The association between NSAID treatment (for at least two days in the first postoperative week) and symptomatic anastomotic leakage (within 90 days) was evaluated with multiple logistic regression, with adjustment for pertinent confounding factors. Results: Some 1495 patients were included in the study. Of these, 27% received postoperative NSAIDs for at least two days in the first postoperative week. Symptomatic anastomotic leakage occurred in 11% and 14% in the NSAID and non-NSAID group, respectively. With adjustment for confounders, the odds ratio for leakage among patients who received NSAIDs compared with those who did not was 0.88 (95% CI 0.65-1.20). No differences were seen between non-selective and COX-2-selective NSAIDs. Conclusion: Postoperative NSAID treatment does not seem to increase the risk of symptomatic anastomotic leakage after anterior resection for rectal cancer. NSAID use appears to be safe, but a well-powered randomized clinical trial is warranted.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
NSAID, COX-2 selective, Non-selective, Anastomotic dehiscence, Postoperative complications
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:umu:diva-141825 (URN)10.1016/j.ejso.2017.06.010 (DOI)000413615600014 ()28687432 (PubMedID)
Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2018-06-09Bibliographically approved
Rutegård, M., Kverneng Hultberg, D., Angenete, E. & Lydrup, M.-L. (2017). Substantial underreporting of anastomotic leakage after anterior resection for rectal cancer in the Swedish Colorectal Cancer Registry. Acta Oncologica, 56(12), 1741-1745
Open this publication in new window or tab >>Substantial underreporting of anastomotic leakage after anterior resection for rectal cancer in the Swedish Colorectal Cancer Registry
2017 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 12, p. 1741-1745Article in journal (Refereed) Published
Abstract [en]

Background: The causes and effects of anastomotic leakage after anterior resection are difficult to study in small samples and have thus been evaluated using large population-based national registries. To assess the accuracy of such research, registries should be validated continuously.Material and methods: Patients who underwent anterior resection for rectal cancer during 2007-2013 in 15 different hospitals in three healthcare regions in Sweden were included in the study. Registry data and information from patient records were retrieved. Registered anastomotic leakage within 30 postoperative days was evaluated, using all available registry data and using only the main variable anastomotic insufficiency. With the consensus definition of anastomotic leakage developed by the International Study Group on Rectal Cancer as reference, validity measures were calculated.Results: Some 1507 patients were included in the study. The negative and positive predictive values for registered anastomotic leakage were 96 and 88%, respectively, while the -value amounted to 0.76. The false-negative rate was 29%, whereas the false-positive rate reached 1.3% (the vast majority consisting of actual leaks, but occurring after postoperative day 30). Using the main variable anastomotic insufficiency only, the false-negative rate rose to 41%.Conclusions: There is considerable underreporting of anastomotic leakage after anterior resection for rectal cancer in the Swedish Colorectal Cancer Registry. It is probable that this causes an underestimation of the true effects of leakage on patient outcomes, and further quality control is needed.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-143563 (URN)10.1080/0284186X.2017.1332423 (DOI)000418118800011 ()28557608 (PubMedID)
Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2018-06-09Bibliographically approved
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