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  • 1.
    Gkekas, Ioannis
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby hospital Luleå, Luleå, Sweden.
    Novotny, Jan
    Department of Surgery, Sunderby hospital Luleå, Luleå, Sweden..
    Pecen, Ladislav
    Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Microsatellite instability as a prognostic factor in stage II colon cancer patients: a meta-analysis of published literature2017In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 12, p. 6563-6574Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND/AIM: The prognostic role of microsatellite instability (MSI) in stage II colon cancer patients remains controversial despite the fact that it has been investigated in a number of studies. Hazard ratios differ considerably among these studies. We performed a meta-analysis to define the significance of MSI in this group of patients.

    MATERIALS AND METHODS: Studies indexed in PubMed presenting separate data on MSI status and survival outcomes for stage II colon cancer patients have been analyzed using fixed-effect meta-analysis of hazard ratio (HR) according to the method of Peto.

    RESULTS: Analysis was performed on 19 studies including 5,998 patients. A 47.3% of patients received postoperative chemotherapy and included 52.8% males and 47.2% females. Eight studies included some rectal cancer patients although this cohort was not clearly defined in 3 of these. MSI observed in 20.8% (mean) of patients (median 19.9%). HR for overall survival (OS) of MSI vs. microsatellite stable (MSS) tumors for the entire population: 0.73 (95% confidence interval (CI)=0.33-1.65); HR for disease-free survival (DFS):0.60 (95%CI=0.27-1.32). No statistical significant difference was found when studies analyzing MSI with genotyping (MG) and immunohistochemistry (IHC) were compared separately (MG vs. IHC: HR OS 0.45, 95%CI=0.10-2.05 vs. 0.95, 95%CI=0.57-1.58; HR DFS 0.51, 95%CI=0.14-1.85 vs. 0.67, 95%CI=0.26-1.70). However, numerically MSI determination with genotyping shows significantly lower hazard ratios for both DFS and OS. Separate analysis of studies describing colon cancer patients only showed HR OS 0.72 (95%CI=0.31-1.71); HR DFS 0.60 (95%CI=0.27-1.31).

    CONCLUSION: No significant relation was found between MSI status and OS or DFS. Routine determination of MSI status to guide postoperative management of stage II colon cancer patients cannot be recommended. New large scale high quality studies are needed to answer this question definitively, since currently analyzed studies vary considerably.

  • 2.
    Gkekas, Ioannis
    et al.
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Palmgren, Jonathan
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Näsvall, Pia
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Dahlberg, Michael
    Department of Surgery, Sunderby Medical Center, Luleå, Sweden.
    Intra-abdominal organ strangulation during intraoperative endoscopic retrograde cholangiopancreatography with rendezvous cannulation: case report2015In: Endoscopy, ISSN 0013-726X, E-ISSN 1438-8812, Vol. 47, p. E231-E231Article in journal (Refereed)
  • 3.
    Hurtig, Jennie
    et al.
    Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden..
    Gkekas, Ioannis
    Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden..
    Näsvall, Pia
    Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden..
    Vandrande mjälte – ovanlig men viktig differentialdiagnos vid akut buksmärta hos barn2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 47, article id FA9ZArticle in journal (Other academic)
    Abstract [en]

    Wandering spleen is a rare reason for acute abdominal pain in pediatric patients caused by laxity of the splenic ligaments. It can be complicated by torsion of the pedicle, leading to ischemia, a situation that in most cases results in acute abdominal surgery. To prevent ischemia of a mobile spleen caused by a total occlusion of the pedicle, splenopexy can be considered. We present an unusual case where changes in the position of the operating table during diagnostic laparoscopy might have caused a total occlusion of the pedicle.

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