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Publications (10 of 78) Show all publications
Rutegård, M., Svensson, J., Segelman, J., Matthiessen, P., Lydrup, M.-L. & Park, J. M. (2024). Anastomotic leakage in relation to type of mesorectal excision and defunctioning stoma use in anterior resection for rectal cancer. Diseases of the Colon & Rectum, 67(3), 398-405
Open this publication in new window or tab >>Anastomotic leakage in relation to type of mesorectal excision and defunctioning stoma use in anterior resection for rectal cancer
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2024 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 67, no 3, p. 398-405Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anastomotic leakage after anterior resection for rectal cancer is more common after total mesorectal excision compared to partial mesorectal excision but might be mitigated by a defunctioning stoma.

OBJECTIVE: The aim is to assess how anastomotic leakage is affected by type of mesorectal excision and defunctioning stoma use.

DESIGN: This is a retrospective multicenter cohort study evaluating anastomotic leakage after anterior resection. Multivariable Cox regression with HRs and 95% CIs was used to contrast mesorectal excision types and defunctioning stoma use with respect to anastomotic leakage, with adjustment for confounding.

SETTINGS: This multicenter study included patients from 11 Swedish hospitals between 2014 and 2018.

PATIENTS: Patients who underwent anterior resection for rectal cancer were included.

MAIN OUTCOMES MEASURES: Anastomotic leakage rates within and after 30 days of surgery are described up to 1 year after surgery.

RESULTS: Anastomotic leakage occurred in 24.2% and 9.0% of 1126 patients operated with total and partial mesorectal excision, respectively. Partial compared to total mesorectal excision was associated with a reduction in leakage, with an adjusted HR of 0.46 (95% CI, 0.29-0.74). Early leak rates within 30 days were 14.9% with and 12.5% without a stoma, whereas late leak rates after 30 days were 7.5% with and 1.9% without a stoma. After adjustment, defunctioning stoma was associated with a lower early leak rate (HR 0.47; 95% CI, 0.28-0.77). However, the late leak rate was nonsignificantly higher in patients with defunctioning stomas (HR 1.69; 95% CI, 0.59-4.85).

LIMITATIONS: This study was limited by its retrospective observational study design.

CONCLUSIONS: Anastomotic leakage is common up to 1 year after anterior resection for rectal cancer, where partial mesorectal excision is associated with a lower leak rate. Defunctioning stomas seem to decrease the occurrence of leakage, although partially by only delaying the diagnosis. See Video Abstract.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
Keywords
Anterior resection, Leak, Mesorectal excision, Rectal, Stoma
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-222965 (URN)10.1097/DCR.0000000000003050 (DOI)001169589200009 ()37994449 (PubMedID)2-s2.0-85184657029 (Scopus ID)
Funder
Knut and Alice Wallenberg Foundation, RV-762241Swedish Society of Medicine, SLS-934594Cancerforskningsfonden i Norrland, AMP 19-978Bengt Ihres Foundation, SLS-934603Swedish Cancer Society, CAN 2018/589
Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2024-04-11Bibliographically approved
Grahn, O., Holmgren, K., Hong, M.-G., Sund, M. & Rutegård, M. (2024). Mutation of the cyclooxygenase 2 gene promoter and anastomotic leakage in colorectal cancer patients: retrospective cohort study. BJS Open, 8(1), Article ID zrae004.
Open this publication in new window or tab >>Mutation of the cyclooxygenase 2 gene promoter and anastomotic leakage in colorectal cancer patients: retrospective cohort study
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2024 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 8, no 1, article id zrae004Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-221114 (URN)10.1093/bjsopen/zrae004 (DOI)001153893100001 ()38289394 (PubMedID)2-s2.0-85184510640 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationSwedish Society of MedicineCancerforskningsfonden i Norrland
Available from: 2024-02-27 Created: 2024-02-27 Last updated: 2024-02-27Bibliographically approved
Gerdin, A., Park, J., Häggström, J., Segelman, J., Matthiessen, P., Lydrup, M.-L. & Rutegård, M. (2024). Preoperative beta blockers and other drugs in relation to anastomotic leakage after anterior resection for rectal cancer. Colorectal Disease
Open this publication in new window or tab >>Preoperative beta blockers and other drugs in relation to anastomotic leakage after anterior resection for rectal cancer
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2024 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: Previous research has indicated that preoperative beta blocker therapy is associated with a decreased risk of complications after surgery for rectal cancer. This is thought to arise because of the anti-inflammatory activity of the drug. These results need to be reproduced and analyses extended to other drugs with such properties, as this information might be useful in clinical decision-making. The main aim of this work was to replicate previous findings of beta blocker use as a prognostic marker for postoperative leakage. We also investigated whether drug exposure might induce anastomotic leaks.

Method: This is a retrospective multicentre cohort study, comprising 1126 patients who underwent anterior resection for rectal cancer between 2014 and 2018. The use of any preoperative beta blocker was treated as the primary exposure, while anastomotic leakage within 12 months of surgery was the outcome. Secondary exposures comprised angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins and metformin. Using multivariable regression, we performed a replication analysis with a predictive aim for beta blockers only, while adjustment for confounding was done in more causally oriented analyses for all drugs. We estimated incidence rate ratio (IRR) and relative risk (RR) with 95% confidence intervals (CIs).

Results: Anastomotic leakage occurred in 20.6% of patients. Preoperative beta blockers were used by 22.7% of the cohort, while the leak distribution was almost identical between exposure groups. In the main replication analysis, no association could be detected (IRR 0.95, 95% CI 0.68–1.33). In the causally oriented analyses, only metformin affected the risk of leakage (RR 1.59, 95% Cl 1.31–1.92).

Conclusion: While previous research has suggested that preoperative beta blocker use could be prognostic of anastomotic leakage, this study could not detect any such association. On the contrary, our results indicate that preoperative beta blocker use neither predicts nor causes anastomotic leakage after anterior resection for rectal cancer.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
adenocarcinoma, beta blockers, leak, metformin, rectum
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-222425 (URN)10.1111/codi.16933 (DOI)001181677400001 ()38462750 (PubMedID)2-s2.0-85187112434 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationSwedish Society of MedicineCancerforskningsfonden i NorrlandBengt Ihres FoundationSwedish Cancer Society
Available from: 2024-03-28 Created: 2024-03-28 Last updated: 2024-03-28
Lindmark, G., Olsson, L., Sitohy, B., Israelsson, A., Blomqvist, J., Kero, S., . . . Hammarström, M.-L. (2024). qRT-PCR analysis of CEACAM5, KLK6, SLC35D3, MUC2 and POSTN in colon cancer lymph nodes: An improved method for assessment of tumor stage and prognosis. International Journal of Cancer, 154(3), 573-584
Open this publication in new window or tab >>qRT-PCR analysis of CEACAM5, KLK6, SLC35D3, MUC2 and POSTN in colon cancer lymph nodes: An improved method for assessment of tumor stage and prognosis
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2024 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 154, no 3, p. 573-584Article in journal (Refereed) Published
Abstract [en]

One fourth of colorectal cancer patients having curative surgery will relapse of which the majority will die. Lymph node (LN) metastasis is the single most important prognostic factor and a key factor when deciding on postoperative treatment. Presently, LN metastases are identified by histopathological examination, a subjective method analyzing only a small LN volume and giving no information on tumor aggressiveness. To better identify patients at risk of relapse we constructed a qRT-PCR test, ColoNode, that determines levels of CEACAM5, KLK6, SLC35D3, MUC2 and POSTN mRNAs. Combined these biomarkers estimate the tumor cell load and aggressiveness allocating patients to risk categories with low (0, −1), medium (1), high (2) and very high (3) risk of recurrence. Here we present result of a prospective, national multicenter study including 196 colon cancer patients from 8 hospitals. On average, 21 LNs/patient, totally 4698 LNs, were examined by both histopathology and ColoNode. At 3-year follow-up, 36 patients had died from colon cancer or lived with recurrence. ColoNode identified all patients that were identified by histopathology and in addition 9 patients who were undetected by histopathology. Thus, 25% of the patients who recurred were identified by ColoNode only. Multivariate Cox regression analysis proved ColoNode (1, 2, 3 vs 0, −1) as a highly significant risk factor with HR 4.24 [95% confidence interval, 1.42-12.69, P =.01], while pTN-stage (III vs I/II) lost its univariate significance. In conclusion, ColoNode surpassed histopathology by identifying a significantly larger number of patients with future relapse and will be a valuable tool for decisions on postoperative treatment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
colon cancer, ColoNode, lymph nodes, prognosis, tumor markers
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-214620 (URN)10.1002/ijc.34718 (DOI)001067494700001 ()37700602 (PubMedID)2-s2.0-85170666995 (Scopus ID)
Funder
Region VästerbottenSwedish Cancer SocietySwedish Research Council, 2017-00675The Kempe FoundationsUmeå UniversityVinnova
Available from: 2023-09-27 Created: 2023-09-27 Last updated: 2024-01-12Bibliographically approved
Rutegård, M., Gerdin, A., Forssell, J., Sjöström, O., Söderström, A. & Boström, P. (2024). Robotic low anterior resection with complete splenic flexure mobilization and defunctioning left-sided loop colostomy: a case series. Journal of Surgical Case Reports, 2024(1), Article ID rjad709.
Open this publication in new window or tab >>Robotic low anterior resection with complete splenic flexure mobilization and defunctioning left-sided loop colostomy: a case series
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2024 (English)In: Journal of Surgical Case Reports, E-ISSN 2042-8812, Vol. 2024, no 1, article id rjad709Article in journal (Refereed) Published
Abstract [en]

A defunctioning stoma is used to alleviate the consequences of anastomotic leakage after low anterior resection for rectal cancer. A loop ileostomy is often preferred but may lead to dehydration and kidney injury. Here, we present a case series for an alternative: the left-sided loop colostomy. A convenience sample of four patients underwent robotic low anterior resection for rectal cancer. A complete splenic flexure mobilization and a total mesorectal excision were performed. To defunction the anastomosis, the redundant left colon was brought up to a stoma site in the left iliac fossa and matured as a loop colostomy. Two patients experienced minor stoma leaks and one also had a small prolapse, while all patients had their colostomies reversed on average 7 months after surgery without complications. There were no dehydration episodes and creatinine levels remained within baseline levels at end of follow-up (on average 18 months).

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
anastomotic leakage, defunctioning stoma, loop stoma, total mesorectal excision
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-220445 (URN)10.1093/jscr/rjad709 (DOI)001141131100005 ()2-s2.0-85183294769 (Scopus ID)
Funder
Region Västerbotten, HSN 530-2022
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-02-16Bibliographically approved
Axman, E., Holmberg, H., Rutegård, M. & De La Croix, H. (2023). Association between previous inguinal hernia surgery and the risk of anastomotic leakage after colorectal surgery: nationwide registry-based study. BJS Open, 7(4), Article ID zrad076.
Open this publication in new window or tab >>Association between previous inguinal hernia surgery and the risk of anastomotic leakage after colorectal surgery: nationwide registry-based study
2023 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 7, no 4, article id zrad076Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-215115 (URN)10.1093/bjsopen/zrad076 (DOI)001059215100001 ()37650245 (PubMedID)2-s2.0-85172005589 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationSwedish Society of Medicine, SLS-973834
Available from: 2023-10-20 Created: 2023-10-20 Last updated: 2024-02-01Bibliographically approved
Rutegård, M., Häggström, J., Back, E., Holmgren, K., Wixner, J., Rutegård, J., . . . Sjöström, O. (2023). Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure: nationwide population-based study. BJS Open, 7(3), Article ID zrad010.
Open this publication in new window or tab >>Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure: nationwide population-based study
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2023 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 7, no 3, article id zrad010Article in journal (Refereed) Published
Abstract [en]

Background: Electrolyte disturbances and dehydration are common after anterior resection for rectal cancer with a defunctioning loop ileostomy. High-quality population-based studies on the impact of a defunctioning loop ileostomy on renal failure are lacking.

Methods: This was a nationwide observational study, based on the Swedish Colorectal Cancer Registry of patients undergoing anterior resection for rectal cancer between 2008 and 2016, with follow-up until 2017. Patients with severe co-morbidity, with age greater than 80 years, and with pre-existing renal failure were excluded. Loop ileostomy at index surgery constituted exposure, while a diagnosis of renal failure was the outcome. Acute and chronic events were analysed separately. Inverse probability weighting with adjustment for confounding derived from a causal diagram was employed. Hazards ratios (HRs) with 95 per cent c.i. are reported.

Results: A total of 5355 patients were eligible for analysis. At 5-year follow-up, all renal failure events (acute and chronic) were 7.2 per cent and 3.3 per cent in the defunctioning stoma and no stoma groups respectively. In the weighted analysis, a HR of 11.59 (95 per cent c.i. 5.68 to 23.65) for renal failure in ostomates was detected at 1 year, with the largest effect from acute renal failure (HR 24.04 (95 per cent c.i. 8.38 to 68.93)). Later follow-up demonstrated a similar pattern, but with smaller effect sizes.

Conclusion: Patients having a loop ileostomy in combination with anterior resection for rectal cancer are more likely to have renal failure, especially early after surgery. Strategies are needed, such as careful fluid management protocols, and further research into alternative stoma types or reduction in stoma formation.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-211795 (URN)10.1093/bjsopen/zrad010 (DOI)37161674 (PubMedID)2-s2.0-85161657368 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationSwedish Society of MedicineCancerforskningsfonden i Norrland
Available from: 2023-07-12 Created: 2023-07-12 Last updated: 2024-02-01Bibliographically approved
Sandén, G., Svensson, J., Ljuslinder, I. & Rutegård, M. (2023). Defunctioning stoma before neoadjuvant treatment or resection of endoscopically obstructing rectal cancer. International Journal of Colorectal Disease, 38(1), Article ID 24.
Open this publication in new window or tab >>Defunctioning stoma before neoadjuvant treatment or resection of endoscopically obstructing rectal cancer
2023 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 38, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate whether patients with endoscopically untraversable rectal cancer may benefit from a defunctioning stoma created before neoadjuvant therapy or resectional surgery.

Methods: This retrospective study comprise patients diagnosed with rectal cancer during 2007–2020 in Region Västerbotten, Sweden. The primary outcome was time between diagnosis and any treatment, while survival and the incidence of complications were secondary outcomes. Excluded were patients without endoscopic obstruction, patients already having a stoma, patients with recurrent disease, palliative patients, and patients receiving a stoma shortly after diagnosis due to any urgent bowel-related complication. Data were obtained from the Swedish Colorectal Cancer Registry and medical records. Kaplan–Meier failure curves were drawn, and a multivariable Cox regression model was employed for confounding adjustment.

Results: Out of 843 patients, 57 remained after applying exclusion criteria. Some 12/57 (21%) patients received a planned stoma before treatment, and the remainder received upfront neoadjuvant therapy or surgery. Median time to any treatment was 51 days for the planned stoma group and 36 days for the control group, with an adjusted hazard ratio of 0.28 (95% confidence interval: 0.12–0.64). Complications occurred at a rate of 5/12 (42%) and 7/45 (16%) in the planned stoma group and control group, respectively. Survival was similar between groups.

Conclusion: A planned stoma results in treatment delay, but it remains unclear whether this is clinically relevant. Complications were more common in the planned stoma group, although the data are limited. While larger studies are needed, it seems feasible to avoid defunctioning stomas even in endoscopically obstructing rectal cancers.

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Bowel Obstruction, Endoscopy, Rectal Cancer, Stoma
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:umu:diva-204495 (URN)10.1007/s00384-023-04318-8 (DOI)000918433400001 ()36698033 (PubMedID)2-s2.0-85146873003 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationSwedish Society of Medicine
Available from: 2023-02-08 Created: 2023-02-08 Last updated: 2024-02-01Bibliographically approved
Rutegård, M., Moshtaghi-Svensson, J., Weibull, C. E., Ottander, U., Nordenvall, C. & Sund, M. (2023). Exposure to oestrogen and risk of anastomotic leakage after colorectal cancer surgery - A clue to the different leak rates in men and women.. Colorectal Disease, 25(1), 9-15
Open this publication in new window or tab >>Exposure to oestrogen and risk of anastomotic leakage after colorectal cancer surgery - A clue to the different leak rates in men and women.
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2023 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 25, no 1, p. 9-15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Colorectal anastomotic leakage is consistently more common in men, regardless of tumour location. This fact is largely unexplained but might be a consequence of biological differences including hormonal exposure and not only related to anatomy.

METHODS: This was a retrospective, nationwide registry-based observational study of post-menopausal women operated for colorectal cancer with an anastomosis between 2007 and 2016. Hormonal exposure before surgery, as defined by prescribed drugs affecting oestrogen levels, was related to postoperative anastomotic leakage, using mixed-effects logistic regression models with adjustment for confounding. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were derived. In addition, separate estimates according to tumour location were computed, and a sensitivity analysis excluding topical oestrogen hormone exposure was conducted.

RESULTS: Some 16,535 post-menopausal women were included, of which 16.2% were exposed to drugs increasing oestrogen levels before surgery. In this exposed group compared to the unexposed, leak rates were 3.1 and 3.8%, respectively. After adjustment, a reduction of anastomotic leakage in the exposed group was detected (OR: 0.77; 95% CI: 0.59-0.99). This finding was largely attributed to the rectal cancer subgroup (OR: 0.55; 95% CI: 0.36-0.85), while the exclusion of topical oestrogen drugs further reduced the estimates of the main analysis (OR: 0.63; 95% CI: 0.38-1.02).

CONCLUSIONS: Anastomotic leakage rates are lower in women exposed to hormone replacement therapy before surgery for colorectal cancer, which might explain some of the difference in leak rates between men and women, especially regarding rectal cancer.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
anastomotic insufficiency, gender, hormones, sex
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-199794 (URN)10.1111/codi.16300 (DOI)000853430300001 ()36007883 (PubMedID)2-s2.0-85137874282 (Scopus ID)
Funder
Cancerforskningsfonden i NorrlandThe Cancer Society in StockholmKnut and Alice Wallenberg FoundationSwedish Society of Medicine
Available from: 2022-09-28 Created: 2022-09-28 Last updated: 2024-02-01Bibliographically approved
Rutegård, M., Tang, A., Gregoire, D. J., Stewart, C., Hurt, L., Chandler, S., . . . Harris, D. (2023). Oral antibiotics and mechanical bowel preparation for colorectal surgery: a prospective observational study of surgical site infection and microbial analysis. International Journal of Colorectal Disease, 38(1), Article ID 210.
Open this publication in new window or tab >>Oral antibiotics and mechanical bowel preparation for colorectal surgery: a prospective observational study of surgical site infection and microbial analysis
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2023 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 38, no 1, article id 210Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Surgical site infections (SSIs) are common in colorectal surgery. Mechanical bowel preparation (MBP) in conjunction with oral antibiotics (OABs) have been shown to reduce SSI rates. It however is still unclear which OABs to use, and how this can be implemented in practice.

METHODS: This is a prospective observational study carried out in Swansea Bay University Health Board during 2019-2021, evaluating the introduction of OABs in a stepwise manner on the incidence of SSI in major colorectal surgery. A control group having MBP only was compared to two OAB groups: one group had MBP plus metronidazole only and the second MBP plus metronidazole and neomycin. A 30-day follow-up after surgery was ascertained via chart review and telephone contact. Logistic regression was performed to estimate the relation between OAB use and SSI, with adjustment for confounding. In a subset of patients, faecal samples were analysed through 16S rRNA amplicon sequencing before and after OAB treatment, depicting the impact of the gut microbiome.

RESULTS: In total 160 patients were analysed: 46 patients had MBP only, whilst 76 patients had MBP plus metronidazole only and 38 patients had MBP with metronidazole/neomycin. The SSI rate in the entire cohort was 33.8%, whilst the adjusted ORs for the single- and dual-OAB groups were 0.76 (95% CI: 0.17-1.81) and 0.50 (95% CI: 0.17-1.52). The microbial analysis demonstrated that the relative abundance for many bacterial genera was changed before and after OAB treatment, but no link with SSI development could be shown.

CONCLUSIONS: Introduction of OABs in conjunction with MBP in colorectal surgery is feasible, and may potentially lead to lower rates of SSI, as well as altering the community structure of the faecal microbiome. More research is needed, especially considering different OABs and mechanistic studies of the gut microbiome in the context of colorectal surgery.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Abscess, Anastomotic leak, Antibiotics, Colorectal cancer, Infection, Laxatives
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-212987 (URN)10.1007/s00384-023-04497-4 (DOI)37555867 (PubMedID)2-s2.0-85167369851 (Scopus ID)
Funder
Swedish Society of Medicine, SLS-934594Cancerforskningsfonden i Norrland, AMP 19-978Bengt Ihres Foundation, SLS-934603
Available from: 2023-08-21 Created: 2023-08-21 Last updated: 2024-02-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0974-6373

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