Scandinavian Journal of Surgery最新文献

{"title":"Outpatient laser treatment of pilonidal sinus disease: A retrospective study of short-term outcomes.","authors":"Ellen Sirkka, Heidi-Mari Myllykangas, Henrik Nuutinen","doi":"10.1177/14574969261488782","DOIUrl":"https://doi.org/10.1177/14574969261488782","url":null,"abstract":"<p><strong>Background and aims: </strong>Sinus Laser-assisted Closure has been shown to be a safe and effective treatment option for pilonidal sinus disease. The aim of this study was to evaluate the short-term outcomes of outpatient laser pilonidal sinus surgery and to determine whether treatment in an outpatient clinic setting influences postoperative recovery and recurrence rates.</p><p><strong>Methods: </strong>A single-center retrospective analysis was conducted including all consecutive patients with pilonidal sinus disease who underwent Sinus Laser-assisted Closure treatment in an outpatient setting under local anesthesia between 2021 and 2024. Selected patients were scheduled for follow-up, and all patients were instructed to contact the department in case of continuous or recurrent complaints for a clinical assessment of persistent disease or recurrence at the outpatient clinic. Persistent or residual disease within 2 months after the procedure was classified as residual disease, whereas disease detected after 2 months was classified as recurrence. Final rates of persistent disease and recurrence were assessed retrospectively from electronic medical records in December 2024. Patient-related data were collected from medical records, and statistical analyses were performed using IBM SPSS Statistics, version 29.</p><p><strong>Results: </strong>Between 01 January 2021 and 31 December 2024, 80 patients were treated with outpatient Sinus Laser-assisted Closure-56 (70%) men and 24 (30%) women. The mean age was 34.9 (SD = 10.7) years. The mean follow-up period was 14.4 (SD = 8.3) months, with a minimum follow-up of 2 months. Persistent disease was reported by eight (10%) patients. Disease recurrence occurred in nine patients (11%). The mean duration of sick leave was 3.0 (SD = 4.7) days. Postoperative infections were observed in six patients (8%), four (5%) of whom required postoperative wound care. No other complications were reported.</p><p><strong>Conclusions: </strong>Outpatient Sinus Laser-assisted Closure under local anesthesia is an effective and feasible alternative to operating room-based surgery for selected patients with pilonidal sinus disease, with promising healing outcomes and a favorable recovery and complication profile.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261488782"},"PeriodicalIF":2.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency operation for penetrating thoracic non-cardiac injuries: A 10-year review at a major trauma centre in South Africa.","authors":"Shuba Kosna, Victor Kong, Daniel Lee, Akash Boppana, Jonathan Ko, Joshua Ahn, Cynthia Cheung, Howard Wain, Grant Laing, John Bruce, Wanda Bekker, Damian Clarke","doi":"10.1177/14574969261484258","DOIUrl":"https://doi.org/10.1177/14574969261484258","url":null,"abstract":"<p><strong>Background and aims: </strong>Penetrating thoracic injury is relatively common and is encountered in most trauma centres in South Africa. This study focuses exclusively on patients who required acute operative intervention following penetrating thoracic trauma for a non-cardiac injury.</p><p><strong>Methods: </strong>A retrospective study was conducted on patients who sustained penetrating thoracic trauma requiring operative intervention over the 10 years from January 2012 to December 2022 at a major trauma centre in South Africa.</p><p><strong>Results: </strong>A total of 2548 patients with penetrating thoracic trauma were reviewed, of which 9% (229/2548) required an emergency operative intervention. Of these 229 patients, 79% (180/229) had a penetrating cardiac injury and 21% (49/229) a penetrating non-cardiac injury. A total of 49 patients were included in the final analysis, comprising 98% (48/49) males with a mean age of 31 years. There were 82% (40/49) stab wounds and 18% (9/49) gunshot wounds. The median injury severity score was 14. The most common indication for surgery was haemodynamic instability in 55% (27/49), drainage of blood into the tube thoracostomy in 14% (7/49), imminent or actual cardiac arrest in 7% (3/49) and computed tomography scan findings in 24% (12/49). The most common injuries were to the thoracic wall arteries (16/49) and the thoracic great vessels (13/49). The overall morbidity rate was 35% (17/49), and the mortality rate was 18% (9/49).</p><p><strong>Conclusion: </strong>Most patients who sustain a penetrating thoracic injury can be treated non-operatively. In a small percentage of patients, an urgent operative exploration is necessary for a non-cardiac injury. Most of the injuries mandating urgent operation are caused by stab wounds, and the most common indication for surgery was haemodynamic instability. Appropriate surgical access is vital in managing these injuries. Surgeons managing these patients must be familiar with these potential injuries to make appropriate surgical decisions.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261484258"},"PeriodicalIF":2.1,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal radius fractures in working-aged adults - Do we actually know what to do with them? A narrative review.","authors":"Laura Kärnä, Toni Luokkala, Sondre Hassellund, Antti P Launonen","doi":"10.1177/14574969261486971","DOIUrl":"https://doi.org/10.1177/14574969261486971","url":null,"abstract":"<p><strong>Background: </strong>Working-age adults occupy a clinically distinct position between adolescents and the elderly, and treatment decisions in this group must balance overtreatment: unnecessary surgery, prolonged immobilisation and redundant radiographic surveillance against undertreatment leading to functional impairment. We aim to identify areas where the evidence base is shifting or remains insufficient.</p><p><strong>Methods: </strong>This narrative review synthesises current evidence on the working-age population with distal radius fracture, focusing on diagnostic evaluation, treatment, immobilisation and follow-up.</p><p><strong>Results: </strong>After volar locking plate fixation, early mobilisation appears safe and may improve early range of motion and grip strength without compromising alignment; routine surveillance can reasonably be reduced to clinical assessment, with imaging reserved for symptomatic patients. In nonoperative treatment, the 10- to 14-day radiograph captures most secondary displacement events, while subsequent imaging, including the traditional 5- to 6-week radiograph, adds little decision-changing value in fractures acceptable at 10 days. Counselling patients to self-refer if recovery stalls is likely more efficient than routine review of every patient.Key uncertainties remain: the optimal immobilisation duration for displaced and reduced fractures; the validation of displacement thresholds against patient-reported outcomes and predict-and-operate strategies that triage fractures for surgery on presentation radiographs, which risk expanding the surgical indication.</p><p><strong>Conclusion: </strong>Current evidence supports a risk-stratified approach to immobilisation and follow-up, early mobilisation after stable fixation and the systematic incorporation of return-to-work outcomes. Many protocols still derive from tradition; high-quality trials in working-age patients are needed to address radiological thresholds, operative versus nonoperative comparisons, immobilisation duration, follow-up intensity and return-to-work determinants.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261486971"},"PeriodicalIF":2.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nordic parastomal hernia paradox: A regional survey of prophylaxis and repair.","authors":"Jan Roland Lambrecht, Erling Oma, Christoffer Odensten, Elisa Mäkaräinen","doi":"10.1177/14574969261461388","DOIUrl":"https://doi.org/10.1177/14574969261461388","url":null,"abstract":"<p><strong>Background and aims: </strong>To evaluate current preferences and practices as well as institutional policies regarding parastomal hernia (PSH) prevention and repair among Nordic surgeons.</p><p><strong>Methods: </strong>A cross-sectional, web-based survey was distributed to consultant-level surgeons and senior trainees across Denmark, Finland, Norway, and Sweden, assessing demographics, prophylaxis practices, and repair preferences.</p><p><strong>Results: </strong>A total of 191 surgeons responded, of whom 98% practiced in academic or regional hospitals and 50% had >10 years of specialist experience. Among the 166 respondents (87%) who performed permanent end colostomies, only 28% currently used prophylactic mesh, while 53% had never used it, and 19% had discontinued prior use. Prophylactic adoption varied markedly by country: Finland (81%) versus Denmark (0%). Primary barriers were belief in acceptable non-mesh outcomes (42%) and complication fears (40%). Among current mesh users, the intraperitoneal funnel (Chimney) technique was most prevalent (54%). For PSH repair (n = 111), laparoscopic Sugarbaker was the most frequently performed (41%) and preferred (34%) technique. Robotic Pauli emerged as the second most preferred approach (20%), and robotic-assisted repair was used by 17% of repair-performing surgeons, but preferred by 39% of hernia/abdominal wall reconstruction (AWR) specialists. Open surgery was used by 50% but preferred by only 20%, reflecting a marked preference-utilization gap. One-third of respondents (36%) believed more patients should be offered elective PSH repair, with significant country-level variation: 65% of Swedish surgeons favored more repairs, while 42% of Danish surgeons favored fewer repairs.</p><p><strong>Conclusion: </strong>A substantial implementation gap in PSH prophylaxis persists across the Nordic region, driven by surgical culture rather than evidence. In contrast, repair practice is shifting decisively toward robotic retromuscular techniques, led by specialists. The perceived need for more elective repairs, particularly given the high mortality (up to 29%) of emergency repair, supports adopting centralized referral pathways-modeled on the Danish experience-to improve regional outcomes.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261461388"},"PeriodicalIF":2.1,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and outcomes of bowel dysfunction in surgically treated patients with lumbar spinal stenosis.","authors":"Heikki Mäntymäki, Leevi A Toivonen, Jahangir A Khan, Sakari Pietiläinen, Tuomo Thesleff, Leena-Mari Mäntymäki","doi":"10.1177/14574969261483405","DOIUrl":"https://doi.org/10.1177/14574969261483405","url":null,"abstract":"<p><strong>Background and aims: </strong>Lumbar spinal stenosis is primarily associated with back pain and lower limb symptoms, whereas cauda equina symptoms, such as bowel dysfunction, that is, defecation difficulties and/or incontinence, are less frequently recognized. The prevalence of bowel dysfunction in patients with lumbar spinal stenosis and the impact of surgical treatment on these symptoms remain unclear. The aim of this study was to investigate the prevalence of bowel dysfunction in patients with lumbar spinal stenosis and whether spinal surgery alleviates these symptoms.</p><p><strong>Methods: </strong>A retrospective survey was sent to all patients who underwent surgical treatment for lumbar spinal stenosis at Tampere University Hospital in 2023. Bowel dysfunction symptoms were assessed using a questionnaire addressing both baseline and postoperative status. Baseline characteristics, operative details, and prospectively collected patient-reported outcome measures were obtained from the medical records and hospital databases.</p><p><strong>Results: </strong>Of the 338 patients who underwent surgery, 154 (46%) completed the survey and were included in the analysis. Preoperative bowel dysfunction was reported in 57 (37%) patients. Among them, 19 (33%) patients experienced postoperative improvement, including complete resolution in 14 (25%) cases. Conversely, 21 (14%) patients reported postoperative worsening, including 13 (8%) patients with new-onset symptoms. Acute surgery was independently associated with postoperative deterioration (odds ratio = 4.9, 95% confidence interval = 1.4-16.7, p = 0.012). Overall, 43 (28%) patients reported bowel dysfunction both preoperatively and postoperatively.</p><p><strong>Conclusions: </strong>Bowel dysfunction is common and may be under-recognized in patients with lumbar spinal stenosis. Although approximately one-third of patients improved after decompressive spine surgery, 14% reported worsening of symptoms. This suggests that routine assessment of bowel symptoms may be relevant in lumbar spinal stenosis patients.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261483405"},"PeriodicalIF":2.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional differences and trends in treatment approaches for femoral neck fractures in Finland: A nationwide analysis.","authors":"Toni Hido, Oskari Leino, Inari Laaksonen, Markus Matilainen, Elina Ekman","doi":"10.1177/14574969261481920","DOIUrl":"https://doi.org/10.1177/14574969261481920","url":null,"abstract":"<p><strong>Background and aims: </strong>Femoral neck fractures represent a major health concern in aging populations due to their morbidity and mortality. Although operative treatment is the standard, regional and temporal variations in surgical approaches exist. This study evaluates nationwide trends in the treatment of femoral neck fractures in Finland from 1997 to 2018.</p><p><strong>Methods: </strong>Data from the Finnish National Hospital Discharge Register were analyzed for 75,043 skeletally mature patients undergoing primary surgery for acute femoral neck fractures. Surgical methods-internal fixation, cemented and cementless hemiarthroplasty, and total hip arthroplasty-were assessed across 21 hospital districts. Trends in treatment choices, hospital stays, surgical delays, and demographics were analyzed using the Mann-Kendall test.</p><p><strong>Results: </strong>Treatment patterns demonstrated a clear shift toward cemented hemiarthroplasty, in line with evolving clinical guidelines. The use of total hip arthroplasty increased in northern regions. Internal fixation remained more common in selected regions, ranging from 13.6% to 66% across hospital districts, despite an overall decline in use. The proportion of short hospital stays (0-3 days) increased by 31.5% during the study period. Surgical delays also improved, as evidenced by a reduction of 15.3% in the proportion of patients waiting 2 or more days for surgery. Patients undergoing total hip arthroplasty continued to experience the longest delays (a total of 39.7% for 2+ day delays). The overall incidence of surgically treated femoral neck fractures decreased in almost all regions.</p><p><strong>Conclusion: </strong>Over two decades, treatment of femoral neck fractures in Finland has evolved, with shorter hospital stays and reduced surgical delays. However, significant regional differences in surgical approaches persist, highlighting the need for more consistent national treatment protocols. Further research is warranted to understand the drivers of these variations and their impact on outcomes.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261481920"},"PeriodicalIF":2.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted versus laparoscopic gastrectomy in a low-incidence Nordic country: A single-center retrospective study.","authors":"Magnus H Fasting, Ulrik Joys, Dag T Førland, Caroline Skagemo, Tobias Hauge, Egil Johnson, Tom Mala","doi":"10.1177/14574969261480875","DOIUrl":"10.1177/14574969261480875","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted gastrectomy is increasingly used in the treatment of gastric cancer, but the evidence on outcomes in Western low-volume centers remains limited. We aimed to evaluate the surgical and oncological outcomes during implementation of robotic-assisted gastrectomy in a university hospital in Norway and to compare outcomes with laparoscopic-assisted gastrectomy.</p><p><strong>Methods: </strong>All patients undergoing curative-intent resection for gastric adenocarcinoma at Oslo University Hospital with either robotic-assisted gastrectomy or laparoscopic-assisted gastrectomy from November 2018 to December 2025 were included in this retrospective cohort study. Laparoscopic-assisted gastrectomy was introduced at the center in 2015 and robotic-assisted gastrectomy in 2018. During the study period, two surgeons received training in laparoscopic-assisted gastrectomy, while robotic-assisted gastrectomy was implemented with sequential training of five surgeons. The main outcome was textbook outcome, defined as no serious complications, R0 resection, no conversion to open surgery, at least 15 lymph nodes in the specimen, and no 30-day mortality or readmission. Secondary outcomes included R0 resection, number of lymph nodes, serious complications, anastomotic leakage, procedure time and overall survival.</p><p><strong>Results: </strong>During the study period, there were 136 attempted robotic-assisted gastrectomies and 134 attempted laparoscopic-assisted gastrectomies, of which 108 (79%) and 104 (78%) were completed (<i>p</i> = 0.72). The overall distribution of tumor location differed between the robotic-assisted gastrectomy and laparoscopic-assisted gastrectomy groups (<i>p</i> = 0.03). Otherwise, the groups were comparable for the assessed baseline characteristics. Textbook outcome was achieved in 54/108 (50%) robotic-assisted gastrectomy and 55/104 (53%) laparoscopic-assisted gastrectomy procedures (<i>p</i> = 0.67). Procedure time was 60 min (95% confidence interval: 41, 79) longer in robotic-assisted gastrectomy versus laparoscopic-assisted gastrectomy. R0 resection was observed in 94/108 (87%) patients after robotic-assisted gastrectomy and 100/104 (96%) after laparoscopic-assisted gastrectomy (<i>p</i> = 0.03). There was no difference in other short-term outcomes or overall survival.</p><p><strong>Conclusion: </strong>Robotic-assisted gastrectomy was associated with a similar textbook outcome rate compared with that of laparoscopic-assisted gastrectomy. The lower rate of R0 resections after robotic-assisted gastrectomy warrants continued audit and further evaluation.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261480875"},"PeriodicalIF":2.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival following colorectal cancer resection in nonagenarians: A Swedish nationwide population-based study.","authors":"Parisa G Mörlin, Mojgan C Sifolahzadeh, Maziar Nikberg, Peter Matthiessen, Abbas Chabok","doi":"10.1177/14574969261481930","DOIUrl":"https://doi.org/10.1177/14574969261481930","url":null,"abstract":"<p><strong>Background and aims: </strong>To evaluate survival according to treatment strategy among nonagenarians diagnosed with colorectal cancer in Sweden.</p><p><strong>Methods: </strong>This retrospective population-based register study used data from the Swedish Colorectal Cancer Registry. All patients aged ⩾90 years diagnosed with colorectal cancer in Sweden between 2010 and 2019 were included. Patient demographics, tumour characteristics, treatment data, and perioperative outcomes were analysed. Overall survival and relative survival were assessed.</p><p><strong>Results: </strong>A total of 2055 nonagenarians with colorectal cancer were identified. The median age was 91 (range: 90-106), and 1254 (61%) were women. Overall, 1026 patients (50%) underwent bowel resection, of whom 655 (64%) had elective surgery.Among patients undergoing bowel resection, 1- and 3-year overall survival rates were 71% and 37%, respectively. Relative survival was comparable to that of the general population matched for age, sex, and calendar year. Patients who underwent elective resection had significantly longer median survival than those undergoing emergency surgery (37 vs 22 months, <i>p</i> < 0.001). Emergency resection was associated with higher 30- and 90-day mortality than elective resection (15% vs 4%; <i>p</i> < 0.001 and 26% vs 5%; <i>p</i> < 0.001, respectively).In multivariable Cox regression analysis restricted to patients undergoing bowel resection, male sex (hazard ratio = 1.30; standard error = 0.08; <i>p</i> < 0.001), emergency surgery (hazard ratio = 1.70; standard error = 0.09; <i>p</i> < 0.001), advanced tumour stage (hazard ratio = 1.61; standard error = 0.05; <i>p</i> < 0.001), and higher American Society of Anaesthesiologists score (hazard ratio = 1.35; standard error = 0.06; <i>p</i> < 0.001) were independently associated with an increased risk of death.</p><p><strong>Conclusion: </strong>Half of all nonagenarians diagnosed with colorectal cancer underwent bowel resection. Survival following resection was comparable to that expected in the age-matched general population, whereas emergency surgery was associated with substantially higher short-term mortality and poorer long-term survival.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261481930"},"PeriodicalIF":2.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early stoma-related complications in end-colostomy patients: A prospective single-center study.","authors":"Anu Vormisto, Erkki-Ville Wirta, Kirsi Lehto, Marja Hyöty, Heini Huhtala, Jaana Janhunen, Ilona Helavirta","doi":"10.1177/14574969261467357","DOIUrl":"10.1177/14574969261467357","url":null,"abstract":"<p><strong>Background: </strong>End colostomies are performed frequently in both emergency and elective abdominal surgery. The aim of this study was to assess early stoma-related complications and to identify risk factors for severe complications.</p><p><strong>Methods: </strong>All patients undergoing surgery with an end colostomy during 2018-2020 at Tampere University Hospital were identified. This was a single-center study based on a prospective stoma registry complemented with additional retrospective clinical data. A stoma-related complication was classified as severe (Clavien-Dindo grade ⩾3a) or mild (<3a).</p><p><strong>Results: </strong>The study comprises 360 patients (median age = 71, interquartile range = 64-78 years); 197 (55%) patients were male, and out of these 360 patients, 242 (67%) underwent elective operation and 118 (33%) underwent emergency surgery. There were 18/118 (15%) severe stoma-related complications in the emergency and 12/242 (5%) in the elective group. Stoma site was marked preoperatively for 53/118 (45%) in the emergency group and for 235/242 (97%) patients in the elective group. Most of the stomas were performed by a specialist or resident in gastrointestinal surgery (95%, 342/360). In univariate analyses, emergency surgery (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.6-7.4, p = 0.002), smoking (OR = 2.9, 95% CI = 1.3-6.8, p = 0.01), lack of experience in gastrointestinal surgery of the operating surgeon (OR = 4.9, 95% CI = 1.6-14.8, p = 0.05, unmarked stoma site (OR = 2.3, 95% CI = 1.0-5.2, p = 0.04), and American Society of Anesthesiologists (ASA) score IV-V (OR = 2.7, 95% CI = 1.2-6.0, p = 0.01) showed increased risk of severe stoma complications. In multivariate logistic regression analysis, smoking (OR = 3.3, 95% CI = 1.3-7.9, p = 0.009) was associated with severe stoma complications.</p><p><strong>Conclusion: </strong>Morbidity associated with end colostomy is common, especially in emergency surgery. Smoking was the only independent risk factor for severe short-term stoma complications. Stoma site planning and cessation of smoking may reduce stoma-related complications.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"257-263"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary metastasectomy in Iceland: Long-term nationwide trends and outcomes.","authors":"Carlos Magnus Rabelo, Luis Gisli Rabelo, Sigurdis Haraldsdottir, Tomas Gudbjartsson, Halla Vidarsdottir","doi":"10.1177/14574969261468491","DOIUrl":"10.1177/14574969261468491","url":null,"abstract":"<p><strong>Background and aims: </strong>Pulmonary metastases are generally associated with poor prognosis, and only a selected subset of patients undergo surgery. However, population-level data on outcomes remain limited. This study aimed to evaluate temporal trends and outcomes of pulmonary metastasectomy (PM) in a nationwide cohort over more than two decades.</p><p><strong>Methods: </strong>This retrospective cohort study included all patients who underwent PMs in Iceland between 2001 and 2021. The study period was divided into three 7-year intervals for comparison. Survival was evaluated from the first PM using the Kaplan-Meier analysis, and prognostic factors were assessed using multivariable Cox regression.</p><p><strong>Results: </strong>A total of 179 PMs were performed, with procedure volume increasing significantly during the final study period. The median age at the first PM was 62 years, and 54% of patients were male. The most common indication was metastatic colorectal carcinoma (39.3%), followed by renal cell carcinoma (16.4%) and sarcoma (10%). Median follow-up was 52 months. Early major postoperative complications occurred in 2.2% of cases, with a 30-day mortality rate of 1.1%. Five-year overall survival was 49.7%, and 55.5%, 60.9%, and 35.7% for colorectal carcinoma, renal cell carcinoma, and sarcoma tumor subtypes, respectively. Five-year overall survival increased significantly from 31% to 55% across the first and last 7-year periods. In addition to sarcoma histology and an operation in the first period, negative prognostic factors included advanced age, a greater number of metastases, and a prior extrathoracic metastasectomy.</p><p><strong>Conclusions: </strong>The use of PM increased over time and was accompanied by improved long-term survival, likely reflecting advances in systemic therapy, imaging, and patient selection. The procedure had a low rate of major complications, and 5-year survival rates were comparable to those reported in international data.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"354-363"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}