Scandinavian Journal of Surgery最新文献

{"title":"Finnish translation, validation, and reproducibility of BREAST-Q modules relevant to breast cancer treatment.","authors":"Pauliina Homsy, Jussi Repo, Charlotta Kuhlefelt, Andrew Lindford, Hanna Ihalainen, Susanna Kauhanen, Tiina Jahkola","doi":"10.1177/14574969241277636","DOIUrl":"10.1177/14574969241277636","url":null,"abstract":"<p><strong>Background and objective: </strong>Breast cancer and its treatments can have a marked impact on the patient health-related quality of life. The aim of this study was to produce and validate Finnish versions of the breast-conserving treatment, mastectomy and breast reconstruction modules of the BREAST-Q, a patient-reported outcome tool designed specifically for women undergoing treatment for breast cancer.</p><p><strong>Methods: </strong>The relevant BREAST-Q modules were translated to Finnish according to established guidelines. Altogether 777 preoperative women were recruited at the Breast Surgery Unit and the Plastic Surgery Unit of Helsinki University Hospital between December 2019 and March 2021. This included 541 patients scheduled for breast-conserving surgery, 86 for mastectomy, and 150 for breast reconstruction. Postoperative patients were recruited through a postal survey, approaching 500 women operated for breast cancer in 2017, including 250 women who had undergone breast-conserving surgery and 250 women who had undergone mastectomy, as well as 339 women who had undergone breast reconstruction between August 2017 and July 2019. The patients were invited to fill the BREAST-Q modules relevant to their treatment and the general health-related quality-of-life instrument SF-36. A repeat administration of the BREAST-Q was done 2 weeks later.</p><p><strong>Results: </strong>A total of 665 (41%) women participated in the study, 339 (44%) preoperatively and 326 (39%) postoperatively. The BREAST-Q subscales showed high internal consistency with most Cronbach's alphas > 0.8. The repeatability of the subscales was excellent with most intra-class correlation coefficients > 0.75. Low or negligible correlation was observed between BREAST-Q subscales and SF-36 domains.</p><p><strong>Conclusions: </strong>The Finnish version of the BREAST-Q modules breast-conserving treatment, mastectomy, and breast reconstruction performs well in assessing the health-related quality of life of women undergoing surgery for breast cancer or breast reconstruction.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"65-72"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299557","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":"Different biliary tract cancers, same operation: Importance of cancer origin in patients with hilar-invading tumors.","authors":"Hasan Ahmad Al-Saffar, Hannes Jansson, Olof Danielsson, Carlos F Moro, Christian Sturesson","doi":"10.1177/14574969241282480","DOIUrl":"10.1177/14574969241282480","url":null,"abstract":"<p><strong>Background and aims: </strong>For patients with biliary tract cancer involving the hepatic hilum, major hepatic resection with extrahepatic bile duct resection may be required. In addition to perihilar cholangiocarcinoma (PHCC), the same extent of surgery is used in advanced gallbladder cancer (GBC) and intrahepatic cholangiocarcinoma (IHCC) with hilar involvement. Few studies compare prognostic factors and long-term outcomes across tumor types. This study compared risk characteristics and outcomes after surgery in all subtypes of biliary tract cancer with hilar involvement.</p><p><strong>Methods: </strong>Patients with biliary tract cancer with hilar involvement undergoing major liver resection and extrahepatic bile duct resection between 2011 and 2021 at a single center were retrospectively analyzed. The primary postoperative outcome was overall survival. Secondary outcomes were recurrence-free survival and postoperative complications. Survival analysis was performed with Cox regression analysis and Kaplan-Meier method.</p><p><strong>Results: </strong>One-hundred and eight patients were included. Seventy-three (67%) had PHCC, 24 (22%) had GBC, and 11 (10%) had IHCC. Hilar-invading IHCC and GBC had more adverse histopathological factors like lymph node positivity (p = 0.021), higher number of positive nodes (p = 0.043), and larger tumor size (p < 0.001) compared with PHCC. Peritoneal invasion and lymph node positivity were significant independent predictors for survival (p = 0.011 and p = 0.004, respectively). Median overall survival was 29 months for PHCC, 22 months for GBC and 21 months for IHCC (p = 0.53). IHCC tended to recur earlier (p = 0.046) than GBC and PHCC (6, 15, and 18 months, respectively).</p><p><strong>Conclusion: </strong>Patients with biliary tract cancer with hilar involvement undergoing major liver resection and resection of extrahepatic bile ducts had similar overall survival regardless of subtype, while IHCC recurred earlier. Peritoneal cancer invasion was common in all subtypes, including PHCC, and was an independent prognostic factor. This finding may support routine reporting of peritoneal invasion-status in resected biliary tract cancer.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"35-43"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394706","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":"Magnetic Resonance Imaging - Derived Psoas Muscle Area and Survival in Patients Treated Invasively for Peripheral Arterial Disease.","authors":"Minea Söderlund, Henni Huhtamo, Sara Protto, Jussi A Hernesniemi, Damir Vakhitov, Niku Oksala, Niina Khan","doi":"10.1177/14574969241282485","DOIUrl":"10.1177/14574969241282485","url":null,"abstract":"<p><strong>Background and aims: </strong>Psoas muscle parameters estimated from computed tomography images, as surrogates for sarcopenia, have been found to be associated with post-interventional outcomes after a wide range of cardiovascular procedures. The pre-interventional assessment in patients undergoing invasive treatment for peripheral arterial disease is increasingly often carried out with magnetic resonance imaging (MRI), and we therefore sought to investigate the predictive potential of MRI-derived psoas muscle area in this cohort.</p><p><strong>Methods: </strong>A total of 899 patients with available sufficient quality pre-interventional MRI conducted within 6 months prior to treatment undergoing open, endovascular, or hybrid revascularization procedures for claudication and/or limb-threatening ischemia at Tampere University hospital between 2010 and 2020 were retrospectively studied in this single-center cohort study. The follow-up lasted until 17 June 2021. Psoas muscle areas were measured from the magnetic resonance images at the L4 level, and the reliability of muscle parameter measurements was tested with intraclass correlation coefficient analysis. The average psoas muscle area values (mean of left and right psoas surface areas) were z-scored and analyzed separately for men and women.</p><p><strong>Results: </strong>The median follow-up time was 5.9 years (interquartile range (IQR) = 2.7-7.8), and the overall mortality count was 259 (28.8%) (29.5% n = 168/569 for men and 27.6% n = 91/330 for women). The intraclass correlation coefficient analysis showed excellent interrater reliability for psoas muscle measurements. The muscle surface areas were larger in men (mean = 7.58 cm²) compared to women (mean = 5.27 cm²) (p < 0.001). Higher psoas muscle area was associated with better survival in women (p = 0.003, hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.6-0.9 per 1 SD), whereas in men, an independent association of the muscle parameter with mortality was not found.</p><p><strong>Conclusions: </strong>MRI-derived psoas muscle area may be a prognostic factor for clinical use.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"44-55"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479072","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-onset rectal cancer: Experience of a single-center, high-volume unit.","authors":"Taru M Lehtonen, Laura E Koskenvuo, Anna H Lepistö","doi":"10.1177/14574969241282543","DOIUrl":"10.1177/14574969241282543","url":null,"abstract":"<p><strong>Background and objective: </strong>The incidence of early-onset colorectal cancer among the young (<50 years) has been reported to have risen in last decades. This retrospective study aimed to investigate the characteristics of early-onset rectal cancers (EO-RCs) and potential changes in proportion of EO-RCs, and further to report the mortality and recurrence rates of EO-RCs.</p><p><strong>Methods: </strong>In the years 2007-2021, 2557 rectal cancer (RC) patients were operated in Helsinki University Hospital and of them 147 were 18-49 years old. Cumulative overall survival (OS), disease-specific survival, and disease-free survival were calculated using the Kaplan-Meier analysis.</p><p><strong>Results: </strong>The percentual amount of the EO-RCs varied between 2.5% and 11.3% annually and there was no perceivable trend. Majority were adenocarcinomas (98.7%), of which 8.8% were mucinous. Predisposing factors such as Lynch syndrome, polyposis, or ulcerative colitis were seen in 26 patients (17.7%) and in 10 of 22 patients (45.5%) under 35 years. The cumulative 5-year OS was 91.9% in stage I, 93.3% in stage II, 86.7% in stage III, and 50.0% in stage IV disease. Metastatic recurrence was found in 22 cases (18.4%) and local recurrence in 8 patients (5.4%) and 6 patients had both.</p><p><strong>Conclusions: </strong>In our cohort of 147 EO-RC patients, OS was good and the clinical course did not seem to differ much from the course of RC in general population.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"22-34"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479071","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 diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis.","authors":"Luís Duarte-Gamas, Mariana Fragão-Marques, Petar Zlatanovic, José P Andrade, João Rocha-Neves","doi":"10.1177/14574969241282611","DOIUrl":"10.1177/14574969241282611","url":null,"abstract":"<p><strong>Background: </strong>Carotid endarterectomy (CEA) carries a risk of perioperative stroke, particularly during carotid cross-clamping. While neurological monitoring is reliable for patients under regional anesthesia, alternative options are needed for those unsuitable for regional anesthesia. Near-infrared spectroscopy (NIRS) is commonly used during CEA, but its diagnostic accuracy varies, particularly under general anesthesia.</p><p><strong>Methods: </strong>A systematic review with meta-analysis was performed to assess the diagnostic accuracy of intraoperative NIRS in detecting clamp-associated hemodynamic cerebral ischemia in patients under general anesthesia. MEDLINE, Google Scholar, and Web of Science were searched for studies that compared NIRS with the occurrence of immediate or early postoperative neurological deficits in patients undergoing CEA under GA. Meta-regression was performed to explore causes of heterogeneity.</p><p><strong>Results: </strong>A total of 28 studies involving 5729 patients were included. The results show that NIRS has a summary sensitivity of 47.5% and a summary specificity of 90.3% in diagnosing clamp-associated cerebral ischemia under general anesthesia, with an area under the ROC curve (AUC-ROC) of 0.85. The presence of a contralateral carotid occlusion (CCO) increased summary sensitivity while smoking history the presence of CCO and smoking history decreased summary specificity. For postoperative stroke prediction, NIRS has a summary sensitivity of 49.5% and summary specificity of 88.5%, with an AUC-ROC of 0.85.</p><p><strong>Conclusions: </strong>NIRS is a specific but not highly sensitive tool for detecting cerebral ischemia during CEA, and its use in combination with more sensitive neuromonitoring methods is recommended, in order to guide intraoperative neuroprotective strategies.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"84-94"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696035","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":"Systematic review and meta-analysis comparing robotic total mesorectal excision versus transanal total mesorectal excision for rectal cancer.","authors":"Mohamed Ali Chaouch, Mohammad Iqbal Hussain, Maissa Jellali, Amine Gouader, Alessandro Mazzotta, Adriano Carneiro da Costa, Bassem Krimi, Jim Khan, Hani Oweira","doi":"10.1177/14574969241271784","DOIUrl":"10.1177/14574969241271784","url":null,"abstract":"<p><strong>Introduction: </strong>The best approach for total mesorectal excision (TME) remains controversial. Two recently described approaches are robotic TME (RTME) and transanal TME (TaTME). This systematic review and meta-analysis aimed to compare the outcomes between robotic surgery and TaTME in patients undergoing rectal cancer resection.</p><p><strong>Methods: </strong>We structured this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines 2020 and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines. An electronic search of relevant literature was conducted on 20 May 2023. The protocol was registered in PROSPERO (CRD42023435259).</p><p><strong>Results: </strong>Eleven eligible nonrandomised studies were included in this study. The study included 2796 patients (RTME = 1800; TaTME = 996). The RTME group had a higher rate of complete TME. However, no significant differences were observed in mortality, morbidity, severe complications, operative time, conversion rate, anastomotic leak, hospital stay, CRM-positive resection margin, distal resection margin, number of harvested lymph nodes, abdominoperineal resection (APR) rate, or local recurrence between the RTME and TaTME groups.</p><p><strong>Conclusion: </strong>The RTME technique may ensure a higher rate of complete TME than TaTME. However, no significant differences were observed in most postoperative outcomes and oncological safety between the RTME and TaTME groups. Evidence does not conclusively favor one technique over the other, highlighting the need for additional randomized controlled trials to better define their roles in rectal cancer surgery.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"73-83"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299558","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":"Carpal tunnel release under local anesthesia with or without distal median nerve block: Double-blind randomized clinical trial.","authors":"Noora Heikkinen, Yrjänä Nietosvaara, Aleksi Reito, Joonas Sirola, Mikael Hytönen, Aukusti Savolainen, Mikko P Räisänen","doi":"10.1177/14574969241277028","DOIUrl":"10.1177/14574969241277028","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity, and its surgical treatment is carpal tunnel release (CTR). It is mostly performed in local anesthesia. There are no clinical randomized controlled trials (RCTs) comparing local infiltration anesthesia with or without a distal median nerve block in CTR. The aim of the PERSONNEL trial (carPal tunnEl ReleaSe lOcal iNfiltratioN mEdian bLockade) is to assess whether a distal median nerve block reduces pain during and after the procedure in addition to local anesthesia.</p><p><strong>Methods: </strong>This is a single-center randomized clinical superiority trial comparing local anesthesia alone and local anesthesia with a distal median nerve block for CTR in patients with CTS. Adult patients will be randomized in one university hospital in Finland, and the intended sample size is 118. The primary outcome is the mean pain level after the procedure during 72 h using a visual analogue scale (VAS). The secondary outcomes include expected pain; pain during the injection of the anesthetic solution caused by pressure, burning, needle sting, and total pain; worst pain during the surgery; duration of anesthesia; number of experienced needle stings; Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ); pain killer consumption;, patient satisfaction using Net Promoter Score (NPS); and complications.</p><p><strong>Discussion: </strong>Patient satisfaction is a crucial factor in modern healthcare. A distal median nerve block may reduce pain during and after CTR, potentially increasing patient satisfaction with the given treatment. It can also be hypothesized that better postoperative pain control may prevent complications, for example, complex regional pain syndrome. However, we lack adequate evidence to justify the use of distal median nerve block, which can itself predispose patients to complications, for example, median nerve injury. Therefore, there is a need for adequate RCTs to assess its efficacy. The results of this study can be used to optimize anesthesia for carpal tunnel surgery, improve patient satisfaction, and possibly prevent complications.</p><p><strong>Registration: </strong>ClinicalTrials.gov NCT05372393.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"13-21"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299556","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":"Association of the ascending aortic length with acute type A aortic dissection: A retrospective cohort study.","authors":"Tarmo Korpela, Elina Salomaa, Petteri Kauhanen, Tuomas Selander, Marja Hedman, Annastiina Husso","doi":"10.1177/14574969241294261","DOIUrl":"10.1177/14574969241294261","url":null,"abstract":"<p><strong>Background and aims: </strong>To investigate whether, alongside aortic dilatation, ascending aortic (AA) elongation is associated with the increased risk for aortic dissection.</p><p><strong>Methods: </strong>This retrospective study included patients treated for Stanford type A aortic dissection (n = 102) in Kuopio University Hospital between 2009 and 2022, patients with AA dilatation (maximal diameter > 40 mm) (n = 134), and healthy controls (n = 191). AA length and dimensions were measured from aortic computed tomography angiography (CTA) images. AA length was defined as the distance between the aortic annulus and the origin of the brachiocephalic trunk.</p><p><strong>Results: </strong>After adjusting the AA length to the patients' age, height, body surface area (BSA), sex, and maximal diameter, the dissected aortas were 14 mm longer than in the healthy controls and 5 mm longer than in the dilated non-dissected aortas (p < 0.001). The dilated non-dissected aortas were 8 mm longer than in the healthy controls (p < 0.001). In the dissection cohort, 25/102 (25%) patients had maximal AA diameter < 55 mm and 16/102 (16%) patients had maximal AA diameter ⩾ 55 mm together with AA length > 110 mm. By combining 110 mm AA length and < 55 mm diameter, 58% of the dissection patients would have been identified instead of using solely AA diameter ⩾ 55 mm as a cut-off criterion, based on which only 33% patients met the indication for elective surgery.</p><p><strong>Conclusion: </strong>AA length seemed to have an association with acute type A dissection, and therefore, it could be an additional tool in identifying patients who may benefit from preventive aortic surgery.[Formula: see text].</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"56-64"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711688","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":"Letter to the Editor: Emergency surgery influences oncological outcome in small intestinal neuroendocrine tumors.","authors":"Waleed Ahmad, Abdur Rehman","doi":"10.1177/14574969241310047","DOIUrl":"10.1177/14574969241310047","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"109-110"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878442","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":"Letter to the editor: Preoperatively suspected gallbladder cancer improves survival compared with incidental gallbladder cancer in pT3 patients.","authors":"Abdur Rehman, Adam U A Butt, Saba Shafiq","doi":"10.1177/14574969241298036","DOIUrl":"10.1177/14574969241298036","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"107-108"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577118","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}