Scandinavian Journal of Surgery最新文献

{"title":"Incidence and outcome of acute kidney injury in open abdomen treatment following open surgery for ruptured abdominal aortic aneurysm.","authors":"Henriette Fagertun, Knut A Rise Langlo, Pål Klepstad, Skule Mo, Tor-Arne Hegvik, Linn Åldstedt Nyrønning, Martin Björck, Arne Seternes","doi":"10.1177/14574969261438658","DOIUrl":"10.1177/14574969261438658","url":null,"abstract":"<p><strong>Background and aims: </strong>Acute kidney injury (AKI) is a key contributor to multiorgan dysfunction and mortality in ruptured abdominal aortic aneurysm (rAAA). Intra-abdominal hypertension and abdominal compartment syndrome (ACS), complications potentially resulting in AKI, can be prevented or managed with open abdomen treatment (OAT). Using consensus-based definitions, this study characterizes AKI in rAAA patients managed with OAT and examines the impact of abdominal wall closure on renal function.</p><p><strong>Methods: </strong>A single-center observational cohort study including all consecutive patients treated with OAT after open surgical repair for rAAA from September 2009 to January 2024. AKI was diagnosed and staged based on urine output (UO) and S-creatinine (SCr) as defined by the KDIGO classification, reassessed at closure of the abdomen and at discharge.</p><p><strong>Results: </strong>Seventy-three patients (mean age 73 years, 85% male) received OAT, prophylactically in 63 (85%) and due to ACS in 11 (15%). AKI occurred in 71 patients (97%) at a median of 2 (IQR, 2-3) days of admittance; 22 patients (30%) had stage 3 AKI, including 13 (18%) needing renal replacement therapy. The multivariable logistic regression showed SCr at admittance (p = .034) and perioperative diuresis (p = .018) as predictors of stage 3 AKI. The UO criterion diagnosed more patients than SCr alone (p = .001). Abdominal closure did not aggravate kidney function. In AKI stage 3, 90-day survival was 46% versus 80% in AKI stage 1 and 2 (p = .008). Forty-seven out of 51 survivors (92%) had resolution of their AKI before discharge.</p><p><strong>Conclusions: </strong>Defined by KDIGO, AKI developed in 71/73 (97%) of rAAA patients with OAT after surgical repair. UO was the most sensitive parameter. AKI was diagnosed at median 2 days of admittance and was transient in majority of survivors. There was no aggravation of kidney function at delayed primary abdominal closure.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"300-311"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213128","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":"Long-term study to assess quality of life and cost outcomes of different delayed breast reconstruction techniques: A randomized controlled trial (GoBreast).","authors":"Fredrik Brorson, Emma Hansson, Anna Paganini, Anna Elander, Mikael Svensson","doi":"10.1177/14574969261462051","DOIUrl":"10.1177/14574969261462051","url":null,"abstract":"<p><strong>Background: </strong>The aim of breast reconstruction after mastectomy is to improve quality of life and patient satisfaction, but cost-effectiveness of different reconstruction techniques remains uncertain due to methodological limitations in existing studies. High-quality trial-based economic evaluations are therefore needed. This study aimed to compare the quality of life and cost outcomes of patients randomized to different delayed breast reconstruction techniques based on previous receipt of radiotherapy.</p><p><strong>Methods: </strong>A single-site randomized controlled trial (GoBreast; NCT03963427) including women aged 18-60 undergoing delayed breast reconstruction was conducted. Patients without previous radiotherapy were randomized to either thoracodorsal flap with implant (TD) or two-stage expander (EXP), while patients with previous receipt of radiotherapy were randomized to either latissimus dorsi with implant (LD) or deep inferior epigastric artery perforator (DIEP) flap. Outcomes included health-related quality of life (HRQoL) (by SF-6D utilities), re-operations, and direct/indirect costs over long-term follow-up.</p><p><strong>Results: </strong>Among patients without previous radiotherapy (<i>n</i> = 75), EXP had slightly lower direct healthcare costs, but higher indirect costs, and generated a statistically significant positive change in HRQoL utility value (0.06 (0.02;0.9)) and fewer re-operations (2.34 vs 4.73) during a mean follow-up of 12.9 years. Among patients who had received radiotherapy (<i>n</i> = 25), there were no statistically significant differences in HRQoL utility scores or total costs, but a higher re-operation rate for LD as compared to DIEP.</p><p><strong>Conclusion: </strong>Among patients without previous radiotherapy, EXP yielded superior HRQoL and fewer re-operations compared to TD. In patients with previous receipt of radiotherapy, DIEP reconstruction was associated with fewer re-operations and comparable costs compared to LD.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"273-281"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354196","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":"Time to move beyond BMI alone in predicting arthroplasty infections: A large single-center retrospective cohort study.","authors":"Elisa Kosonen, Rasmus Liukkonen, Aleksi Reito, Eerik Skyttä, Antti Eskelinen","doi":"10.1177/14574969261438911","DOIUrl":"10.1177/14574969261438911","url":null,"abstract":"<p><strong>Background and aims: </strong>A high body mass index (BMI) has traditionally been a strict criterion for surgical eligibility for arthroplasty based on the increased risk for periprosthetic joint infection (PJI). Individuals with obesity are two to four times more likely to undergo joint arthroplasty. There are limited data on how well BMI predicts PJI risk and whether strict BMI-based surgical criteria are justified.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included all primary total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) performed at our institution between 1 January 2008 and 28 November 2023. Survival was analyzed using the Kaplan-Meier method, with PJI as the primary outcome. The association between BMI and PJI was assessed using logistic regression and Cox proportional hazards regression.</p><p><strong>Results: </strong>A total of 54,879 arthroplasties (23,544 hip and 31,335 knee arthroplasties) were included. The median age was 68 years (interquartile range (IQR): 60-75), and 60.0% of patients were female. The risk for PJI was highest in patients with a BMI >45. After THA, the lowest risk for PJI was seen with a BMI <25 (1.0%) and between 25 and 30 (1.1%) after TKA. After THA, a J-shaped association between BMI and PJI was observed in logistic regression analysis, as the risk for PJI increased in patients with both low and high BMIs. A J-shaped association between BMI and PJI was also observed in Cox regression analysis after both TKA and THA. Men had a higher risk for PJI after THA than women, whereas no sex variation was observed after TKA.</p><p><strong>Conclusion: </strong>The risk for PJI does not increase linearly with BMI and the risk differs between women and men. When BMI exceeds 45, risk levels become notably high. Otherwise, the absolute risk differences between different BMI categories are relatively low. Emphasis should be placed on individualized risk assessment and shared decision-making rather than focusing solely on BMI.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"291-299"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787414","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":"Treatment of localized rectal cancer in the Nordic countries-comparison of Nordic to Dutch, ESMO, and NCCN guidelines.","authors":"Erkki-Ville Wirta, Usman Saeed, Gijs Stuart, Laurids Østergaard Poulsen, Camilla Qvortrup, Pia Österlund, Jørgen Smeby, Jens Ravn Eriksen, Bengt Glimelius, Esther Consten, Pamela Buchwald, Toni T Seppälä, Johannes Kurt Schultz","doi":"10.1177/14574969261462056","DOIUrl":"10.1177/14574969261462056","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer treatment in Nordic countries has traditionally differed, especially regarding neoadjuvant treatment. The aim of this review is to give an overview of the current rectal cancer guidelines in the Nordics and compare these to international guidelines.</p><p><strong>Methods: </strong>Oncologists and colorectal surgeons from the Nordic countries (Denmark, Finland, Norway, and Sweden) and the Netherlands were invited to participate in this narrative review. Two consensus meetings were held to agree on the content. All authors provided recommendations from their national guidelines. In addition, recommendations from the European Society of Medical Oncology (ESMO) and from the US National Comprehensive Cancer Network (NCCN) guidelines were extracted.</p><p><strong>Results: </strong>Several differences between the included guidelines were identified. The radiological \"sigmoid take-off\" definition for the upper margin of the rectum has been adapted in Denmark and the Netherlands, whereas the other guidelines rely on distance from the anal verge on rigid sigmoidoscopy. Indications for direct surgery vary considerably, where the NCCN guidelines recommend more aggressive neoadjuvant treatment, primarily total neoadjuvant therapy (TNT), the Nordic and European guidelines open for direct surgery more often, and reserve especially TNT for high-risk cases. European countries more often recommend short-course radiotherapy, whereas NCCN maintains chemoradiotherapy as the mainstay. Whereas intentional and opportunistic organ preservation is an established part of the Dutch, NCCN, and ESMO guidelines, its use is mostly restricted to clinical trials in the Nordics. The Nordics and the Netherlands are restrictive in terms of adjuvant treatment, which is frequently recommended in ESMO and NCCN. Whereas neoadjuvant immunotherapy is recommended for mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) rectal cancer in NCCN, this use is off-label in Europe and not routinely recommended.</p><p><strong>Conclusion: </strong>Although all guidelines rely on the same evidence, there are considerable differences, especially in the indications and type of oncologic treatment, both in the neoadjuvant and in the adjuvant setting.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"364-382"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521362","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":"Quality of life after thyroid surgery: A prospective cohort study with a 12-month follow-up period.","authors":"Juha Honkanen, Krisztina Molnár, Abdulmatin Moradi, Tuomo Karhumaa, Sanna Kakko, Petri Koivunen, Hanna Franssila, Merja Vakkala, Timo Kaakinen, Janne Liisanantti","doi":"10.1177/14574969261458566","DOIUrl":"10.1177/14574969261458566","url":null,"abstract":"<p><strong>Background: </strong>A substantial number of thyroid surgeries are performed annually, and most patients are of working age. Research on the impact of thyroid surgery on patient quality of life (QoL) remains limited. This study evaluated changes in QoL within 1 year after thyroid surgery and identified risk factors for poor postoperative QoL. The prevalence of depressive symptoms and their association with QoL outcomes were examined.</p><p><strong>Methods: </strong>A prospective cohort study including all consecutive patients (n = 314) who underwent lobectomy or total thyroidectomy at Oulu University Hospital in Finland between September 2021 and December 2022. QoL was assessed using the RAND-36 questionnaire, and depressive symptoms were measured with the Beck Depression Inventory (BDI) before surgery and at 6 and 12 months postoperatively. Poor QoL was defined as a RAND-36 score more than two standard deviations below the age-adjusted population mean.</p><p><strong>Results: </strong>Overall QoL improved, particularly in mental well-being, but remained below the Finnish population norms across all domains in patients with complete QoL data across all time points (n = 143). Preoperative depressive symptoms were present in 42% of patients who completed the baseline BDI questionnaire (n = 162). Among these patients, QoL improved in the same domains but remained below the baseline level of the overall cohort. At 12 months (n = 157), 64% of patients had good QoL and 36% had poor QoL. In multivariable analysis, female gender, poor baseline QoL, and preoperative depressive symptoms independently predicted poor QoL at 12 months.</p><p><strong>Conclusion: </strong>Thyroid surgery improves QoL over 12 months, especially in mental health, but remains below the general population. Depressive symptoms are common and predict worse recovery, indicating that patients may benefit from preoperative psychological assessment and support.Clinical trial registrationN/A.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"322-331"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310096","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 variations in surgeries for carpal tunnel syndrome and ulnar nerve disorders: A registry-based study in Finland.","authors":"Vieda Lusa, Ville Ponkilainen, Anniina Laurema, Ville M Mattila, Teemu Karjalainen","doi":"10.1177/14574969261458557","DOIUrl":"10.1177/14574969261458557","url":null,"abstract":"<p><strong>Background and aims: </strong>A large variation in surgery rates can be indicative of its overuse. In Finland, surgeries for carpal tunnel syndrome (CTS) and ulnar nerve disorder (UN) are common, but regional differences in their incidence rates remain unexplored. This study examined how the incidence rates of these surgeries vary across hospital districts in Finland to evaluate regional consistency.</p><p><strong>Methods: </strong>We compared regional age- and sex-adjusted incidence rates per 100,000 person-years based on data from Finland's Care Register for Health Care for CTS and UN surgeries from 2010 to 2021, calculated relative to population size as reported by Statistics Finland. The study included 21 hospital districts in Finland.</p><p><strong>Results: </strong>During the 4-year period from 2018 to 2021, the difference between the lowest (99.6 cases per 100,000 person-years (95% confidence interval (CI) 80.7-122)) and the highest (351 cases per 100,000 person-years (95% CI 336-367)) adjusted incidence rates for CTS surgery was 3.5-fold, with a median adjusted incidence rate of 213 cases per 100,000 person-years. Over the same period, the difference between the lowest (1.04 cases per 100,000 person-year (95% CI 0.03-5.78)) and the highest (81.9 cases per 100,000 person-years (95% CI 73.2-91.5)) adjusted incidence rates for UN surgery was up to 79-fold, with a median adjusted incidence rate of 17.8 cases per 100,000 person-years.</p><p><strong>Conclusions: </strong>Surgery for CTS shows up to a 3.5-fold variation across Finland's hospital districts. Although less common in absolute numbers, surgical treatment rates for UN vary up to 79-fold among these regions. Such significant variations are unlikely to be attributed solely to differences in population morbidity. Instead, the findings indicate that the criteria for performing these surgeries vary considerably across the Finland's hospital districts, suggesting a potential overuse in certain areas.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"344-353"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340877","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":"A two-center randomized clinical superiority trial of single-anastomosis sleeve ileal bypass versus sleeve gastrectomy for severe obesity: SASSY study protocol.","authors":"Helene M Haug, Rolf E Hagen, Jon A Kristinsson, Marius Svanevik, Rune Sandbu, Asle W Medhus, Morten W Fagerland, Carl F Schou, Tom Mala, Torgeir T Søvik","doi":"10.1177/14574969261470903","DOIUrl":"10.1177/14574969261470903","url":null,"abstract":"<p><strong>Background: </strong>Single-anastomosis sleeve ileal bypass is a novel metabolic bariatric surgery intended to enhance metabolic outcomes and reduce the risk of postoperative complications. Although preliminary outcome data for single-anastomosis sleeve ileal bypass are promising, evidence from adequately powered, randomized head-to-head comparisons is scarce. This trial compares the efficacy and safety of single-anastomosis sleeve ileal bypass versus sleeve gastrectomy in patients with class II obesity (body mass index = 35.0-39.9 kg/m²) with at least one obesity‑related comorbidity or class III obesity (body mass index ⩾40.0 kg/m²).</p><p><strong>Methods: </strong>This two-center randomized clinical superiority trial enrolls patients eligible for metabolic bariatric surgery at two specialized Norwegian centers. Included patients are randomly assigned (1:1) to either single-anastomosis sleeve ileal bypass or sleeve gastrectomy with standardized perioperative treatment and care. The primary endpoint is the between-group difference in change in body mass index from baseline to 2 years after single-anastomosis sleeve ileal bypass versus sleeve gastrectomy. Secondary endpoints include additional weight loss outcomes, the prevalence of gastroesophageal reflux disease, surgical and postoperative complications, obesity-related comorbidities, nutritional status, bone mineral density, gastrointestinal symptoms, quality of life, and rates of revisional and conversion surgery. All endpoints will be evaluated at 2 and 5 years after surgery. Statistical analyses utilize linear mixed models and analysis of covariance within an intention-to-treat framework.</p><p><strong>Discussion: </strong>This trial will provide high-level evidence with robust and comparative outcome data on single-anastomosis sleeve ileal bypass and sleeve gastrectomy, aiming to clarify the clinical utility of single-anastomosis sleeve ileal bypass and inform surgical practice. Findings will address gaps in medium- and long-term evidence regarding weight loss, safety, comorbidity resolution, and quality of life following single-anastomosis sleeve ileal bypass.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"391-399"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680899","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":"Two decades of abdominal aortic aneurysm repair in the Nordic countries from 1998 to 2017: A population-based registry analysis.","authors":"Riku Pirinen, Matti Laine, Kim Gunnarsson, Martin Altreuther, Jacob Budtz-Lilly, Anders Wanhainen, Kevin Mani, Maarit Venermo","doi":"10.1177/14574969261461395","DOIUrl":"10.1177/14574969261461395","url":null,"abstract":"<p><strong>Background and aims: </strong>Over recent decades, the management of abdominal aortic aneurysms (AAAs) has undergone substantial transformation, influenced by the introduction of minimally invasive endovascular aneurysm repair (EVAR), advances in early detection, a reduction in disease prevalence, and aging. This study investigated long-term trends in AAA repair incidence, treatment modality, and mortality outcomes across Denmark, Finland, Norway, and Sweden-four neighboring countries with comparable healthcare systems and registry infrastructures.</p><p><strong>Methods: </strong>National registry data were used to identify intact (iAAA) and ruptured abdominal aortic aneurysm (rAAA) repairs from 1998 to 2017 (2008-2017 for Norway). Repair incidence, treatment modality (EVAR vs open repair (OAR)), and mortality (30-day and 1-year) were calculated and compared by country, age group, sex, and time period. Life-table analyses assessed long-term survival.</p><p><strong>Results: </strong>We identified 39,683 iAAA and 15,086 rAAA repairs. During the study, iAAA repair incidence rose markedly among octogenarians, while rAAA repair incidence declined across all countries. EVAR usage increased over time for both iAAA (11.0%-54.1%) and rAAA (2.5%-24.3%). Perioperative mortality declined throughout the study, with 30-day mortality after iAAA repair falling to 1.9% and after rAAA repair to 27.3%. One‑year mortality similarly improved: for iAAA, it reached 5.9%, and for rAAA, it reached 35.8%. Women had consistently higher 30-day and 1-year mortality than men across all procedure types. Outcomes and survival trends were largely similar between the four countries.</p><p><strong>Conclusion: </strong>In the Nordic countries, rAAA repair incidence decreased substantially between 1998 and 2017. EVAR adoption increased and was associated with a rising incidence of iAAA repair in octogenarians. Mortality rates were comparable across the four countries and declined over time for both iAAA and rAAA repair. However, females had consistently poorer perioperative survival than males.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"332-343"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340881","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":"Minimal long-term impact of anastomotic leakage on quality of life after anterior resection for rectal cancer: A population-based cohort study.","authors":"Marcus Lindsköld, Anders Gerdin, Jennifer Park, Jenny Häggström, Marie-Louise Lydrup, Peter Matthiessen, Henrik Jutesten, Sofia Sandberg, Eva Angenete, Petrus Vinnars, Pamela Buchwald, Martin Rutegård","doi":"10.1177/14574969261467712","DOIUrl":"10.1177/14574969261467712","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage after anterior resection for rectal cancer is associated with long-term morbidity, such as bowel dysfunction, but its impact on health-related quality of life remains insufficiently studied. The aim of this study was to evaluate the association between anastomotic leakage and health-related quality of life 3 years after surgery.</p><p><strong>Methods: </strong>In this population-based prospective cohort study, patients who underwent anterior resection for rectal cancer in Sweden between 2015 and 2017 were identified through the Swedish Colorectal Cancer Registry. Health-related quality of life was assessed 3 years after surgery using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. The primary outcome was the QLQ-C30 summary score. Targeted maximum likelihood estimation was applied to estimate the adjusted effect of anastomotic leakage on health-related quality of life.</p><p><strong>Results: </strong>Of 1778 eligible patients, 1178 (66.3%) responded, including 104 (8.8%) with anastomotic leakage. Patients with anastomotic leakage reported a lower mean QLQ-C30 summary score compared to those without anastomotic leakage (80 vs 86, p < 0.001). After adjustment for confounders, anastomotic leakage was associated with a 4-point difference in summary score (p < 0.01). Patients with anastomotic leakage also reported worse body image. Compared with patients without anastomotic leakage, those with anastomotic leakage and no stoma reported more perianal skin irritation, while those with a stoma more frequently reported stool leakage from the stoma bag.</p><p><strong>Conclusions: </strong>Anastomotic leakage after anterior resection is associated with a small negative effect on overall health-related quality of life 3 years after surgery. Nevertheless, specific functional impairments-particularly related to body image, and stoma- or perianal symptoms-persist and warrant attention. These findings highlight the importance of patient counseling and long-term follow-up after anastomotic leakage.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"247-256"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521271","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 of patients with complete metabolic response on [¹⁸F]FDG PET/CT after chemotherapy prior to transplantation for colorectal liver metastases.","authors":"Nadide Mutlukoca Stern, Svein Dueland, Pål-Dag Line, Trygve Syversveen, Harald Grut","doi":"10.1177/14574969261438696","DOIUrl":"10.1177/14574969261438696","url":null,"abstract":"<p><strong>Background and aims: </strong>The primary aim was to compare disease-free survival (DFS), overall survival (OS), and post relapse survival (PRS) in patients undergoing transplantation for colorectal liver metastases (CRLM) who achieved complete metabolic response (CMR) on pre-transplant [¹⁸F]FDG PET/CT after chemotherapy, with patients presenting with low or high metabolic tumor volume (MTV).</p><p><strong>Methods: </strong>Pre-operative [¹⁸F]FDG PET/CT and diagnostic CT scans from 45 patients included in the Secondary Cancer (SECA) 1 and 2 studies were evaluated. MTV was derived from the [¹⁸F]FDG PET/CT, and patients with CMR (MTV = 0) were identified. Patients were stratified into three subgroups: MTV 0, MTV low, and MTV high. DFS, OS, and PRS were compared using the Kaplan-Meier method and the log-rank test. Baseline characteristics and CT reassessment data were analyzed using the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>Thirteen patients with CMR had significantly longer DFS and OS than patients in the MTV high group (<i>p</i> = 0.033 and 0.030), but significantly shorter DFS and OS than those in the MTV low group (<i>p</i> = 0.042 and 0.018). PRS did not differ significantly between patients with CMR and those with low or high MTV (<i>p</i> = 0.121 and 0.130). Imaging findings of extensive growth along the liver capsule and/or possible tumor extension beyond the liver capsule on CT had significantly shorter OS (<i>p</i> = 0.010 and <0.001), including after exclusion of the MTV high group (0.034 and <0.001).</p><p><strong>Conclusion: </strong>Patients with CMR on [¹⁸F]FDG PET/CT after chemotherapy prior to liver transplantation for CRLM had intermediate DFS, OS, and PRS compared with patients with low and high MTV.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"264-272"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822906","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}