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Article ; Online: Predictive Factors for Delayed Gastric Emptying After Pancreatoduodenectomy: A Swedish National Registry-Based Study.

Zdanowski, A Hörberg / Wennerblom, J / Rystedt, J / Andersson, B / Tingstedt, B / Williamsson, Caroline

2023 Volume 47, Issue 12, Page(s) 3289–3297

Abstract: Background: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). DGE causes prolonged hospital stay and a decrease in quality of life. This study analyzes predictive factors for development of DGE after PD, also in ... ...

Abstract	Background: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). DGE causes prolonged hospital stay and a decrease in quality of life. This study analyzes predictive factors for development of DGE after PD, also in the absence of surgical complications. Method: Data from the Swedish National Pancreatic Cancer Registry for patients undergoing standard and pylorus preserving open PD from January 2010 until June 30, 2018, were collected. Data were analyzed in two groups, no DGE and DGE. A subgroup of patients with DGE but without surgical complications was compared to patients without DGE or any other surgical complication. Results: In total, 2503 patients were included, of which 470 (19%) had DGE. In the DGE group, 238 had other coexisting surgical complications and 232 had not. Postoperative pancreatic fistula (OR = 4.22, p < 0.001), surgical infection (OR = 1.44, p = 0.013), heart disease (OR = 1.32, p = 0.023) and medical complications (OR = 1.35, p = 0.025) increased the risk for DGE. A standard PD compared with pylorus preserving resection (OR = 1.69, p = 0.001) and a reconstruction with a pancreaticojejunostomy compared with a pancreaticogastrostomy (OR = 1.83, p < 0.001) increased the risk. For patients without surgical complications, a standard PD and reconstruction with pancreaticojejunostomy still increased the risk for DGE. Conclusion: DGE is more common after standard PD compared to pylorus preserving PD and after reconstruction with PJ compared to PG in this national cohort, both in the presence of other surgical complications as well as in the absence of other complications.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Gastroparesis/epidemiology ; Gastroparesis/etiology ; Quality of Life ; Sweden/epidemiology ; Pylorus/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Gastric Emptying ; Risk Factors
Language	English
Publishing date	2023-09-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-023-07175-2
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Article ; Online: Hyperglycemia and insulin infusion in pancreatoduodenectomy: a prospective cohort study on feasibility and impact on complications.

Ekström, Eva / Fagher, Katarina / Tingstedt, Bobby / Rystedt, Jenny / Nilsson, Johan / Löndahl, Magnus / Andersson, Bodil

International journal of surgery (London, England)

2023 Volume 109, Issue 12, Page(s) 3770–3777

Abstract: Background: Hyperglycemia is a risk factor for postoperative complications but its impact on outcome after pancreatoduodenectomy (PD) is scarcely studied. This prospective cohort study aimed to assess the effect of continuous insulin infusion on ... ...

Abstract	Background: Hyperglycemia is a risk factor for postoperative complications but its impact on outcome after pancreatoduodenectomy (PD) is scarcely studied. This prospective cohort study aimed to assess the effect of continuous insulin infusion on postoperative complications and blood glucose, as well as to evaluate the impact of hyperglycemia on complications, after PD. Materials and methods: One hundred patients planned for PD at Skåne University Hospital, Sweden were prospectively included for perioperative continuous insulin infusion and a historic cohort of 100 patients was included retrospectively. Median blood glucose levels were calculated and data on complications were analyzed and compared between the historic cohort and the intervention group as well as between normo- and hyperglycemic patients. Results: Median glucose levels were significantly lower in the intervention group compared to the historic cohort up to 30 days postoperatively (median glucose 8.5 mmol/l (interquartile range 6.4-11) vs. 9.1 mmol/l (interquartile range 6.8-17) ( P =0.007)). No significant differences in complication rates were recorded between these two groups. The incidence of complications classified as Clavien ≥3 was higher in hyperglycemic patients (100 vs. 27%, P =0.024). Among hyperglycemic patients the prevalence of preoperative diabetes was higher compared to normoglycemic patients (52 vs.12%, P <0.001). In patients with a known diagnosis of diabetes, a trend, although not statistically significant, towards a lower incidence of postoperative pancreatic fistula grade B and C, as well as postpancreatectomy hemorrhage grade B and C, was seen compared to those without preoperative diabetes (6.8 vs. 14%, P =0.231 and 2.3 vs. 7.0%, P =0.238, respectively). Conclusion: Insulin infusion in the early postoperative phase after PD is feasible in a non-ICU setting and significantly decreased blood glucose levels. The influence on complications was limited. Preoperative diabetes was a significant predictor of postoperative hyperglycemia and was associated with a lower incidence of clinically significant postoperative pancreatic fistula.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Blood Glucose ; Pancreatic Fistula/epidemiology ; Pancreatic Fistula/etiology ; Retrospective Studies ; Prospective Studies ; Feasibility Studies ; Hyperglycemia/epidemiology ; Hyperglycemia/etiology ; Insulin ; Diabetes Mellitus/drug therapy ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/etiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2023-12-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000714
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Article ; Online: Importance of resection margin after resection of colorectal liver metastases in the era of modern chemotherapy: population-based cohort study.

Östrand, Emil / Rystedt, Jenny / Engstrand, Jennie / Frühling, Petter / Hemmingsson, Oskar / Sandström, Per / Sternby Eilard, Malin / Tingstedt, Bobby / Buchwald, Pamela

BJS open

2024 Volume 8, Issue 3

Abstract: Background: Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and ≥1 mm influence overall survival in ... ...

Abstract	Background: Resection margin has been associated with overall survival following liver resection for colorectal liver metastasis. The aim of this study was to examine how resection margins of 0.0 mm, 0.1-0.9 mm and ≥1 mm influence overall survival in patients resected for colorectal liver metastasis in a time of modern perioperative chemotherapy and surgery. Methods: Using data from the national registries Swedish Colorectal Cancer Registry and Swedish National Quality Registry for Liver, Bile Duct and Gallbladder Cancer, patients that had liver resections for colorectal liver metastasis between 2009 and 2013 were included. In patients with a narrow or unknown surgical margin the original pathological reports were re-reviewed. Factors influencing overall survival were analysed using a Cox proportional hazard model. Results: A total of 754 patients had a known margin status, of which 133 (17.6%) patients had a resection margin <1 mm. The overall survival in patients with a margin of 0 mm or 0.1-0.9 mm was 42 (95% c.i. 31 to 53) and 48 (95% c.i. 35 to 62) months respectively, compared with 75 (95% c.i. 65 to 85) for patients with ≥1 mm margin, P < 0.001. Margins of 0 mm or 0.1-0.9 mm were associated with poor overall survival in the multivariable analysis, HR 1.413 (95% c.i. 1.030 to 1.939), P = 0.032, and 1.399 (95% c.i. 1.025 to 1.910), P = 0.034, respectively. Conclusions: Despite modern chemotherapy the resection margin is still an important factor for the survival of patients resected for colorectal liver metastasis, and a margin of ≥1 mm is needed to achieve the best possible outcome.
MeSH term(s)	Humans ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/mortality ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Liver Neoplasms/drug therapy ; Liver Neoplasms/mortality ; Male ; Female ; Margins of Excision ; Aged ; Hepatectomy ; Middle Aged ; Sweden/epidemiology ; Registries ; Proportional Hazards Models ; Cohort Studies ; Aged, 80 and over
Language	English
Publishing date	2024-05-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrae035
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Article ; Online: Intermittent scanning continuous glucose monitoring is safe and useful in postsurgical glucose monitoring after pancreatoduodenectomy.

Fagher, Katarina / Ekström, Eva / Rystedt, Jenny / Tingstedt, Bobby / Andersson, Bodil / Löndahl, Magnus

Acta diabetologica

2023 Volume 60, Issue 12, Page(s) 1727–1733

Abstract: Aims: Intermittently scanned continuous glucose monitoring (isCGM) systems have not been thoroughly evaluated during in-hospital stay, and there are concerns about accuracy during various conditions. Patients undergoing pancreatoduodenectomy have an ... ...

Abstract	Aims: Intermittently scanned continuous glucose monitoring (isCGM) systems have not been thoroughly evaluated during in-hospital stay, and there are concerns about accuracy during various conditions. Patients undergoing pancreatoduodenectomy have an increased risk of hyperglycaemia after surgery which is aggravated by parenteral nutrition therapy. This study aims to evaluate glycaemic control and safety during insulin infusion in a surgical non-ICU ward, using a hybrid glucose monitoring approach with isCMG and periodic point-of-care (POC) testing. Methods: We prospectively included 100 patients with a resectable pancreatic tumour. After surgery, continuous insulin infusion was initiated when POC glucose was > 7 mmol/l and titrated to maintain glucose between 7 and 10 mmol/l. Glucose was monitored with isCGM together with intermittent POC, every 3-6 h. Median absolute relative difference (MARD) and hypoglycaemic events were evaluated. Mean glucose was compared with a historic control (n = 100) treated with multiple subcutaneously insulin injections, monitored with POC only. Results: The intervention group (isCGM/POC) had significantly lower POC glucose compared with the historic control group (8.8 ± 2.2 vs. 10.4 ± 3.4 mmol/l, p < 0.001). MARD was 17.8% (IQR 10.2-26.7). isCGM readings were higher than POC measurements in 91% of the paired cases, and isCGM did not miss any hypoglycaemic event. About 4.5% of all isCGM readings were < 3.9 mmol/l, but only six events were confirmed with POC, and none was < 3.0 mmol/l. Conclusions: A hybrid approach with isCGM/POC is a safe and effective treatment option in a non-ICU setting after pancreatoduodenectomy.
MeSH term(s)	Humans ; Blood Glucose Self-Monitoring ; Blood Glucose ; Diabetes Mellitus, Type 1 ; Pancreaticoduodenectomy/adverse effects ; Hypoglycemic Agents ; Insulin
Chemical Substances	Blood Glucose ; Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2023-08-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1097676-0
ISSN	1432-5233 ; 0940-5429
ISSN (online)	1432-5233
ISSN	0940-5429
DOI	10.1007/s00592-023-02158-0
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Article ; Online: An analysis of gender differences in treatment and outcome of periampullary tumours in Sweden - A national cohort study.

Williamsson, Caroline / Rystedt, Jenny / Andersson, Bodil

HPB : the official journal of the International Hepato Pancreato Biliary Association

2020 Volume 23, Issue 6, Page(s) 847–853

Abstract: Background: Little is known of possible gender differences in treatment of periampullary tumours and outcome after pancreatoduodenectomy (PD), and the aim of this study was therefore to investigate any variances from national multicentre perspective.: ...

Abstract	Background: Little is known of possible gender differences in treatment of periampullary tumours and outcome after pancreatoduodenectomy (PD), and the aim of this study was therefore to investigate any variances from national multicentre perspective. Methods: Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients diagnosed with a periampullary tumour from 2012 throughout 2017 was collected. The material was analysed in two groups, men and women, for palliative treatment and curative intended resection. Results: A total of 5677 patients were included, 2906 (51%) men and 2771 (49%) women. Women were older than men, 72 (65-78) years vs. 70 (64-76), p < 0.001. A lesser proportion of women were planned for resection (1131 (41%) vs. 1288 (44%), p = 0.008), but after adjusting for age and tumour location no difference was seen. Postoperative morbidity was equal, but women had significantly better long-term survival than men. The survival was equal for palliative men and women. Conclusion: No gender bias could be established when analysing treatment for periampullary tumours in Sweden, even though less women were offered surgery. Data suggest that even though women were older they tolerate surgery well and hence offering PD at a higher age for women could be suggested.
MeSH term(s)	Ampulla of Vater/surgery ; Cohort Studies ; Common Bile Duct Neoplasms/surgery ; Female ; Humans ; Male ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Sex Factors ; Sweden/epidemiology ; Treatment Outcome
Language	English
Publishing date	2020-12-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2020.11.1145
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Article ; Online: In Response to Letter to the Editor: Resanovic A, Resanovic V, Zdravkovic D, Toskovic B, Djordjevic M (2016) Bile Duct Injuries Indeed are a Rare, But Much Feared Complication.

Rystedt, J / Lindell, G / Montgomery, A

World journal of surgery

2016 Volume 40, Issue 9, Page(s) 2295–2296

Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Letter
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-016-3540-z
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Article ; Online: Completeness and correctness of cholecystectomy data in a national register--GallRiks.

Rystedt, J / Montgomery, A / Persson, G

Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society

2014 Volume 103, Issue 4, Page(s) 237–244

Abstract: Background and aims: To validate the Swedish Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) concerning completeness and correctness of entered data for cholecystectomies and evaluating the effect of repeated ...

Abstract	Background and aims: To validate the Swedish Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) concerning completeness and correctness of entered data for cholecystectomies and evaluating the effect of repeated audits. It is crucial for any register to obtain a high accuracy in order to be a credible and reliable source for quality evaluation, research, and development. Materials and methods: Completeness was determined by cross-matching the register with the Swedish National Patient Register. Completeness and overall correctness were assessed by comparing registered data to medical records. Correctness for rare occasions, such as bile duct injuries, was evaluated by comparing with claims sent to the Swedish Patient Insurance. Results: Of 64,538 cholecystectomies, 82.9% of the operations were registered in GallRiks and the coverage increased over time. By random sample, 94,919 sets of data were available for comparison at the first and second audit and the entries were found to be correct in 97.2% and 98.2% cases, respectively. A 100% correctness for bile duct injuries (n = 40) was seen when the index-operation was registered in GallRiks. Conclusion: GallRiks demonstrates high completeness, high correctness of entered data, and no indications of failure to report serious adverse events. Repeated audits increased the quality of registered data. GallRiks may be used for clinical evaluation on local and national level and the database enables scientific studies to be performed.
MeSH term(s)	Cholecystectomy/methods ; Cholecystectomy/statistics & numerical data ; Gallstones/surgery ; Hospital Records/statistics & numerical data ; Humans ; Quality Assurance, Health Care ; Registries/statistics & numerical data ; Reproducibility of Results ; Retrospective Studies ; Sweden
Language	English
Publishing date	2014-12
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2077691-3
ISSN	1799-7267 ; 1457-4969
ISSN (online)	1799-7267
ISSN	1457-4969
DOI	10.1177/1457496914523412
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Article ; Online: Quality-of-life after bile duct injury repaired by hepaticojejunostomy: a national cohort study.

Sturesson, Christian / Hemmingsson, Oskar / Månsson, Christopher / Sandström, Per / Strömberg, Cecilia / Taflin, Helena / Rystedt, Jenny

Scandinavian journal of gastroenterology

2020 Volume 55, Issue 9, Page(s) 1087–1092

Abstract: Objectives: Reports on quality-of-life (QoL) after bile duct injury (BDI) show conflicting results. The aim of this cohort study was to evaluate QoL stratified according to type of treatment.: Methods: QoL assessment using the SF-36 (36-item short ... ...

Abstract	Objectives: Reports on quality-of-life (QoL) after bile duct injury (BDI) show conflicting results. The aim of this cohort study was to evaluate QoL stratified according to type of treatment. Methods: QoL assessment using the SF-36 (36-item short form health survey) questionnaire. Patients with post-cholecystectomy BDI needing hepaticojejunostomy (HJ) were compared to all other treatments (BDI repair) and to patients without BDI at cholecystectomy (controls). Results: Patients needing a HJ after BDI reported reduced long-term QoL irrespective of time for diagnosis and repair in both the physical (PCS; Conclusions: Patients with postoperative diagnosis and patients with BDIs needing biliary reconstruction with HJ both reported reduced long-term QoL.
MeSH term(s)	Bile Duct Diseases ; Bile Ducts/surgery ; Cholecystectomy ; Cholecystectomy, Laparoscopic/adverse effects ; Cohort Studies ; Humans ; Quality of Life
Language	English
Publishing date	2020-07-31
Publishing country	England
Document type	Journal Article
ZDB-ID	82042-8
ISSN	1502-7708 ; 0036-5521
ISSN (online)	1502-7708
ISSN	0036-5521
DOI	10.1080/00365521.2020.1800076
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Article ; Online: Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor.

Rystedt, Jenny / Tingstedt, Bobby / Ansorge, Christoph / Nilsson, Johan / Andersson, Bodil

HPB : the official journal of the International Hepato Pancreato Biliary Association

2018 Volume 21, Issue 3, Page(s) 268–274

Abstract: Background: Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding.: Methods: Patients registered for pancreatoduodenectomy in the Swedish National ... ...

Abstract	Background: Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding. Methods: Patients registered for pancreatoduodenectomy in the Swedish National Pancreatic and Periampullary Cancer Registry, 2011 to 2016, were included. Major intraoperative bleeding was defined as ≥1000 ml. Univariable and multivariable analysis of preoperative parameters were performed. Results: In total, 1864 patients were included. The median blood loss was 600 ml, and 502 patients (27%) had registered bleeding of ≥1000 ml. Preoperative independent risk factors associated with major bleeding were male sex (p < 0.001), body mass index (BMI) ≥25 kg/m Conclusion: Most predictive parameters for major intraoperative bleeding are not modifiable. PBD is an independent predictor for major intraoperative bleeding and to reduce the risk, patients with resectable periampullary tumors should, if possible, be subject to surgery without preoperative biliary drainage.
MeSH term(s)	Aged ; Blood Loss, Surgical/prevention & control ; Databases, Factual ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Preoperative Care ; Retrospective Studies ; Risk Factors ; Sweden ; Treatment Outcome
Language	English
Publishing date	2018-08-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2018.07.024
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Article ; Online: Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective.

Rystedt, Jenny / Lindell, Gert / Montgomery, Agneta

World journal of surgery

2016 Volume 40, Issue 1, Page(s) 73–80

Abstract: Background: Bile duct injury (BDI) is a rare complication associated with cholecystectomy, and recommendations for treatment are based on publications from referral centers with a selection of major injuries and failures after primary repair. The aim ... ...

Abstract	Background: Bile duct injury (BDI) is a rare complication associated with cholecystectomy, and recommendations for treatment are based on publications from referral centers with a selection of major injuries and failures after primary repair. The aim was to analyze the frequency, treatment, and outcome of BDIs in an unselected population-based cohort. Methods: This was a retrospective cohort study including all BDIs registered in GallRiks (Swedish quality register for gallstone surgery and ERCP) during 2007-2011. Data for this study were based on a national follow-up survey where medical records were scrutinized and BDIs classified according to the Hannover classification. Results: A total of 174 BDIs arising from 55,134 cholecystectomies (0.3%) identified at 60 hospitals were included with a median follow-up of 37 months (9-69). 155 BDIs (89%) were detected during cholecystectomy, and immediate repair was attempted in 140 (90%). A total of 27 patients (18%) were referred to a HPB referral center. Hannover Grade C1 (i.e., small lesion <5 mm) dominated (n = 102; 59%). The most common repair was "suture over T-tube" (n = 78; 45%) and reconstruction with hepaticojejunostomy was performed in 30 patients (17%). A total of 31 patients (18 %) were diagnosed with stricture, 19 of which were primarily repaired with "suture over T-tube." The median in-hospital-stay was 14 days (1-149). Conclusions: The majority of BDIs were detected during the cholecystectomy and repaired by the operating surgeon. Although this is against most current recommendations, short-term outcome was surprisingly good.
MeSH term(s)	Bile Ducts/injuries ; Cholecystectomy/adverse effects ; Cholecystectomy/statistics & numerical data ; Female ; Gallbladder Neoplasms/epidemiology ; Gallbladder Neoplasms/etiology ; Humans ; Incidence ; Male ; Population Surveillance ; Registries ; Retrospective Studies ; Sweden/epidemiology
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-015-3281-4
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