Performance of an Algorithm Grading Surgery-Related Adverse Events According to the Clavien-Dindo Classification.

Objective: To assess performance of an algorithm for automated grading of surgery-related adverse events (AEs) according to Clavien-Dindo (C-D) classification.

Summary Background Data: Surgery-related AEs are common, lead to increased morbidity for patients, and raise healthcare costs. Resource-intensive manual chart review is still standard and to our knowledge algorithms using electronic health record (EHR) data to grade AEs according to C-D classification have not been explored.

Type II diabetes and metformin use does not affect colorectal cancer prognosis.

Previous studies on the impact of metformin and colorectal cancer (CRC) outcomes have been limited by small size and confounding by indication, yielding inconsistent results. The aim of this study was to assess whether diabetes and pre-diagnostic metformin use influence CRC prognosis. The study was performed using the Colorectal Cancer Data Base Sweden, a register-linkage originating from the Swedish Colorectal Cancer Register with linkage to national health care registers and demographic registers.

Survival after surgery beyond total mesorectal excision for primary locally advanced rectal cancer, a population-based study.

Background: The aim of this study was to compare relative survival in non-metastatic rectal cancer clinically staged as T3-T4 requiring beyond total mesorectal excision (TME) to that after standard TME.

Methods: This population-based study included all patients operated with anterior resection, abdominoperineal excision or Hartmann's procedure for non-metastatic rectal cancer clinically staged as T3-T4 in Sweden between 2009 and 2018. Relative survival was analysed in relation to surgery beyond TME (bTME), which was subcategorized as bTME- and bTME + to account for extent of resection.

Bone turnover biomarkers reflect radiation-induced bone injuries in women with non-metastatic rectal cancer.

Preoperative radiotherapy (RT) for non-metastatic rectal cancer reduces local recurrence rates but can cause pelvic insufficiency fractures. Despite the high morbidity from RT-induced skeletal injuries, predictive and preventive measures are lacking. How these injuries are reflected by bone biomarkers are largely unknown.

Preoperative use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diuretics increases the risk of dehydration after ileostomy formation: population-based cohort study.

Background: Readmission rates following ileostomy formation are high. Dehydration and consecutive renal failure are common causes of readmission, potentially pronounced by drugs affecting the homeostasis. The aim of the study was to assess the risk of dehydration after ileostomy formation in patients treated with angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) or diuretics.

Dam-calf contact rearing in Switzerland: Aspects of management and milking.

Cow-calf contact (CCC) rearing is becoming an increasingly popular alternative to the common practice of early separation of cow and calf in dairy management. Milkability can be impaired in nursing cows, which contributes to the loss of machine milk yield caused by calf intake, especially in pure dam-calf contact (DCC) systems. The aims of this study were (1) to describe the current status quo of DCC rearing regarding management and milking and (2) to evaluate the effects of DCC (suckling and milking vs.

The augmented value of using clinical notes in semi-automated surveillance of deep surgical site infections after colorectal surgery.

Background: In patients who underwent colorectal surgery, an existing semi-automated surveillance algorithm based on structured data achieves high sensitivity in detecting deep surgical site infections (SSI), however, generates a significant number of false positives. The inclusion of unstructured, clinical narratives to the algorithm may decrease the number of patients requiring manual chart review. The aim of this study was to investigate the performance of this semi-automated surveillance algorithm augmented with a natural language processing (NLP) component to improve positive predictive value (PPV) and thus workload reduction (WR).

External validation of semi-automated surveillance algorithms for deep surgical site infections after colorectal surgery in an independent country.

Background: Automated surveillance methods that re-use electronic health record data are considered an attractive alternative to traditional manual surveillance. However, surveillance algorithms need to be thoroughly validated before being implemented in a clinical setting. With semi-automated surveillance patients are classified as low or high probability of having developed infection, and only high probability patients subsequently undergo manual record review.

Quality of life and patient reported symptoms after colorectal cancer in a Swedish population.

Aim: A proportion of patients treated for colorectal cancer have impaired quality of life (QoL) but it is uncertain if the level of QoL differs from the corresponding background population. This population-based cohort study aimed to evaluate health-related QoL in colorectal cancer patients and compare their QoL with that of a Swedish reference population.

Methods: Patients who underwent surgery for colorectal cancer Stages I-III in the Stockholm-Gotland region in 2013-2015 received the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the QLQ-CR29 questionnaires and the low anterior resection syndrome score, 1 year after surgery.

Impact of radiotherapy on bone health in women with rectal cancer - A prospective cohort study.

Introduction: Pelvic radiotherapy (RT) increases the risk of pelvic insufficiency fractures. The aim was to investigate if RT is associated with changes in serum bone biomarkers in women with rectal cancer, and to examine the incidence of radiation-induced bone injuries and the association with bone biomarkers.

Material And Methods: Women diagnosed with rectal cancer stage I-III, planned for abdominal surgery ± preoperative (chemo) RT, were prospectively included and followed one year.

Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study.

Background: Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production.

Aim: To investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer.

Methods: Women diagnosed with stage I-III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year.

Oncological outcomes after complete mesocolic excision in right-sided colon cancer: a population-based study.

Aim: Complete mesocolic excision (CME) has been proposed as the preferred surgical technique for resection of colon cancer. This prospective cohort study evaluates the effect of CME surgery on colon cancer mortality after right-sided hemicolectomy on a population level.

Methods: Data from the Swedish Colorectal Cancer Registry and the Cause of Death Registry on all patients treated with elective right-sided hemicolectomy for colon cancer Stages I-III in the Stockholm County 2008-2012 were analysed.

Differences in management and outcome for colon and rectal carcinoma with synchronous liver metastases: a population-based cohort study.

Aim: Surgical treatment of colorectal cancer with synchronous colorectal liver metastases (SCRLM) can follow three different strategies with regard to the timing of liver resection. The aim of this study was to describe the selection of surgical strategy, focusing on differences between colon and rectal cancer with SCRLM, postoperative morbidity/mortality and survival.

Method: This was a retrospective population-based study of patients with SCRLM registered in the Swedish Colorectal Cancer Registry in the Stockholm/Gotland region during 2010-2017 and treated with surgical resection of the primary tumour and liver metastases (LM).

Improvement of the experience of colorectal cancer patients in Sweden with a regional cancer plan.

Aim: The Stockholm-Gotland Regional Cancer Plan was launched in 2012 to improve cancer care. A personal contact nurse (CN), an individual written care plan (IWCP) and a standardized care pathway (SCP) were introduced. The aim of the current study was to evaluate whether these efforts have resulted in an improved experience for patients treated for colorectal cancer.

The effects of testosterone administration on muscle areas of the trunk and pelvic floor in hysterectomized women with low testosterone levels: proof-of-concept study.

Objective: The aim of this study was to determine the effect of testosterone administration on trunk and pelvic floor muscle area in women with low testosterone levels.

Methods: Participants were hysterectomized women with total testosterone<31 ng/dL and/or free testosterone<3.5 pg/mL; participating in the Testosterone Dose Response in Surgically Menopausal Women (TDSM) trial.

Acute primary testicular failure due to radiotherapy increases risk of severe postoperative adverse events in rectal cancer patients.

Aim: The aim of this study is to analyze postoperative adverse events (AE) in relation to acute primary testicular failure after radiotherapy (RT) for rectal cancer.

Method: This relation was assessed in 104 men, included in a previous prospective cohort study of men treated with surgical resection of the rectum for rectal cancer stage I-III. Postoperative AE were graded according to Clavien-Dindo (2004).

Low anterior resection syndrome after right- and left-sided resections for colonic cancer.

Background: This population-based cohort study aimed to evaluate occurrence of low anterior resection syndrome (LARS) and correlate this to health-related quality of life in patients who had undergone segmental colonic resection for colonic cancer in the Stockholm-Gotland region. The hypothesis was that there is a difference in occurrence of LARS depending on whether a right- or a left-sided resection was performed.

Methods: Patients who underwent segmental colonic resection for colonic cancer stages I-III in the Stockholm-Gotland region in 2013-2015 received EORTC QLQ-C30, QLQ-CR29 and LARS score questionnaires 1 year after surgery.

Effect of radiotherapy for rectal cancer on ovarian androgen production.

Background: The impact of radiotherapy (RT) for rectal cancer on ovarian androgen production is unknown. The aim was to examine the effect of RT for rectal cancer on androgen levels in non-oophorectomised women and the association with female sexual desire.

Method: This prospective cohort study included women treated with surgery for rectal cancer with or without RT.

Patterns of complications following urinary tract reconstruction after multivisceral surgery in colorectal and anal cancer.

Background: Multi-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications.

Methods: All patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004-2015 were included in this retrospective cohort study.

Changes in Clinical Practice Reduce the Rate of Anastomotic Leakage After Colorectal Resections.

Background: Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections.

Methods: Retrospective cohort study based on prospectively collected data.

Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose-response study in young healthy men.

Testosterone dose-dependently increases appendicular muscle mass. However, the effects of testosterone administration on the core muscles of the trunk and the pelvis have not been evaluated. The present study evaluated the effects of testosterone administration on truncal and pelvic muscles in a dose-response trial.

Complete mesocolic excision in right-sided colon cancer does not increase severe short-term postoperative adverse events.

Aim: The aim was to assess whether complete mesocolic excision (CME) in patients with right-sided colon cancer is related to short-term mortality or postoperative adverse events requiring reoperation. The complete mobilization of an integral mesocolon and central ligation of blood vessels are essential steps in CME surgery. The resultant specimen, with an intact mesocolic fascia and a high number of harvested lymph nodes, is believed to be oncologically favourable.