Publications by authors named "Ernesto Sparrelid"
Objectives: This study aimed to develop and externally validate a model for predicting insufficient future liver remnant (FLR) hypertrophy after portal vein embolization (PVE) based on clinical factors and radiomics of pretreatment computed tomography (CT) PATIENTS AND METHODS: Clinical information and CT scans of 241 consecutive patients from three Swedish centers were retrospectively collected. One center (120 patients) was applied for model development, and the other two (59 and 62 patients) as test cohorts. Logistic regression analysis was adopted for clinical model development.
View Article and Find Full Text PDFIntraductal papillary mucinous neoplasms (IPMNs) display four histological subtypes: gastric foveolar, pancreaticobiliary, intestinal, and oncocytic. All of these subtypes harbor a different risk of cancer development. The clinical impact of these subtypes concerning the occurrence of high-grade dysplasia (HGD)/cancer (C) in specific morphological types, such as branch-duct (BD), main-duct (MD), and mixed-type (MT) IPMNs, has been less investigated.
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- - The study aimed to investigate the risk of pancreatic cancer following benign gallbladder disease (GBD) in a nationwide cohort of Swedish individuals aged 20-79 who had undergone cholecystitis or cholecystectomy from 1992 to 2016, along with matched non-exposed individuals.
- - Over a 15-year period, the researchers found that those with a history of GBD had a significantly higher incidence of pancreatic cancer within the first two years after diagnosis, with a hazard ratio of 2.74, particularly in younger patients aged 20-49, where the risk was even more pronounced.
- - The results suggest the need for increased clinical monitoring for pancreatic cancer in patients who have
Article Synopsis
- This study aimed to explore the impact of chronic obstructive pulmonary disease (COPD) on the risk of postoperative complications after pancreatoduodenectomy, a surgery for pancreatic cancer.
- Of 1009 patients studied, 57 had COPD, but no significant link was found between COPD and major complications as assessed by the Clavien-Dindo score (CD≥ IIIa). However, COPD was linked to a higher risk of developing postoperative pancreatic fistula (POPF).
- The findings suggest that while COPD does not increase overall complication rates significantly, it does pose a higher risk for POPF, indicating the need for careful evaluation of COPD in surgical risk assessments.
Surgical management of chronic pancreatitis: A narrative review.
United European Gastroenterol J
October 2024
Chronic pancreatitis is a severe disabling disease with persistent pain as the most prominent symptom often leading to significant quality of life (QoL) reduction. Current international guidelines propagate a step-up approach in which surgery should only be considered as a last resort in patients with failure of both medical and endoscopic interventions. Accumulating evidence, however, suggests that surgery is superior to endoscopic therapy and that early surgical intervention is beneficial in terms of pain relief, pancreatic function and QoL.
View Article and Find Full Text PDFBackground: Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR.
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- Metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming more common and is linked to serious health issues like liver cancer and cardiovascular disease.
- A study evaluated the risk of developing cholangiocarcinoma (CCA) in MASLD patients compared to a matched control group, using data from the Swedish National Patient Register over a span of 33 years.
- The results showed that only 0.1% of MASLD patients developed CCA, which is similar to the 0.3% occurrence in the general population, suggesting that there's no need for increased monitoring for CCA in MASLD patients.
Background: The overall treatment response among patients with locally advanced pancreatic cancer (LAPC) is poorly understood as most studies report solely on resected patients. We aimed to investigate the outcomes in patients with LAPC as an intention-to-treat-analysis from the time of diagnosis from a complete source population.
Patients And Methods: An observational cohort study in a population-defined region within a universal healthcare system.
Article Synopsis
- The study investigates how the length of time taken during liver surgeries affects the likelihood of postoperative complications in patients undergoing different types of liver resections.
- A total of 5,424 patients were analyzed from multiple centers between 2000 and 2022, focusing on procedures like right hemihepatectomy, technically major resection, and left lateral sectionectomy.
- Results show that patients in the longest operative time group had a significantly higher risk of complications, particularly in various surgical approaches like open, laparoscopic, and robotic surgeries.
Objective: The objective of this study was to evaluate the long-term oncological outcomes of patients with colorectal liver metastasis (CRLM) randomized for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH).
Introduction: For advanced CRLM, TSH or ALPPS may be needed for tumor freedom. The randomized, controlled, multicenter trial LIGRO showed an increased resection rate in patients who underwent ALPPS but no difference in morbidity or mortality.
Introduction: Following major liver resection, posthepatectomy liver failure (PHLF) is associated with a high mortality rate. As there is no therapy for PHLF available, avoidance remains the main goal. A sufficient future liver remnant (FLR) is one of the most important factors to reduce the risk for PHLF; however, it is not known which patients benefit of volumetric assessment prior to major surgery.
View Article and Find Full Text PDFObjective: To compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma.
Summary Background Data: Ampullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking.
Article Synopsis
- The study aimed to determine the need for routine surveillance after pancreatic cancer surgery and to analyze surveillance practices in Nordic countries.
- A review of global clinical guidelines and a survey of 20 pancreatic units in Norway, Sweden, Denmark, and Finland revealed inconsistent recommendations and practices regarding postoperative follow-up.
- Despite most units conducting routine surveillance, evidence supporting long-term monitoring (up to 5 years) is limited and varies significantly between institutions.
Objective: This is a preplanned, health economic evaluation from the LIGRO trial. One hundred patients with colorectal liver metastases (CRLM) and standardized future liver remnant <30% were randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or two-staged hepatectomy (TSH).
Summary Background Data: TSH, is an established method in advanced CRLM.
Article Synopsis
- Fibroblast activation protein (FAPI) is gaining attention as a target for imaging various cancers using radiolabeled inhibitors, but no clear imaging protocols have been established yet.
- This study aimed to determine if the time required for FAPI PET/CT imaging could be shortened from 4 minutes to 3 minutes per bed position without compromising image quality or diagnostic capability.
- Results showed that while images taken at 3 minutes had acceptable quality, those taken at 1 and 2 minutes were significantly worse than those at 4 minutes, indicating that a reduction in acquisition time could be feasible but with limits to maintain image integrity.
Differences in Lymph Node Metastases Patterns Among Non-pancreatic Periampullary Cancers and Histologic Subtypes: An International Multicenter Retrospective Cohort Study and Systematic Review.
Ann Surg Oncol
July 2024
Background: Standard lymphadenectomy for pancreatoduodenectomy is defined for pancreatic ductal adenocarcinoma and adopted for patients with non-pancreatic periampullary cancer (NPPC), ampullary adenocarcinoma (AAC), distal cholangiocarcinoma (dCCA), or duodenal adenocarcinoma (DAC). This study aimed to compare the patterns of lymph node metastases among the different NPPCs in a large series and in a systematic review to guide the discussion on surgical lymphadenectomy and pathology assessment.
Methods: This retrospective cohort study included patients after pancreatoduodenectomy for NPPC with at least one lymph node metastasis (2010-2021) from 24 centers in nine countries.
Article Synopsis
- International guidelines suggest that monitoring minimally invasive pancreatic surgery (MIPS) is important, but there is a lack of data, particularly on minimally invasive distal pancreatectomy (MIDP).
- This study analyzed data from 1672 patients in 83 European centers to compare robot-assisted distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP), focusing on intraoperative events, major morbidity, and mortality.
- Findings showed RDP had fewer intraoperative complications but longer surgery times compared to LDP; both procedures had low mortality rates, with LDP still being the more common approach despite the rising use of RDP.