A. Wibe - Academia.edu (original) (raw)

Papers by A. Wibe

Research paper thumbnail of Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study

BJOG: An International Journal of Obstetrics & Gynaecology, 2020

Setting Two Norwegian health regions. Population or sample Women with first deliveries between Ma... more Setting Two Norwegian health regions. Population or sample Women with first deliveries between May 2009 and December 2010. Conclusions Mode of first delivery modified AI prevalence during the 6-year period, whereas age, bowel disease and bowel evacuation problems were associated with higher prevalence of AI from late first pregnancy to 6 years postpartum.

Research paper thumbnail of Changes in Anal Incontinence Among First Time Mothers-What Happens in Pregnancy and During the First Year After Delivery?

Research paper thumbnail of The EURECCA project: Data items scored by European colorectal cancer audit registries

European Journal of Surgical Oncology (EJSO), 2012

Aims: The EURECCA (European Registration of Cancer Care) consortium is currently formed by nine i... more Aims: The EURECCA (European Registration of Cancer Care) consortium is currently formed by nine independently founded national colorectal audit registrations, of which most already run for many years. The cumulative experience of EURECCA's participants could be used to identify a 'core dataset' that covers all important aspects needed for high quality auditing and at the same time lacking needless data items that only consumes administrative effort. The aim of this study is to compare the data items used by the nine registries participating in EURECCA to identify a core dataset and explore options for future research. Methods: All colorectal outcome registrations participating in the EURECCA project were asked to supply a list with all the data items they score. Items were scored 'present' if they appeared literally in a registration or in case they could be calculated using other items in the same registration. The definition of a 'shared data item' was that at least eight of the nine participating registries scored the item.

Research paper thumbnail of A National Strategic Change in Treatment Policy for Rectal Cancer—Implementation of Total Mesorectal Excision as Routine Treatment in Norway. A National Audit

Diseases of the Colon & Rectum, 2002

Rectal cancer surgery has been characterized by a high incidence of local recurrence, an occurren... more Rectal cancer surgery has been characterized by a high incidence of local recurrence, an occurrence which influences survival negatively. In Norway there was a growing recognition that local recurrence rates were related to surgeon performance and that surgeons applying a standardized surgical technique in the form of total mesorectal excision could achieve better results. This contrasts with the prevailing argument voiced by many opinion leaders that local recurrence rates and possibly survival rates can only be improved by adjuvant or neoadjuvant treatment strategies. The Norwegian Rectal Cancer Project-initiated in 1993-aimed at improving the outcome of patients with rectal cancer by implementing total mesorectal excision as the standard rectal resection technique. This observational national cohort study covers all new patients (3,319) with rectal cancer from a population of 4.5 million treated between November 1993 and August 1997. The main outcome measures were local recurrence, survival, and postoperative mortality and morbidity rates. The technique of total mesorectal excision was compared with conventional surgery. The proportion of patients undergoing total mesorectal excision was 78 percent in 1994, increasing to 92 percent in 1997. The observed local recurrence rate for patients undergoing a curative resection was 6 percent in the group treated by total mesorectal excision and 12 percent in the conventional surgery group. Four-year survival rate was 73 percent after total mesorectal excision and 60 percent after conventional surgery. Postoperative mortality rate was 3 percent and the anastomotic dehiscence rate was 10 percent. Radiotherapy was given to 5 percent and chemotherapy to 3 percent of the patients in the curative resection group. A refinement of the surgical resection technique for rectal cancer can be achieved on a national level, the technique of total mesorectal excision can be widely distributed, and surgery alone can give good results.

Research paper thumbnail of Oncological Outcomes After Total Mesorectal Excision for Cure for Cancer of the Lower Rectum: Anterior vs. Abdominoperineal Resection

Diseases of the Colon & Rectum, 2004

This study was designed to examine the outcome of cancer of the lower rectum, particularly the ra... more This study was designed to examine the outcome of cancer of the lower rectum, particularly the rates of local recurrence and survival for tumors located in this area that have been treated by anterior or abdominoperineal resections. A prospective, observational, national, cohort study which is part of the Norwegian Rectal Cancer Project. The present cohort includes all patients undergoing total mesorectal excision in 47 hospitals during the period November 1993 to December 1999. A total of 2,136 patients with rectal cancer within 12 cm of the anal verge were analyzed; there were 1,315 (62 percent) anterior resections and 821 (38 percent) abdominoperineal resections. The lower edge of the tumor was located 0 to 5 cm from the anal verge in 791 patients, 6 to 8 cm in 558 patients, and 9 to 12 cm in 787 patients. According to the TNM classification, there were 33 percent Stage I, 35 percent Stage II, and 32 percent Stage III. Univariate analyses: The five-year local recurrence rate was 15 percent in the lower level, 13 percent in the intermediate level, and 9 percent in the upper level (P=0.014). It was 10 percent local recurrence after anterior resection and 15 percent after abdominoperineal resection (P=0.008). The five-year survival rate was 59 percent in the lower level, 62 percent in the intermediate level, and 69 percent in the upper level (P<0.001), respectively, and it was 68 percent in the anterior-resection group and 55 percent in the abdominoperineal-resection group (P<0.001). Multivariate analyses: The level of the tumor influenced the risk of local recurrence (hazard ratio, 1.8; 95 percent confidence interval, 1.1-2.3), but the operative procedure, anterior resection vs. abdominoperineal resection, did not (hazard ratio, 1.2; 95 percent confidence interval, 0.7-1.8). On the contrary, operative procedure influenced survival (hazard ratio, 1.3; 95 percent confidence interval, 1-1.6), but tumor level did not (hazard ratio, 1.1; 95 percent confidence interval, 0.9-1.5). In addition to patient and tumor characteristics (T4 tumors), intraoperative bowel perforation and tumor involvement of the circumferential margin were identified as significant prognostic factors, which were more common in the lower rectum, explaining the inferior prognosis for tumors in this region. T4 tumors, R1 resections, and/or intraoperative perforation of the tumor or bowel wall are main features of low rectal cancers, causing inferior oncologic outcomes for tumors in this area. If surgery is optimized, preventing intraoperative perforation and involvement of the circumferential resection margin, the prognosis for cancers of the lower rectum seems not to be inherently different from that for tumors at higher levels. In that case, the level of the tumor or the type of resection will not be indicators for selecting patients for radiotherapy.

Research paper thumbnail of Long-term surgical load in patients with ileal pouch-anal anastomosis

Colorectal Disease, 2009

To evaluate surgical workload and complications in patients who had undergone restorative proctoc... more To evaluate surgical workload and complications in patients who had undergone restorative proctocolectomy, through long-term follow-up in one single institution. From 1984 to 2006, 304 consecutive patients underwent Ileal Pouch-Anal Anastomosis (IPAA). There were 182 stapled and 122 hand-sewn anastomoses. A protective loop ileostomy was established in 256 patients (84%), whereas 48 patients (16%) were without a covering stoma. Twenty-nine patients (10%) suffered from early anastomotic leakage. A protective stoma did not prevent early anastomotic dehiscence (P = 0.11) or the number of pelvic abscesses (P = 0.09). Early complications required 20 laparotomies with creation of a diverting stoma in nine patients. There were 16 (6%) complications related to closure of the loop ileostomy. Sixty-six patients needed an additional re-operation related to the IPAA procedure. There were 20 removals of pouches and three permanent diverting stomas. The estimated removal rate at 20 years of a functioning pouch was 11% (CI +/- 6). Altogether 100 (33%) patients had one or more surgical procedures, excluding dilations of anastomotic strictures and closing of a loop ileostomy. These 100 patients underwent 187 surgical procedures. The estimated rate of a first re-operation due to complications was 52% (CI +/- 16) in 20 years. Hand-sewn anastomoses had similar complications and failure rates as stapled anastomoses. More than half of patients operated with restorative proctocolectomy will need surgical intervention within 20 years and the failure rate is more than 10%. The high risk of complications and failure inherent in the procedure should not be ignored.

Research paper thumbnail of Total mesorectal excision for rectal cancer - what can be achieved by a national audit?

Colorectal Disease, 2003

Objective The results of rectal cancer surgery in Norway have been poor. In a national audit for ... more Objective The results of rectal cancer surgery in Norway have been poor. In a national audit for the period 1986-88, 28% of the patients developed local recurrence (LR) following treatment with a curative intent. Five-year overall survival was 55% for patients younger than 75 years. The aim of this study is to report how an initiative focusing on better surgery can improve the prognosis for rectal cancer patients on a national level. Methods In 1994, the Norwegian Rectal Cancer Group was founded. The aim of this initiative was to improve the surgical standard by implementing total mesorectal excision (TME) on a national level and to evaluate the results. A number of courses were arranged to teach the surgeons the TME technique, and pathologists were trained to increase the standard of both macroscopic and microscopic assessment of specimens. A rectal cancer registry was established, and all surgical departments treating rectal cancer were invited to transfer their clinical data to this registry. Each department regularly receives its own results together with the national average for comparison and quality control. Results The Rectal Cancer Registry includes all patients with rectal cancer diagnosed since November 1993. From then until December 1999, 5382 patients had a tumour located within 16 cm from the anal verge, and 3432 patients underwent rectal resection with a curative intent. Of these, 9% had adjuvant radiotherapy, and 2% were given chemotherapy. There was a rapid implementation of the new technique, as 78% underwent TME in 1994, increasing to 96% in 1998. After 39 months mean followup the rate of local recurrence was 8%, and 5-year overall survival was 71% for patients younger than 75 years. Conclusions An optimized surgical technique (TME) for rectal cancer can reduce the rate of local recurrence and increase overall survival. This improved surgical treatment can be implemented on a national level within a few years. Specialization of surgeons, feedback of results and a separate rectal cancer registry are thought to be major contributors to the improved treatment.

Research paper thumbnail of Inadvertent perforation during rectal cancer resection in Norway

British Journal of Surgery, 2004

Background Inadvertent perforation of the bowel or tumour is a relatively common complication dur... more Background Inadvertent perforation of the bowel or tumour is a relatively common complication during resection of rectal cancer. The purpose of this study was to examine intraoperative perforation following the introduction of mesorectal excision as a standard surgical technique in Norway. Methods This was a prospective national cohort study of 2873 patients undergoing major resection of rectal carcinoma at 54 Norwegian hospitals from November 1993 to December 1999. Results The overall perforation rate was 8·1 per cent (234 of 2873 patients). In a multivariate analysis, the risk of perforation was significantly greater in patients undergoing abdominoperineal resection (odds ratio (OR) 5·6 (95 per cent confidence interval (c.i.) 3·5 to 8·8)) and in those aged 80 years or more (OR 2·0 (95 per cent c.i. 1·2 to 3·5)). The 5-year local recurrence rate was 28·8 per cent following perforation, compared with 9·9 per cent in patients with no perforation (P < 0·001); survival rates were 41...

Research paper thumbnail of Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national level

British Journal of Surgery, 2004

Background The purpose of this prospective study was to examine the influence of hospital caseloa... more Background The purpose of this prospective study was to examine the influence of hospital caseload on long-term outcome following standardization of rectal cancer surgery at a national level. Methods Data relating to all 3388 Norwegian patients with rectal cancer treated for cure between November 1993 and December 1999 were recorded in a national database. Treating hospitals were divided into four groups according to their annual caseload: hospitals in group 1 (n = 4) carried out 30 or more procedures, those in group 2 (n = 6) performed 20–29 procedures, group 3 (n = 16) 10–19 procedures and group 4 (n = 28) fewer than ten procedures. Results The 5-year local recurrence rates were 9·2, 14·7, 12·5 and 17·5 per cent (P = 0·003) and 5-year overall survival rates were 64·4, 64·0, 60·8 and 57·8 per cent (P = 0·105) respectively in the four hospital caseload groups. An annual hospital caseload of less than ten procedures increased the risk of local recurrence compared with that in hospita...

Research paper thumbnail of Long-term function after ileal pouch-anal anastomosis -Function does not deteriorate with time

Colorectal Disease, 2010

There are conflicting reports regarding long term function after ileal pouch-anal anastomosis (IP... more There are conflicting reports regarding long term function after ileal pouch-anal anastomosis (IPAA). The aim of the present prospective study was to investigate the influence of duration as an independent factor on long-term function results. Between 1984 and 2007, 315 patients underwent IPAA and were followed by a standardised interview and endoscopy protocol. There were 1802 interviews. Two hundred and thirty-five patients had three or more visits and these data were analysed by Time-Series-Cross-Section multivariate regression analysis. The mean time follow up was 12 years and the mean interval between visits was 34.5 months. Mean frequency of defecation was 5.2 in the day and 0.55 at night. This did not change with time. Daytime and night incontinence occurred in 13% and 21%. There was no change in incontinence, urgency, soiling or perineal excoriation with time. After 24 years the cumulative incidence of pouchitis was 43.5%. Twenty patients had chronic pouchitis (6.3%). The interval from IPAA did not influence the long-term functional outcome.

Research paper thumbnail of Lunchtime Posters

Colorectal Disease, 2012

Aim: This study aimed to assess the feasibility of colorectal single access laparoscopic surgery ... more Aim: This study aimed to assess the feasibility of colorectal single access laparoscopic surgery (C-SALS) in routine practice without compromising safety. Method: Clinical data were prospectively collected during our initial experience of C-SALS. Results: Since August 2011, 50 C-SALS have been performed. Over the same period, 58 classic laparoscopic and 31 open colorectal procedures were performed. Patients suitable for laparoscopic colorectal surgery have been systematically enrolled for C-SALS. Exclusion criteria were obesity, rectal cancer, T4 tumours, and previous laparotomy. There were 29 men and 21 women with a mean age of 49 years. Median BMI was 24 (17–31). Procedures performed were: 38 segmental colectomies, three sub-total colectomies, one secondary proctectomy with ileal-pouch anal anastomosis (IPAA), six restorative proctocolectomies with IPAA, one small bowel resection and one adhesiolysis. Indications were IBD, diverticulitis or malignancy. There were no intra-operative complications. Three patients (6%) were converted to laparotomy and one patient (2%) to classic laparoscopy. Median skin incision length was 4 cm (3–6). There was no mortality. Three IBD patients (6%) developed anastomotic dehiscence. Median hospital stay was 6 days (3–18) and median follow-up was 4.7 months (1–12). Conclusion: C-SALS is feasible and safe. Randomised controlled trials are required to point out long-term advantages.

Research paper thumbnail of Survival in Rectal Cancer in the Nordic countries and Scotland

The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperat... more The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperative treatments; a multitude of surgical and technical choices; possibilities of postoperative treatments and postoperative care and follow up. In this thesis, some aspects of this complex paradigm have been further investigated. One of the most feared complications after rectal cancer surgery is anastomotic leakage. The risk of anastomotic leakage is affected by non-influenceable factors related to the tumour and the patient. In the first paper, the risk of anastomotic leakage in relation to a surgical instrument, the circular stapler, was investigated. The risk of leakage was 7% or 11%, depending on the choice of instrument. In the second paper, a long-term evaluation of survival and local recurrence rates in the Swedish Rectal Cancer Trial was made. Randomisation was to either preoperative radiotherapy followed by surgery or surgery alone. After 13 years median follow-up, survival was ...

Research paper thumbnail of Prognostic signi ® cance of the circumferential resection margin following total mesorectal excision for rectal cancer

Background: Knowledge of prognostic factors following resection of rectal cancer may be used in t... more Background: Knowledge of prognostic factors following resection of rectal cancer may be used in the selection of patients for adjuvant therapy. This study examined the prognostic impact of the circumferential resection margin on local recurrence, distant metastasis and survival rates. Methods: A national population-based rectal cancer registry included all 3319 new patients from November 1993 to August 1997. Some 686 patients underwent total mesorectal excision with a known circumferential margin. This shortest radial resection margin was measured in ®xed specimens. None of the patients had adjuvant radiotherapy. Results: Following potentially curative resection and after a median follow-up of 29 (range 14± 60) months, the overall local recurrence rate was 7 per cent (46 of 686 patients): 22 per cent among patients with a positive resection margin and 5 per cent in those with a negative margin (margin greater than 1 mm). Forty per cent of patients with a positive margin developed di...

Research paper thumbnail of Assessment of self‐rated health 5 years after Roux‐en‐Y gastric bypass for severe obesity

BJS Open

Background: Patients' perceptions of health change after bariatric surgery are complex. The aim o... more Background: Patients' perceptions of health change after bariatric surgery are complex. The aim of this study was to explore whether self-rated health (SRH), a widely used tool in public health research, might be relevant as an outcome measure after Roux-en-Y gastric bypass (RYGB) for severe obesity. Methods: This was a single-centre retrospective study of a local quality registry. SRH score was registered at baseline and 5 years after RYGB. SRH, one of the 36 items in the quality-of-life Short Form 36 (SF-36 ®) questionnaire, is the answer to this single question: 'In general, would you say your health is excellent (1), very good (2), good (3), fair (4) or poor (5)?' Change in SRH was analysed in relation to change in weight, co-morbidities and quality of life after 5 years. Results: Of a total of 359 patients who underwent RYGB between September 2006 and February 2011, 233 (64⋅9 per cent) reported on SRH before and 5 years after surgery. Of these, 180 (77⋅3 per cent) were women, and the mean(s.d.) age was 40(9) years. Some 154 patients (66⋅1 per cent) reported an improvement in SRH, 60 (25⋅8 per cent) had no change, and SRH decreased in 19 patients (8⋅2 per cent). SRH in improvers was related to better scores in all SF-36 ® domains, whereas SRH in non-improvers was related to unchanged or worsened scores in all SF-36 ® domains except physical function. Conclusion: Two-thirds of patients reported improved SRH 5 years after RYGB for severe obesity. In view of its simplicity, SRH may be an easy-to-use outcome measure in bariatric surgery.

Research paper thumbnail of Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

BJOG: An International Journal of Obstetrics & Gynaecology

Research paper thumbnail of Complications and risk prediction in treatment of elderly patients with rectal cancer

International Journal of Colorectal Disease, 2015

ABSTRACT

Research paper thumbnail of 73 The Norwegian programme

Research paper thumbnail of Physical exercise during adjuvant chemotherapy for colorectal cancer—a non-randomized feasibility study

Supportive Care in Cancer

Background Colorectal cancer (CRC) is the third most common cancer worldwide, and a large proport... more Background Colorectal cancer (CRC) is the third most common cancer worldwide, and a large proportion of the patients receive adjuvant oxaliplatin-based chemotherapy. Most of these experience chemotherapy-induced peripheral neuropathy (CIPN), affecting quality of life. Evidence to advise exercise to reduce CIPN is limited. The primary aim of this study was to investigate the feasibility of an exercise intervention and data collection among CRC patients during adjuvant chemotherapy. Material and methods This non-randomized feasibility study included CRC patients admitted to adjuvant chemotherapy to an intervention consisting of supervised aerobic endurance, resistance, and balance exercises twice a week at the hospital in addition to home-based exercise once a week. A physiotherapist supervised the patients, and the intervention lasted throughout the period of adjuvant chemotherapy (12–24 weeks). Participants performed physical tests and filled in questionnaires at baseline, 3, 6, 9, ...

Research paper thumbnail of Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

British Journal of Surgery

Research paper thumbnail of Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival

Research paper thumbnail of Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study

BJOG: An International Journal of Obstetrics & Gynaecology, 2020

Setting Two Norwegian health regions. Population or sample Women with first deliveries between Ma... more Setting Two Norwegian health regions. Population or sample Women with first deliveries between May 2009 and December 2010. Conclusions Mode of first delivery modified AI prevalence during the 6-year period, whereas age, bowel disease and bowel evacuation problems were associated with higher prevalence of AI from late first pregnancy to 6 years postpartum.

Research paper thumbnail of Changes in Anal Incontinence Among First Time Mothers-What Happens in Pregnancy and During the First Year After Delivery?

Research paper thumbnail of The EURECCA project: Data items scored by European colorectal cancer audit registries

European Journal of Surgical Oncology (EJSO), 2012

Aims: The EURECCA (European Registration of Cancer Care) consortium is currently formed by nine i... more Aims: The EURECCA (European Registration of Cancer Care) consortium is currently formed by nine independently founded national colorectal audit registrations, of which most already run for many years. The cumulative experience of EURECCA's participants could be used to identify a 'core dataset' that covers all important aspects needed for high quality auditing and at the same time lacking needless data items that only consumes administrative effort. The aim of this study is to compare the data items used by the nine registries participating in EURECCA to identify a core dataset and explore options for future research. Methods: All colorectal outcome registrations participating in the EURECCA project were asked to supply a list with all the data items they score. Items were scored 'present' if they appeared literally in a registration or in case they could be calculated using other items in the same registration. The definition of a 'shared data item' was that at least eight of the nine participating registries scored the item.

Research paper thumbnail of A National Strategic Change in Treatment Policy for Rectal Cancer—Implementation of Total Mesorectal Excision as Routine Treatment in Norway. A National Audit

Diseases of the Colon & Rectum, 2002

Rectal cancer surgery has been characterized by a high incidence of local recurrence, an occurren... more Rectal cancer surgery has been characterized by a high incidence of local recurrence, an occurrence which influences survival negatively. In Norway there was a growing recognition that local recurrence rates were related to surgeon performance and that surgeons applying a standardized surgical technique in the form of total mesorectal excision could achieve better results. This contrasts with the prevailing argument voiced by many opinion leaders that local recurrence rates and possibly survival rates can only be improved by adjuvant or neoadjuvant treatment strategies. The Norwegian Rectal Cancer Project-initiated in 1993-aimed at improving the outcome of patients with rectal cancer by implementing total mesorectal excision as the standard rectal resection technique. This observational national cohort study covers all new patients (3,319) with rectal cancer from a population of 4.5 million treated between November 1993 and August 1997. The main outcome measures were local recurrence, survival, and postoperative mortality and morbidity rates. The technique of total mesorectal excision was compared with conventional surgery. The proportion of patients undergoing total mesorectal excision was 78 percent in 1994, increasing to 92 percent in 1997. The observed local recurrence rate for patients undergoing a curative resection was 6 percent in the group treated by total mesorectal excision and 12 percent in the conventional surgery group. Four-year survival rate was 73 percent after total mesorectal excision and 60 percent after conventional surgery. Postoperative mortality rate was 3 percent and the anastomotic dehiscence rate was 10 percent. Radiotherapy was given to 5 percent and chemotherapy to 3 percent of the patients in the curative resection group. A refinement of the surgical resection technique for rectal cancer can be achieved on a national level, the technique of total mesorectal excision can be widely distributed, and surgery alone can give good results.

Research paper thumbnail of Oncological Outcomes After Total Mesorectal Excision for Cure for Cancer of the Lower Rectum: Anterior vs. Abdominoperineal Resection

Diseases of the Colon & Rectum, 2004

This study was designed to examine the outcome of cancer of the lower rectum, particularly the ra... more This study was designed to examine the outcome of cancer of the lower rectum, particularly the rates of local recurrence and survival for tumors located in this area that have been treated by anterior or abdominoperineal resections. A prospective, observational, national, cohort study which is part of the Norwegian Rectal Cancer Project. The present cohort includes all patients undergoing total mesorectal excision in 47 hospitals during the period November 1993 to December 1999. A total of 2,136 patients with rectal cancer within 12 cm of the anal verge were analyzed; there were 1,315 (62 percent) anterior resections and 821 (38 percent) abdominoperineal resections. The lower edge of the tumor was located 0 to 5 cm from the anal verge in 791 patients, 6 to 8 cm in 558 patients, and 9 to 12 cm in 787 patients. According to the TNM classification, there were 33 percent Stage I, 35 percent Stage II, and 32 percent Stage III. Univariate analyses: The five-year local recurrence rate was 15 percent in the lower level, 13 percent in the intermediate level, and 9 percent in the upper level (P=0.014). It was 10 percent local recurrence after anterior resection and 15 percent after abdominoperineal resection (P=0.008). The five-year survival rate was 59 percent in the lower level, 62 percent in the intermediate level, and 69 percent in the upper level (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), respectively, and it was 68 percent in the anterior-resection group and 55 percent in the abdominoperineal-resection group (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Multivariate analyses: The level of the tumor influenced the risk of local recurrence (hazard ratio, 1.8; 95 percent confidence interval, 1.1-2.3), but the operative procedure, anterior resection vs. abdominoperineal resection, did not (hazard ratio, 1.2; 95 percent confidence interval, 0.7-1.8). On the contrary, operative procedure influenced survival (hazard ratio, 1.3; 95 percent confidence interval, 1-1.6), but tumor level did not (hazard ratio, 1.1; 95 percent confidence interval, 0.9-1.5). In addition to patient and tumor characteristics (T4 tumors), intraoperative bowel perforation and tumor involvement of the circumferential margin were identified as significant prognostic factors, which were more common in the lower rectum, explaining the inferior prognosis for tumors in this region. T4 tumors, R1 resections, and/or intraoperative perforation of the tumor or bowel wall are main features of low rectal cancers, causing inferior oncologic outcomes for tumors in this area. If surgery is optimized, preventing intraoperative perforation and involvement of the circumferential resection margin, the prognosis for cancers of the lower rectum seems not to be inherently different from that for tumors at higher levels. In that case, the level of the tumor or the type of resection will not be indicators for selecting patients for radiotherapy.

Research paper thumbnail of Long-term surgical load in patients with ileal pouch-anal anastomosis

Colorectal Disease, 2009

To evaluate surgical workload and complications in patients who had undergone restorative proctoc... more To evaluate surgical workload and complications in patients who had undergone restorative proctocolectomy, through long-term follow-up in one single institution. From 1984 to 2006, 304 consecutive patients underwent Ileal Pouch-Anal Anastomosis (IPAA). There were 182 stapled and 122 hand-sewn anastomoses. A protective loop ileostomy was established in 256 patients (84%), whereas 48 patients (16%) were without a covering stoma. Twenty-nine patients (10%) suffered from early anastomotic leakage. A protective stoma did not prevent early anastomotic dehiscence (P = 0.11) or the number of pelvic abscesses (P = 0.09). Early complications required 20 laparotomies with creation of a diverting stoma in nine patients. There were 16 (6%) complications related to closure of the loop ileostomy. Sixty-six patients needed an additional re-operation related to the IPAA procedure. There were 20 removals of pouches and three permanent diverting stomas. The estimated removal rate at 20 years of a functioning pouch was 11% (CI +/- 6). Altogether 100 (33%) patients had one or more surgical procedures, excluding dilations of anastomotic strictures and closing of a loop ileostomy. These 100 patients underwent 187 surgical procedures. The estimated rate of a first re-operation due to complications was 52% (CI +/- 16) in 20 years. Hand-sewn anastomoses had similar complications and failure rates as stapled anastomoses. More than half of patients operated with restorative proctocolectomy will need surgical intervention within 20 years and the failure rate is more than 10%. The high risk of complications and failure inherent in the procedure should not be ignored.

Research paper thumbnail of Total mesorectal excision for rectal cancer - what can be achieved by a national audit?

Colorectal Disease, 2003

Objective The results of rectal cancer surgery in Norway have been poor. In a national audit for ... more Objective The results of rectal cancer surgery in Norway have been poor. In a national audit for the period 1986-88, 28% of the patients developed local recurrence (LR) following treatment with a curative intent. Five-year overall survival was 55% for patients younger than 75 years. The aim of this study is to report how an initiative focusing on better surgery can improve the prognosis for rectal cancer patients on a national level. Methods In 1994, the Norwegian Rectal Cancer Group was founded. The aim of this initiative was to improve the surgical standard by implementing total mesorectal excision (TME) on a national level and to evaluate the results. A number of courses were arranged to teach the surgeons the TME technique, and pathologists were trained to increase the standard of both macroscopic and microscopic assessment of specimens. A rectal cancer registry was established, and all surgical departments treating rectal cancer were invited to transfer their clinical data to this registry. Each department regularly receives its own results together with the national average for comparison and quality control. Results The Rectal Cancer Registry includes all patients with rectal cancer diagnosed since November 1993. From then until December 1999, 5382 patients had a tumour located within 16 cm from the anal verge, and 3432 patients underwent rectal resection with a curative intent. Of these, 9% had adjuvant radiotherapy, and 2% were given chemotherapy. There was a rapid implementation of the new technique, as 78% underwent TME in 1994, increasing to 96% in 1998. After 39 months mean followup the rate of local recurrence was 8%, and 5-year overall survival was 71% for patients younger than 75 years. Conclusions An optimized surgical technique (TME) for rectal cancer can reduce the rate of local recurrence and increase overall survival. This improved surgical treatment can be implemented on a national level within a few years. Specialization of surgeons, feedback of results and a separate rectal cancer registry are thought to be major contributors to the improved treatment.

Research paper thumbnail of Inadvertent perforation during rectal cancer resection in Norway

British Journal of Surgery, 2004

Background Inadvertent perforation of the bowel or tumour is a relatively common complication dur... more Background Inadvertent perforation of the bowel or tumour is a relatively common complication during resection of rectal cancer. The purpose of this study was to examine intraoperative perforation following the introduction of mesorectal excision as a standard surgical technique in Norway. Methods This was a prospective national cohort study of 2873 patients undergoing major resection of rectal carcinoma at 54 Norwegian hospitals from November 1993 to December 1999. Results The overall perforation rate was 8·1 per cent (234 of 2873 patients). In a multivariate analysis, the risk of perforation was significantly greater in patients undergoing abdominoperineal resection (odds ratio (OR) 5·6 (95 per cent confidence interval (c.i.) 3·5 to 8·8)) and in those aged 80 years or more (OR 2·0 (95 per cent c.i. 1·2 to 3·5)). The 5-year local recurrence rate was 28·8 per cent following perforation, compared with 9·9 per cent in patients with no perforation (P < 0·001); survival rates were 41...

Research paper thumbnail of Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national level

British Journal of Surgery, 2004

Background The purpose of this prospective study was to examine the influence of hospital caseloa... more Background The purpose of this prospective study was to examine the influence of hospital caseload on long-term outcome following standardization of rectal cancer surgery at a national level. Methods Data relating to all 3388 Norwegian patients with rectal cancer treated for cure between November 1993 and December 1999 were recorded in a national database. Treating hospitals were divided into four groups according to their annual caseload: hospitals in group 1 (n = 4) carried out 30 or more procedures, those in group 2 (n = 6) performed 20–29 procedures, group 3 (n = 16) 10–19 procedures and group 4 (n = 28) fewer than ten procedures. Results The 5-year local recurrence rates were 9·2, 14·7, 12·5 and 17·5 per cent (P = 0·003) and 5-year overall survival rates were 64·4, 64·0, 60·8 and 57·8 per cent (P = 0·105) respectively in the four hospital caseload groups. An annual hospital caseload of less than ten procedures increased the risk of local recurrence compared with that in hospita...

Research paper thumbnail of Long-term function after ileal pouch-anal anastomosis -Function does not deteriorate with time

Colorectal Disease, 2010

There are conflicting reports regarding long term function after ileal pouch-anal anastomosis (IP... more There are conflicting reports regarding long term function after ileal pouch-anal anastomosis (IPAA). The aim of the present prospective study was to investigate the influence of duration as an independent factor on long-term function results. Between 1984 and 2007, 315 patients underwent IPAA and were followed by a standardised interview and endoscopy protocol. There were 1802 interviews. Two hundred and thirty-five patients had three or more visits and these data were analysed by Time-Series-Cross-Section multivariate regression analysis. The mean time follow up was 12 years and the mean interval between visits was 34.5 months. Mean frequency of defecation was 5.2 in the day and 0.55 at night. This did not change with time. Daytime and night incontinence occurred in 13% and 21%. There was no change in incontinence, urgency, soiling or perineal excoriation with time. After 24 years the cumulative incidence of pouchitis was 43.5%. Twenty patients had chronic pouchitis (6.3%). The interval from IPAA did not influence the long-term functional outcome.

Research paper thumbnail of Lunchtime Posters

Colorectal Disease, 2012

Aim: This study aimed to assess the feasibility of colorectal single access laparoscopic surgery ... more Aim: This study aimed to assess the feasibility of colorectal single access laparoscopic surgery (C-SALS) in routine practice without compromising safety. Method: Clinical data were prospectively collected during our initial experience of C-SALS. Results: Since August 2011, 50 C-SALS have been performed. Over the same period, 58 classic laparoscopic and 31 open colorectal procedures were performed. Patients suitable for laparoscopic colorectal surgery have been systematically enrolled for C-SALS. Exclusion criteria were obesity, rectal cancer, T4 tumours, and previous laparotomy. There were 29 men and 21 women with a mean age of 49 years. Median BMI was 24 (17–31). Procedures performed were: 38 segmental colectomies, three sub-total colectomies, one secondary proctectomy with ileal-pouch anal anastomosis (IPAA), six restorative proctocolectomies with IPAA, one small bowel resection and one adhesiolysis. Indications were IBD, diverticulitis or malignancy. There were no intra-operative complications. Three patients (6%) were converted to laparotomy and one patient (2%) to classic laparoscopy. Median skin incision length was 4 cm (3–6). There was no mortality. Three IBD patients (6%) developed anastomotic dehiscence. Median hospital stay was 6 days (3–18) and median follow-up was 4.7 months (1–12). Conclusion: C-SALS is feasible and safe. Randomised controlled trials are required to point out long-term advantages.

Research paper thumbnail of Survival in Rectal Cancer in the Nordic countries and Scotland

The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperat... more The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperative treatments; a multitude of surgical and technical choices; possibilities of postoperative treatments and postoperative care and follow up. In this thesis, some aspects of this complex paradigm have been further investigated. One of the most feared complications after rectal cancer surgery is anastomotic leakage. The risk of anastomotic leakage is affected by non-influenceable factors related to the tumour and the patient. In the first paper, the risk of anastomotic leakage in relation to a surgical instrument, the circular stapler, was investigated. The risk of leakage was 7% or 11%, depending on the choice of instrument. In the second paper, a long-term evaluation of survival and local recurrence rates in the Swedish Rectal Cancer Trial was made. Randomisation was to either preoperative radiotherapy followed by surgery or surgery alone. After 13 years median follow-up, survival was ...

Research paper thumbnail of Prognostic signi ® cance of the circumferential resection margin following total mesorectal excision for rectal cancer

Background: Knowledge of prognostic factors following resection of rectal cancer may be used in t... more Background: Knowledge of prognostic factors following resection of rectal cancer may be used in the selection of patients for adjuvant therapy. This study examined the prognostic impact of the circumferential resection margin on local recurrence, distant metastasis and survival rates. Methods: A national population-based rectal cancer registry included all 3319 new patients from November 1993 to August 1997. Some 686 patients underwent total mesorectal excision with a known circumferential margin. This shortest radial resection margin was measured in ®xed specimens. None of the patients had adjuvant radiotherapy. Results: Following potentially curative resection and after a median follow-up of 29 (range 14± 60) months, the overall local recurrence rate was 7 per cent (46 of 686 patients): 22 per cent among patients with a positive resection margin and 5 per cent in those with a negative margin (margin greater than 1 mm). Forty per cent of patients with a positive margin developed di...

Research paper thumbnail of Assessment of self‐rated health 5 years after Roux‐en‐Y gastric bypass for severe obesity

BJS Open

Background: Patients' perceptions of health change after bariatric surgery are complex. The aim o... more Background: Patients' perceptions of health change after bariatric surgery are complex. The aim of this study was to explore whether self-rated health (SRH), a widely used tool in public health research, might be relevant as an outcome measure after Roux-en-Y gastric bypass (RYGB) for severe obesity. Methods: This was a single-centre retrospective study of a local quality registry. SRH score was registered at baseline and 5 years after RYGB. SRH, one of the 36 items in the quality-of-life Short Form 36 (SF-36 ®) questionnaire, is the answer to this single question: 'In general, would you say your health is excellent (1), very good (2), good (3), fair (4) or poor (5)?' Change in SRH was analysed in relation to change in weight, co-morbidities and quality of life after 5 years. Results: Of a total of 359 patients who underwent RYGB between September 2006 and February 2011, 233 (64⋅9 per cent) reported on SRH before and 5 years after surgery. Of these, 180 (77⋅3 per cent) were women, and the mean(s.d.) age was 40(9) years. Some 154 patients (66⋅1 per cent) reported an improvement in SRH, 60 (25⋅8 per cent) had no change, and SRH decreased in 19 patients (8⋅2 per cent). SRH in improvers was related to better scores in all SF-36 ® domains, whereas SRH in non-improvers was related to unchanged or worsened scores in all SF-36 ® domains except physical function. Conclusion: Two-thirds of patients reported improved SRH 5 years after RYGB for severe obesity. In view of its simplicity, SRH may be an easy-to-use outcome measure in bariatric surgery.

Research paper thumbnail of Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

BJOG: An International Journal of Obstetrics & Gynaecology

Research paper thumbnail of Complications and risk prediction in treatment of elderly patients with rectal cancer

International Journal of Colorectal Disease, 2015

ABSTRACT

Research paper thumbnail of 73 The Norwegian programme

Research paper thumbnail of Physical exercise during adjuvant chemotherapy for colorectal cancer—a non-randomized feasibility study

Supportive Care in Cancer

Background Colorectal cancer (CRC) is the third most common cancer worldwide, and a large proport... more Background Colorectal cancer (CRC) is the third most common cancer worldwide, and a large proportion of the patients receive adjuvant oxaliplatin-based chemotherapy. Most of these experience chemotherapy-induced peripheral neuropathy (CIPN), affecting quality of life. Evidence to advise exercise to reduce CIPN is limited. The primary aim of this study was to investigate the feasibility of an exercise intervention and data collection among CRC patients during adjuvant chemotherapy. Material and methods This non-randomized feasibility study included CRC patients admitted to adjuvant chemotherapy to an intervention consisting of supervised aerobic endurance, resistance, and balance exercises twice a week at the hospital in addition to home-based exercise once a week. A physiotherapist supervised the patients, and the intervention lasted throughout the period of adjuvant chemotherapy (12–24 weeks). Participants performed physical tests and filled in questionnaires at baseline, 3, 6, 9, ...

Research paper thumbnail of Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

British Journal of Surgery

Research paper thumbnail of Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival