Kjetil Søreide

University of Bergen, Bergen, Hordaland, Norway

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Publications (135)362.46 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) is the third most common cancer worldwide. Survival is largely stage-dependant, guided by the tumor–node–metastases (TNM) system for TNM assessment. Histopathological evaluation, including assessment of lymph node status, is important for correct TNM staging. However, recent updates in the TNM system have resulted in controversy. A continued debate on definitions resulting in potential up- and downstaging of patients, which may obscure survival data, has led the investigators to investigate other or alternative staging tools. Consequently, additional prognostic factors have been searched for using the regular light microscopy. Among the factors evaluated by histopathology include the evaluation of tumor budding and stromal environment, angiogenesis, as well as involvement of the immune system (including the ‘Immunoscore’). We review the current role of histopathology, controversies in TNM-staging and suggested alternatives to better predict outcome for CRC patients in the era of genomic medicine.
    Scandinavian Journal of Gastroenterology. 08/2014;
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    ABSTRACT: Background Since the introduction of uncemented hip implants, there has been a search for the best surface coating to enhance bone apposition in order to improve retention. The surface coating of the different stems varies between products. The aim was to assess the retention force and bone adaption in two differently coated stems in a weight-bearing goat model.Materials and methodsHydroxyapatite (HA) and electrochemically deposited calcium phosphate (CP; Bonit®) on geometrically comparable titanium-based femoral stems were implanted into 12 (CP group) and 35 (HA group) goats. The animal model included physiological loading of the implants for 6 months. The pull-out force of the stems was measured, and bone apposition was microscopically evaluated.ResultsAfter exclusion criteria were applied, the number of available goats was 4 in the CP group and 11 in the HA group. The CP-coated stems had significantly lower retention forces compared with the HA-coated ones after 6 months (CP median 47 N, HA median 1,696 N, p¿=¿0.003). Bone sections revealed a lower degree of bone apposition in the CP-coated stems, with more connective tissue in the bone/implant interface compared with the HA group.Conclusion In this study, HA had better bone apposition and needed greater pull-out force in loaded implants. The application of CP on the loaded titanium surface to enhance the apposition of bone is questioned.
    Journal of Orthopaedic Surgery and Research 08/2014; 9(1):69. · 1.01 Impact Factor
  • Cancer 08/2014; · 5.20 Impact Factor
  • K Søreide
    British Journal of Surgery 07/2014; 101(8):964-5. · 4.84 Impact Factor
  • Kjetil Søreide, Malin Sund
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    ABSTRACT: Pancreatic cancer remains one of the deadliest human cancers with little progress made in survival over the past decades, and 5-year survival usually below 5%. Despite this dismal scenario, progresses have been made in understanding of the underlying tumour biology through among other definition of precursor lesions, delineation of molecular pathways, and advances in genome-wide technology. Further, exploring the relationship between epidemiological risk factors involving metabolic features to that of an altered cancer metabolism may provide the foundation for new therapies. Here we explore how nutrients and caloric intake may influence the KRAS-driven ductal carcinogenesis through mediators of metabolic stress, including autophagy in presence of TP53, advanced glycation end products (AGE) and the receptors (RAGE) and ligands (HMGB1), as well as glutamine pathways, among others. Effective understanding the cancer metabolism mechanisms in pancreatic cancer may propose new ways of prevention and treatment.
    Cancer letters 04/2014; · 4.86 Impact Factor
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    ABSTRACT: Mortality rates in perforated peptic ulcer (PPU) have remained unchanged. The aim of this study was to compare known clinical factors and three scoring systems (American Society of Anesthesiologists (ASA), Boey and peptic ulcer perforation (PULP)) in the ability to predict mortality in PPU. This is a consecutive, observational cohort study of patients surgically treated for perforated peptic ulcer over a decade (January 2001 through December 2010). Primary outcome was 30-day mortality. A total of 172 patients were included, of whom 28 (16 %) died within 30 days. Among the factors associated with mortality, the PULP score had an odds ratio (OR) of 18.6 and the ASA score had an OR of 11.6, both with an area under the curve (AUC) of 0.79. The Boey score had an OR of 5.0 and an AUC of 0.75. Hypoalbuminaemia alone (≤37 g/l) achieved an OR of 8.7 and an AUC of 0.78. In multivariable regression, mortality was best predicted by a combination of increasing age, presence of active cancer and delay from admission to surgery of >24 h, together with hypoalbuminaemia, hyperbilirubinaemia and increased creatinine values, for a model AUC of 0.89. Six clinical factors predicted 30-day mortality better than available risk scores. Hypoalbuminaemia was the strongest single predictor of mortality and may be included for improved risk estimation.
    Journal of Gastrointestinal Surgery 03/2014; · 2.36 Impact Factor
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    Hanne R Hagland, Kjetil Søreide
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    ABSTRACT: The interconnectivity between diet, gut microbiota and cell molecular responses is well known; however, only recently has technology allowed the identification of strains of microorganisms harbored in the gastrointestinal tract that may increase susceptibility to cancer. The colonic environment appears to play a role in the development of colon cancer, which is influenced by the human metabolic lifestyle and changes in the gut microbiome. Studying metabolic changes at the cellular level in cancer be useful for developing novel improved preventative measures, such as screening through metabolic breath-tests or treatment options that directly affect the metabolic pathways responsible for the carcinogenicity.
    Cancer letters 03/2014; · 4.86 Impact Factor
  • K Søreide
    British Journal of Surgery 03/2014; 101(4):438. · 4.84 Impact Factor
  • Marianne Berg, Hanne R Hagland, Kjetil Søreide
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    ABSTRACT: In colorectal cancer a distinct subgroup of tumours demonstrate the CpG island methylator phenotype (CIMP). However, a consensus of how to score CIMP is not reached, and variation in definition may influence the reported CIMP prevalence in tumours. Thus, we sought to compare currently suggested definitions and cut-offs for methylation markers and how they influence CIMP classification in colon cancer. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA), with subsequent fragment analysis, was used to investigate methylation of tumour samples. In total, 31 CpG sites, located in 8 different genes (RUNX3, MLH1, NEUROG1, CDKN2A, IGF2, CRABP1, SOCS1 and CACNA1G) were investigated in 64 distinct colon cancers and 2 colon cancer cell lines. The Ogino gene panel includes all 8 genes, in addition to the Weisenberger panel of which only 5 of the 8 genes included were investigated. In total, 18 alternative combinations of scoring of CIMP positivity on probe-, gene-, and panel-level were analysed and compared. For 47 samples (71%), the CIMP status was constant and independent of criteria used for scoring; 34 samples were constantly scored as CIMP negative, and 13 (20%) consistently scored as CIMP positive. Only four of 31 probes (13%) investigated showed no difference in the numbers of positive samples using the different cut-offs. Within the panels a trend was observed that increasing the gene-level stringency resulted in a larger difference in CIMP positive samples than increasing the probe-level stringency. A significant difference between positive samples using 'the most stringent' as compared to 'the least stringent' criteria (20% vs 46%, respectively; p<0.005) was demonstrated. A statistical significant variation in the frequency of CIMP depending on the cut-offs and genes included in a panel was found, with twice as many positives samples by least compared to most stringent definition used.
    PLoS ONE 01/2014; 9(1):e86657. · 3.53 Impact Factor
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    K Søreide, K Thorsen, J A Søreide
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    ABSTRACT: Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred. Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3·8-14 per 100 000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0·63 (95 per cent confidence interval (c.i.) 0·41 to 0·97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2·97, 95 per cent c.i. 1·06 to 8·29) and 1-year (RR 1·49, 1·10 to 2·03) risk of ulcer recurrence. Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies.
    British Journal of Surgery 01/2014; 101(1):e51-64. · 4.84 Impact Factor
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    ABSTRACT: The Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine-which received its first Impact Factor in 2013-is extremely grateful for the time, hard work and support of its highly-qualified peer reviewers. The editors of the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, the Norwegian Air Ambulance Foundation and BioMed Central would like to show our appreciation by thanking the following people for their assistance reviewing manuscripts for the journal in 2013.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 01/2014; 22(1):4. · 1.68 Impact Factor
  • Kjetil Søreide, Jon Kristian Narvestad
    Injury 01/2014; · 1.93 Impact Factor
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    A Bergenfelz, K Søreide
    British Journal of Surgery 11/2013; · 4.84 Impact Factor
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    ABSTRACT: More than 235 million patients undergo surgery every year worldwide, but less than 1% are enrolled in surgical clinical trials--few of which are international collaborations. Several levels of action are needed to improve this situation. International research collaborations in surgery between developed and developing countries could encourage capacity building and quality improvement, and mutually enhance care for patients with surgical disorders. Low-income and middle-income countries increasingly report much the same range of surgical diseases as do high-income countries (eg, cancer, cardiovascular disease, and the surgical sequelae of metabolic syndrome); collaboration is therefore of mutual interest. Large multinational trials that cross cultures and levels of socioeconomic development might have faster results and wider applicability than do single-country trials. Surgeons educated in research methods, and aided by research networks and trial centres, are needed to foster these international collaborations. Barriers to collaboration could be overcome by adoption of global strategies for regulation, health insurance, ethical approval, and indemnity coverage for doctors.
    The Lancet 09/2013; 382(9898):1140-51. · 39.06 Impact Factor
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    ABSTRACT: Lymph node (LN) harvest is influenced by several factors, including tumor genetics. Microsatellite instability (MSI) is associated with improved node harvest, but the association to other genetic factors is largely unknown. Prospective series of stage I-III colon cancer patients undergoing ex-vivo sentinel-node sampling. The presence of MSI, KRAS mutations in codons 12 and 13, and BRAF V600E mutations was analysed. Uni- and multivariate regression models for node sampling were adjusted for clinical, pathological and molecular features. Of 204 patients, 67% had an adequate harvest (≥12 nodes). Adequate harvest was highest in patients whose tumors exhibited MSI (79%; OR=2.5, 95% CI 1.2-4.9; P=0.007) or were located in the proximal colon (73%; OR=2.8, 95% CI 1.5-5.3; P=0.002). In multiple linear regression, MSI was a significant predictor of the total LN count (P=0.02). Total node count was highest for cancers with MSI and no KRAS/BRAF mutations. The independent association between MSI and a high LN count persisted for stage I-II cancers (P=0.04). Tumor location in the proximal colon was the only significant predictor of an adequate LN harvest (adjusted OR=2.4, 95% CI 1.2-4.9; P=0.01). An increase in the total number of nodes harvested was not associated with an increase in nodal metastasis. Number of nodes harvested is highest for cancers of the proximal colon and with MSI. The nodal harvest associated with MSI is influenced by BRAF and KRAS genotypes, even for cancers of proximal location. Mechanisms behind the molecular diversity and node yield should be further explored.
    Molecular Medicine 08/2013; · 4.47 Impact Factor
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    ABSTRACT: Trauma is a major global cause of morbidity and mortality. Population-based studies identifying high-risk populations and regions may facilitate primary prevention and the development of optimal trauma systems. This study describes the epidemiology of adult trauma deaths in Norway and identifies high-risk areas by assessing different geographical measures of rurality. All trauma-related deaths in Norway from 1998 to 2007 among individuals aged 16-66 years were identified by accessing national registries. Mortality data were analysed by linkage to population and geographical data at municipal, county and national levels. Three measures of rurality (centrality, population density and settlement density) were compared based on their association with trauma mortality rates. The study included 8466 deaths, of which 78% were males. The national annual trauma mortality rate was 28.7 per 100,000. Population density was the best predictor of high-risk areas, and there was a consistent inverse relationship between mortality rates and population density. The most rural areas had 52% higher trauma mortality rates compared to the most urban areas. This difference was largely due to deaths following transport-related injury. Seventy-eight per cent of all deaths occurred in the prehospital phase. Rural areas and death following self-harm had higher proportion of prehospital deaths. Rural areas, as defined by population density, are at a higher risk of deaths following traumatic injuries and have higher proportions of prehospital deaths and deaths following transport-related injuries. The heterogeneous characteristics of trauma populations with respect to geography and mode of injury should be recognised in the planning of preventive strategies and in the organisation of trauma care.
    Injury 07/2013; · 1.93 Impact Factor
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    ABSTRACT: Objective. While patient-reported outcome measures (PROMs) in ERCP are scarce, these reports are important for making improvements in quality of care. This study sought to document patient satisfaction and specifically pain related to endoscopic retrograde cholangiopancreatography (ERCP) procedures and to identify predictors for these experiences. Methods. From 2007 through 2009, prospective data from consecutive ERCP procedures at 11 hospitals during normal daily practice were recorded. Information regarding undesirable events that occurred during a 30-day follow-up period was also reported. The patient-reported pain, discomfort and general satisfaction with the ERCP were recorded. Results. Data from 2808 ERCP procedures were included in this study. Patient questionnaires were returned for 52.6% of the procedures. Moderate or severe pain was experienced in 15.5% and 14.0% of the procedures during the ERCP and in 10.8% and 7.7% of the procedures after the ERCP, respectively. In addition, female gender, endoscopic sphincterotomy (EST), and longer procedure times served as independent predictors of increased pain during the ERCP. The performing hospitals and sedation regimens were independent predictors of the procedural pain experience. In 90.9% of the procedures, the patients were satisfied with the information overall, and in 98.3% of the procedures, the patients were satisfied with the treatment provided. Independent predictors of dissatisfaction with the treatment included the occurrence of specific complications after ERCP and pain during or after the procedure. Conclusions. Female gender, the performance of EST and longer procedure times were independent predictors for increased procedure-related pain. The individual hospital and sedation regimen predicts the patient's pain experience.
    Scandinavian Journal of Gastroenterology. 06/2013; 48(7).
  • Scandinavian Journal of Gastroenterology 05/2013; · 2.33 Impact Factor
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    ABSTRACT: AIM: Evaluation of ≥ 12 lymph nodes (LNs) is recommended after surgery for colon cancer. A harvest of ≤ 8 is considered poor, but few reports have evaluated risk factors associated with a poor harvest. This aims of this study were to analyze the clinical, surgical, and pathological factors associated with poor LN harvest(LNH), total number of examined nodes, and the effect of LN number on stage. METHODS: All patients reported to the Norwegian Colorectal Cancer Registry during 2007 and 2008 who underwent were curative resection for stage I-III colon cancer were studied. Risk factors for poor LNH and the proportion of stage III disease were analyzed by univariate and multivariate analyses. RESULTS: A total of 2,879 patients were included in the study. The median LNH was 14. Overall, 69.9% had ≥12 lymph nodes, and 14.4% had ≤ 8 LN (poor harvest). Multivariate analysis showed, male sex, age >75 years, sigmoid tumours, pT category 1-2, failure to use the pathology report template, and distance of ≤5 cm from the bowel resection margin were all independent factors for poor LNH. Age <65 years, pT category 3-4, and poor tumour differentiation were independent predictors of stage III disease. An increased LNH did not increase the proportion of patients identified as being LN positive at the ≤8, 9-11, and ≥12 LN levels. CONCLUSION: Adequate LNH was achieved in the majority of curative colon cancer resections in this national cohort. Elderly, males, patients with sigmoid cancers, and a short distal margin were at increased risk of a poor LNH. This article is protected by copyright. All rights reserved.
    Colorectal Disease 04/2013; · 2.08 Impact Factor
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    ABSTRACT: BACKGROUND: Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Mortality ranges from 3-40% and several prognostic scoring systems have been suggested. The aim of this study was to review the available scoring systems for PPU patients, and to assert if there is evidence to prefer one to the other. MATERIAL AND METHODS: We searched PubMed for the mesh terms "perforated peptic ulcer", "scoring systems", "risk factors", "outcome prediction", "mortality", "morbidity" and the combinations of these terms. In addition to relevant scores introduced in the past (e.g. Boey score), we included recent studies published between January 2000 and December 2012) that reported on scoring systems for prediction of morbidity and mortality in PPU patients. RESULTS: A total of ten different scoring systems used to predict outcome in PPU patients were identified; the Boey score, the Hacettepe score, the Jabalpur score the peptic ulcer perforation (PULP) score, the ASA score, the Charlson comorbidity index, the sepsis score, the Mannheim Peritonitis Index (MPI), the Acute physiology and chronic health evaluation II (APACHE II), the simplified acute physiology score II (SAPS II), the Mortality probability models II (MPM II), the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity physical sub-score (POSSUM-phys score). Only four of the scores were specifically constructed for PPU patients. In five studies the accuracy of outcome prediction of different scoring systems was evaluated by receiver operating characteristics curve (ROC) analysis, and the corresponding area under the curve (AUC) among studies compared. Considerable variation in performance both between different scores and between different studies was found, with the lowest and highest AUC reported between 0.63 and 0.98, respectively. CONCLUSION: While the Boey score and the ASA score are most commonly used to predict outcome for PPU patients, considerable variations in accuracy for outcome prediction were shown. Other scoring systems are hampered by a lack of validation or by their complexity that precludes routine clinical use. While the PULP score seems promising it needs external validation before widespread use.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 04/2013; 21(1):25. · 1.68 Impact Factor

Publication Stats

772 Citations
362.46 Total Impact Points

Institutions

  • 2007–2014
    • University of Bergen
      • Department of Surgical Sciences
      Bergen, Hordaland, Norway
  • 2005–2014
    • Stavanger University Hospital
      • • Department of Gastrointestinal Surgery
      • • Division of Surgery
      • • Department of Pathology
      Stavenger, Rogaland, Norway
  • 2013
    • Skåne University Hospital
      Malmö, Skåne, Sweden
  • 2009–2013
    • University of Oslo
      Kristiania (historical), Oslo County, Norway
  • 2011
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009–2011
    • Norsk Luftambulanse
      Drøbak, Akershus county, Norway
  • 2010
    • University Hospital of North Norway
      • Department of Gastroenterological Surgery
      Tromsø, Troms, Norway
  • 2007–2009
    • University of Stavanger (UiS)
      • Department of Mathematics and Natural Science
      Stavenger, Rogaland, Norway