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Due to copyright reasons, an electronic copy of the thesis must be ordered from the faculty. In order for the faculty to have time to process the order, it must be received by the faculty no later than 2 days prior to the public defence. Orders received later than 2 days before the defence will not be processed. Inquiries regarding the thesis after the public defence must be addressed to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Avdelingslege Lotte Fynne, Regionshospital Silkeborg
- Second opponent: Professor Stig Norderval, UiT - The Arctic University of Norway
- Third member and chair of the evaluation committee: Professor II Henrik Schirmer, University of Oslo
Chair of the Defence
Adjunct Professor Signe Søvik, University of Oslo
Principal Supervisor
Professor Dejan Ignjatovic, Faculty of Medicine, University of Oslo
Summary
The extended D3-mesenterectomy during right colectomy for cancer aims for improved cancer survival by removing the draining lymph nodes around the superior mesenteric vessels. The procedure, however, causes an injury to a significant portion of the extrinsic nerves in the superior mesenteric plexus (SMP) distal to the pancreatic notch. The exact anatomical image and physiological importance of the nerve plexus at this level are not well studied.
This thesis studied the anatomy, defined the nerve damage, and explored its consequences to bowel motility, bowel function, and Quality of Life.
The nerve plexus and its damage were mapped using dissection, histological slides, and nano-CT. The studies confirmed that the SMP follows the superior mesenteric artery (SMA) in a well-defined paravasculare sheath. In this sheath, the nerve plexus has a spiral structure. 59% of the nerves at the middle colic artery level were transected during the procedure. However, the total nerve damage caused by the procedure is probably more extensive if we take the spiral structure of the plexus into account.
The significantly reduced small bowel transit time three weeks after the procedure (Tool: Wireless Motility Capsule) manifested itself through a transient short period with frequent, loose stools (Diary-based study).
At six months, the small bowel transit time showed a clear tendency towards normalization. In the long-term surveys (Tools: Gastrointestinal Quality of Life Index and Diarrhea Assessment Score), the stools still tended to be slightly looser and more frequent than the stools of the patients operated with right colectomy without the nerve injuring mesenterectomy. However, the quality of life was equal in both groups.
Additional information
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