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Wolthuis AM, D’Hoore A, Van Cutsem E. Health-related quality of life in rectal cancer: a topic more relevant now than ever. BJS Open 2022; 6:6955779. [PMID: 36546341 PMCID: PMC9772868 DOI: 10.1093/bjsopen/zrac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Albert M Wolthuis
- Abdominal Surgery, University Hospitals Leuven and KULeuven, Leuven, Belgium
| | - André D’Hoore
- Abdominal Surgery, University Hospitals Leuven and KULeuven, Leuven, Belgium
| | - Eric Van Cutsem
- Correspondence to: Eric Van Cutsem, Digestive Oncology, University Hospitals Leuven and KULeuven, Leuven, Belgium (e-mail: )
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Zaborowski AM, Adamina AAM, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Bach SAS, Bala M, Barussaud M, Bausys A, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JW, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Collinson R, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D’Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Figueiredo N, Fleming F, Foppa C, Fowler G, Frasson M, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Salido AJ, Jiménez-Toscano M, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, Julião GPS, Panaiotti L, Panis Y, Papamichael D, Patel S, Uriburu JCP, Peng SL, Pera M, Perez RO, Petrov A, Pfeffer F, Phang TP, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Meneses JCR, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shlomina A, Sigismondo G, Singnomklao T, Siragusa L, Smart N, Solis-Peña A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Zhou J, Winter DC. Impact of microsatellite status in early-onset colonic cancer. Br J Surg 2022; 109:632-636. [PMID: 35522613 DOI: 10.1093/bjs/znac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. METHODS Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. RESULTS A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). CONCLUSION Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers.
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Asnong A, D’Hoore A, Wolthuis A, Van Molhem Y, Van Geluwe B, Devoogdt N, De Groef A, De Vrieze T, Dams L, Geraerts I. Is evaluation by questionnaires sufficient to cover all aspects of bowel symptoms in rectal cancer patients after low anterior resection? Colorectal Dis 2022; 24:611-620. [PMID: 35040548 PMCID: PMC9306656 DOI: 10.1111/codi.16055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 01/01/2023]
Abstract
AIM The aim of the study was to investigate whether bowel symptoms related to low anterior resection for rectal cancer can be sufficiently well evaluated by the Low Anterior Resection Syndrome (LARS) questionnaire score or the ColoRectal Functional Outcome (COREFO) questionnaire compared with a stool diary. METHOD All patients underwent low anterior resection for rectal cancer. They were asked to fill out a stool diary, the LARS questionnaire and the COREFO questionnaire, at 1, 4, 6 and 12 months after low anterior resection or stoma closure. The main outcome measure was the amount of association (calculated by means of canonical correlation analysis) between items on anal incontinence for faeces, frequency of bowel movements, clustering of bowel movements, urgency and soiling. RESULTS Ninety-five patients were included. Items on anal incontinence for faeces and frequency of bowel movements were significantly correlated between the LARS questionnaire or the COREFO questionnaire, versus the stool diary, respectively. Items on soiling were significantly correlated between the COREFO questionnaire and the stool diary. CONCLUSION Although the LARS questionnaire and the COREFO questionnaire are reliable and valid for measuring low anterior resection syndrome after rectal cancer, our results show that there are no strong associations with the stool diary. Therefore, we can conclude that there is additional clinical information to be obtained from the stool diary. In order to evaluate all aspects of low anterior resection syndrome, we suggest the addition of a stool diary or a combination of different measurement methods during patient follow-up.
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Affiliation(s)
- Anne Asnong
- Department of Rehabilitation SciencesKU Leuven – University of LeuvenLeuvenBelgium
| | - André D’Hoore
- Department of Abdominal SurgeryUniversity Hospitals GasthuisbergLeuvenBelgium,KU Leuven – University of LeuvenLeuvenBelgium
| | - Albert Wolthuis
- Department of Abdominal SurgeryUniversity Hospitals GasthuisbergLeuvenBelgium,KU Leuven – University of LeuvenLeuvenBelgium
| | - Yves Van Molhem
- Department of Abdominal SurgeryOLV HospitalsAalst/Asse/NinoveBelgium
| | - Bart Van Geluwe
- Department of Abdominal SurgeryUniversity Hospitals GasthuisbergLeuvenBelgium
| | - Nele Devoogdt
- Department of Rehabilitation SciencesKU Leuven – University of LeuvenLeuvenBelgium,Center for LymphedemaUniversity Hospitals LeuvenLeuvenBelgium
| | - An De Groef
- Department of Rehabilitation SciencesKU Leuven – University of LeuvenLeuvenBelgium,Department of Rehabilitation SciencesUniversity of AntwerpAntwerpBelgium,International Research Group Pain in MotionBrusselsBelgium
| | - Tessa De Vrieze
- Department of Rehabilitation SciencesKU Leuven – University of LeuvenLeuvenBelgium,Department of Rehabilitation Sciences and PhysiotherapyMOVANTUniversity of AntwerpAntwerpBelgium
| | - Lore Dams
- Department of Rehabilitation SciencesKU Leuven – University of LeuvenLeuvenBelgium,International Research Group Pain in MotionBrusselsBelgium,Department of Rehabilitation Sciences and PhysiotherapyMOVANTUniversity of AntwerpAntwerpBelgium
| | - Inge Geraerts
- Department of Rehabilitation SciencesKU Leuven – University of LeuvenLeuvenBelgium
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Boon K, Bislenghi G, D’Hoore A, Boon N, Wolthuis AM. Do older patients (> 80 years) also benefit from ERAS after colorectal resection? A safety and feasibility study. Aging Clin Exp Res 2021; 33:1345-1352. [PMID: 32720244 DOI: 10.1007/s40520-020-01655-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the safety and feasibility of a standard Enhanced Recovery After Surgery (ERAS) program following colorectal resection in a geriatric population, aged 80 years and older. METHODS In this single-center before-after cohort study all patients aged 80 years and older were included after colorectal resection. Patients were divided in a pre-ERAS and an ERAS group, according to the type of perioperative care. Data were prospectively collected and analysed retrospectively. The primary outcome was short-term complication rate. Secondary outcome parameters were length of stay (LOS), 30-day mortality and readmission rate. RESULTS Over 4 years, 219 patients were included. Of those, 151 underwent colonic and 68 rectal resection, following the ERAS protocol perioperatively in 45 and 21 cases. There were no differences in complication rate, 30-day mortality or readmission rate in the pre-ERAS versus ERAS groups. LOS after colonic resection was reduced by 2.5 days in the ERAS group (p = 0.020). Laparoscopy was found to be an independent variable of LOS (p < 0.001, p = 0.009) and complication rate (p = 0.011, p < 0.001) for colonic and rectal surgery respectively. DISCUSSION A standard ERAS protocol is safe and feasible in older patients undergoing colorectal resection. Colon resection was related with shorter LOS without increasing morbidity, readmission rate nor 30-day mortality. No adverse outcome after rectal resection was found either. Laparoscopy was associated with lower complication rate and shorter LOS. CONCLUSION A laparoscopic approach within an ERAS protocol should be considered for colorectal resection in every patient regardless of age.
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Bislenghi G, Vanhaverbeke A, Fieuws S, de Buck van Overstraeten A, D’Hoore A, Schuermans A, Wolthuis AM. Risk factors for surgical site infection after colorectal resection: a prospective single centre study. An analysis on 287 consecutive elective and urgent procedures within an institutional quality improvement project. Acta Chir Belg 2021; 121:86-93. [PMID: 31577178 DOI: 10.1080/00015458.2019.1675969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To determine the incidence and to investigate risk factors for surgical site infections (SSIs) in a cohort of patients undergoing colorectal surgery. MATERIAL & METHODS Data from all consecutive patients operated at our department in an elective or in an urgent setting over a 4-month period were prospectively collected and analysed. The updated Centres for Disease Control and Prevention guidelines were used to define and to score SSIs during weekly meetings. Multivariate analysis was performed considering a list of 20 potential perioperative risk factors. RESULTS A total of 287 patients (mean age 56.9 ± 16.8 years, 51.2% male) were included. Thirty-five patients (12.2%) developed SSI. Independent risk factors for SSI were BMI <20 kg/m2 (OR 3.70; p = .022), cancer (OR 0.33; p = .046), respiratory comorbidity (OR 3.15; p = .035), presence of a preoperative stoma (OR 3.74; p = .003), and operative time ≥3 hours (OR 2.93; p = .014). CONCLUSION Identified incidence and risk factors for the development of SSI after colorectal surgery were consistent with those already reported in the literature. The possibility to develop a validated prediction model for SSIs warrants further investigation, in order to target specific preventive measures on high-risk population.
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Affiliation(s)
- Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Steffen Fieuws
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, KU Leuven, University of Leuven and University of Hasselt, Leuven, Belgium
| | | | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Annette Schuermans
- Department of Public Health and Primary Care, University Hospitals Leuven, Leuven, Belgium
| | - Albert M. Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Affiliation(s)
- A. D’Hoore
- Department of Abdominal Surgery, University Clinic Gasthuisberg, Leuven
| | - F. Penninckx
- Department of Abdominal Surgery, University Clinic Gasthuisberg, Leuven
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Machiels K, Pozuelo del Río M, Martinez-De la Torre A, Xie Z, Pascal Andreu V, Sabino J, Santiago A, Campos D, Wolthuis A, D’Hoore A, De Hertogh G, Ferrante M, Manichanh C, Vermeire S. Early Postoperative Endoscopic Recurrence in Crohn's Disease Is Characterised by Distinct Microbiota Recolonisation. J Crohns Colitis 2020; 14:1535-1546. [PMID: 32333762 PMCID: PMC7648170 DOI: 10.1093/ecco-jcc/jjaa081] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Intestinal microbiota dysbiosis is implicated in Crohn's disease [CD] and may play an important role in triggering postoperative disease recurrence [POR]. We prospectively studied faecal and mucosal microbial recolonisation following ileocaecal resection to identify the predictive value of recurrence-related microbiota. METHODS Mucosal and/or faecal samples from 121 CD patients undergoing ileocaecal resection were collected at predefined time points before and after surgery. Ileal biopsies were collected from 39 healthy controls. POR was defined by a Rutgeerts score ≥i2b. The microbiota was evaluated by 16S rRNA sequencing. Prediction analysis was performed using C5.0 and Random Forest algorithms. RESULTS The mucosa-associated microbiota in CD patients was characterised by a depletion of butyrate-producing species (false discovery rate [FDR] <0.01) and enrichment of Proteobacteria [FDR = 0.009] and Akkermansia spp. [FDR = 0.02]. Following resection, a mucosal enrichment of Lachnospiraceae [FDR <0.001] was seen in all patients but in POR patients, also Fusobacteriaceae [FDR <0.001] increased compared with baseline. Patients without POR showed a decrease of Streptococcaceae [FDR = 0.003] and Actinomycineae [FDR = 0.06]. The mucosa-associated microbiota profile had good discriminative power to predict POR, and was superior to clinical risk factors. At Month 6, patients experiencing POR had a higher abundance of taxa belonging to Negativicutes [FDR = 0.04] and Fusobacteria [FDR = 0.04] compared with patients without POR. CONCLUSIONS Microbiota recolonisation after ileocaecal resection is different between recurrence and non-recurrence patients, with Fusobacteria as the most prominent player driving early POR. These bacteria involved in the early recolonisation and POR represent a promising therapeutic strategy in the prevention of disease recurrence.
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Affiliation(s)
- Kathleen Machiels
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | | | | | - Zixuan Xie
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain
| | | | - João Sabino
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Alba Santiago
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain
| | - David Campos
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Chaysavanh Manichanh
- Department of Gastroenterology, Vall d’Hebron Research Institute, Barcelona, Spain,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Séverine Vermeire
- Department of Chronic Diseases Metabolism and Ageing, KU Leuven, Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium,Corresponding author: Severine Vermeire, MD, PhD, Department of Gastroenterology & Hepatology, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium. Tel.: +32 16344225; fax +32 16344419;
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Wasmann KATGM, Klaver CEL, van der Bilt JDW, Nagtegaal ID, Wolthuis AM, van Santvoort HC, Ramshorst B, D’Hoore A, de Wilt JHW, Tanis PJ. Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks. J Gastrointest Surg 2020; 24:2113-2120. [PMID: 31749095 PMCID: PMC7441085 DOI: 10.1007/s11605-019-04426-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multivisceral resection for T4b colon cancer constitutes a heterogeneous group of surgical procedures. The purpose of this study was to explore clinically distinct categories of multivisceral resection, with subsequent correlation to postoperative complications and oncological outcomes. METHODS In this multicenter cohort study, all consecutive patients without metastases who underwent multivisceral resection for pT4bN0-2M0 colon cancer between 2000 and 2014 were included. Multivisceral resection was divided into four categories: (i) gastrointestinal (including the stomach), (ii) urologic ((partial) bladder and ureter), (iii) solid organ (spleen, kidney, liver, pancreas, and uterus), and (iv) abdominal wall/omentum/ovaries. The primary outcome was surgical complications and secondary outcomes were 5-year intra-abdominal recurrence, disease-free survival, and overall survival. RESULTS In total, 130 patients who underwent curative intent resection of pT4 colon cancer were included. Patients who underwent multivisceral resection within multiple categories were assigned to one of the categories based on hierarchy of clinical impact after exploratory analysis. For the primary endpoint, 55 patients were assigned to gastrointestinal, 14 to urologic, 14 to solid organ, and 47 to abdominal wall/omentum/ovaries multivisceral resection. Gastrointestinal multivisceral resection was independently associated with surgical complications (HR 3.9, 95% CI 1.4-10.6). Abdominal wall/omentum/ovaries multivisceral resection was significantly related with intra-abdominal recurrence (HR 7.8, 95% CI 1.0-57.8). The 5-year disease-free survival and overall survival showed no significant differences per multivisceral resection category. CONCLUSIONS Multivisceral resections for T4b colon cancer are heterogeneous procedures considering risk profiles. The proposed multivisceral resection subclassification needs validation, but might improve comparability between studies and hospitals (auditing).
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Affiliation(s)
- Karin A. T. G. M. Wasmann
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Charlotte E. L. Klaver
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jarmila D. W. van der Bilt
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ,grid.410569.f0000 0004 0626 3338Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Iris D. Nagtegaal
- grid.10417.330000 0004 0444 9382Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert M. Wolthuis
- grid.410569.f0000 0004 0626 3338Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Hjalmar C. van Santvoort
- grid.415960.f0000 0004 0622 1269Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Bert Ramshorst
- grid.415960.f0000 0004 0622 1269Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - André D’Hoore
- grid.410569.f0000 0004 0626 3338Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Johannes H. W. de Wilt
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pieter J. Tanis
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Bulens P, Debucquoy A, Joye I, Wolthuis A, D’Hoore A, Van Cutsem E, Dekervel J, Sagaert X, Dresen R, Vandecaveye V, Deroose C, Haustermans K. Comparison of surgical data and survival outcome of rectal cancer patients that need upfront surgery after chemoradiotherapy versus salvage surgery after watch-and-wait. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dhyani M, Joshi N, Bemelman WA, Gee MS, Yajnik V, D’Hoore A, Traverso G, Donowitz M, Mostoslavsky G, Lu TK, Lineberry N, Niessen HG, Peer D, Braun J, Delaney CP, Dubinsky MC, Guillory AN, Pereira M, Shtraizent N, Honig G, Polk DB, Hurtado-Lorenzo A, Karp JM, Michelassi F. Challenges in IBD Research: Novel Technologies. Inflamm Bowel Dis 2019; 25:S24-S30. [PMID: 31095703 PMCID: PMC6787667 DOI: 10.1093/ibd/izz077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 12/15/2022]
Abstract
Novel technologies is part of five focus areas of the Challenges in IBD research document, which also includes preclinical human IBD mechanisms, environmental triggers, precision medicine and pragmatic clinical research. The Challenges in IBD research document provides a comprehensive overview of current gaps in inflammatory bowel diseases (IBD) research and delivers actionable approaches to address them. It is the result of a multidisciplinary input from scientists, clinicians, patients, and funders, and represents a valuable resource for patient centric research prioritization. In particular, the novel technologies section is focused on prioritizing unmet clinical needs in IBD that will benefit from novel technologies applied to: 1) non-invasive detection and monitoring of active inflammation and assessment of treatment response; 2) mucosal targeted drug delivery systems; and 3) prevention of post-operative septic complications and treatment of fistulizing complications. Proposed approaches include development of multiparametric imaging modalities and biosensors, to enable non invasive or minimally invasive detection of pro-inflammatory signals to monitor disease activity and treatment responses. Additionally, technologies for local drug delivery to control unremitting disease and increase treatment efficacy while decreasing systemic exposure are also proposed. Finally, research on biopolymers and other sealant technologies to promote post-surgical healing; and devices to control anastomotic leakage and prevent post-surgical complications and recurrences are also needed.
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Affiliation(s)
- Manish Dhyani
- Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Nitin Joshi
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Michael S Gee
- Massachusetts General Hospital, Boston, Massachusetts
| | - Vijay Yajnik
- Takeda Pharmaceutical Company, Boston, Massachusetts
| | - André D’Hoore
- University Hospital Gasthuisberg and University of Leuven, Leuven, Belgium
| | - Giovanni Traverso
- Brigham and Women’s Hospital, Harvard Medical School and Massachusetts Institute of Technology, Boston, Massachusetts
| | - Mark Donowitz
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Timothy K Lu
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Heiko G Niessen
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Dan Peer
- School of Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Braun
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai, Los Angeles, California
| | | | | | | | | | | | - Gerard Honig
- Crohn’s & Colitis Foundation, New York, New York
| | - David Brent Polk
- Department of Biochemistry and Molecular Biology, University of Southern California,Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Andrés Hurtado-Lorenzo
- Crohn’s & Colitis Foundation, New York, New York,Address correspondence to: Andrés Hurtado-Lorenzo, PhD, 733 3rd Ave Suite 510, New York, NY USA 10017 ()
| | - Jeffrey M Karp
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard-MIT Division of Health Sciences and Technology, Broad Institute and Harvard Stem Cell Institute, Boston, Massachusetts
| | - Fabrizio Michelassi
- New York-Presbyterian Hospital and Weill Cornell School of Medicine, New York, New York
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Demey K, Wolthuis A, de Buck van Overstraeten A, Fieuws S, Vandecaveye V, Van Cutsem E, D’Hoore A. External Validation of the Prognostic Nomogram (COMPASS) for Patients with Peritoneal Carcinomatosis of Colorectal Cancer. Ann Surg Oncol 2017; 24:3604-3608. [DOI: 10.1245/s10434-017-6042-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Indexed: 11/18/2022]
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Spinelli A, D’Hoore A, Panis Y, Bemelman WA, Jayne DG, Fürst A. Critical appraisal of two randomized clinical trials on pathologic outcomes. coloproctology 2017. [DOI: 10.1007/s00053-017-0178-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Joye I, Debucquoy A, Fieuws S, Wolthuis A, Sagaert X, D’Hoore A, Haustermans K. Can clinical factors be used as a selection tool for an organ-preserving strategy in rectal cancer? Acta Oncol 2016; 55:1047-52. [PMID: 27142064 DOI: 10.3109/0284186x.2016.1167954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Rectal cancer patients who achieve a good response to chemoradiotherapy (CRT), may be offered less invasive surgery or even no surgery at all. Implementation of such a policy, however, requires precise patient selection. This study identifies pretreatment clinical factors that are associated with pathological complete response (pCR) and ypT0-1N0 and evaluates their performance as a selection tool for organ-preserving strategies. MATERIAL AND METHODS Patients with rectal cancer treated with CRT and total mesorectal excision between January 2000 and December 2014 were retrospectively included. Following clinical characteristics were extracted from the medical files: age, gender, body mass index, ASA score, cT-stage, cN-stage, distance from the anal verge, pretreatment carcinoembryonic antigen (CEA), pretreatment hemoglobin and distance from the mesorectal fascia. Univariable and multivariable binary logistic regression models were used to predict pCR and ypT0-1N0. The discriminative ability of the prediction models was evaluated by receiver operating characteristic analysis. RESULTS A total of 620 patients were included of whom 120 experienced a pCR (19%) and 170 patients achieved ypT0-1N0 response (27%). A low pretreatment CEA, a high pretreatment hemoglobin and a high cN-stage were associated with pCR in multivariable analysis. A low pretreatment CEA, a low cT-stage and a high cN-stage were associated with ypT0-1N0. After cross validation, the area under the curve for the pCR and ypT0-1N0 prediction model equaled 0.609 and 0.632, respectively. CONCLUSION Despite their statistical significance, the value of pretreatment clinical variables in the prediction of pCR and ypT0-1N0 is very limited. To safely select patients for organ preservation, other strategies need to be explored.
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Affiliation(s)
- Ines Joye
- Department of Oncology, KU Leuven, University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies Debucquoy
- Department of Oncology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Steffen Fieuws
- I-Biostat, KU Leuven University and Hasselt University, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Xavier Sagaert
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karin Haustermans
- Department of Oncology, KU Leuven, University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
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de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D, Rimola J, Ferrante M, Van Assche G, Wolthuis A, D’Hoore A. Modified Side-To-Side Isoperistaltic Strictureplasty over the Ileocaecal Valve: An Alternative to Ileocaecal Resection in Extensive Terminal Ileal Crohn's Disease. J Crohns Colitis 2016; 10:437-42. [PMID: 26674959 PMCID: PMC4946765 DOI: 10.1093/ecco-jcc/jjv230] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative to ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease [CD]. METHODS This type of strictureplasty was proposed to all patients with an extensive strictured [neo-] terminal ileal segment [> 20 cm]. Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography [MRE] and ileocolonoscopy at 6 months. RESULTS Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty [male 9/29, median age 38 [range: 16-64] years]. The median length of strictureplasty was 50 [27-110] cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic-assisted procedure. Median length of hospital stay was 9 [6-17] days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow-up showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow-up of 21 [1-54] months, respectively. CONCLUSION A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggests that clearance of microbial stasis may play a role in this process.
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Affiliation(s)
| | - S. Vermeire
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - D. Vanbeckevoort
- University Hospitals Leuven, Department of Radiology, KU Leuven, Belgium
| | - J. Rimola
- Hospital Clinic de Barcelona, Department of Radiology, Barcelona, Spain
| | - M. Ferrante
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - G. Van Assche
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - A. Wolthuis
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| | - A. D’Hoore
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
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Affiliation(s)
| | | | - D. Vanbeckevoort
- Department of Radiology,University Hospital Gasthuisberg, Leuven, Belgium
| | | | - S. Fieuws
- I-Biostat, Katholieke Universiteit Leuven and Universiteit Hasselt, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, Belgium
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Jochmans I, Topal B, D’Hoore A, Aerts R, Vanbeckevoort D, Bielen D, Haustermans K, Van Cutsem E, Penninckx F. Yield of Routine Imaging after Curative Colorectal Cancer Treatment. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2008.11680182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- I. Jochmans
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | - B. Topal
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | - A. D’Hoore
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | - R. Aerts
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | | | - D. Bielen
- Radiology, University Clinic Gasthuisberg, Leuven, Belgium
| | - K. Haustermans
- Radiotherapy, University Clinic Gasthuisberg, Leuven, Belgium
| | - E. Van Cutsem
- Digestive Oncology, University Clinic Gasthuisberg, Leuven, Belgium
| | - F. Penninckx
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
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Affiliation(s)
- B. van Geluwe
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. Wolthuis
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - F. Penninckx
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
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Stadt JVD, D’Hoore A, Duinslaeger M, Chasse E, Penninckx F. Long-Term Results after Excision Haemorrhoidectomy versus Stapled Haemorrhoidopexy for Prolapsing Haemorrhoids A Belgian prospective randomized trial. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2005.11679665] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J. Van de Stadt
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Department of Digestive Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - A. D’Hoore
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Hospital Erasme, Université Libre de Bruxelles, Brussels; Department of Abdominal Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - M. Duinslaeger
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- University Clinic Gasthuisberg, Leuven; Department of Digestive Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - E. Chasse
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Department of Digestive Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
| | - F. Penninckx
- On behalf of the Belgian Section of Colorectal Surgery, a section of the Royal Belgian Society for Surgery
- Hospital Erasme, Université Libre de Bruxelles, Brussels; Department of Abdominal Surgery, Academic Hospital, Vrije Universiteit van Brussel, Brussels
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Wolthuis A, Iudicello A, Penninckx F, D’Hoore A. Early Experience with Elective Single-port Laparoscopic Appendectomy and Cholecystectomy in Day-case Surgery. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2011.11680761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A.M. Wolthuis
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. Iudicello
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - F. Penninckx
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
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Van Geluwe B, Stuto A, DaPozzo F, Fieuws S, Meurette G, Lehur P, D’Hoore A. Relief of obstructed defecation syndrome after stapled transanal rectal resection (STARR): a meta-analysis. Acta Chir Belg 2014; 114:189-97. [PMID: 25102709 DOI: 10.1080/00015458.2014.11681007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Stapled transanal rectal resection (STARR) is a promising new treatment for obstructed defecation syndrome (ODS) associated with rectal intussusception and/or rectocele. The aim of this work was to assess the efficacy of STARR to treat ODS. METHODS Outcome data after STARR for ODS were pooled according to the used constipation score. As different types of constipation scores were reported, and standardized effect sizes were calculated before performing a meta-analysis. RESULTS Twenty-six publications were identified with a median follow-up of 12 months (range: 3-42). In total 1298 patients were included. Six different scoring systems were used. In total 43 estimates of the effect STARR were analyzed. All studies showed a significant improvement in ODS yielding a combined standardized effect size of 3.8 (95% CI : 3.2-4.5). Although a very high degree of heterogeneity between effect sizes has been observed (I2 = 93.3%), suggesting an overestimation of this improvement. This is partially due to the use of various instruments, but largely originating from (unmeasured) study characteristics. CONCLUSIONS The consistent finding of a decrease in the various ODS-scores confirms that STARR can reduce ODS but the effect is overestimated. This meta-analysis clearly highlights some methodological shortcomings in published data. Heterogeneity in ODS scoring implies the need for standard effect size calculation to compare published results, and underlines the urgent need for a more uniform and accurate data reporting.
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Affiliation(s)
- B. Van Geluwe
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven, Belgium
| | - A. Stuto
- Department of Surgery, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - F. DaPozzo
- Department of Surgery, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - S. Fieuws
- Interuniversity centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - G. Meurette
- Department of Digestive and Endocrine Surgery, University Hospital, Hotel Dieu, Nantes, France
| | - P.A. Lehur
- Department of Digestive and Endocrine Surgery, University Hospital, Hotel Dieu, Nantes, France
| | - A. D’Hoore
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven, Belgium
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Wolthuis A, Penninckx F, Cornille JB, Fieuws S, D’Hoore A. Recurrent symptoms after stapled haemorrhoidopexy and the impact on patient satisfaction after a minimum of 2 years follow-up. Acta Chir Belg 2012; 112:419-22. [PMID: 23397822 DOI: 10.1080/00015458.2012.11680865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stapled haemorrhoidopexy came as an attractive alternative to treat grade 3 haemorrhoids. This study aims to assess the nature of recurrent symptoms and the impact on patient satisfaction after a minimum follow-up of two years in a group of patients who underwent stapled haemorrhoidopexy. METHODS A standardized questionnaire was used to evaluate a consecutive group of patients by telephone treated by a stapled haemorrhoidopexy between January 2004 and December 2007. Outcome assessment comprised residual symptoms, subsequent treatment, and patient satisfaction. RESULTS Hundred sixty-five patients underwent a stapled haemorrhoidopexy in the study period. Twenty-five patients (15%) were lost to follow-up. The included 140 patients presented with grade 2 (16) or grade 3 (124) prolapsing internal haemorrhoids. Median age was 50 years (range 27-79) and 56% were males. Median follow-up was 43 months (range 25-87). At final follow-up, 79 patients (56%) remained symptom-free. Nevertheless, 89% were more than satisfied. Only 11% were disappointed with the ultimate outcome. Recurrent symptoms were prolapse (52 patients), anal bleeding (46 patients), anal pressure or pain (24 patients) and pruritus (21 patients). Thirty-five patients had subsequent therapy: 20 underwent surgical resection and 15 had sclerotherapy or rubber band ligation. Patient satisfaction correlates with the number of recurrent (residual) symptoms and the need for further treatment. CONCLUSION Despite the high symptomatic recurrence rate after stapled haemorrhoidopexy, 89% of patients were satisfied. This suggests that recurrent or residual symptoms after stapled haemorrhoidopexy are often less severe compared to the initial presenting symptoms.
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Affiliation(s)
- A.M. Wolthuis
- Department of Abdominal Surgery,University Hospital Gasthuisberg Leuven, Belgium
| | - F. Penninckx
- Department of Abdominal Surgery,University Hospital Gasthuisberg Leuven, Belgium
| | - J.-B. Cornille
- Department of Abdominal Surgery,University Hospital Gasthuisberg Leuven, Belgium
| | - S. Fieuws
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven and Universiteit Hasselt, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery,University Hospital Gasthuisberg Leuven, Belgium
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Fierens J, Wolthuis A, Penninckx F, D’Hoore A, D’Hoore A. Enhanced recovery after surgery (ERAS) protocol: prospective study of outcome in colorectal surgery. Acta Chir Belg 2012; 112:355-8. [PMID: 23175923 DOI: 10.1080/00015458.2012.11680851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fast-track programs (ERAS) have been shown to improve postoperative recovery in colorectal surgery, combining newer anesthetic and minimally invasive surgery with evidence-based adjustments to facilitate revalidation. This prospective study evaluated the outcome of an ERAS protocol implementation in a university colorectal unit. METHODS Between 2009 and 2010, 94 patients (49 males and 45 females) underwent an elective colorectal resection and were included in this protocol. All data were prospectively gathered in an electronic database. A cohort comparison was performed with 120 patients operated on in 2008 before ERAS implementation. RESULTS The median age was 58 years [range: 29-76 years] and the median ASA score was 2. All colorectal procedures (85 sigmoid resections, 7 right hemicolectomies and 2 low anterior resections) were performed laparoscopically, with a conversion rate of 9,5%. Complications were noted in 14 patients (14,9%); two patients (2,1%) required a laparoscopic drainage of an infected hematoma during initial hospital stay. A significant (p < 0,001) reduced median postoperative hospital stay of 4 days [range : 2-11 days] in the ERAS group, compared with 6 days [range : 3-37] in the non fast-track group was noted. Early readmission occurred in five patients (5,3%) because of anastomotic leakage (n = 2), ileus (n = 2) and a wound infection (n = 1). CONCLUSION These results of length of stay, morbidity and readmission-rates have important implications for the organization of health care, waiting lists and costs. Therefore the ERAS principles should be more wide-spread implemented.
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Affiliation(s)
- J. Fierens
- Department of Abdominal Surgery, University hospital Gasthuisberg Leuven, Belgium
| | - A.M. Wolthuis
- Department of Abdominal Surgery, University hospital Gasthuisberg Leuven, Belgium
| | - F. Penninckx
- Department of Abdominal Surgery, University hospital Gasthuisberg Leuven, Belgium
| | - A.D. D’Hoore
- Department of Abdominal Surgery, University hospital Gasthuisberg Leuven, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, University hospital Gasthuisberg Leuven, Belgium
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Horch RE, D’Hoore A, Holm T, Kneser U, Hohenberger W, Arkudas A. Laparoscopic Abdominoperineal Resection with Open Posterior Cylindrical Excision and Primary Transpelvic VRAM Flap. Ann Surg Oncol 2012; 19:502-503. [DOI: 10.1245/s10434-011-1977-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
PURPOSE A low pelvic anastomosis is associated with a substantial risk of leakage. A defunctioning stoma (DS) reduces the clinical anastomotic leak rate and the need for re-operation, but stoma closure has its own risk of morbidity and mortality. This study aims to audit morbidity and mortality after loop ileostomy (LI) closure. PATIENTS AND METHODS The medical records of 197 consecutive patients who underwent closure of a defunctioning LI between August 2003 and July 2008 were reviewed. Postoperative morbidity and mortality were recorded. RESULTS Transverse closure of the enterotomy was performed in 149 patients (75.6%), segmental enterectomy with hand-sewn end-to-end anastomosis in 26 (13.2%) and stapled side-to-side anastomosis in 22 (11.2%). Overall postoperative morbidity and mortality were 32.0% and 0.5%, respectively. The surgical complication rate was 30.5%, including prolonged ileus (11.2%), small bowel obstruction (4.1%), anastomotic leak (3.0%) and wound infection (4.6%). Surgical complications were more frequent in male patients (p = 0.005). Prolonged ileus was more frequent when the interval to stoma reversal exceeded 12 weeks (14.3% versus 3.5% ; p = 0.02). The incidence of complications was not influenced by the closure technique. Nineteen patients (9.6%) required re-operation for anastomotic leak (n = 8), wound infection (n = 1), small bowel obstruction (n = 3) and incisional herniation (n = 7). CONCLUSION LI closure is associated with clinically relevant morbidity and mortality. This association should be taken into account in the context of a routine DS policy and should be part of the patient's information.
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Affiliation(s)
- A. D’Haeninck
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A.M. Wolthuis
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - F. Penninckx
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - M. D’Hondt
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
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Hompes D, D’Hoore A, Van Cutsem E, Ceelen W, Peeters M, Van der Speeten K, Bertrand C, Kerger J, Legendre H. Evaluation of the treatment of peritoneal carcinomatosis of colorectal cancer (CRC) with complete cytoreduction and hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) with oxaliplatin: A Belgian multicenter prospective phase II clinical study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4101 Background: Up to 25% of patients with metastatic CRC present with peritoneal carcinomatosis (PC) as the only site of metastases. The concept of Complete Cytoreductive Surgery (CCRS) followed by Hyperthermia and Intraperitoneal Chemotherapy (HIPEC) was developed, aiming for locoregional disease control and long-term survival. Methods: This prospective multicentre registry included 48 patients (M/F ratio 17/31) with PC from CRC, who underwent CCRS and HIPEC with oxaliplatin(460mg/m2). In 72.9% of patients the primary tumor had been previously resected. Median PCI (peritoneal cancer index) was 11 [1–22], with a median of 6 [1–11] abdominal regions involved and a median lesion size score of 3 [1–3]. In 11 cases associated lymph nodes (63.6% mesenteric, 27.3% para-aortic) were resected. To obtain CCRS a median of 2 [2–6] organs needed to be resected, with anterior resection in 45.8%, total colectomy in 8.3% and small bowel resection in 12.5% of cases. A median of 1 [0–6] anastomosis was performed per patient, of which one third were low and 82.1% were performed after HIPEC. Eleven ileostomies and 5 colostomies were constructed. Results: Median operation time was 460min.[125–840], with a median blood loss of 475ml [2- 6000]. HIPEC posed few procedural problems. There was no postoperative mortality. Complication rate was 52.1%, with 18 intra- and 17 extra-abdominal complications. Anastomotic leakage occurred in 10.4% of patients, bleeding in 6.3% and prolonged ileus in 22.9%. Median hospital stay was 20 [5–65] days. Occurrence of intra-abdominal complications significantly affected hospital stay (p=0.0012), but no risk factors for occurrence of postoperative complications could be clearly identified. Median follow-up was 22.7 [3.2–55.7] months, with 91.7% 2-year overall survival. Progression-free survival at 2 years is 64.6%, with PC recurrence in 29.2% of patients and other metastatic disease in 25%. Multivariate analysis only retained the CEA-level as a significant prognostic factor (p=0.0065). Conclusions: CCRS followed by HIPEC for PC of colorectal origin is safe and has longer than expected PFS and OS. No significant financial relationships to disclose.
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Affiliation(s)
- D. Hompes
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - A. D’Hoore
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - E. Van Cutsem
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - W. Ceelen
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - M. Peeters
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - K. Van der Speeten
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - C. Bertrand
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - J. Kerger
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
| | - H. Legendre
- University Hospitals Gasthuisberg, Leuven, Belgium; University Hospital Gent, Gent, Belgium; Ziekenhuis Oost-Limburg, Genk, Belgium; Hopital de Jolimont, Jolimont, Belgium; UCL Mont-Godinne, Yvoir, Belgium
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Baig M, Larach J, Chang S, Long C, Weiss E, Nogueras J, Wexner S, Bouchoucha M, Devroede G, Dorval E, Faye A, Arhan P, Arsac M, Zbar A, Oyetunji R, Gill R, D’Annibale A, Morpurgo E, Fiscon V, Termini B, Serventi A, Sovernigo G, Orsini C, Fa-Si-Oen P, van de Gender P, Putter H, Ectors N, D’Hoore A, Topal B, Penninckx F, Marques C, Nahas S, Nahas C, Sobrado C, Habr-Gama A, Kiss D, Verdaasdonk E, Bueno de Mesquita J, Stassen L, Nano M, Prunotto M, Ferronato M, Solej M, Galloni M, Pigot F, Dao-Quang M, Castinel A, Juguet F, Bouchard D, Bockle J, Allaert F, de la Portilla F, Zbar A, Rada R, Vega J, Cisneros N, Maldonado V, Utrera A, Espinosa E, Trecca A, Gaj F, Di Lorenzo G, Ricciardi M, Silano M, Bella A, Sperone M, Vorobiev G, Tsarkov P, Sorokin E. Erratum. Tech Coloproctol 2009. [DOI: 10.1007/s10151-006-0317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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