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de Jongh C, van der Meulen MP, Gertsen EC, Brenkman HJF, van Sandick JW, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, Wijnhoven BPL, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, Daams F, van der Peet DL, van Grieken NCT, Heisterkamp J, van Etten B, van den Berg JW, Pierie JP, Eker HH, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, Wevers KP, Hol L, Wessels FJ, Haj Mohammad N, Frederix GWJ, van Hillegersberg R, Siersema PD, Vegt E, Ruurda JP. Impact of 18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study. Ann Surg Oncol 2024:10.1245/s10434-024-15103-4. [PMID: 38526832 DOI: 10.1245/s10434-024-15103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging. MATERIALS AND METHODS In this cost analysis, four staging strategies were modeled in a decision tree: (1) 18FFDG-PET/CT first, then SL, (2) SL only, (3) 18FFDG-PET/CT only, and (4) neither SL nor 18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3-4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18FFDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations). RESULTS 18FFDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding 18FFDG-PET/CT to SL increased costs by €1058 per patient; IQR €870-1253 in the sensitivity analysis. CONCLUSIONS For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine 18FFDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs. TRIAL REGISTRATION NCT03208621. This trial was registered prospectively on 30-06-2017.
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Affiliation(s)
- Cas de Jongh
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | | | - Emma C Gertsen
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Hylke J F Brenkman
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Johanna W van Sandick
- Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Misha D P Luyer
- Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Jan J B van Lanschot
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | | | | | - Jan H M B Stoot
- Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands
| | | | | | - Marc J van Det
- Surgery Department, ZGT Hospital, Almelo, The Netherlands
| | | | - Freek Daams
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nicole C T van Grieken
- Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joos Heisterkamp
- Surgery Department, Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands
| | | | | | - Jean-Pierre Pierie
- Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Hasan H Eker
- Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Annemieke Y Thijssen
- Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Eric J T Belt
- Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Eelco Wassenaar
- Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Kevin P Wevers
- Surgery Department, Isala Hospital, Zwolle, The Netherlands
| | - Lieke Hol
- Gastroenterology Department, Maasstad Hospital, Rotterdam, The Netherlands
| | - Frank J Wessels
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Nadia Haj Mohammad
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Gastroenterology and Hepatology Department, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands
| | - Erik Vegt
- Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
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2
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Wesselink E, Staritsky LE, van Zutphen M, Geijsen AJMR, Kok DE, Kruyt F, Veenstra RP, Spillenaar Bilgen EJ, Kouwenhoven EA, de Wilt JHW, Kampman E, van Duijnhoven FJB. The association between the adapted dietary inflammatory index and colorectal cancer recurrence and all-cause mortality. Clin Nutr 2021; 40:4436-4443. [PMID: 33478795 DOI: 10.1016/j.clnu.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The inflammatory potential of the diet has been linked to colorectal cancer (CRC) development and mortality. However, it is unknown whether it is also associated with CRC recurrence. Therefore, the aim of this study was to investigate the associations between the inflammatory potential of the diet and plasma inflammation markers as well as recurrence and all-cause mortality in CRC patients. METHODS Data of the Colorectal cancer, Observational, LONgitudinal (COLON) study, a prospective cohort study, was used. Dietary intake, assessed using a semi-quantitative food frequency questionnaire, was available for 1478 patients at diagnosis and for 1334 patients six months after diagnosis. Dietary intake data were used to calculate the adapted dietary inflammatory index (ADII). Data about cancer recurrence and all-cause mortality, were assessed through linkage with the Netherlands Cancer Registry and the Municipal Personal Records Database, respectively. The association between the ADII (continuous) and inflammation markers (Interleukin (IL)6, IL8, IL10, Tumor Necrosis Factor (TNF)α, high sensitivity C-reactive protein (hsCRP) and a summary inflammatory z-score), measured with a multiplex assay using electrochemiluminiscence detection, was assessed using quantile regression analyses. Restricted cubic splines (RCS) analyses and multivariable Cox proportional hazard models were used to explore the relationship between the ADII and CRC outcomes. RESULTS During a median follow-up time of 3.2 years (Interquartile range (IQR) 2.0-4.1) for recurrence and 4.8 years (IQR 3.5-5.9) for all-cause mortality, 228 recurrences and 279 deaths occurred. A more pro-inflammatory diet at diagnosis as well as six months after diagnosis was associated with higher levels of TNFα, hsCRP and the summary inflammatory z-score. Results of RCS showed no relationship between the ADII and CRC outcomes at both time points. Also results of the Cox proportional hazard models showed no associations between the ADII at both time points and recurrence (HR (95%CI) 0.98 (0.94-1.04) & 0.96 (0.91-1.02) or all-cause mortality (HR (95%CI) 1.03 (0.98-1.07) & 1.00 (0.95-1.05)). CONCLUSION Our study did not show an association between the ADII and recurrence and all-cause mortality in CRC patients. Further research should also take into account molecular tumor subtypes, as the effect of the inflammatory potential of the diet on cancer recurrence and mortality is more likely to be present in tumors with an inflammatory signature. CLINICAL TRIAL REGISTRY NUMBERS AND WEBSITE The colon study: NCT03191110; clinical trials.gov.
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Affiliation(s)
- Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Laura E Staritsky
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Flip Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Renzo P Veenstra
- Department of Gastroenterology, Martini Hospital, Groningen, the Netherlands
| | | | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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3
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Wennmacker SZ, de Savornin Lohman EAJ, Hasami NA, Nagtegaal ID, Boermeester MA, Verheij J, Spillenaar Bilgen EJ, Meijer JWH, Bosscha K, van der Linden JC, Hermans JJ, de Reuver PR, Drenth JPH, van Laarhoven CJHM. Overtreatment of Nonneoplastic Gallbladder Polyps due to Inadequate Routine Ultrasound Assessment. Dig Surg 2020; 38:1-7. [PMID: 33302266 DOI: 10.1159/000511896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/15/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The primary aim was to assess the diagnostic accuracy of routine ultrasound assessment for gallbladder polyps. The secondary aim was to identify the characteristics that differentiate neoplastic polyps from nonneoplastic polyps. METHODS A total of 156 patients with histopathologically proven gallbladder polyps in 4 Dutch hospitals between 2003 and 2013 were included. Sensitivity and specificity of ultrasound for polyp size, number of polyps, and polyp type were assessed using histopathological findings as a reference standard. In addition, diagnostic accuracy of sonographic size ≥1 cm for neoplasia was assessed. Subgroup analysis for patients with polyps as primary indication for cholecystectomy was performed. The sonographic polyp characteristics on preoperative routine ultrasound were described. RESULTS Fifty-six percent of gallbladder polyps were preoperatively identified on ultrasound, of which 31% were neoplastic. Sensitivity and specificity of ultrasound to estimate polyp size were 93 and 43% (subgroup; 92 and 33%). Sensitivity and specificity of sonographic polyp size ≥1 cm for neoplasia were 86 and 32% (subgroup; 94 and 26%). No specific sonographic characteristics for neoplastic polyps could be established due to lack of reporting. CONCLUSION Routine ultrasound assessment of polyps is associated with overestimation of polyp size and low specificity of sonographic size ≥1 cm for neoplasia, which contributes to surgical overtreatment of nonneoplastic polyps.
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Affiliation(s)
- Sarah Z Wennmacker
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands,
| | | | - Nesar A Hasami
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Joanne Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jos W H Meijer
- Department of Pathology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - John J Hermans
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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4
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da Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, van Brunschot S, Bakker OJ, Bollen TL, Dejong CH, van Goor H, Boermeester MA, Bruno MJ, van Eijck CH, Timmer R, Weusten BL, Consten EC, Brink MA, Spanier BWM, Bilgen EJS, Nieuwenhuijs VB, Hofker HS, Rosman C, Voorburg AM, Bosscha K, van Duijvendijk P, Gerritsen JJ, Heisterkamp J, de Hingh IH, Witteman BJ, Kruyt PM, Scheepers JJ, Molenaar IQ, Schaapherder AF, Manusama ER, van der Waaij LA, van Unen J, Dijkgraaf MG, van Ramshorst B, Gooszen HG, Boerma D. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet 2015; 386:1261-1268. [PMID: 26460661 DOI: 10.1016/s0140-6736(15)00274-3] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission cholecystectomy is poor, and concerns exist about an increased risk of cholecystectomy-related complications with this approach. In this study, we aimed to compare same-admission and interval cholecystectomy, with the hypothesis that same-admission cholecystectomy would reduce the risk of recurrent gallstone-related complications without increasing the difficulty of surgery. METHODS For this multicentre, parallel-group, assessor-masked, randomised controlled superiority trial, inpatients recovering from mild gallstone pancreatitis at 23 hospitals in the Netherlands (with hospital discharge foreseen within 48 h) were assessed for eligibility. Adult patients (aged ≥18 years) were eligible for randomisation if they had a serum C-reactive protein concentration less than 100 mg/L, no need for opioid analgesics, and could tolerate a normal oral diet. Patients with American Society of Anesthesiologists (ASA) class III physical status who were older than 75 years of age, all ASA class IV patients, those with chronic pancreatitis, and those with ongoing alcohol misuse were excluded. A central study coordinator randomly assigned eligible patients (1:1) by computer-based randomisation, with varying block sizes of two and four patients, to cholecystectomy within 3 days of randomisation (same-admission cholecystectomy) or to discharge and cholecystectomy 25-30 days after randomisation (interval cholecystectomy). Randomisation was stratified by centre and by whether or not endoscopic sphincterotomy had been done. Neither investigators nor participants were masked to group assignment. The primary endpoint was a composite of readmission for recurrent gallstone-related complications (pancreatitis, cholangitis, cholecystitis, choledocholithiasis needing endoscopic intervention, or gallstone colic) or mortality within 6 months after randomisation, analysed by intention to treat. The trial was designed to reduce the incidence of the primary endpoint from 8% in the interval group to 1% in the same-admission group. Safety endpoints included bile duct leakage and other complications necessitating re-intervention. This trial is registered with Current Controlled Trials, number ISRCTN72764151, and is complete. FINDINGS Between Dec 22, 2010, and Aug 19, 2013, 266 inpatients from 23 hospitals in the Netherlands were randomly assigned to interval cholecystectomy (n=137) or same-admission cholecystectomy (n=129). One patient from each group was excluded from the final analyses, because of an incorrect diagnosis of pancreatitis in one patient (in the interval group) and discontinued follow-up in the other (in the same-admission group). The primary endpoint occurred in 23 (17%) of 136 patients in the interval group and in six (5%) of 128 patients in the same-admission group (risk ratio 0·28, 95% CI 0·12-0·66; p=0·002). Safety endpoints occurred in four patients: one case of bile duct leakage and one case of postoperative bleeding in each group. All of these were serious adverse events and were judged to be treatment related, but none led to death. INTERPRETATION Compared with interval cholecystectomy, same-admission cholecystectomy reduced the rate of recurrent gallstone-related complications in patients with mild gallstone pancreatitis, with a very low risk of cholecystectomy-related complications. FUNDING Dutch Digestive Disease Foundation.
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Affiliation(s)
- David W da Costa
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Stefan A Bouwense
- Department of Operating Room/Evidence-Based Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicolien J Schepers
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, Netherlands; Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Olaf J Bakker
- Department of Surgery, University Medical Center Utrecht, Netherlands
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Cornelis H Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Robin Timmer
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Bas L Weusten
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Esther C Consten
- Department of Surgery, Meander Medical Center, Amersfoort, Netherlands
| | - Menno A Brink
- Department of Gastroenterology, Meander Medical Center, Amersfoort, Netherlands
| | | | | | | | - H Sijbrand Hofker
- Department of Surgery, University Medical Center Groningen, Netherlands
| | - Camiel Rosman
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Annet M Voorburg
- Department of Gastroenterology, Diakonessenhuis, Utrecht, Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | | | - Jos J Gerritsen
- Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands
| | | | | | - Ben J Witteman
- Department of Gastroenterology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Philip M Kruyt
- Department of Surgery, Gelderse Vallei Hospital, Ede, Netherlands
| | - Joris J Scheepers
- Department of Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | | | | | - Eric R Manusama
- Department of Surgery, Medical Center Leeuwarden, Netherlands
| | | | - Jacco van Unen
- Department of Surgery, Laurentius Hospital, Roermond, Netherlands
| | | | | | - Hein G Gooszen
- Department of Operating Room/Evidence-Based Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Djamila Boerma
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands.
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5
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Krijtenburg P, Spillenaar Bilgen EJ, Seesink M. [Capnothorax following a diagnostic laparoscopy]. Ned Tijdschr Geneeskd 2015; 159:A8918. [PMID: 26374722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An 84-year-old woman underwent a diagnostic laparoscopy preceding a planned total gastrectomy. A bilateral pneumothorax was diagnosed postoperatively, following an uneventful procedure. The patient's clinical parameters led to the diagnosis of capnothorax, a rare complication of laparoscopic surgery. It is important to be able to differentiate between a capnothorax and a pneumothorax because the treatment is different: a capnothorax can generally be treated conservatively. The perioperative signs and symptoms, physiology and treatment of a capnothorax are discussed in this article.
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6
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Schout PJC, Spillenaar Bilgen EJ, Groenen MJM. Routine screening for colon cancer after conservative treatment of diverticulitis. Dig Surg 2012; 29:408-11. [PMID: 23171930 DOI: 10.1159/000345332] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/22/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS It is generally advised to perform colonoscopy after conservatively treated diverticulitis because colon cancer may present itself with similar symptoms, laboratory and radiological results. With this study we investigated in what percentage of patients a malignancy was found by performing routine colonoscopy or radiologic imaging after a conservatively treated episode of diverticulitis, and whether this follow-up programme could be reserved for a selected group of patients. METHODS In our hospital, routine colonoscopy or, as a second choice, radiologic imaging has been standard practice over the last decade. We collected all colonoscopy and radiologic imaging results that were conducted of all 516 patients who were diagnosed with diverticulitis in this period. RESULTS Of those 516 patients, 378 had undergone colonoscopy, 45 radiologic imaging and 93 did not undergo any additional investigation. Eight cases of malignant neoplasia were found in those patients (2.1%), and an additional number of 40 adenomatous polyps (9.5%). Six out of 8 patients with colon cancer reported rectal blood loss, significant weight loss or persisting abdominal pain after being treated for diverticulitis. CONCLUSIONS In patients who were conservatively treated with routine colonoscopy or radiologic imaging for apparent diverticulitis, a malignant tumour was found in the colon in 2.1% of them. If only performed in patients reporting alarm symptoms, a case of colon cancer would be missed in only 0.5% of patients conservatively treated for diverticulitis. Therefore, screening for colon cancer after conservative treatment of diverticulitis is only indicated in symptomatic patients.
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Affiliation(s)
- Pim J C Schout
- Department of Surgery, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
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Slegers CAD, Bloemsma GC, Horjus CS, Visser H, Robijn RJ, Spillenaar Bilgen EJ. [Abdominal pain with a microvascular cause]. Ned Tijdschr Geneeskd 2012; 156:A4434. [PMID: 22414672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 50-year-old Caucasian man was admitted with unexplained abdominal pain. Based on CT scan results, a perforation resulting from colitis of the transverse colon was suspected. Additional colonoscopy showed ulcerative stenosis of the transverse colon. Initially, the patient recovered on conservative treatment; however, because of persistent stenosis, an elective resection of the transverse colon was performed. A CT scan revealed free gas around the anastomosis on the fourth postoperative day. Relaparotomy revealed leakage and diffuse ischaemic changes around the anastomosis as well as perforations at different sites on the small bowel. Postoperative CT angiography showed stenosis of the proximal celiac trunk, which was successfully stented. Digital subtraction angiography (DSA) revealed luminal irregularities of the superior mesenteric, the middle colic as well as the main hepatic and splenic arteries. Eventually, the clinical presentation and surgical, radiologic and histopathological findings together led to the diagnosis of polyarteritis nodosa (PAN). Aggressive treatment with glucocorticoids and cyclophosphamide resulted in the resolution of symptoms and the disappearance of radiologic abnormalities.
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Affiliation(s)
- Claire A D Slegers
- Rijnstate Ziekenhuis, Arnhem, Afd. Interne Geneeskunde, the Netherlands.
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8
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Eshuis EJ, Bemelman WA, van Bodegraven AA, Sprangers MAG, Bossuyt PMM, van Milligen de Wit AWM, Crolla RMPH, Cahen DL, Oostenbrug LE, Sosef MN, Voorburg AMCJ, Davids PHP, van der Woude CJ, Lange J, Mallant RC, Boom MJ, Lieverse RJ, van der Zaag ES, Houben MHMG, Vecht J, Pierik REGJM, van Ditzhuijsen TJM, Prins HA, Marsman WA, Stockmann HB, Brink MA, Consten ECJ, van der Werf SDJ, Marinelli AWKS, Jansen JM, Gerhards MF, Bolwerk CJM, Stassen LPS, Spanier BWM, Bilgen EJS, van Berkel AM, Cense HA, van Heukelem HA, van de Laar A, Slot WB, Eijsbouts QA, van Ooteghem NAM, van Wagensveld B, van den Brande JMH, van Geloven AAW, Bruin KF, Maring JK, Oldenburg B, van Hillegersberg R, de Jong DJ, Bleichrodt R, van der Peet DL, Dekkers PEP, Goei TH, Stokkers PCF. Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial). BMC Surg 2008; 8:15. [PMID: 18721465 PMCID: PMC2533646 DOI: 10.1186/1471-2482-8-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 08/22/2008] [Indexed: 12/24/2022] Open
Abstract
Background With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction. The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. Methods/design The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. Discussion The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. Trial registration Nederlands Trial Register NTR1150
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Affiliation(s)
- Emma J Eshuis
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
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Besselink MGH, van Santvoort HC, Nieuwenhuijs VB, Boermeester MA, Bollen TL, Buskens E, Dejong CHC, van Eijck CHJ, van Goor H, Hofker SS, Lameris JS, van Leeuwen MS, Ploeg RJ, van Ramshorst B, Schaapherder AFM, Cuesta MA, Consten ECJ, Gouma DJ, van der Harst E, Hesselink EJ, Houdijk LPJ, Karsten TM, van Laarhoven CJHM, Pierie JPEN, Rosman C, Bilgen EJS, Timmer R, van der Tweel I, de Wit RJ, Witteman BJM, Gooszen HG. Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg 2006; 6:6. [PMID: 16606471 PMCID: PMC1508161 DOI: 10.1186/1471-2482-6-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 04/11/2006] [Indexed: 12/16/2022] Open
Abstract
Background The initial treatment of acute necrotizing pancreatitis is conservative. Intervention is indicated in patients with (suspected) infected necrotizing pancreatitis. In the Netherlands, the standard intervention is necrosectomy by laparotomy followed by continuous postoperative lavage (CPL). In recent years several minimally invasive strategies have been introduced. So far, these strategies have never been compared in a randomised controlled trial. The PANTER study (PAncreatitis, Necrosectomy versus sTEp up appRoach) was conceived to yield the evidence needed for a considered policy decision. Methods/design 88 patients with (suspected) infected necrotizing pancreatitis will be randomly allocated to either group A) minimally invasive 'step-up approach' starting with drainage followed, if necessary, by videoscopic assisted retroperitoneal debridement (VARD) or group B) maximal necrosectomy by laparotomy. Both procedures are followed by CPL. Patients will be recruited from 20 hospitals, including all Dutch university medical centres, over a 3-year period. The primary endpoint is the proportion of patients suffering from postoperative major morbidity and mortality. Secondary endpoints are complications, new onset sepsis, length of hospital and intensive care stay, quality of life and total (direct and indirect) costs. To demonstrate that the 'step-up approach' can reduce the major morbidity and mortality rate from 45 to 16%, with 80% power at 5% alpha, a total sample size of 88 patients was calculated. Discussion The PANTER-study is a randomised controlled trial that will provide evidence on the merits of a minimally invasive 'step-up approach' in patients with (suspected) infected necrotizing pancreatitis.
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Affiliation(s)
- Marc GH Besselink
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | | | | | | | - Thomas L Bollen
- Department of Radiology, St. Antonius Hospital Nieuwegein, The Netherlands
| | - Erik Buskens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Cornelis HC Dejong
- Department of Surgery, University Hospital Maastricht and NUTRIM institute, The Netherlands
| | | | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Sijbrand S Hofker
- Department of Surgery, University Medical Center Groningen, The Netherlands
| | - Johan S Lameris
- Department of Radiology, Academic Medical Center Amsterdam, The Netherlands
| | | | - Rutger J Ploeg
- Department of Surgery, University Medical Center Groningen, The Netherlands
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands
| | | | - Miguel A Cuesta
- Department of Surgery, VU Medical Center Amsterdam, The Netherlands
| | - Esther CJ Consten
- Department of Surgery, Meander Medical Center Amersfoort, The Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - Erwin van der Harst
- Department of Surgery, Medical Center Rijnmond Zuid Rotterdam, The Netherlands
| | - Eric J Hesselink
- Department of Surgery, Gelre Hospitals Apeldoorn, The Netherlands
| | - Lex PJ Houdijk
- Department of Surgery, Medical Center Alkmaar, The Netherlands
| | - Tom M Karsten
- Department of Surgery, Reinier de Graaf Group Delft, The Netherlands
| | | | | | - Camiel Rosman
- Department of Surgery, Canisius Wilhelmina Hospital Nijmegen, The Netherlands
| | | | - Robin Timmer
- Department of Gastroenterology, St. Antonius Hospital Nieuwegein, The Netherlands
| | | | - Ralph J de Wit
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Ben JM Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Ede, The Netherlands
| | - Hein G Gooszen
- Department of Surgery, University Medical Center Utrecht, The Netherlands
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