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van Egmond R, van Kesteren J, Kaomba L, Philipo GS, Borgstein E, Rinkes IB, Rijken M, Kruijff S, Stortelder E. Empowering Tomorrow's Cancer Specialists: Evaluating the Co-creation and Impact of Malawi's First Surgical Oncology Summerschool. J Cancer Educ 2024:10.1007/s13187-024-02400-5. [PMID: 38334895 DOI: 10.1007/s13187-024-02400-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/10/2024]
Abstract
Annually more than 1 million newly diagnosed cancer cases and 500,000 cancer-related deaths occur in Sub Saharan Africa (SSA). By 2030, the cancer burden in Africa is expected to double accompanied by low survival rates. Surgery remains the primary treatment for solid tumours especially where other treatment modalities are lacking. However, in SSA, surgical residents lack sufficient training in cancer treatment. In 2022, Malawian and Dutch specialists co-designed a training course focusing on oncologic diseases and potential treatment options tailored to the Malawian context. The aim of this study was to describe the co-creation process of a surgical oncology education activity in a low resource setting, at the same time attempting to evaluate the effectiveness of this training program. The course design was guided and evaluated conform Kirkpatrick's requirements for an effective training program. Pre-and post-course questionnaires were conducted to evaluate the effectiveness. Thirty-five surgical and gynaecological residents from Malawi participated in the course. Eighty-six percent of respondents (n = 24/28) were highly satisfied at the end of the course. After a 2-month follow-up, 84% (n = 16/19) frequently applied the newly acquired knowledge, and 74% (n = 14/19) reported to have changed their patient care. The course costs were approximately 119 EUR per attendee per day. This course generally received generally positively feedback, had high satisfaction rates, and enhanced knowledge and confidence in the surgical treatment of cancer. Its effectiveness should be further evaluated using the same co-creation model in different settings. Integrating oncology into the regular curriculum of surgical residents is recommended.
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Affiliation(s)
- Remco van Egmond
- Department of Surgery, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
- Netherlands Society for International Surgery (NSIS), Soest, The Netherlands
| | - Jurre van Kesteren
- Netherlands Society for International Surgery (NSIS), Soest, The Netherlands
- Department of Surgery, Amsterdam University Medical Centres, Location VUmc, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Lucy Kaomba
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
- The College of Surgeons of East Central and Southern Africa (COSECSA), Arusha, Tanzania
| | - Godfrey Sama Philipo
- The College of Surgeons of East Central and Southern Africa (COSECSA), Arusha, Tanzania
- The Branch for Global Surgical Care (BGSC), University of British Columbia, Vancouver, Canada
| | - Eric Borgstein
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
- The College of Surgeons of East Central and Southern Africa (COSECSA), Arusha, Tanzania
| | - Inne Borel Rinkes
- Netherlands Society for International Surgery (NSIS), Soest, The Netherlands
- Department of Oncology, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Marcus Rijken
- Netherlands Cancer Institute, Amsterdam, The Netherlands
- Workingparty International Safe Motherhood & Reproductive Health, Groningen, The Netherlands
- Department of OBGYN, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Julius Global Health, Utrecht University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre, Groningen, The Netherlands
| | - Eva Stortelder
- Netherlands Society for International Surgery (NSIS), Soest, The Netherlands.
- Julius Global Health, Utrecht University Medical Centre Utrecht, Utrecht, The Netherlands.
- Department of Surgery, Utrecht University Medical Centre, Utrecht, The Netherlands.
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van Kesteren J, van Goudoever LAE, Conteh A, van Acker GJD, Bonjer HJ, Bolkan HA. Technical Perspective for Video Based Assessment of Surgeries in Low-Resource Settings. J Surg Educ 2023; 80:495-498. [PMID: 36775728 DOI: 10.1016/j.jsurg.2023.01.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Scalable digital learning environments are essential to sustain surgical training programs worldwide. Detailed images of surgeries enriched with educational annotations are vital to train the eyes of the learners. Here, we report a low-cost method, deployed in a low-resource setting in West Africa, which may contribute to the growth of use in open-sourced digital surgical resources world-wide. DESIGN This paper is based on the authors participatory and observational experiences creating surgical video content by way of recording surgical procedures and reflecting on field notes and video content. All surgeries were recorded between January and December 2018. SETTING Masanga Hospital, a rural district hospital in Sierra Leone, West Africa. PARTICIPANTS Thirty-five patients undergoing inguinal hernia repair, elective caesarian section, salpingectomy, bowel resection, hydrocele repair, or below-knee amputation consented for recording their surgical procedure and using the anonymized material for educational purposes. RESULTS This manual for non-professional cinematographers provides chronological steps for shooting a surgical procedure in a low-resource setting. Recording a surgical procedure to explain surgical techniques, and perform quality assessment through error analysis and coaching requires more than just point-and-shoot. While taking into account local customs and possibilities, practical tips were provided to prepare for the set-up, and recording of a surgical procedure in a low-resourced setting. CONCLUSION Commercially available digital video technology allows for filming high-quality surgical procedures for educational purposes at rural district hospitals in a low-resource setting.
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Affiliation(s)
- Jurre van Kesteren
- Department of Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, The Netherlands; Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Leandra A E van Goudoever
- Global Surgery Amsterdam, Amsterdam, The Netherlands; Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amara Conteh
- Masanga Hospital, Tonkolili district, Sierra Leone
| | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, The Netherlands; Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway; CapaCare, Norway
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van Kesteren J, Meylahn-Jansen PJ, Conteh A, Lissenberg-Witte BI, van Duinen AJ, Ashley T, Bonjer HJ, Bolkan HA. Inguinal hernia surgery learning curves by associate clinicians. Surg Endosc 2023; 37:2085-2094. [PMID: 36303045 PMCID: PMC10017565 DOI: 10.1007/s00464-022-09726-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Open inguinal hernia repair is the most commonly performed procedure in general surgery in sub-Saharan Africa, but data on its learning curve are lacking. This study evaluated the learning curve characteristics to improve surgical training and enable scaling up hernia surgery in low- and middle-income countries. METHODS Logbook data of associate clinicians enrolled in a surgical training program in Sierra Leone were collected and their first 55 hernia surgeries following the Bassini technique (herniorrhaphies) were analyzed in cohorts of five cases. Studied variables were gradient of decline of operating time, variation in operating time, and length of stay (LOS). Eleven subsequent cohorts of each five herniorrhaphies were investigated. RESULTS Seventy-five trainees enrolled in the training program between 2011 and 2020 were eligible for inclusion. Thirty-one (41.3%) performed the minimum of 55 herniorrhaphies, and had also complete personal logbook data. Mean operating times dropped from 79.6 (95% CI 75.3-84.0) to 48.6 (95% CI 44.3-52.9) minutes between the first and last cohort, while standard deviation in operating time nearly halved to 15.4 (95% CI 11.7-20.0) minutes, and LOS was shortened by 3 days (8.5 days, 95%CI 6.1-10.8 vs. 5.4 days, 95% 3.1-7.6). Operating times flattened after 31-35 cases which corresponded with 1.5 years of training. CONCLUSIONS The learning curve of inguinal hernia surgery for associate clinicians flattens after 31-35 procedures. Training programs can be tailored based on this finding. The recorded learning curve may serve as a baseline for future training techniques.
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Affiliation(s)
- Jurre van Kesteren
- Department of Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Pauline J Meylahn-Jansen
- Global Surgery Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Thomas Ashley
- CapaCare, Trondheim, Norway
- Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone
- Department of General Surgery, North Cumbria University Hospital, Carlisle, UK
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Centers, Location Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
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van Kesteren J, van Duinen AJ, Marah F, van Delft D, Spector AL, Cassidy LD, Groen RS, Jabbi SMBB, Bah S, Medo JA, Kamanda-Bongay A, van Leerdam D, Westendorp J, Mathéron HM, Mönnink GLE, Vas Nunes J, Lindenbergh KC, Hoel SK, Løvdal SM, Østensen MN, Solberg H, Boateng D, Klipstein-Grobusch K, van Herwaarden D, Martens JPJ, Bonjer HJ, Sankoh O, Grobusch MP, Bolkan HA. PREvalence Study on Surgical COnditions (PRESSCO) 2020: A Population-Based Cross-Sectional Countrywide Survey on Surgical Conditions in Post-Ebola Outbreak Sierra Leone. World J Surg 2022; 46:2585-2594. [PMID: 36068404 PMCID: PMC9529684 DOI: 10.1007/s00268-022-06695-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Background Understanding the burden of diseases requiring surgical care at national levels is essential to advance universal health coverage. The PREvalence Study on Surgical COnditions (PRESSCO) 2020 is a cross-sectional household survey to estimate the prevalence of physical conditions needing surgical consultation, to investigate healthcare-seeking behavior, and to assess changes from before the West African Ebola epidemic. Methods This study (ISRCTN: 12353489) was built upon the Surgeons Overseas Surgical Needs Assessment (SOSAS) tool, including expansions. Seventy-five enumeration areas from 9671 nationwide clusters were sampled proportional to population size. In each cluster, 25 households were randomly assigned and visited. Need for surgical consultations was based on verbal responses and physical examination of selected household members. Results A total of 3,618 individuals from 1,854 households were surveyed. Compared to 2012, the prevalence of individuals reporting one or more relevant physical conditions was reduced from 25 to 6.2% (95% CI 5.4–7.0%) of the population. One-in-five conditions rendered respondents unemployed, disabled, or stigmatized. Adult males were predominantly prone to untreated surgical conditions (9.7 vs. 5.9% women; p < 0.001). Financial constraints were the predominant reason for not seeking care. Among those seeking professional health care, 86.7% underwent surgery. Conclusion PRESSCO 2020 is the first surgical needs household survey which compares against earlier study data. Despite the 2013–2016 Ebola outbreak, which profoundly disrupted the national healthcare system, a substantial reduction in reported surgical conditions was observed. Compared to one-time measurements, repeated household surveys yield finer granular data on the characteristics and situations of populations in need of surgical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06695-7.
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Affiliation(s)
- Jurre van Kesteren
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Foday Marah
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
| | - Diede van Delft
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
| | - Antoinette L Spector
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura D Cassidy
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Reinou S Groen
- Johns Hopkins School of Medicine, Baltimore, USA
- SOS - Surgeons OverSeas, New York, NY, USA
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - James A Medo
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | | | - Daniel van Leerdam
- CapaCare, Trondheim, Norway
- KIT, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Josien Westendorp
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Hanna M Mathéron
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Giulia L E Mönnink
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Jonathan Vas Nunes
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Karel C Lindenbergh
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sara K Hoel
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sofie M Løvdal
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mia N Østensen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Helene Solberg
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Boateng
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - H Jaap Bonjer
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Martin P Grobusch
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
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Puylaert CAJ, Scheijmans JCG, Borgstein ABJ, Andeweg CS, Bartels-Rutten A, Beets GL, van Berge Henegouwen MI, Braak SJ, Couvreur R, Daams F, van Es HW, Franken LC, Grotenhuis BA, Hendriks ER, de Hingh IHJT, Hoeijmakers F, Ten Holder JT, Huisman PM, Kazemier G, van Kesteren F, van Kesteren J, Keywani K, Kuiper SZ, Lange MDJ, Lobatto ME, du Mée AWF, Poeze M, van Praag EM, van Rossen J, van Santvoort HC, Sedee WJA, Seelen LWF, Sharabiany S, Sosef NL, Quanjel MJR, Veltman J, Verhagen T, van de Vlasakker VCJ, Weeder PD, van Werven JR, Wesdorp NJ, van Dieren S, Han AX, Russell CA, de Jong MD, Bossuyt PMM, Quarles van Ufford JME, Prokop MW, Gisbertz SS, Prins JM, Besselink MG, Boermeester MA, Gietema HA, Stoker J. Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT): Multicenter Study. Ann Surg 2020; 272:919-924. [PMID: 33021367 PMCID: PMC7668335 DOI: 10.1097/sla.0000000000004218] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms. SUMMARY OF BACKGROUND DATA Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown. METHODS This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia. RESULTS A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8-2.1]. Individual yields were 0.7% (95% CI: 0.2-1.1) for chest CT and 1.1% (95% CI: 0.6-1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence. CONCLUSIONS One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.
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Affiliation(s)
- Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jochem C G Scheijmans
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander B J Borgstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Geerard L Beets
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Roy Couvreur
- Department of Surgery, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Freek Daams
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Hendrik W van Es
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Lotte C Franken
- Department of Surgery, Flevo Hospital, Almere, the Netherlands
| | - Brechtje A Grotenhuis
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eduard R Hendriks
- Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands
| | | | | | - Joris T Ten Holder
- Department of Pulmonary Medicine, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Peter M Huisman
- Department of Radiology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Floortje van Kesteren
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Kammy Keywani
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sara Z Kuiper
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Maurits D J Lange
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark E Lobatto
- Department of Radiology, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | | | - Martijn Poeze
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Elise M van Praag
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorit van Rossen
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, UMC Utrecht Cancer Center, UMC Utrecht, Utrecht, the Netherlands
| | - Wouter J A Sedee
- Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | - Leonard W F Seelen
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nico L Sosef
- Department of Surgery, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | - Marian J R Quanjel
- Department of Pulmonary Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jeroen Veltman
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Tim Verhagen
- Department of Surgery, Hospital Group Twente, Almelo, the Netherlands
| | | | - Pepijn D Weeder
- Department of Surgery, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | | | - Nina J Wesdorp
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alvin X Han
- Laboratory of Applied Evolutionary Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Colin A Russell
- Laboratory of Applied Evolutionary Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hester A Gietema
- Department of Radiology, Maastricht UMC+, Maastricht, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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