1
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Ketel MHM, Klarenbeek BR, Abma I, Belgers EHJ, Coene PPLO, Dekker JWT, van Duijvendijk P, Emous M, Gisbertz SS, Haveman JW, Heisterkamp J, Nieuwenhuijzen GAP, Ruurda JP, van Sandick JW, van der Sluis PC, van Det MJ, van Esser S, Law S, de Steur WO, Sosef MN, Wijnhoven B, Hannink G, Rosman C, van Workum F. Nationwide Association of Surgical Performance of Minimally Invasive Esophagectomy With Patient Outcomes. JAMA Netw Open 2024; 7:e246556. [PMID: 38639938 PMCID: PMC11031683 DOI: 10.1001/jamanetworkopen.2024.6556] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024] Open
Abstract
Importance Suboptimal surgical performance is hypothesized to be associated with less favorable patient outcomes in minimally invasive esophagectomy (MIE). Establishing this association may lead to programs that promote better surgical performance of MIE and improve patient outcomes. Objective To investigate associations between surgical performance and postoperative outcomes after MIE. Design, Setting, and Participants In this nationwide cohort study of 15 Dutch hospitals that perform more than 20 MIEs per year, 7 masked expert MIE surgeons assessed surgical performance using videos and a previously developed and validated competency assessment tool (CAT). Each hospital submitted 2 representative videos of MIEs performed between November 4, 2021, and September 13, 2022. Patients registered in the Dutch Upper Gastrointestinal Cancer Audit between January 1, 2020, and December 31, 2021, were included to examine patient outcomes. Exposure Hospitals were divided into quartiles based on their MIE-CAT performance score. Outcomes were compared between highest (top 25%) and lowest (bottom 25%) performing quartiles. Transthoracic MIE with gastric tube reconstruction. Main Outcome and Measure The primary outcome was severe postoperative complications (Clavien-Dindo ≥3) within 30 days after surgery. Multilevel logistic regression, with clustering of patients within hospitals, was used to analyze associations between performance and outcomes. Results In total, 30 videos and 970 patients (mean [SD] age, 66.6 [9.1] years; 719 men [74.1%]) were included. The mean (SD) MIE-CAT score was 113.6 (5.5) in the highest performance quartile vs 94.1 (5.9) in the lowest. Severe postoperative complications occurred in 18.7% (41 of 219) of patients in the highest performance quartile vs 39.2% (40 of 102) in the lowest (risk ratio [RR], 0.50; 95% CI, 0.24-0.99). The highest vs the lowest performance quartile showed lower rates of conversions (1.8% vs 8.9%; RR, 0.21; 95% CI, 0.21-0.21), intraoperative complications (2.7% vs 7.8%; RR, 0.21; 95% CI, 0.04-0.94), and overall postoperative complications (46.1% vs 65.7%; RR, 0.54; 95% CI, 0.24-0.96). The R0 resection rate (96.8% vs 94.2%; RR, 1.03; 95% CI, 0.97-1.05) and lymph node yield (mean [SD], 38.9 [14.7] vs 26.2 [9.0]; RR, 3.20; 95% CI, 0.27-3.21) increased with oncologic-specific performance (eg, hiatus dissection, lymph node dissection). In addition, a high anastomotic phase score was associated with a lower anastomotic leakage rate (4.6% vs 17.7%; RR, 0.14; 95% CI, 0.06-0.31). Conclusions and Relevance These findings suggest that better surgical performance is associated with fewer perioperative complications for patients with esophageal cancer on a national level. If surgical performance of MIE can be improved with MIE-CAT implementation, substantially better patient outcomes may be achievable.
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Affiliation(s)
- Mirte H. M. Ketel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Inger Abma
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | | | - Marloes Emous
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Twee-Steden Hospital, Tilburg, the Netherlands
| | | | - Jelle P. Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Pieter C. van der Sluis
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marc J. van Det
- Department of Surgery, Hospital Group Twente (ZGT), Almelo, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | - Simon Law
- Department of Surgery, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, China
| | - Wobbe O. de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bas Wijnhoven
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
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2
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Henckens SPG, Liu D, Gisbertz SS, Kalff MC, Anderegg MCJ, Crull D, Daams F, van Dalsen AD, Dekker JWT, van Det MJ, van Duijvendijk P, Eshuis WJ, Groenendijk RPR, Haveman JW, van Hillegersberg R, Luyer MDP, Olthof PB, Pierie JPEN, Plat VD, Rosman C, Ruurda JP, van Sandick JW, Sosef MN, Voeten DM, Vijgen GHEJ, Bijlsma MF, Meijer SL, Hulshof MCCM, Oyarce C, Lagarde SM, van Laarhoven HWM, van Berge Henegouwen MI. Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma. Br J Surg 2024; 111:znae034. [PMID: 38387083 PMCID: PMC10883709 DOI: 10.1093/bjs/znae034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma. METHODS This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesophageal or gastro-oesophageal junctional adenocarcinoma between 2007 and 2016. The primary endpoint was the association of Mandard score and TRG-ypN score with recurrence patterns (rate, location, and time to recurrence). The secondary endpoint was overall survival. RESULTS Among 2746 inclusions, recurrence rates increased with higher Mandard scores (TRG1 30.6%, TRG2 44.9%, TRG3 52.9%, TRG4 61.4%, TRG5 58.2%; P < 0.001). Among patients with recurrent disease, the distribution (locoregional versus distant) was the same for the different TRG groups. Patients with TRG1 developed more brain recurrences (17.7 versus 9.8%; P = 0.001) and had a longer mean overall survival (44 versus 35 months; P < 0.001) than those with TRG>1. The TRG>1-ypN+ group had the highest recurrence rate (64.9%) and worst overall survival (mean 27 months). Compared with the TRG>1-ypN0 group, patients with TRG1-ypN+ had a higher risk of recurrence (51.9 versus 39.6%; P < 0.001) and worse mean overall survival (33 versus 41 months; P < 0.001). CONCLUSION Improved tumour response to neoadjuvant therapy was associated with lower recurrence rates and higher overall survival rates. Among patients with recurrent disease, TRG1 was associated with a higher incidence of brain recurrence than TRG>1. Residual nodal disease influenced prognosis more negatively than residual disease at the primary tumour site.
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Affiliation(s)
- Sofie P G Henckens
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Dajia Liu
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Centre for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marianne C Kalff
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Maarten C J Anderegg
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - David Crull
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | | | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | | | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Pim B Olthof
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | | | - Victor D Plat
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | | | - Daan M Voeten
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Guy H E J Vijgen
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Maarten F Bijlsma
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Centre for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Oncode Institute, Amsterdam, the Netherlands
| | - Sybren L Meijer
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Pathology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Radiotherapy, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Cesar Oyarce
- Centre for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Oncode Institute, Amsterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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Eryigit Ö, van de Graaf FW, Nieuwenhuijs VB, Sosef MN, de Graaf EJR, Menon AG, Lange MM, Lange JF. A comparison between real-time intraoperative voice dictation and the operative report in laparoscopic cholecystectomy: a multicenter prospective observational study. Langenbecks Arch Surg 2023; 408:334. [PMID: 37624422 PMCID: PMC10457217 DOI: 10.1007/s00423-023-03079-w] [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: 11/17/2022] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The current operative report often inadequately reflects events occurring during laparoscopic cholecystectomy (LC). The addition of intraoperative video recording to the operative report has already proven to add important information. It was hypothesized that real-time intraoperative voice dictation (RIVD) can provide an equal or more complete overview of the operative procedure compared to the narrative operative report (NR) produced postoperatively. METHODS SONAR is a multicenter prospective observational trial, conducted at four surgical centers in the Netherlands. Elective LCs of patients aged 18 years and older were included. Participating surgeons were requested to dictate the essential steps of LC during surgery. RIVDs and NRs were reviewed according to the stepwise LC guideline of the Dutch Society for Surgery. The cumulative adequacy rates for RIVDs were compared with those of the postoperatively written NR. RESULTS 79 of 90 cases were eligible for inclusion and available for further analysis. RIVD resulted in a significantly higher adequacy rate compared to NR for the circumferential dissection of the cystic duct and artery (NR 32.5% vs. RIVD 61.0%, P = 0.016). NR had higher adequacy rates in reporting the transection of the cystic duct (NR 100% vs. RIVD 77.9%, P = < 0.001) and the removal of the gallbladder from the liver bed (NR 98.7% vs. RIVD 68.8%, P < 0.001). The total adequacy was not significantly different between the two reporting methods (NR 78.0% vs. RIVD 76.4%, P = 1.00). CONCLUSION Overall, the adequacy of RIVD is comparable to the postoperatively written NR in reporting surgical steps in LC. However, the most essential surgical step, the circumferential dissection of the cystic duct and artery, was reported more adequately in RIVD.
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Affiliation(s)
- Özgür Eryigit
- Department of Surgery, Erasmus University Medical Center, Internal Postal Address H-173, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Floyd W van de Graaf
- Department of Surgery, Erasmus University Medical Center, Internal Postal Address H-173, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | | | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen and Heerlen, the Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle Aan Den IJssel, the Netherlands
| | - Anand G Menon
- Department of Surgery, Erasmus University Medical Center, Internal Postal Address H-173, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Surgery, IJsselland Hospital, Capelle Aan Den IJssel, the Netherlands
| | - Marilyne M Lange
- Department of Pathology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Internal Postal Address H-173, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Surgery, IJsselland Hospital, Capelle Aan Den IJssel, the Netherlands
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4
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van der Velden AL, Vermeer TA, Boerma EJG, Belgers EH, Stoot JH, Leers MP, Sosef MN, Vijgen GH. Vitamin insufficiency after surgery for oesophagogastric neoplasms: a study protocol for a prospective intervention study. BMJ Open 2023; 13:e067981. [PMID: 37407040 DOI: 10.1136/bmjopen-2022-067981] [Citation(s) in RCA: 1] [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] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Oesophageal cancer (EC) and gastric cancer (GC) are among the top 10 cancers worldwide. Both diseases impact the nutritional status of patients and their Quality of Life (QoL). Preoperative malnutrition is reported in 42%-80%. However, studies investigating postoperative nutritional status are limited, and postoperative identification and treatment of micronutrient and macronutrient deficiencies are currently lacking in (inter-)national guidelines. The aim of this study is to identify and target micronutrient deficiencies after surgery for oesophagogastric neoplasms. METHODS This is a single-centre prospective intervention trial performed in Zuyderland Medical Centre. 248 patients who underwent oesophagectomy (n=124) or (sub)total gastrectomy (n=124) from 2011 until 2022 will be included. Both groups will receive Calcium Soft Chew D3 and a multivitamin supplement (MVS) specifically developed according to the type of operation patients underwent; the oesophagectomy group will receive Multi-E and the gastrectomy group will receive Multi-G. The MVSs will be taken once daily and Calcium Soft Chew D3 two times per day. Supplementation will start after baseline measurements. At baseline (T0), blood withdrawal for micronutrient analysis and faecal elastase-1 analysis for exocrine pancreatic insufficiency (EPI) will be performed. Additionally, patients will receive questionnaires regarding QoL and dietary behaviour. After 180 days of supplementation (T1), baseline measurements will be repeated, and the supplement tolerance questionnaire will be completed. Measurements will also be conducted after 360 days (T2) and after 720 days (T3) of supplementation. The main study parameter is micronutrient deficiency (yes/no) for all measurements. Secondary parameters include occurrence of EPI (n, %), diarrhoea (n, %), steatorrhoea (n, %) or bloating (n, %), time between surgery and start of supplementation (mean in months), and QoL at all time points. ETHICS AND DISSEMINATION The study was approved by the Zuyderland Medical Centre Ethics Committee, Heerlen, the Netherlands. The findings will be disseminated through scientific congresses and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05281380.
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Affiliation(s)
| | - Thomas A Vermeer
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Eric Hj Belgers
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jan Hmb Stoot
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Mathie Pg Leers
- Clinical Chemistry & Hematology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Guy Hej Vijgen
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
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5
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Tweed TTT, van Dam KAM, Sosef MN, Belgers HJ. Metachronic distal rectovaginal septum metastasis with prior laparoscopic anterior resection for proximal rectal carcinoma. J Surg Case Rep 2023; 2023:rjad303. [PMID: 37220594 PMCID: PMC10200359 DOI: 10.1093/jscr/rjad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023] Open
Abstract
Metastatic disease in the vagina of other origins such as rectal cancer is rare and only very few cases have been reported. A female patient developed an isolated metachronic metastasis located at the lower part of the rectovaginal septum, 8 months after curative resection for proximal rectal cancer. An excision of the tumour was performed with primary closure of the vaginal wall. Histopathological examination confirmed the solid tumour to be metastatic disease from rectal origin with free margins. A year later, the patient received a lobectomy of the left lower lobe, due to distant metastasis of rectal origin 2 years after primary surgery. The patient is currently 4 years postoperatively, alive and shows no sign on recurrent disease. This case illustrates that awareness and early recognition of this rare presentation can lead to adequate treatment plans.
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Affiliation(s)
- Thaís T T Tweed
- Department of Surgery, Division of Gastro-Intestinal Surgery, Zuyderland Medical Center, Sittard-Geleen, Heerlen, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kayleigh A M van Dam
- Correspondence address. Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands. Tel: + 31 (0) 618705361; E-mail:
| | - Meindert N Sosef
- Department of Surgery, Division of Gastro-Intestinal Surgery, Zuyderland Medical Center, Sittard-Geleen, Heerlen, The Netherlands
| | - Henricus J Belgers
- Department of Surgery, Division of Gastro-Intestinal Surgery, Zuyderland Medical Center, Sittard-Geleen, Heerlen, The Netherlands
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6
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Kalff MC, van Berge Henegouwen MI, Baas PC, Bahadoer RR, Belt EJT, Brattinga B, Claassen L, Ćosović A, Crull D, Daams F, van Dalsen AD, Dekker JWT, van Det MJ, Drost M, van Duijvendijk P, Eshuis WJ, van Esser S, Gaspersz MP, Görgec B, Groenendijk RPR, Hartgrink HH, van der Harst E, Haveman JW, Heisterkamp J, van Hillegersberg R, Kelder W, Kingma BF, Koemans WJ, Kouwenhoven EA, Lagarde SM, Lecot F, van der Linden PP, Luyer MDP, Nieuwenhuijzen GAP, Olthof PB, van der Peet DL, Pierie JPEN, Pierik EGJMR, Plat VD, Polat F, Rosman C, Ruurda JP, van Sandick JW, Scheer R, Slootmans CAM, Sosef MN, Sosef OV, de Steur WO, Stockmann HBAC, Stoop FJ, Voeten DM, Vugts G, Vijgen GHEJ, Weeda VB, Wiezer MJ, van Oijen MGH, Gisbertz SS. Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care: The Dutch Nationwide Ivory Study. Ann Surg 2023; 277:619-628. [PMID: 35129488 DOI: 10.1097/sla.0000000000005292] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer. SUMMARY OF BACKGROUND DATA The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer. METHODS Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007-2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods. RESULTS Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% ( P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 ( P <0.001), and median survival increased from 35 to 41 months ( P = 0.027). CONCLUSION In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.
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Affiliation(s)
- Marianne C Kalff
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Peter C Baas
- Department of Surgery, Martini Ziekenhuis, Groningen, the Netherlands
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Baukje Brattinga
- Department of Surgery, MC Leeuwarden, Leeuwarden, the Netherlands
| | - Linda Claassen
- Department of Surgery, Gelre Ziekenhuis, Apeldoorn, the Netherlands
| | - Admira Ćosović
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - David Crull
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Freek Daams
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Manon Drost
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | | | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | | | - Burak Görgec
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | | | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | | | - Wendy Kelder
- Department of Surgery, Martini Ziekenhuis, Groningen, the Netherlands
| | - B Feike Kingma
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Willem J Koemans
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | | | | | - Frederik Lecot
- Department of Surgery, Zuyderland, Heerlen, the Netherlands
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Pim B Olthof
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | | | | | | | - Victor D Plat
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - Rene Scheer
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Odin V Sosef
- Department of Surgery, Zuyderland, Heerlen, the Netherlands
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Fanny J Stoop
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Daan M Voeten
- Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Víola B Weeda
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Martijn G H van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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7
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Kuijper SC, Pape M, Vissers PAJ, Jeene PM, Kouwenhoven EA, Haj Mohammad N, Ruurda JP, Sosef MN, Verhoeven RHA, van Laarhoven HWM. Trends in best-case, typical and worst-case survival scenarios of patients with non-metastatic esophagogastric cancer between 2006 and 2020: A population-based study. Int J Cancer 2023; 153:33-43. [PMID: 36855965 DOI: 10.1002/ijc.34488] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
New treatment options and centralization of surgery have improved survival for patients with non-metastatic esophageal or gastric cancer. It is unknown, however, which patients benefitted the most from treatment advances. The aim of this study was to identify best-case, typical and worst-case scenarios in terms of survival time, and to assess if survival associated with these scenarios changed over time. Patients with non-metastatic potentially resectable esophageal or gastric cancer diagnosed between 2006 and 2020 were selected from the Netherlands Cancer Registry. Best-case (20th percentile), upper-typical (40th percentile), typical (median), lower-typical (60th percentile) and worst-case (80th percentile) survival scenarios were defined, and regression analysis was used to investigate the change in survival time for each scenario across years. For patients with esophageal cancer (N = 24 352) survival time improved on average 12.0 (until 2011), 1.5 (until 2018), 0.7, 0.4 and 0.2 months per year for the best-case, upper-typical, median, lower-typical and worst-case scenario, respectively. For patients with gastric cancer (N = 9993) survival time of the best-case scenario remained constant, whereas the upper-typical, median, lower-typical and worst-case scenario improved on average with 1.0 (until 2018), 0.5, 0.2 and 0.2 months per year, respectively. Subgroup analyses showed that, survival scenarios improved for nearly all patients across treatment groups and for patients with squamous cell carcinomas or adenocarcinomas. Survival improved for almost all patients suggesting that in clinical practice the vast majority of patients benefitted from treatment advances. The clinically most meaningful survival advantage was observed for the best-case scenario of esophageal cancer.
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Affiliation(s)
- Steven C Kuijper
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Marieke Pape
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Pauline A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Surgery, Radboud University Medical Center, The Netherlands
| | - Paul M Jeene
- Amsterdam UMC location University of Amsterdam, Radiotherapy, Amsterdam, The Netherlands
- Radiotherapiegroep, Deventer, The Netherlands
| | | | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Hospital, Heerlen, The Netherlands
| | - Rob H A Verhoeven
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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8
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de Graaff MR, Hogenbirk RNM, Janssen YF, Elfrink AKE, Liem RSL, Nienhuijs SW, de Vries JPPM, Elshof JW, Verdaasdonk E, Melenhorst J, van Westreenen HL, Besselink MGH, Ruurda JP, van Berge Henegouwen MI, Klaase JM, den Dulk M, van Heijl M, Hegeman JH, Braun J, Voeten DM, Würdemann FS, Warps ALK, Alberga AJ, Suurmeijer JA, Akpinar EO, Wolfhagen N, van den Boom AL, Bolster-van Eenennaam MJ, van Duijvendijk P, Heineman DJ, Wouters MWJM, Kruijff S, Koningswoud-Terhoeve CL, Belt E, van der Hoeven JAB, Marres GMH, Tozzi F, von Meyenfeldt EM, Coebergh RRJ, van den Braak, Huisman S, Rijken AM, Balm R, Daams F, Dickhoff C, Eshuis WJ, Gisbertz SS, Zandbergen HR, Hartemink KJ, Keessen SA, Kok NFM, Kuhlmann KFD, van Sandick JW, Veenhof AA, Wals A, van Diepen MS, Schoonderwoerd L, Stevens CT, Susa D, Bendermacher BLW, Olofsen N, van Himbeeck M, de Hingh IHJT, Janssen HJB, Luyer MDP, Nieuwenhuijzen GAP, Ramaekers M, Stacie R, Talsma AK, Tissink MW, Dolmans D, Berendsen R, Heisterkamp J, Jansen WA, de Kort-van Oudheusden M, Matthijsen RM, Grünhagen DJ, Lagarde SM, Maat APWM, van der Sluis PC, Waalboer RB, Brehm V, van Brussel JP, Morak M, Ponfoort ED, Sybrandy JEM, Klemm PL, Lastdrager W, Palamba HW, van Aalten SM, Tseng LNL, van der Bogt KEA, de Jong WJ, Oosterhuis JWA, Tummers Q, van der Wilden GM, Ooms S, Pasveer EH, Veger HTC, Molegraafb MJ, Nieuwenhuijs VB, Patijn GA, van der Veldt MEV, Boersma D, van Haelst STW, van Koeverden ID, Rots ML, Bonsing BA, Michiels N, Bijlstra OD, Braun J, Broekhuis D, Brummelaar HW, Hartgrink HH, Metselaar A, Mieog JSD, Schipper IB, de Steur WO, Fioole B, Terlouw EC, Biesmans C, Bosmans JWAM, Bouwense SAW, Clermonts SHEM, Coolsen MME, Mees BME, Schurink GWH, Duijff JW, van Gent T, de Nes LCF, Toonen D, Beverwijk MJ, van den Hoed E, Keizers B, Kelder W, Keller BPJA, Pultrum BB, van Rosum E, Wijma AG, van den Broek F, Leclercq WKG, Loos MJA, Sijmons JML, Vaes RHD, Vancoillie PJ, Consten ECJ, Jongen JMJ, Verheijen PM, van Weel V, Arts CHP, Jonker J, Murrmann-Boonstra G, Pierie JPEN, Swart J, van Duyn EB, Geelkerken RH, de Groot R, Moekotte NL, Stam A, Voshaar A, van Acker GJD, Bulder RMA, Swank DJ, Pereboom ITA, Hoffmann WH, Orsini M, Blok JJ, Lardenoije JHP, Reijne MMPJ, van Schaik P, Smeets L, van Sterkenburg SMM, Harlaar NJ, Mekke S, Verhaakt T, Cancrinus E, van Lammeren GW, Molenaar IQ, van Santvoort HC, Vos AWF, Schouten- van der Velden AP, Woensdregt K, Mooy-Vermaat SP, Scharn DM, Marsman HA, Rassam F, Halfwerk FR, Andela AJ, Buis CI, van Dam GM, ten Duis K, van Etten B, Lases L, Meerdink M, de Meijer VE, Pranger B, Ruiter S, Rurenga M, Wiersma A, Wijsmuller AR, Albers KI, van den Boezem PB, Klarenbeek B, van der Kolk BM, van Laarhoven CJHM, Matthée E, Peters N, Rosman C, Schroen AMA, Stommel MWJ, Verhagen AFTM, van der Vijver R, Warlé MC, de Wilt JHW, van den Berg JW, Bloemert T, de Borst GJ, van Hattum EH, Hazenberg CEVB, van Herwaarden JA, van Hillegerberg R, Kroese TE, Petri BJ, Toorop RJ, Aarts F, Janssen RJL, Janssen-Maessen SHP, Kool M, Verberght H, Moes DE, Smit JW, Wiersema AM, Vierhout BP, de Vos B, den Boer FC, Dekker NAM, Botman JMJ, van Det MJ, Folbert EC, de Jong E, Koenen JC, Kouwenhoven EA, Masselink I, Navis LH, Belgers HJ, Sosef MN, Stoot JHMB. Impact of the COVID-19 pandemic on surgical care in the Netherlands. Br J Surg 2022; 109:1282-1292. [PMID: 36811624 PMCID: PMC10364688 DOI: 10.1093/bjs/znac301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/14/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. METHODS A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. RESULTS Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001). CONCLUSION The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.
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Affiliation(s)
- Michelle R de Graaff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.,Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Rianne N M Hogenbirk
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Yester F Janssen
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Arthur K E Elfrink
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ronald S L Liem
- Department of Surgery, Dutch Obesity Clinic, Gouda, the Netherlands.,Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jan-Willem Elshof
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Emiel Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Marc G H Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Johannes H Hegeman
- Department of Surgery, Ziekenhuisgroep Twente Almelo-Hengelo, Almelo, Hengelo, the Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Daan M Voeten
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Franka S Würdemann
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anne-Loes K Warps
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anna J Alberga
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J Annelie Suurmeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Erman O Akpinar
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nienke Wolfhagen
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | | | - David J Heineman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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9
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Hoek VT, Edomskis PP, Stark PW, Lambrichts DPV, Draaisma WA, Consten ECJ, Lange JF, Bemelman WA, Hop WC, Opmeer BC, Reitsma JB, Scholte RA, Waltmann EWH, Legemate A, Bartelsman JF, Meijer DW, de Brouwer M, van Dalen J, Durbridge M, Geerdink M, Ilbrink GJ, Mehmedovic S, Middelhoek P, Boom MJ, Consten ECJ, van der Bilt JDW, van Olden GDJ, Stam MAW, Verweij MS, Vennix S, Musters GD, Swank HA, Boermeester MA, Busch ORC, Buskens CJ, El-Massoudi Y, Kluit AB, van Rossem CC, Schijven MP, Tanis PJ, Unlu C, van Dieren S, Gerhards MF, Karsten TM, de Nes LC, Rijna H, van Wagensveld BA, Koff eman GI, Steller EP, Tuynman JB, Bruin SC, van der Peet DL, Blanken-Peeters CFJM, Cense HA, Jutte E, Crolla RMPH, van der Schelling GP, van Zeeland M, de Graaf EJR, Groenendijk RPR, Karsten TM, Vermaas M, Schouten O, de Vries MR, Prins HA, Lips DJ, Bosker RJI, van der Hoeven JAB, Diks J, Plaisier PW, Kruyt PM, Sietses C, Stommel MWJ, Nienhuijs SW, de Hingh IHJT, Luyer MDP, van Montfort G, Ponten EH, Smulders JF, van Duyn EB, Klaase JM, Swank DJ, Ottow RT, Stockmann HBAC, Vermeulen J, Vuylsteke RJCLM, Belgers HJ, Fransen S, von Meijenfeldt EM, Sosef MN, van Geloven AAW, Hendriks ER, ter Horst B, Leeuwenburgh MMN, van Ruler O, Vogten JM, Vriens EJC, Westerterp M, Eijsbouts QAJ, Bentohami A, Bijlsma TS, de Korte N, Nio D, Govaert MJPM, Joosten JJA, Tollenaar RAEM, Stassen LPS, Wiezer MJ, Hazebroek EJ, Smits AB, van Westreenen HL, Lange JF, Brandt A, Nijboer WN, Mulder IM, Toorenvliet BR, Weidema WF, Coene PPLO, Mannaerts GHH, den Hartog D, de Vos RJ, Zengerink JF, Hoofwijk AGM, Hulsewé KWE, Melenhorst J, Stoot JHMB, Steup WH, Huijstee PJ, Merkus JWS, Wever JJ, Maring JK, Heisterkamp J, van Grevenstein WMU, Vriens MR, Besselink MGH, Borel Rinkes IHM, Witkamp AJ, Slooter GD, Konsten JLM, Engel AF, Pierik EGJM, Frakking TG, van Geldere D, Patijn GA, D’Hoore BAJL, de Buck AVO, Miserez M, Terrasson I, Wolthuis A, di Saverio S, de Blasiis MG. Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial. Surg Endosc 2022; 36:7764-7774. [PMID: 35606544 PMCID: PMC9485102 DOI: 10.1007/s00464-022-09326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/01/2022] [Indexed: 10/31/2022]
Abstract
Abstract
Background
This study aimed to compare laparoscopic lavage and sigmoidectomy as treatment for perforated diverticulitis with purulent peritonitis during a 36 month follow-up of the LOLA trial.
Methods
Within the LOLA arm of the international, multicentre LADIES trial, patients with perforated diverticulitis with purulent peritonitis were randomised between laparoscopic lavage and sigmoidectomy. Outcomes were collected up to 36 months. The primary outcome of the present study was cumulative morbidity and mortality. Secondary outcomes included reoperations (including stoma reversals), stoma rates, and sigmoidectomy rates in the lavage group.
Results
Long-term follow-up was recorded in 77 of the 88 originally included patients, 39 were randomised to sigmoidectomy (51%) and 38 to laparoscopic lavage (49%). After 36 months, overall cumulative morbidity (sigmoidectomy 28/39 (72%) versus lavage 32/38 (84%), p = 0·272) and mortality (sigmoidectomy 7/39 (18%) versus lavage 6/38 (16%), p = 1·000) did not differ. The number of patients who underwent a reoperation was significantly lower for lavage compared to sigmoidectomy (sigmoidectomy 27/39 (69%) versus lavage 17/38 (45%), p = 0·039). After 36 months, patients alive with stoma in situ was lower in the lavage group (proportion calculated from the Kaplan–Meier life table, sigmoidectomy 17% vs lavage 11%, log-rank p = 0·0268). Eventually, 17 of 38 (45%) patients allocated to lavage underwent sigmoidectomy.
Conclusion
Long-term outcomes showed that laparoscopic lavage was associated with less patients who underwent reoperations and lower stoma rates in patients alive after 36 months compared to sigmoidectomy. No differences were found in terms of cumulative morbidity or mortality. Patient selection should be improved to reduce risk for short-term complications after which lavage could still be a valuable treatment option.
Graphical abstract
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10
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Willems S, Daemen JHT, Hulsewé KWE, Belgers EHJ, Sosef MN, Soufidi K, Vissers YLJ, de Loos ER. Outcomes after hybrid minimally invasive treatment of Boerhaave syndrome: a single-institution experience. Acta Chir Belg 2022:1-6. [PMID: 35020548 DOI: 10.1080/00015458.2022.2029035] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Spontaneous esophageal perforation or Boerhaave syndrome is a life-threatening emergency, associated with significant morbidity and mortality. In this retrospective series we describe our single-center experience with a hybrid minimally invasive treatment approach for the treatment of Boerhaave syndrome. METHODS Clinical data of all patients who presented with spontaneous esophageal rupture between January 2009 and December 2019 were analyzed. All patients underwent esophageal endoscopic stenting to seal the perforation and debridement of the contaminated mediastinal and pleural cavity through video-assisted thoracoscopic surgery (VATS). Primary outcome measure was defined as in-hospital death and 30-day mortality. RESULTS Twelve patients were included with a median age of 63 years (interquartile range [IQR] 51-74 years) of whom 58% (n = 7) were male. The median Pittsburg perforation severity score was 6.5 (IQR 6-9). Endoscopic reintervention was required in 8 patients (67%), primarily due to stent dislocation. In addition, 5 patients (42%) required re-VATS due to empyema formation. Thirty-day mortality and in-hospital mortality were respectively 17% (n = 2) and 25% (n = 3). CONCLUSION Endoscopic stenting in combination with thoracoscopic debridement is an effective and safe minimally invasive hybrid approach for the treatment of Boerhaave syndrome. This is depicted by the relatively low mortality rates, even among patients with high perforation severity scores. The relatively low mortality rates may be attributed to the combined approach of rapidly sealing the defect and decontamination of the thorax. Future studies should aim to corroborate this evidence which is limited by its sample size and retrospective nature.
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Affiliation(s)
- Stefanie Willems
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Jean H. T. Daemen
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Karel W. E. Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Eric H. J. Belgers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Khalida Soufidi
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Yvonne L. J. Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Erik R. de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
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11
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van der Wilk BJ, Noordman BJ, Neijenhuis LKA, Nieboer D, Nieuwenhuijzen GAP, Sosef MN, van Berge Henegouwen MI, Lagarde SM, Spaander MCW, Valkema R, Biermann K, Wijnhoven BPL, van der Gaast A, van Lanschot JJB, Doukas M, Nikkessen S, Luyer M, Schoon EJ, Roef MJ, van Lijnschoten I, Oostenbrug LE, Riedl RG, Gisbertz SS, Krishnadath KK, Bennink RJ, Meijer SL. Active Surveillance Versus Immediate Surgery in Clinically Complete Responders After Neoadjuvant Chemoradiotherapy for Esophageal Cancer: A Multicenter Propensity Matched Study. Ann Surg 2021; 274:1009-1016. [PMID: 31592898 DOI: 10.1097/sla.0000000000003636] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compared outcomes of patients with esophageal cancer and clinically complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) undergoing active surveillance or immediate surgery. BACKGROUND Since nearly one-third of patients with esophageal cancer show pathologically complete response after nCRT according to CROSS regimen, the oncological benefit of immediate surgery in cCR is topic of debate. METHODS Patients with cCR based on endoscopic biopsies and endoscopic ultrasonography with fine-needle aspiration initially declining or accepting immediate surgery after nCRT were identified between 2011 and 2018. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), rate and timing of distant dissemination, and postoperative outcomes. RESULTS Some 98 patients with cCR were identified: 31 in the active surveillance- and 67 in the immediate surgery group with median followup of survivors of 27.7 and 34.8 months, respectively. Propensity score matching resulted in 2 comparable groups (n = 29 in both groups). Patients undergoing active surveillance or immediate surgery had a 3-year OS of 77% and 55% (HR 0.41; 95% CI 0.14-1.20, P = 0.104), respectively. The 3-year PFS was 60% and 54% (HR 1.08; 95% CI 0.44-2.67, P = 0.871), respectively. Patients undergoing active surveillance or immediate surgery had a comparable distant dissemination rate (both groups 28%), radical resection rate (both groups 100%), and severity of postoperative complications (Clav- ien-Dindo grade ≥ 3: 43% vs 45%, respectively). CONCLUSION In this retrospective study, OS and PFS in patients with cCR undergoing active surveillance or immediate surgery were not significantly different. Active surveillance with postponed surgery for recurrent disease was not associated with a higher distant dissemination rate or more severe adverse postoperative outcomes.
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Affiliation(s)
- Berend J van der Wilk
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bo J Noordman
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roelf Valkema
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ate van der Gaast
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J Jan B van Lanschot
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michael Doukas
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Suzan Nikkessen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Misha Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mark J Roef
- Department of Radiology and Nuclear Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Liekele E Oostenbrug
- Department of Gastroenterology & Hepatology, Zuyder- land Medical Center, Heerlen, the Netherlands
| | - Robert G Riedl
- Department of Pathology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands
| | - Kausilia K Krishnadath
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands
| | - Sybren L Meijer
- Department of Pathology, Amsterdam University Medical Centers - location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands
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12
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Luijten JCHBM, Nieuwenhuijzen GAP, Sosef MN, de Hingh IHJT, Rosman C, Ruurda JP, van Duijvendijk P, Heisterkamp J, de Steur WO, van Laarhoven HWM, Besselink MG, Groot Koerkamp B, van Santvoort HC, Lemmens VEP, Vissers PAJ. Impact of nationwide centralization of oesophageal, gastric, and pancreatic surgery on travel distance and experienced burden in the Netherlands. Eur J Surg Oncol 2021; 48:348-355. [PMID: 34366174 DOI: 10.1016/j.ejso.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/07/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with oesophageal, gastric, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase. MATERIALS AND METHODS All patients who underwent surgery between 2006 and 2017 for oesophageal, gastric and pancreatic cancer in the Netherlands were included. Travel distance between patient's home address and hospital of surgery in kilometres was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance. RESULTS Over 23,838 patients were included, in whom median travel distance for surgical care increased for oesophageal cancer (n = 9217) from 18 to 28 km, for gastric cancer (n = 6743) from 9 to 26 km, and for pancreatic cancer (n = 7878) from 18 to 25 km (all p < 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to traveling extra kilometres. Patients aged >70 years travelled less often independently (56% versus 68%), as compared to patients aged ≤70 years. CONCLUSION With nationwide centralization, travel distance increased for patients undergoing oesophageal, gastric, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale, travel distances in the Netherlands remain limited.
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Affiliation(s)
- J C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | | | - M N Sosef
- Department of Surgery, Zuyderland Hospital, Heerlen, the Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - C Rosman
- Department of Surgery, Radboudumc, Nijmegen, the Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - J Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, Embraze Regional Cancer Network, the Netherlands
| | - W O de Steur
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - H C van Santvoort
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Surgery, Sint. Antonius, Nieuwegein, the Netherlands
| | - V E P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - P A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.
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13
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Koemans WJ, van Dieren JM, van den Berg JG, Meijer GA, Snaebjornsson P, Chalabi M, Lecot F, Riedl R, Krijgsman O, Hofland I, Broeks A, Voncken FEM, Peppelenbosch MP, Sosef MN, van Sandick JW, Kodach LL. High CD8 + tumour-infiltrating lymphocyte density associates with unfavourable prognosis in oesophageal adenocarcinoma following poor response to neoadjuvant chemoradiotherapy. Histopathology 2021; 79:238-251. [PMID: 33660299 DOI: 10.1111/his.14361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
AIMS Determining prognosis following poor response to neoadjuvant chemoradiotherapy (nCRT) in oesophageal adenocarcinoma (OAC) remains challenging. An immunosuppressive tumour microenvironment (TME) as well as immune infiltrate density and composition are considered to play a critical role in the immune interaction between host and tumour and can predict therapy response and survival in many cancers, including gastrointestinal malignancies. The aim of this study was to establish the TME characteristics associated with survival following a poor response to nCRT. METHODS AND RESULTS The prognostic significance of OAC-associated CD3+ , CD4+ , CD8+ , forkhead box protein 3 (FoxP3+ ) and programmed cell death ligand 1 (PD-L1) expression was studied by immunohistochemistry and quantified by automated image analysis in 123 patients who underwent nCRT and curative resection. Results from good and poor responders were contrasted and immune infiltration was related to disease course in both groups. Subsequently a cohort of 57 patients with a moderate response to nCRT was analysed in a similar fashion. Tumour cell percentage positively correlated to immune infiltration markers. In good and moderate responders, none of the immune infiltrate parameters was associated with survival; in poor responders CD8+ was an independent negative predictor of OS in univariate analysis (P = 0.03) and high CD8+ infiltration was associated with worse OS (15 versus 32 months, P = 0.042). CONCLUSION A high CD8+ density is an independent biomarker of poor OS in poor responders to nCRT, but not in good and moderate responders. Our results suggest that patients with a poor response to nCRT but concomitant high CD8+ counts in the resection specimen require adjuvant therapy.
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Affiliation(s)
- Willem J Koemans
- Department of Surgical Oncology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jolanda M van Dieren
- Department of Gastrointestinal Oncology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jose G van den Berg
- Department of Pathology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gerrit A Meijer
- Department of Pathology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Myriam Chalabi
- Department of Gastrointestinal Oncology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Frederig Lecot
- Department of Surgery, Zuyderland Hospital, Heerlen, the Netherlands
| | - Robert Riedl
- Department of Pathology, Zuyderland Hospital, Heerlen, the Netherlands
| | - Oscar Krijgsman
- Departments of Molecular Oncology and Immunology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ingrid Hofland
- Departments of Core Facility, Molecular Pathology and Biobanking, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annegien Broeks
- Departments of Core Facility, Molecular Pathology and Biobanking, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Francine E M Voncken
- Department of Radiotherapy, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Maikel P Peppelenbosch
- Departments of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Hospital, Heerlen, the Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Liudmila L Kodach
- Department of Pathology, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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14
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Eryigit Ö, van de Graaf FW, Nieuwenhuijs VB, Sosef MN, de Graaf EJR, Menon AG, Lange MM, Lange JF. Association of Video Completed by Audio in Laparoscopic Cholecystectomy With Improvements in Operative Reporting. JAMA Surg 2021; 155:617-623. [PMID: 32432660 DOI: 10.1001/jamasurg.2020.0741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance All events that transpire during laparoscopic cholecystectomy (LC) cannot be adequately reproduced in the operative note. Video recording is already known to add important information regarding this operation. Objective It is hypothesized that additional audio recordings can provide an even better procedural understanding by capturing the surgeons' considerations. Design, Setting, and Participants The Simultaneous Video and Audio Recording of Laparoscopic Cholecystectomy Procedures (SONAR) trial is a multicenter prospective observational trial conducted in the Netherlands in which operators were requested to dictate essential steps of LC. Elective LCs of patients 18 years and older were eligible for inclusion. Data collection occurred from September 18, 2018, to November 13, 2018. Main Outcomes and Measures Adequacy rates for video recordings and operative note were compared. Adequacy was defined as the competent depiction of a surgical step and expressed as the number of adequate steps divided by the total applicable steps for all cases. In case of discrepancies, in which a step was adequately observed in the video recording but inadequately reported in the operative note, an expert panel analyzed the added value of the audio recording to resolve the discrepancy. Results A total of 79 patients (49 women [62.0%]; mean [SD] age, 54.3 [15.9] years) were included. Video recordings resulted in higher adequacy for the inspection of the gallbladder (note, 39 of 79 cases [49.4%] vs video, 79 of 79 cases [100%]; P < .001), the inspection of the liver condition (note, 17 of 79 [21.5%] vs video, 78 of 79 cases [98.7%]; P < .001), and the circumferential dissection of the cystic duct and the cystic artery (note, 25 of 77 [32.5%] vs video, 62 of 77 [80.5%]; P < .001). The total adequacy was higher for the video recordings (note, 849 of 1089 observations [78.0%] vs video, 1005 of 1089 observations [92.3%]; P < .001). In the cases of discrepancies between video and note, additional audio recordings lowered discrepancy rates for the inspection of the gallbladder (without audio, 40 of 79 cases [50.6%] vs with audio, 17 of 79 cases [21.5%]; P < .001), the inspection of the liver condition (without audio, 61 of 79 [77.2%] vs with audio, 37 of 79 [46.8%]; P < .001), the circumferential dissection of the cystic duct and the cystic artery (without audio, 43 of 77 cases [55.8%] vs with audio, 17 of 77 cases [22.1%]; P < .001), and similarly for the removal of the first accessory trocar (without audio, 27 of 79 [34.2%] vs with audio, 16 of 79 [20.3%]; P = .02), the second accessory trocar (without audio, 24 of 79 [30.4%] vs with audio, 11 of 79 [13.9%]; P < .001), and the third accessory trocar (without audio, 27 of 79 [34.2%] vs with audio, 14 of 79 [17.7%]; P < .001). The total discrepancy was lower with audio adjustment (without audio, 254 of 1089 observations [23.3%] vs with audio, 128 of 1089 observations [11.8%]; P < .001). Conclusions and Relevance Audio recording during LC significantly improves the adequacy of depicting essential surgical steps and exhibits lower discrepancies between video and operative note.
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Affiliation(s)
- Özgür Eryigit
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Floyd W van de Graaf
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen and Heerlen, the Netherlands
| | | | - Anand G Menon
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marilyne M Lange
- Department of Pathology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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15
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Moossdorff M, Sastrowijoto SH, Sosef MN, de Witte E. [A cecum carcinoma and liver and peritoneal lesions]. Ned Tijdschr Geneeskd 2021; 165:D4974. [PMID: 33560609] [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: 06/12/2023]
Abstract
A 37-year-old male presented with acute lower right abdominal pain. A CT-scan showed a cecal mass. During laparoscopic right colectomy, multiple liver lesions and peritoneal deposits were seen. Histology confirmed pT4aN0 cecum carcinoma, but the liver lesions were consistent with sarcoidosis, and the peritoneal deposits were suggestive of benign mesothelioma.
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Affiliation(s)
- M Moossdorff
- Zuyderland Medisch Centrum, afd. Heelkunde, Heerlen
| | | | - M N Sosef
- Zuyderland Medisch Centrum, afd. Heelkunde, Heerlen
- Contact: M.N. Sosef
| | - E de Witte
- Zuyderland Medisch Centrum, afd. Heelkunde, Heerlen
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16
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Koemans WJ, Larue RTHM, Kloft M, Ruisch JE, Compter I, Riedl RG, Heij LR, van Elmpt W, Berbée M, Buijsen J, Lambin P, Sosef MN, Grabsch HI. Lymph node response to chemoradiotherapy in oesophageal cancer patients: relationship with radiotherapy fields. Esophagus 2021; 18:100-110. [PMID: 32889674 PMCID: PMC7794105 DOI: 10.1007/s10388-020-00777-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of lymph node metastasis (LNmets) is a poor prognostic factor in oesophageal cancer (OeC) patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery. Tumour regression grade (TRG) in LNmets has been suggested as a predictor for survival. The aim of this study was to investigate whether TRG in LNmets is related to their location within the radiotherapy (RT) field. METHODS Histopathological TRG was retrospectively classified in 2565 lymph nodes (LNs) from 117 OeC patients treated with nCRT and surgery as: (A) no tumour, no signs of regression; (B) tumour without regression; (C) viable tumour and regression; and (D) complete response. Multivariate survival analysis was used to investigate the relationship between LN location within the RT field, pathological TRG of the LN and TRG of the primary tumour. RESULTS In 63 (54%) patients, viable tumour cells or signs of regression were seen in 264 (10.2%) LNs which were classified as TRG-B (n = 56), C (n = 104) or D (n = 104) LNs. 73% of B, C and D LNs were located within the RT field. There was a trend towards a relationship between LN response and anatomical LN location with respect to the RT field (p = 0.052). Multivariate analysis showed that only the presence of LNmets within the RT field with TRG-B is related to poor overall survival. CONCLUSION Patients have the best survival if all LNmets show tumour regression, even if LNmets are located outside the RT field. Response in LNmets to nCRT is heterogeneous which warrants further studies to better understand underlying mechanisms.
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Affiliation(s)
- Willem J. Koemans
- Department of Surgery, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands ,grid.430814.aDepartment of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruben T. H. M. Larue
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382The D-Lab, Department of Precision Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maximilian Kloft
- grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jessica E. Ruisch
- grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Inge Compter
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Robert G. Riedl
- Department of Pathology, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands
| | - Lara R. Heij
- grid.412301.50000 0000 8653 1507Department of General, Gastrointestinal, Hepatobiliary and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany ,grid.412301.50000 0000 8653 1507Department of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Wouter van Elmpt
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maaike Berbée
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jeroen Buijsen
- grid.412966.e0000 0004 0480 1382Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Philippe Lambin
- grid.412966.e0000 0004 0480 1382The D-Lab, Department of Precision Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands
| | - Heike I. Grabsch
- grid.412966.e0000 0004 0480 1382Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands ,grid.9909.90000 0004 1936 8403Pathology and Data Analytics, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
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Maassen van den Brink M, Tweed TTT, de Hoogt PA, Hoofwijk AGM, Hulsewé KWE, Sosef MN, Stoot JHMB. The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics? Dig Surg 2020; 38:58-65. [PMID: 33171465 DOI: 10.1159/000511180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. METHODS This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. RESULTS A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, p = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, p < 0.001), longer operating time (3.2 vs. 2.5 hours, p < 0.001), and more readmissions (10.9 vs. 8.5%, p < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, p < 0.001), less morbidity (37.3 vs. 55.1%, p < 0.001), and less mortality (1.8 vs. 5.6%, p = 0.013) for laparoscopy. CONCLUSION During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.
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Affiliation(s)
| | - Thaís T T Tweed
- Department of General Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands,
| | - Patrick A de Hoogt
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A G M Hoofwijk
- Department of General Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Karel W E Hulsewé
- Department of General Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Meindert N Sosef
- Department of General Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Jan H M B Stoot
- Department of General Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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18
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Anderegg MCJ, Ruurda JP, Gisbertz SS, Blom RLGM, Sosef MN, Wijnhoven BPL, Hulshof MCCM, Bergman JJGHM, van Laarhoven HWM, van Berge Henegouwen MI. Feasibility of extended chemoradiotherapy plus surgery for patients with cT4b esophageal carcinoma. Eur J Surg Oncol 2019; 46:626-631. [PMID: 31706717 DOI: 10.1016/j.ejso.2019.10.023] [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] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/02/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Treatment of cT4b esophageal carcinoma usually consists of definitive chemoradiotherapy (dCRT). However, outcome after dCRT in these patients is poor. Whether surgery should have a place in the treatment of cT4b esophageal cancer is still subject to debate. Goal of this study was to evaluate the feasibility of esophagectomy after extended chemoradiotherapy in patients with cT4b esophageal cancer. METHODS Patients with cT4b esophageal carcinoma, as determined by endoscopic ultrasound and (PET-)CT, were eligible for this phase-2 study. Patients were treated with weekly carboplatin + paclitaxel with 50.4 Gy radiotherapy in 28 fractions for 5.5 weeks followed by an explorative thoracotomy and esophagectomy if deemed feasible. RESULTS From July 2011 through March 2013, 16 patients were enrolled. Five patients did not undergo surgery because of detection of distant metastases during/after CRT (n = 3), unwillingness to undergo surgery (n = 1) or death before start of CRT (n = 1). Of the 13 patients who completed CRT, 3 patients experienced major hematologic toxicity (grade 3). A radical (R0) resection was achieved in 9 of 11 patients. Postoperative complications occurred in 9 patients. A reoperation was performed in 2 patients and 2 patients died in hospital after surgery. Three patients developed recurrent disease (1 locoregional and 2 systemic) after a mean interval of 17 months. Median overall survival of all included patients was 14.3 months. CONCLUSIONS In certain patients with cT4b esophageal carcinoma a radical resection can be accomplished after chemoradiotherapy. However, this treatment is associated with considerable complications and should therefore be reserved for physically fit patients. NETHERLANDS TRIAL REGISTER NUMBER NTR3060.
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Affiliation(s)
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center, Utrecht, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Rachel L G M Blom
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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19
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Hagens ERC, van Berge Henegouwen MI, van Sandick JW, Cuesta MA, van der Peet DL, Heisterkamp J, Nieuwenhuijzen GAP, Rosman C, Scheepers JJG, Sosef MN, van Hillegersberg R, Lagarde SM, Nilsson M, Räsänen J, Nafteux P, Pattyn P, Hölscher AH, Schröder W, Schneider PM, Mariette C, Castoro C, Bonavina L, Rosati R, de Manzoni G, Mattioli S, Garcia JR, Pera M, Griffin M, Wilkerson P, Chaudry MA, Sgromo B, Tucker O, Cheong E, Moorthy K, Walsh TN, Reynolds J, Tachimori Y, Inoue H, Matsubara H, Kosugi SI, Chen H, Law SYK, Pramesh CS, Puntambekar SP, Murthy S, Linden P, Hofstetter WL, Kuppusamy MK, Shen KR, Darling GE, Sabino FD, Grimminger PP, Meijer SL, Bergman JJGHM, Hulshof MCCM, van Laarhoven HWM, Mearadji B, Bennink RJ, Annema JT, Dijkgraaf MGW, Gisbertz SS. Distribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study. BMC Cancer 2019; 19:662. [PMID: 31272485 PMCID: PMC6610993 DOI: 10.1186/s12885-019-5761-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An important parameter for survival in patients with esophageal carcinoma is lymph node status. The distribution of lymph node metastases depends on tumor characteristics such as tumor location, histology, invasion depth, and on neoadjuvant treatment. The exact distribution is unknown. Neoadjuvant treatment and surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy has not been reached. The aim of this study is to determine the distribution of lymph node metastases in patients with resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed. This can be the foundation for a uniform worldwide staging system and establishment of the optimal surgical strategy for esophageal cancer patients. METHODS The TIGER study is an international observational cohort study with 50 participating centers. Patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival. DISCUSSION The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed based on these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics. TRIAL REGISTRATION NCT03222895 , date of registration: July 19th, 2017.
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Affiliation(s)
- Eliza R C Hagens
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | | | - Miguel A Cuesta
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | | | | | - Camiel Rosman
- Radboud universitair medisch centrum, Nijmegen, The Netherlands
| | | | | | | | | | | | - Jari Räsänen
- Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | | | | | | | | | - Paul M Schneider
- Triemli Medical Center and Hirslanden Medical Center, Zürich, Switzerland
| | | | | | - Luigi Bonavina
- Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, University of Milano, Milan, Italy
| | | | | | | | | | - Manuel Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | - Michael Griffin
- Royal Victoria Infirmary, New Castle upon Tyne Hospitals, New Castle, UK
| | | | | | | | - Olga Tucker
- Heart of England Foundation Trust, Birmingham, UK
| | - Edward Cheong
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | | | | | - Haruhiro Inoue
- Showa University, Northern Yokohama Hospital, Yokohama, Japan
| | | | - Shin-Ichi Kosugi
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Japan
| | - Haiquan Chen
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | | | | | | | | | | | | | | | | | - Peter P Grimminger
- University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sybren L Meijer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jacques J G H M Bergman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Maarten C C M Hulshof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Hanneke W M van Laarhoven
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Banafsche Mearadji
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Roel J Bennink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands. .,Department of Gastro-Intestinal Surgery, Amsterdam UMC, location AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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20
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Cords CI, Lerut AVM, Sosef MN. [Two ominous hematomas of the abdominal wall]. Ned Tijdschr Geneeskd 2019; 163:D2821. [PMID: 30730680] [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: 06/09/2023]
Abstract
A 51 years old woman came to the emergency room with acute onset abdominal hematomas. She complained of vague abdominal pain without preceding trauma. Two large hematomas were present, one in the infra-umbilical region and one in the right flank, corresponding to Cullen's and Grey Turner's sign, respectively. Laboratory analysis and CT confirmed the diagnosis of necrotising pancreatitis.
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Affiliation(s)
- Charlotte I Cords
- Zuyderland Medisch Centrum, afd. Chirurgie, Sittard-Geleen
- Contact: C.I. Cords
| | - An V M Lerut
- Zuyderland Medisch Centrum, afd. Chirurgie, Sittard-Geleen
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21
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Larue RTHM, Klaassen R, Jochems A, Leijenaar RTH, Hulshof MCCM, van Berge Henegouwen MI, Schreurs WMJ, Sosef MN, van Elmpt W, van Laarhoven HWM, Lambin P. Pre-treatment CT radiomics to predict 3-year overall survival following chemoradiotherapy of esophageal cancer. Acta Oncol 2018; 57:1475-1481. [PMID: 30067421 DOI: 10.1080/0284186x.2018.1486039] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiomic features retrieved from standard CT-images have shown prognostic power in several tumor sites. In this study, we investigated the prognostic value of pretreatment CT radiomic features to predict overall survival of esophageal cancer patients after chemoradiotherapy. MATERIAL AND METHODS Two datasets of independent centers were analyzed, consisting of esophageal cancer patients treated with concurrent chemotherapy (Carboplatin/Paclitaxel) and 41.4Gy radiotherapy, followed by surgery if feasible. In total, 1049 radiomic features were calculated from the primary tumor volume. Recursive feature elimination was performed to select the 40 most relevant predictors. Using these 40 features and six clinical variables as input, two random forest (RF) models predicting 3-year overall survival were developed. RESULTS In total 165 patients from center 1 and 74 patients from center 2 were used. The radiomics-based RF model yielded an area under the curve (AUC) of 0.69 (95%CI 0.61-0.77), with the top-5 most important features for 3-year survival describing tumor heterogeneity after wavelet filtering. In the validation dataset, the RF model yielded an AUC of 0.61 (95%CI 0.47-0.75). Kaplan Meier plots were significantly different between risk groups in the training dataset (p = .027) and borderline significant in the validation dataset (p = .053). The clinical RF model yielded AUCs of 0.63 (95%CI 0.54-0.71) and 0.62 (95%CI 0.49-0.76) in the training and validation dataset, respectively. Risk groups did not reach a significant correlation with pathological response in the primary tumor. CONCLUSIONS A RF model predicting 3-year overall survival based on pretreatment CT radiomic features was developed and validated in two independent datasets of esophageal cancer patients. The radiomics model had better prognostic power compared to the model using standard clinical variables.
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Affiliation(s)
- Ruben T. H. M. Larue
- The D-Lab: Decision Support for Precision Medicine, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Remy Klaassen
- Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arthur Jochems
- The D-Lab: Decision Support for Precision Medicine, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralph T. H. Leijenaar
- The D-Lab: Decision Support for Precision Medicine, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Wendy M. J. Schreurs
- Department of Nuclear Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Philippe Lambin
- The D-Lab: Decision Support for Precision Medicine, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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22
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Sosef MN, Bosch JG, van Oostayen J, Visser T, Reiber JHC, Rosendaal FR. Relation of Plasma Coagulation Factor VII and Fibrinogen to Carotid Artery Intima-Media Thickness. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648848] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryPlasma clotting factor VII and plasma fibrinogen have been claimed as independent risk factors for occlusive cardiovascular disease. The aim of this study was to investigate whether these coagulation parameters affect early atherosclerosis, additional to their possible effect on arterial thrombosis.We used high-resolution quantitative ultrasonography to measure carotid intima-media thickness in 121 healthy volunteers, aged 18 to 56 years. It has previously been demonstrated that an increased artery wall thickness is seen in advanced atherosclerosis. To validate our methodology for relatively young individuals, we assessed the association of intima-media thickness with the risk-factor status of our subjects, by including classical cardiovascular risk factors, e. g. age, sex, serum cholesterol, smoking habits and blood pressure. Thereafter, we studied the effect of factor VII and fibrinogen plasma levels on carotid intimamedia thickness, as well as that of polymorphisms of the factor VII and fibrinogen genes.All classical risk factors except smoking and family history were associated with intima-media thickness. When adjusted for by multivariate linear regression analysis, age, blood pressure and cholesterol appeared to be independent determinants of intima-media thickness. Factor VII and fibrinogen levels showed no association in multivariate analysis with intima-media thickness. We conclude that artery wall thickness measurement by ultrasound is a useful tool to investigate the role of clotting factors in early atherosclerosis. Factor VII and fibrinogen levels in young and middle-aged volunteers have no association with early artherosclerotic vessel wall changes.
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Affiliation(s)
- M N Sosef
- The Department of Clinical Epidemiology, University Hospital Leiden, The Netherlands
| | - J G Bosch
- The Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
| | - J van Oostayen
- The Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
| | - T Visser
- The Department of Hemostasis and Thrombosis Research Center, University Hospital Leiden, The Netherlands
| | - J H C Reiber
- The Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
| | - F R Rosendaal
- The Department of Clinical Epidemiology, University Hospital Leiden, The Netherlands
- The Department of Hemostasis and Thrombosis Research Center, University Hospital Leiden, The Netherlands
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23
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Noordman BJ, Spaander MCW, Valkema R, Wijnhoven BPL, van Berge Henegouwen MI, Shapiro J, Biermann K, van der Gaast A, van Hillegersberg R, Hulshof MCCM, Krishnadath KK, Lagarde SM, Nieuwenhuijzen GAP, Oostenbrug LE, Siersema PD, Schoon EJ, Sosef MN, Steyerberg EW, van Lanschot JJB. Detection of residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer (preSANO): a prospective multicentre, diagnostic cohort study. Lancet Oncol 2018; 19:965-974. [PMID: 29861116 DOI: 10.1016/s1470-2045(18)30201-8] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND After neoadjuvant chemoradiotherapy for oesophageal cancer, roughly half of the patients with squamous cell carcinoma and a quarter of those with adenocarcinoma have a pathological complete response of the primary tumour before surgery. Thus, the necessity of standard oesophagectomy after neoadjuvant chemoradiotherapy should be reconsidered for patients who respond sufficiently to neoadjuvant treatment. In this study, we aimed to establish the accuracy of detection of residual disease after neoadjuvant chemoradiotherapy with different diagnostic approaches, and the optimal combination of diagnostic techniques for clinical response evaluations. METHODS The preSANO trial was a prospective, multicentre, diagnostic cohort study at six centres in the Netherlands. Eligible patients were aged 18 years or older, had histologically proven, resectable, squamous cell carcinoma or adenocarcinoma of the oesophagus or oesophagogastric junction, and were eligible for potential curative therapy with neoadjuvant chemoradiotherapy (five weekly cycles of carboplatin [area under the curve 2 mg/mL per min] plus paclitaxel [50 mg/m2 of body-surface area] combined with 41·4 Gy radiotherapy in 23 fractions) followed by oesophagectomy. 4-6 weeks after completion of neoadjuvant chemoradiotherapy, patients had oesophagogastroduodenoscopy with biopsies and endoscopic ultrasonography with measurement of maximum tumour thickness. Patients with histologically proven locoregional residual disease or no-pass during endoscopy and without distant metastases underwent immediate surgical resection. In the remaining patients a second clinical response evaluation was done (PET-CT, oesophagogastroduodenoscopy with biopsies, endoscopic ultrasonography with measurement of maximum tumour thickness, and fine-needle aspiration of suspicious lymph nodes), followed by surgery 12-14 weeks after completion of neoadjuvant chemoradiotherapy. The primary endpoint was the correlation between clinical response during clinical response evaluations and the final pathological response in resection specimens, as shown by the proportion of tumour regression grade (TRG) 3 or 4 (>10% residual carcinoma in the resection specimen) residual tumours that was missed during clinical response evaluations. This study was registered with the Netherlands Trial Register (NTR4834), and has been completed. FINDINGS Between July 22, 2013, and Dec 28, 2016, 219 patients were included, 207 of whom were included in the analyses. Eight of 26 TRG3 or TRG4 tumours (31% [95% CI 17-50]) were missed by endoscopy with regular biopsies and fine-needle aspiration. Four of 41 TRG3 or TRG4 tumours (10% [95% CI 4-23]) were missed with bite-on-bite biopsies and fine-needle aspiration. Endoscopic ultrasonography with maximum tumour thickness measurement missed TRG3 or TRG4 residual tumours in 11 of 39 patients (28% [95% CI 17-44]). PET-CT missed six of 41 TRG3 or TRG4 tumours (15% [95% CI 7-28]). PET-CT detected interval distant histologically proven metastases in 18 (9%) of 190 patients (one squamous cell carcinoma, 17 adenocarcinomas). INTERPRETATION After neoadjuvant chemoradiotherapy for oesophageal cancer, clinical response evaluation with endoscopic ultrasonography, bite-on-bite biopsies, and fine-needle aspiration of suspicious lymph nodes was adequate for detection of locoregional residual disease, with PET-CT for detection of interval metastases. Active surveillance with this combination of diagnostic modalities is now being assessed in a phase 3 randomised controlled trial (SANO trial; Netherlands Trial Register NTR6803). FUNDING Dutch Cancer Society.
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Affiliation(s)
- Bo Jan Noordman
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Manon C W Spaander
- Department of Gastroenterology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Roelf Valkema
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | - Joël Shapiro
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ate van der Gaast
- Department of Medical Oncology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | | | | | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | | | - Peter D Siersema
- Department of Gastroenterology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands; Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Erik J Schoon
- Department of Gastroenterology, Catharina Hospital, Eindhoven, Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, Netherlands
| | - J Jan B van Lanschot
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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24
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Valkenet K, Trappenburg JCA, Ruurda JP, Guinan EM, Reynolds JV, Nafteux P, Fontaine M, Rodrigo HE, van der Peet DL, Hania SW, Sosef MN, Willms J, Rosman C, Pieters H, Scheepers JJG, Faber T, Kouwenhoven EA, Tinselboer M, Räsänen J, Ryynänen H, Gosselink R, van Hillegersberg R, Backx FJG. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg 2018; 105:502-511. [DOI: 10.1002/bjs.10803] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/12/2017] [Accepted: 11/27/2017] [Indexed: 01/22/2023]
Abstract
Abstract
Background
Up to 40 per cent of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy.
Methods
Patients with oesophageal cancer were randomized to a home-based IMT programme before surgery or usual care. IMT included the use of a flow-resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60 per cent of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning.
Results
Postoperative pneumonia was diagnosed in 47 (39·2 per cent) of 120 patients in the IMT group and in 43 (35·5 per cent) of 121 patients in the control group (relative risk 1·10, 95 per cent c.i. 0·79 to 1·53; P = 0·561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 76·2(26·4) to 89·0(29·4) cmH2O (P < 0·001) in the intervention group and from 74·0(30·2) to 80·0(30·1) cmH2O in the control group (P < 0·001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (P < 0·001) and from 4 min 20 s to 5 min 5 s in the control group (P = 0·007). The increases were highest in the intervention group (P < 0·050).
Conclusion
Despite an increase in preoperative inspiratory muscle function, home-based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. Registration number: NCT01893008 (https://www.clinicaltrials.gov).
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Affiliation(s)
- K Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J C A Trappenburg
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E M Guinan
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - P Nafteux
- Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Fontaine
- Department of Physiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - H E Rodrigo
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D L van der Peet
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - S W Hania
- Department of Physiotherapy, VU University Medical Centre, Amsterdam, The Netherlands
| | - M N Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - J Willms
- Department of Physiotherapy, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - C Rosman
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - H Pieters
- Department of Physiotherapy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J J G Scheepers
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - T Faber
- Department of Physiotherapy, Reinier de Graaf Hospital, Delft, The Netherlands
| | - E A Kouwenhoven
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - M Tinselboer
- Department of Physiotherapy, Hospital Group Twente, Almelo, The Netherlands
| | - J Räsänen
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - H Ryynänen
- Department of Physiotherapy, Helsinki University Central Hospital, Helsinki, Finland
| | - R Gosselink
- Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium
| | - R van Hillegersberg
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F J G Backx
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
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25
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Noordman BJ, Wijnhoven BPL, Lagarde SM, Boonstra JJ, Coene PPLO, Dekker JWT, Doukas M, van der Gaast A, Heisterkamp J, Kouwenhoven EA, Nieuwenhuijzen GAP, Pierie JPEN, Rosman C, van Sandick JW, van der Sangen MJC, Sosef MN, Spaander MCW, Valkema R, van der Zaag ES, Steyerberg EW, van Lanschot JJB. Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: a stepped-wedge cluster randomised trial. BMC Cancer 2018; 18:142. [PMID: 29409469 PMCID: PMC5801846 DOI: 10.1186/s12885-018-4034-1] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/23/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (nCRT) plus surgery is a standard treatment for locally advanced oesophageal cancer. With this treatment, 29% of patients have a pathologically complete response in the resection specimen. This provides the rationale for investigating an active surveillance approach. The aim of this study is to assess the (cost-)effectiveness of active surveillance vs. standard oesophagectomy after nCRT for oesophageal cancer. METHODS This is a phase-III multi-centre, stepped-wedge cluster randomised controlled trial. A total of 300 patients with clinically complete response (cCR, i.e. no local or disseminated disease proven by histology) after nCRT will be randomised to show non-inferiority of active surveillance to standard oesophagectomy (non-inferiority margin 15%, intra-correlation coefficient 0.02, power 80%, 2-sided α 0.05, 12% drop-out). Patients will undergo a first clinical response evaluation (CRE-I) 4-6 weeks after nCRT, consisting of endoscopy with bite-on-bite biopsies of the primary tumour site and other suspected lesions. Clinically complete responders will undergo a second CRE (CRE-II), 6-8 weeks after CRE-I. CRE-II will include 18F-FDG-PET-CT, followed by endoscopy with bite-on-bite biopsies and ultra-endosonography plus fine needle aspiration of suspected lymph nodes and/or PET- positive lesions. Patients with cCR at CRE-II will be assigned to oesophagectomy (first phase) or active surveillance (second phase of the study). The duration of the first phase is determined randomly over the 12 centres, i.e., stepped-wedge cluster design. Patients in the active surveillance arm will undergo diagnostic evaluations similar to CRE-II at 6/9/12/16/20/24/30/36/48 and 60 months after nCRT. In this arm, oesophagectomy will be offered only to patients in whom locoregional regrowth is highly suspected or proven, without distant dissemination. The main study parameter is overall survival; secondary endpoints include percentage of patients who do not undergo surgery, quality of life, clinical irresectability (cT4b) rate, radical resection rate, postoperative complications, progression-free survival, distant dissemination rate, and cost-effectiveness. We hypothesise that active surveillance leads to non-inferior survival, improved quality of life and a reduction in costs, compared to standard oesophagectomy. DISCUSSION If active surveillance and surgery as needed after nCRT leads to non-inferior survival compared to standard oesophagectomy, this organ-sparing approach can be implemented as a standard of care.
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Affiliation(s)
- Bo Jan Noordman
- Department of Surgery, Erasmus MC – University Medical Centre, Suite Z-839, P.O. Box 2040 3000, CA Rotterdam, The Netherlands
| | - Bas P. L. Wijnhoven
- Department of Surgery, Erasmus MC – University Medical Centre, Suite Z-839, P.O. Box 2040 3000, CA Rotterdam, The Netherlands
| | - Sjoerd M. Lagarde
- Department of Surgery, Erasmus MC – University Medical Centre, Suite Z-839, P.O. Box 2040 3000, CA Rotterdam, The Netherlands
| | - Jurjen J. Boonstra
- Department of Gastroenterology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Michael Doukas
- Department of Pathology, Erasmus MC – University Medical Centre, Rotterdam, the Netherlands
| | - Ate van der Gaast
- Department of Medical Oncology, Erasmus MC – University Medical Centre, Rotterdam, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | | | | | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johanna W. van Sandick
- Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology, Erasmus MC – University Medical Centre, Rotterdam, the Netherlands
| | - Roelf Valkema
- Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Centre, Rotterdam, the Netherlands
| | | | - Ewout W. Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, formerly department of Public Health, Erasmus MC – University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - J. Jan B. van Lanschot
- Department of Surgery, Erasmus MC – University Medical Centre, Suite Z-839, P.O. Box 2040 3000, CA Rotterdam, The Netherlands
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26
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Hupkens BJP, Maas M, Martens MH, van der Sande ME, Lambregts DMJ, Breukink SO, Melenhorst J, Houwers JB, Hoff C, Sosef MN, Leijtens JWA, Berbee M, Beets-Tan RGH, Beets GL. Organ Preservation in Rectal Cancer After Chemoradiation: Should We Extend the Observation Period in Patients with a Clinical Near-Complete Response? Ann Surg Oncol 2017; 25:197-203. [PMID: 29134378 DOI: 10.1245/s10434-017-6213-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND To assess whether extending the observation period in patients with a near clinical complete response (near cCR) after chemoradiation (CRT) leads to an impaired oncological outcome. METHODS Patients who had a clinical complete response (cCR) 8-10 weeks after CRT restaging with magnetic resonance imaging and endoscopy were offered a watch-and-wait strategy (W&W1), while patients with a near cCR were offered to undergo local excision or a second restaging 6-12 weeks later. Patients who achieved a cCR at the second restaging were also offered a watch-and-wait strategy (W&W2). RESULTS Overall, 102 patients with a cCR at the first restaging immediately entered the W&W1, while the remaining 68 patients had a near cCR: 19 patients underwent transanal endoscopic microsurgery and 49 patients opted for a second restaging. Additionally, 44/49 (90%) patients showed a cCR at the second restaging and entered the W&W2. Patients in the W&W1 group had a 2-year local regrowth-free rate (LRFR) of 84% and 2-year overall survival (OS) of 99%, while patients in the W&W2 group had a 2-year LRFR of 73% and OS of 98% (p > 0.05). Multivariable Cox regression analyses showed that late inclusion was not a significant predictive factor for higher risk of LR or lower non-regrowth disease-free survival. CONCLUSIONS Overall, 90% of patients with a near cCR 8-10 weeks after CRT will proceed to a cCR 6-12 weeks later; therefore, it seems logical to extend the observation period rather than to proceed to surgery. Although there is a non-significant increase in local regrowth rate in these patients, it does not seem to impact the oncological outcome.
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Affiliation(s)
- Britt J P Hupkens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Milou H Martens
- Department of Surgery, Zuyderland Medical Centre, Heerlen/Sittard, The Netherlands
| | | | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Janneke B Houwers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen/Sittard, The Netherlands
| | | | - Maaike Berbee
- Department of Radiotherapy, Maastro Clinic, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
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27
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Larue RTHM, van Timmeren JE, de Jong EEC, Feliciani G, Leijenaar RTH, Schreurs WMJ, Sosef MN, Raat FHPJ, van der Zande FHR, Das M, van Elmpt W, Lambin P. Influence of gray level discretization on radiomic feature stability for different CT scanners, tube currents and slice thicknesses: a comprehensive phantom study. Acta Oncol 2017; 56:1544-1553. [PMID: 28885084 DOI: 10.1080/0284186x.2017.1351624] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radiomic analyses of CT images provide prognostic information that can potentially be used for personalized treatment. However, heterogeneity of acquisition- and reconstruction protocols influences robustness of radiomic analyses. The aim of this study was to investigate the influence of different CT-scanners, slice thicknesses, exposures and gray-level discretization on radiomic feature values and their stability. MATERIAL AND METHODS A texture phantom with ten different inserts was scanned on nine different CT-scanners with varying tube currents. Scans were reconstructed with 1.5 mm or 3 mm slice thickness. Image pre-processing comprised gray-level discretization in ten different bin widths ranging from 5 to 50 HU and different resampling methods (i.e., linear, cubic and nearest neighbor interpolation to 1 × 1 × 3 mm3 voxels) were investigated. Subsequently, 114 textural radiomic features were extracted from a 2.1 cm3 sphere in the center of each insert. The influence of slice thickness, exposure and bin width on feature values was investigated. Feature stability was assessed by calculating the concordance correlation coefficient (CCC) in a test-retest setting and for different combinations of scanners, tube currents and slice thicknesses. RESULTS Bin width influenced feature values, but this only had a marginal effect on the total number of stable features (CCC > 0.85) when comparing different scanners, slice thicknesses or exposures. Most radiomic features were affected by slice thickness, but this effect could be reduced by resampling the CT-images before feature extraction. Statistics feature 'energy' was the most dependent on slice thickness. No clear correlation between feature values and exposures was observed. CONCLUSIONS CT-scanner, slice thickness and bin width affected radiomic feature values, whereas no effect of exposure was observed. Optimization of gray-level discretization to potentially improve prognostic value can be performed without compromising feature stability. Resampling images prior to feature extraction decreases the variability of radiomic features.
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Affiliation(s)
- Ruben T. H. M. Larue
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Janna E. van Timmeren
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Evelyn E. C. de Jong
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Giacomo Feliciani
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralph T. H. Leijenaar
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wendy M. J. Schreurs
- Department of Nuclear Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Frank H. P. J. Raat
- Department of Radiology, Laurentius Medical Centre, Roermond, The Netherlands
| | | | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO, the D-Lab), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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28
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Klinkert M, de Jong MC, Sosef MN, van Nunen AB, Belgers HJ. Surgical treatment of a rare complication after endoscopic stent placement for anastomotic leakage after esophageal resection. World J Surg Proced 2017; 7:1-5. [DOI: 10.5412/wjsp.v7.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/21/2017] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
The best approach to achieve cure in esophageal cancer is a combination of chemo-radiation and surgery. However, complications occur in half of patients. The current report, reports a rare but severe complication: Complete obstruction of the esophagus, induced by preoperative chemo-radiation therapy. Normally, strictures are treated by repeated dilatations, however, in case of complete obstruction, the perforation rate of standard blind anterograde wire access and dilation is severely increased. In order to minimize the risk of perforations, the rendezvous technique was introduced. This technique involves an anterograde approach in combination with a retrograde approach in order to open and dilatate the esophagus. While technical success rates between 83% and 100% have been reported in literature, data on clinical outcomes are scarcer. The limited amount of studies available claim that success was achieved in almost half of patients. The patient in our case currently has an oral diet without restrictions and rates his quality of life with a VAS-score ten out of ten.
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29
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Larue RTHM, Van De Voorde L, Berbée M, van Elmpt WJC, Dubois LJ, Panth KM, Peeters SGJA, Claessens A, Schreurs WMJ, Nap M, Warmerdam FARM, Erdkamp FLG, Sosef MN, Lambin P. A phase 1 'window-of-opportunity' trial testing evofosfamide (TH-302), a tumour-selective hypoxia-activated cytotoxic prodrug, with preoperative chemoradiotherapy in oesophageal adenocarcinoma patients. BMC Cancer 2016; 16:644. [PMID: 27535748 PMCID: PMC4989456 DOI: 10.1186/s12885-016-2709-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 08/11/2016] [Indexed: 01/03/2023] Open
Abstract
Background Neo-adjuvant chemoradiotherapy followed by surgery is the standard treatment with curative intent for oesophageal cancer patients, with 5-year overall survival rates up to 50 %. However, patients’ quality of life is severely compromised by oesophagectomy, and eventually many patients die due to metastatic disease. Most solid tumours, including oesophageal cancer, contain hypoxic regions that are more resistant to chemoradiotherapy. The hypoxia-activated prodrug evofosfamide works as a DNA-alkylating agent under these hypoxic conditions, which directly kills hypoxic cancer cells and potentially minimizes resistance to conventional therapy. This drug has shown promising results in several clinical studies when combined with chemotherapy. Therefore, in this phase I study we investigate the safety of evofosfamide added to the chemoradiotherapy treatment of oesophageal cancer. Methods/Design A phase I, non-randomized, single-centre, open-label, 3 + 3 trial with repeated hypoxia PET imaging, will test the safety of evofosfamide in combination with neo-adjuvant chemoradiotherapy in potentially resectable oesophageal adenocarcinoma patients. Investigated dose levels range from 120 mg/m2 to 340 mg/m2. Evofosfamide will be administered one week before the start of chemoradiotherapy (CROSS-regimen) and repeated weekly up to a total of six doses. PET/CT acquisitions with hypoxia tracer 18F-HX4 will be made before and after the first administration of evofosfamide, allowing early assessment of changes in hypoxia, accompanied with blood sampling to measure hypoxia blood biomarkers. Oesophagectomy will be performed according to standard clinical practice. Higher grade and uncommon non-haematological, haematological, and post-operative toxicities are the primary endpoints according to the CTCAEv4.0 and Clavien-Dindo classifications. Secondary endpoints are reduction in hypoxic fraction based on 18F-HX4 imaging, pathological complete response, histopathological negative circumferential resection margin (R0) rate, local and distant recurrence rate, and progression free and overall survival. Discussion This is the first clinical trial testing evofosfamide in combination with chemoradiotherapy. The primary objective is to determine the dose limiting toxicity of this combined treatment and herewith to define the maximum tolerated dose and recommended phase 2 dose for future clinical studies. The addition of non-invasive repeated hypoxia imaging (‘window-of-opportunity’) enables us to identify the biologically effective dose. We believe this approach could also be used for other hypoxia targeted drugs. Trial registration ClinicalTrials.gov Identifier: NCT02598687.
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Affiliation(s)
- Ruben T H M Larue
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lien Van De Voorde
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wouter J C van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ludwig J Dubois
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kranthi M Panth
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sarah G J A Peeters
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cancer Research UK & Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Ann Claessens
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wendy M J Schreurs
- Department of Nuclear Medicine, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Marius Nap
- Department of Pathology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Fabiënne A R M Warmerdam
- Department of Medical Oncology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Frans L G Erdkamp
- Department of Medical Oncology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands.,Surgical Collaborative Network Limburg, Limburg, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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30
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Haverkamp L, Parry K, van Berge Henegouwen MI, van Laarhoven HW, Bonenkamp JJ, Bisseling TM, Siersema PD, Sosef MN, Stoot JH, Beets GL, de Steur WO, Hartgrink HH, Verspaget HW, van der Peet DL, Plukker JT, van Etten B, Wijnhoven BPL, van Lanschot JJ, van Hillegersberg R, Ruurda JP. Esophageal and Gastric Cancer Pearl: a nationwide clinical biobanking project in the Netherlands. Dis Esophagus 2016; 29:435-41. [PMID: 25824294 DOI: 10.1111/dote.12347] [Citation(s) in RCA: 8] [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] [Indexed: 12/11/2022]
Abstract
Esophageal and gastric cancer is associated with a poor prognosis since many patients develop recurrent disease. Treatment requires specific expertise and a structured multidisciplinary approach. In the Netherlands, this type of expertise is mainly found at the University Medical Centers (UMCs) and a few specialized nonacademic centers. Aim of this study is to implement a national infrastructure for research to gain more insight in the etiology and prognosis of esophageal and gastric cancer and to evaluate and improve the response on (neoadjuvant) treatment. Clinical data are collected in a prospective database, which is linked to the patients' biomaterial. The collection and storage of biomaterial is performed according to standard operating procedures in all participating UMCs as established within the Parelsnoer Institute. The collected biomaterial consists of tumor biopsies, blood samples, samples of malignant and healthy tissue of the resected specimen and biopsies of recurrence. The collected material is stored in the local biobanks and is encoded to respect the privacy of the donors. After approval of the study was obtained from the Institutional Review Board, the first patient was included in October 2014. The target aim is to include 300 patients annually. In conclusion, the eight UMCs of the Netherlands collaborated to establish a nationwide database of clinical information and biomaterial of patients with esophageal and gastric cancer. Due to the national coverage, a high number of patients are expected to be included. This will provide opportunity for future studies to gain more insight in the etiology, treatment and prognosis of esophageal and gastric cancer.
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Affiliation(s)
- L Haverkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K Parry
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - H W van Laarhoven
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - J J Bonenkamp
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T M Bisseling
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M N Sosef
- Department of Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands
| | - J H Stoot
- Department of Surgery, Orbis Medical Center, Sittard, The Netherlands
| | - G L Beets
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - D L van der Peet
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - J T Plukker
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - B van Etten
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J J van Lanschot
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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31
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Noordman BJ, Shapiro J, Spaander MC, Krishnadath KK, van Laarhoven HW, van Berge Henegouwen MI, Nieuwenhuijzen GA, van Hillegersberg R, Sosef MN, Steyerberg EW, Wijnhoven BP, van Lanschot JJB. Accuracy of Detecting Residual Disease After Cross Neoadjuvant Chemoradiotherapy for Esophageal Cancer (preSANO Trial): Rationale and Protocol. JMIR Res Protoc 2015; 4:e79. [PMID: 26121676 PMCID: PMC4526968 DOI: 10.2196/resprot.4320] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/03/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Results from the recent CROSS trial showed that neoadjuvant chemoradiotherapy (nCRT) significantly increased survival as compared to surgery alone in patients with potentially curable esophageal cancer. Furthermore, in the nCRT arm 49% of patients with a squamous cell carcinoma (SCC) and 23% of patients with an adenocarcinoma (AC) had a pathologically complete response in the resection specimen. These results provide a rationale to reconsider and study the timing and necessity of esophagectomy in (all) patients after application of the CROSS regimen. OBJECTIVE We propose a "surgery as needed" approach after completion of nCRT. In this approach, patients will undergo active surveillance after completion of nCRT. Surgical resection would be offered only to those patients in whom residual disease or a locoregional recurrence is highly suspected or proven. However, before a surgery as needed approach in oesophageal cancer patients (SANO) can be tested in a randomized controlled trial, we aim to determine the accuracy of detecting the presence or absence of residual disease after nCRT (preSANO trial). METHODS This study is set up as a prospective, single arm, multicenter, diagnostic trial. Operable patients with potentially curable SCC or AC of the esophagus or esophagogastric junction will be included. Approximately 4-6 weeks after completion of nCRT all included patients will undergo a first clinical response evaluation (CRE-I) including endoscopy with (random) conventional mucosal biopsies of the primary tumor site and of any other suspected lesions in the esophagus and radial endo-ultrasonography (EUS) for measurement of tumor thickness and area. Patients in whom no locoregional or disseminated disease can be proven by cytohistology will be offered a postponed surgical resection 6-8 weeks after CRE-I (ie, approximately 12-14 weeks after completion of nCRT). In the week preceding the postponed surgical resection, a second clinical response evaluation (CRE-II) will be planned that will include a whole body PET-CT, followed again by endoscopy with (random) conventional mucosal biopsies of the primary tumor site and any other suspected lesions in the esophagus, radial EUS for measurement of tumor thickness and area, and linear EUS plus fine needle aspiration of PET-positive lesions and/or suspected lymph nodes. The main study parameter is the correlation between the clinical response assessment during CRE-I and CRE-II and the final pathological response in the resection specimen. RESULTS The first patient was enrolled on July 23, 2013, and results are expected in January 2016. CONCLUSIONS If this preSANO trial shows that the presence or absence of residual tumor can be predicted reliably 6 or 12 weeks after completion of nCRT, a randomized trial comparing nCRT plus standard surgery versus chemoradiotherapy plus "surgery as needed" will be conducted (SANO trial). TRIAL REGISTRATION Netherlands Trial Register: NTR4834; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4834 (archived by Webcite at http://www.webcitation.org/6Ze7mn67B).
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Affiliation(s)
- Bo Jan Noordman
- Erasmus MC - University Medical Center Rotterdam, Department of Surgery, Rotterdam, Netherlands.
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Tegels JJW, Hulsewé KWE, Sosef MN, Stoot JHMB. Morbidity and mortality after total gastrectomy for gastric malignancy: do not forget about geriatric frailty and nutrition. Surgery 2015; 157:406-7. [PMID: 25616952 DOI: 10.1016/j.surg.2014.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Juul J W Tegels
- Department of Surgery, Orbis Medical Centre, Sittard-Geleen, P.O. Box 5500, 6130 MB, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Orbis Medical Centre, Sittard-Geleen, P.O. Box 5500, 6130 MB, The Netherlands; Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Orbis Medical Centre, Sittard-Geleen, P.O. Box 5500, 6130 MB, The Netherlands; Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Orbis Medical Centre, Sittard-Geleen, P.O. Box 5500, 6130 MB, The Netherlands; Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
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33
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Reisinger KW, Bosmans JWAM, Uittenbogaart M, Alsoumali A, Poeze M, Sosef MN, Derikx JPM. Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery. Ann Surg Oncol 2015; 22:4445-52. [PMID: 25893413 PMCID: PMC4644199 DOI: 10.1245/s10434-015-4558-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Indexed: 12/15/2022]
Abstract
Background Esophageal surgery is associated with complications and mortality. It is highly important to develop tools predicting unfavorable postoperative outcome. Esophageal cancer and neoadjuvant chemoradiotherapy (CRT) induce skeletal muscle wasting, which leads to diminished physiologic reserves. The purpose of this study was to investigate whether the degree of muscle mass lost during neoadjuvant CRT predicts postoperative mortality. Methods A total of 123 consecutive patients undergoing surgery for esophageal malignancy in the period 2008–2012 were included, of whom 114 received neoadjuvant CRT. Skeletal muscle mass was measured on routinely performed CT scans by assessing L3 muscle index (according to the Prado method) before and after neoadjuvant CRT, and the amount of muscle mass lost during neoadjuvant CRT (muscle loss index) was calculated. It was investigated whether this amount was associated with postoperative 30-day or in-hospital mortality and morbidity. Results In the complete cohort, no significant association between loss of muscle mass and mortality was found. However, skeletal muscle mass was significantly lower in patients with stage III–IV tumors compared with stage I–II tumors, prior to neoadjuvant CRT. In the stage III–IV subgroup, the amount of muscle mass lost during neoadjuvant CRT was predictive of postoperative mortality: −13.5 % (standard deviation 6.2 %) in patients who died postoperatively compared with −5.0 % (standard deviation 8.3 %) in surviving patients, p = 0.02. Conclusions Measurement of muscle mass loss during neoadjuvant chemoradiotherapy may provide a readily available and inexpensive assessment to identify patients at risk for developing unfavorable postoperative outcome after resection of esophageal malignancies, especially in patients with stage III–IV tumors.
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Affiliation(s)
- Kostan W Reisinger
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Joanna W A M Bosmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | | | - Abdulaziz Alsoumali
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands
| | - Joep P M Derikx
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
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Blom RLGM, Bogush T, Brücher BLDM, Chang AC, Davydov M, Dudko E, Leong T, Polotsky B, Swanson PE, van Rossum PSN, Ruurda JP, Sagaert X, Tjulandin S, Schraepen MC, Sosef MN, van Hillegersberg R. Therapeutic approaches to gastroesophageal junction adenocarcinomas. Ann N Y Acad Sci 2015; 1325:197-210. [PMID: 25266026 DOI: 10.1111/nyas.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/23/2022]
Abstract
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the distinction between adenocarcinomas above, below, or within the gastroesophageal junction; combined modality therapy; tumor markers for use in personalized medicine; PET-CT and endoscopic biopsies in the evaluation of response to neoadjuvant chemoradiation therapy; a standardized grading system for tumor regression in squamous cell cancer and adenocarcinoma; the experimental basis for new approaches to medical treatment; the criteria measuring response in esophageal cancer; and the impact of novel imaging on staging and response assessment.
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Affiliation(s)
- Rachel L G M Blom
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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Gardenbroek TJ, Pinkney TD, Sahami S, Morton DG, Buskens CJ, Ponsioen CY, Tanis PJ, Löwenberg M, van den Brink GR, Broeders IA, Pullens PH, Seerden T, Boom MJ, Mallant-Hent RC, Pierik RE, Vecht J, Sosef MN, van Nunen AB, van Wagensveld BA, Stokkers PC, Gerhards MF, Jansen JM, Acherman Y, Depla AC, Mannaerts GH, West R, Iqbal T, Pathmakanthan S, Howard R, Magill L, Singh B, Htun Oo Y, Negpodiev D, Dijkgraaf MG, Ram D'Haens G, Bemelman WA. The ACCURE-trial: the effect of appendectomy on the clinical course of ulcerative colitis, a randomised international multicenter trial (NTR2883) and the ACCURE-UK trial: a randomised external pilot trial (ISRCTN56523019). BMC Surg 2015; 15:30. [PMID: 25887789 PMCID: PMC4393565 DOI: 10.1186/s12893-015-0017-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/26/2015] [Indexed: 12/18/2022] Open
Abstract
Background Over the past 20 years evidence has accumulated confirming the immunomodulatory role of the appendix in ulcerative colitis (UC). This led to the idea that appendectomy might alter the clinical course of established UC. The objective of this body of research is to evaluate the short-term and medium-term efficacy of appendectomy to maintain remission in patients with UC, and to establish the acceptability and cost-effectiveness of the intervention compared to standard treatment. Methods/Design These paired phase III multicenter prospective randomised studies will include patients over 18 years of age with an established diagnosis of ulcerative colitis and a disease relapse within 12 months prior to randomisation. Patients need to have been medically treated until complete clinical (Mayo score <3) and endoscopic (Mayo score 0 or 1) remission. Patients will then be randomised 1:1 to a control group (maintenance 5-ASA treatment, no appendectomy) or elective laparoscopic appendectomy plus maintenance treatment. The primary outcome measure is the one year cumulative UC relapse rate - defined both clinically and endoscopically as a total Mayo-score ≥5 with endoscopic subscore of 2 or 3. Secondary outcomes that will be assessed include the number of relapses per patient at 12 months, the time to first relapse, health related quality of life and treatment costs, and number of colectomies in each arm. Discussion The ACCURE and ACCURE-UK trials will provide evidence on the role and acceptability of appendectomy in the treatment of ulcerative colitis and the effects of appendectomy on the disease course. Trial registration NTR2883; ISRCTN56523019
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Affiliation(s)
- Tjibbe J Gardenbroek
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Thomas D Pinkney
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Saloomeh Sahami
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Dion G Morton
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Christianne J Buskens
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Gijs R van den Brink
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ivo Amj Broeders
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Paul Hjm Pullens
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | - Tom Seerden
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - Maarten J Boom
- Department of Surgery, Flevo Hospital, Almere, The Netherlands
| | | | | | - Juda Vecht
- Department of Gastroenterology, Isala Hospital, Zwolle, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands
| | - Annick B van Nunen
- Department of Gastroenterology, Atrium Medical Center, Heerlen, The Netherlands
| | | | - Pieter Cf Stokkers
- Department of Gastroenterology, Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Yair Acherman
- Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands
| | | | - Guido Hh Mannaerts
- Department of Surgery, St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Rachel West
- Department of Gastroenterology, St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Tariq Iqbal
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | | | - Rebecca Howard
- Birmingham Clinical Trials Unit, University Hospitals Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University Hospitals Birmingham, Birmingham, UK
| | - Baljit Singh
- Department of Surgery, University Hospitals Leicester, Leicester, UK
| | - Ye Htun Oo
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Dmitri Negpodiev
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | | | - Geert Ram D'Haens
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Weijs TJ, Toxopeus ELA, Ruurda JP, Luyer MDP, Nieuwenhuijzen GAP, Schraepen MC, Sosef MN, Wijnhoven BPL, Schets IRM, Bleys RLAW, van Hillegersberg R. Leaving a mobilized thoracic esophagus in situ when incurable cancer is discovered intraoperatively. Ann Thorac Surg 2014; 99:490-4. [PMID: 25499476 DOI: 10.1016/j.athoracsur.2014.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/19/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Occasionally incurable cancer is encountered after completion of the thoracic (first) phase of a three-phase esophagectomy. The outcome of aborting the operation at this stage, leaving the mobilized thoracic esophagus in situ, is unknown. METHODS A multicenter retrospective analysis was performed of patients in whom a completely mobilized thoracic esophagus was left in situ when incurable disease was discovered intraoperatively. The occurrence of esophageal necrosis or perforation, mortality, and all other adverse events were recorded and graded by severity. RESULTS Some 18 patients were included. The median admission time was 9 days. All patients had resumed oral intake at discharge, except for 1 patient who was fed through a nasojejunal tube. After the operation, the median overall survival was 2.9 months. Postoperatively, 7 patients (39%) experienced major surgical adverse events, and 11 patients (61%) had no or only minor adverse events. Major adverse events were associated with the patient's death in 6 patients (33%), within 5 to 34 days postoperatively. Esophageal perforation or ischemia developed in 4 patients (22%) and 1 patient (6%), respectively. No predictive factors could be identified. CONCLUSIONS Leaving a completely mobilized thoracic esophagus in situ when incurable cancer was discovered intraoperatively was a successful strategy in more than half of the patients. However, one third experienced major adverse events leading to mortality.
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Affiliation(s)
- Teus J Weijs
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eelke L A Toxopeus
- Department of Surgery, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | | | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ilona R M Schets
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
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37
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Japink D, Nap M, Sosef MN, Nelemans PJ, Coy JF, Beets G, von Meyenfeldt MF, Leers MP. Reproducibility studies for experimental epitope detection in macrophages (EDIM). J Immunol Methods 2014; 407:40-7. [DOI: 10.1016/j.jim.2014.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Valkenet K, Trappenburg JCA, Gosselink R, Sosef MN, Willms J, Rosman C, Pieters H, Scheepers JJG, de Heus SC, Reynolds JV, Guinan E, Ruurda JP, Rodrigo EHE, Nafteux P, Fontaine M, Kouwenhoven EA, Kerkemeyer M, van der Peet DL, Hania SW, van Hillegersberg R, Backx FJG. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial. Trials 2014; 15:144. [PMID: 24767575 PMCID: PMC4019558 DOI: 10.1186/1745-6215-15-144] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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] [Received: 11/06/2013] [Accepted: 04/03/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design. METHODS/DESIGN The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study). In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion.The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications, quality of life, and on postoperative respiratory muscle function and lung function. DISCUSSION The PREPARE study is the first multicenter randomized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection. TRIAL REGISTRATION NCT01893008.
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Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Jaap CA Trappenburg
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, University Hospital Leuven, Tervuursevest 101, Leuven 3001, Belgium
| | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, PO Box 4446, Heerlen 6401 CX, The Netherlands
| | - Jerome Willms
- Department of Physical Therapy, Atrium Medical Center, PO Box 4446, Heerlen 6401 CX, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | - Heleen Pieters
- Department of Physical Therapy, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | - Joris JG Scheepers
- Department of Surgery, Reinier de Graaf Hospital, PO Box 5011, Delft 2600 GA, The Netherlands
| | - Saskia C de Heus
- Department of Physical Therapy, Reinier de Graaf Hospital, PO Box 5011, Delft 2600 GA, The Netherlands
| | - John V Reynolds
- Department of Surgery, St James’s Hospital, Trinity Centre for Health Sciences, Dublin 8, Ireland
| | - Emer Guinan
- Discipline of Physiotherapy, St James’s Hospital, Trinity Centre for Health Sciences, Dublin 8, Ireland
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Els HE Rodrigo
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49 3000, Leuven, Belgium
| | - Marianne Fontaine
- Department of Physical Therapy, University Hospitals Leuven, Herestraat 49 3000, Leuven, Belgium
| | - Ewout A Kouwenhoven
- Department of Surgery, Hospital Group Twente (ZGT), PO Box 7600, Almelo 7600 SZ, The Netherlands
| | - Margot Kerkemeyer
- Department of Physical Therapy, Hospital Group Twente (ZGT), PO Box 7600, Almelo 7600 SZ, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands
| | - Sylvia W Hania
- Department of Physical Therapy, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Frank JG Backx
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
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Blom RLGM, Sosef MN, Nap M, Lammering G, van den Berkmortel F, Hulshof MCCM, Meijer SL, Wilmink HW, van Berge Henegouwen MI. Comparison of two neoadjuvant chemoradiotherapy regimens in patients with potentially curable esophageal carcinoma. Dis Esophagus 2013; 27:380-7. [PMID: 24006852 DOI: 10.1111/dote.12110] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] [Indexed: 12/11/2022]
Abstract
The implementation of neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) patients has led to improved survival rates. Worldwide, different CRT regimens are applied. It is unknown how these regimens relate to each other regarding efficacy. Therefore, the aim of this study was to determine the preferred regimen regarding toxicity of, response to CRT, and long-term survival after esophagectomy in EC patients. EC patients in two centers who underwent CRT with different regimens prior to surgery were included in this study. CRT consisted of 50.4Gy combined with two cycles of cisplatin and 5-FU(center A), or 41.4Gy combined with five cycles of carboplatin and paclitaxel (center B). Toxicity, response to therapy and long-term survival were compared between groups. One hundred sisty-five patients were included. Forty-one percent of patients in center A developed ≥1 toxicity ≥ grade 3 versus 25% in center B (P = 0.025). CRT with a cisplatin-based regimen was an independent predictor for development of toxicity ≥ grade 3 (P = 0.043). There were no differences in response between both regimens (P = 0.904). Three-year survival was 61% (A) versus 57% (B) (P = 0.725). The carboplatin/paclitaxel/41.4Gy regimen causes less toxicity compared to the cisplatin/5-FU/50.4Gy regimen with nonsignificant differences in response rates and long-term survival; therefore our results support this regimen to be the preferred regimen for EC patients.
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Affiliation(s)
- R L G M Blom
- Department of Surgery, Academic Medical Center, Amsterdam
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Blom RLGM, Vliegen RFA, Schreurs WMJ, Belgers HJ, Stohr I, Oostenbrug LE, Sosef MN. External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma. Dis Esophagus 2012; 25:555-9. [PMID: 22150869 DOI: 10.1111/j.1442-2050.2011.01289.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 12/11/2022]
Abstract
One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months, only 1% of patients developed cervical lymph node metastases. This study shows no additional value of external ultrasonography to a negative PET-CT. According to our results, it can be omitted in the primary workup. However, suspect lymph nodes on PET-CT should be confirmed by FNA to exclude false positives if it would change treatment plan.
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Affiliation(s)
- R L G M Blom
- Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands
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Gorissen KJ, Benning D, Berghmans T, Snoeijs MG, Sosef MN, Hulsewe KWE, Luyer MDP. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg 2012; 99:721-7. [PMID: 22318712 DOI: 10.1002/bjs.8691] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the implementation of multimodal analgesia regimens in fast-track surgery programmes, non-steroidal anti-inflammatory drugs (NSAIDs) are being prescribed routinely. However, doubts have been raised concerning the safety of NSAIDs in terms of anastomotic healing. METHODS Data on patients who had undergone primary colorectal anastomosis at two teaching hospitals between January 2008 and December 2010 were analysed retrospectively. Exact use of NSAIDs was recorded. Rates of anastomotic leakage were compared between groups and corrected for known risk factors in both univariable and multivariable analyses. RESULTS A total of 795 patients were divided into four groups according to NSAID use: no NSAIDs (471 patients), use of non-selective NSAIDs (201), use of selective cyclo-oxygenase (COX) 2 inhibitors (79), and use of both selective and non-selective NSAIDs (44). The overall leak rate was 9.9 per cent (10.0 per cent for right colonic, 8.7 per cent for left colonic and 12.4 per cent for rectal anastomoses). Known risk factors such as smoking and use of steroids were not significantly associated with anastomotic leakage. Stapled anastomosis was identified as an independent predictor of leakage in multivariable analysis (odds ratio (OR) 2.22, 95 per cent confidence interval 1.30 to 3.80; P = 0.003). Patients on NSAIDs had higher anastomotic leakage rates than those not on NSAIDs (13.2 versus 7.6 per cent; OR 1.84, 1.13 to 2.98; P = 0.010). This effect was mainly due to non-selective NSAIDs (14.5 per cent; OR 2.13, 1.24 to 3.65; P = 0.006), not selective COX-2 inhibitors (9 per cent; OR 1.16, 0.49 to 2.75; P = 0.741). The overall mortality rate was 4.2 per cent, with no significant difference between groups (P = 0.438). CONCLUSION Non-selective NSAIDs may be associated with anastomotic leakage.
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Affiliation(s)
- K J Gorissen
- Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands
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Faber TJE, Japink D, Leers MPG, Sosef MN, von Meyenfeldt MF, Nap M. Activated macrophages containing tumor marker in colon carcinoma: immunohistochemical proof of a concept. Tumour Biol 2011; 33:435-41. [PMID: 22134871 DOI: 10.1007/s13277-011-0269-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/07/2011] [Indexed: 11/29/2022] Open
Abstract
The presence of carcinoembryonic antigen (CEA)-containing activated macrophages has been demonstrated in peripheral blood from patients with colorectal carcinoma. Macrophages migrate from the circulation into the tissue, phagocytose debris, and return to the bloodstream. Hence it seems likely that activated macrophages containing tumor debris, i.e., tumor marker, are present in the stroma of colorectal carcinoma. After phagocytosis, they could follow a hematogenic or lymphogenic route to the peripheral blood. The aim of this study is to assess the presence of tumor marker-containing activated macrophages in the stroma of colon carcinoma and in regional lymph nodes. From 10 cases of colon carcinoma, samples of tumor tissue and metastasis-free lymph nodes were cut in serial sections and stained for CD68 to identify macrophages and for CEA, cytokeratin, or M30 presence. Slides were digitalised and visually inspected using two monitors, comparing the CD68 stain to the tumor marker stain to evaluate the presence of tumor marker-positive macrophages. Macrophages containing tumor marker could be identified in tumor stroma and in metastasis-free regional lymph nodes. The distribution varied for the different markers, CEA-positive macrophages being most abundant. The presence of macrophages containing tumor marker in the tumor stroma and lymph nodes from patients with colon carcinoma could be confirmed in this series using serial immunohistochemistry. This finding supports the concept of activated macrophages, after phagocytosing cell debris, being transported or migrating through the lymphatic system. These results support the potential of tumor marker-containing macrophages to serve as a marker for diagnosis and follow-up of colon cancer patients.
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Affiliation(s)
- T J E Faber
- Department of General Surgery, Atrium Medical Center Parkstad, Heerlen, Netherlands
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Biere SS, Maas KW, Bonavina L, Garcia JR, van Berge Henegouwen MI, Rosman C, Sosef MN, de Lange ESM, Bonjer HJ, Cuesta MA, van der Peet DL. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg 2011; 11:2. [PMID: 21226918 PMCID: PMC3031195 DOI: 10.1186/1471-2482-11-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a rise in incidence of esophageal carcinoma due to increasing incidence of adenocarcinoma. Probably the only curative option to date is the use of neoadjuvant therapy followed by surgical resection. Traditional open esophageal resection is associated with a high morbidity and mortality rate. Furthermore, this approach involves long intensive care unit stay, in-hospital stay and long recovery period. Minimally invasive esophagectomy could reduce the morbidity and accelerate the post-operative recovery. METHODS/DESIGN Comparison between traditional open and minimally invasive esophagectomy in a multi-center, randomized trial. Patients with a resectable intrathoracic esophageal carcinoma, including the gastro-esophageal junction tumors (Siewert I) are eligible for inclusion. Prior thoracic surgery and cervical esophageal carcinoma are indications for exclusion. The surgical technique involves a right thoracotomy with lung blockade and laparotomy either with a cervical or thoracic anastomosis for the traditional group. The minimally invasive procedure involves a right thoracoscopy in prone position with a single lumen tube and laparoscopy either with a cervical or thoracic anastomosis. All patients in both groups will undergo identical pre-operative and post-operative protocol. Primary endpoint of this study are post-operative respiratory complications within the first two post-operative weeks confirmed by clinical, radiological and sputum culture data. Secondary endpoints are the operative data, the post-operative data and oncological data such as quality of the specimen and survival. Operative data include duration of the operation, blood loss and conversion to open procedure. Post-operative data include morbidity (major and minor), quality of life tests and hospital stay.Based on current literature and the experience of all participating centers, an incidence of pulmonary complications for 57% in the traditional arm and 29% in the minimally invasive arm, it is estimated that per arm 48 patients are needed. This is based on a two-sided significance level (alpha) of 0.05 and a power of 0.80. Knowing that approximately 20% of the patients will be excluded, we will randomize 60 patients per arm. DISCUSSION The TIME-trial is a prospective, multi-center, randomized study to define the role of minimally invasive esophageal resection in patients with resectable intrathoracic and junction esophageal cancer. TRIAL REGISTRATION (NETHERLANDS TRIAL REGISTER): NTR2452.
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Affiliation(s)
- Surya Say Biere
- Department of Surgery, VU university medical center, Amsterdam, the Netherlands
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Swank HA, Vermeulen J, Lange JF, Mulder IM, van der Hoeven JAB, Stassen LPS, Crolla RMPH, Sosef MN, Nienhuijs SW, Bosker RJI, Boom MJ, Kruyt PM, Swank DJ, Steup WH, de Graaf EJR, Weidema WF, Pierik REGJM, Prins HA, Stockmann HBAC, Tollenaar RAEM, van Wagensveld BA, Coene PPLO, Slooter GD, Consten ECJ, van Duijn EB, Gerhards MF, Hoofwijk AGM, Karsten TM, Neijenhuis PA, Blanken-Peeters CFJM, Cense HA, Mannaerts GHH, Bruin SC, Eijsbouts QAJ, Wiezer MJ, Hazebroek EJ, van Geloven AAW, Maring JK, D'Hoore AJL, Kartheuser A, Remue C, van Grevenstein HMU, Konsten JLM, van der Peet DL, Govaert MJPM, Engel AF, Reitsma JB, Bemelman WA. The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis in perforated diverticulitis (NTR2037). BMC Surg 2010; 10:29. [PMID: 20955571 PMCID: PMC2974662 DOI: 10.1186/1471-2482-10-29] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [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: 09/06/2010] [Accepted: 10/18/2010] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy.The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). METHODS/DESIGN In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and power = 90%) in favour of the patients with resection with primary anastomosis. Secondary endpoints for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. DISCUSSION The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy for both purulent and faecal generalised peritonitis. TRIAL REGISTRATION Nederlands Trial Register NTR2037.
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Affiliation(s)
- Hilko A Swank
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jefrey Vermeulen
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Irene M Mulder
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Laurents PS Stassen
- Department of Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands
| | | | - Meindert N Sosef
- Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Maarten J Boom
- Department of Surgery, Flevo Hospital, Almere, The Netherlands
| | - Philip M Kruyt
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Dingeman J Swank
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
| | - Willem H Steup
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Eelco JR de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Wibo F Weidema
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | | | - Hubert A Prins
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Rob AEM Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Esther CJ Consten
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Eino B van Duijn
- Department of Surgery, Meander Hospital, Amersfoort, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Anton GM Hoofwijk
- Department of Surgery, Orbis Medical Centre, Sittard, The Netherlands
| | - Thomas M Karsten
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Peter A Neijenhuis
- Department of Surgery, Rijnland Ziekenhuis, Leiderdorp and Alphen aan den Rijn, The Netherlands
| | | | - Huib A Cense
- Department of Surgery, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - Guido HH Mannaerts
- Department of Surgery, St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Sjoerd C Bruin
- Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anna AW van Geloven
- Department of Surgery, Tergooi Hospitals, Hilversum and Blaricum, The Netherlands
| | - John K Maring
- Department of Surgery, Twee Steden Hospital, Tilburg and Waalwijk, The Netherlands
| | - André JL D'Hoore
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - Alex Kartheuser
- Department of Surgery, University Hospital St.-Luc, Brussels, Belgium
| | - Christophe Remue
- Department of Surgery, University Hospital St.-Luc, Brussels, Belgium
| | | | - Joop LM Konsten
- Department of Surgery, Vie Curi Medical Centre, Venlo and Venray, The Netherlands
| | | | - Marc JPM Govaert
- Department of Surgery, Westfries Hospital, Hoorn, The Netherlands
| | - Alexander F Engel
- Department of Surgery, Zaans Medical Centre, Zaandam, The Netherlands
| | - Johannes B Reitsma
- Department of Biostatistics and Epidemiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Bakker CM, Vliegen RFA, Sosef MN. Nausea caused by a jejunal lipoma. Clin Gastroenterol Hepatol 2009; 7:A16. [PMID: 19268723 DOI: 10.1016/j.cgh.2008.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 12/13/2008] [Accepted: 12/16/2008] [Indexed: 02/07/2023]
Affiliation(s)
- C Minke Bakker
- Department of Internal Medicine and Gastroenterology, Atrium Medical Center, Heerlen, The Netherlands
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Japink D, Leers MPG, Sosef MN, Nap M. CEA in activated macrophages. New diagnostic possibilities for tumor markers in early colorectal cancer. Anticancer Res 2009; 29:3245-3251. [PMID: 19661342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Serum tumor markers show low sensitivity, making them unsuitable for early detection of cancer. Activated macrophages (AM) from peripheral blood can accumulate tumor marker substances and facilitate early detection in prostate cancer. Here it was investigated whether carcinoembryonic antigen (CEA)-containing macrophages (CEACM) can be used to detect colorectal cancer (CRC) at earlier stages than can serum CEA. PATIENTS AND METHODS Peripheral blood was collected from patients with CRC (n=48), inflammatory colorectal disease (n=5) and from healthy controls (n=18). After separating and labeling AM with CD14-APC/CD16-FITC, AM were intracellularly labeled with anti-CEA antibody and flow cytometrically analyzed. Serum CEA and C-reactive protein (CRP) were measured. RESULTS The fraction-size of CEACM discriminated between controls and CRC patients, irrespective of AJCC stage (AJCC stage I-IV, p< or =0.0001). Serum CEA values were significantly elevated in AJCC stage II, III and IV (p=0.02, 0.006 and <0.0001, respectively). Combining CEACM with CRP levels separated CRC from inflammatory colorectal disease. CONCLUSION CEACM combined with CRP appears to have diagnostic potential in early CRC.
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Affiliation(s)
- Dennis Japink
- Department of General Surgery, Atrium Medical Center Parkstad, Henry Dunantstraat 5, P.O. Box 4446, 6401 CX, Heerlen, the Netherlands.
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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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van der Gaag NA, de Castro SMM, Rauws EAJ, Bruno MJ, van Eijck CHJ, Kuipers EJ, Gerritsen JJGM, Rutten JP, Greve JW, Hesselink EJ, Klinkenbijl JHG, Rinkes IHMB, Boerma D, Bonsing BA, van Laarhoven CJ, Kubben FJGM, van der Harst E, Sosef MN, Bosscha K, de Hingh IHJT, Th de Wit L, van Delden OM, Busch ORC, van Gulik TM, Bossuyt PMM, Gouma DJ. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct) OPeration (DROP-trial). BMC Surg 2007; 7:3. [PMID: 17352805 PMCID: PMC1828149 DOI: 10.1186/1471-2482-7-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 03/12/2007] [Indexed: 01/11/2023] Open
Abstract
Background Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, papilla, distal bile duct) tumor is associated with a higher risk of postoperative complications than in non-jaundiced patients. Preoperative biliary drainage was introduced in an attempt to improve the general condition and thus reduce postoperative morbidity and mortality. Early studies showed a reduction in morbidity. However, more recently the focus has shifted towards the negative effects of drainage, such as an increase of infectious complications. Whether biliary drainage should always be performed in jaundiced patients remains controversial. The randomized controlled multicenter DROP-trial (DRainage vs. Operation) was conceived to compare the outcome of a 'preoperative biliary drainage strategy' (standard strategy) with that of an 'early-surgery' strategy, with respect to the incidence of severe complications (primary-outcome measure), hospital stay, number of invasive diagnostic tests, costs, and quality of life. Methods/design Patients with obstructive jaundice due to a periampullary tumor, eligible for exploration after staging with CT scan, and scheduled to undergo a "curative" resection, will be randomized to either "early surgical treatment" (within one week) or "preoperative biliary drainage" (for 4 weeks) and subsequent surgical treatment (standard treatment). Primary outcome measure is the percentage of severe complications up to 90 days after surgery. The sample size calculation is based on the equivalence design for the primary outcome measure. If equivalence is found, the comparison of the secondary outcomes will be essential in selecting the preferred strategy. Based on a 40% complication rate for early surgical treatment and 48% for preoperative drainage, equivalence is taken to be demonstrated if the percentage of severe complications with early surgical treatment is not more than 10% higher compared to standard treatment: preoperative biliary drainage. Accounting for a 10% dropout, 105 patients are needed in each arm resulting in a study population of 210 (alpha = 0.95, beta = 0.8). Discussion The DROP-trial is a randomized controlled multicenter trial that will provide evidence whether or not preoperative biliary drainage is to be performed in patients with obstructive jaundice due to a periampullary tumor.
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Affiliation(s)
| | - Steve MM de Castro
- Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
| | - Erik AJ Rauws
- Department of Gastroenterology, Amsterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Amsterdam, the Netherlands
| | | | - Ernst J Kuipers
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jan-Paul Rutten
- Department of Surgery, University Hospital Maastricht, Maastricht, the Netherlands
| | - Jan Willem Greve
- Department of Surgery, University Hospital Maastricht, Maastricht, the Netherlands
| | - Erik J Hesselink
- Department of Surgery, Gelre Hospital, Apeldoorn, the Netherlands
| | | | | | - Djamila Boerma
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | | | - Frank JGM Kubben
- Department of Gastroenterology, Medical Center Rijnmond Zuid, Rotterdam, the Netherlands
| | - Erwin van der Harst
- Department of Surgery, Medical Center Rijnmond Zuid, Rotterdam, the Netherlands
| | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, Heerlen, the Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | | | - Laurens Th de Wit
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Otto M van Delden
- Department of Radiology, Academic Medical Center Amsterdam, The Netherlands
| | - Olivier RC Busch
- Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
| | - Patrick MM Bossuyt
- Department of clinical epidemiology and biostatistics, Academic Medical Center Amsterdam, the Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center Amsterdam, the Netherlands
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Sosef MN, De Bondt RB, Bosma A, De Bruijn C, Van Gulik TM. The fate of autologous hepatocytes transplanted into spleen, pancreas, mesentery, stomach, and small bowel wall in pigs. HPB (Oxford) 2007; 9:216-8. [PMID: 18333225 PMCID: PMC2063604 DOI: 10.1080/13651820701329233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Indexed: 12/12/2022]
Affiliation(s)
- Meindert N. Sosef
- Departments of Surgery (Surgical Laboratory), Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Robert B.J. De Bondt
- Departments of Surgery (Surgical Laboratory), Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Anne Bosma
- Departments of Pathology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Cora De Bruijn
- Departments of Nuclear Medicine, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Thomas M. Van Gulik
- Departments of Surgery (Surgical Laboratory), Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
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Abstract
BACKGROUND Recent publications show promising results using fibrin glue in the treatment of anal fistulas. The technique is simple, repeatable, with minor surgical trauma so that sphincter function is preserved and further treatment options are not compromised. The aim of this pilot study was to analyse if we could reproduce the results reported in the literature, using this simple technique. METHODS Patients with a primary or recurrent anal fistula were included in this trial. Patients with a complex fistula were excluded. Under general or spinal anaesthesia, the fistulas were curetted and injected with fibrin glue. Follow-up visits were scheduled for 1 week, 6 weeks and 6 months. RESULTS Twenty-seven patients were included. The overall success rate was 33% after a mean follow-up of 27 weeks. Patients with a recurrent fistula had a poorer outcome (success rate 14%). None of the patients suffered from postoperative continence problems, and no other complications were recorded. CONCLUSION This study confirms the safety of fibrin glue in the treatment of anal fistulas. However, a high success rate could not be reproduced.
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Affiliation(s)
- Suzanne S Gisbertz
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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