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de Rijk F, Sissingh NJ, Boel TT, Timmerhuis HC, de Jong M, Pauw HS, van Veldhuisen CL, Hallensleben ND, Anten M, Brink MA, Curvers WL, van Duijvendijk P, Hazen WL, Kuiken SD, Poen AC, Quispel R, Römkens T, Spanier B, Tan A, Vleggaar FP, Voorburg A, Witteman B, Ali UA, Issa Y, Bouwense S, Voermans RP, van Wanrooij R, Stommel M, van Hooft JE, de Jonge PJ, van Goor H, Boermeester MA, Besselink MG, Bruno MJ, Verdonk RC, van Santvoort HC. Development of pancreatic diseases during long-term follow-up after acute pancreatitis: a post-hoc analysis of a prospective multicenter cohort. J Gastroenterol Hepatol 2024; 39:674-684. [PMID: 38191176 DOI: 10.1111/jgh.16453] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/30/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIM More insight into the incidence of and factors associated with progression following a first episode of acute pancreatitis (AP) would offer opportunities for improvements in disease management and patient counseling. METHODS A long-term post hoc analysis of a prospective cohort of patients with AP (2008-2015) was performed. Primary endpoints were recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), and pancreatic cancer. Cumulative incidence calculations and risk analyses were performed. RESULTS Overall, 1184 patients with a median follow-up of 9 years (IQR: 7-11) were included. RAP and CP occurred in 301 patients (25%) and 72 patients (6%), with the highest incidences observed for alcoholic pancreatitis (40% and 22%). Pancreatic cancer was diagnosed in 14 patients (1%). Predictive factors for RAP were alcoholic and idiopathic pancreatitis (OR 2.70, 95% CI 1.51-4.82 and OR 2.06, 95% CI 1.40-3.02), and no pancreatic interventions (OR 1.82, 95% CI 1.10-3.01). Non-biliary etiology (alcohol: OR 5.24, 95% CI 1.94-14.16, idiopathic: OR 4.57, 95% CI 2.05-10.16, and other: OR 2.97, 95% CI 1.11-7.94), RAP (OR 4.93, 95% CI 2.84-8.58), prior pancreatic interventions (OR 3.10, 95% CI 1.20-8.02), smoking (OR 2.33, 95% CI 1.14-4.78), and male sex (OR 2.06, 95% CI 1.05-4.05) were independently associated with CP. CONCLUSION Disease progression was observed in a quarter of pancreatitis patients. We identified several risk factors that may be helpful to devise personalized strategies with the intention to reduce the impact of disease progression in patients with AP.
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Affiliation(s)
- Fem de Rijk
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N J Sissingh
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - T T Boel
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H C Timmerhuis
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Mjp de Jong
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, The Netherlands
| | - H S Pauw
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - C L van Veldhuisen
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - N D Hallensleben
- Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mpgf Anten
- Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands
| | - M A Brink
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - W L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - W L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - S D Kuiken
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - A C Poen
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
| | - R Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Teh Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Bwm Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Acitl Tan
- Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Amcj Voorburg
- Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands
| | - Bjm Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - U Ahmed Ali
- Department of Surgery, Division of Colorectal Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Y Issa
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Saw Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - R P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rlj van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mwj Stommel
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - P J de Jonge
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H van Goor
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - M A Boermeester
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R C Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Argillander T, van der Hulst H, van der Zaag-Loonen H, van Duijvendijk P, Dekker J, van der Bol J, Bastiaannet E, Verkuyl J, Neijenhuis P, Hamaker M, Schiphorst A, Aukema T, Burghgraef T, Sonneveld D, Schuijtemaker J, van der Meij W, van den Bos F, Portielje J, Souwer E, van Munster B. Predictive value of selected geriatric parameters for postoperative outcomes in older patients with rectal cancer – A multicenter cohort study. J Geriatr Oncol 2022; 13:796-802. [DOI: 10.1016/j.jgo.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
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Luijten JCHBM, Vissers PAJ, Brom L, de Bièvre M, Buijsen J, Rozema T, Mohammad NH, van Duijvendijk P, Kouwenhoven EA, Eshuis WJ, Rosman C, Siersema PD, van Laarhoven HWM, Verhoeven RHA, Nieuwenhuijzen GAP, Westerman MJ. Clinical variation in the organization of clinical pathways in esophagogastric cancer, a mixed method multiple case study. BMC Health Serv Res 2022; 22:527. [PMID: 35449018 PMCID: PMC9022421 DOI: 10.1186/s12913-022-07845-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Among esophagogastric cancer patients, the probability of having undergone treatment with curative intent has been shown to vary, depending on the hospital of diagnosis. However, little is known about the factors that contribute to this variation. In this study, we sought to understand the organization of clinical pathways and their association with variation in practice. Methods A mixed-method study using quantitative and qualitative data was conducted. Quantitative data were obtained from the Netherlands Cancer Registry (e.g., outpatient clinic consultations and diagnostic procedures). For qualitative data, thematic content analysis was performed using semi-structured interviews (n = 30), observations of outpatient clinic consultations (n = 26), and multidisciplinary team meetings (MDTM, n = 16) in eight hospitals, to assess clinicians’ perspectives regarding the clinical pathways. Results Quantitative analyses showed that patients more often underwent surgical consultation prior to the MDTM in hospitals associated with a high probability of receiving treatment with curative intent, but more often consulted with a geriatrician in hospitals associated with a low probability of such treatment. The organization of clinical pathways was analyzed quantitatively at three levels: regional, local, and patient levels. At a regional level, hospitals differed in terms of the number of patients discussed during the MDTM. At the local level, the revision of radiological images and restaging after neoadjuvant treatment varied. At the patient level, some hospitals routinely conduct fitness tests, whereas others estimated the patient’s physical fitness during an outpatient clinic consultation. Few clinicians performed a standard geriatric consultation in older patients to assess their mental fitness and frailty. Conclusion Surgical consultation prior to MDTM was more often conducted in hospitals associated with a high probability of receiving treatment with curative intent, whereas a geriatrician was consulted more often in hospitals associated with a low probability of receiving such treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07845-2.
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Affiliation(s)
- J C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - P A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.,Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - L Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands
| | - M de Bièvre
- Department of Gastroenterology, Viecuri Medical Center, Venlo, The Netherlands
| | - J Buijsen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - T Rozema
- Department of Radiation Oncology, Verbeten Insitute, Tilburg, The Netherlands
| | - N Haj Mohammad
- Department of Medical Oncology, Utrecht UMC, Utrecht University, Utrecht, The Netherlands
| | | | | | - W J Eshuis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rosman
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - P D Siersema
- Department of Gastroenterology, Radboudumc, Nijmegen, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands. .,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - M J Westerman
- Department of Epidemiology and Datascience, Amsterdam UMC, Amsterdam, The Netherlands
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Argillander TE, Schäfer S, van Westreenen HL, Kamper A, van der Zaag-Loonen HJ, van Duijvendijk P, van Munster BC. The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer. J Geriatr Oncol 2022; 13:888-891. [PMID: 35339404 DOI: 10.1016/j.jgo.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Affiliation(s)
- T E Argillander
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands.
| | - S Schäfer
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
| | | | - A Kamper
- Department of Geriatrics, Isala Hospital, Zwolle, the Netherlands
| | - H J van der Zaag-Loonen
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
| | | | - B C van Munster
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
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Argillander TE, Heil TC, Melis RJF, van Duijvendijk P, Klaase JM, van Munster BC. Preoperative physical performance as predictor of postoperative outcomes in patients aged 65 and older scheduled for major abdominal cancer surgery: A systematic review. Eur J Surg Oncol 2021; 48:570-581. [PMID: 34629224 DOI: 10.1016/j.ejso.2021.09.019] [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: 05/21/2021] [Revised: 09/02/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Abdominal cancer surgery is associated with considerable morbidity in older patients. Assessment of preoperative physical status is therefore essential. The aim of this review was to describe and compare the objective physical tests that are currently used in abdominal cancer surgery in the older patient population with regard to postoperative outcomes. METHODS Medline, Embase, CINAHL and Web of Science were searched until 31 December 2020. Non-interventional cohort studies were eligible if they included patients ≥65 years undergoing abdominal cancer surgery, reported results on objective preoperative physical assessment such as Cardiopulmonary Exercise Testing (CPET), field walk tests or muscle strength, and on postoperative outcomes. RESULTS 23 publications were included (10 CPET, 13 non-CPET including Timed Up & Go, grip strength, 6-minute walking test (6MWT) and incremental shuttle walk test (ISWT)). Meta-analysis was precluded due to heterogeneity between study cohorts, different cut-off points, and inconsistent reporting of outcomes. In CPET studies, ventilatory anaerobic threshold and minute ventilation/carbon dioxide production gradient were associated with adverse outcomes. ISWT and 6MWT predicted outcomes in two studies. Tests addressing muscle strength and function were of limited value. No study compared different physical tests. DISCUSSION CPET has the ability to predict adverse postoperative outcomes, but it is time-consuming and requires expert assessment. ISWT or 6MWT might be a feasible alternative to estimate aerobic capacity. Muscle strength and function tests currently have limited value in risk prediction. Future research should compare the predictive value of different physical instruments with regard to postoperative outcomes in older surgical patients.
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Affiliation(s)
- T E Argillander
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands; University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - T C Heil
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - J M Klaase
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B C van Munster
- University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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7
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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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8
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Zaman ACGNM, Tytgat KMAJ, Klinkenbijl JHG, Boer FCD, Brink MA, Brinkhuis JC, Bruinvels DJ, Dol LCM, van Duijvendijk P, Hemmer PHJ, Lamme B, Loosveld OJL, Mok MM, Rejda T, Rutten H, Schoorlemmer A, Sonneveld DJ, Stassen LPS, Veenstra RP, van de Ven A, Velzing ER, Frings-Dresen MHW, de Boer AGEM. Effectiveness of a Tailored Work-Related Support Intervention for Patients Diagnosed with Gastrointestinal Cancer: A Multicenter Randomized Controlled Trial. J Occup Rehabil 2021; 31:323-338. [PMID: 32880094 PMCID: PMC8172517 DOI: 10.1007/s10926-020-09920-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Purpose The aim of this research was to study the effectiveness on return to work (RTW) of an early tailored work-related support intervention in patients diagnosed with curative gastrointestinal cancer. Methods A multicenter randomized controlled trial was undertaken, in which patients were assigned randomly to the intervention or the control group (usual care). The intervention encompassed three psychosocial work-related support meetings, starting before treatment. Five self-reported questionnaires were sent over twelve months of follow-up. Primary outcome was days until RTW (fulltime or partial) and secondary outcomes included work status, quality of life, work ability, and work limitations. Descriptive analysis, Kaplan-Meier analysis, relative risk ratio and linear mixed models were applied. Results Participants (N = 88) had a mean age of 55 years; 67% were male and the most common cancer type was colon cancer (66%). Of the participants, 42 were randomized to the intervention group. The median time from sick leave until RTW was 233 days (range 187-279 days) for the control group, versus 190 days (range 139-240 days) for the intervention group (log-rank p = 0.37). The RTW rate at twelve months after baseline was 83.3% for the intervention group and 73.5% for the control group. Work limitations did statistically differ between the groups over time (p = 0.01), but quality of life and work ability did not. Conclusion Patients in the intervention group seem to take fewer days to RTW, albeit not to a statistically significant extent.Trial registration Trial NL4920 (NTR5022) (Dutch Trial Register https://www.trialregister.nl ).
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Affiliation(s)
- A. C. G. N. M. Zaman
- Amsterdam UMC (Location AMC), Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - K. M. A. J. Tytgat
- Amsterdam UMC (Location AMC), Department of Gastroenterology, University of Amsterdam, Amsterdam, The Netherlands
| | - J. H. G. Klinkenbijl
- Department of Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - F. C. den Boer
- Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands
| | - M. A. Brink
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | | | | | - L. C. M. Dol
- Department of Surgery, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - P. H. J. Hemmer
- Department of Surgical Oncology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - B. Lamme
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - O. J. L. Loosveld
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - M. M. Mok
- Department of Surgery, OLVG (Location East), Amsterdam, The Netherlands
| | - T. Rejda
- Tomas Rejda Counselling (Oncological Occupational Physician), Alphen aan den Rijn, The Netherlands
| | - H. Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - A. Schoorlemmer
- Amsterdam UMC (Location AMC), Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - D. J. Sonneveld
- Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands
| | - L. P. S. Stassen
- Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - R. P. Veenstra
- Department of Gastroenterology, Martini Hospital, Groningen, The Netherlands
| | - A. van de Ven
- Department of General Surgery, Flevo Hospital, Almere, The Netherlands
| | - E. R. Velzing
- Vel.Onc@Work Counselling (Oncological Occupational Physician), Leidschendam, The Netherlands
| | - M. H. W. Frings-Dresen
- Amsterdam UMC (Location AMC), Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - A. G. E. M. de Boer
- Amsterdam UMC (Location AMC), Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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9
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Schuijt HJ, Oud FMM, Bruns EJR, van Duijvendijk P, Van der Zaag-Loonen HJ, Spies PE, van Munster BC. Does the Dutch Safety Management Program predict adverse outcomes for older patients in the emergency department? Neth J Med 2020; 78:244-250. [PMID: 33093249] [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: 06/11/2023]
Abstract
PURPOSE Frailty screening in the emergency department may identify frail patients at risk for adverse outcomes. This study investigated if the Dutch Safety Management Program (VMS) screener predicts outcomes in older patients in the emergency department. METHODS In this prospective cohort study, patients aged 70 years or older presenting to the emergency department were recruited on workdays between 10:00 AM and 7:00 PM from May 2017 until August 2017. Patients were screened in four domains: activities of daily living, malnutrition, risk of delirium, and risk of falling. After 90 days of follow up, mortality, functional decline, living situation, falls, readmission to the emergency department, and readmission to the hospital were recorded. VMS was studied using the total VMS score as a predictor with ROC curve analysis, and using a cut-off point to divide patients into frail and non-frail groups to calculate positive predictive value (PPV) and negative predictive value (NPV). RESULTS A total of 249 patients were included. Higher VMS score was associated with 90-day mortality (AUC 0.65, 95% CI 0.54-0.76) and falling (AUC 0.67, 95% CI 0.56-0.78). VMS frailty predicted mortality (PPV 0.15, NPV 0.94, p = 0.05) and falling (PPV 0.22, NPV 0.92, p = 0.02), but none of the other outcomes. CONCLUSION In this selected group of patients, higher VMS score was associated with 90-day mortality and falls. The low positive predictive value shows that the VMS screener is unsuitable for identifying high-risk patients in the ED. The high negative predictive value indicates that the screener can identify patients not at risk for adverse medical outcomes. This could be useful to determine which patients should undergo additional screening.
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Affiliation(s)
- H-J Schuijt
- Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, the Netherlands, Department of Surgery, University Medical Centre Utrecht, the Netherlands, Department of Surgery, Gelre Hospitals, Apeldoorn and Zutphen, the Netherlands
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10
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Olthof PB, Elfrink AKE, Marra E, Belt EJT, van den Boezem PB, Bosscha K, Consten ECJ, den Dulk M, Gobardhan PD, Hagendoorn J, van Heek TNT, IJzermans JNM, Klaase JM, Kuhlmann KFD, Leclercq WKG, Liem MSL, Manusama ER, Marsman HA, Mieog JSD, Oosterling SJ, Patijn GA, Te Riele W, Swijnenburg RJ, Torrenga H, van Duijvendijk P, Vermaas M, Kok NFM, Grünhagen DJ. Volume-outcome relationship of liver surgery: a nationwide analysis. Br J Surg 2020; 107:917-926. [PMID: 32207856 PMCID: PMC7384098 DOI: 10.1002/bjs.11586] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/25/2019] [Revised: 01/15/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022]
Abstract
Background Evidence for an association between hospital volume and outcomes for liver surgery is abundant. The current Dutch guideline requires a minimum volume of 20 annual procedures per centre. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit. Methods This was a nationwide study in the Netherlands. All liver resections reported in the Dutch Hepato Biliary Audit between 2014 and 2017 were included. Annual centre volume was calculated and classified in categories of 20 procedures per year. Main outcomes were major morbidity (Clavien–Dindo grade IIIA or higher) and 30‐day or in‐hospital mortality. Results A total of 5590 liver resections were done across 34 centres with a median annual centre volume of 35 (i.q.r. 20–69) procedures. Overall major morbidity and mortality rates were 11·2 and 2·0 per cent respectively. The mortality rate was 1·9 per cent after resection for colorectal liver metastases (CRLMs), 1·2 per cent for non‐CRLMs, 0·4 per cent for benign tumours, 4·9 per cent for hepatocellular carcinoma and 10·3 per cent for biliary tumours. Higher‐volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer. There was no association between hospital volume and either major morbidity or mortality in multivariable analysis, after adjustment for known risk factors for adverse events. Conclusion Hospital volume and postoperative outcomes were not associated.
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Affiliation(s)
- P B Olthof
- Department of Surgery, Erasmus MC, Erasmus University, Rotterdam, the Netherlands.,Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A K E Elfrink
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - E Marra
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands
| | - E J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - P B van den Boezem
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's- Hertogenbosch, the Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - M den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P D Gobardhan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - J Hagendoorn
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - T N T van Heek
- Department of Surgery, Gelderse Vallei Hospital, Ede, the Netherlands
| | - J N M IJzermans
- Department of Surgery, Erasmus MC, Erasmus University, Rotterdam, the Netherlands
| | - J M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - K F D Kuhlmann
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W K G Leclercq
- Department of Surgery, Máxima Medisch Centrum, Veldhoven, the Netherlands
| | - M S L Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands
| | - E R Manusama
- Department of Surgery, Medical Centre Leeuwardena, Leeuwarden, the Netherlands
| | - H A Marsman
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - S J Oosterling
- Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - G A Patijn
- Department of Surgery, Isala Hospital, Zwollea, the Netherlands
| | - W Te Riele
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - R-J Swijnenburg
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H Torrenga
- Department of Surgery, Deventer Hospital, Deventer, the Netherlands
| | - P van Duijvendijk
- Department of Surgery, Isala Hospital, Zwollea, the Netherlands.,Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, the Netherlands
| | - M Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den Ijssel, the Netherlands
| | - N F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - D J Grünhagen
- Department of Surgery, Erasmus MC, Erasmus University, Rotterdam, the Netherlands
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11
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Lambrichts DPV, Bolkenstein HE, van der Does DCHE, Dieleman D, Crolla RMPH, Dekker JWT, van Duijvendijk P, Gerhards MF, Nienhuijs SW, Menon AG, de Graaf EJR, Consten ECJ, Draaisma WA, Broeders IAMJ, Bemelman WA, Lange JF. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg 2019; 106:458-466. [PMID: 30811050 PMCID: PMC6593757 DOI: 10.1002/bjs.11129] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 08/08/2018] [Revised: 10/13/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Abstract
This multicentre retrospective cohort study included 447 patients with Hinchey Ib and II diverticular abscesses, who were treated with antibiotics, with or without percutaneous drainage. Abscesses of 3 and 5 cm in size were at higher risk of short‐term treatment failure and emergency surgery respectively. Initial non‐surgical treatment of Hinchey Ib and II diverticular abscesses was comparable between patients treated with antibiotics only and those who underwent percutaneous drainage in combination with antibiotics, with regard to short‐ and long‐term outcomes.
![]() Most do not need drainage
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Affiliation(s)
- D P V Lambrichts
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | - H E Bolkenstein
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | | | - D Dieleman
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | | | - M F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - A G Menon
- Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands.,Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
| | - E J R de Graaf
- Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | - J F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands.,Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
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12
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Seesing MFJ, van der Veen A, Brenkman HJF, Stockmann HBAC, Nieuwenhuijzen GAP, Rosman C, van den Wildenberg FJH, van Berge Henegouwen MI, van Duijvendijk P, Wijnhoven BPL, Stoot JHMB, Lacle M, Ruurda JP, van Hillegersberg R. Erratum: Resection of hepatic and pulmonary metastasis from metastatic esophageal and gastric cancer: a nationwide study. Dis Esophagus 2019; 32:5535883. [PMID: 31504355 PMCID: PMC7729205 DOI: 10.1093/dote/doz069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- M F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | - A van der Veen
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | - H J F Brenkman
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | | | | | - C Rosman
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen
| | | | | | | | - B P L Wijnhoven
- Department of Surgical Oncology, Erasmus University Medical Center, Rotterdam
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen
| | - M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
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13
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Seesing MFJ, van der Veen A, Brenkman HJF, Stockmann HBAC, Nieuwenhuijzen GAP, Rosman C, van den Wildenberg FJH, van Berge Henegouwen MI, van Duijvendijk P, Wijnhoven BPL, Stoot JHMB, Lacle M, Ruurda JP, van Hillegersberg R. Resection of hepatic and pulmonary metastasis from metastatic esophageal and gastric cancer: a nationwide study. Dis Esophagus 2019; 32:5480096. [PMID: 31220859 PMCID: PMC7705435 DOI: 10.1093/dote/doz034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/08/2019] [Accepted: 03/28/2019] [Indexed: 12/11/2022]
Abstract
The standard of care for gastroesophageal cancer patients with hepatic or pulmonary metastases is best supportive care or palliative chemotherapy. Occasionally, patients can be selected for curative treatment instead. This study aimed to evaluate patients who underwent a resection of hepatic or pulmonary metastasis with curative intent. The Dutch national registry for histo- and cytopathology was used to identify these patients. Data were retrieved from the individual patient files. Kaplan-Meier survival analysis was performed. Between 1991 and 2016, 32,057 patients received a gastrectomy or esophagectomy for gastroesophageal cancer in the Netherlands. Of these patients, 34 selected patients received a resection of hepatic metastasis (n = 19) or pulmonary metastasis (n = 15) in 21 different hospitals. Only 4 patients received neoadjuvant therapy before metastasectomy. The majority of patients had solitary, metachronous metastases. After metastasectomy, grade 3 (Clavien-Dindo) complications occurred in 7 patients and mortality in 1 patient. After resection of hepatic metastases, the median potential follow-up time was 54 months. Median overall survival (OS) was 28 months and the 1-, 3-, and 5- year OS was 84%, 41%, and 31%, respectively. After pulmonary metastases resection, the median potential follow-up time was 80 months. The median OS was not reached and the 1-, 3-, and 5- year OS was 67%, 53%, and 53%, respectively. In selected patients with gastroesophageal cancer with hepatic or pulmonary metastases, metastasectomy was performed with limited morbidity and mortality and offered a 5-year OS of 31-53%. Further prospective studies are required.
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Affiliation(s)
- M F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | - A van der Veen
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | - H J F Brenkman
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | | | | | - C Rosman
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen
| | | | | | | | - B P L Wijnhoven
- Department of Surgical Oncology, Erasmus University Medical Center, Rotterdam
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen
| | - M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht
| | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht,Address correspondence to: Richard van Hillegersberg, MD, PhD, Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100 G04.228, 3508 GA, Utrecht, the Netherlands.
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14
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Hupkens BJP, Breukink SO, Olde Reuver Of Briel C, Tanis PJ, de Noo ME, van Duijvendijk P, van Westreenen HL, Dekker JWT, Chen TYT, Juul T. Dutch validation of the low anterior resection syndrome score. Colorectal Dis 2018; 20:881-887. [PMID: 29679514 DOI: 10.1111/codi.14228] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Received: 12/07/2017] [Accepted: 03/26/2018] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to validate the Dutch translation of the low anterior resection syndrome (LARS) score in a population of Dutch rectal cancer patients. METHOD Patients who underwent surgery for rectal cancer received the LARS score questionnaire, a single quality of life (QoL) category question and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. A subgroup of patients received the LARS score twice to assess the test-retest reliability. RESULTS A total of 165 patients were included in the analysis, identified in six Dutch centres. The response rate was 62.0%. The percentage of patients who reported 'major LARS' was 59.4%. There was a high proportion of patients with a perfect or moderate fit between the QoL category question and the LARS score, showing a good convergent validity. The LARS score was able to discriminate between patients with or without neoadjuvant radiotherapy (P = 0.003), between total and partial mesorectal excision (P = 0.008) and between age groups (P = 0.039). There was a statistically significant association between a higher LARS score and an impaired function on the global QoL subscale and the physical, role, emotional and social functioning subscales of the EORTC QLQ-C30 questionnaire. The test-retest reliability of the LARS score was good, with an interclass correlation coefficient of 0.79. CONCLUSION The good psychometric properties of the Dutch version of the LARS score are comparable overall to the earlier validations in other countries. Therefore, the Dutch translation can be considered to be a valid tool for assessing LARS in Dutch rectal cancer patients.
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Affiliation(s)
- B J P Hupkens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C Olde Reuver Of Briel
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Medical Research Data Management, Deventer, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M E de Noo
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | | | | | - J W T Dekker
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - T Y T Chen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - T Juul
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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15
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Brenkman HJF, Gertsen EC, Vegt E, van Hillegersberg R, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, van der Peet DL, Daams F, van Sandick JW, van Grieken NCT, Heisterkamp J, van Etten B, Haveman JW, Pierie JP, Jonker F, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, van Laarhoven HWM, Wessels FJ, Haj Mohammad N, van Stel HF, Frederix GWJ, Siersema PD, Ruurda JP. Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study). BMC Cancer 2018; 18:450. [PMID: 29678145 PMCID: PMC5910577 DOI: 10.1186/s12885-018-4367-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/18/2017] [Accepted: 04/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3–4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. Methods This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3–4b, N0–3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. Discussion In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. Trial registration NCT03208621. This trial was registered prospectively on June 30, 2017.
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Affiliation(s)
- H J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E Vegt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - S S Gisbertz
- Academic Medical Center, Amsterdam, The Netherlands
| | - M D P Luyer
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - S M Lagarde
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - W O de Steur
- Leiden University Medical Center, Leiden, The Netherlands
| | - H H Hartgrink
- Leiden University Medical Center, Leiden, The Netherlands
| | - J H M B Stoot
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - K W E Hulsewe
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | | | | | | | - F Daams
- VU University Medical Center, Amsterdam, The Netherlands
| | - J W van Sandick
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Heisterkamp
- Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands
| | - B van Etten
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J W Haveman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P Pierie
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F Jonker
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A Y Thijssen
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - E J T Belt
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - E Wassenaar
- Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - H W M van Laarhoven
- Academic Medical Center, Amsterdam, The Netherlands.,Propsective Observational Cohort study of Oesophageal-gastric cancer Patients (POCOP) of the Dutch Upper GI Cancer Group (DUCG), Amsterdam, The Netherlands
| | - F J Wessels
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - N Haj Mohammad
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H F van Stel
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - G W J Frederix
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P D Siersema
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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16
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Sier MF, Wisselink DD, Ubbink DT, Oostenbroek RJ, Veldink GJ, Lamme B, van Duijvendijk P, van Geloven AAW, Eijsbouts QAJ, Bemelman WA. Randomized clinical trial of intracutaneously versus transcutaneously sutured ileostomy to prevent stoma-related complications (ISI trial). Br J Surg 2018; 105:637-644. [PMID: 29493785 PMCID: PMC5947256 DOI: 10.1002/bjs.10750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/13/2017] [Revised: 09/27/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Abstract
Background Ileostomy construction is a common procedure but can be associated with morbidity. The stoma is commonly secured to the skin using transcutaneous sutures. It is hypothesized that intracutaneous sutures result in a tighter adherence of the peristomal skin to the stoma plate to prevent faecal leakage. The study aimed to compare the effect of intracutaneous versus transcutaneous suturing of ileostomies on faecal leakage and quality of life. Methods This randomized trial was undertaken in 11 hospitals in the Netherlands. Patients scheduled to receive an ileostomy for any reason were randomized to intracutaneous or transcutaneous suturing (IC and TC groups respectively). The primary outcome was faecal leakage. Secondary outcomes were stoma‐related quality of life and costs of stoma‐related materials and reinterventions. Results Between April 2011 and February 2016, 339 patients were randomized to the IC (170) or TC (169) group. Leakage rates were higher in the IC than in the TC group (52·4 versus 41·4 per cent respectively; risk difference 11·0 (95 per cent c.i. 0·3 to 21·2) per cent). Skin irritation rates were high (78·2 versus 72·2 per cent), but did not differ significantly between the groups (risk difference 6·1 (95 per cent c.i. –3·2 to 15·10) per cent). There were no significant differences in quality of life or costs between the groups. Conclusion Intracutaneous suturing of an ileostomy is associated with more peristomal leakage than transcutaneous suturing. Overall stoma‐related complications did not differ between the two techniques. Registration number: NTR2369 (
http://www.trialregister.nl). More leaks with intracutaneous
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Affiliation(s)
- M F Sier
- Department of Surgery, University Medical Centre Leiden, Leiden, The Netherlands
| | - D D Wisselink
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - R J Oostenbroek
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - G J Veldink
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - B Lamme
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | - Q A J Eijsbouts
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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17
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Tada K, Roy-Chowdhury N, Prasad V, Kim BH, Manchikalapudi P, Fox IJ, van Duijvendijk P, Bosma PJ, Roy-Chowdhury J. Long-Term Amerlioration of Bilirubin Glucuronidation Defect in Gunn Rats by Transplanting Genetically Modified Immortalized Autologous Hepatocytes. Cell Transplant 2017; 7:607-16. [PMID: 9853589 DOI: 10.1177/096368979800700611] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ex vivo gene therapy, in which hepatocytes are harvested from mutants, retrovirally transduced with a normal gene and transplanted back into the donor, has been used for correction of inherited metabolic defects of liver. Major drawbacks of this method include limited availability of autologous hepatocytes, inefficient retroviral transduction of primary hepatocytes, and the limited number of hepatocytes that can be transplanted safely. To obviate these problems, we transduced primary hepatocytes derived from inbred bilirubin–UDP–glucuronosyl–transferase (BUGT)-deficient Gunn rats by infection with a recombinant retrovirus expressing temperature-sensitive mutant SV40 large T antigen (tsT). The immortalized cells were then transduced with a second recombinant retrovirus expressing human B-UGT, and a clone expressing high levels of the enzyme was expanded by culturing at permissive temperature (33°C). At 37°C, tsT antigen was degraded and the cells expressed UGT activity toward bilirubin at a level approximately twice that present in normal rat liver homogenates. For seeding the cells into the liver bed, 1 × 107 cells were injected into the spleens of syngeneic Gunn rats five times at 10-day intervals. Excretion of bilirubin glucuronides in bile was demonstrated by HPLC analysis and serum bilirubin levels were reduced by 27 to 52% in 40 days after the first transplantation and remained so throughout the duration of the study (120 days). None of the transplanted Gunn rats or SCID mice transplanted with the immortalized cells developed tumors. © 1998 Elsevier Science Inc.
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Affiliation(s)
- K Tada
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10462, USA
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18
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Loozen CS, Kortram K, Kornmann VNN, van Ramshorst B, Vlaminckx B, Knibbe CAJ, Kelder JC, Donkervoort SC, Nieuwenhuijzen GAP, Ponten JEH, van Geloven AAW, van Duijvendijk P, Bos WJW, Besselink MGH, Gouma DJ, van Santvoort HC, Boerma D. Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis. Br J Surg 2017; 104:e151-e157. [DOI: 10.1002/bjs.10406] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/12/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Many patients who have surgery for acute cholecystitis receive postoperative antibiotic prophylaxis, with the intent to reduce infectious complications. There is, however, no evidence that extending antibiotics beyond a single perioperative dose is advantageous. This study aimed to determine the effect of extended antibiotic prophylaxis on infectious complications in patients with mild acute cholecystitis undergoing cholecystectomy.
Methods
For this randomized controlled non-inferiority trial, adult patients with mild acute calculous cholecystitis undergoing cholecystectomy at six major teaching hospitals in the Netherlands, between April 2012 and September 2014, were assessed for eligibility. Patients were randomized to either a single preoperative dose of cefazolin (2000 mg), or antibiotic prophylaxis for 3 days after surgery (intravenous cefuroxime 750 mg plus metronidazole 500 mg, three times daily), in addition to the single dose. The primary endpoint was rate of infectious complications within 30 days after operation.
Results
In the intention-to-treat analysis, three of 77 patients (4 per cent) in the extended antibiotic group and three of 73 (4 per cent) in the standard prophylaxis group developed postoperative infectious complications (absolute difference 0·2 (95 per cent c.i. –8·2 to 8·9) per cent). Based on a margin of 5 per cent, non-inferiority of standard prophylaxis compared with extended prophylaxis was not proven. Median length of hospital stay was 3 days in the extended antibiotic group and 1 day in the standard prophylaxis group.
Conclusion
Standard single-dose antibiotic prophylaxis did not lead to an increase in postoperative infectious complications in patients with mild acute cholecystitis undergoing cholecystectomy. Registration number: NTR3089 (www.trialregister.nl).
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Affiliation(s)
- C S Loozen
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - K Kortram
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - V N N Kornmann
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - B van Ramshorst
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - B Vlaminckx
- Department of Medical Microbiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - C A J Knibbe
- Department of Clinical Pharmacology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - J C Kelder
- Department of Clinical Epidemiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - S C Donkervoort
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - J E H Ponten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - W J W Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M G H Besselink
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - D J Gouma
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - H C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - D Boerma
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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19
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Margadant C, Bruns E, Sloothaak D, van Duijvendijk P, van Raamt A, van der Zaag H, Buskens C, van Munster B, van der Zaag E. Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer. Eur J Surg Oncol 2016; 42:1654-1659. [DOI: 10.1016/j.ejso.2016.05.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/22/2016] [Accepted: 05/31/2016] [Indexed: 01/06/2023] Open
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20
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Bruns ERJ, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, van der Zaag ES, Bemelman WA, van Munster BC. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis 2016; 18:O267-77. [PMID: 27332897 DOI: 10.1111/codi.13429] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Abstract
AIM Prehabilitation, defined as enhancement of the preoperative condition of a patient, is a possible strategy for improving postoperative outcome. Lack of muscle strength and poor physical condition, increasingly prevalent in older patients, are risk factors for postoperative complications. Eighty-five per cent of patients with colorectal cancer are aged over 60 years. Since surgery is the cornerstone of their treatment, this review systemically examined the literature on the effect of physical prehabilitation in older patients undergoing colorectal surgery. METHOD Trials and case-control studies investigating the effect of physical prehabilitation in patients over 60 years undergoing colorectal surgery were retrieved from MEDLINE, EMBASE, CINAHL and the Cochrane library. Patient characteristics, the type of intervention and outcome measurements were recorded. The risk of bias and heterogeneity was assessed. RESULTS Five studies including 353 patients were identified. They were small, containing an average of 77 patients and were of moderate methodological quality. Compliance rates of the prehabilitation programme varied from 16 to 97%. None of the studies could identify a significant reduction of postoperative complications or length of hospital stay. Four studies showed physical improvement (walking distance, respiratory endurance) in the prehabilitation group. Clinical heterogeneity precluded a meta-analysis. CONCLUSION Prehabilitation is a possible means of enhancing the physical condition of patients preoperatively. The quality of studies in older patients undergoing colorectal surgery is poor, despite the increase in elderly people with colorectal cancer. Defining specific patient groups at risk and standardizing the outcome are essential for improving the results of treatment.
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Affiliation(s)
- E R J Bruns
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - B van den Heuvel
- Department of Surgery, VU Medical Centre, Amsterdam, the Netherlands
| | - C J Buskens
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - S Festen
- Department of Medicine, University Medical Centre, Groningen, the Netherlands
| | - E B Wassenaar
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - E S van der Zaag
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - W A Bemelman
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - B C van Munster
- Department of Medicine, University Medical Centre, Groningen, the Netherlands.,Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands
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21
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Borstlap WAA, Tanis PJ, Koedam TWA, Marijnen CAM, Cunningham C, Dekker E, van Leerdam ME, Meijer G, van Grieken N, Nagtegaal ID, Punt CJA, Dijkgraaf MGW, De Wilt JH, Beets G, de Graaf EJ, van Geloven AAW, Gerhards MF, van Westreenen HL, van de Ven AWH, van Duijvendijk P, de Hingh IHJT, Leijtens JWA, Sietses C, Spillenaar-Bilgen EJ, Vuylsteke RJCLM, Hoff C, Burger JWA, van Grevenstein WMU, Pronk A, Bosker RJI, Prins H, Smits AB, Bruin S, Zimmerman DD, Stassen LPS, Dunker MS, Westerterp M, Coene PP, Stoot J, Bemelman WA, Tuynman JB. A multi-centred randomised trial of radical surgery versus adjuvant chemoradiotherapy after local excision for early rectal cancer. BMC Cancer 2016; 16:513. [PMID: 27439975 PMCID: PMC4955121 DOI: 10.1186/s12885-016-2557-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 02/19/2016] [Accepted: 07/13/2016] [Indexed: 12/13/2022] Open
Abstract
Background Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5–20 %) suggesting that local excision alone is not sufficient, while completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients. Methods/Study design In this multicentre randomised trial, patients with an intermediate risk T1-2 rectal cancer, that has been locally excised using an endoluminal technique, will be randomized between adjuvant chemo-radiotherapylimited to the mesorectum and standard completion total mesorectal excision (TME). To strictly monitor the risk of locoregional recurrence in the experimental arm and enable early salvage surgery, there will be additional follow up with frequent MRI and endoscopy. The primary outcome of the study is three-year local recurrence rate. Secondary outcomes are morbidity, disease free and overall survival, stoma rate, functional outcomes, health related quality of life and costs. The design is a non inferiority study with a total sample size of 302 patients. Discussion The results of the TESAR trial will potentially demonstrate that adjuvant chemoradiotherapy is an oncological safe treatment option in patients who are confronted with the difficult clinical dilemma of a radically removed intermediate risk early rectal cancer by polypectomy or transanal surgery that is conventionally treated with subsequent radical surgery. Preserving the rectum using adjuvant radiotherapy is expected to significantly improve morbidity, function and quality of life if compared to completion TME surgery. Trial registration NCT02371304, registration date: February 2015
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Affiliation(s)
- W A A Borstlap
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T W A Koedam
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - C A M Marijnen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - C Cunningham
- Department of Surgery, Oxford University Hospital, Oxford, UK
| | - E Dekker
- Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M E van Leerdam
- Department of Gastroenterology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - G Meijer
- Department of Pathology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - N van Grieken
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - I D Nagtegaal
- Department of Pathology, RadboudUMC, Nijmegen, The Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J H De Wilt
- Department of Surgery, RadboudUMC, Nijmegen, The Netherlands
| | - G Beets
- Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - E J de Graaf
- Department of Surgery, IJselland Hospital, Capelle aan de Ijssel, The Netherlands
| | | | - M F Gerhards
- Department of surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | | | | | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - J W A Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - C Sietses
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | - C Hoff
- Department of Surgery, Medisch Centrum Leewarden, Leeuwarden, The Netherlands
| | - J W A Burger
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - A Pronk
- Department of Surgery, Diaconessenziekehuis, Utrecht, The Netherlands
| | - R J I Bosker
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | - H Prins
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - A B Smits
- Department of Surgery, Sint. Antonius Hospital, Nieuwegein, The Netherlands
| | - S Bruin
- Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands
| | - D D Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - L P S Stassen
- Department of Surgery, MUMC, Maastricht, The Netherlands
| | - M S Dunker
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - M Westerterp
- Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - P P Coene
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - J Stoot
- Department of Surgery, Zuyderland Hospital, Sittard, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.
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22
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Berkel AEM, Rosman C, Koop R, van Duijvendijk P, van der Palen J, Klaase JM. Isosorbide dinitrate ointment vs botulinum toxin A (Dysport) as the primary treatment for chronic anal fissure: a randomized multicentre study. Colorectal Dis 2014; 16:O360-6. [PMID: 24629060 DOI: 10.1111/codi.12615] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 11/28/2013] [Accepted: 01/14/2014] [Indexed: 12/21/2022]
Abstract
AIM Nitric oxide donors, such as isosorbide dinitrate ointment (ISDN), are considered as first-choice agents in the treatment of chronic anal fissure. Injection with botulinum toxin A in the internal anal sphincter is often used as a second-line therapy, although it may give better results and fewer side effects than nitric oxide donors. The aim of this randomized clinical trial was to investigate whether botulinum toxin A (Dysport) is more effective than ISDN in the primary treatment of chronic anal fissure. METHOD From April 2005 until October 2009, 60 patients (32 men) with a median age of 42 (25-82) years were randomized to receive either ISDN 10 mg/ml (1%) (n = 33) or injection with 60 units of Dysport (n = 27). The primary end-point was the percentage of complete fissure healing after 8 weeks. RESULTS After a median of 9 weeks complete fissure healing was noted in 18 of 27 patients in the Dysport group and in 11 of 33 patients in the ISDN group (P = 0.010). Absolute improvement of pain scores after 9 weeks was similar in both groups (P = 0.733). Patients treated with Dysport had fewer side effects than patients treated with ISDN (P = 0.028). Of the patients with a healed fissure, 28% of the Dysport group and 50% of the ISDN group had a recurrence within 1 year (P = 0.286; hazard ratio 2.08; 95% CI = 0.54-7.97). CONCLUSION Dysport is more effective than ISDN ointment and has fewer side effects in the primary treatment of chronic anal fissure. The recurrence rate within 1 year in both treatment groups is high.
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Affiliation(s)
- A E M Berkel
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
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23
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Sloothaak DAM, Grewal S, Doornewaard H, van Duijvendijk P, Tanis PJ, Bemelman WA, van der Zaag ES, Buskens CJ. Lymph node size as a predictor of lymphatic staging in colonic cancer. Br J Surg 2014; 101:701-6. [PMID: 24676735 DOI: 10.1002/bjs.9451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND In colonic cancer, the number of harvested lymph nodes is associated with prognosis. The aim of this study was to determine the contribution of small lymph nodes to pathological staging, and to analyse the hypothesis that node size is a confounder in the relationship between prognosis and nodal harvest. METHODS Nodal harvest and size were analysed in patients who underwent elective surgery for colonic cancer. Visible and palpable nodes were harvested without fat clearance techniques, and conventional histology was performed. RESULTS Metastases were found in 99 of 2043 measured lymph nodes in 150 patients. Lymph nodes smaller than 3 mm were positive in 8.0 per cent of patients (12 of 150), but were the sole reason for upstaging in only 1.3 per cent (2 of 150). No metastases were found among 95 nodes of 1 mm or less. Metastatic nodes were larger than those without metastasis (median (i.q.r.) 5.0 (3.2-7.0) versus 3.8 (2.4-5.2) mm; P < 0·001), but a receiver operating characteristic (ROC) curve did not identify a relevant cut-off point to predict metastatic involvement. A hazard ratio of 0.71 (95 per cent confidence interval 0.50 to 1.01) was suggestive of an association between disease recurrence and increased node size, although not significant (P = 0.056). In patients with N0 disease, there was a correlation between node size and harvest (Pearson's correlation 0.317, P = 0.002), and a nodal yield of at least 12 was associated with a larger median node size (4.3 (3.3-5.0) versus 3.4 (2.7-4.0) mm; P = 0.015). CONCLUSION The contribution of lymph nodes smaller than 3 mm to nodal staging is limited. Increased node size is associated with increased nodal yield, and could be a confounder in the relationship between prognosis and nodal harvest in patients with N0 disease.
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Affiliation(s)
- D A M Sloothaak
- Departments of Surgery and Pathology, Gelre Hospital, Apeldoorn, The Netherlands; Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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de Vos tot Nederveen Cappel WH, Buskens E, van Duijvendijk P, Cats A, Menko FH, Griffioen G, Slors JF, Nagengast FM, Kleibeuker JH, Vasen HFA. Decision analysis in the surgical treatment of colorectal cancer due to a mismatch repair gene defect. Gut 2003; 52:1752-5. [PMID: 14633956 PMCID: PMC1773904 DOI: 10.1136/gut.52.12.1752] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In view of the high risk of developing a new primary colorectal carcinoma (CRC), subtotal colectomy rather than segmental resection or hemicolectomy is the preferred treatment in hereditary non-polyposis colorectal cancer (HNPCC) patients. Subtotal colectomy however implies a substantial decrease in quality of life. To date, colonoscopic surveillance has been shown to reduce CRC occurrence. AIMS To compare the potential health effects in terms of life expectancy (LE) for patients undergoing subtotal colectomy or hemicolectomy for CRC. METHODS A decision analysis (Markov) model was created. Information on the 10 year risk of CRC after subtotal colectomy (4%) and hemicolectomy (16%) and stages of CRCs detected within a two year surveillance interval (32% Dukes' A, 54% Dukes' B, and 14% Dukes' C) were derived from two cohort studies. Five year survival rates used for the different Dukes stages (A, B, and C) were 98%, 80%, and 60%, respectively. Remaining LE values were calculated for hypothetical cohorts with an age at CRC diagnosis of 27, 47, and 67 years, respectively. Remaining LE values were also calculated for patients with CRC of Dukes' stage A. RESULTS The overall LE gain of subtotal colectomy compared with hemicolectomy at ages 27, 47, and 67 was 2.3, 1, and 0.3 years, respectively. Specifically for Dukes' stage A, this would be 3.4, 1.5, and 0.4 years. CONCLUSIONS Unless surveillance results improve, subtotal colectomy still seems the preferred treatment for CRC in HNPCC in view of the difference in LE. For older patients, hemicolectomy may be an option as there is no appreciable difference in LE.
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van Duijvendijk P, Slors JFM, Taat CW, van Tets WF, van Tienhoven G, Obertop H, Boeckxstaens GEE. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 2002. [PMID: 12358246 DOI: 10.1016/s0002-9270(02)04138-2] [Citation(s) in RCA: 44] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Anorectal function is greatly disturbed after rectal surgery with or without radiotherapy (RT). To clarify the underlying mechanisms, we designed a prospective study to evaluate the effect of RT and surgery on anorectal function and clinical outcome of patients with a rectal carcinoma. METHODS Thirty-four patients with a rectal carcinoma participated in this study. They filled out a symptom questionnaire and underwent anal manometry, anal and rectal mucosal electrosensitivity testing, and a rectal barostat, before surgery, 4 and 12 months postoperatively. Thirteen patients were lost to follow-up, 14 underwent surgery alone (total mesorectal excision [TME]), and seven also received RT (RT + TME). RESULTS Functional outcome was disappointing in both groups, with at 4 months a significantly higher defecation frequency after RT + TME as compared with TME. Anal sphincter function and rectal sensitivity to pressure-controlled distention were not affected by either treatment. Rectal compliance, however, was significantly reduced after RT + TME at 4 and 1 2 months, resulting in lower rectal volumes at the thresholds for first sensation and desire to defecate. Rectal but not anal mucosal electrosensitivity was higher after TME + RT. CONCLUSIONS Anorectal function after rectal surgery with or without RT is greatly hampered because of a decreased rectal compliance. After 12 months, partial improvement is shown, especially in the absence of RT.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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van Duijvendijk P, Slors JFM, Taat CW, van Tets WF, van Tienhoven G, Obertop H, Boeckxstaens GEE. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 2002; 97:2282-9. [PMID: 12358246 DOI: 10.1111/j.1572-0241.2002.05782.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anorectal function is greatly disturbed after rectal surgery with or without radiotherapy (RT). To clarify the underlying mechanisms, we designed a prospective study to evaluate the effect of RT and surgery on anorectal function and clinical outcome of patients with a rectal carcinoma. METHODS Thirty-four patients with a rectal carcinoma participated in this study. They filled out a symptom questionnaire and underwent anal manometry, anal and rectal mucosal electrosensitivity testing, and a rectal barostat, before surgery, 4 and 12 months postoperatively. Thirteen patients were lost to follow-up, 14 underwent surgery alone (total mesorectal excision [TME]), and seven also received RT (RT + TME). RESULTS Functional outcome was disappointing in both groups, with at 4 months a significantly higher defecation frequency after RT + TME as compared with TME. Anal sphincter function and rectal sensitivity to pressure-controlled distention were not affected by either treatment. Rectal compliance, however, was significantly reduced after RT + TME at 4 and 1 2 months, resulting in lower rectal volumes at the thresholds for first sensation and desire to defecate. Rectal but not anal mucosal electrosensitivity was higher after TME + RT. CONCLUSIONS Anorectal function after rectal surgery with or without RT is greatly hampered because of a decreased rectal compliance. After 12 months, partial improvement is shown, especially in the absence of RT.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 2001; 44:1800-7. [PMID: 11742165 DOI: 10.1007/bf02234458] [Citation(s) in RCA: 216] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to assess the functional outcome and the quality of life of laparoscopic-assisted ileal pouch-anal anastomosis compared with conventional ileal pouch-anal anastomosis. Further, body image and cosmesis were evaluated in both groups. METHODS Sixteen patients who underwent a laparoscopic-assisted ileal pouch-anal anastomosis between March 1996 and September 1999 were matched with 19 patients who had a conventional ileal pouch-anal anastomosis. Patients were matched for the time period after surgery, distribution of familial adenomatous polyposis/ulcerative colitis, and one/two-stage procedure. Thirty-two patients agreed to fill out a set of questionnaires that assessed functional outcome, quality of life, body image, and cosmesis. Quality of life was measured with the Short Form 36 Health Survey questionnaire and the Gastrointestinal Quality of Life Index. The Body Image Questionnaire was used to measure patients' perceptions of and satisfaction with their own body and their attitude toward their bodily appearance (body image) and the degree of satisfaction of patients with respect to the physical appearance of the scar (cosmesis). RESULTS Patients in the conventional group were older than patients in the laparoscopic-assisted group (mean 39.2 +/- 8.4 vs. 30.6 +/- 7.1 years; P < 0.01). No differences were found in functional outcome and quality of life. Satisfaction with the cosmetic result of the scar was significantly higher in the laparoscopic-assisted group compared with the conventional group. Body image score was higher in the laparoscopic-assisted group when compared with the conventional group, although not significant. CONCLUSIONS The functional outcome and quality of life of laparoscopic-assisted ileal pouch-anal anastomosis is not different from conventional ileal pouch-anal anastomosis. In the long-term, better cosmesis is the most important advantage after laparoscopic surgery.
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Affiliation(s)
- M S Dunker
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
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Vasen HF, van Duijvendijk P, Buskens E, Bülow C, Björk J, Järvinen HJ, Bülow S. Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients. Gut 2001; 49:231-5. [PMID: 11454800 PMCID: PMC1728380 DOI: 10.1136/gut.49.2.231] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The choice of colorectal surgery in patients with familial adenomatous polyposis lies between the morbidity of proctocolectomy and ileum-pouch-anal anastomosis (IPAA) and the mortality from rectal cancer after total colectomy and ileorectal anastomosis (IRA). The aims of the present study were: (1) to assess the risk of dying from rectal cancer after IRA, (2) to compare the life expectancy between patients with an IRA and those with an IPAA, and (3) to investigate whether regular endoscopic examination of the rectum leads to detection of cancer at an earlier stage. METHODS Clinical and pathological data on 659 patients who underwent colectomy and ileorectal anastomosis were collected from four national polyposis registries-that is, in Denmark, Finland, Sweden, and the Netherlands. Data were analysed using survival analysis methods. Decision analysis was used to compare the life expectancy between patients with an IRA and those with an IPAA. RESULTS A total of 47 patients developed rectal cancer after IRA. The risk of dying from rectal cancer was 12.5% (95% confidence interval 7.1--17.9%) by age 65. Compared with IRA, IPAA would lead to an increase in life expectancy of 1.8 years. Seventy five per cent of patients with rectal cancer had a negative rectoscopy within 12 months before the diagnosis. CONCLUSION IRA is associated with substantial mortality due to rectal cancer. Follow up examinations of the rectum does not have sufficient preventive effect on morbidity and mortality of rectal cancer.
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Affiliation(s)
- H F Vasen
- The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, the Netherlands.
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van Duijvendijk P, Slors JF, Taat CW, van Lochem LT, Bonsel GJ, de Vries JW, Obertop H. What is the benefit of preoperative sperm preservation for patients who undergo restorative proctocolectomy for benign diseases? Dis Colon Rectum 2000; 43:838-42. [PMID: 10859086 DOI: 10.1007/bf02238024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE In patients with benign colorectal diseases undergoing a restorative proctocolectomy with an ileal pouch-anal anastomosis, semen cryopreservation seems rational to enable the possibility of procreation in case surgery leads to sexual disorders or impotence. The aim of this study was to determine the preoperative and postoperative semen quality in patients undergoing ileal pouch-anal anastomosis. In addition, the study sought to determine the incidence of surgery-induced sexual dysfunction to evaluate the economic efficiency of semen cryopreservation as compared with alternatives such as microsurgical epididymal sperm aspiration. METHODS Preoperative and postoperative semen analyses were offered to 97 patients with ileal pouch-anal anastomosis with benign colorectal diseases since 1989. The direct costs of the semen cryopreservation program were determined and compared with those of alternatives. RESULTS In 34 of 40 consecutive patients with ileal pouch-anal anastomosis who made use of preoperative semen preservation, normal sperm concentrations, motility, and morphology were found. Mean semen characteristics of all 23 patients who returned for postoperative analysis were not different from preoperative values, but they were for total sperm number. Two patients developed temporary retrograde ejaculation postoperatively. None of the preserved semen samples was used, thus semen cryopreservation benefited none of these patients. The total costs of semen cryopreservation are between 2.2 and 5 times higher than the costs for one microsurgical epididymal sperm aspiration procedure. CONCLUSIONS Preoperative semen cryopreservation in patients undergoing ileal pouch-anal anastomosis because of benign colorectal diseases is quite feasible. However, most likely because of improved surgical techniques and the increasing number of effective alternatives, preoperative semen cryopreservation in patients with ileal pouch-anal anastomosis is no longer cost effective.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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van Duijvendijk P, Slors JF, Taat CW, Bemelman WA, van Lochem LT. [Proctocolectomy with an ileal pouch-anal anastomosis; results from 100 consecutive patients in the Academic Medical Center at Amsterdam, 1994-1999]. Ned Tijdschr Geneeskd 2000; 144:612-6. [PMID: 10761550] [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: 02/16/2023]
Abstract
OBJECTIVE To evaluate the results of proctocolectomy with creation of an ileac pouch anal anastomosis (IPAA). DESIGN Retrospective. METHOD Of the 100 patients in whom an IPAA procedure was performed in the period 1994/'99 in the Department of Surgery of the Academic Medical Centre, Amsterdam, the Netherlands, data were collected on the complications: in the patients with a follow-up of over 12 months the functional results were studied. RESULTS The group comprised 48 males and 52 females with a mean age of 36.3 years (range: 15-62). Preoperative diagnoses were ulcerative colitis (n = 84), familial polyposis coli (12), slow transit obstipation (2), Hirschsprung's disease (1) and Muir-Torre syndrome (1). Median operating time was 2.3 h, peroperative blood and fluid loss 500 ml and median hospital stay 15 days. There was no mortality. Ten patients had a loop ileostomy formation, in 6 because of postoperative complications. A total of 30 patients developed postoperative complications, peroperatively or during follow-up 10 of those patients needed a relaparotomy. After 12 months 1 pouch had to be excised and 2 patients still had a loop ileostomy due to postoperative complications. In 56 patients with at least 12 months follow-up, median 24-hour stool frequency was 6. Eighty-nine per cent of these patients were satisfied or highly satisfied with the overall outcome. CONCLUSION A proctocolectomy with IPAA formation is a safe procedure with good functional results.
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van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF. Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 1999; 230:648-54. [PMID: 10561088 PMCID: PMC1420918 DOI: 10.1097/00000658-199911000-00006] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [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: 12/17/2022]
Abstract
OBJECTIVE To compare the long-term functional results of ileorectal anastomosis (IRA) with those of ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP). SUMMARY BACKGROUND DATA In patients with FAP, hundreds of colorectal adenomas develop, and the patient will die of colorectal cancer if left untreated. The surgeon must choose between colectomy with IRA and restorative proctocolectomy with IPAA. One factor crucial to decision making is the functional outcome after either procedure. To date, studies on this issue have reported conflicting results and have been based on small series of patients. METHODS To assess various functional variables, a questionnaire was sent to 323 patients with FAP who underwent either IRA or IPAA and who were registered at the Netherlands Foundation for the Detection of Hereditary Tumors. The overall response rate was 86%; the responders comprised 161 patients who underwent IRA and 118 patients who underwent IPAA. RESULTS Patients who underwent IRA scored significantly better for daytime and nighttime stool frequency, soiling, occasional passive incontinence, flatus and feces discrimination, stool consistency, and need for antidiarrheal medication. There was no difference with regard to perianal irritation, episodes of bowel discomfort, or dietary restrictions. The functional results according to the aggregate score of the Gastro-Intestinal Functional Outcome Scale, where the items specified above were integrated (0 indicating a poor and 100 a good overall function), were significantly better in patients with an IRA (74.5) than in patients with an IPAA (66.0) (p < 0.01). CONCLUSION The functional outcome after IRA is significantly better than after IPAA. On the basis of these results, IRA might still be considered in patients with a mild phenotypic expression of the disease in the rectum.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Slors JF, Bemelman WA, van Duijvendijk P. [Surgical treatment of ulcerative colitis and familial adenomatous polyposis: recent developments]. Ned Tijdschr Geneeskd 1999; 143:1490; author reply 1491. [PMID: 10443265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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van Duijvendijk P, Vasen HF, Bertario L, Bülow S, Kuijpers JH, Schouten WR, Guillem JG, Taat CW, Slors JF. Cumulative risk of developing polyps or malignancy at the ileal pouch-anal anastomosis in patients with familial adenomatous polyposis. J Gastrointest Surg 1999; 3:325-30. [PMID: 10481126 DOI: 10.1016/s1091-255x(99)80075-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [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] [Indexed: 01/31/2023]
Abstract
Restorative proctocolectomy with an ileal pouch-anal anastomosis is performed in an increasing number of patients with familial adenomatous polyposis (FAP). Two techniques are currently used to construct an ileal pouch-anal anastomosis: (1) a double-stapled anastomosis between the pouch and the anal canal and (2) mucosectomy with a hand-sewn ileoanal anastomosis at the dentate line. Although this procedure is thought to abolish the risk of colorectal adenoma, an increasing number of case reports have been published concerning the development of adenoma at the anastomotic site. The purpose of this study was to evaluate the overall cumulative risk of developing adenomatous polyps after ileal pouch-anal anastomosis and to compare the cumulative risk after either anastomotic technique. A total of 126 consecutive FAP patients undergoing a restorative proctocolectomy were identified from polyposis registries in The Netherlands, Denmark, Italy, Germany, and New York. Life-table analysis was used to calculate the cumulative risk of developing polyps in 97 patients with at least 1 year of endoscopic follow-up (median 66 months, range 12 to 188 months). A double-stapled anastomosis was used in 35 patients, whereas in 62 patients a hand-sewn anastomosis with a mucosectomy was performed. In 13 patients polyps developed at the anastomotic site, four with severe and four with moderate dysplasia. None of the patients developed a carcinoma at the anastomotic site. The cumulative risk of developing a polyp at the anastomotic site was 8% (95% confidence interval 2% to 14%) at 3.5 years and 18% (95% confidence interval 8% to 28%) at 7 years, respectively. The risk of developing a polyp at the anastomotic site within 7 years was 31% for patients with a double-stapled vs. 10% for patients with a hand-sewn anastomosis with mucosectomy (P = 0.03 [log-rank test]). Because FAP patients undergoing a restorative proctocolectomy with either a double-stapled or hand-sewn anastomosis have a substantial risk of developing adenomatous polyps at the anastomotic site, lifelong endoscopic surveillance is mandatory in both groups.
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Affiliation(s)
- P van Duijvendijk
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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Tada K, Roy-Chowdhury N, Prasad V, Kim BH, Manchikalapudi P, Fox IJ, van Duijvendijk P, Bosma PJ, Roy-Chowdhury J. Long-term amelioration of bilirubin glucuronidation defect in Gunn rats by transplanting genetically modified immortalized autologous hepatocytes. Cell Transplant 1998. [PMID: 9853589 DOI: 10.1016/s0963-6897(98)00035-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ex vivo gene therapy, in which hepatocytes are harvested from mutants, retrovirally transduced with a normal gene and transplanted back into the donor, has been used for correction of inherited metabolic defects of liver. Major drawbacks of this method include limited availability of autologous hepatocytes, inefficient retroviral transduction of primary hepatocytes, and the limited number of hepatocytes that can be transplanted safely. To obviate these problems, we transduced primary hepatocytes derived from inbred bilirubin-UDP-glucuronosyl-transferase (BUGT)-deficient Gunn rats by infection with a recombinant retrovirus expressing temperature-sensitive mutant SV40 large T antigen (tsT). The immortalized cells were then transduced with a second recombinant retrovirus expressing human B-UGT, and a clone expressing high levels of the enzyme was expanded by culturing at permissive temperature (33 degrees C). At 37 degrees C, tsT antigen was degraded and the cells expressed UGT activity toward bilirubin at a level approximately twice that present in normal rat liver homogenates. For seeding the cells into the liver bed, 1 x 10(7) cells were injected into the spleens of syngeneic Gunn rats five times at 10-day intervals. Excretion of bilirubin glucuronides in bile was demonstrated by HPLC analysis and serum bilirubin levels were reduced by 27 to 52% in 40 days after the first transplantation and remained so throughout the duration of the study (120 days). None of the transplanted Gunn rats or SCID mice transplanted with the immortalized cells developed tumors.
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Affiliation(s)
- K Tada
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10462, USA
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