1
|
van Geffen EGM, Langhout JMA, Hazen SJA, Sluckin TC, van Dieren S, Beets GL, Beets-Tan RGH, Borstlap WAA, Burger JWA, Horsthuis K, Intven MPW, Aalbers AGJ, Havenga K, Marinelli AWKS, Melenhorst J, Nederend J, Peulen HMU, Rutten HJT, Schreurs WH, Tuynman JB, Verhoef C, de Wilt JHW, Marijnen CAM, Tanis PJ, Kusters M, On Behalf Of The Dutch Snapshot Research Group. Evolution of clinical nature, treatment and survival of locally recurrent rectal cancer: Comparative analysis of two national cross-sectional cohorts. Eur J Cancer 2024; 202:114021. [PMID: 38520925 DOI: 10.1016/j.ejca.2024.114021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND In the Netherlands, use of neoadjuvant radiotherapy for rectal cancer declined after guideline revision in 2014. This decline is thought to affect the clinical nature and treatability of locally recurrent rectal cancer (LRRC). Therefore, this study compared two national cross-sectional cohorts before and after the guideline revision with the aim to determine the changes in treatment and survival of LRRC patients over time. METHODS Patients who underwent resection of primary rectal cancer in 2011 (n = 2094) and 2016 (n = 2855) from two nationwide cohorts with a 4-year follow up were included. Main outcomes included time to LRRC, synchronous metastases at time of LRRC diagnosis, intention of treatment and 2-year overall survival after LRRC. RESULTS Use of neoadjuvant (chemo)radiotherapy for the primary tumour decreased from 88.5% to 60.0% from 2011 to 2016. The 3-year LRRC rate was not significantly different with 5.1% in 2011 (n = 114, median time to LRRC 16 months) and 6.3% in 2016 (n = 202, median time to LRRC 16 months). Synchronous metastasis rate did not significantly differ (27.2% vs 33.7%, p = 0.257). Treatment intent of the LRRC shifted towards more curative treatment (30.4% vs. 47.0%, p = 0.009). In the curatively treated group, two-year overall survival after LRRC diagnoses increased from 47.5% to 78.7% (p = 0.013). CONCLUSION Primary rectal cancer patients in 2016 were treated less often with neoadjuvant (chemo)radiotherapy, while LRRC rates remained similar. Those who developed LRRC were more often candidate for curative intent treatment compared to the 2011 cohort, and survival after curative intent treatment also improved substantially.
Collapse
Affiliation(s)
- E G M van Geffen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J M A Langhout
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S J A Hazen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - T C Sluckin
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G L Beets
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - W A A Borstlap
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Horsthuis
- Department of Radiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M P W Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre Utrecht, the Netherlands
| | - A G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - K Havenga
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A W K S Marinelli
- Department of Surgery, Haaglanden Medisch Centrum, Den Haag, the Netherlands
| | - J Melenhorst
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - H M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - W H Schreurs
- Department of Surgery, Nothwest Clinics, Alkmaar, the Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - M Kusters
- Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
| | | |
Collapse
|
2
|
van der Aa DC, Gisbertz SS, Anderegg MCJ, Lagarde SM, Klaassen R, Meijer SL, van Dieren S, Hulshof M, Bergman J, Bennink RJ, van Laarhoven HWM, van Berge Henegouwen MI. 18F-FDG-PET/CT to Detect Pathological Complete Response After Neoadjuvant Treatment in Patients with Cancer of the Esophagus or Gastroesophageal Junction: Accuracy and Long-Term Implications. J Gastrointest Cancer 2023:10.1007/s12029-023-00951-2. [PMID: 37393217 DOI: 10.1007/s12029-023-00951-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The curative strategy for patients with esophageal cancer without distant metastases consists of esophagectomy with preceding chemo(radio)therapy (CRT). In 10-40% of patients treated with CRT, no viable tumor is detectable in the resection specimen (pathological complete response (pCR)). This study aims to define the clinical outcomes of patients with a pCR and to assess the accuracy of post-CRT FDG-PET/CT in the detection of a pCR. METHODS Four hundred sixty-three patients with cancer of the esophagus or gastroesophageal junction who underwent esophageal resection after CRT between 1994 and 2013 were included. Patients were categorized as pathological complete responders or noncomplete responders. Standardized uptake value (SUV) ratios of 135 post-CRT FDG-PET/CTs were calculated and compared with the pathological findings in the corresponding resection specimens. RESULTS Of the 463 included patients, 85 (18.4%) patients had a pCR. During follow-up, 25 (29.4%) of these 85 patients developed recurrent disease. Both 5-year disease-free survival (5y-DFS) and 5-year overall survival (5y-OS) were significantly higher in complete responders compared to noncomplete responders (5y-DFS 69.6% vs. 44.2%; P = 0.001 and 5y-OS 66.5% vs. 43.7%; P = 0.001). Not pCR, but only pN0 was identified as an independent predictor of (disease-free) survival. CONCLUSION Patients with a pCR have a higher probability of survival compared to noncomplete responders. One third of patients with a pCR do develop recurrent disease, and pCR can therefore not be equated with cure. FDG-PET/CT was inaccurate to predict pCR and therefore cannot be used as a sole diagnostic tool to predict pCR after CRT for esophageal cancer.
Collapse
Affiliation(s)
- D C van der Aa
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - M C J Anderegg
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - R Klaassen
- Department of Medical Oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - S L Meijer
- Department of Pathology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - McCm Hulshof
- Department of Radiotherapy, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - Jjghm Bergman
- Department of Gastroenterology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - R J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - H W M van Laarhoven
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands
- Department of Medical Oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands.
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.
| |
Collapse
|
3
|
van Oostendorp JY, Sluckin TC, Han-Geurts IJM, van Dieren S, Schouten R. Treatment of haemorrhoids: rubber band ligation or sclerotherapy (THROS)? Study protocol for a multicentre, non-inferiority, randomised controlled trial. Trials 2023; 24:374. [PMID: 37270601 DOI: 10.1186/s13063-023-07400-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/22/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Haemorrhoidal disease (HD) is a common condition with significant epidemiologic and economic implications. While it is possible to treat symptomatic grade 1-2 haemorrhoids with rubber band ligation (RBL) or sclerotherapy (SCL), the effectiveness of these treatments compatible with current standards has not yet been investigated with a randomised controlled trial. The hypothesis is that SCL is not inferior to RBL in terms of symptom reduction (patient-related outcome measures (PROMs)), patient experience, complications or recurrence rate. METHODS AND ANALYSIS This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy for symptomatic grade 1-2 haemorrhoids in adults (> 18 years). Patients are preferably randomised between the two treatment arms. However, patients with a strong preference for one of the treatments and refuse randomisation are eligible for the registration arm. Patients either receive 4 cc Aethoxysklerol 3% SCL or 3 × RBL. The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates. Secondary outcome measures are patient experience, number of treatments and days of sick leave from work. Data are collected at 4 different time points. DISCUSSION The THROS trial is the first large multicentre randomised trial to study the difference in effectivity between RBL and SCL for the treatment of grade 1-2 HD. It will provide information as to which treatment method (RBL or SCL) is the most effective, gives fewer complications and is experienced by the patient as the best option. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers, location AMC (nr. 2020_053). The gathered data and results will be submitted for publication in peer-reviewed journals and spread to coloproctological associations and guidelines. TRIAL REGISTRATION Dutch Trial Register NL8377 . Registered on 12-02-2020.
Collapse
Affiliation(s)
- J Y van Oostendorp
- Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Proctos Kliniek, Prof. Bronkhorstlaan 10, 3823 MB, Bilthoven, The Netherlands
| | - T C Sluckin
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - I J M Han-Geurts
- Proctos Kliniek, Prof. Bronkhorstlaan 10, 3823 MB, Bilthoven, The Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - R Schouten
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
| |
Collapse
|
4
|
Doppenberg D, Lagerwaard FJ, van Dieren S, Meijerink MR, van der Vliet JJ, Besselink MG, van Tienhoven G, Versteijne E, Slotman BJ, Wilmink JW, Kazemier G, Bruynzeel AME. Optimizing patient selection for stereotactic ablative radiotherapy in patients with locally advanced pancreatic cancer after initial chemotherapy - a single center prospective cohort. Front Oncol 2023; 13:1149961. [PMID: 37324027 PMCID: PMC10264658 DOI: 10.3389/fonc.2023.1149961] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Background The role of stereotactic ablative radiation therapy (SABR) as local treatment option after chemotherapy for locally advanced pancreatic cancer (LAPC) is evolving. However adequate patient selection criteria for SABR in patients with LAPC are lacking. Methods A prospective institutional database collected data of patients with LAPC treated with chemotherapy, mainly FOLFIRINOX, followed by SABR, which was delivered using magnetic resonance guided radiotherapy, 40 Gy in 5 fractions within two weeks. Primary endpoint was overall survival (OS). Cox regression analyses were performed to identify predictors for OS. Results Overall, 74 patients were included, median age 66 years, 45.9% had a KPS score of ≥90. Median OS was 19.6 months from diagnosis and 12.1 months from start of SABR. Local control was 90% at one year. Multivariable Cox regression analyses identified KPS ≥90, age <70, and absence of pain prior to SABR as independent favorable predictors for OS. The rate of grade ≥3 fatigue and late gastro-intestinal toxicity was 2.7%. Conclusions SABR is a well-tolerated treatment in patients with unresectable LAPC following chemotherapy, with better outcomes when applied in patients with higher performance score, age <70 years and absence of pain. Future randomized trials will have to confirm these findings.
Collapse
Affiliation(s)
- D. Doppenberg
- Amsterdam UMC, Department of Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands
| | - F. J. Lagerwaard
- Amsterdam UMC, Department of Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| | - S. van Dieren
- Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands
| | - M. R. Meijerink
- Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department Intervention Radiology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J. J. van der Vliet
- Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Medical Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- LAVA Therapeutics, Utrecht, Netherlands
| | - M. G. Besselink
- Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, Netherlands
| | - G. van Tienhoven
- Amsterdam UMC, Department of Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| | - E. Versteijne
- Amsterdam UMC, Department of Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| | - B. J. Slotman
- Amsterdam UMC, Department of Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| | - J. W. Wilmink
- Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Medical Oncology, University of Amsterdam, Amsterdam, Netherlands
| | - G. Kazemier
- Cancer Center Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Surgery, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - A. M. E. Bruynzeel
- Amsterdam UMC, Department of Radiation Oncology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
5
|
Geraedts A, Mulay S, Vahl A, Verhagen H, Wisselink W, de Mik S, van Dieren S, Koelemay M, Balm R, Balm R, Elshof J, Elsman B, Hamming J, Koelemay M, Kropman R, Poyck P, Schurink G, de Smet A, van Sterkenburg S, Ünlü C, Vahl A, Verhagen H, Vriens P, de Vries J, Wever J, Wisselink W, Zeebregts C. Post-operative Surveillance and Long Term Outcome after Endovascular Aortic Aneurysm Repair in Patients with an Initial Post-operative Computed Tomography Angiogram Without Abnormalities: the Multicentre Retrospective ODYSSEUS Study. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Selles CA, Mulders MAM, van Dieren S, Goslings JC, Schep NWL. Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures. J Bone Joint Surg Am 2021; 103:1970-1976. [PMID: 34314400 DOI: 10.2106/jbjs.20.01345] [Citation(s) in RCA: 6] [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: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to compare the cost-effectiveness and cost-utility between plaster cast immobilization and volar plate fixation for acceptably reduced intra-articular distal radial fractures. METHODS A cost-effectiveness analysis was conducted as part of a randomized controlled trial comparing operative (volar plate fixation) with nonoperative (plaster cast immobilization) treatment in patients between 18 and 75 years old with an acceptably reduced intra-articular distal radial fracture. Health-care utilization and use of resources per patient were documented prospectively and included direct medical costs, direct non-medical costs, and indirect costs. All analyses were performed according to the intention-to-treat principle. RESULTS The mean total cost per patient was $291 (95% bias-corrected and accelerated confidence interval [bcaCI] = -$1,286 to $1,572) higher in the operative group compared with the nonoperative group. The mean total number of quality-adjusted life-years (QALYs) gained at 12 months was significantly higher in the operative group than in the nonoperative group (mean difference = 0.15; 95% bcaCI = 0.056 to 0.243). The difference in the cost per QALY (incremental cost-effectiveness ratio [ICER]) was $2,008 (95% bcaCI = -$9,608 to $18,222) for the operative group compared with the nonoperative group, which means that operative treatment is more effective but also more expensive. Subgroup analysis including only patients with a paid job showed that the ICER was -$3,500 per QALY for the operative group with a paid job compared with the nonoperative group with a paid job, meaning that operative treatment is more effective and less expensive for patients with a paid job. CONCLUSIONS The difference in QALYs gained for the operatively treated group was equivalent to an additional 55 days of perfect health per year. In adult patients with an acceptably reduced intra-articular distal radial fracture, operative treatment is a cost-effective intervention, especially in patients with paid employment. Operative treatment is slightly more expensive than nonoperative treatment but provides better functional results and a better quality of life. LEVEL OF EVIDENCE Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- C A Selles
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.,Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - M A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - S van Dieren
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - J C Goslings
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - N W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | |
Collapse
|
7
|
Musters S, van Noort H, van Dieren S, Geelen S, Maaskant J, Bemelman W, Nieveen van Dijkum E, Besselink M, Eskes A. CN11 Impact of a surgical ward breakfast buffet on nutritional intake in postoperative (oncological) patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
8
|
Dekker L, Han-Geurts IJM, Rørvik HD, van Dieren S, Bemelman WA. Rubber band ligation versus haemorrhoidectomy for the treatment of grade II-III haemorrhoids: a systematic review and meta-analysis of randomised controlled trials. Tech Coloproctol 2021; 25:663-674. [PMID: 33683503 PMCID: PMC8124052 DOI: 10.1007/s10151-021-02430-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/15/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The aim of this study was to review clinical outcome of haemorrhoidectomy and rubber band ligation in grade II-III haemorrhoids. METHODS A systematic review was conducted. Medline, Embase, Cochrane Library, Clinicaltrials.gov, and the WHO International Trial Registry Platform were searched, from inception until May 2018, to identify randomised clinical trials comparing rubber band ligation with haemorrhoidectomy for grade II-III haemorrhoids. The primary outcome was control of symptoms. Secondary outcomes included postoperative pain, postoperative complications, anal continence, patient satisfaction, quality of life and healthcare costs were assessed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Three hundred and twenty-four studies were identified. Eight trials met the inclusion criteria. All trials were of moderate methodological quality. Outcome measures were diverse and not clearly defined. Control of symptoms was better following haemorrhoidectomy. Patients had less pain after rubber band ligation. There were more complications (bleeding, urinary retention, anal incontinence/stenosis) in the haemorrhoidectomy group. Patient satisfaction was equal in both groups. There were no data on quality of life and healthcare costs except that in one study patients resumed work more early after rubber band ligation. CONCLUSIONS Haemorrhoidectomy seems to provide better symptom control but at the cost of more pain and complications. However, due to the poor quality of the studies analysed/it is not possible to determine which of the two procedures provides the best treatment for grade II-III haemorrhoids. Further studies focusing on clearly defined outcome measurements taking patients perspective and economic impact into consideration are required.
Collapse
Affiliation(s)
- L Dekker
- Department of Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands.
| | - I J M Han-Geurts
- Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands
| | - H D Rørvik
- Department of Surgery, Holbæk Hospital, Holbæk, Denmark
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | - S van Dieren
- Department of Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Heidsma CM, Engelsman AF, van Dieren S, Stommel MWJ, de Hingh I, Vriens M, Hol L, Festen S, Mekenkamp L, Hoogwater FJH, Daams F, Klümpen HJ, Besselink MG, van Eijck CH, Nieveen van Dijkum EJ. Watchful waiting for small non-functional pancreatic neuroendocrine tumours: nationwide prospective cohort study (PANDORA). Br J Surg 2021; 108:888-891. [PMID: 33783475 PMCID: PMC10364894 DOI: 10.1093/bjs/znab088] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
This prospective nationwide cohort study examined the feasibility of a watchful-waiting protocol for non-functional pancreatic neuroendocrine tumours (NF-pNET) of 2 cm or smaller. In total, 8 of 76 patients (11 per cent) with a NF-pNET no larger than 2 cm showed significant tumour progression (more than 0.5 cm/year) during 17 months of follow-up, of whom two opted for resection. No patient developed metastases. Quality of life was poorer than in the reference population. Watchful waiting seems a safe alternative to upfront surgery in patients with a NF-pNET no larger than 2 cm, although longer follow-up is necessary.
Collapse
Affiliation(s)
- C M Heidsma
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A F Engelsman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M W J Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - I de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - M Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L Hol
- Department of Gastroenterology and Metabolism, Maasstad Hospital, Rotterdam, the Netherlands
| | - S Festen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - L Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - F J H Hoogwater
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - F Daams
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - H-J Klümpen
- 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
| | - C H van Eijck
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - E J Nieveen van Dijkum
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Stellingwerf ME, Bemelman WA, Löwenberg M, Ponsioen CY, D'Haens GR, van Dieren S, Buskens CJ. A nationwide database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy? Colorectal Dis 2021; 23:64-73. [PMID: 32524670 DOI: 10.1111/codi.15184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/20/2020] [Indexed: 02/08/2023]
Abstract
AIM Although has been suggested that an appendectomy has a positive effect on the disease course in patients with ulcerative colitis (UC), recent studies indicate a potential increase in risk of colectomy and colorectal cancer (CRC). This study aimed to evaluate the rates of colectomy and CRC after appendectomy in UC patients using a nationwide prospective database [the Initiative on Crohn and Colitis Parelsnoer Institute - Inflammatory Bowel Disease (ICC PSI-IBD) database]. METHOD All UC patients were retrieved from the ICC PSI-IBD database between January 2007 and May 2018. Primary outcomes were colectomy and CRC. Outcomes were compared in patients with and without appendectomy, with a separate analysis for timing of appendectomy (before or after UC diagnosis). RESULTS A total of 826 UC patients (54.7% female; median age 46 years, range 18-89 years) were included. Sixty-three (7.6%) patients had previously undergone appendectomy: 24 (38.1%) before and 33 (52.4%) after their diagnosis of UC. In multivariate analysis, appendectomy after UC diagnosis was associated with a significantly lower colectomy rate compared with no appendectomy [hazard ratio (HR) 0.16, 95% C: 0.04-0.66, P = 0.011], and the same nonsignificant trend was seen in patients with an appendectomy before UC diagnosis (HR 0.35, 95% CI 0.08-1.41, P = 0.138). Appendectomy was associated with delayed colectomy, particularly when it was performed after diagnosis of UC (P = 0.009). No significant differences were found in the CRC rate between patients with and without appendectomy (1.6% vs 1.2%; P = 0.555). CONCLUSION Appendectomy in established UC is associated with an 84% decreased risk of colectomy and a delay in surgery. Since the colon is in situ for longer, the risk of developing CRC remains, which underscores the importance of endoscopic surveillance programmes.
Collapse
Affiliation(s)
- M E Stellingwerf
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - G R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
11
|
Slooter MD, Talboom K, Sharabiany S, van Helsdingen CPM, van Dieren S, Ponsioen CY, Nio CY, Consten ECJ, Wijsman JH, Boermeester MA, Derikx JPM, Musters GD, Bemelman WA, Tanis PJ, Hompes R. IMARI: multi-Interventional program for prevention and early Management of Anastomotic leakage after low anterior resection in Rectal cancer patIents: rationale and study protocol. BMC Surg 2020; 20:240. [PMID: 33059647 PMCID: PMC7565357 DOI: 10.1186/s12893-020-00890-w] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background Anastomotic leakage (AL) is still a common and feared complication after low anterior resection (LAR) for rectal cancer. The multifactorial pathophysiology of AL and lack of standardised treatment options requires a multi-modal approach to improve long-term anastomotic integrity. The objective of the IMARI-trial is to determine whether the one-year anastomotic integrity rate in patients undergoing LAR for rectal cancer can be improved using a multi-interventional program. Methods IMARI is a multicentre prospective clinical effectiveness trial, whereby current local practice (control cohort) will be evaluated, and subsequently compared to results after implementation of the multi-interventional program (intervention cohort). Patients undergoing LAR for rectal cancer will be included. The multi-interventional program includes three preventive interventions (mechanical bowel preparation with oral antibiotics, tailored full splenic flexure mobilization and intraoperative fluorescence angiography using indocyanine green) combined with a standardised pathway for early detection and active management of AL. The primary outcome is anastomotic integrity, confirmed by CT-scan at one year postoperatively. Secondary outcomes include incidence of AL, protocol compliance and association with AL, temporary and permanent stoma rate, reintervention rate, quality of life and functional outcome. Microbiome analysis will be conducted to investigate the role of the rectal microbiome in AL. In a Dutch nationwide study, the AL rate was 20%, with anastomotic integrity of 90% after one year. Based on an expected reduction of AL due to the preventive approaches of 50%, and increase of anastomotic integrity by a standardised pathway for early detection and active management of AL, we hypothesised that the anastomotic integrity rate will increase from 90 to 97% at one year. An improvement of 7% in anastomotic integrity at one year was considered clinically relevant. A total number of 488 patients (244 per cohort) are needed to detect this difference, with 80% statistical power. Discussion The IMARI-trial is designed to evaluate whether a multi-interventional program can improve long-term anastomotic integrity after rectal cancer surgery. The uniqueness of IMARI lies in the multi-modal design that addresses the multifactorial pathophysiology for prevention, and a standardised pathway for early detection and active treatment of AL. Trial registration Trialregister.nl (NL8261), January 2020.
Collapse
Affiliation(s)
- M D Slooter
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - K Talboom
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
| | - S Sharabiany
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - S van Dieren
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - C Y Ponsioen
- Department of Gastroenterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - C Y Nio
- Department of Radiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - J H Wijsman
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - M A Boermeester
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J P M Derikx
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - G D Musters
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
| | | |
Collapse
|
12
|
Slooter MD, de Bruin DM, Eshuis WJ, Veelo DP, van Dieren S, Gisbertz SS, van Berge Henegouwen MI. Quantitative fluorescence-guided perfusion assessment of the gastric conduit to predict anastomotic complications after esophagectomy. Dis Esophagus 2020; 34:5917378. [PMID: 33016305 PMCID: PMC8141822 DOI: 10.1093/dote/doaa100] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fluorescence angiography (FA) assesses anastomotic perfusion during esophagectomy with gastric conduit reconstruction, but its interpretation is subjective. This study evaluated time to fluorescent enhancement in the gastric conduit, with the aim to determine a threshold to predict postoperative anastomotic complications. METHODS In a prospective cohort study, all consecutive patients undergoing esophagectomy with gastric conduit reconstruction from July 2018 to October 2019 were included. FA was performed before anastomotic reconstruction following injection of indocyanine green (ICG). During FA, the following time points were recorded: ICG injection, first fluorescent enhancement in the lung, at the base of the gastric conduit, at the planned anastomotic site, and at ICG watershed or in the tip of the gastric conduit. Anastomotic complications including anastomotic leakage and clinically relevant strictures were documented. RESULTS Eighty-four patients were included, the majority (67 out of 84, 80%) of which underwent an Ivor Lewis procedure. After a median follow-up of 297 days, anastomotic leakage was observed in 12 out of 84 (14.3%) and anastomotic stricture in 12 out of 82 (14.6%). Time between ICG injection and enhancement in the tip was predictive for anastomotic leakage (P = 0.174, area under the curve = 0.731), and a cut-off value of 98 seconds was derived (specificity: 98%). All times to enhancement at the planned anastomotic site and ICG watershed were significantly predictive for the occurrence of a stricture, however area under the curves were <0.7. CONCLUSIONS The identified fluorescent threshold can be used for intraoperative decision making or to identify potentially high-risk patients for anastomotic leakage after esophagectomy with gastric conduit reconstruction.
Collapse
Affiliation(s)
- M D Slooter
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - D M de Bruin
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, the Netherlands
| | - W J Eshuis
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - D P Veelo
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Amsterdam, the Netherlands
| | - S van Dieren
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - S S Gisbertz
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - M I van Berge Henegouwen
- Address correspondence to: Professor Dr M.I. van Berge Henegouwen, MD, PhD, surgeon, Department of Surgery, Amsterdam University Medical Centres (UMC), location Academic Medical Centre (AMC), Postbox 22660, 1100 DD Amsterdam, the Netherlands.
| |
Collapse
|
13
|
Schreuder AM, Nunez Vas BC, Booij KAC, van Dieren S, Besselink MG, Busch OR, van Gulik TM. Optimal timing for surgical reconstruction of bile duct injury: meta-analysis. BJS Open 2020; 4:776-786. [PMID: 32852893 PMCID: PMC7528508 DOI: 10.1002/bjs5.50321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background Major bile duct injury (BDI) after cholecystectomy generally requires surgical reconstruction by means of hepaticojejunostomy. However, there is controversy regarding the optimal timing of surgical reconstruction. Methods A systematic review was performed by searching PubMed, Embase and Cochrane databases for studies published between 1990 and 2018 reporting on the timing of hepaticojejunostomy for BDI (PROSPERO registration CRD42018106611). The main outcomes were postoperative morbidity, postoperative mortality and anastomotic stricture. When individual patient data were available, time intervals of these studies were attuned to render these comparable with other studies. Data for comparable time intervals were pooled using a random‐effects model. In addition, data for all included studies were pooled using a generalized linear model. Results Some 21 studies were included, representing 2484 patients. In these studies, 15 different time intervals were used. Eight studies used the time intervals of less than 14 days (early), 14 days to 6 weeks (intermediate) and more than 6 weeks (delayed). Meta‐analysis revealed a higher risk of postoperative morbidity in the intermediate interval (early versus intermediate: risk ratio (RR) 0·73, 95 per cent c.i. 0·54 to 0·98; intermediate versus delayed: RR 1·50, 1·16 to 1·93). Stricture rate was lowest in the delayed interval group (intermediate versus delayed: RR 1·53, 1·07 to 2·20). Postoperative mortality did not differ within time intervals. The additional analysis demonstrated increased odds of postoperative morbidity for reconstruction between 2 and 6 weeks, and decreased odds of anastomotic stricture for delayed reconstruction. Conclusion This meta‐analysis found that surgical reconstruction of BDI between 2 and 6 weeks should be avoided as this was associated with higher risk of postoperative morbidity and hepaticojejunostomy stricture.
Collapse
Affiliation(s)
- A M Schreuder
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B C Nunez Vas
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - K A C Booij
- Department of Plastic and Reconstructive Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - O R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Dingemans SA, Birnie MFN, Sanders FRK, van den Bekerom MPJ, Backes M, van Beeck E, Bloemers FW, van Dijkman B, Flikweert E, Haverkamp D, Holtslag HR, Hoogendoorn JM, Joosse P, Parkkinen M, Roukema G, Sosef N, Twigt BA, van Veen RN, van der Veen AH, Vermeulen J, Winkelhagen J, van der Zwaard BC, van Dieren S, Goslings JC, Schepers T. Correction to: Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial). BMC Musculoskelet Disord 2020; 21:520. [PMID: 32758205 PMCID: PMC7409494 DOI: 10.1186/s12891-020-03516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S A Dingemans
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M F N Birnie
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - F R K Sanders
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M Backes
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - E van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - F W Bloemers
- Department of Surgery, Trauma Unit, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - B van Dijkman
- Department of Surgery, Flevo Hospital, P.O. Box 3005, 1300 EG, Almere, The Netherlands
| | - E Flikweert
- Department of Surgery, Deventer Hospital, P.O. Box 5001, 7400 GC, Deventer, The Netherlands
| | - D Haverkamp
- Department of Surgery, Slotervaart Hospital, P.O. Box 90440, 1006 BK, Amsterdam, The Netherlands
| | - H R Holtslag
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J M Hoogendoorn
- Department of Surgery, Haaglanden MC, P.O. Box 432, 2501 CK, The Hague, The Netherlands
| | - P Joosse
- Department of Surgery, Noordwest Hospital Group, P.O. Box 501, 1815 JD, Alkmaar, The Netherlands
| | - M Parkkinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - G Roukema
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands
| | - N Sosef
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - B A Twigt
- Department of Surgery, BovenIJ Hospital, P.O. Box 37610, 1030 BD, Amsterdam, The Netherlands
| | - R N van Veen
- Department of Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - A H van der Veen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands
| | - J Vermeulen
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - J Winkelhagen
- Department of Surgery, Westfries Hospital, P.O. Box 600, 1620 AR, Hoorn, The Netherlands
| | - B C van der Zwaard
- Department of Orthopaedics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | - S van Dieren
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J C Goslings
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - T Schepers
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
15
|
Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, Tanis PJ, Bemelman WA. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg 2020; 107:1414-1428. [PMID: 32639049 PMCID: PMC7540681 DOI: 10.1002/bjs.11759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/24/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.
Collapse
Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - J E Tuijp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - L Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Korrel M, Lof S, van Hilst J, Alseidi A, Boggi U, Busch OR, van Dieren S, Edwin B, Fuks D, Hackert T, Keck T, Khatkov I, Malleo G, Poves I, Sahakyan MA, Bassi C, Abu Hilal M, Besselink MG. Predictors for Survival in an International Cohort of Patients Undergoing Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 2020; 28:1079-1087. [PMID: 32583198 PMCID: PMC7801299 DOI: 10.1245/s10434-020-08658-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Background Surgical factors, including resection of Gerota’s fascia, R0-resection, and lymph node yield, may be associated with survival after distal pancreatectomy (DP) for pancreatic ductal adenocarcinoma (PDAC), but evidence from large multicenter studies is lacking. This study aimed to identify predictors for overall survival after DP for PDAC, especially those related to surgical technique. Patients and Methods Data from an international retrospective cohort including patients from 11 European countries and the USA who underwent DP for PDAC (2007–2015) were analyzed. Cox proportional hazard analyses were performed and included Gerota’s fascia resection, R0 resection, lymph node ratio, extended resection, and a minimally invasive approach. Results Overall, 1200 patients from 34 centers with median follow-up of 15 months [interquartile range (IQR) 5–31 months] and median survival period of 30 months [95% confidence interval (CI), 27–33 months] were included. Gerota’s fascia resection [hazard ratio (HR) 0.74; p = 0.019], R0 resection (HR 0.70; p = 0.006), and decreased lymph node ratio (HR 0.28; p < 0.001) were associated with improved overall survival, whereas extended resection (HR 1.75; p < 0.001) was associated with worse overall survival. A minimally invasive approach did not improve survival as compared with an open approach (HR 1.14; p = 0.350). Adjuvant chemotherapy (HR 0.67; p = 0.003) was also associated with improved overall survival. Conclusions This international cohort identified Gerota’s fascia resection, R0 resection, and decreased lymph node ratio as factors associated with improved overall survival during DP for PDAC. Surgeons should strive for R0 resection and adequate lymphadenectomy and could also consider Gerota’s fascia resection in their routine surgical approach. Electronic supplementary material The online version of this article (10.1245/s10434-020-08658-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Korrel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - J van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, OLVG Oost, Amsterdam, The Netherlands
| | - A Alseidi
- Division of Hepatopancreatobiliary and Endocrine Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - U Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - O R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B Edwin
- Department of HPB Surgery, The Intervention Center, Institute for Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - D Fuks
- Department of Surgery, Institut Mutualiste Montsouris, Paris, France
| | - T Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Keck
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - I Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - G Malleo
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - I Poves
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - M A Sahakyan
- Department of HPB Surgery, The Intervention Center, Institute for Clinical Medicine, Oslo University Hospital, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - C Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - M Abu Hilal
- Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | |
Collapse
|
17
|
Lambrichts DPV, van Dieren S, Bemelman WA, Lange JF. Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial. Br J Surg 2020; 107:1686-1694. [PMID: 32521053 PMCID: PMC7687276 DOI: 10.1002/bjs.11715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/11/2020] [Accepted: 04/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several studies have been published favouring sigmoidectomy with primary anastomosis over Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis (Hinchey grade III or IV), but cost-related outcomes were rarely reported. The present study aimed to evaluate costs and cost-effectiveness within the DIVA arm of the Ladies trial. METHODS This was a cost-effectiveness analysis of the DIVA arm of the multicentre randomized Ladies trial, comparing primary anastomosis over Hartmann's procedure for Hinchey grade III or IV diverticulitis. During 12-month follow-up, data on resource use, indirect costs (Short Form Health and Labour Questionnaire) and quality of life (EuroQol Five Dimensions) were collected prospectively, and analysed according to the modified intention-to-treat principle. Main outcomes were incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, expressed as the ratio of incremental costs and the incremental probability of being stoma-free or incremental quality-adjusted life-years respectively. RESULTS Overall, 130 patients were included, of whom 64 were allocated to primary anastomosis (46 and 18 with Hinchey III and IV disease respectively) and 66 to Hartmann's procedure (46 and 20 respectively). Overall mean costs per patient were lower for primary anastomosis (€20 544, 95 per cent c.i. 19 569 to 21 519) than Hartmann's procedure (€28 670, 26 636 to 30 704), with a mean difference of €-8126 (-14 660 to -1592). The ICER was €-39 094 (95 per cent bias-corrected and accelerated (BCa) c.i. -1213 to -116), indicating primary anastomosis to be more cost-effective. The ICUR was €-101 435 (BCa c.i. -1 113 264 to 251 840). CONCLUSION Primary anastomosis is more cost-effective than Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis.
Collapse
Affiliation(s)
- D P V Lambrichts
- Departments of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Amsterdam University Medical Centre, AMC, Amsterdam, the Netherlands
| | - S van Dieren
- Amsterdam University Medical Centre, AMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Amsterdam University Medical Centre, AMC, Amsterdam, the Netherlands
| | - J F Lange
- Departments of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.,IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| |
Collapse
|
18
|
Detering R, van Oostendorp SE, Meyer VM, van Dieren S, Bos ACRK, Dekker JWT, Reerink O, van Waesberghe JHTM, Marijnen CAM, Moons LMG, Beets-Tan RGH, Hompes R, van Westreenen HL, Tanis PJ, Tuynman JB. MRI cT1-2 rectal cancer staging accuracy: a population-based study. Br J Surg 2020; 107:1372-1382. [PMID: 32297326 PMCID: PMC7496930 DOI: 10.1002/bjs.11590] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 01/25/2023]
Abstract
Background Adequate MRI‐based staging of early rectal cancers is essential for decision‐making in an era of organ‐conserving treatment approaches. The aim of this population‐based study was to determine the accuracy of routine daily MRI staging of early rectal cancer, whether or not combined with endorectal ultrasonography (ERUS). Methods Patients with cT1–2 rectal cancer who underwent local excision or total mesorectal excision (TME) without downsizing (chemo)radiotherapy between 1 January 2011 and 31 December 2018 were selected from the Dutch ColoRectal Audit. The accuracy of imaging was expressed as sensitivity, specificity, and positive predictive value (PPV) and negative predictive value. Results Of 7382 registered patients with cT1–2 rectal cancer, 5539 were included (5288 MRI alone, 251 MRI and ERUS; 1059 cT1 and 4480 cT2). Among patients with pT1 tumours, 54·7 per cent (792 of 1448) were overstaged by MRI alone, and 31·0 per cent (36 of 116) by MRI and ERUS. Understaging of pT2 disease occurred in 8·2 per cent (197 of 2388) and 27·9 per cent (31 of 111) respectively. MRI alone overstaged pN0 in 17·3 per cent (570 of 3303) and the PPV for assignment of cN0 category was 76·3 per cent (2733 of 3583). Of 834 patients with pT1 N0 disease, potentially suitable for local excision, tumours in 253 patients (30·3 per cent) were staged correctly as cT1 N0, whereas 484 (58·0 per cent) and 97 (11·6 per cent) were overstaged as cT2 N0 and cT1–2 N1 respectively. Conclusion This Dutch population‐based analysis of patients who underwent local excision or TME surgery for cT1–2 rectal cancer based on preoperative MRI staging revealed substantial overstaging, indicating the weaknesses of MRI and missed opportunities for organ preservation strategies.
Collapse
Affiliation(s)
- R Detering
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S E van Oostendorp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - V M Meyer
- Department of Surgery, Zwolle, the Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A C R K Bos
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - O Reerink
- Department of Radiotherapy, Isala Hospital, Zwolle, the Netherlands
| | | | | | - L M G Moons
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Hompes
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J B Tuynman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | | |
Collapse
|
19
|
Mackay TM, Smits FJ, Latenstein AEJ, Bogte A, Bonsing BA, Bos H, Bosscha K, Brosens LAA, Hol L, Busch ORC, Creemers GJ, Curvers WL, den Dulk M, van Dieren S, van Driel LMJW, Festen S, van Geenen EJM, van der Geest LG, de Groot DJA, de Groot JWB, Haj Mohammad N, Haberkorn BCM, Haver JT, van der Harst E, Hemmink GJM, de Hingh IH, Hoge C, Homs MYV, van Huijgevoort NC, Jacobs MAJM, Kerver ED, Liem MSL, Los M, Lubbinge H, Luelmo SAC, de Meijer VE, Mekenkamp L, Molenaar IQ, van Oijen MGH, Patijn GA, Quispel R, van Rijssen LB, Römkens TEH, van Santvoort HC, Schreinemakers JMJ, Schut H, Seerden T, Stommel MWJ, Ten Tije AJ, Venneman NG, Verdonk RC, Verheij J, van Vilsteren FGI, de Vos-Geelen J, Vulink A, Wientjes C, Wit F, Wessels FJ, Zonderhuis B, van Werkhoven CH, van Hooft JE, van Eijck CHJ, Wilmink JW, van Laarhoven HWM, Besselink MG. Impact of nationwide enhanced implementation of best practices in pancreatic cancer care (PACAP-1): a multicenter stepped-wedge cluster randomized controlled trial. Trials 2020; 21:334. [PMID: 32299515 PMCID: PMC7161112 DOI: 10.1186/s13063-020-4180-z] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/18/2020] [Indexed: 01/05/2023] Open
Abstract
Background Pancreatic cancer has a very poor prognosis. Best practices for the use of chemotherapy, enzyme replacement therapy, and biliary drainage have been identified but their implementation in daily clinical practice is often suboptimal. We hypothesized that a nationwide program to enhance implementation of these best practices in pancreatic cancer care would improve survival and quality of life. Methods/design PACAP-1 is a nationwide multicenter stepped-wedge cluster randomized controlled superiority trial. In a per-center stepwise and randomized manner, best practices in pancreatic cancer care regarding the use of (neo)adjuvant and palliative chemotherapy, pancreatic enzyme replacement therapy, and metal biliary stents are implemented in all 17 Dutch pancreatic centers and their regional referral networks during a 6-week initiation period. Per pancreatic center, one multidisciplinary team functions as reference for the other centers in the network. Key best practices were identified from the literature, 3 years of data from existing nationwide registries within the Dutch Pancreatic Cancer Project (PACAP), and national expert meetings. The best practices follow the Dutch guideline on pancreatic cancer and the current state of the literature, and can be executed within daily clinical practice. The implementation process includes monitoring, return visits, and provider feedback in combination with education and reminders. Patient outcomes and compliance are monitored within the PACAP registries. Primary outcome is 1-year overall survival (for all disease stages). Secondary outcomes include quality of life, 3- and 5-year overall survival, and guideline compliance. An improvement of 10% in 1-year overall survival is considered clinically relevant. A 25-month study duration was chosen, which provides 80% statistical power for a mortality reduction of 10.0% in the 17 pancreatic cancer centers, with a required sample size of 2142 patients, corresponding to a 6.6% mortality reduction and 4769 patients nationwide. Discussion The PACAP-1 trial is designed to evaluate whether a nationwide program for enhanced implementation of best practices in pancreatic cancer care can improve 1-year overall survival and quality of life. Trial registration ClinicalTrials.gov, NCT03513705. Trial opened for accrual on 22th May 2018.
Collapse
Affiliation(s)
- T M Mackay
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - F J Smits
- Department of surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A E J Latenstein
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - A Bogte
- Department of gastroenterology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | - B A Bonsing
- Department of surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - H Bos
- Department of medical oncology, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - K Bosscha
- Department of surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - L A A Brosens
- Department of pathology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of pathology, Radboud University, Nijmegen, the Netherlands
| | - L Hol
- Department of gastroenterology, Maasstad Hospital, Rotterdam, the Netherlands
| | - O R C Busch
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - G J Creemers
- Department of medical oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - W L Curvers
- Department of gastroenterology, Catharina Hospital, Eindhoven, the Netherlands
| | - M den Dulk
- Department of surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - S van Dieren
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - L M J W van Driel
- Department of gastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - S Festen
- Department of surgery, OLVG, Amsterdam, the Netherlands
| | - E J M van Geenen
- Department of gastroenterology, Radboud UMC, Nijmegen, the Netherlands
| | - L G van der Geest
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - D J A de Groot
- Department of medical oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - J W B de Groot
- Department of medical oncology, Oncology Center Isala, Zwolle, the Netherlands
| | - N Haj Mohammad
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | - B C M Haberkorn
- Department of medical oncology, Maasstad Hospital, Rotterdam, the Netherlands
| | - J T Haver
- Department of nutrition and dietetics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - E van der Harst
- Department of surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - G J M Hemmink
- Department of gastroenterology, Oncology Center Isala, Zwolle, the Netherlands
| | - I H de Hingh
- Department of surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - C Hoge
- Department of gastroenterology, Maastricht UMC+, Maastricht, the Netherlands
| | - M Y V Homs
- Department of medical oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N C van Huijgevoort
- Department of gastroenterology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M A J M Jacobs
- Department of gastroenterology, Cancer Center Amsterdam, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands
| | - E D Kerver
- Department of medical oncology, OLVG, Amsterdam, the Netherlands
| | - M S L Liem
- Department of surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M Los
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | - H Lubbinge
- Department of gastroenterology, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - S A C Luelmo
- Department of medical oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - V E de Meijer
- Department of surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - L Mekenkamp
- Department of medical oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - I Q Molenaar
- Department of surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | - M G H van Oijen
- Department of medical oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - G A Patijn
- Department of surgery, Oncology Center Isala, Zwolle, the Netherlands
| | - R Quispel
- Department of gastroenterology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - L B van Rijssen
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - T E H Römkens
- Department of gastroenterology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - H C van Santvoort
- Department of surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - H Schut
- Department of medical oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - T Seerden
- Department of gastroenterology, Amphia Hospital, Breda, the Netherlands
| | - M W J Stommel
- Department of surgery, Radboud UMC, Nijmegen, the Netherlands
| | - A J Ten Tije
- Department of medical oncology, Amphia Hospital, Breda, the Netherlands
| | - N G Venneman
- Department of gastroenterology and hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - R C Verdonk
- Department of gastroenterology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | - J Verheij
- Department of pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F G I van Vilsteren
- Department of gastroenterology, University Medical Center Groningen, Groningen, the Netherlands
| | - J de Vos-Geelen
- Department of medical oncology, Maastricht UMC+, Maastricht, the Netherlands
| | - A Vulink
- Department of medical oncology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - C Wientjes
- Department of gastroenterology, OLVG, Amsterdam, the Netherlands
| | - F Wit
- Department of surgery, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - F J Wessels
- Department of radiology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht & St. Antonius Hospital, Nieuwegein, the Netherlands
| | - B Zonderhuis
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands
| | - C H van Werkhoven
- Julius Center for Health Sciences and primary care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J E van Hooft
- Department of gastroenterology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C H J van Eijck
- Department of surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J W Wilmink
- Department of medical oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H W M van Laarhoven
- Department of medical oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Besselink
- Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.
| | | |
Collapse
|
20
|
van Dalen ASHM, Jansen M, van Haperen M, van Dieren S, Buskens CJ, Nieveen van Dijkum EJM, Bemelman WA, Grantcharov TP, Schijven MP. Implementing structured team debriefing using a Black Box in the operating room: surveying team satisfaction. Surg Endosc 2020; 35:1406-1419. [PMID: 32253558 PMCID: PMC7886753 DOI: 10.1007/s00464-020-07526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating. Electronic supplementary material The online version of this article (10.1007/s00464-020-07526-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Haperen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Grantcharov
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
21
|
van Dijk ST, Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA. Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis. Am J Gastroenterol 2018; 113:1045-1052. [PMID: 29700480 DOI: 10.1038/s41395-018-0030-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Traditionally uncomplicated acute diverticulitis was routinely treated with antibiotics, although evidence for this strategy was lacking. Recently, two randomized clinical trials (AVOD trial and DIABOLO trial) published short-term results of omitting antibiotics compared to routine antibiotic treatment. Both showed no significant differences regarding recovery from the initial episode, as well as rates of complicated or recurrent diverticulitis and sigmoid resection. However, both studies showed a trend of higher rates of sigmoid resection in the observational groups. Here, the long-term effects of omitting antibiotics in first episode uncomplicated acute diverticulitis were assessed. METHODS A total of 528 patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomized to either an observational or an antibiotic treatment strategy (DIABOLO trial). Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months' follow up. Differences between the groups were explored and risk factors were identified using multivariable logistic regression. RESULTS Complete case analyses showed no difference in rates of recurrent diverticulitis (15.4% in the observational group versus 14.9% in the antibiotic group; p = 0.885), complicated diverticulitis (4.8% versus 3.3%; p = 0.403) and sigmoid resection (9.0% versus. 5.0%; p = 0.085). Young patients (<50 years) and patients with a pain score at presentation of 8 or higher on a visual analogue pain scale were at risk for complicated or recurrent diverticulitis. In this multivariable analysis, treatment type (with or without antibiotics) was not an independent predictor for complicated or recurrent diverticulitis. CONCLUSION Omitting antibiotics in the treatment of uncomplicated acute diverticulitis did not result in more complicated diverticulitis, recurrent diverticulitis or sigmoid resections at long-term follow up. As the DIABOLO trial was not powered for these secondary outcome measures, some uncertainty remains whether (small) non-significant differences could be true associations.
Collapse
Affiliation(s)
- S T van Dijk
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - L Daniels
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands.,Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - Ç Ünlü
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - N de Korte
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - S van Dieren
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - H B Stockmann
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - B C Vrouenraets
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - E C Consten
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - J A van der Hoeven
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - Q A Eijsbouts
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - I F Faneyte
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - M G Dijkgraaf
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands
| | | |
Collapse
|
22
|
Westerduin E, van Dieren S, Bemelman WA, Tanis PJ. Reply to 'Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer; an analysis of 59 cases'. Colorectal Dis 2018; 20:160-161. [PMID: 28963778 DOI: 10.1111/codi.13903] [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] [Received: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 02/08/2023]
Affiliation(s)
- E Westerduin
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands
| | - S van Dieren
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
23
|
Dingemans SA, Birnie MFN, Sanders FRK, van den Bekerom MPJ, Backes M, van Beeck E, Bloemers FW, van Dijkman B, Flikweert E, Haverkamp D, Holtslag HR, Hoogendoorn JM, Joosse P, Parkkinen M, Roukema G, Sosef N, Twigt BA, van Veen RN, van der Veen AH, Vermeulen J, Winkelhagen J, van der Zwaard BC, van Dieren S, Goslings JC, Schepers T. Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial). BMC Musculoskelet Disord 2018; 19:35. [PMID: 29386053 PMCID: PMC5793393 DOI: 10.1186/s12891-018-1946-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. DESIGN This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. DISCUSSION If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs. TRIAL REGISTRATION This study was registered at the Netherlands Trial Register (NTR5965), Clinicaltrials.gov ( NCT02896998 ) on July 15th 2016.
Collapse
Affiliation(s)
- S. A. Dingemans
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - M. F. N. Birnie
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - F. R. K. Sanders
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | | | - M. Backes
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - E. van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - F. W. Bloemers
- Department of Surgery, Trauma Unit, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - B. van Dijkman
- Department of Surgery, Flevo Hospital, P.O. Box 3005, 1300 EG Almere, The Netherlands
| | - E. Flikweert
- Department of Surgery, Deventer Hospital, P.O. Box 5001, 7400 GC Deventer, The Netherlands
| | - D. Haverkamp
- Department of Surgery, Slotervaart Hospital, P.O. Box 90440, 1006BK Amsterdam, The Netherlands
| | - H. R. Holtslag
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - J. M. Hoogendoorn
- Department of Surgery, Haaglanden MC, P.O. Box 432, 2501 CK The Hague, The Netherlands
| | - P. Joosse
- Department of Surgery, Noordwest Hospital Group, P.O. Box 501, 1815 JD Alkmaar, The Netherlands
| | - M. Parkkinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - G. Roukema
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| | - N. Sosef
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT Hoofddorp, The Netherlands
| | - B. A. Twigt
- Department of Surgery, BovenIJ Hospital, P.O. Box 37610, 1030 BD Amsterdam, The Netherlands
| | - R. N. van Veen
- Department of Surgery, OLVG, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands
| | - A. H. van der Veen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - J. Vermeulen
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT Hoofddorp, The Netherlands
| | - J. Winkelhagen
- Department of Surgery, Westfries Hospital, P.O. Box 600, 1620 AR Hoorn, The Netherlands
| | - B. C. van der Zwaard
- Department of Orthopaedics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME ‘s-Hertogenbosch, The Netherlands
| | - S. van Dieren
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - J. C. Goslings
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands
| | - T. Schepers
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| |
Collapse
|
24
|
Borstlap WAA, Musters GD, Stassen LPS, van Westreenen HL, Hess D, van Dieren S, Festen S, van der Zaag EJ, Tanis PJ, Bemelman WA. Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study. Surg Endosc 2017; 32:315-327. [PMID: 28664443 PMCID: PMC5770507 DOI: 10.1007/s00464-017-5679-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/19/2017] [Indexed: 12/13/2022]
Abstract
Introduction Non-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the Endosponge® therapy. Methods In this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed. Results Between July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy. Median follow-up was 14 (7–29) months. At 6 months, the anastomosis had healed in 16 (53%) patients. At last follow-up, anastomotic integrity was found in 21 (70%) and continuity was restored in 20 (67%) patients. Non-healing at 12 months was observed in 10/29 (34%) patients overall, and in 3/14 (21%) when therapy started within three weeks following the index operation. Major LARS was reported in 12/15 (80%) patients. The direct medical costs were €8933 (95% CI 7268–10,707) per patient. Conclusion Vacuum-assisted early transanal closure of a leaking anastomosis after total mesorectal excision with 73% preoperative radiotherapy showed that acceptable anastomotic healing rates and stoma reversal rates can be achieved. Early diagnosis and start of treatment seems crucial.
Collapse
Affiliation(s)
- W A A Borstlap
- Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - G D Musters
- Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - L P S Stassen
- Department of Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands
| | | | - D Hess
- Department of Surgery, Antonius Zorggroep, Sneek, The Netherlands
| | - S van Dieren
- Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - S Festen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - E J van der Zaag
- Department of Surgery, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| |
Collapse
|
25
|
Vennix S, van Dieren S, Opmeer BC, Lange JF, Bemelman WA. Cost analysis of laparoscopic lavage compared with sigmoid resection for perforated diverticulitis in the Ladies trial. Br J Surg 2017; 104:62-68. [PMID: 28000941 PMCID: PMC6681137 DOI: 10.1002/bjs.10329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 06/13/2016] [Accepted: 08/25/2016] [Indexed: 11/18/2022]
Abstract
Background Laparoscopic peritoneal lavage is an alternative to sigmoid resection in selected patients presenting with purulent peritonitis from perforated diverticulitis. Although recent trials have lacked superiority for lavage in terms of morbidity, mortality was not compromised, and beneficial secondary outcomes were shown. These included shorter duration of surgery, less stoma formation and less surgical reintervention (including stoma reversal) for laparoscopic lavage versus sigmoid resection respectively. The cost analysis of laparoscopic lavage for perforated diverticulitis in the Ladies RCT was assessed in the present study. Methods This study involved an economic evaluation of the randomized LOLA (LaparOscopic LAvage) arm of the Ladies trial (comparing laparoscopic lavage with sigmoid resection in patients with purulent peritonitis due to perforated diverticulitis). The actual resource use per individual patient was documented prospectively and analysed (according to intention‐to‐treat) for up to 1 year after randomization. Results Eighty‐eight patients were randomized to either laparoscopic lavage (46) or sigmoid resection (42). The total medical costs for lavage were lower (mean difference € − 3512, 95 per cent bias‐corrected and accelerated c.i. −16 020 to 8149). Surgical reintervention increased costs in the lavage group, whereas stoma reversal increased costs in the sigmoid resection group. Differences in favour of laparoscopy were robust when costs were varied by ±20 per cent in a sensitivity analysis (mean cost difference € − 2509 to −4438). Conclusion Laparoscopic lavage for perforated diverticulitis is more cost‐effective than sigmoid resection. Further evidence of lavage superiority
Collapse
Affiliation(s)
- S Vennix
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - S van Dieren
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - B C Opmeer
- Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
26
|
Klompmaker S, de Rooij T, Korteweg JJ, van Dieren S, van Lienden KP, van Gulik TM, Busch OR, Besselink MG. Systematic review of outcomes after distal pancreatectomy with coeliac axis resection for locally advanced pancreatic cancer. Br J Surg 2017; 103:941-9. [PMID: 27304847 DOI: 10.1002/bjs.10148] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/07/2016] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pancreatic cancer involving the coeliac axis is considered unresectable by most guidelines, with a median survival of 6-11 months. A subgroup of these patients can undergo distal pancreatectomy with coeliac axis resection, but consensus on the value of this procedure is lacking. The evidence for this procedure, including the impact of preoperative hepatic artery embolization and (neo)adjuvant therapy, was evaluated. METHODS A systematic review was performed according to the PRISMA guidelines until 27 May 2015. The primary endpoint was overall survival; secondary endpoints included morbidity and radical resection rates. RESULTS A total of 19 retrospective studies, involving 240 patients, were included. The methodological quality of the studies ranged from poor to moderate. A radical resection was reported in 74·5 per cent (152 of 204), major morbidity in 27 per cent (26 of 96), ischaemic morbidity in 9·0 per cent (21 of 223) and 90-day mortality in 3·5 per cent (4 of 113). Overall, 35·5 per cent of patients (55 of 155) underwent preoperative hepatic artery embolization without an apparent beneficial impact on ischaemic morbidity. Overall, 15·7 per cent (29 of 185) had neoadjuvant and 51·0 per cent (75 of 147) had adjuvant therapy. There was a difference in survival between patient series where less than half of patients had (neo)adjuvant chemotherapy and series where more than half were receiving this treatment: case-weighted median overall survival was 16 (range 9-48) versus 18 (10-26) months respectively (P = 0·002). Overall median survival for the whole study population was 14·4 (range 9-48) months. CONCLUSION Distal pancreatectomy with coeliac axis resection seems a valuable option for selected patients with pancreatic cancer involving the coeliac axis with acceptable morbidity and mortality, and a median survival of 18 months when combined with (neo)adjuvant therapy.
Collapse
Affiliation(s)
- S Klompmaker
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - T de Rooij
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J J Korteweg
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - S van Dieren
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - K P van Lienden
- Departments of Interventional Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - T M van Gulik
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - O R Busch
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M G Besselink
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Balvers K, van Dieren S, Baksaas-Aasen K, Gaarder C, Brohi K, Eaglestone S, Stanworth S, Johansson PI, Ostrowski SR, Stensballe J, Maegele M, Goslings JC, Juffermans NP. Combined effect of therapeutic strategies for bleeding injury on early survival, transfusion needs and correction of coagulopathy. Br J Surg 2017; 104:222-229. [PMID: 28079258 DOI: 10.1002/bjs.10330] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/10/2016] [Accepted: 08/25/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleeding. METHODS A prospective multicentre observational study was performed in six level 1 trauma centres. Injured patients who received at least 4 units of red blood cells (RBCs) were analysed and divided into groups receiving a low (less than 1 : 1) or high (1 or more : 1) ratio of plasma or platelets to RBCs, and in receipt or not of tranexamic acid or fibrinogen products (fibrinogen concentrates or cryoprecipitate). Logistic regression models were used to assess the effect of transfusion strategies on the outcomes 'alive and free from massive transfusion' (at least 10 units of RBCs in 24 h) and early 'normalization of coagulopathy' (defined as an international normalized ratio of 1·2 or less). RESULTS A total of 385 injured patients with ongoing bleeding were included in the study. Strategies that were independently associated with an increased number of patients alive and without massive transfusion were a high platelet to RBC ratio (odds ratio (OR) 2·67, 95 per cent c.i. 1·24 to 5·77; P = 0·012), a high plasma to RBC ratio (OR 2·07, 1·03 to 4·13; P = 0·040) and treatment with tranexamic acid (OR 2·71, 1·29 to 5·71; P = 0·009). No strategies were associated with correction of coagulopathy. CONCLUSION A high platelet or plasma to RBC ratio, and use of tranexamic acid were associated with a decreased need for massive transfusion and increased survival in injured patients with bleeding. Early normalization of coagulopathy was not seen for any transfusion ratio, or for use of tranexamic acid or fibrinogen products.
Collapse
Affiliation(s)
- K Balvers
- Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - S van Dieren
- Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - K Baksaas-Aasen
- Department of Traumatology, Oslo University Hospital, Oslo, Norway.,Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - C Gaarder
- Department of Traumatology, Oslo University Hospital, Oslo, Norway
| | - K Brohi
- Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Eaglestone
- Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Stanworth
- National Health Service (NHS) Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - J Stensballe
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M Maegele
- Department for Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - N P Juffermans
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | | |
Collapse
|
28
|
Sperna Weiland NH, Brevoord D, Jöbsis DA, de Beaumont EMFH, Evers V, Preckel B, Hollmann MW, van Dieren S, de Mol BAJM, Immink RV. Cerebral oxygenation during changes in vascular resistance and flow in patients on cardiopulmonary bypass - a physiological proof of concept study. Anaesthesia 2016; 72:49-56. [DOI: 10.1111/anae.13631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 12/17/2022]
Affiliation(s)
- N. H. Sperna Weiland
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | - D. Brevoord
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | - D. A. Jöbsis
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | | | - V. Evers
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | - B. Preckel
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | - M. W. Hollmann
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | - S. van Dieren
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
| | - B. A. J. M. de Mol
- Department of Cardiothoracic Surgery; Academic Medical Center; Amsterdam The Netherlands
| | - R. V. Immink
- Department of Anaesthesiology; Academic Medical Center; Amsterdam The Netherlands
- Laboratory for Clinical Cardiovascular Physiology; Department of Anatomy and Embryology; Academic Medical Center; Amsterdam The Netherlands
| |
Collapse
|
29
|
Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg 2016; 104:52-61. [PMID: 27686365 DOI: 10.1002/bjs.10309] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/29/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Antibiotics are advised in most guidelines on acute diverticulitis, despite a lack of evidence to support their routine use. This trial compared the effectiveness of a strategy with or without antibiotics for a first episode of uncomplicated acute diverticulitis. METHODS Patients with CT-proven, primary, left-sided, uncomplicated, acute diverticulitis were included at 22 clinical sites in the Netherlands, and assigned randomly to an observational or antibiotic treatment strategy. The primary endpoint was time to recovery during 6 months of follow-up. Main secondary endpoints were readmission rate, complicated, ongoing and recurrent diverticulitis, sigmoid resection and mortality. Intention-to-treat and per-protocol analyses were done. RESULTS A total of 528 patients were included. Median time to recovery was 14 (i.q.r. 6-35) days for the observational and 12 (7-30) days for the antibiotic treatment strategy, with a hazard ratio for recovery of 0·91 (lower limit of 1-sided 95 per cent c.i. 0·78; P = 0·151). No significant differences between the observation and antibiotic treatment groups were found for secondary endpoints: complicated diverticulitis (3·8 versus 2·6 per cent respectively; P = 0·377), ongoing diverticulitis (7·3 versus 4·1 per cent; P = 0·183), recurrent diverticulitis (3·4 versus 3·0 per cent; P = 0·494), sigmoid resection (3·8 versus 2·3 per cent; P = 0·323), readmission (17·6 versus 12·0 per cent; P = 0·148), adverse events (48·5 versus 54·5 per cent; P = 0·221) and mortality (1·1 versus 0·4 per cent; P = 0·432). Hospital stay was significantly shorter in the observation group (2 versus 3 days; P = 0·006). Per-protocol analyses were concordant with the intention-to-treat analyses. CONCLUSION Observational treatment without antibiotics did not prolong recovery and can be considered appropriate in patients with uncomplicated diverticulitis. Registration number: NCT01111253 (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- L Daniels
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ç Ünlü
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Departments of Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - N de Korte
- Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - B C Vrouenraets
- Department of Surgery, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - E C Consten
- Meander Medical Centre, Amersfoort, The Netherlands
| | | | - Q A Eijsbouts
- Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - I F Faneyte
- Ziekenhuisgroep Twente Hospital, Almelo, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M G Dijkgraaf
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
30
|
Basta Y, Baur O, van Dieren S, Klinkenbijl J, Fockens P, Tytgat K. O-001 The influence of multidisciplinary teams on diagnosis and treatment. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
van Dijk AH, de Reuver PR, Tasma TN, van Dieren S, Hugh TJ, Boermeester MA. Systematic review of antibiotic treatment for acute calculous cholecystitis. Br J Surg 2016; 103:797-811. [PMID: 27027851 DOI: 10.1002/bjs.10146] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/16/2015] [Accepted: 02/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC. METHODS A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non-operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random-effects model. RESULTS Twelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent. CONCLUSION Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy.
Collapse
Affiliation(s)
- A H van Dijk
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - P R de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T N Tasma
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - S van Dieren
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - T J Hugh
- Upper Gastrointestinal Surgery Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Jilesen APJ, van Eijck CHJ, in't Hof KH, van Dieren S, Gouma DJ, van Dijkum EJMN. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review. World J Surg 2016; 40:729-48. [PMID: 26661846 PMCID: PMC4746219 DOI: 10.1007/s00268-015-3328-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.
Collapse
Affiliation(s)
- Anneke P J Jilesen
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands.
| | | | - K H in't Hof
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - S van Dieren
- Department of Methodology and Statistics Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Tol JAMG, Brosens LAA, van Dieren S, van Gulik TM, Busch ORC, Besselink MGH, Gouma DJ. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg 2014; 102:237-45. [DOI: 10.1002/bjs.9709] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/18/2014] [Accepted: 10/17/2014] [Indexed: 12/17/2022]
Abstract
Abstract
Background
According to some studies, the number of lymph nodes with metastases in relation to the total number of removed lymph nodes, the lymph node ratio (LNR), is one of the most powerful predictors of survival after resection in patients with pancreatic cancer. However, contradictory results have been reported, and small sample sizes of the cohorts and different definitions of a microscopic positive resection margin (R1) hamper the interpretation of data.
Methods
The predictive value of LNR for 3-year survival was assessed using a Cox proportional hazards model. From 1992 to 2012, all patients with pancreatic and periampullary cancer operated on with pancreatoduodenectomy were selected from a database. Clinicopathological characteristics were analysed. Microscopic positive resection margin was defined as the microscopic presence of tumour cells within 1 mm of the margins. A nomogram was created.
Results
Some 760 patients were included. Predictive factors for death in 350 patients with pancreatic ductal adenocarcinoma included in the nomogram were: R1 resection (hazard ratio (HR) 1·55, 95 per cent c.i. 1·07 to 2·25), poor tumour differentiation (HR 2·78, 1·40 to 5·52), LNR above 0·18 (HR 1·75, 1·13 to 2·70) and no adjuvant therapy (HR 1·54, 1·01 to 2·34). The C statistic was 0·658 (0·632 to 0·698), and calibration was good (Hosmer–Lemeshow χ2 = 5·67, P =0·773). LNR and poor tumour differentiation (HR 4·51 and 3·30 respectively) were also predictive in patients with distal common bile duct (CBD) cancer. LNR, R1 resection and jaundice were predictors of death in patients with ampullary cancer (HR 7·82, 2·68 and 1·93 respectively).
Conclusion
LNR is a common predictor of poor survival in pancreatic, distal CBD and ampullary cancer.
Collapse
Affiliation(s)
- J A M G Tol
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - L A A Brosens
- Departments of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S van Dieren
- Departments of Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - T M van Gulik
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - O R C Busch
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M G H Besselink
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - D J Gouma
- Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
34
|
van der Leeuw J, van Dieren S, Beulens JWJ, Boeing H, Spijkerman AMW, van der Graaf Y, van der A DL, Nöthlings U, Visseren FLJ, Rutten GEHM, Moons KGM, van der Schouw YT, Peelen LM. The validation of cardiovascular risk scores for patients with type 2 diabetes mellitus. Heart 2014; 101:222-9. [PMID: 25256148 DOI: 10.1136/heartjnl-2014-306068] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 11/04/2022] Open
Abstract
OBJECTIVE Various cardiovascular prediction models have been developed for patients with type 2 diabetes. Their predictive performance in new patients is mostly not investigated. This study aims to quantify the predictive performance of all cardiovascular prediction models developed specifically for diabetes patients. DESIGN AND METHODS Follow-up data of 453, 1174 and 584 type 2 diabetes patients without pre-existing cardiovascular disease (CVD) in the EPIC-NL, EPIC-Potsdam and Secondary Manifestations of ARTerial disease cohorts, respectively, were used to validate 10 prediction models to estimate risk of CVD or coronary heart disease (CHD). Discrimination was assessed by the c-statistic for time-to-event data. Calibration was assessed by calibration plots, the Hosmer-Lemeshow goodness-of-fit statistic and expected to observed ratios. RESULTS There was a large variation in performance of CVD and CHD scores between different cohorts. Discrimination was moderate for all 10 prediction models, with c-statistics ranging from 0.54 (95% CI 0.46 to 0.63) to 0.76 (95% CI 0.67 to 0.84). Calibration of the original models was poor. After simple recalibration to the disease incidence of the target populations, predicted and observed risks were close. Expected to observed ratios of the recalibrated models ranged from 1.06 (95% CI 0.81 to 1.40) to 1.55 (95% CI 0.95 to 2.54), mainly driven by an overestimation of risk in high-risk patients. CONCLUSIONS All 10 evaluated models had a comparable and moderate discriminative ability. The recalibrated, but not the original, prediction models provided accurate risk estimates. These models can assist clinicians in identifying type 2 diabetes patients who are at low or high risk of developing CVD.
Collapse
Affiliation(s)
- J van der Leeuw
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S van Dieren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - J W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - A M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D L van der A
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - U Nöthlings
- Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G E H M Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L M Peelen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
35
|
van Dieren S, Kengne AP, Chalmers J, Beulens JWJ, Davis TME, Fulcher G, Heller SR, Patel A, Colagiuri S, Hamet P, Mancia G, Marre M, Neal B, Williams B, Peelen LM, van der Schouw YT, Woodward M, Zoungas S. Intensification of medication and glycaemic control among patients with type 2 diabetes - the ADVANCE trial. Diabetes Obes Metab 2014; 16:426-32. [PMID: 24251579 DOI: 10.1111/dom.12238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/02/2013] [Accepted: 11/02/2013] [Indexed: 02/04/2023]
Abstract
AIMS The aim of this study was to assess associations between patient characteristics, intensification of blood glucose-lowering treatment through oral glucose-lowering therapy and/or insulin and effective glycaemic control in type 2 diabetes. METHODS 11 140 patients from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial who were randomized to intensive glucose control or standard glucose control and followed up for a median of 5 years were categorized into two groups: effective glycaemic control [haemoglobin A1c (HbA1c) ≤ 7.0% or a proportionate reduction in HbA1c over 10%] or ineffective glycaemic control (HbA1c > 7.0% and a proportionate reduction in HbA1c less than or equal to 10%). Therapeutic intensification was defined as addition of an oral glucose-lowering agent or commencement of insulin. Pooled logistic regression models examined the associations between patient factors, intensification and effective glycaemic control. RESULTS A total of 7768 patients (69.7%), including 3198 in the standard treatment group achieved effective glycaemic control. Compared to patients with ineffective control, patients with effective glycaemic control had shorter duration of diabetes and lower HbA1c at baseline and at the time of treatment intensification. Treatment intensification with addition of an oral agent or commencement of insulin was associated with a 107% [odds ratio, OR: 2.07 (95% confidence interval, CI: 1.95-2.20)] and 152% [OR: 2.52 (95% CI: 2.30-2.77)] greater chance of achieving effective glycaemic control, respectively. These associations were robust after adjustment for several baseline characteristics and not modified by the number of oral medications taken at the time of treatment intensification. CONCLUSIONS Effective glycaemic control was associated with treatment intensification at lower HbA1c levels at all stages of the disease course and in both arms of the ADVANCE trial.
Collapse
Affiliation(s)
- S van Dieren
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
van Dieren S, Czernichow S, Chalmers J, Kengne AP, de Galan BE, Poulter N, Woodward M, Beulens JWJ, Grobbee DE, van der Schouw YT, Zoungas S. Weight changes and their predictors amongst 11 140 patients with type 2 diabetes in the ADVANCE trial. Diabetes Obes Metab 2012; 14:464-9. [PMID: 22226008 DOI: 10.1111/j.1463-1326.2012.01556.x] [Citation(s) in RCA: 34] [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: 11/27/2022]
Abstract
AIMS To determine the baseline characteristics and glucose-lowering therapies associated with weight change among patients with type 2 diabetes. METHODS Eleven thousand one hundred and forty participants in the ADVANCE trial were randomly assigned to an intensive [aiming for a haemoglobin A1c (HbA1c) ≤6.5%] or a standard blood glucose-control strategy. Weight was measured at baseline and every 6 months over a median follow-up of 5 years. Multivariable linear regression and linear-mixed effect models were used to examine predictors of weight change. RESULTS The mean difference in weight between the intensive and standard glucose-control arm during follow-up was 0.75 kg (95% CI: 0.56-0.94), p-value <0.001. The mean weight decreased by 0.70 kg (95% CI: 0.53-0.87), p < 0.001 by the end of follow-up in the standard arm but remained stable in the intensive arm, with a non-significant gain of 0.16 kg (95% CI: -0.02 to 0.34), p = 0.075. Baseline factors associated with weight gain were younger age, higher HbA1c, Caucasian ethnicity and number of glucose-lowering medications. Treatment combinations including insulin [3.22 kg (95% CI: 2.92-3.52)] and thiazolidinediones [3.06 kg (95% CI: 2.69-3.43)] were associated with the greatest weight gain while treatment combinations including sulphonylureas were associated with less weight gain [0.71 kg (95%CI: 0.39-1.03)]. CONCLUSIONS Intensive glucose-control regimens are not necessarily associated with substantial weight gain. Patient characteristic associated with weight change were age, ethnicity, smoking and HbA1c. The main treatment strategies predicting weight gain were the use of insulin and thiazolidinediones.
Collapse
Affiliation(s)
- S van Dieren
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
van Dieren S, Beulens JWJ, Kengne AP, Peelen LM, Rutten GEHM, Woodward M, van der Schouw YT, Moons KGM. Prediction models for the risk of cardiovascular disease in patients with type 2 diabetes: a systematic review. Heart 2011; 98:360-9. [PMID: 22184101 DOI: 10.1136/heartjnl-2011-300734] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT A recent overview of all CVD models applicable to diabetes patients is not available. OBJECTIVE To review the primary prevention studies that focused on the development, validation and impact assessment of a cardiovascular risk model, scores or rules that can be applied to patients with type 2 diabetes. DESIGN Systematic review. DATA SOURCES Medline was searched from 1966 to 1 April 2011. STUDY SELECTION A study was eligible when it described the development, validation or impact assessment of a model that was constructed to predict the occurrence of cardiovascular disease in people with type 2 diabetes, or when the model was designed for use in the general population but included diabetes as a predictor. DATA EXTRACTION A standardized form was sued to extract all data of the CVD models. RESULTS 45 prediction models were identified, of which 12 were specifically developed for patients with type 2 diabetes. Only 31% of the risk scores has been externally validated in a diabetes population, with an area under the curve ranging from 0.61 to 0.86 and 0.59 to 0.80 for models developed in a diabetes population and in the general population, respectively. Only one risk score has been studied for its effect on patient management and outcomes. 10% of the risk scores are advocated in national diabetes guidelines. CONCLUSION Many cardiovascular risk scores are available that can be applied to patients with type 2 diabetes. A minority of these risk scores has been validated and tested for its predictive accuracy, with only a few showing a discriminative value of ≥0.80. The impact of applying these risk scores in clinical practice is almost completely unknown, but their use is recommended in various national guidelines.
Collapse
Affiliation(s)
- S van Dieren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
van Dieren S, Peelen LM, Nöthlings U, van der Schouw YT, Rutten GEHM, Spijkerman AMW, van der A DL, Sluik D, Boeing H, Moons KGM, Beulens JWJ. External validation of the UK Prospective Diabetes Study (UKPDS) risk engine in patients with type 2 diabetes. Diabetologia 2011; 54:264-70. [PMID: 21076956 PMCID: PMC3017299 DOI: 10.1007/s00125-010-1960-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 10/08/2010] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Treatment guidelines recommend the UK Prospective Diabetes Study (UKPDS) risk engine for predicting cardiovascular risk in patients with type 2 diabetes, although validation studies showed moderate performance. The methods used in these validation studies were diverse, however, and sometimes insufficient. Hence, we assessed the discrimination and calibration of the UKPDS risk engine to predict 4, 5, 6 and 8 year cardiovascular risk in patients with type 2 diabetes. METHODS The cohort included 1,622 patients with type 2 diabetes. During a mean follow-up of 8 years, patients were followed for incidence of CHD and cardiovascular disease (CVD). Discrimination and calibration were assessed for 4, 5, 6 and 8 year risk. Discrimination was examined using the c-statistic and calibration by visually inspecting calibration plots and calculating the Hosmer-Lemeshow χ(2) statistic. RESULTS The UKPDS risk engine showed moderate to poor discrimination for both CHD and CVD (c-statistic of 0.66 for both 5 year CHD and CVD risks), and an overestimation of the risk (224% and 112%). The calibration of the UKPDS risk engine was slightly better for patients with type 2 diabetes who had been diagnosed with diabetes more than 10 years ago compared with patients diagnosed more recently, particularly for 4 and 5 year predicted CVD and CHD risks. Discrimination for these periods was still moderate to poor. CONCLUSIONS/INTERPRETATION We observed that the UKPDS risk engine overestimates CHD and CVD risk. The discriminative ability of this model is moderate, irrespective of various subgroup analyses. To enhance the prediction of CVD in patients with type 2 diabetes, this model should be updated.
Collapse
Affiliation(s)
- S van Dieren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
van Dieren S, Nöthlings U, van der Schouw YT, Spijkerman AMW, Rutten GEHM, van der A DL, Sluik D, Weikert C, Joost HG, Boeing H, Beulens JWJ. Non-fasting lipids and risk of cardiovascular disease in patients with diabetes mellitus. Diabetologia 2011; 54:73-7. [PMID: 20959955 PMCID: PMC2995865 DOI: 10.1007/s00125-010-1945-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/20/2010] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the effect of postprandial time on the associations and predictive value of non-fasting lipid levels and cardiovascular disease risk in participants with diabetes. METHODS This study was conducted among 1,337 participants with diabetes from the Dutch and German (Potsdam) contributions to the European Prospective Investigation into Cancer and Nutrition. At baseline, total cholesterol, LDL- and HDL-cholesterol and triacylglycerol concentrations were measured and the ratio of total cholesterol/HDL-cholesterol was calculated. Participants were followed for incidence of cardiovascular disease. RESULTS Lipid concentrations changed minimally with increasing postprandial time, except for triacylglycerol which was elevated just after a meal and declined over time (1.86 at 0.1 h to 1.33 at >6 h, p for trend <0.001). During a mean follow-up of 8 years, 116 cardiovascular events were documented. After adjustment for potential confounders, triacylglycerol (HR for third tertile compared with first tertile (HR(t)₃(to)₁), 1.73 [95% CI 1.04, 2.87]), HDL-cholesterol (HR(t)₃(to)₁, 0.41 [95% CI 0.23, 0.72]) and total cholesterol/HDL-cholesterol ratio (HR(t)₃(to)₁, 1.65 [95% CI 0.95, 2.85]) were associated with cardiovascular disease, independent of postprandial time. Cardiovascular disease risk prediction using the UK Prospective Diabetes Study risk engine was not affected by postprandial time. CONCLUSIONS/INTERPRETATION Postprandial time did not affect associations between lipid concentrations and cardiovascular disease risk in patients with diabetes, nor did it influence prediction of cardiovascular disease. Therefore, it may not be necessary to use fasting blood samples to determine lipid concentrations for cardiovascular disease risk prediction in patients with diabetes.
Collapse
Affiliation(s)
- S van Dieren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
van Dieren S, Uiterwaal CSPM, van der Schouw YT, van der A DL, Boer JMA, Spijkerman A, Grobbee DE, Beulens JWJ. Coffee and tea consumption and risk of type 2 diabetes. Diabetologia 2009; 52:2561-9. [PMID: 19727658 DOI: 10.1007/s00125-009-1516-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 08/07/2009] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the association of consumption of coffee and tea, separately and in total, with risk of type 2 diabetes and which factors mediate these relations. METHODS This research was conducted as part of the Dutch Contribution to the European Prospective Investigation into Cancer and Nutrition, which involves a prospective cohort of 40,011 participants with a mean follow-up of 10 years. A validated food-frequency questionnaire was used to assess coffee and tea consumption and other lifestyle and dietary factors. The main outcome was verified incidence of type 2 diabetes. Blood pressure, caffeine, magnesium and potassium were examined as possible mediating factors. RESULTS During follow-up, 918 incident cases of type 2 diabetes were documented. After adjustment for potential confounders, coffee and tea consumption were both inversely associated with type 2 diabetes, with hazard ratios of 0.77 (95% CI 0.63-0.95) for 4.1-6.0 cups of coffee per day (p for trend = 0.033) and 0.63 (95% CI: 0.47-0.86) for >5.0 cups of tea per day (p for trend = 0.002). Total daily consumption of at least three cups of coffee and/or tea reduced the risk of type 2 diabetes by approximately 42%. Adjusting for blood pressure, magnesium, potassium and caffeine did not attenuate the associations. CONCLUSIONS/INTERPRETATION Drinking coffee or tea is associated with a lowered risk of type 2 diabetes, which cannot be explained by magnesium, potassium, caffeine or blood pressure effects. Total consumption of at least three cups of coffee or tea per day may lower the risk of type 2 diabetes.
Collapse
Affiliation(s)
- S van Dieren
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|