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Guijt MC, Heineman DJ, Jonker JT. Recurrent Falls Due to Hypoglycemia: Case of an IGF-2-producing Fibrous Tumor of the Pleura. JCEM Case Rep 2024; 2:luae061. [PMID: 38666048 PMCID: PMC11045011 DOI: 10.1210/jcemcr/luae061] [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] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 04/28/2024]
Abstract
This case report delineates the clinical presentation of a 77-year-old male who experienced falls and sustained a humerus fracture attributed to hypoglycemia. Despite the absence of insulin use and normal laboratory results for cortisol, TSH, blood count, and liver and kidney function, a fasting test revealed diminished C-peptide and insulin levels, ruling out insulinoma, exogenous insulin use, or β-cell hyperplasia. Subsequent laboratory investigations demonstrated lowered IGF-1 and elevated IGF-2 levels, indicative of an IGF-2-producing tumor as the etiology of the hypoglycemia. A positron emission tomography computed tomography scan identified a right-sided thoracic cavity tumor, prompting an open resection. Postoperatively, hypoglycemic episodes abated within 2 days, and pathology confirmed a 14.9-cm solitary fibrous tumor. Nonislet cell tumor hypoglycemia (NICTH), also known as Doege Potter syndrome, arises from aberrant production of IGF-2 or its precursors. Elevated IGF-2 levels induce hypoglycemia through heightened glucose uptake on binding to insulin receptors. The literature supports the efficacy of both surgical intervention and corticosteroids in managing NICTH. This case underscores the importance of considering NICTH as a rare etiology in unexplained hypoglycemia cases, advocating for the utility of fasting tests in diagnosis, and suggesting surgical resection as a viable treatment option when radical excision is feasible.
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Affiliation(s)
- Mathijs Cornelis Guijt
- Department of Internal Medicine, Haga Ziekenhuis Den Haag, Els Borst-Eilersplein 275, 2545 AA, Den Haag, The Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam—Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jacqueline Thérèse Jonker
- Department of Internal Medicine, Alrijne Ziekenhuis Leiderdorp, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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van Vuren RMG, Janssen YF, Hogenbirk RNM, de Graaff MR, van den Hoek R, Kruijff S, Heineman DJ, van der Plas WY, Wouters MWJM. The Impact of the COVID-19 Pandemic on Time to Treatment in Surgical Oncology: A National Registry Study in The Netherlands. Cancers (Basel) 2024; 16:1738. [PMID: 38730690 PMCID: PMC11083561 DOI: 10.3390/cancers16091738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
To avoid delay in oncological treatment, a 6-weeks norm for time to treatment has been agreed on in The Netherlands. However, the impact of the COVID-19 pandemic on health systems resulted in reduced capacity for regular surgical care. In this study, we investigated the impact of the COVID-19 pandemic on time to treatment in surgical oncology in The Netherlands. METHODS A population-based analysis of data derived from five surgical audits, including patients who underwent surgery for lung cancer, colorectal cancer, upper gastro-intestinal, and hepato-pancreato-biliary (HPB) malignancies, was performed. The COVID-19 cohort of 2020 was compared to the historic cohorts of 2018 and 2019. Primary endpoints were time to treatment initiation and the proportion of patients whose treatment started within 6 weeks. The secondary objective was to evaluate the differences in characteristics and tumour stage distribution between patients treated before and during the COVID-19 pandemic. RESULTS A total of 14,567 surgical cancer patients were included in this study, of these 3292 treatments were started during the COVID-19 pandemic. The median time to treatment decreased during the pandemic (26 vs. 27 days, p < 0.001) and the proportion of patients whose treatment started within 6 weeks increased (76% vs. 73%, p < 0.001). In a multivariate logistic regression analysis, adjusting for patient characteristics, no significant difference in post-operative outcomes between patients who started treatment before or after 6 weeks was found. Overall, the number of procedures performed per week decreased by 8.1% during the pandemic. This reduction was most profound for patients with stage I lung carcinoma and colorectal carcinoma. There were fewer patients with pulmonary comorbidities in the pandemic cohort (11% vs. 13%, p = 0.003). CONCLUSIONS Despite pressure on the capacity of the healthcare system during the COVID-19 pandemic, a larger proportion of surgical oncological patients started treatment within six weeks, possibly due to prioritisation of cancer care and reductions in elective procedures. However, during the pandemic, a decrease in the number of surgical oncological procedures performed in The Netherlands was observed, especially for patients with stage I disease.
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Affiliation(s)
- Roos M. G. van Vuren
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Yester F. Janssen
- Department of Neurosurgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands;
- TRACER Europe B.V., Aarhusweg 2-1, 9723 JJ Groningen, The Netherlands
| | - Rianne N. M. Hogenbirk
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Michelle R. de Graaff
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
- Dutch Institute for Clinical Auditing, Scientific Bureau, 2333 AA Leiden, The Netherlands
| | - Rinske van den Hoek
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - David J. Heineman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.J.H.); (W.Y.v.d.P.)
| | - Willemijn Y. van der Plas
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.J.H.); (W.Y.v.d.P.)
| | - Michel W. J. M. Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, 2333 AA Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
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van Steenwijk QCA, Spaans LN, Heineman DJ, van den Broek FJC, Dickhoff C. Population-based study on surgical care for primary spontaneous pneumothorax. Eur J Cardiothorac Surg 2024; 65:ezae104. [PMID: 38489837 PMCID: PMC10980590 DOI: 10.1093/ejcts/ezae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The optimal surgical strategy for primary spontaneous pneumothorax remains a matter of debate and variation in surgical practice is expected. This variation may influence clinical outcomes, such as postoperative complications and length of stay. This national population-based registry study provides an overview and extent of variability of current surgical practice and outcomes in the Netherlands. METHODS To identify national patterns of care and between-hospital variability in the treatment of primary spontaneous pneumothorax, patients who underwent surgical pleurodesis and/or bullectomy between 2014 and 2021, were identified from the Dutch Lung Cancer Audit-Surgery database. The type of surgical intervention, postoperative complications, length of stay and ipsilateral recurrences were recorded. RESULTS AND CONCLUSIONS Out of 4338 patients, 1851 patients were identified to have primary spontaneous pneumothorax. The median age was 25 years (interquartile range 20-31) and 82% was male. The most performed surgical procedure was bullectomy with pleurodesis (83%). The overall complication rate was 12% (Clavien-Dindo grade ≥III 6%), with the highest recorded incidence for persistent air leak >5 days (5%). Median postoperative length of stay was 4 days (interquartile range 3-6) and 0.7% underwent a repeat pleurodesis for ipsilateral recurrence. Complication rate and length of stay differed considerably between hospitals. There were no differences between the surgical procedures. In the Netherlands, surgical patients with primary spontaneous pneumothorax are preferably treated with bullectomy plus pleurodesis. Postoperative complications and length of stay vary widely and are considerable in this young patient group. This may be reduced by optimization of surgical care.
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Affiliation(s)
- Quirine C A van Steenwijk
- Department of Surgery, Maxima Medical Centre, Veldhoven, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Louisa N Spaans
- Department of Surgery, Maxima Medical Centre, Veldhoven, Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Schreurs AMF, Overtoom EM, de Boer MA, van der Houwen LEE, Lier MCI, van den Akker T, Cornette J, Vogelvang TE, Beenakkers ICM, Rosman AN, Maas JWM, Heineman DJ, Finken MJJ, de Vries JJJ, Burger NB, Schaap TP, Bloemenkamp KWM, Mijatovic V. Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system. BJOG 2023; 130:1620-1628. [PMID: 37280664 DOI: 10.1111/1471-0528.17556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/29/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. DESIGN A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). SETTING Nationwide, the Netherlands. POPULATION All pregnant women between April 2016 and April 2018. METHODS This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. MAIN OUTCOME MEASURES Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. RESULTS In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. CONCLUSIONS SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.
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Affiliation(s)
- Anneke M F Schreurs
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Evelien M Overtoom
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisette E E van der Houwen
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marit C I Lier
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Jerome Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Tatjana E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anaesthesiology, Division Vital Functions, Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Jacques W M Maas
- Department of Obstetrics and Gynaecology and GROW - School for Oncology and Reproduction, Maastricht UMC+, Maastricht, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martijn J J Finken
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan J J de Vries
- Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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van Dorp M, Trimbos C, Schreurs WH, Dickhoff C, Heineman DJ, Torensma B, Kazemier G, van den Broek FJC, Slotman BJ, Dahele M. Colorectal Pulmonary Metastases: Pulmonary Metastasectomy or Stereotactic Radiotherapy? Cancers (Basel) 2023; 15:5186. [PMID: 37958360 PMCID: PMC10647532 DOI: 10.3390/cancers15215186] [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: 09/12/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Pulmonary metastasectomy and stereotactic ablative radiotherapy (SABR) are both guideline-recommended treatments for selected patients with oligometastatic colorectal pulmonary metastases. However, there is limited evidence comparing these local treatment modalities in similar patient groups. METHODS We retrospectively reviewed records of consecutive patients treated for colorectal pulmonary metastases with surgical metastasectomy or SABR from 2012 to 2019 at two Dutch referral hospitals that had different approaches toward the local treatment of colorectal pulmonary metastases, one preferring surgery, the other preferring SABR. Two comparable patient groups were identified based on tumor and treatment characteristics. RESULTS The metastasectomy group comprised 40 patients treated for 69 metastases, and the SABR group had 60 patients who were treated for 90 metastases. Median follow-up was 38 months (IQR: 26-67) in the surgery group and 46 months (IQR: 30-79) in the SABR group. Median OS was 58 months (CI: 20-94) in the metastasectomy group and 70 months (CI: 29-111) in the SABR group (p = 0.23). Five-year local recurrence-free survival (LRFS) was 44% after metastasectomy and 30% after SABR (p = 0.16). Median progression-free survival (PFS) was 15 months (CI: 3-26) in the metastasectomy group and 10 months (CI: 6-13) in the SABR group (p = 0.049). Local recurrence rate was 12.5/7.2% of patients/metastases respectively after metastasectomy and 38.3/31.1% after SABR (p < 0.001). Lower BED Gy10 was correlated with an increased likelihood of recurrence (p = 0.025). Clavien Dindo grade III-V complication rates were 2.5% after metastasectomy and 0% after SABR (p = 0.22). CONCLUSION In this retrospective cohort study, pulmonary metastasectomy and SABR had comparable overall survival, local recurrence-free survival, and complication rates, despite patients in the SABR group having a significantly lower progression-free survival and local control rate. These data would support a randomized controlled trial comparing surgery and SABR in operable patients with radically resectable colorectal pulmonary metastases.
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Affiliation(s)
- Martijn van Dorp
- Amsterdam University Medical Center, Location VUmc, Department of Cardiothoracic Surgery, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Constantia Trimbos
- Amsterdam University Medical Center, Location VUmc, Department of Cardiothoracic Surgery, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | | | - Chris Dickhoff
- Amsterdam University Medical Center, Location VUmc, Department of Cardiothoracic Surgery, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - David J. Heineman
- Amsterdam University Medical Center, Location VUmc, Department of Cardiothoracic Surgery, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Bart Torensma
- Department of Anesthesiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Geert Kazemier
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Amsterdam University Medical Center, Location VUmc, Department of Surgery, 1007 MB Amsterdam, The Netherlands
| | | | - Ben J. Slotman
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Amsterdam University Medical Center, Location VUmc, Department of Radiation Oncology, 1007 MB Amsterdam, The Netherlands
| | - Max Dahele
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Amsterdam University Medical Center, Location VUmc, Department of Radiation Oncology, 1007 MB Amsterdam, The Netherlands
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Dickhoff C, Unal S, Heineman DJ, Winkelman JA, Braun J, Bahce I, van Dorp M, Senan S, Dahele M. Feasibility of salvage resection following locoregional failure after chemoradiotherapy and consolidation durvalumab for unresectable stage III non-small cell lung cancer. Lung Cancer 2023; 182:107294. [PMID: 37442060 DOI: 10.1016/j.lungcan.2023.107294] [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: 02/08/2023] [Revised: 05/05/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION In patients with unresectable stage III non-small cell lung cancer, high-dose chemoradiotherapy (CRT) followed by consolidation durvalumab improves the 5-year overall survival compared to CRT alone. The feasibility and safety of salvage surgery for such patients who subsequently develop locoregional failure (LRF) is unclear. We evaluated our institutional experience with radical-intent salvage surgery in this patient population. MATERIALS AND METHODS Details of patients undergoing salvage surgery for locoregional failure after CRT and durvalumab were identified from an institutional surgical database. Each patient's case underwent multidisciplinary discussion at initial disease presentation, and again at time of progression. RESULTS Ten patients underwent salvage surgery for LRF after prior concurrent (n = 9) or sequential (n = 1) platinum-based high-dose chemo-radiotherapy followed by durvalumab. Consolidation durvalumab was completed in 4 patients, and discontinued in 6, due to either toxicity or disease progression. Median time between end of radiotherapy to detection of LRF was 19 months (range 6-75). Seven patients underwent a lobectomy, 1 a bilobectomy and 2 patients a pneumonectomy. Postoperative morbidity (Clavien-Dindo grade III-V) and 90-day mortality were 10% and 0%, respectively. Median follow-up after surgery was 7 months (range 1-25) during which 2 patients died (both 9 months post-operatively), one due to distant progression, and one of sepsis/bleeding. Eight patients are alive at 1-23 months post-surgery, with 6 showing no evidence of disease. CONCLUSIONS Our results suggest that salvage pulmonary resection can be performed safely in selected patients with LRF following chemoradiotherapy and durvalumab. This radical-intent treatment option merits consideration by multidisciplinary lung tumor boards.
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Affiliation(s)
- C Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - S Unal
- Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - D J Heineman
- Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - J A Winkelman
- Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - J Braun
- Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands
| | - I Bahce
- Department of Pulmonary Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - M van Dorp
- Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - S Senan
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - M Dahele
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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van Dorp M, Wolfhagen N, Torensma B, Dickhoff C, Kazemier G, Heineman DJ, Schreurs WH. Pulmonary metastasectomy and repeat metastasectomy for colorectal pulmonary metastases: outcomes from the Dutch Lung Cancer Audit for Surgery. BJS Open 2023; 7:7153159. [PMID: 37146204 PMCID: PMC10162679 DOI: 10.1093/bjsopen/zrad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Surgical resection of recurrent pulmonary metastases in patients with colorectal cancer is an established treatment option; however, the evidence for repeat resection is limited. The aim of this study was to analyse long-term outcomes from the Dutch Lung Cancer Audit for Surgery. METHODS Data from the mandatory Dutch Lung Cancer Audit for Surgery were used to analyse all patients after metastasectomy or repeat metastasectomy for colorectal pulmonary metastases from January 2012 to December 2019 in the Netherlands. Kaplan-Meier survival analysis was performed to determine the difference in survival. Multivariable Cox regression analyses were performed to identify predictors of survival. RESULTS A total of 1237 patients met the inclusion criteria, of which 127 patients underwent repeat metastasectomy. Five-year overall survival was 53 per cent after pulmonary metastasectomy for colorectal pulmonary metastases and 52 per cent after repeat metastasectomy (P = 0.852). The median follow-up was 42 (range 0-285) months. More patients experienced postoperative complications after repeat metastasectomy compared with the first metastasectomy (18.1 per cent versus 11.6 per cent respectively; P = 0.033). Eastern Cooperative Oncology Group performance status greater than or equal to 1 (HR 1.33, 95 per cent c.i. 1.08 to 1.65; P = 0.008), multiple metastases (HR 1.30, 95 per cent c.i. 1.01 to 1.67; P = 0.038), and bilateral metastases (HR 1.50, 95 per cent c.i. 1.01 to 2.22; P = 0.045) were prognostic factors on multivariable analysis for pulmonary metastasectomy. Diffusing capacity of the lungs for carbon monoxide less than 80 per cent (HR 1.04, 95 per cent c.i. 1.01 to 1.06; P = 0.004) was the only prognostic factor on multivariable analysis for repeat metastasectomy. CONCLUSION This study demonstrates that patients with colorectal pulmonary metastases have comparable median and 5-year overall survival rates after primary or recurrent pulmonary metastasectomy. However, repeat metastasectomy has a higher risk of postoperative complications.
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Affiliation(s)
- Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | | | - Bart Torensma
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Smesseim I, van Boerdonk RA, Dickhoff C, Heineman DJ, Dahele MR, Radonic T, Bahce I, Rauh SP, Comans EFI, Daniels HJMA. Focal 18 F-FDG uptake predicts progression of pre-invasive squamous bronchial lesions to invasive cancers. Thorac Cancer 2023; 14:840-847. [PMID: 36802171 PMCID: PMC10040284 DOI: 10.1111/1759-7714.14815] [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: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/20/2023] Open
Abstract
INTRODUCTION Pre-invasive squamous lesions of the central airways can progress into invasive lung cancers. Identifying these high-risk patients could enable detection of invasive lung cancers at an early stage. In this study, we investigated the value of 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET) scans in predicting progression in patients with pre-invasive squamous endobronchial lesions. METHODS In this retrospective study, patients with pre-invasive endobronchial lesions, who underwent an 18 F-FDG PET scan at the VU University Medical Center Amsterdam, between January 2000 and December 2016, were included. Autofluorescence bronchoscopy (AFB) was used for tissue sampling and was repeated every 3 months. The minimum and median follow-up was 3 and 46.5 months. Study endpoints were the occurrence of biopsy proven invasive carcinoma, time-to-progression and overall survival (OS). RESULTS A total number of 40 of 225 patients met the inclusion criteria of which 17 (42.5%) patients had a positive baseline 18 F-FDG PET scan. A total of 13 of 17 (76.5%) developed invasive lung carcinoma during follow-up, with a median time to progression of 5.0 months (range, 3.0-25.0). In 23 (57.5%) patients with a negative 18 F-FDG PET scan at baseline, 6 (26%) developed lung cancer, with a median time to progression of 34.0 months (range, 14.0-42.0 months, p < 0.002). With a median OS of 56.0 months (range, 9.0-60.0 months) versus 49.0 months (range, 6.0-60.0 months) (p = 0.876) for the 18 F-FDG PET positive and negative groups, respectively. CONCLUSIONS Patients with pre-invasive endobronchial squamous lesions and a positive baseline 18 F-FDG PET scan were at high-risk for developing lung carcinoma, highlighting that this patient group requires early radical treatment.
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Affiliation(s)
- Illaa Smesseim
- Department of Pulmonary Diseases, Amsterdam University Medical Center, Location Free University Medical Center, Amsterdam, The Netherlands
| | - Robert A van Boerdonk
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Max R Dahele
- Department of Radiotherapy, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Idris Bahce
- Department of Pulmonary Diseases, Amsterdam University Medical Center, Location Free University Medical Center, Amsterdam, The Netherlands
| | - Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Emile F I Comans
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hans J M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, Location Free University Medical Center, Amsterdam, The Netherlands
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9
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De Swart ME, Zonderhuis BM, Hellingman T, Kuiper BI, Dickhoff C, Heineman DJ, Hendrickx JJ, Kouwenhoven MC, Van Moorselaar RJA, Schuur M, Tenhagen M, Van Der Velde S, De Witt Hamer PC, Zijlstra JM, Kazemier G. Incomplete patient information exchange and unnecessary repeat diagnostics during oncological referrals in the Netherlands: exploring the role of information exchange. Health Informatics J 2023; 29:14604582231153795. [PMID: 36708072 DOI: 10.1177/14604582231153795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Data management in transmural care is complex. Without digital innovations like Health Information Exchange (HIE), patient information is often dispersed and inaccessible across health information systems between hospitals. The extent of information loss and consequences remain unclear. We aimed to quantify patient information availability of referred oncological patients and to assess its impact on unnecessary repeat diagnostics by observing all oncological multidisciplinary team meetings (MDTs) in a tertiary hospital. During 84 multidisciplinary team meetings, 165 patients were included. Complete patient information was provided in 17.6% (29/165, CI = 12.3-24.4) of patients. Diagnostic imaging was shared completely in 52.5% (74/141, CI = 43.9-60.9), imaging reports in 77.5% (100/129, CI = 69.2-84.2), laboratory results in 55.2% (91/165, CI = 47.2-62.8), ancillary test reports in 58.0% (29/50, CI = 43.3-71.5), and pathology reports in 60.0% (57/95, CI = 49.4-69.8). A total of 266 tests were performed additionally, with the main motivation not previously performed followed by inconclusive or insufficient quality of previous tests. Diagnostics were repeated unnecessarily in 15.8% (26/165, CI = 10.7-22.4) of patients. In conclusion, patient information was provided incompletely in majority of referrals discussed in oncological multidisciplinary team meetings and led to unnecessary repeat diagnostics in a small number of patients. Additional research is needed to determine the benefit of Health Information Exchange to improve data transfer in oncological care.
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Affiliation(s)
- Merijn E De Swart
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Barbara M Zonderhuis
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Tessa Hellingman
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Babette I Kuiper
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - David J Heineman
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Jan J Hendrickx
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Mathilde Cm Kouwenhoven
- Department of Neurology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - R Jeroen A Van Moorselaar
- Department of Urology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Susanne Van Der Velde
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Philip C De Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Ringgold: 1209Amsterdam UMC, VU University Medical Center, The Netherlands
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10
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de Graaff MR, Hogenbirk RNM, Janssen YF, Elfrink AKE, Liem RSL, Nienhuijs SW, de Vries JPPM, Elshof JW, Verdaasdonk E, Melenhorst J, van Westreenen HL, Besselink MGH, Ruurda JP, van Berge Henegouwen MI, Klaase JM, den Dulk M, van Heijl M, Hegeman JH, Braun J, Voeten DM, Würdemann FS, Warps ALK, Alberga AJ, Suurmeijer JA, Akpinar EO, Wolfhagen N, van den Boom AL, Bolster-van Eenennaam MJ, van Duijvendijk P, Heineman DJ, Wouters MWJM, Kruijff S, Koningswoud-Terhoeve CL, Belt E, van der Hoeven JAB, Marres GMH, Tozzi F, von Meyenfeldt EM, Coebergh RRJ, van den Braak, Huisman S, Rijken AM, Balm R, Daams F, Dickhoff C, Eshuis WJ, Gisbertz SS, Zandbergen HR, Hartemink KJ, Keessen SA, Kok NFM, Kuhlmann KFD, van Sandick JW, Veenhof AA, Wals A, van Diepen MS, Schoonderwoerd L, Stevens CT, Susa D, Bendermacher BLW, Olofsen N, van Himbeeck M, de Hingh IHJT, Janssen HJB, Luyer MDP, Nieuwenhuijzen GAP, Ramaekers M, Stacie R, Talsma AK, Tissink MW, Dolmans D, Berendsen R, Heisterkamp J, Jansen WA, de Kort-van Oudheusden M, Matthijsen RM, Grünhagen DJ, Lagarde SM, Maat APWM, van der Sluis PC, Waalboer RB, Brehm V, van Brussel JP, Morak M, Ponfoort ED, Sybrandy JEM, Klemm PL, Lastdrager W, Palamba HW, van Aalten SM, Tseng LNL, van der Bogt KEA, de Jong WJ, Oosterhuis JWA, Tummers Q, van der Wilden GM, Ooms S, Pasveer EH, Veger HTC, Molegraafb MJ, Nieuwenhuijs VB, Patijn GA, van der Veldt MEV, Boersma D, van Haelst STW, van Koeverden ID, Rots ML, Bonsing BA, Michiels N, Bijlstra OD, Braun J, Broekhuis D, Brummelaar HW, Hartgrink HH, Metselaar A, Mieog JSD, Schipper IB, de Steur WO, Fioole B, Terlouw EC, Biesmans C, Bosmans JWAM, Bouwense SAW, Clermonts SHEM, Coolsen MME, Mees BME, Schurink GWH, Duijff JW, van Gent T, de Nes LCF, Toonen D, Beverwijk MJ, van den Hoed E, Keizers B, Kelder W, Keller BPJA, Pultrum BB, van Rosum E, Wijma AG, van den Broek F, Leclercq WKG, Loos MJA, Sijmons JML, Vaes RHD, Vancoillie PJ, Consten ECJ, Jongen JMJ, Verheijen PM, van Weel V, Arts CHP, Jonker J, Murrmann-Boonstra G, Pierie JPEN, Swart J, van Duyn EB, Geelkerken RH, de Groot R, Moekotte NL, Stam A, Voshaar A, van Acker GJD, Bulder RMA, Swank DJ, Pereboom ITA, Hoffmann WH, Orsini M, Blok JJ, Lardenoije JHP, Reijne MMPJ, van Schaik P, Smeets L, van Sterkenburg SMM, Harlaar NJ, Mekke S, Verhaakt T, Cancrinus E, van Lammeren GW, Molenaar IQ, van Santvoort HC, Vos AWF, Schouten- van der Velden AP, Woensdregt K, Mooy-Vermaat SP, Scharn DM, Marsman HA, Rassam F, Halfwerk FR, Andela AJ, Buis CI, van Dam GM, ten Duis K, van Etten B, Lases L, Meerdink M, de Meijer VE, Pranger B, Ruiter S, Rurenga M, Wiersma A, Wijsmuller AR, Albers KI, van den Boezem PB, Klarenbeek B, van der Kolk BM, van Laarhoven CJHM, Matthée E, Peters N, Rosman C, Schroen AMA, Stommel MWJ, Verhagen AFTM, van der Vijver R, Warlé MC, de Wilt JHW, van den Berg JW, Bloemert T, de Borst GJ, van Hattum EH, Hazenberg CEVB, van Herwaarden JA, van Hillegerberg R, Kroese TE, Petri BJ, Toorop RJ, Aarts F, Janssen RJL, Janssen-Maessen SHP, Kool M, Verberght H, Moes DE, Smit JW, Wiersema AM, Vierhout BP, de Vos B, den Boer FC, Dekker NAM, Botman JMJ, van Det MJ, Folbert EC, de Jong E, Koenen JC, Kouwenhoven EA, Masselink I, Navis LH, Belgers HJ, Sosef MN, Stoot JHMB. Impact of the COVID-19 pandemic on surgical care in the Netherlands. Br J Surg 2022; 109:1282-1292. [PMID: 36811624 PMCID: PMC10364688 DOI: 10.1093/bjs/znac301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/14/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. METHODS A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. RESULTS Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001). CONCLUSION The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.
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Affiliation(s)
- Michelle R de Graaff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.,Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Rianne N M Hogenbirk
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Yester F Janssen
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Arthur K E Elfrink
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ronald S L Liem
- Department of Surgery, Dutch Obesity Clinic, Gouda, the Netherlands.,Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jan-Willem Elshof
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Emiel Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Marc G H Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Johannes H Hegeman
- Department of Surgery, Ziekenhuisgroep Twente Almelo-Hengelo, Almelo, Hengelo, the Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Daan M Voeten
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Franka S Würdemann
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anne-Loes K Warps
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anna J Alberga
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J Annelie Suurmeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Erman O Akpinar
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nienke Wolfhagen
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | | | - David J Heineman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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11
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Joosten JJ, Gisbertz SS, Heineman DJ, Daams F, Eshuis WJ, van Berge Henegouwen MI. The role of fluorescence angiography in colonic interposition after esophagectomy. Dis Esophagus 2022; 36:6779887. [PMID: 36309805 PMCID: PMC10150173 DOI: 10.1093/dote/doac076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 12/11/2022]
Abstract
Colonic interposition is an alternative for gastric conduit reconstruction after esophagectomy. Anastomotic leakage (AL) occurs in 15-25% of patients and may be attributed to reduced blood supply after vascular ligation. Indocyanine green fluorescence angiography (ICG-FA) can visualize tissue perfusion. We aimed to give an overview of the first experiences of ICG-FA and AL rate in colonic interposition. This study included all consecutive patients who underwent a colonic interposition between January 2015 and December 2021 at a tertiary referral center. Surgery was performed for the following indications: inability to use the stomach because of previous surgery or extensive tumour involvement, cancer recurrence in the gastric conduit, or because of complications after initial esophagectomy. Since 2018 ICG-FA was performed before anastomotic reconstruction by administration of ICG injection (0.1 mg/kg/bolus), using the Spy-phi (Stryker, Kalamazoo, MI). Twenty-eight patients (9 female, mean age 62.8), underwent colonic interposition of whom 15 (54%) underwent ICG-FA-guided surgery. Within the ICG-FA group, three (20%) AL occurred, whereas in the non-ICG-FA group, three AL and one graft necrosis (31%) occurred (P=0.67). There was a change of management due to the FA assessment in three patients in the FA group (20%) which led to the choice of a different bowel segment for the anastomosis. Mean operative times in the ICG-FA and non-ICG-FA groups were 372±99 and 399±113 minutes, respectively (P=0.85). ICG-FA is a safe, easy and feasible technique to assess perfusion of colonic interpositions. ICG-FA is of added value leading to a change in management in a considerable percentage of patients. Its role in prevention of AL remains to be elucidated.
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Affiliation(s)
- J J Joosten
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.,Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - D J Heineman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - F Daams
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - W J Eshuis
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
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12
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Plat VD, Stam WT, Bootsma BT, Straatman J, Klausch T, Heineman DJ, van der Peet DL, Daams F. Short-term outcome for high-risk patients after esophagectomy. Dis Esophagus 2022; 36:6611914. [PMID: 35724560 PMCID: PMC9817823 DOI: 10.1093/dote/doac028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 02/14/2022] [Indexed: 01/11/2023]
Abstract
Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection; however, it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Of 5,438 patients, 945 and 431 high-risk patients underwent TTE and THE, respectively. After propensity score matching, mortality (6.3 vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥ 3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0 vs. 2.2%, P = 0.020). Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice, these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.
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Affiliation(s)
- Victor D Plat
- Address correspondence to: V.D. Plat, MD, Amsterdam University Medical Centers, VU University Medical center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Wessel T Stam
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Boukje T Bootsma
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas Klausch
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands,Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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13
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Joosten PJ, Winkelman TA, Heineman DJ, Hashemi SM, Bahce I, Senan S, Paul MA, Hartemink KJ, Dahele M, Dickhoff C. Salvage Surgery for Patients With Local Recurrence or Persistent Disease After Treatment With Chemoradiotherapy for SCLC. JTO Clin Res Rep 2021; 2:100172. [PMID: 34590022 PMCID: PMC8474289 DOI: 10.1016/j.jtocrr.2021.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The role of salvage surgery for patients with locoregional (LR) recurrence or persistent SCLC after radical chemoradiotherapy (CRT) for limited-stage disease is not well established. We evaluated our experience. Methods We conducted a retrospective study of consecutive patients who underwent salvage pulmonary resection for LR-recurrent or persistent SCLC between 2008 and 2020 at the Amsterdam University Medical Center. Results A total of 10 patients were identified. Median age at initial diagnosis of limited-stage SCLC was 58.5 years (48-71 y). All patients had radical-intent concurrent CRT. Of the 10 patients, 9 were diagnosed with LR-recurrent or persistent disease with a median of 18 months (3-78 y) after CRT. All patients underwent an anatomical radical resection and mediastinal lymph node dissection. No 90-day mortality was recorded. In addition, one patient developed a LR recurrence 7 months after resection. Distant progression was found in three patients at 6, 32, and 61 months after surgery, all of whom subsequently died of progressive SCLC. Median follow-up was 22.5 months (2-86 mos). Disease-free survival was 34 months; overall survival was not reached. Conclusions For highly selected patients with LR-recurrent or persistent SCLC after CRT, salvage surgery is feasible and can result in clinically meaningful survival. Such patients should be presented to the multidisciplinary tumor board.
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Affiliation(s)
- Pieter J.M. Joosten
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Toon A. Winkelman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - David J. Heineman
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Sayed M.S. Hashemi
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Marinus A. Paul
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Corresponding author. Address for correspondence: Chris Dickhoff, MD, PhD, Department Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
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14
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Winkelman JA, van der Woude L, Heineman DJ, Bahce I, Damhuis RA, Mahtab EAF, Hartemink KJ, Senan S, Maat APWM, Braun J, Paul MA, Dahele M, Dickhoff C. A nationwide population-based cohort study of surgical care for patients with superior sulcus tumors: Results from the Dutch Lung Cancer Audit for Surgery (DLCA-S). Lung Cancer 2021; 161:42-48. [PMID: 34509720 DOI: 10.1016/j.lungcan.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Data on national patterns of care for patients with superior sulcus tumors (SST) is currently lacking. We investigated the distribution of surgical care and outcome for patients with SST in the Netherlands. MATERIAL AND METHODS Data was retrieved from the Dutch Lung Cancer Audit for Surgery (DLCA-S) for all patients undergoing resection for clinical stage IIB-IV SST from 2012 to 2019. Because DLCA-S is not linked to survival data, survival for a separate cohort (2015-2017) was obtained from the Netherlands Cancer Registry (NCR). RESULTS In the study period, 181 patients had SST surgery, representing 1.03% (181/17488) of all lung cancer pulmonary resections. For 2015-2017, the SST resection rate was 14.4% (79/549), and patients with stage IIB/III SST treated with trimodality had a 3-year overall survival of 67.4%. 63.5% of patients were male, and median age was 60 years. Almost 3/4 of tumors were right sided. Surgery was performed in 20 hospitals, with average number of annual resections ranging from ≤ 1 (n = 17) to 9 (n = 1). 39.8% of resections were performed in 1 center and 63.5% in the 3 most active centers. 12.7% of resections were extended (e.g. vertebral resection). 85.1% of resections were complete (R0). Morbidity and 30-day mortality were 51.4% and 3.3% respectively. Despite treating patients with a higher ECOG performance score and more extended resections, the highest volume center had rates of morbidity/mortality, and length of hospital stay that were comparable to those of the medium volume (n = 2) and low-volume centers (n = 1). CONCLUSION In the Netherlands, surgery for SST accounts for about 1% of all lung cancer pulmonary resections, the number of SST resections/hospital/year varies widely, with most centers performing an average of ≤ 1/year. Morbidity and mortality are acceptable and survival compares favourably with the literature. Although further centralisation is possible, it is unknown whether this will improve outcomes.
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Affiliation(s)
- J A Winkelman
- Department of Cardiothoracic Surgery, the Netherlands.
| | - L van der Woude
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Postbus 9101, 6500 HB Nijmegen, the Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands
| | - D J Heineman
- Department of Cardiothoracic Surgery, the Netherlands; Surgery, the Netherlands
| | - I Bahce
- Pulmonary Diseases, Amsterdam University Medical Center, Location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - R A Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511DT Utrecht, the Netherlands
| | - E A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, the Netherlands
| | - K J Hartemink
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - S Senan
- Radiation Oncology, the Netherlands
| | - A P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, the Netherlands
| | - J Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, the Netherlands
| | - M A Paul
- Department of Cardiothoracic Surgery, the Netherlands
| | - M Dahele
- Radiation Oncology, the Netherlands
| | - C Dickhoff
- Department of Cardiothoracic Surgery, the Netherlands; Surgery, the Netherlands
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15
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Hoeijmakers F, Heineman DJ, Schreurs WH. Response. Chest 2021; 159:888-889. [PMID: 33563450 DOI: 10.1016/j.chest.2020.08.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- F Hoeijmakers
- Department of Surgery, Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Leiden University Medical Center, and the Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - D J Heineman
- Department of Surgery and Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - W H Schreurs
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
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16
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Hoeijmakers F, Hartemink KJ, Verhagen AF, Steup WH, Marra E, Röell WFB, Heineman DJ, Schreurs WH, Tollenaar RAEM, Wouters MWJM. Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery. Eur J Cardiothorac Surg 2021; 61:110-117. [PMID: 34410339 PMCID: PMC8715850 DOI: 10.1093/ejcts/ezab376] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Persistent air leak (PAL; >5 days after surgery) is the most common complication after pulmonary resection and associated with prolonged hospital stay and increased morbidity. Literature is contradictory about the prevention and treatment of PAL. Variation is therefore hypothesized. The aim of this study is to understand the variation in the incidence, preventive management and treatment of PAL. METHODS Data from the Dutch Lung Cancer Audit for Surgery were combined with results of an online survey among Dutch thoracic surgeons. The national incidence of PAL and case-mix corrected between-hospital variation were calculated in patients who underwent an oncological (bi)lobectomy or segmentectomy between January 2012 and December 2018. By multivariable logistic regression, factors associated with PAL were assessed. A survey was designed to assess variation in (preventive) management and analysed using descriptive statistics. Hospital-level associations between management strategies and PAL were assessed by univariable linear regression. RESULTS Of 12 382 included patients, 9.0% had PAL, with a between-hospital range of 2.6–19.3%. Factors associated with PAL were male sex, poor lung function, low body mass index, high American Society of Anesthesiologists (ASA) score, pulmonary comorbidity, upper lobe resection, (bi)lobectomy (vs segmentectomy), right-sided tumour and robotic-assisted thoracic surgery. Perioperative (preventive) management of PAL differed widely between hospitals. When using water seal compared to suction drainage, the average incidence of PAL decreased 2.9%. CONCLUSIONS In the Netherlands, incidence and perioperative (preventive) management of PAL vary widely. Using water seal instead of suction drainage and increasing awareness are potential measures to reduce this variation.
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Affiliation(s)
- Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Koen J Hartemink
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ad F Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem H Steup
- Department of Surgery, HAGA Hospital, Den Haag, Netherlands
| | - Elske Marra
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | | | - David J Heineman
- Department of Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | | | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.,Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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17
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Heineman DJ, Hoeijmakers F, Schreurs WH. Response. Chest 2021; 159:2519. [PMID: 34099149 DOI: 10.1016/j.chest.2021.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- David J Heineman
- Departments of Surgery and Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amersterdam, The Netherlands.
| | - Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
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18
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van der Woude L, Wouters MWJM, Hartemink KJ, Heineman DJ, Verhagen AFTM. Completeness of lymph node dissection in patients undergoing minimally invasive- or open surgery for non-small cell lung cancer: A nationwide study. Eur J Surg Oncol 2020; 47:1784-1790. [PMID: 33223414 DOI: 10.1016/j.ejso.2020.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/08/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE In patients with NSCLC, lymph node metastases are an important prognostic factor. Despite an accurate pre-operative work up, for optimal staging an intrapulmonary- and mediastinal lymph node dissection (LND) as part of the operation is mandatory. The aim of this study is to assess the completeness of LND in patients undergoing an intended curative resection for NSCLC in the Netherlands and to compare performance between open surgery and minimally invasive surgery (MIS). MATERIALS AND METHODS The intraoperative LND was evaluated in 7460 patients who had undergone a lobectomy for clinically staged N0-1 NSCLC (2013-2018). The LND was considered complete, when three mediastinal (N2) lymph node stations, including station 7, were sampled or dissected, in addition to the lymph nodes from station 10 and 11. A comparison was made between open surgery and MIS. RESULTS Of 5154 patients, who had MIS, a sufficient intrapulmonary LND was performed in 47.9% and a sufficient mediastinal LND in 58.6%. A complete LND was performed in 31.6%. For 2306 patients who had an open resection, these numbers were 45.0%, 59.0%, and 30.6%, respectively. The overall between-hospital variation in a complete LND ranged between 0 and 72.5%. CONCLUSION In the Netherlands, a complete LND of both intrapulmonary- and mediastinal lymph nodes is performed only in a minority of patients with clinically staged N0-1 NSCLC, with substantial between-hospital variation. No differences were seen between open surgery and MIS. Because of poor performance, completeness of lymph node dissection will be recorded as a mandatory performance indicator in our national audit, to improve the quality of resection.
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Affiliation(s)
- Lisa van der Woude
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Cardiothoracic Surgery, Postbus 9101, 6500, HB Nijmegen, the Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA Leiden, the Netherlands.
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA Leiden, the Netherlands; Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgery, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands.
| | - Koen J Hartemink
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgery, Plesmanlaan 121, 1066, CX Amsterdam, the Netherlands.
| | - David J Heineman
- Amsterdam University Medical Center, Department of Surgery, Postbus 7057, 1008 MB Amsterdam, the Netherlands; Amsterdam University Medical Center, Department of Cardiothoracic Surgery, Postbus 7057, 1008, MB Amsterdam, the Netherlands.
| | - Ad F T M Verhagen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Cardiothoracic Surgery, Postbus 9101, 6500, HB Nijmegen, the Netherlands.
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Dickhoff C, Senan S, Schneiders FL, Veltman J, Hashemi S, Daniels JMA, Fransen M, Heineman DJ, Radonic T, van de Ven PM, Bartelink IH, Meijboom LJ, Garcia-Vallejo JJ, Oprea-Lager DE, de Gruijl TD, Bahce I. Ipilimumab plus nivolumab and chemoradiotherapy followed by surgery in patients with resectable and borderline resectable T3-4N0-1 non-small cell lung cancer: the INCREASE trial. BMC Cancer 2020; 20:764. [PMID: 32795284 PMCID: PMC7427738 DOI: 10.1186/s12885-020-07263-9] [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: 03/23/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022] Open
Abstract
Background The likelihood of a tumor recurrence in patients with T3-4N0–1 non-small cell lung cancer following multimodality treatment remains substantial, mainly due distant metastases. As pathological complete responses (pCR) in resected specimens are seen in only a minority (28–38%) of patients following chemoradiotherapy, we designed the INCREASE trial (EudraCT-Number: 2019–003454-83; Netherlands Trial Register number: NL8435) to assess if pCR rates could be further improved by adding short course immunotherapy to induction chemoradiotherapy. Translational studies will correlate changes in loco-regional and systemic immune status with patterns of recurrence. Methods/design This single-arm, prospective phase II trial will enroll 29 patients with either resectable, or borderline resectable, T3-4N0–1 NSCLC. The protocol was approved by the institutional ethics committee. Study enrollment commenced in February 2020. On day 1 of guideline-recommended concurrent chemoradiotherapy (CRT), ipilimumab (IPI, 1 mg/kg IV) and nivolumab (NIVO, 360 mg flat dose IV) will be administered, followed by nivolumab (360 mg flat dose IV) after 3 weeks. Radiotherapy consists of once-daily doses of 2 Gy to a total of 50 Gy, and chemotherapy will consist of a platinum-doublet. An anatomical pulmonary resection is planned 6 weeks after the last day of radiotherapy. The primary study objective is to establish the safety of adding IPI/NIVO to pre-operative CRT, and its impact on pathological tumor response. Secondary objectives are to assess the impact of adding IPI/NIVO to CRT on disease free and overall survival. Exploratory objectives are to characterize tumor inflammation and the immune contexture in the tumor and tumor-draining lymph nodes (TDLN), and to explore the effects of IPI/NIVO and CRT and surgery on distribution and phenotype of peripheral blood immune subsets. Discussion The INCREASE trial will evaluate the safety and local efficacy of a combination of 4 modalities in patients with resectable, T3-4N0–1 NSCLC. Translational research will investigate the mechanisms of action and drug related adverse events. Trial registration Netherlands Trial Registration (NTR): NL8435, Registered 03 March 2020.
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Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Joris Veltman
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Sayed Hashemi
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Marieke Fransen
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Imke H Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Juan J Garcia-Vallejo
- Department of Molecular Cell Biology & Immunology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
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20
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Hoeijmakers F, Heineman DJ, Daniels JM, Beck N, Tollenaar RAEM, Wouters MWJM, Marang-van de Mheen PJ, Schreurs WH. Variation Between Multidisciplinary Tumor Boards in Clinical Staging and Treatment Recommendations for Patients With Locally Advanced Non-small Cell Lung Cancer. Chest 2020; 158:2675-2687. [PMID: 32738254 PMCID: PMC7768935 DOI: 10.1016/j.chest.2020.07.054] [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] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/15/2020] [Accepted: 07/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background Accurate diagnosis and staging are crucial to ensure uniform allocation to the optimal treatment methods for non-small cell lung cancer (NSCLC) patients, but may differ among multidisciplinary tumor boards (MDTs). Discordance between clinical and pathologic TNM stage is particularly important for patients with locally advanced NSCLC (stage IIIA) because it may influence their chance of allocation to curative-intent treatment. We therefore aimed to study agreement on staging and treatment to gain insight into MDT decision-making. Research Question What is the level of agreement on clinical staging and treatment recommendations among MDTs in stage IIIA NSCLC patients? Study Design and Methods Eleven MDTs each evaluated the same 10 pathologic stage IIIA NSCLC patients in their weekly meeting (n = 110). Patients were selected purposively for their challenging nature. All MDTs received exactly the same clinical information and images per patient. We tested agreement in cT stage, cN stage, cM stage (TNM 8th edition), and treatment proposal among MDTs using Randolph’s free-marginal multirater kappa. Results Considerable variation among the MDTs was seen in T staging (κ, 0.55 [95% CI, 0.34-0.75]), N staging (κ, 0.59 [95% CI, 0.35-0.83]), overall TNM staging (κ, 0.53 [95% CI, 0.35-0.72]), and treatment recommendations (κ, 0.44 [95% CI, 0.32-0.56]). Most variation in T stage was seen in patients with suspicion of invasion of surrounding structures, which influenced such treatment recommendations as induction therapy and type. For N stage, distinction between N1 and N2 disease was an important source of discordance among MDTs. Variation occurred between 2 patients even regarding M stage. A wide range of additional diagnostics was proposed by the MDTs. Interpretation This study demonstrated high variation in staging and treatment of patients with stage IIIA NSCLC among MDTs in different hospitals. Although some variation may be unavoidable in these challenging patients, we should strive for more uniformity.
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Affiliation(s)
- Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - David J Heineman
- Department of Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes M Daniels
- Department of Pulmonary Diseases, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Naomi Beck
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands; Department of Surgical Oncology, The Netherlands Cancer Institute / Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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de Ruiter JC, Heineman DJ, Daniels JM, van Diessen JN, Damhuis RA, Hartemink KJ. The role of surgery for stage I non-small cell lung cancer in octogenarians in the era of stereotactic body radiotherapy in the Netherlands. Lung Cancer 2020; 144:64-70. [PMID: 32371262 DOI: 10.1016/j.lungcan.2020.04.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Resection is the standard treatment for stage I non-small cell lung cancer (NSCLC) in operable patients. Stereotactic body radiotherapy (SBRT) is recommended for inoperable patients. A shift from surgery to SBRT is expected in elderly patients due to increased frailty and competing risks. We assessed the current influence of age on treatment decision-making and overall survival (OS). MATERIALS AND METHODS We performed a retrospective cohort study using data from patients with clinical stage I NSCLC diagnosed in 2012-2016 and treated with lobectomy, segmentectomy, wedge resection, or SBRT, retrieved from the Netherlands Cancer Registry. Patient characteristics and OS were compared between SBRT and (sub)lobar resection for patients aged 18-79 and ≥80 years. RESULTS AND CONCLUSION 8764 patients treated with lobectomy (n = 4648), segmentectomy (n = 122), wedge resection (n = 272), or SBRT (n = 3722) were included. In 2012-2016, SBRT was increasingly used for octogenarians and younger patients from 75.3% to 83.7% and from 30.8% to 43.2%, respectively. Five-year OS in the whole population was 70% after surgery versus 39% after SBRT and 50% versus 27% in octogenarians. After correction for age, gender, year of diagnosis, and clinical T-stage, OS was equal after lobectomy and SBRT in the first 2 years after diagnosis. However, after >2 years, OS was better after lobectomy than after SBRT. SBRT is the prevailing treatment in octogenarians with stage I NSCLC. While surgery is associated with better OS than SBRT, factors other than treatment modality (e.g. comorbidity) may have had a significant impact on survival. The wider application of SBRT in octogenarians likely reflects the frailty of this group. Registries and trials are required to identify key determinants of frailty in this specific population to improve patient selection for surgery or SBRT.
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Affiliation(s)
- Julianne C de Ruiter
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - David J Heineman
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Johannes Ma Daniels
- Department of Pulmonary Diseases, Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Judi Na van Diessen
- Department of Radiotherapy, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Ronald Am Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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Bousema JE, Heineman DJ, Dijkgraaf MGW, Annema JT, van den Broek FJC. Adherence to the mediastinal staging guideline and unforeseen N2 disease in patients with resectable non-small cell lung cancer: Nationwide results from the Dutch Lung Cancer Audit - Surgery. Lung Cancer 2020; 142:51-58. [PMID: 32088606 DOI: 10.1016/j.lungcan.2020.02.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Invasive mediastinal staging is advised by guidelines in patients with resectable non-small cell lung cancer (NSCLC) and suspicious lymph nodes (cN1-3) or for central, FDG-non-avid or peripheral tumours >3 cm. Our objective was to assess current guideline adherence and consequent unforeseen N2 disease (uN2) in NSCLC patients having various indications for mediastinal staging. MATERIALS AND METHODS We analysed the Dutch Lung Cancer Audit - Surgery data of all patients who underwent a primary lung resection with lymph node dissection for NSCLC in 2017-2018. Based on the 2015 ESTS-ERS-ESGE guideline we assessed the use of initial endosonography and confirmatory mediastinoscopy as well as uN2 rates. RESULTS A total of 2238 patients were analysed. 43 % (95 %-CI: 41-45) underwent initial endosonography followed by a confirmatory mediastinoscopy in 44 % (95 %-CI:40-47) of them, resulting in a 19 % (95 %-CI: 17-20) rate of properly staged patient according to the guidelines. uN2 was demonstrated in 12.5 % (95 %-CI: 9.7-16.0) of correctly staged patients compared to 10.9 % (95 %-CI: 9.6-12.4) who were not (p = .36). The highest uN2 rate was found in cN1-3 patients who were not staged (23.0 %, 95 %-CI: 16.4-31.2) compared to 13.0 % (95 %-CI: 9.7-17.1) who were (p = .01). CONCLUSION Guideline adherence in Dutch NSCLC patients with an indication for invasive mediastinal staging is poor. The highest uN2 rate was found in unstaged cN1-3 patients, suggesting that this subgroup may benefit from an appropriate staging conform guidelines.
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Affiliation(s)
- Jelle E Bousema
- Department of Surgery, Máxima MC, Veldhoven, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.
| | - David J Heineman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, PO BOX 7057, 1117 MB, Amsterdam, the Netherlands.
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, PO BOX 22700 (J.1B-226), 1100 DE, Amsterdam, the Netherlands.
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, PO BOX 22700, 1100 DE, Amsterdam, the Netherlands.
| | - Frank J C van den Broek
- Department of Surgery, Máxima MC, Veldhoven, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.
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Voeten DM, den Bakker CM, Goedegebuure RSA, Heineman DJ, Daams F, van der Peet DL. [Non-metastatic oesophageal cancer: diagnosis and treatment]. Ned Tijdschr Geneeskd 2019; 163:D3718. [PMID: 31556490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The incidence of oesophageal cancer is on the rise, particularly due to an increase in the number of adenocarcinomas of the distal oesophagus. Adenomas and squamous cell carcinomas are the most common histological subtypes; each should be considered as a different entity. The diagnosis 'oesophageal cancer' is confirmed on the basis of histopathological investigation of biopsies, whereas tumour staging is conducted through transoesophageal endoscopic ultrasound and FDG-PET/CT diagnostics. There are various options to treat patients with oesophageal cancer, such as endoscopic resection, multimodal therapy or definitive chemoradiotherapy. Since 2012, neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for oesophageal cancer, except with regard to patients with a T1 or M1 tumour. In the Netherlands, most surgical procedures are now minimally invasive procedures. Despite improved treatment options, mortality rates associated with oesophageal cancer remain high.
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Affiliation(s)
- Daan M Voeten
- Amsterdam UMC, afd. Heelkunde, Amsterdam
- Contact: D.M. Voeten
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24
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Voeten DM, den Bakker CM, Heineman DJ, Ket JCF, Daams F, van der Peet DL. Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta-analyses and Systematic Review of Literature. World J Surg 2019; 43:1271-1285. [PMID: 30607604 DOI: 10.1007/s00268-018-04901-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Standard therapy for loco-regionally advanced, resectable oesophageal carcinoma is trimodality therapy (TMT) consisting of neoadjuvant chemoradiotherapy and oesophagectomy. Evidence of survival advantage of TMT over organ-preserving definitive chemoradiotherapy (dCRT) is inconclusive. The aim of this study is to compare survival between TMT and dCRT. METHODS A systematic review and meta-analyses were conducted. Randomised controlled trials and observational studies on resectable, curatively treated, oesophageal carcinoma patients above 18 years were included. Three online databases were searched for studies comparing TMT with dCRT. Primary outcomes were 1-, 2-, 3- and 5-year overall survival rates. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs and cohort studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation. RESULTS Thirty-two studies described in 35 articles were included in this systematic review, and 33 were included in the meta-analyses. Two-, three- and five-year overall survival was significantly lower in dCRT compared to TMT, with relative risks (RRs) of 0.69 (95% CI 0.57-0.83), 0.76 (95% CI 0.63-0.92) and 0.57 (95% CI 0.47-0.71), respectively. When only analysing studies with equal patient groups at baseline, no significant differences for 2-, 3- and 5-year overall survival were found with RRs of 0.83 (95% CI 0.62-1.10), 0.81 (95% CI 0.57-1.14) and 0.63 (95% CI 0.36-1.12). CONCLUSION These meta-analyses do not show clear survival advantage for TMT over dCRT. Only a non-significant trend towards better survival was seen, assuming comparable patient groups at baseline. Non-operative management of oesophageal carcinoma patients might be part of a personalised and tailored treatment approach in future. However, to date hard evidence proving its non-inferiority compared to operative management is lacking.
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Affiliation(s)
- Daan M Voeten
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - Chantal M den Bakker
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
| | | | - Freek Daams
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
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25
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Heineman DJ, van Berge Henegouwen MI. Extensive thoracoscopic mediastinal lymph node dissection on the left side: how it should be done. J Thorac Dis 2019; 11:62-64. [PMID: 30863573 DOI: 10.21037/jtd.2019.01.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David J Heineman
- Department of Surgery, Amsterdam UMC, VU University Medical Center, 1081 HV, Amsterdam, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, 1081 HV, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
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26
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Beck N, Hoeijmakers F, van der Willik EM, Heineman DJ, Braun J, Tollenaar RA, Schreurs WH, Wouters MW. National Comparison of Hospital Performances in Lung Cancer Surgery: The Role of Case Mix Adjustment. Ann Thorac Surg 2018; 106:412-420. [DOI: 10.1016/j.athoracsur.2018.02.074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 01/11/2023]
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27
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Dickhoff C, Rodriguez Schaap PM, Otten RHJ, Heymans MW, Heineman DJ, Dahele M. Salvage surgery for local recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: a systematic review. Ther Adv Med Oncol 2018; 10:1758835918787989. [PMID: 30023008 PMCID: PMC6047243 DOI: 10.1177/1758835918787989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: Stereotactic body (or ablative) radiotherapy (SBRT/SABR) is now a
guideline-recommended treatment for medically inoperable patients with
peripherally-located, stage I non-small cell lung cancer (NSCLC), and for
medically operable patients who decline surgery. The 5-year local failure
rate after SBRT is about 10% and in highly selected patients, surgery has
been used as a salvage therapy. We performed a systematic review to address
the feasibility, safety, and outcome of salvage surgery for locally
recurrent early stage NSCLC after SBRT. Methods: A systematic literature search was performed according to Preferred Reporting
Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
PubMed, Embase and Cochrane databases
were searched and two authors independently assessed the articles. A total
of seven eligible articles were identified. Results: All seven articles were retrospective case series, representing a total of 47
patients. Surgery was completed in all patients. Where reported in
sufficient detail, morbidity (four studies) was between 29 and 50% (series
of two patients) and 90-day mortality (six studies) was between 0% (four
studies) and 11% (n = 1, disease progression). Median
(n = 5)/mean (n = 1) reported or
calculated follow ups were 7–54.5/17.3 months. Median overall survival was
reported in three studies and ranged between 13.6–82.7 months. Crude
survival in three others was 2–35 months. Conclusion: Limited, low-level evidence prevents firm conclusions, but based on the
existing data, salvage surgery after local recurrence of NSCLC following
SBRT appears technically feasible, with acceptable morbidity and mortality
in appropriately selected and counselled patients who are fit enough and who
accept the risks (level of evidence 4, strength of recommendation C).
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Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Rene H J Otten
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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28
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Bousema JE, Dijkgraaf MGW, Papen-Botterhuis NE, Schreurs HW, Maessen JG, van der Heijden EH, Steup WH, Braun J, Noyez VJJM, Hoeijmakers F, Beck N, van Dorp M, Claessens NJM, Hiddinga BI, Daniels JMA, Heineman DJ, Zandbergen HR, Verhagen AFTM, van Schil PE, Annema JT, van den Broek FJC. MEDIASTinal staging of non-small cell lung cancer by endobronchial and endoscopic ultrasonography with or without additional surgical mediastinoscopy (MEDIASTrial): study protocol of a multicenter randomised controlled trial. BMC Surg 2018; 18:27. [PMID: 29776444 PMCID: PMC5960166 DOI: 10.1186/s12893-018-0359-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 03/22/2018] [Accepted: 05/02/2018] [Indexed: 12/24/2022] Open
Abstract
Background In case of suspicious lymph nodes on computed tomography (CT) or fluorodeoxyglucose positron emission tomography (FDG-PET), advanced tumour size or central tumour location in patients with suspected non-small cell lung cancer (NSCLC), Dutch and European guidelines recommend mediastinal staging by endosonography (endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS)) with sampling of mediastinal lymph nodes. If biopsy results from endosonography turn out negative, additional surgical staging of the mediastinum by mediastinoscopy is advised to prevent unnecessary lung resection due to false negative endosonography findings. We hypothesize that omitting mediastinoscopy after negative endosonography in mediastinal staging of NSCLC does not result in an unacceptable percentage of unforeseen N2 disease at surgical resection. In addition, omitting mediastinoscopy comprises no extra waiting time until definite surgery, omits one extra general anaesthesia and hospital admission, and may be associated with lower morbidity and comparable survival. Therefore, this strategy may reduce health care costs and increase quality of life. The aim of this study is to compare the cost-effectiveness and cost-utility of mediastinal staging strategies including and excluding mediastinoscopy. Methods/design This study is a multicenter parallel randomized non-inferiority trial comparing two diagnostic strategies (with or without mediastinoscopy) for mediastinal staging in 360 patients with suspected resectable NSCLC. Patients are eligible for inclusion when they underwent systematic endosonography to evaluate mediastinal lymph nodes including tissue sampling with negative endosonography results. Patients will not be eligible for inclusion when PET/CT demonstrates ‘bulky N2-N3’ disease or the combination of a highly suspicious as well as irresectable mediastinal lymph node. Primary outcome measure for non-inferiority is the proportion of patients with unforeseen N2 disease at surgery. Secondary outcome measures are hospitalization, morbidity, overall 2-year survival, quality of life, cost-effectiveness and cost-utility. Patients will be followed up 2 years after start of treatment. Discussion Results of the MEDIASTrial will have immediate impact on national and international guidelines, which are accessible to public, possibly reducing mediastinoscopy as a commonly performed invasive procedure for NSCLC staging and diminishing variation in clinical practice. Trial registration The trial is registered at the Netherlands Trial Register on July 6th, 2017 (NTR 6528). Electronic supplementary material The online version of this article (10.1186/s12893-018-0359-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jelle E Bousema
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.,University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- University of Amsterdam, Amsterdam, the Netherlands.,Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Hermien W Schreurs
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erik H van der Heijden
- Department of Pulmonary Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem H Steup
- Department of Surgery, HagaZiekenhuis, Den Haag, the Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Naomi Beck
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - Martijn van Dorp
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Niels J M Claessens
- Department of Pulmonary Medicine, Rijnstate ziekenhuis, Arnhem, the Netherlands
| | - Birgitta I Hiddinga
- Department of Pulmonary Medicine, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Harmen R Zandbergen
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul E van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jouke T Annema
- University of Amsterdam, Amsterdam, the Netherlands.,Department of Pulmonary Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Frank J C van den Broek
- Department of Surgery, Máxima Medical Center, PO BOX 7777, 5500 MB, Veldhoven, the Netherlands.
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Heineman DJ, Daniels JM, Schreurs WH. Clinical staging of NSCLC: current evidence and implications for adjuvant chemotherapy. Ther Adv Med Oncol 2017; 9:599-609. [PMID: 29081843 PMCID: PMC5564882 DOI: 10.1177/1758834017722746] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
Survival of all non-small cell lung cancer (NSCLC) patients is disappointing, with a 5-year survival of 18%. Staging NSCLC patients is crucial because it determines the choice of treatment and prognosis. Clinical staging is a complex process that comes with many challenges and with low accuracy between the clinical and pathological stage. Treatment modalities for stage I-III NSCLC consist of surgical resection, radiotherapy and chemotherapy. This review describes the current evidence on staging and the implications on adjuvant chemotherapy. For stage I disease, staging is most accurate. Primary treatment consists of surgery or stereotactic ablative radiotherapy. When a patient has stage II disease, staging is less accurate because more diagnostic modalities are necessary to stage the mediastinal lymph nodes. Surgery remains the primary treatment modality and platinum-based adjuvant chemotherapy gives a 4% 5-year survival benefit. Staging patients with stage III disease is difficult because of the heterogeneity of the patients. It should be decided if a patient has potentially resectable disease with or without risk of incomplete resection. Induction therapy with chemo(radio)therapy followed by surgical resection or definitive chemoradiotherapy are the treatments of choice. The 5-year survival can reach 44% in selected patients. Decisions in staging and treating patients with NSCLC should be made by a multidisciplinary team with sufficient expertise in all aspects of staging and treatment.
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Affiliation(s)
- David J Heineman
- Department of Surgery and Cardiothoracic Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Johannes M Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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30
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Abstract
We present an unusual case of partial anomalous venous drainage in which the vein of the right upper lobe drains into the superior vena cava, together with the azygos vein. This was discovered during surgery for a lung tumor of the right upper lobe. We present the embryological background, functional consequences and literature on this rare anatomical anomaly.
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Affiliation(s)
- David J Heineman
- 1 Department of Surgery, 2 Department of Pulmonary Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Joost G van den Aardweg
- 1 Department of Surgery, 2 Department of Pulmonary Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Wilhelmina H Schreurs
- 1 Department of Surgery, 2 Department of Pulmonary Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands
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31
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Heineman DJ, Ten Berge M, Schreurs W. F-045ADEQUACY OF STAGING NON-SMALL CELL LUNG CANCER : A DUTCH LUNG SURGERY AUDIT. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.45] [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: 11/14/2022] Open
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34
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Abstract
BACKGROUND The optimal approach to operative treatment of humeral shaft fractures remains debatable. Previously published trials have been limited in size and have been inconclusive regarding important patient outcome variables following treatment with either intramedullary nails or plates. We conducted a meta-analysis of available trials comparing treatment of humeral shaft fractures. METHODS We performed a literature search from 1967 to November 2007 in the main medical search engines and selected 4 randomized trials that compared nails and plates in patients with humeral shaft fractures and that reported on complications due to surgery. We statistically pooled patient data using standard meta-analytic approaches. Our primary outcome was the total complication rate, comprised of all complications listed in the articles included. Secondary outcomes included non-union, infection, nerve palsy, and reoperation rate. Methodology was assessed using the CLEAR NPT. RESULTS When pooling the data of the 4 trials (n = 203 patients), we did not find a statistically significant difference between implants in the rate of total complications, non-union, infection, nerve-palsy, or the need for reoperation. The studies included were small and had methodological limitations. CONCLUSIONS Our meta-analysis suggests stastistically insignificant differences between plates and nails in the treatment of humeral shaft fractures. Small sample sizes, study heterogeneity, and methodological limitations argue strongly for a definitive, large trial. We recommend that this trial should be a randomized controlled trial with appropriate allocation of patients and blinding of patients and care providers and outcome assessors, and that it should include patient-important outcomes.
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Affiliation(s)
- David J Heineman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdamthe Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdamthe Netherlands
| | - Sean E Nork
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, WAthe Netherlands
| | - Kees-Jan Ponsen
- Trauma Unit, Department of Surgery, AMC, Amsterdamthe Netherlands
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ONCanada
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