1
|
van Kleef JJ, Dijksterhuis WPM, van den Boorn HG, Prins M, Verhoeven RHA, Gisbertz SS, Slingerland M, Mohammad NH, Creemers GJ, Neelis KJ, Heisterkamp J, Rosman C, Ruurda JP, Kouwenhoven EA, van de Poll-Franse LV, van Oijen MGH, Sprangers MAG, van Laarhoven HWM. Prognostic value of patient-reported quality of life for survival in oesophagogastric cancer: analysis from the population-based POCOP study. Gastric Cancer 2021; 24:1203-1212. [PMID: 34251543 PMCID: PMC8502147 DOI: 10.1007/s10120-021-01209-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accumulating evidence of trials demonstrates that patient-reported health-related quality of life (HRQoL) at diagnosis is prognostic for overall survival (OS) in oesophagogastric cancer. However, real-world data are lacking. Moreover, differences in disease stages and tumour-specific symptoms are usually not taken into consideration. The aim of this population-based study was to assess the prognostic value of HRQoL, including tumour-specific scales, on OS in patients with potentially curable and advanced oesophagogastric cancer. METHODS Data were derived from the Netherlands Cancer Registry and the patient reported outcome registry (POCOP). Patients included in POCOP between 2016 and 2018 were stratified for potentially curable (cT1-4aNallM0) or advanced (cT4b or cM1) disease. HRQoL was measured with the EORTC QLQ-C30 and the tumour-specific OG25 module. Cox proportional hazards models assessed the impact of HRQoL, sociodemographic and clinical factors (including treatment) on OS. RESULTS In total, 924 patients were included. Median OS was 38.9 months in potentially curable patients (n = 795) and 10.6 months in patients with advanced disease (n = 129). Global Health Status was independently associated with OS in potentially curable patients (HR 0.89, 99%CI 0.82-0.97), together with several other HRQoL items: appetite loss, dysphagia, eating restrictions, odynophagia, and body image. In advanced disease, the Summary Score was the strongest independent prognostic factor (HR 0.75, 99%CI 0.59-0.94), followed by fatigue, pain, insomnia and role functioning. CONCLUSION In a real-world setting, HRQoL was prognostic for OS in patients with potentially curable and advanced oesophagogastric cancer. Several HRQoL domains, including the Summary Score and several OG25 items, could be used to develop or update prognostic models.
Collapse
Affiliation(s)
- J J van Kleef
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
| | - W P M Dijksterhuis
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - H G van den Boorn
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - M Prins
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - R H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - N Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - G-J Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - K J Neelis
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - J Heisterkamp
- Department of Surgery, Elizabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Comprehensive Cancer Network EMBRAZE, Breda, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E A Kouwenhoven
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - L V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - M G H van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - M A G Sprangers
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Public Health Research Institute, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Office D3-312, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Jezerskyte E, van Berge Henegouwen MI, van Laarhoven HWM, van Kleef JJ, Eshuis WJ, Heisterkamp J, Hartgrink HH, Rosman C, van Hillegersberg R, Hulshof MCCM, Sprangers MAG, Gisbertz SS. Postoperative Complications and Long-Term Quality of Life After Multimodality Treatment for Esophageal Cancer: An Analysis of the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). Ann Surg Oncol 2021; 28:7259-7276. [PMID: 34036429 PMCID: PMC8519926 DOI: 10.1245/s10434-021-10144-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Esophagectomy has major effects on health-related quality of life (HR-QoL). Postoperative complications might contribute to a decreased HR-QOL. This population-based study aimed to investigate the difference in HR-QoL between patients with and without complications after esophagectomy for cancer. METHODS A prospective comparative cohort study was performed with data from the Netherlands Cancer Registry (NCR) and Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). All patients with esophageal and gastroesophageal junction (GEJ) cancer after esophagectomy in the period 2015-2018 were enrolled. The study investigated HR-QoL at baseline, then 3, 6, 9, 12, 18, and 24 months postoperatively, comparing patients with and without complications as well as with and without anastomotic leakage. RESULTS The 486 enrolled patients comprised 270 patients with complications and 216 patients without complications. Significantly more patients with complications had comorbidities (69.6% vs 57.3%; p = 0.001). No significant difference in HR-QoL was found over time between the patients with and without complications. In both groups, a significant decline in short-term HR-QoL was found in various HR-QoL domains, which were restored to the baseline level during the 12-month follow-up period. No significant difference was found in HR-QoL between the patients with and without anastomotic leakage. The patients with grades 2 and 3 anastomotic leakage reported significantly more "choking when swallowing" at 6 months (ß = 14.5; 95% confidence interval [CI], - 24.833 to - 4.202; p = 0.049), 9 months (ß = 22.4, 95% CI, - 34.259 to - 10.591; p = 0.007), and 24 months (ß = 24.6; 95% CI, - 39.494 to - 9.727; p = 0.007) than the patients with grade 1 or no anastomotic leakage. CONCLUSION In general, postoperative complications were not associated with decreased short- or long-term HR-QoL for patients after esophagectomy for esophageal or GEJ cancer. The temporary decrease in HR-QoL likely is related to the nature of esophagectomy and reconstruction itself.
Collapse
Affiliation(s)
- E Jezerskyte
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Amsterdam UMC, Department of Medical Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J J van Kleef
- Amsterdam UMC, Department of Medical Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - W J Eshuis
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J Heisterkamp
- Department of Surgery, Embraze Comprehensive Cancer Network, Elisabeth- Tweesteden Hospital, Tilburg, The Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C C M Hulshof
- Amsterdam UMC, Department of Radiotherapy, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M A G Sprangers
- Amsterdam UMC, Department of Medical Psychology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
| | | |
Collapse
|
3
|
van de Water LF, van Kleef JJ, Dijksterhuis WPM, Henselmans I, van den Boorn HG, Vaarzon Morel NM, Schut KF, Daams JG, Smets EMA, van Laarhoven HWM. Communicating treatment risks and benefits to cancer patients: a systematic review of communication methods. Qual Life Res 2020; 29:1747-1766. [PMID: 32333238 PMCID: PMC7295838 DOI: 10.1007/s11136-020-02503-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients are increasingly involved in decision-making processes. Hence, clinicians need to inform patients about the risks and benefits of different treatment options in order for patients to make well informed decisions. The aim of this review is to determine the effects of methods of communicating prognostic information about (1) disease progression (survival, progression, recurrence and remission), (2) side effects and complications and (3) health-related quality of life (HRQL) on cognitive, affective and behavioral outcomes in cancer patients. METHODS A literature search was performed to select articles that were published up to November 2019 and that examined verbal and/or visual risk communication interventions in an oncological clinical setting. RESULTS The search yielded 14,875 studies; 28 studies were ultimately included. For disease progression information, we found that framing affects treatment choice. Furthermore, limiting the amount of progression information in a graphical display could benefit patients' understanding of risks and benefits. For prognostic information about side effects and complications, precise and defined risk information was better understood than information presented in words. When displaying HRQL data, no consensus was found on which graph type to use. CONCLUSION Great heterogeneity in the results and methodology and in the compared communication formats precluded us from drawing any further conclusions. Practical implications for clinicians are to consider the effects that different types of framing might have on the patient and to not rely exclusively on words to describe risks, but rather include at least some form of numbers or visualization.
Collapse
Affiliation(s)
- L F van de Water
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - J J van Kleef
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - W P M Dijksterhuis
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - I Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - H G van den Boorn
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - N M Vaarzon Morel
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - K F Schut
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - J G Daams
- Amsterdam University Medical Centers, Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
| |
Collapse
|
4
|
Coebergh van den Braak RRJ, van Rijssen LB, van Kleef JJ, Vink GR, Berbee M, van Berge Henegouwen MI, Bloemendal HJ, Bruno MJ, Burgmans MC, Busch ORC, Coene PPLO, Coupé VMH, Dekker JWT, van Eijck CHJ, Elferink MAG, Erdkamp FLG, van Grevenstein WMU, de Groot JWB, van Grieken NCT, de Hingh IHJT, Hulshof MCCM, Ijzermans JNM, Kwakkenbos L, Lemmens VEPP, Los M, Meijer GA, Molenaar IQ, Nieuwenhuijzen GAP, de Noo ME, van de Poll-Franse LV, Punt CJA, Rietbroek RC, Roeloffzen WWH, Rozema T, Ruurda JP, van Sandick JW, Schiphorst AHW, Schipper H, Siersema PD, Slingerland M, Sommeijer DW, Spaander MCW, Sprangers MAG, Stockmann HBAC, Strijker M, van Tienhoven G, Timmermans LM, Tjin-a-Ton MLR, van der Velden AMT, Verhaar MJ, Verkooijen HM, Vles WJ, de Vos-Geelen JMPGM, Wilmink JW, Zimmerman DDE, van Oijen MGH, Koopman M, Besselink MGH, van Laarhoven HWM. Nationwide comprehensive gastro-intestinal cancer cohorts: the 3P initiative. Acta Oncol 2018; 57:195-202. [PMID: 28723307 DOI: 10.1080/0284186x.2017.1346381] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The increasing sub-classification of cancer patients due to more detailed molecular classification of tumors, and limitations of current trial designs, require innovative research designs. We present the design, governance and current standing of three comprehensive nationwide cohorts including pancreatic, esophageal/gastric, and colorectal cancer patients (NCT02070146). Multidisciplinary collection of clinical data, tumor tissue, blood samples, and patient-reported outcome (PRO) measures with a nationwide coverage, provides the infrastructure for future and novel trial designs and facilitates research to improve outcomes of gastrointestinal cancer patients. MATERIAL AND METHODS All patients aged ≥18 years with pancreatic, esophageal/gastric or colorectal cancer are eligible. Patients provide informed consent for: (1) reuse of clinical data; (2) biobanking of primary tumor tissue; (3) collection of blood samples; (4) to be informed about relevant newly identified genomic aberrations; (5) collection of longitudinal PROs; and (6) to receive information on new interventional studies and possible participation in cohort multiple randomized controlled trials (cmRCT) in the future. RESULTS In 2015, clinical data of 21,758 newly diagnosed patients were collected in the Netherlands Cancer Registry. Additional clinical data on the surgical procedures were registered in surgical audits for 13,845 patients. Within the first two years, tumor tissue and blood samples were obtained from 1507 patients; during this period, 1180 patients were included in the PRO registry. Response rate for PROs was 90%. The consent rate to receive information on new interventional studies and possible participation in cmRCTs in the future was >85%. The number of hospitals participating in the cohorts is steadily increasing. CONCLUSION A comprehensive nationwide multidisciplinary gastrointestinal cancer cohort is feasible and surpasses the limitations of classical study designs. With this initiative, novel and innovative studies can be performed in an efficient, safe, and comprehensive setting.
Collapse
Affiliation(s)
| | - L. B. van Rijssen
- Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J. J. van Kleef
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - G. R. Vink
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. Berbee
- Department of Radiation Oncology, Maastro Clinic, Maastricht, The Netherlands
| | | | - H. J. Bloemendal
- Department of Medical Oncology, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - M. J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M. C. Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - O. R. C. Busch
- Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - P. P. L. O. Coene
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - V. M. H. Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J. W. T. Dekker
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - C. H. J. van Eijck
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M. A. G. Elferink
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - F. L. G. Erdkamp
- Department of Medical Oncology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | | | | | - N. C. T. van Grieken
- Department of Pathology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - M. C. C. M. Hulshof
- Department of Radiotherapy, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J. N. M. Ijzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | - M. Los
- Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - G. A. Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I. Q. Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M. E. de Noo
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | | | - C. J. A. Punt
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - R. C. Rietbroek
- Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - W. W. H. Roeloffzen
- Department of Medical Oncology, Treant Zorggroep, Hoogeveen, The Netherlands
| | - T. Rozema
- Department of Radiotherapy, Instituut Verbeeten, Tilburg, The Netherlands
| | - J. P. Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J. W. van Sandick
- Department of Surgery, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - H. Schipper
- Stichting voor Patiënten met Kanker aan het Spijsverteringskanaal (SPKS), Utrecht, The Netherlands
| | - P. D. Siersema
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M. Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - D. W. Sommeijer
- Department of Medical Oncology, Flevoziekenhuis, Almere, The Netherlands
| | - M. C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M. A. G. Sprangers
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - M. Strijker
- Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G. van Tienhoven
- Department of Radiotherapy, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L. M. Timmermans
- Stichting voor Patiënten met Kanker aan het Spijsverteringskanaal (SPKS), Utrecht, The Netherlands
| | - M. L. R. Tjin-a-Ton
- Department of Medical Oncology, Hospital Rivierenland, Tiel, The Netherlands
| | | | - M. J. Verhaar
- Department of Medical Oncology, Zuwe Hofpoort Hospital, Woerden, The Netherlands
| | - H. M. Verkooijen
- Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W. J. Vles
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | | | - J. W. Wilmink
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - D. D. E. Zimmerman
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - M. G. H. van Oijen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - M. Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. G. H. Besselink
- Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | | |
Collapse
|