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Sterk MFM, Crolla RMPH, Verseveld M, Dekker JWT, van der Schelling GP, Verhoef C, Olthof PB. Uptake of robot-assisted colon cancer surgery in the Netherlands. Surg Endosc 2023; 37:8196-8203. [PMID: 37644155 PMCID: PMC10615967 DOI: 10.1007/s00464-023-10383-5] [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: 06/02/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The robot-assisted approach is now often used for rectal cancer surgery, but its use in colon cancer surgery is less well defined. This study aims to compare the outcomes of robotic-assisted colon cancer surgery to conventional laparoscopy in the Netherlands. METHODS Data on all patients who underwent surgery for colon cancer from 2018 to 2020 were collected from the Dutch Colorectal Audit. All complications, readmissions, and deaths within 90 days after surgery were recorded along with conversion rate, margin and harvested nodes. Groups were stratified according to the robot-assisted and laparoscopic approach. RESULTS In total, 18,886 patients were included in the analyses. The operative approach was open in 15.2%, laparoscopic in 78.9% and robot-assisted in 5.9%. The proportion of robot-assisted surgery increased from 4.7% in 2018 to 6.9% in 2020. There were no notable differences in outcomes between the robot-assisted and laparoscopic approach for Elective cT1-3M0 right, left, and sigmoid colectomy. Only conversion rate was consistently lower in the robotic group. (4.6% versus 8.8%, 4.6% versus 11.6%, and 1.6 versus 5.9%, respectively). CONCLUSIONS This nationwide study on surgery for colon cancer shows there is a gradual but slow adoption of robotic surgery for colon cancer up to 6.9% in 2020. When comparing the outcomes of right, left, and sigmoid colectomy, clinical outcomes were similar between the robotic and laparoscopic approach. However, conversion rate is consistently lower in the robotic procedures.
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Affiliation(s)
| | | | - Mareille Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | | | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Pim B Olthof
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.
- Department of Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
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2
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Boeding JRE, Cuperus IE, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, Schreinemakers JMJ. Postponing surgery to optimise patients with acute right-sided obstructing colon cancer - A pilot study. Eur J Surg Oncol 2023; 49:106906. [PMID: 37061403 DOI: 10.1016/j.ejso.2023.04.005] [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: 09/20/2022] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Right-sided obstructing colon cancer is most often treated with acute resection. Recent studies on right-sided obstructing colon cancer report higher mortality and morbidity rates than those in patients without obstruction. The aim of this study is to retrospectively analyse whether it is possible to optimise the health condition of patients with acute right-sided obstructing colon cancer, prior to surgery, and whether this improves postoperative outcomes. METHOD All consecutive patients with high suspicion of, or histologically proven, right-sided obstructing colon cancer, treated with curative intent between March 2013 and December 2019, were analysed retrospectively. Patients were divided into two groups: optimised group and non-optimised group. Pre-operative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. RESULTS In total, 54 patients were analysed in this study. Twenty-four patients received optimisation before elective surgery, and thirty patients received emergency surgery, without optimisation. Scheduled surgery was performed after a median of eight days (IQR 7-12). Postoperative complications were found in twelve (50%) patients in the optimised group, compared to twenty-three (77%) patients in the non-optimised group (p = 0.051). Major complications were diagnosed in three (13%) patients with optimisation, compared to ten (33%) patients without optimisation (p = 0.111). Postoperative in-hospital stay, 30-day mortality, as well as primary anastomosis were comparable in both groups. CONCLUSION This pilot study suggests that pre-operative optimisation of patients with obstructing right sided colonic cancer may be feasible and safe but is associated with longer in-patient stay.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Iris E Cuperus
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Aalbers AGJ, Beets GL, Boerma EJG, Borstlap J, van Breest Smallenburg V, Burger JWA, Crolla RMPH, Daniëls-Gooszen AW, Davids PHP, Dunker MS, Fabry HFJ, Furnée EJB, van Gils RAH, de Haas RJ, Hoogendoorn S, van Koeverden S, de Korte FI, Oosterling SJ, Peeters KCMJ, Posma LAE, Pultrum BB, Rothbarth J, Rutten HJT, Schasfoort RA, Schreurs WH, Simons PCG, Smits AB, Talsma AK, The GYM, van Tilborg F, Tuynman JB, Vanhooymissen IJ, van de Ven AWH, Verdaasdonk EGG, Vermaas M, Vliegen RFA, Vogelaar FJ, de Vries M, Vroemen JC, van Vugt ST, Westerterp M, van Westreenen HL, de Wilt JHW, van der Zaag ES, Zimmerman DDE, Marijnen CAM, Tanis PJ, Kusters M. ASO Visual Abstract: Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting. Ann Surg Oncol 2023; 30:5486-5488. [PMID: 37394674 DOI: 10.1245/s10434-023-13666-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Radiology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Arend G J Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Jaap Borstlap
- Department of Radiology, Treant Zorggroep, Hoogeveen, the Netherlands
| | | | | | | | | | - Paul H P Davids
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Michalda S Dunker
- Department of Surgery, Northwest Clinics, NWZ Alkmaar, Alkmaar, the Netherlands
| | - Hans F J Fabry
- Department of Surgery, Bravis Hospital, Roosendaal, the Netherlands
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Fleur I de Korte
- Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisanne A E Posma
- Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands
| | - Bareld B Pultrum
- Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Harm J T Rutten
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Petra C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Aaldert K Talsma
- Department of Surgery, Deventer Hospital, Deventer, the Netherlands
| | - G Y Mireille The
- Department of Radiology, Bravis Hospital, Roosendaal, the Netherlands
| | - Fiek van Tilborg
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Inge J Vanhooymissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Joy C Vroemen
- Department of Radiology, Flevoziekenhuis, Almere, the Netherlands
| | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.
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Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Aalbers AGJ, Beets GL, Boerma EJG, Borstlap J, van Breest Smallenburg V, Burger JWA, Crolla RMPH, Daniëls-Gooszen AW, Davids PHP, Dunker MS, Fabry HFJ, Furnée EJB, van Gils RAH, de Haas RJ, Hoogendoorn S, van Koeverden S, de Korte FI, Oosterling SJ, Peeters KCMJ, Posma LAE, Pultrum BB, Rothbarth J, Rutten HJT, Schasfoort RA, Schreurs WH, Simons PCG, Smits AB, Talsma AK, The GYM, van Tilborg F, Tuynman JB, Vanhooymissen IJS, van de Ven AWH, Verdaasdonk EGG, Vermaas M, Vliegen RFA, Vogelaar FJ, de Vries M, Vroemen JC, van Vugt ST, Westerterp M, van Westreenen HL, de Wilt JHW, van der Zaag ES, Zimmerman DDE, Marijnen CAM, Tanis PJ, Kusters M. Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting. Ann Surg Oncol 2023; 30:5472-5485. [PMID: 37340200 PMCID: PMC10409808 DOI: 10.1245/s10434-023-13460-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/12/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. METHODS Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either 'node-picking' (the removal of an individual LLN) or 'partial regional node dissection' (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. RESULTS Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7-3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2-2.5, p = 0.874). CONCLUSION Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.
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Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Arend G J Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Jaap Borstlap
- Department of Radiology, Treant Zorggroep, Hoogeveen, the Netherlands
| | | | | | | | | | - Paul H P Davids
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Michalda S Dunker
- Department of Surgery, Northwest Clinics, NWZ Alkmaar, Alkmaar, the Netherlands
| | - Hans F J Fabry
- Department of Surgery, Bravis Hospital, Roosendaal, the Netherlands
| | - Edgar J B Furnée
- Division of Abdominal Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Fleur I de Korte
- Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisanne A E Posma
- Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands
| | - Bareld B Pultrum
- Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands
| | - Harm J T Rutten
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Petra C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Aaldert K Talsma
- Department of Surgery, Deventer Hospital, Deventer, the Netherlands
| | - G Y Mireille The
- Department of Radiology, Bravis Hospital, Roosendaal, the Netherlands
| | - Fiek van Tilborg
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Inge J S Vanhooymissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Joy C Vroemen
- Department of Radiology, Flevoziekenhuis, Almere, the Netherlands
| | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.
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Hol JC, Burghgraef TA, Rutgers MLW, Crolla RMPH, van Geloven AAW, de Jong GM, Hompes R, Leijtens JWA, Polat F, Pronk A, Smits AB, Tuynman JB, Verdaasdonk EGG, Consten ECJ, Sietses C. Impact of a diverting ileostomy in total mesorectal excision with primary anastomosis for rectal cancer. Surg Endosc 2023; 37:1916-1932. [PMID: 36258000 PMCID: PMC10017638 DOI: 10.1007/s00464-022-09669-x] [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: 02/24/2022] [Accepted: 09/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of diverting ileostomy in total mesorectal excision (TME) for rectal cancer with primary anastomosis is debated. The aim of this study is to gain insight in the clinical consequences of a diverting ileostomy, with respect to stoma rate at one year and stoma-related morbidity. METHODS Patients undergoing TME with primary anastomosis for rectal cancer between 2015 and 2017 in eleven participating hospitals were included. Retrospectively, two groups were compared: patients with or without diverting ileostomy construction during primary surgery. Primary endpoint was stoma rate at one year. Secondary endpoints were severity and rate of anastomotic leakage, overall morbidity rate within thirty days and stoma (reversal) related morbidity. RESULTS In 353 out of 595 patients (59.3%) a diverting ileostomy was constructed during primary surgery. Stoma rate at one year was 9.9% in the non-ileostomy group and 18.7% in the ileostomy group (p = 0.003). After correction for confounders, multivariate analysis showed that the construction of a diverting ileostomy during primary surgery was an independent risk factor for stoma at one year (OR 2.563 (95%CI 1.424-4.611), p = 0.002). Anastomotic leakage rate was 17.8% in the non-ileostomy group and 17.2% in the ileostomy group (p = 0.913). Overall 30-days morbidity rate was 37.6% in the non-ileostomy group and 56.1% in the ileostomy group (p < 0.001). Stoma reversal related morbidity rate was 17.9%. CONCLUSIONS The stoma rate at one year was higher in patients with ileostomy construction during primary surgery. The incidence and severity of anastomotic leakage were not reduced by construction of an ileostomy. The morbidity related to the presence and reversal of a diverting ileostomy was substantial.
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Affiliation(s)
- Jeroen C Hol
- Department of Surgery, Amsterdam University Medical Center, Location VU Medical Centre, De Boelelaan 117, 1081 HB, Amsterdam, The Netherlands.
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
| | - Thijs A Burghgraef
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marieke L W Rutgers
- Department of Surgery, Amsterdam University Medical Center, Location Academic Medical Centre, Amsterdam, The Netherlands
| | | | | | - Gabie M de Jong
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center, Location Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Location VU Medical Centre, De Boelelaan 117, 1081 HB, Amsterdam, The Netherlands
| | | | - Esther C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Colin Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
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6
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Burghgraef TA, Sikkenk DJ, Crolla RMPH, Fahim M, Melenhorst J, Moumni ME, Schelling GVD, Smits AB, Stassen LPS, Verheijen PM, Consten ECJ. Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency. Int J Colorectal Dis 2023; 38:9. [PMID: 36630001 PMCID: PMC9834356 DOI: 10.1007/s00384-022-04303-7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision. METHODS A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. RESULTS In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve. CONCLUSION The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.
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Affiliation(s)
- T A Burghgraef
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
| | - D J Sikkenk
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - M Fahim
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - J Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M El Moumni
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - A B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L P S Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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7
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Giesen LJX, Dekker JWT, Verseveld M, Crolla RMPH, van der Schelling GP, Verhoef C, Olthof PB. Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study. Surg Endosc 2023; 37:912-920. [PMID: 36042043 PMCID: PMC9945537 DOI: 10.1007/s00464-022-09568-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
AIM An increasing number of centers have implemented a robotic surgical program for rectal cancer. Several randomized controls trials have shown similar oncological and postoperative outcomes compared to standard laparoscopic resections. While introducing a robot rectal resection program seems safe, there are no data regarding implementation on a nationwide scale. Since 2018 robot resections are separately registered in the mandatory Dutch Colorectal Audit. The present study aims to evaluate the trend in the implementation of robotic resections (RR) for rectal cancer relative to laparoscopic rectal resections (LRR) in the Netherlands between 2018 and 2020 and to compare the differences in outcomes between the operative approaches. METHODS Patients with rectal cancer who underwent surgical resection between 2018 and 2020 were selected from the Dutch Colorectal Audit. The data included patient characteristics, disease characteristics, surgical procedure details, postoperative outcomes. The outcomes included any complication within 90 days after surgery; data were categorized according to surgical approach. RESULTS Between 2018 and 2020, 6330 patients were included in the analyses. 1146 patients underwent a RR (18%), 3312 patients a LRR (51%), 526 (8%) an open rectal resection, 641 a TaTME (10%), and 705 had a local resection (11%). The proportion of males and distal tumors was higher in the RR compared to the LRR. Over time, the proportion of robotic procedures increased from 15% (95% confidence intervals (CI) 13-16%) in 2018 to 22% (95% CI 20-24%) in 2020. Conversion rate was lower in the robotic group [4% (95% CI 3-5%) versus 7% (95% CI 6-8%)]. Anastomotic leakage rate was similar with 16%. Defunctioning ileostomies were more common in the RR group [42% (95% CI 38-46%) versus 29% (95% CI 26-31%)]. CONCLUSION Rectal resections are increasingly being performed through a robot-assisted approach in the Netherlands. The proportion of males and low rectal cancers was higher in RR compared to LRR. Overall outcomes were comparable, while conversion rate was lower in RR, the proportion of defunctioning ileostomies was higher compared to LRR.
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Affiliation(s)
- L J X Giesen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - M Verseveld
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - C Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P B Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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8
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Hol JC, Burghgraef TA, Rutgers MLW, Crolla RMPH, van Geloven NAW, Leijtens JWA, Polat F, Pronk A, Smits AB, Tuynman JB, Verdaasdonk EGG, Consten ECJ, Hompes R, Sietses C. Comparison of three-year oncological results after restorative low anterior resection, non-restorative low anterior resection and abdominoperineal resection for rectal cancer. European Journal of Surgical Oncology 2022; 49:730-737. [PMID: 36460530 DOI: 10.1016/j.ejso.2022.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/31/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Oncological outcome might be influenced by the type of resection in total mesorectal excision (TME) for rectal cancer. The aim was to see if non-restorative LAR would have worse oncological outcome. A comparison was made between non-restorative low anterior resection (NRLAR), restorative low anterior resection (RLAR) and abdominoperineal resection (APR). MATERIALS AND METHODS This retrospective cohort included data from patients undergoing TME for rectal cancer between 2015 and 2017 in eleven Dutch hospitals. A comparison was made for each different type of procedure (APR, NRLAR or RLAR). Primary outcome was 3-year overall survival (OS). Secondary outcomes included 3-year disease-free survival (DFS) and 3-year local recurrence (LR) rate. RESULTS Of 998 patients 363 underwent APR, 132 NRLAR and 503 RLAR. Three-year OS was worse after NRLAR (78.2%) compared to APR (86.3%) and RLAR (92.2%, p < 0.001). This was confirmed in a multivariable Cox regression analysis (HR 1.85 (1.07, 3.19), p = 0.03). The 3-year DFS was also worse after NRLAR (60.3%), compared to APR (70.5%) and RLAR (80.1%, p < 0.001), HR 2.05 (1.42, 2.97), p < 0.001. The LR rate was 14.6% after NRLAR, 5.2% after APR and 4.8% after RLAR (p = 0.005), HR 3.22 (1.61, 6.47), p < 0.001. CONCLUSION NRLAR might be associated with worse 3-year OS, DFS and LR rate compared to RLAR and APR.
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Affiliation(s)
- Jeroen C Hol
- Department of Surgery, Amsterdam University Medical Center, Location VU Medical Centre, Amsterdam, the Netherlands; Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands.
| | - Thijs A Burghgraef
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marieke L W Rutgers
- Department of Surgery, Amsterdam University Medical Center, Location Academic Medical Centre, Amsterdam, the Netherlands
| | | | | | | | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Location VU Medical Centre, Amsterdam, the Netherlands
| | | | - Esther C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center, Location Academic Medical Centre, Amsterdam, the Netherlands
| | - Colin Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
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9
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Dijkstra EA, Hospers GAP, Kranenbarg EMK, Fleer J, Roodvoets AGH, Bahadoer RR, Guren MG, Tjalma JJJ, Putter H, Crolla RMPH, Hendriks MP, Capdevila J, Radu C, van de Velde CJH, Nilsson PJ, Glimelius B, van Etten B, Marijnen CAM. Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer - The RAPIDO trial. Radiother Oncol 2022; 171:69-76. [PMID: 35447283 DOI: 10.1016/j.radonc.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/01/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE The RAPIDO trial demonstrated a decrease in disease-related treatment failure (DrTF) and an increase in pathological complete responses (pCR) in locally advanced rectal cancer (LARC) patients receiving total neoadjuvant treatment (TNT) compared to conventional chemoradiotherapy. This study examines health-related quality of life (HRQL), bowel function, and late toxicity in patients in the trial. MATERIALS AND METHODS Patients were randomized between short-course radiotherapy followed by pre-operative chemotherapy (EXP), or chemoradiotherapy and optional post-operative chemotherapy (STD). The STD group was divided into patients who did (STD+) and did not (STD-) receive post-operative chemotherapy. Three years after surgery patients received HRQL (EORTC QLQ-C30, QLQ-CR29 and QLQ-CIPN20) and LARS questionnaires. Patients who experienced a DrTF event before the toxicity assessments (6, 12, 24, or 36 months) were excluded from analyses. RESULTS Of 574 eligible patients, 495 questionnaires were returned (86%) and 453 analyzed (79% completed within time limits). No significant differences were observed between the groups regarding QLQ-C30, QLQ-CR29 or LARS scores. Sensory-related symptoms occurred significantly more often in the EXP group compared to all STD patients, but not compared to STD+ patients. Any toxicity of any grade and grade ≥ 3 toxicity was comparable between the EXP and STD groups at all time-points. Neurotoxicity grade 1-2 occurred significantly more often in the EXP and STD+ group at all time-points compared to the STD- group. CONCLUSION The results demonstrate that TNT for LARC, yielding improved DrTF and pCRs, does not compromise HRQL, bowel functional or results in more grade ≥3 toxicity compared to standard chemoradiotherapy at three years after surgery in DrTF-free patients.
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Affiliation(s)
- Esmée A Dijkstra
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Joke Fleer
- Department of Health Sciences, Section Health Psychology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | | | - Jolien J J Tjalma
- Department of General Practice, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands
| | | | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, the Netherlands
| | - Jaume Capdevila
- Department of Medical Oncology, Vall Hebron Institute of Oncology (VHIO), Vall Hebron University Hospital, Autonomous University of Barcelona (UAB), Spain
| | - Calin Radu
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | | | - Per J Nilsson
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
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10
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Hoek VT, Edomskis PP, Stark PW, Lambrichts DPV, Draaisma WA, Consten ECJ, Lange JF, Bemelman WA, Hop WC, Opmeer BC, Reitsma JB, Scholte RA, Waltmann EWH, Legemate A, Bartelsman JF, Meijer DW, de Brouwer M, van Dalen J, Durbridge M, Geerdink M, Ilbrink GJ, Mehmedovic S, Middelhoek P, Boom MJ, Consten ECJ, van der Bilt JDW, van Olden GDJ, Stam MAW, Verweij MS, Vennix S, Musters GD, Swank HA, Boermeester MA, Busch ORC, Buskens CJ, El-Massoudi Y, Kluit AB, van Rossem CC, Schijven MP, Tanis PJ, Unlu C, van Dieren S, Gerhards MF, Karsten TM, de Nes LC, Rijna H, van Wagensveld BA, Koff eman GI, Steller EP, Tuynman JB, Bruin SC, van der Peet DL, Blanken-Peeters CFJM, Cense HA, Jutte E, Crolla RMPH, van der Schelling GP, van Zeeland M, de Graaf EJR, Groenendijk RPR, Karsten TM, Vermaas M, Schouten O, de Vries MR, Prins HA, Lips DJ, Bosker RJI, van der Hoeven JAB, Diks J, Plaisier PW, Kruyt PM, Sietses C, Stommel MWJ, Nienhuijs SW, de Hingh IHJT, Luyer MDP, van Montfort G, Ponten EH, Smulders JF, van Duyn EB, Klaase JM, Swank DJ, Ottow RT, Stockmann HBAC, Vermeulen J, Vuylsteke RJCLM, Belgers HJ, Fransen S, von Meijenfeldt EM, Sosef MN, van Geloven AAW, Hendriks ER, ter Horst B, Leeuwenburgh MMN, van Ruler O, Vogten JM, Vriens EJC, Westerterp M, Eijsbouts QAJ, Bentohami A, Bijlsma TS, de Korte N, Nio D, Govaert MJPM, Joosten JJA, Tollenaar RAEM, Stassen LPS, Wiezer MJ, Hazebroek EJ, Smits AB, van Westreenen HL, Lange JF, Brandt A, Nijboer WN, Mulder IM, Toorenvliet BR, Weidema WF, Coene PPLO, Mannaerts GHH, den Hartog D, de Vos RJ, Zengerink JF, Hoofwijk AGM, Hulsewé KWE, Melenhorst J, Stoot JHMB, Steup WH, Huijstee PJ, Merkus JWS, Wever JJ, Maring JK, Heisterkamp J, van Grevenstein WMU, Vriens MR, Besselink MGH, Borel Rinkes IHM, Witkamp AJ, Slooter GD, Konsten JLM, Engel AF, Pierik EGJM, Frakking TG, van Geldere D, Patijn GA, D’Hoore BAJL, de Buck AVO, Miserez M, Terrasson I, Wolthuis A, di Saverio S, de Blasiis MG. Laparoscopic peritoneal lavage versus sigmoidectomy for perforated diverticulitis with purulent peritonitis: three-year follow-up of the randomised LOLA trial. Surg Endosc 2022; 36:7764-7774. [PMID: 35606544 PMCID: PMC9485102 DOI: 10.1007/s00464-022-09326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/01/2022] [Indexed: 10/31/2022]
Abstract
Abstract
Background
This study aimed to compare laparoscopic lavage and sigmoidectomy as treatment for perforated diverticulitis with purulent peritonitis during a 36 month follow-up of the LOLA trial.
Methods
Within the LOLA arm of the international, multicentre LADIES trial, patients with perforated diverticulitis with purulent peritonitis were randomised between laparoscopic lavage and sigmoidectomy. Outcomes were collected up to 36 months. The primary outcome of the present study was cumulative morbidity and mortality. Secondary outcomes included reoperations (including stoma reversals), stoma rates, and sigmoidectomy rates in the lavage group.
Results
Long-term follow-up was recorded in 77 of the 88 originally included patients, 39 were randomised to sigmoidectomy (51%) and 38 to laparoscopic lavage (49%). After 36 months, overall cumulative morbidity (sigmoidectomy 28/39 (72%) versus lavage 32/38 (84%), p = 0·272) and mortality (sigmoidectomy 7/39 (18%) versus lavage 6/38 (16%), p = 1·000) did not differ. The number of patients who underwent a reoperation was significantly lower for lavage compared to sigmoidectomy (sigmoidectomy 27/39 (69%) versus lavage 17/38 (45%), p = 0·039). After 36 months, patients alive with stoma in situ was lower in the lavage group (proportion calculated from the Kaplan–Meier life table, sigmoidectomy 17% vs lavage 11%, log-rank p = 0·0268). Eventually, 17 of 38 (45%) patients allocated to lavage underwent sigmoidectomy.
Conclusion
Long-term outcomes showed that laparoscopic lavage was associated with less patients who underwent reoperations and lower stoma rates in patients alive after 36 months compared to sigmoidectomy. No differences were found in terms of cumulative morbidity or mortality. Patient selection should be improved to reduce risk for short-term complications after which lavage could still be a valuable treatment option.
Graphical abstract
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11
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Burghgraef TA, Hol JC, Rutgers ML, Crolla RMPH, van Geloven AAW, Hompes R, Leijtens JWA, Pronk A, Smits AB, Tuynman JB, Verdaasdonk EGG, Polat F, Verheijen PM, Sietses C, Consten ECJ. ASO Visual Abstract: Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results of a Population-Based Cohort in Experienced Centers. Ann Surg Oncol 2022. [PMID: 34988839 DOI: 10.1245/s10434-021-10894-2] [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: 11/18/2022]
Affiliation(s)
- T A Burghgraef
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands.,Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - J C Hol
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands.,Department of Surgery, Amsterdam UMC, Locatie VUmc, Amsterdam, the Netherlands
| | - M L Rutgers
- Department of Surgery, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - R Hompes
- Department of Surgery, Amsterdam UMC, Locatie AMC, Amsterdam, the Netherlands
| | - J W A Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, the Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC, Locatie VUmc, Amsterdam, the Netherlands
| | - E G G Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - F Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands
| | - C Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands. .,Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
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12
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Burghgraef TA, Hol JC, Rutgers ML, Crolla RMPH, van Geloven AAW, Hompes R, Leijtens JWA, Polat F, Pronk A, Smits AB, Tuynman JB, Verdaasdonk EGG, Verheijen PM, Sietses C, Consten ECJ. Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers. Ann Surg Oncol 2021; 29:1910-1920. [PMID: 34608557 PMCID: PMC8810464 DOI: 10.1245/s10434-021-10805-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three techniques while taking the learning curve into account. METHODS This retrospective population-based study cohort included all patients between 2015 and 2017 who underwent a low anterior resection at 11 dedicated centers that had completed the learning curve of the specific technique. The primary outcome was overall survival (OS) during a 3-year follow-up period. The secondary outcomes were 3-year disease-free survival (DFS) and 3-year local recurrence rate. Statistical analysis was performed using Cox-regression. RESULTS The 617 patients enrolled in the study included 252 who underwent a laparoscopic resection, 205 who underwent a robot-assisted resection, and 160 who underwent a transanal low anterior resection. The oncologic outcomes were equal between the three techniques. The 3-year OS rate was 90% for laparoscopic resection, 90.4% for robot-assisted resection, and 87.6% for transanal low anterior resection. The 3-year DFS rate was 77.8% for laparoscopic resection, 75.8% for robot-assisted resection, and 78.8% for transanal low anterior resection. The 3-year local recurrence rate was in 6.1% for laparoscopic resection, 6.4% for robot-assisted resection, and 5.7% for transanal procedures. Cox-regression did not show a significant difference between the techniques while taking confounders into account. CONCLUSION The oncologic results during the 3-year follow-up were good and comparable between laparoscopic, robot-assisted, and transanal total mesorectal technique at experienced centers. These techniques can be performed safely in experienced hands.
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Affiliation(s)
- T A Burghgraef
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands.,Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - J C Hol
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.,Department of Surgery, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
| | - M L Rutgers
- Department of Surgery, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - R Hompes
- Department of Surgery, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - J W A Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - F Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
| | - E G G Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - C Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands. .,Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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13
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Hol JC, Burghgraef TA, Rutgers MLW, Crolla RMPH, van Geloven NAW, Hompes R, Leijtens JWA, Polat F, Pronk A, Smits AB, Tuynman JB, Verdaasdonk EGG, Consten ECJ, Sietses C. Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes. Br J Surg 2021; 108:1380-1387. [PMID: 34370834 DOI: 10.1093/bjs/znab233] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Laparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced morbidity. However, comparative data between the three approaches are lacking. The aim of this study was to compare short-term outcomes for laparoscopic TME, robot-assisted TME and TaTME in expert centres. METHODS Patients undergoing rectal cancer surgery between 2015 and 2017 in expert centres for laparoscopic, robot-assisted or TaTME were included. Outcomes for TME surgery performed by the specialized technique in the expert centres were compared after propensity score matching. The primary outcome was conversion rate. Secondary outcomes were morbidity and pathological outcomes. RESULTS A total of 1078 patients were included. In rectal cancer surgery in general, the overall rate of primary anastomosis was 39.4, 61.9 and 61.9 per cent in laparoscopic, robot-assisted and TaTME centres respectively (P < 0.001). For specialized techniques in expert centres excluding abdominoperineal resection (APR), the rate of primary anastomosis was 66.7 per cent in laparoscopic, 89.8 per cent in robot-assisted and 84.3 per cent in TaTME (P < 0.001). Conversion rates were 3.7 , 4.6 and 1.9 per cent in laparoscopic, robot-assisted and TaTME respectively (P = 0.134). The number of incomplete specimens, circumferential resection margin involvement rate and morbidity rates did not differ. CONCLUSION In the minimally invasive treatment of rectal cancer more primary anastomoses are created in robotic and TaTME expert centres.
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Affiliation(s)
- J C Hol
- Department of Surgery, Amsterdam University Medical Centre, location VU Medical Centre, Amsterdam, The Netherlands.,Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - T A Burghgraef
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.,Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - M L W Rutgers
- Department of Surgery, Amsterdam University Medical Centre, location Academic Medical Centre, Amsterdam, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - R Hompes
- Department of Surgery, Amsterdam University Medical Centre, location Academic Medical Centre, Amsterdam, The Netherlands
| | - J W A Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - F Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam University Medical Centre, location VU Medical Centre, Amsterdam, The Netherlands
| | - E G G Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.,Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - C Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
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14
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Boeding JRE, Ramphal W, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, Schreinemakers JMJ. A Systematic Review Comparing Emergency Resection and Staged Treatment for Curable Obstructing Right-Sided Colon Cancer. Ann Surg Oncol 2020; 28:3545-3555. [PMID: 33067743 DOI: 10.1245/s10434-020-09124-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment for obstructing colon cancer (OCC) is controversial because the outcome of acute resection is less favorable than for patients without obstruction. Few studies have investigated curable right-sided OCC, and patients with OCC usually undergo acute resection. This study aimed to better understand the outcome and best management of potentially curable right-sided OCC. METHODS A systematic review of studies was performed with a focus on differences in mortality and morbidity between emergency resection and staged treatment for patients with potentially curable right-sided OCC. In March 2019, the study searched Embase, Medline, Web of Science, Cochrane, and Google scholar databases according to PRISMA guidelines using search terms related to "colon tumour," "stenosis or obstruction and surgery," and "decompression or stents." All English-language studies reporting emergency or staged treatment for potentially curable right-sided OCC were included in the review. Emergency resection and staged resection were compared for mortality, morbidity, complications, and survival. RESULTS Nine studies were found to be eligible and comprised 600 patients treated with curative intent for their right-sided OCC by emergency resection or staged resection. The mean overall complication rate was 42% (range 19-54%) after emergency resection, and 30% (range 7-44%) after staged treatment. The average mortality rate was 7.2% (range 0-14.5%) after emergency resection and 1.2% (range 0-6.3%) after staged treatment. The 5-year disease-free and overall survival rates were comparable for the two treatments. CONCLUSIONS The patients who received staged treatment for right-sided OCC had lower mortality rates, fewer complications, and fewer anastomotic leaks and stoma creations than the patients who had emergency resection.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, The Netherlands. .,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Winesh Ramphal
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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15
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Mulder T, Crolla RMPH, Kluytmans-van den Bergh MFQ, van Mourik MSM, Romme J, van der Schelling GP, Kluytmans JAJW. Preoperative Oral Antibiotic Prophylaxis Reduces Surgical Site Infections After Elective Colorectal Surgery: Results From a Before-After Study. Clin Infect Dis 2020; 69:93-99. [PMID: 30281072 DOI: 10.1093/cid/ciy839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/28/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications after colorectal procedures and remain an important source of morbidity and costs. Preoperative oral antibiotic prophylaxis is a potential infection control strategy, but its effectiveness without simultaneous use of mechanical bowel preparation (MBP) is unclear. In this study, we aimed to determine whether preoperative oral antibiotics reduce the risk of deep SSIs in elective colorectal surgery. METHODS We performed a before-after analysis in a teaching hospital in the Netherlands. Patients who underwent surgery between January 2012 and December 2015 were included. On 1 January 2013, oral antibiotic prophylaxis with tobramycin and colistin was implemented as standard of care prior to colorectal surgery. The year before implementation was used as the control period. The primary outcome was a composite of deep SSI and/or mortality within 30 days after surgery. RESULTS Of the 1410 patients, 352 underwent colorectal surgery in the control period and 1058 in the period after implementation of the antibiotic prophylaxis. We observed a decrease in incidence of the primary endpoint of 6.2% after prophylaxis implementation. When adjusted for confounders, the risk ratio for development of the primary outcome was 0.58 (95% confidence interval, 0.40-0.79). Other findings included a decreased risk of anastomotic leakage and a reduction in the length of postoperative stay. CONCLUSIONS Preoperative oral antibiotic prophylaxis prior to colorectal surgery is associated with a significant decrease in SSI and/or mortality in a setting without MBP. Preoperative oral antibiotics can therefore be considered without MBP for patients who undergo colorectal surgery.
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Affiliation(s)
- Tessa Mulder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Rogier M P H Crolla
- Department of Surgery, Amphia Academy Infectious Disease Foundation, The Netherlands
| | - Marjolein F Q Kluytmans-van den Bergh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands.,Amphia Academy Infectious Disease Foundation, The Netherlands.,Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Maaike S M van Mourik
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jannie Romme
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | | | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands.,Department of Infection Control, Amphia Hospital, Breda, The Netherlands.,Laboratory for Microbiology, Microvida, Amphia Hospital, Breda, The Netherlands
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16
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Plat VD, Derikx JPM, Jongen AC, Nielsen K, Sonneveld DJA, Tersteeg JJC, Crolla RMPH, van Dam DA, Cense HA, de Meij TGJ, Tuynman JB, de Boer NKH, Daams F. Diagnostic accuracy of urinary intestinal fatty acid binding protein in detecting colorectal anastomotic leakage. Tech Coloproctol 2020; 24:449-454. [PMID: 32107682 DOI: 10.1007/s10151-020-02163-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) remains a severe complication following colorectal surgery, having a negative impact on both short- and long-term outcomes. Since timely detection could enable early intervention, there is a need for the development of novel and accurate, preferably, non-invasive markers. The aim of this study was to investigate whether urinary intestinal fatty acid binding protein (I-FABP) could serve as such a marker. METHODS This prospective multicenter cross-sectional phase two diagnostic study was conducted at four centers in the Netherlands between March 2015 and November 2016. Urine samples of 15 patients with confirmed colorectal AL and 19 patients without colorectal AL on postoperative day 3 were included. Urinary I-FABP levels were determined using enzyme-linked immunosorbent assays and adjusted for urinary creatinine to compensate for renal dysfunction. RESULTS Urinary I-FABP levels were significantly elevated in patients with confirmed AL compared to patients without AL on postoperative day 3 (median: 2.570 ng/ml vs 0.809 ng/ml, p = 0.006). The area under the receiver operating characteristics curve (AUROC) was 0.775, yielding a sensitivity of 80% and specificity of 74% at the optimal cutoff point (> 1.589 ng/ml). This difference remained significant after calculation of I-FABP/creatinine ratios (median: 0.564 ng/µmol vs. 0.158 ng/µmol, p = 0.040), with an AUROC of 0.709, sensitivity of 60% and specificity of 90% at the optimal cutoff point (> 0.469 ng/µmol). CONCLUSIONS Levels of urinary I-FABP and urinary I-FABP/creatinine were significantly elevated in patients with confirmed AL following colorectal surgery, suggesting their potential as a non-invasive biomarker for colorectal anastomotic leakage.
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Affiliation(s)
- V D Plat
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - J P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and VU University Medical Center, Amsterdam, The Netherlands
| | - A C Jongen
- Department of Gastrointestinal Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Nielsen
- Department of Gastrointestinal Surgery, Dijklander ziekenhuis, Hoorn, The Netherlands
| | - D J A Sonneveld
- Department of Gastrointestinal Surgery, Dijklander ziekenhuis, Hoorn, The Netherlands
| | - J J C Tersteeg
- Department of Gastrointestinal Surgery, Amphia ziekenhuis, Breda, The Netherlands
| | - R M P H Crolla
- Department of Gastrointestinal Surgery, Amphia ziekenhuis, Breda, The Netherlands
| | - D A van Dam
- Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - H A Cense
- Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - T G J de Meij
- Department of Pediatric Gastroenterology and Hepatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
| | - N K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - F Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081 HV, Amsterdam, The Netherlands
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17
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Tersteeg JJC, Crolla RMPH, Gobardhan PD, Kint PAM, Niers-Stobbe I, Boonman-de Winter L, Arnold DE, Rozema T, Schreinemakers JMJ. MRI-based guidelines for selective neoadjuvant treatment in rectal cancer: Does MRI adequately predict the indication for radiotherapy in daily practice in a large teaching hospital. Eur J Cancer Care (Engl) 2019; 29:e13190. [PMID: 31863608 DOI: 10.1111/ecc.13190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/06/2019] [Revised: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES According to new Dutch guidelines for rectal cancer, MRI-defined tumour stage determines whether preoperative radiotherapy is indicated. Therefore, we sought to evaluate if preoperative MRI accurately predicts the indication for neoadjuvant treatment in rectal cancer cases in daily practice according to the new Dutch guidelines. METHODS Data for all rectal cancer patients who underwent mesorectal excision in our hospital, between January 2011 and January 2018 were collected retrospectively. We compared histopathologic outcome with tumour staging on preoperative MRI for patients who received no radiotherapy prior to resection or short-course radiotherapy directly followed by resection. RESULTS Of 223 patients treated according to the old guidelines, 94% received neoadjuvant therapy. Of 301 patients treated according to the new guidelines, only 49% did. Under the old guidelines, MRI predicted lymph node metastases with a sensitivity of 74.2% and a specificity of 52.6%. With the new guidelines, sensitivity was 47.5% and specificity was 77.3%. The new guidelines resulted in 45% more patients not being exposed to disadvantages of radiotherapy, but 13% of all patients were undertreated. CONCLUSIONS Concordance between clinical lymph node staging on preoperative MRI and histopathologic staging is limited, resulting in many rectal cancer patients not receiving adequate neoadjuvant therapy.
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Affiliation(s)
- Janneke J C Tersteeg
- Department of Oncological Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Paul D Gobardhan
- Department of Oncological Surgery, Amphia Hospital, Breda, The Netherlands
| | - Peter A M Kint
- Department of Radiology, Amphia Hospital, Breda, The Netherlands
| | | | | | | | - Tom Rozema
- Department of Radiation Oncology, Verbeeten Institute, Breda, The Netherlands
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18
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Boeding JRE, Ramphal W, Crolla RMPH, Gobardhan PD, Schreinemakers JMJ. Differences in Metastatic Pattern in Patients Presenting With or Without Obstructing Colorectal Cancer: A Retrospective Observational Study of 2595 Patients. Ann Surg Oncol 2019; 27:1048-1055. [PMID: 31823170 DOI: 10.1245/s10434-019-08119-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about metastatic patterns in patients with obstructing colorectal cancer (CRC). OBJECTIVE The aim of this study was to determine if metastatic patterns in patients with CRC differ between patients with or without obstruction. METHODS This single-center, observational, retrospective cohort study includes patients who underwent surgery for CRC between 2004 and 2015 in our hospital. Patients were divided into two groups-patients with or without obstructing CRC. All anatomic sites of distant metastases were reported. Differences in synchronous and metachronous metastases were compared between both groups. RESULTS A total of 2595 patients were included for analysis, of whom 315 (12%) presented with obstructing CRC. Synchronous metastases were diagnosed in 483 patients (19%). Patients with obstructing CRC and synchronous metastases, were diagnosed with peritoneal metastases more often than patients without obstruction (37% vs. 16%; p < 0.01). With regard to the location of the tumor, obstructing right-sided CRC patients were diagnosed with peritoneal metastases more often than patients without obstruction (52% vs. 21%; p < 0.01). Additionally, metachronous metastases were found significantly more often in patients with obstructing CRC (27%) compared with patients without obstruction (15%; p < 0.01). CONCLUSIONS Patients with obstructing CRC have more advanced tumor stage compared with patients without obstructing CRC. Synchronous peritoneal metastases are more often encountered in patients with obstructing CRC compared with patients without obstruction. This difference is due to the raised presence of synchronous peritoneal metastases in patients with obstructed right-sided colonic cancer. Furthermore, metachronous metastases are more often found in patients with obstructing CRC.
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Affiliation(s)
| | - Winesh Ramphal
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
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19
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Plat VD, Bootsma BT, Neal M, Nielsen K, Sonneveld DJA, Tersteeg JJC, Crolla RMPH, van Dam DA, Cense HA, Stockmann HBAC, Covington JA, de Meij TGJ, Tuynman JB, de Boer NKH, Daams F. Urinary volatile organic compound markers and colorectal anastomotic leakage. Colorectal Dis 2019; 21:1249-1258. [PMID: 31207011 DOI: 10.1111/codi.14732] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023]
Abstract
AIM Inflammatory markers such as serum C-reactive protein (CRP) are used as routine markers to detect anastomotic leakage following colorectal surgery. However, CRP is characterized by a relatively low predictive value, emphasizing the need for the development of novel diagnostic approaches. Volatile organic compounds (VOCs) are gaseous metabolic products deriving from all conceivable bodily excrements and reflect (alterations in) the patient's physical status. Therefore, VOCs are increasingly considered as potential non-invasive diagnostic biomarkers. The aim of this study was to assess the diagnostic accuracy of urinary VOCs for colorectal anastomotic leakage. METHODS In this explorative multicentre study, urinary VOC profiles of 22 patients with confirmed anastomotic leakage and 27 uneventful control patients following colorectal surgery were analysed by field asymmetric ion mobility spectrometry (FAIMS). RESULTS Urinary VOCs of patients with anastomotic leakage could be distinguished from those of control patients with high accuracy: area under the receiver operating characteristics curve 0.91 (95% CI 0.81-1.00, P < 0.001), sensitivity 86% and specificity 93%. Serum CRP was significantly increased in patients with a confirmed anastomotic leak but with lower diagnostic accuracy compared to VOC analysis (area under the receiver operating characteristics curve 0.82, 95% CI 0.68-0.95, P < 0.001). Combining VOCs and CRP did not result in a significant improvement of the diagnostic performance compared to VOCs alone. CONCLUSION Analysis by FAIMS allowed for discrimination between urinary VOC profiles of patients with a confirmed anastomotic leak and control patients following colorectal surgery. A superior accuracy compared to CRP and apparently high specificity was observed, underlining the potential as a non-invasive biomarker for the detection of colorectal anastomotic leakage.
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Affiliation(s)
- V D Plat
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - B T Bootsma
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - M Neal
- Department of Statistics, University of Warwick, Coventry, UK
| | - K Nielsen
- Department of Gastrointestinal Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - D J A Sonneveld
- Department of Gastrointestinal Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - J J C Tersteeg
- Department of Gastrointestinal Surgery, Amphia Ziekenhuis, Breda, The Netherlands
| | - R M P H Crolla
- Department of Gastrointestinal Surgery, Amphia Ziekenhuis, Breda, The Netherlands
| | - D A van Dam
- Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - H A Cense
- Department of Gastrointestinal Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - H B A C Stockmann
- Department of Gastrointestinal Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - J A Covington
- School of Engineering, University of Warwick, Coventry, UK
| | - T G J de Meij
- Department of Paediatric Gastroenterology and Hepatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - N K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - F Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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20
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Lambrichts DPV, Bolkenstein HE, van der Does DCHE, Dieleman D, Crolla RMPH, Dekker JWT, van Duijvendijk P, Gerhards MF, Nienhuijs SW, Menon AG, de Graaf EJR, Consten ECJ, Draaisma WA, Broeders IAMJ, Bemelman WA, Lange JF. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg 2019; 106:458-466. [PMID: 30811050 PMCID: PMC6593757 DOI: 10.1002/bjs.11129] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/13/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Abstract
This multicentre retrospective cohort study included 447 patients with Hinchey Ib and II diverticular abscesses, who were treated with antibiotics, with or without percutaneous drainage. Abscesses of 3 and 5 cm in size were at higher risk of short‐term treatment failure and emergency surgery respectively. Initial non‐surgical treatment of Hinchey Ib and II diverticular abscesses was comparable between patients treated with antibiotics only and those who underwent percutaneous drainage in combination with antibiotics, with regard to short‐ and long‐term outcomes.
![]() Most do not need drainage
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Affiliation(s)
- D P V Lambrichts
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | - H E Bolkenstein
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | | | - D Dieleman
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | | | - M F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - A G Menon
- Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands.,Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
| | - E J R de Graaf
- Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | - J F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands.,Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
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21
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Ramphal W, Boeding JRE, Schreinemakers JMJ, Gobardhan PD, Rutten HJT, Crolla RMPH. Colonoscopy Surveillance After Colorectal Cancer: the Optimal Interval for Follow-Up. J Gastrointest Cancer 2019; 51:469-477. [PMID: 31155695 DOI: 10.1007/s12029-019-00254-5] [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: 10/26/2022]
Abstract
PURPOSE Patients who have undergone curative surgery for colorectal cancer are at risk of developing a metachronous colorectal tumour or anastomotic recurrence. The aim of this study was to determine the incidence of recurrent colorectal cancer in a cohort of patients who participated in a colonoscopy surveillance programme. METHODS This single-centre retrospective observational cohort study included patients who underwent curative surgery for colorectal cancer between 2005 and 2015. All reports of postoperative colonoscopies were retrieved to calculate the incidence rates of recurrence and metachronous colorectal cancer. RESULTS Of 2420 patients, 1644 (67.9%) underwent at least one postoperative colonoscopy and 776 (32.1%) did not. In 1087 patients, colonoscopy was performed in the first 18 months after surgery, which detected 34 (3.1%) instances of metachronous colorectal tumours or anastomotic recurrence. Thirty-three additional patients were also diagnosed with recurrent colorectal cancer, but the tumours were detected by other diagnostic modalities or detected perioperatively, rather than by colonoscopy. CONCLUSIONS Patients with a history of colorectal cancer have an increased risk for a second colorectal tumour. Therefore, we recommend a colonoscopic surveillance programme with the first colonoscopy performed 1 year after curative surgery, which is in accordance with national guidelines.
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Affiliation(s)
- Winesh Ramphal
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands.
| | - Jeske R E Boeding
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands
| | | | - Paul D Gobardhan
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Rogier M P H Crolla
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK, Breda, The Netherlands
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22
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Beek MA, Bodelier AGL, Crolla RMPH. [Gastric perforation in Eastern European economic migrants]. Ned Tijdschr Geneeskd 2019; 163:D3518. [PMID: 31050268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The general prevalence of perforated peptic ulcers is decreasing and they are, therefore, more likely to be missed. In our hospital, Eastern European migrants are overrepresented in the population of patients with perforated gastric peptic ulcers; due to a higher prevalence of Helicobacter pylori in Eastern Europe, they have a higher chance of developing gastric peptic ulcers than patients of Dutch origin. Treatment is hampered by the language barrier and low compliance rates, with patients often leaving hospital against medical advice and not showing up for follow-up appointments. These patients should, therefore, be informed by an interpreter, so that they are well educated about the disease and its treatment. Furthermore, we advise determination of the presence of H. pylori in these patients either during or directly after surgery, and, if necessary, empirical eradication of the bacteria.
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Affiliation(s)
- Maarten A Beek
- Amphia ziekenhuis, afd. Chirurgie, Breda
- Contact: M.A. Beek
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23
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Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter LJMB, Crolla RMPH, Schreinemakers JMJ. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 2018; 27:730-736. [PMID: 30449500 DOI: 10.1016/j.suronc.2018.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 05/10/2018] [Revised: 08/31/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Anastomotic leakage is one of the most severe early complications after colorectal surgery, and it is associated with a high reoperation rate-, and increased in short-term morbidity and mortality rates. It remains unclear whether anastomotic leakage is associated with poor oncologic outcomes. The aim of this study was to determine the impacts of anastomotic leakage on long-term oncologic outcomes, disease-free survival and overall mortality in patients who underwent curative surgery for colorectal cancer. METHODS This single-centre, retrospective, observational cohort study included patients who underwent curative surgery for colorectal cancer between 2005 and 2015 and who had a primary anastomosis. Survival- and multivariate cox regression analyses were performed to adjust for confounding. RESULTS A total of 1984 patients had a primary anastomosis after surgery. The overall incidence of anastomotic leakage was 7.5%; 19 patients were excluded because they were lost to follow-up. Of the remaining 1965 patients, 41 (2.1%) developed local recurrence associated with anastomotic leakage [adjusted hazard ratio (HR) = 2.25; 95% confidence interval (CI) 1.14-5.29; P = 0.03]. Distant recurrence developed in 291(14.8%) patients with no association with anastomotic leakage [adjusted HR = 1.30 (95% CI: 0.85-1.97) P = 0.23]. Anastomotic leakage was associated with increased long-term mortality [adjusted HR = 1.69 (95% CI 1.32-2.18) P < 0.01]. Five year disease-free survival was significantly decreased in patients with anastomotic leakage, (log rank test P < 0.01). CONCLUSION Anastomotic leakage was significantly associated with increased rates of local recurrence, disease free-survival and overall mortality. Associations of anastomotic leakage with distant recurrence was not found.
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Affiliation(s)
- Winesh Ramphal
- Department of Surgery, Amphia Hospital Breda, the Netherlands.
| | | | | | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
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24
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Boeding JRE, Ramphal W, Crolla RMPH, Boonman-de Winter LJM, Gobardhan PD, Schreinemakers JMJ. Ileus caused by obstructing colorectal cancer-impact on long-term survival. Int J Colorectal Dis 2018; 33:1393-1400. [PMID: 30046958 DOI: 10.1007/s00384-018-3132-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE It is unclear whether obstructing colorectal cancer (CRC) has a worse prognosis than non-obstructing CRC. Of CRC patients, 10-28% present with symptoms of acute obstruction. Previous studies regarding obstruction have been primarily based on short-term outcomes, risk factors and treatment modalities. With this study, we want to determine the long-term survival of patients presenting with acute obstructive CRC. METHODS This single-centre observational retrospective cohort study includes all CRC patients who underwent surgery between December 2004 and 2010. Patients were divided into two groups: ileus and no ileus. Survival analyses were performed for both groups. Additional survival analyses were performed in patients with and without synchronous metastases. The primary outcome was survival in months. RESULTS A total of 1236 patients were included in the analyses. Ileus occurred in 178 patients (14.4%). The 5-year survival for patients with an ileus was 32% and without 60% (P < 0.01). In patients without synchronous metastases, survival with and without an ileus was 40.9 and 68.4%, respectively (P < 0.01). If ileus presentation was complicated by a colon blowout, 5-year survival decreased to 29%. No significant difference was found in patients with synchronous metastases. Survival at 5 years in this subgroup was 10 and 12% for patients with and without an ileus, respectively (P = 0.705). CONCLUSIONS Patients with obstructive CRC have a reduced short-term overall survival. Also, long-term overall survival is impaired in patients who present with acute obstructive CRC compared to patients without obstruction.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
| | - Winesh Ramphal
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Rogier M P H Crolla
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | | | - Paul D Gobardhan
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
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25
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Crolla RMPH, Tersteeg JJC, van der Schelling GP, Wijsman JH, Schreinemakers JMJ. Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results. Surg Endosc 2018; 32:4571-4578. [PMID: 29770881 DOI: 10.1007/s00464-018-6210-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radical resection by multivisceral resection of colorectal T4 tumours is important to reduce local recurrence and improve survival. Oncological safety of laparoscopic resection of T4 tumours is controversial. However, robot-assisted resections might have advantages, such as 3D view and greater range of motion of instruments. The aim of this study is to evaluate the initial results of robot-assisted resection of T4 rectal and distal sigmoid tumours. METHODS This is a cohort study of a prospectively kept database of all robot-assisted rectal and sigmoid resections between 2012 and 2017. Patients who underwent a multivisceral resection for tumours appearing as T4 cancer during surgery were included. Rectal and sigmoid resections are routinely performed with the DaVinci robot, unless an indication for intra-operative radiotherapy exists. RESULTS 28 patients with suspected T4 rectal or sigmoid cancer were included. Most patients (78%) were treated with neoadjuvant chemoradiotherapy (n = 19), short course radiotherapy with long waiting interval (n = 2) or chemotherapy (n = 1). En bloc resection was performed with the complete or part of the invaded organ (prostate, vesicles, bladder, abdominal wall, presacral fascia, vagina, uterus, adnex). In 3 patients (11%), the procedure was converted to laparotomy. Twenty-four R0-resections were performed (86%) and four R1-resections (14%). Median length of surgery was 274 min (IQR 222-354). Median length of stay was 6 days (IQR 5-11). Twelve patients (43%) had postoperative complications: eight (29%) minor complications and four (14%) major complications. There was no postoperative mortality. CONCLUSIONS Robot-assisted laparoscopy seems to be a feasible option for the resection of clinical T4 cancer of the distal sigmoid and rectum in selected cases. Radical resections can be achieved in the majority of cases. Therefore, T4 tumours should not be regarded as a strict contraindication for robot-assisted surgery.
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Affiliation(s)
- Rogier M P H Crolla
- Department of Oncological Surgery, Amphia Hospital, Molengracht 21, 4818CK, Breda, The Netherlands
| | - Janneke J C Tersteeg
- Department of Oncological Surgery, Amphia Hospital, Molengracht 21, 4818CK, Breda, The Netherlands.
| | | | - Jan H Wijsman
- Department of Oncological Surgery, Amphia Hospital, Molengracht 21, 4818CK, Breda, The Netherlands
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Crolla RMPH, Mulder PG, van der Schelling GP. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc 2018; 32:4562-4570. [DOI: 10.1007/s00464-018-6209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
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Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, Warusavitarne J, Buskens CJ, van Bodegraven AA, Brink MA, Consten ECJ, van Wagensveld BA, Rijk MCM, Crolla RMPH, Noomen CG, Houdijk APJ, Mallant RC, Boom M, Marsman WA, Stockmann HB, Mol B, de Groof AJ, Stokkers PC, D'Haens GR, Bemelman WA. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol 2017; 2:785-792. [PMID: 28838644 DOI: 10.1016/s2468-1253(17)30248-0] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/09/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment of patients with ileocaecal Crohn's disease who have not responded to conventional therapy is commonly scaled up to biological agents, but surgery can also offer excellent short-term and long-term results. We compared laparoscopic ileocaecal resection with infliximab to assess how they affect health-related quality of life. METHODS In this randomised controlled, open-label trial, in 29 teaching hospitals and tertiary care centres in the Netherlands and the UK, adults with non-stricturing, ileocaecal Crohn's disease, in whom conventional therapy has failed were randomly allocated (1:1) by an internet randomisation module with biased-coin minimisation for participating centres and perianal fistula to receive laparoscopic ileocaecal resection or infliximab. Eligible patients were aged 18-80 years, had active Crohn's disease of the terminal ileum, and had not responded to at least 3 months of conventional therapy with glucocorticosteroids, thiopurines, or methotrexate. Patients with diseased terminal ileum longer than 40 cm or abdominal abscesses were excluded. The primary outcome was quality of life on the Inflammatory Bowel Disease Questionnaire (IBDQ) at 12 months. Secondary outcomes were general quality of life, measured by the Short Form-36 (SF-36) health survey and its physical and mental component subscales, days unable to participate in social life, days on sick leave, morbidity (additional procedures and hospital admissions), and body image and cosmesis. Analyses of the primary outcome were done in the intention-to-treat population, and safety analyses were done in the per-protocol population. This trial is registered at the Dutch Trial Registry (NTR1150). FINDINGS Between May 2, 2008, and October 14, 2015, 73 patients were allocated to have resection and 70 to receive infliximab. Corrected for baseline differences, the mean IBDQ score at 12 months was 178·1 (95% CI 171·1-185·0) in the resection group versus 172·0 (164·3-179·6) in the infliximab group (mean difference 6·1 points, 95% CI -4·2 to 16·4; p=0·25). At 12 months, the mean SF-36 total score was 112·1 (95% CI 108·0-116·2) in the resection group versus 106·5 (102·1-110·9) in the infliximab group (mean difference 5·6, 95% CI -0·4 to 11·6), the mean physical component score was 47·7 (45·7-49·7) versus 44·6 (42·5-46·8; mean difference 3·1, 4·2 to 6·0), and the mean mental component score was 49·5 (47·0-52·1) versus 46·1 (43·3-48·9; mean difference 3·5, -0·3 to 7·3). Mean numbers of days of sick leave were 3·4 days (SD 7·1) in the resection group versus 1·4 days (4·7) in the infliximab group (p<0·0001), days not able to take part in social life were 1·8 days (6·3) versus 1·1 days (4·5; p=0·20), days of scheduled hospital admission were 6·5 days (3·8) versus 6·8 days (3·2; p=0·84), and the number of patients who had unscheduled hospital admissions were 13 (18%) of 73 versus 15 (21%) of 70 (p=0·68). Body-image scale mean scores in the patients who had resection were 16·0 (95% CI 15·2-16·8) at baseline versus 17·8 (17·1-18·4) at 12 months, and cosmetic scale mean scores were 17·6 (16·6-18·6) versus 18·6 (17·6-19·6). Surgical intervention-related complications classified as IIIa or worse on the Clavien-Dindo scale occurred in four patients in the resection group. Treatment-related serious adverse events occurred in two patients in the infliximab group. During a median follow-up of 4 years (IQR 2-6), 26 (37%) of 70 patients in the infliximab group had resection, and 19 (26%) of 73 patients in the resection group received anti-TNF. INTERPRETATION Laparoscopic resection in patients with limited (diseased terminal ileum <40 cm), non-stricturing, ileocaecal Crohn's disease in whom conventional therapy has failed could be considered a reasonable alternative to infliximab therapy. FUNDING Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | - E Joline de Groof
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands; Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - Emma J Eshuis
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Patrick M M Bossuyt
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, Netherlands
| | - Ailsa Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK
| | | | | | - Ad A van Bodegraven
- Department of Gastroenterology and Hepatology, Zuyderland Hospital, Sittard, Netherlands; VU University Medical Centre, Amsterdam, Netherlands
| | - Menno A Brink
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, Netherlands
| | | | | | - Marno C M Rijk
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, Netherlands
| | | | - Casper G Noomen
- Department of Gastroenterology and Hepatology, Medical Centre Alkmaar, Alkmaar, Netherlands
| | | | - Rosalie C Mallant
- Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, Netherlands
| | - Maarten Boom
- Department of Surgery, Flevo Hospital, Almere, Netherlands
| | - Willem A Marsman
- Department of Gastroenterology, Kennemer Gasthuis, Haarlem, Netherlands
| | | | - Bregje Mol
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | - A Jeroen de Groof
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | - Pieter C Stokkers
- Department of Gastroenterology and Hepatology, OLVG West, Amsterdam, Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands.
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Nijssen MAJ, Schreinemakers JMJ, van der Schelling GP, Crolla RMPH, Rijken AM. Improving Critical View of Safety in Laparoscopic Cholecystectomy by Teaching Interventions. J Surg Educ 2016; 73:442-7. [PMID: 26868305 DOI: 10.1016/j.jsurg.2015.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/29/2015] [Accepted: 11/24/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND Guidelines recommend obtaining a critical view of safety (CVS) during laparoscopic cholecystectomies to prevent serious bile duct injuries. We sought to evaluate the results of a teaching intervention for surgeons and residents about achieving CVS. METHODS The intervention consisted of a lecture followed by a handout on CVS along with a teaching video on how to perform a laparoscopic cholecystectomy and common pitfalls encountered. After 9 months, the whole intervention was repeated. We retrospectively collected demographic data, details about the procedure, and complications for 316 consecutive patients who underwent laparoscopic cholecystectomy and reviewed available videos of laparoscopic cholecystectomy for 229 of these patients. Videos before and after the teaching interventions were reviewed by 2 gastrointestinal surgeons regarding whether CVS was reached, and Kappa statistics were calculated to measure inter-rater agreement. RESULTS Most patients (average age 51 years) underwent laparoscopic cholecystectomy for symptomatic cholelithiasis (n = 171, 75%). CVS was reached in 69% of the preteaching intervention patients (n = 54), in 73% after the first teaching intervention (n = 75) and in 82% after the second intervention (n = 100) (not significant, overall p = 0.070). The complication rates were 24% (n = 13) before the intervention, 19% (n = 14) after the first teaching intervention, and 17% (n = 17) after the second intervention (not significant). In these groups, 1, 3, and 5 cases, correspondingly, with biliary injury were identified. All but 1 complication was related to a type A biliary injury. CONCLUSION After the teaching interventions, the complication rate and the rate of reaching CVS did not improve significantly. To improve surgeons' success in reaching CVS, more personal interventions may be more effective than the group intervention we used in this study. The next step may be to present surgeons and residents who have a low CVS rate directly with their personal results.
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Affiliation(s)
| | | | | | | | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
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29
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Nijssen MAJ, Schreinemakers JMJ, Meyer Z, van der Schelling GP, Crolla RMPH, Rijken AM. Complications After Laparoscopic Cholecystectomy: A Video Evaluation Study of Whether the Critical View of Safety was Reached. World J Surg 2016; 39:1798-803. [PMID: 25711485 DOI: 10.1007/s00268-015-2993-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Achieving the critical view of safety (CVS) before transection of the cystic artery and duct is important to reduce biliary duct injury in laparoscopic cholecystectomy. To gain more insight into complications after laparoscopic cholecystectomy, we investigated whether the criteria for CVS were met during surgery by analyzing videos of operations performed at our institution. METHODS All consecutive patients who underwent a completed laparoscopic cholecystectomy between 2009 and 2011 were included. The videos of the operations of patients with complications were independently reviewed and rated by two investigators with a third consulted in the event of a disagreement. The reviewers answered consecutive questions about whether the CVS criteria were met. Patients who underwent an elective laparoscopic cholecystectomy and had no complications were used as a control group for comparison. RESULTS Of the 1108 consecutive patients who had undergone a laparoscopic cholecystectomy during the study period, 8.8 % developed complications (average age 51 years) and 1.7 % had bile duct injuries [six patients (0.6 %) had a major bile duct injury, type B, D, or E injury]. In the 65 surgical videos available for analysis, CVS was reached in 80 % of cases according to the operative notes. However, the reviewers found that CVS was reached in only 10.8 % of the cases. Only in 18.7 % of the cases the operative notes and video agreed about CVS being reached. CVS was not reached in any of the patients who had biliary injuries. In the control group, CVS was reached significantly more often in 72 %. CONCLUSIONS In our institutional series of laparoscopic cholecystectomies with postoperative complications, CVS was reached in only a few cases. Evaluating surgical videos of laparoscopic cholecystectomy cases are important and we recommend its use to improve surgical technique and decrease the number of biliary injuries.
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Affiliation(s)
- M A J Nijssen
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands,
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30
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de Groof EJ, Buskens CJ, Ponsioen CY, Dijkgraaf MGW, D'Haens GRAM, Srivastava N, van Acker GJD, Jansen JM, Gerhards MF, Dijkstra G, Lange JFM, Witteman BJM, Kruyt PM, Pronk A, van Tuyl SAC, Bodelier A, Crolla RMPH, West RL, Vrijland WW, Consten ECJ, Brink MA, Tuynman JB, de Boer NKH, Breukink SO, Pierik MJ, Oldenburg B, van der Meulen AE, Bonsing BA, Spinelli A, Danese S, Sacchi M, Warusavitarne J, Hart A, Yassin NA, Kennelly RP, Cullen GJ, Winter DC, Hawthorne AB, Torkington J, Bemelman WA. Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial. Trials 2015; 16:366. [PMID: 26289163 PMCID: PMC4545975 DOI: 10.1186/s13063-015-0831-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023] Open
Abstract
Background Currently there is no guideline for the treatment of patients with Crohn’s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs. Methods/Design This is a multicentre, randomized controlled trial. Patients with Crohn’s disease who are over 18 years of age, with newly diagnosed or recurrent active high perianal fistulas, with one internal opening and no anti-TNF usage in the past three months will be considered. Patients with proctitis, recto-vaginal fistulas or anal stenosis will be excluded. Prior to randomisation, an MRI and ileocolonoscopy are required. All treatment will start with seton placement and a course of antibiotics. Patients will then be randomised to: (1) chronic seton drainage (with oral 6-mercaptopurine (6MP)) for one year, (2) anti-TNF medication (with 6MP) for one year (seton removal after six weeks) or (3) advancement plasty after eight weeks of seton drainage (under four months anti-TNF and 6MP for one year). The primary outcome parameter is the number of patients needing fistula-related re-intervention(s). Secondary outcomes are the number of patients with closed fistulas (based on an evaluated MRI score) after 18 months, disease activity, quality of life and costs. Discussion The PISA trial is a multicentre, randomised controlled trial of patients with Crohn’s disease and high perianal fistulas. With the comparison of three generally accepted treatment strategies, we will be able to comment on the efficiency of the various treatment strategies, with respect to several long-term outcome parameters. Trial registration Nederlands Trial Register identifier: NTR4137 (registered on 23 August 2013). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0831-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Joline de Groof
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands. .,Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Christianne J Buskens
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands.
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Nidhi Srivastava
- Department of Gastroenterology and Hepatology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA Den Haag, The Netherlands.
| | - Gijs J D van Acker
- Department of Surgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA Den Haag, The Netherlands.
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Johan F M Lange
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Philip M Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
| | - Sebastiaan A C van Tuyl
- Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
| | - Alexander Bodelier
- Department of Gastroenterology and Hepatology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Rogier M P H Crolla
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
| | - Wietske W Vrijland
- Department of Surgery, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.
| | - Menno A Brink
- Department of Gastroenterology and Hepatology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.
| | - Jurriaan B Tuynman
- Department of Surgery, VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - Marieke J Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Andrea E van der Meulen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Antonino Spinelli
- Department of Surgery, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy.
| | - Silvio Danese
- Department of Gastroenterology and Hepatology, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy.
| | - Matteo Sacchi
- Department of Surgery, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy.
| | - Janindra Warusavitarne
- Department of Surgery, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK.
| | - Ailsa Hart
- Department of Gastroenterology and Hepatology, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, England.
| | - Nuha A Yassin
- Department of Surgery, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK.
| | - Rory P Kennelly
- Department of Surgery, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - Garret J Cullen
- Department of Gastroenterology and Hepatology, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - Desmond C Winter
- Department of Surgery, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - A Barney Hawthorne
- Department of Gastroenterology and Hepatology, Spire Cardiff Hospital, Glamorgan House, Croescadarn Rd, Cardiff, South Glamorgan CF23 8XL, UK.
| | - Jared Torkington
- Department of Surgery, Spire Cardiff Hospital, Glamorgan House, Croescadarn Rd, Cardiff, South Glamorgan CF23 8XL, England.
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands.
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Raats JW, van Eijsden WA, Crolla RMPH, Steyerberg EW, van der Laan L. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLoS One 2015; 10:e0136071. [PMID: 26291459 PMCID: PMC4546338 DOI: 10.1371/journal.pone.0136071] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
Background Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery. Methods We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA) or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality. Results We included 232 patients. 51 (22%) underwent surgery for AAA and 181 (78%) for colorectal cancer. Postoperative delirium occurred in 35 patients (15%). Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7–50]), advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1–3.8]) per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1–5.9]). Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality. Conclusion Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery.
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Affiliation(s)
- Jelle W. Raats
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
- * E-mail:
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Traa MJ, Braeken J, De Vries J, Roukema JA, Slooter GD, Crolla RMPH, Borremans MPM, Den Oudsten BL. Sexual, marital, and general life functioning in couples coping with colorectal cancer: a dyadic study across time. Psychooncology 2015; 24:1181-8. [PMID: 25800938 DOI: 10.1002/pon.3801] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study evaluated the following: (a) levels of sexual, marital, and general life functioning for both patients and partners; (b) interdependence between both members of the couple; and (c) longitudinal change in sexual, marital, and general life functioning and longitudinal stress-spillover effects in these three domains from a dyadic perspective. METHODS Couples (n = 102) completed the Maudsley Marital Questionnaire preoperatively and 3 and 6 months postoperatively. Mean scores were compared with norm scores. A multivariate general linear model and a multivariate latent difference score - structural equation modeling (LDS-SEM), which took into account actor and partner effects, were evaluated. RESULTS Patients and partners reported lower sexual, mostly similar marital, and higher general life functioning compared with norm scores. Moderate to high within-dyad associations were found. The LDS-SEM model mostly showed actor effects. Yet the longitudinal change in the partners' sexual functioning was determined not only by their own preoperative sexual functioning but also by that of the patient. Preoperative sexual functioning did not spill over to the other two domains for patients and partners, whereas the patients' preoperative general life functioning influenced postoperative change in marital and sexual functioning. Health care professionals should examine potential sexual problems but have to be aware that these problems may not spill over to the marital and general life domains. In contrast, low functioning in the general life domain may spill over to the marital and sexual domains. The interdependence between patients and partners implies that a couple-based perspective (e.g., couple-based interventions/therapies) to coping with cancer is needed.
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Affiliation(s)
- Marjan J Traa
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Johan Braeken
- Research Methodology Group, Wageningen University and Research Centre, Wageningen, The Netherlands.,CEMO - Centre for Educational Measurement, University of Oslo, Oslo, Norway
| | - Jolanda De Vries
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Tilburg, The Netherlands
| | - Jan A Roukema
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Gerrit D Slooter
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Surgery, Maxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | | | | | - Brenda L Den Oudsten
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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van Erning FN, Crolla RMPH, Rutten HJT, Beerepoot LV, van Krieken JHJM, Lemmens VEPP. No change in lymph node positivity rate despite increased lymph node yield and improved survival in colon cancer. Eur J Cancer 2015; 50:3221-9. [PMID: 25459398 DOI: 10.1016/j.ejca.2014.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022]
Abstract
AIM To analyse trends over time in the number of lymph nodes evaluated and in the proportion of node positivity and to investigate the impact on survival for patients with colon cancer. PATIENTS AND METHODS 8616 patients resected for M0 colon cancer diagnosed in the southern Netherlands between 2000 and 2011 were included in this study. Trends in nodal evaluation and node positivity were analysed. Multivariable logistic regressions were used to assess the influence of period of diagnosis on adequate nodal evaluation (P12 lymph nodes) and no depositivity after adjusting for patient and tumour characteristics. Crude 5-year relative survival was used as an estimate for disease-specific survival. RESULTS Overall, the proportion adequate nodal evaluation increased from 13% in 2000–2002 to 59% in 2009–2011 (p < 0.0001), whereas the proportion node positivity remained similar across study periods (approximately 35%). Patients diagnosed in later periods were more likely to have received adequate nodal yield (adjusted Odds ratio (OR) 2009–2011 versus 2000–2002 9.8, 95% Confidence interval (CI) 8.3–11.6). However, the adjusted odds of having node positive disease did not differ between periods of diagnosis. Relative excess risk of dying was independently correlated with the number of lymph nodes evaluated (1–8 LNs versus P12 LNs, N0: 2.2, 95% CI 1.7–2.9; N+: 1.7, 95% CI 1.4–2.0) and period of diagnosis (2009–2011 versus 2000–2002, N+ only: 0.8, 95% CI 0.6–1.0). CONCLUSION The reason for improved survival with increased nodal yield is different from simple understaging as the proportion of lymph node positivity remained constant.
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Crolla RMPH, van der Laan L, Veen EJ, Hendriks Y, van Schendel C, Kluytmans J. Reduction of surgical site infections after implementation of a bundle of care. PLoS One 2012; 7:e44599. [PMID: 22962619 PMCID: PMC3433450 DOI: 10.1371/journal.pone.0044599] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/09/2012] [Indexed: 11/22/2022] Open
Abstract
Background Surgical Site Infections (SSI) are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality. Objective Implementing a bundle of care and measuring the effects on the SSI rate. Design Prospective quasi experimental cohort study. Methods A prospective surveillance for SSI after colorectal surgery was performed in the Amphia Hospital, Breda, from January 1, 2008 until January 1, 2012. As part of a National patient safety initiative, a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009. The elements of the bundle were perioperative antibiotic prophylaxis, hair removal before surgery, perioperative normothermia and discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures. Results Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. 1537 colorectal procedures were performed during the study period and 300 SSI (19.5%) occurred. SSI were associated with a prolonged length of stay (mean additional length of stay 18 days) and a significantly higher 6 months mortality (Adjusted OR: 2.71, 95% confidence interval 1.76–4.18). Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle. The adjusted Odds ratio of the SSI rate was 36% lower in 2011 compared to 2008. Conclusion The implementation of the bundle was associated with improved compliance over time and a 36% reduction of the SSI rate after adjustment for confounders. This makes the bundle an important tool to improve patient safety.
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de Vries EN, Prins HA, Crolla RMPH, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MGW, Smorenburg SM, Boermeester MA. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010; 363:1928-37. [PMID: 21067384 DOI: 10.1056/nejmsa0911535] [Citation(s) in RCA: 604] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway. METHODS We examined the effects on patient outcomes of a comprehensive, multidisciplinary surgical safety checklist, including items such as medication, marking of the operative side, and use of postoperative instructions. The checklist was implemented in six hospitals with high standards of care. All complications occurring during admission were documented prospectively. We compared the rate of complications during a baseline period of 3 months with the rate during a 3-month period after implementation of the checklist, while accounting for potential confounders. Similar data were collected from a control group of five hospitals. RESULTS In a comparison of 3760 patients observed before implementation of the checklist with 3820 patients observed after implementation, the total number of complications per 100 patients decreased from 27.3 (95% confidence interval [CI], 25.9 to 28.7) to 16.7 (95% CI, 15.6 to 17.9), for an absolute risk reduction of 10.6 (95% CI, 8.7 to 12.4). The proportion of patients with one or more complications decreased from 15.4% to 10.6% (P<0.001). In-hospital mortality decreased from 1.5% (95% CI, 1.2 to 2.0) to 0.8% (95% CI, 0.6 to 1.1), for an absolute risk reduction of 0.7 percentage points (95% CI, 0.2 to 1.2). Outcomes did not change in the control hospitals. CONCLUSIONS Implementation of this comprehensive checklist was associated with a reduction in surgical complications and mortality in hospitals with a high standard of care. (Netherlands Trial Register number, NTR1943.).
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Affiliation(s)
- Eefje N de Vries
- Departments of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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van de Wall BJM, Draaisma WA, Consten ECJ, van der Graaf Y, Otten MH, de Wit GA, van Stel HF, Gerhards MF, Wiezer MJ, Cense HA, Stockmann HBAC, Leijtens JWA, Zimmerman DDE, Belgers E, van Wagensveld BA, Sonneveld EDJA, Prins HA, Coene PPLO, Karsten TM, Klaase JM, Statius Muller MG, Crolla RMPH, Broeders IAMJ. DIRECT trial. Diverticulitis recurrences or continuing symptoms: Operative versus conservative treatment. A multicenter randomised clinical trial. BMC Surg 2010; 10:25. [PMID: 20691040 PMCID: PMC2928179 DOI: 10.1186/1471-2482-10-25] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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: 06/25/2010] [Accepted: 08/06/2010] [Indexed: 12/05/2022] Open
Abstract
Background Persisting abdominal complaints are common after an episode of diverticulitis treated conservatively. Furthermore, some patients develop frequent recurrences. These two groups of patients suffer greatly from their disease, as shown by impaired health related quality of life and increased costs due to multiple specialist consultations, pain medication and productivity losses. Both conservative and operative management of patients with persisting abdominal complaints after an episode of diverticulitis and/or frequently recurring diverticulitis are applied. However, direct comparison by a randomised controlled trial is necessary to determine which is superior in relieving symptoms, optimising health related quality of life, minimising costs and preventing diverticulitis recurrences against acceptable morbidity and mortality associated with surgery or the occurrence of a complicated recurrence after conservative management. We, therefore, constructed a randomised clinical trial comparing these two treatment strategies. Methods/design The DIRECT trial is a multicenter randomised clinical trial. Patients (18-75 years) presenting themselves with persisting abdominal complaints after an episode of diverticulitis and/or three or more recurrences within 2 years will be included and randomised. Patients randomised for conservative treatment are treated according to the current daily practice (antibiotics, analgetics and/or expectant management). Patients randomised for elective resection will undergo an elective resection of the affected colon segment. Preferably, a laparoscopic approach is used. The primary outcome is health related quality of life measured by the Gastro-intestinal Quality of Life Index, Short-Form 36, EQ-5D and a visual analogue scale for pain quantification. Secondary endpoints are morbidity, mortality and total costs. The total follow-up will be three years. Discussion Considering the high incidence and the multicenter design of this study, it may be assumed that the number of patients needed for this study (n = 214), may be gathered within one and a half year. Depending on the expertise and available equipment, we prefer to perform a laparoscopic resection on patients randomised for elective surgery. Should this be impossible, an open technique may be used as this also reflects the current situation. Trial Registration (Trial register number: NTR1478)
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Eshuis EJ, Bemelman WA, van Bodegraven AA, Sprangers MAG, Bossuyt PMM, van Milligen de Wit AWM, Crolla RMPH, Cahen DL, Oostenbrug LE, Sosef MN, Voorburg AMCJ, Davids PHP, van der Woude CJ, Lange J, Mallant RC, Boom MJ, Lieverse RJ, van der Zaag ES, Houben MHMG, Vecht J, Pierik REGJM, van Ditzhuijsen TJM, Prins HA, Marsman WA, Stockmann HB, Brink MA, Consten ECJ, van der Werf SDJ, Marinelli AWKS, Jansen JM, Gerhards MF, Bolwerk CJM, Stassen LPS, Spanier BWM, Bilgen EJS, van Berkel AM, Cense HA, van Heukelem HA, van de Laar A, Slot WB, Eijsbouts QA, van Ooteghem NAM, van Wagensveld B, van den Brande JMH, van Geloven AAW, Bruin KF, Maring JK, Oldenburg B, van Hillegersberg R, de Jong DJ, Bleichrodt R, van der Peet DL, Dekkers PEP, Goei TH, Stokkers PCF. Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial). BMC Surg 2008; 8:15. [PMID: 18721465 PMCID: PMC2533646 DOI: 10.1186/1471-2482-8-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 08/22/2008] [Indexed: 12/24/2022] Open
Abstract
Background With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction. The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. Methods/design The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. Discussion The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. Trial registration Nederlands Trial Register NTR1150
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Affiliation(s)
- Emma J Eshuis
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
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Crolla RMPH. [Dealing with patient dissatisfaction; a professional skill]. Ned Tijdschr Geneeskd 2003; 147:47; author reply 47-8. [PMID: 12564298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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