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Rutten MJ, van Meurs HS, van de Vrie R, Gaarenstroom KN, Naaktgeboren CA, van Gorp T, Ter Brugge HG, Hofhuis W, Schreuder HWR, Arts HJG, Zusterzeel PLM, Pijnenborg JMA, van Haaften M, Fons G, Engelen MJA, Boss EA, Vos MC, Gerestein KG, Schutter EMJ, Opmeer BC, Spijkerboer AM, Bossuyt PMM, Mol BW, Kenter GG, Buist MR. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial. J Clin Oncol 2016; 35:613-621. [PMID: 28029317 DOI: 10.1200/jco.2016.69.2962] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of > 1 cm. Primary analyses were performed according to the intention-to-treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P < .001). In the laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group ( P < .001). Conclusion Diagnostic laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with PCS.
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Affiliation(s)
- Marianne J Rutten
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Hannah S van Meurs
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Roelien van de Vrie
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Katja N Gaarenstroom
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Christiana A Naaktgeboren
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Toon van Gorp
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Henk G Ter Brugge
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ward Hofhuis
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Henk W R Schreuder
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Henriette J G Arts
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Petra L M Zusterzeel
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Johanna M A Pijnenborg
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maarten van Haaften
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Guus Fons
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Mirjam J A Engelen
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Erik A Boss
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - M Caroline Vos
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kees G Gerestein
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Eltjo M J Schutter
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Brent C Opmeer
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Anje M Spijkerboer
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Patrick M M Bossuyt
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ben Willem Mol
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Gemma G Kenter
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Marrije R Buist
- Marianne J. Rutten, Hannah S. van Meurs, Roelien van de Vrie, Christiana A. Naaktgeboren, Guus Fons, Brent C. Opmeer, Anje M. Spijkerboer, Patrick M.M. Bossuyt, Gemma G. Kenter, and Marrije R. Buist, Academic Medical Center, Amsterdam; Katja N. Gaarenstroom, Leiden University Medical Center, Leiden; Toon van Gorp, Maastricht University Medical Center, Maastricht; Henk G. Ter Brugge, Isala Hospital, Zwolle; Ward Hofhuis, Sint Franciscus Gasthuis, Rotterdam; Henk W.R. Schreuder, University Medical Center Utrecht; Maarten van Haaften, Diakonessenhuis, Utrecht; Henriette J.G. Arts, University Medical Center Groningen, Groningen; Petra L.M. Zusterzeel, Radboud University Medical Center, Nijmegen; Johanna M.A. Pijnenborg and M. Caroline Vos, Elisabeth-Tweesteden Hospital, Tilburg; Mirjam J.A. Engelen, Atrium Medical Center, Heerlen; Erik A. Boss, Máxima Medical Center, Veldhoven; Kees G. Gerestein, Meander Medical Center, Amersfoort; Eltjo M.J. Schutter, Medical Spectrum Twente, Enschede, the Netherlands; and Ben Willem Mol, The Robinson Research Institute, University of Adelaide; The South Australian Health and Medical Research Institute, Adelaide, Australia
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