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Verweij ME, Tanaka MD, Kensen CM, van der Heide UA, Marijnen CAM, Janssen T, Vijlbrief T, van Grevenstein WMU, Moons LMG, Koopman M, Lacle MM, Braat MNGJA, Chalabi M, Maas M, Huibregtse IL, Snaebjornsson P, Grotenhuis BA, Fijneman R, Consten E, Pronk A, Smits AB, Heikens JT, Eijkelenkamp H, Elias SG, Verkooijen HM, Schoenmakers MMC, Meijer GJ, Intven M, Peters FP. Towards Response ADAptive Radiotherapy for organ preservation for intermediate-risk rectal cancer (preRADAR): protocol of a phase I dose-escalation trial. BMJ Open 2023; 13:e065010. [PMID: 37321815 PMCID: PMC10277084 DOI: 10.1136/bmjopen-2022-065010] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/07/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Organ preservation is associated with superior functional outcome and quality of life (QoL) compared with total mesorectal excision (TME) for rectal cancer. Only 10% of patients are eligible for organ preservation following short-course radiotherapy (SCRT, 25 Gy in five fractions) and a prolonged interval (4-8 weeks) to response evaluation. The organ preservation rate could potentially be increased by dose-escalated radiotherapy. Online adaptive magnetic resonance-guided radiotherapy (MRgRT) is anticipated to reduce radiation-induced toxicity and enable radiotherapy dose escalation. This trial aims to establish the maximum tolerated dose (MTD) of dose-escalated SCRT using online adaptive MRgRT. METHODS AND ANALYSIS The preRADAR is a multicentre phase I trial with a 6+3 dose-escalation design. Patients with intermediate-risk rectal cancer (cT3c-d(MRF-)N1M0 or cT1-3(MRF-)N1M0) interested in organ preservation are eligible. Patients are treated with a radiotherapy boost of 2×5 Gy (level 0), 3×5 Gy (level 1), 4×5 Gy (level 2) or 5×5 Gy (level 3) on the gross tumour volume in the week following standard SCRT using online adaptive MRgRT. The trial starts on dose level 1. The primary endpoint is the MTD based on the incidence of dose-limiting toxicity (DLT) per dose level. DLT is a composite of maximum one in nine severe radiation-induced toxicities and maximum one in three severe postoperative complications, in patients treated with TME or local excision within 26 weeks following start of treatment. Secondary endpoints include the organ preservation rate, non-DLT, oncological outcomes, patient-reported QoL and functional outcomes up to 2 years following start of treatment. Imaging and laboratory biomarkers are explored for early response prediction. ETHICS AND DISSEMINATION The trial protocol has been approved by the Medical Ethics Committee of the University Medical Centre Utrecht. The primary and secondary trial results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER WHO International Clinical Trials Registry (NL8997; https://trialsearch.who.int).
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Affiliation(s)
- Maaike E Verweij
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Max D Tanaka
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Chavelli M Kensen
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Corrie A M Marijnen
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tomas Janssen
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tineke Vijlbrief
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Leon M G Moons
- Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Myriam Chalabi
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Inge L Huibregtse
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Remond Fijneman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Esther Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, The Netherlands
| | - Anke B Smits
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Joost T Heikens
- Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands
| | - Hidde Eijkelenkamp
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Gert J Meijer
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martijn Intven
- Department of Radiation-Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Femke P Peters
- Department of Radiation-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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de Bock E, Filipe MD, Herman ES, Pronk A, Boerma D, Heikens JT, Verheijen PM, Vriens MR, Richir MC. Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study. Int J Surg Open 2023; 55:100620. [PMID: 37163195 PMCID: PMC10159662 DOI: 10.1016/j.ijso.2023.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
Background During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic. Methods This multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals. Results One hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06-9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32-0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02-1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02-1.08; p = 0.001), surgical urgency and surgical discipline. Conclusion A confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Eline S Herman
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joost T Heikens
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, the Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
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Scholten B, Westerhout J, Pronk A, Stierum R, Vlaanderen J, Vermeulen R, Jones K, Santonen T, Portengen L. A physiologically-based kinetic (PBK) model for work-related diisocyanate exposure: Relevance for the design and reporting of biomonitoring studies. Environ Int 2023; 174:107917. [PMID: 37062159 DOI: 10.1016/j.envint.2023.107917] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/05/2023] [Accepted: 04/02/2023] [Indexed: 06/19/2023]
Abstract
Diisocyanates are highly reactive substances and known causes of occupational asthma. Exposure occurs mainly in the occupational setting and can be assessed through biomonitoring which accounts for inhalation and dermal exposure and potential effects of protective equipment. However the interpretation of biomonitoring data can be challenging for chemicals with complex kinetic behavior and multiple exposure routes, as is the case for diisocyanates. To better understand the relation between external exposure and urinary concentrations of metabolites of diisocyanates, we developed a physiologically based kinetic (PBK) model for methylene bisphenyl isocyanate (MDI) and toluene di-isocyanate (TDI). The PBK model covers both inhalation and dermal exposure, and can be used to estimate biomarker levels after either single or chronic exposures. Key parameters such as absorption and elimination rates of diisocyanates were based on results from human controlled exposure studies. A global sensitivity analysis was performed on model predictions after assigning distributions reflecting a mixture of parameter uncertainty and population variability. Although model-based predictions of urinary concentrations of the degradation products of MDI and TDI for longer-term exposure scenarios compared relatively well to empirical results for a limited set of biomonitoring studies in the peer-reviewed literature, validation of model predictions was difficult because of the many uncertainties regarding the precise exposure scenarios that were used. Sensitivity analyses indicated that parameters with a relatively large impact on model estimates included the fraction of diisocyanates absorbed and the binding rate of diisocyanates to albumin relative to other macro molecules.We additionally investigated the effects of timing of exposure and intermittent urination, and found that both had a considerable impact on estimated urinary biomarker levels. This suggests that these factors should be taken into account when interpreting biomonitoring data and included in the standard reporting of isocyanate biomonitoring studies.
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Affiliation(s)
- B Scholten
- Risk Assessment for Products in Development, TNO Quality of Life, the Netherlands.
| | - J Westerhout
- Risk Assessment for Products in Development, TNO Quality of Life, the Netherlands
| | - A Pronk
- Risk Assessment for Products in Development, TNO Quality of Life, the Netherlands
| | - R Stierum
- Risk Assessment for Products in Development, TNO Quality of Life, the Netherlands
| | - J Vlaanderen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - R Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - K Jones
- Health and Safety Executive (HSE), Harpur Hill, Buxton, UK
| | - T Santonen
- Finnish Institute of Occupational Health (FIOH), Finland
| | - L Portengen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
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4
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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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5
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Smalbroek B, Geitenbeek R, Burghgraef T, Dijksman L, Hol J, Rutgers M, Crolla R, van Geloven N, Leijtens J, Polat F, Pronk A, Verdaasdonk E, Tuynman J, Sietses C, Postma M, Hompes R, Consten E, Smits A. A Cost Overview of Minimally Invasive Total Mesorectal Excision in Rectal Cancer Patients: A Population-based Cohort in Experienced Centres. Ann Surg Open 2023; 4:e263. [PMID: 37600875 PMCID: PMC10431334 DOI: 10.1097/as9.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 03/09/2023] Open
Abstract
Background Total mesorectal excision has been the gold standard for the operative management of rectal cancer. The most frequently used minimally invasive techniques for surgical resection of rectal cancer are laparoscopic, robot-assisted, and transanal total mesorectal excision. As studies comparing the costs of the techniques are lacking, this study aims to provide a cost overview. Method This retrospective cohort study included patients who underwent total mesorectal resection between 2015 and 2017 at 11 dedicated centers, which completed the learning curve of the specific technique. The primary outcome was total in-hospital costs of each technique up to 30 days after surgery including all major surgical cost drivers, while taking into account different team approaches in the transanal approach. Secondary outcomes were hospitalization and complication rates. Statistical analysis was performed using multivariable linear regression analysis. Results In total, 949 patients were included, consisting of 446 laparoscopic (47%), 306 (32%) robot-assisted, and 197 (21%) transanal total mesorectal excisions. Total costs were significantly higher for transanal and robot-assisted techniques compared to the laparoscopic technique, with median (interquartile range) for laparoscopic, robot-assisted, and transanal at €10,556 (8,642;13,829), €12,918 (11,196;16,223), and € 13,052 (11,330;16,358), respectively (P < 0.001). Also, the one-team transanal approach showed significant higher operation time and higher costs compared to the two-team approach. Length of stay and postoperative complications did not differ between groups. Conclusion Transanal and robot-assisted approaches show higher costs during 30-day follow-up compared to laparoscopy with comparable short-term clinical outcomes. Two-team transanal approach is associated with lower total costs compared to the transanal one-team approach.
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Affiliation(s)
- Bo Smalbroek
- From the Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ritchie Geitenbeek
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijs Burghgraef
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Lea Dijksman
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jeroen Hol
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Marieke Rutgers
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Rogier Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Jeroen Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Emiel Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Jurriaan Tuynman
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Colin Sietses
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Maarten Postma
- Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
| | - Roel Hompes
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Esther Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Anke Smits
- From the Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Verweij ME, Hoendervangers S, von Hebel CM, Pronk A, Schiphorst AHW, Consten ECJ, Smits AB, Heikens JT, Verdaasdonk EGG, Rozema T, Verkooijen HM, van Grevenstein WMU, Intven MPW. Patient- and physician-reported radiation-induced toxicity of short-course radiotherapy with a prolonged interval to surgery for rectal cancer. Colorectal Dis 2023; 25:24-30. [PMID: 36054676 PMCID: PMC10087149 DOI: 10.1111/codi.16315] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
AIM A prolonged interval (>4 weeks) between short-course radiotherapy (25 Gy in five fractions) (SCRT-delay) and total mesorectal excision for rectal cancer has been associated with a decreased postoperative complication rate and offers the possibility of organ preservation in the case of a complete tumour response. This prospective cohort study systematically evaluated patient-reported bowel dysfunction and physician-reported radiation-induced toxicity for 8 weeks following SCRT-delay. METHOD Patients who were referred for SCRT-delay for intermediate risk, oligometastatic or locally advanced rectal cancer were included. Repeated measurements were done for patient-reported bowel dysfunction (measured by the low anterior resection syndrome [LARS] questionnaire and categorized as no, minor or major LARS) and physician-reported radiation-induced toxicity (according to Common Terminology Criteria for Adverse Events version 4.0) before start of treatment (baseline), at completion of SCRT and 1, 2, 3, 4, 6 and 8 weeks thereafter. RESULTS Fifty-one patients were included; 31 (61%) were men and the median age was 67 years (range 44-91). Patient-reported bowel dysfunction and physician-reported radiation-induced toxicity peaked at weeks 1-2 after completion of SCRT and gradually declined thereafter. Major LARS was reported by 44 patients (92%) at some time during SCRT-delay. Grade 3 radiation-induced toxicity was reported in 17 patients (33%) and concerned predominantly diarrhoea. No Grade 4-5 radiation-induced toxicity occurred. CONCLUSION During SCRT-delay, almost every patient experiences temporary mild-moderate radiation-induced toxicity and major LARS, but life-threatening toxicity is rare. SCRT-delay is a safe alternative to SCRT-direct surgery that should be proposed when counselling rectal cancer patients on neoadjuvant strategies.
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Affiliation(s)
- Maaike E Verweij
- Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sieske Hoendervangers
- Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Charlotte M von Hebel
- Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, 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
| | - Anke B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Joost T Heikens
- Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | | | - Tom Rozema
- Department of Radiotherapy, Verbeeten Institute, Tilburg, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Martijn P W Intven
- Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
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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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Dijk W, Di Filippo M, Sander K, Rimbert A, Caillaud A, Thédrez A, Arnaud L, Pronk A, Garcon D, Sotin T, Lindenbaum P, Ozcariz Garcia E, De Barros JP, Duvillard L, Si-Tayeb K, Amigo N, Le Questel JY, Rensen P, Le May C, Moulin P, Cariou B. Identification of a gain-of-function LIPC variant as a novel cause of familial combined hypocholesterolemia. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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9
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Custers PA, Hupkens BJP, Grotenhuis BA, Kuhlmann KFD, Breukink SO, Beets GL, Melenhorst J, Buijsen J, Festen S, de Graaf EJR, Haak HE, Hilling DE, Hoff C, Intven M, Komen N, Kusters M, van Leerdam ME, Peeters KCMJ, Peters FP, Pronk A, van der Sande ME, Schreurs WH, Sonneveld DJA, Talsma AK, Tuynman JB, Valkenburg‐van Iersel LBJ, Vermaas M, de Vos‐Geelen J, van Westreenen HL, de Wilt JHW, Zimmerman DDE. Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery? Colorectal Dis 2022; 24:401-410. [PMID: 35060263 PMCID: PMC9305558 DOI: 10.1111/codi.16034] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022]
Abstract
AIM The aim of this study was to assess the clinical and oncological outcome of a selected group of stage IV rectal cancer patients managed by the watch-and-wait approach following a (near-)complete response of the primary rectal tumour after radiotherapy. METHOD Patients registered in the Dutch watch-and-wait registry since 2004 were selected when diagnosed with synchronous stage IV rectal cancer. Data on patient characteristics, treatment details, follow-up and survival were collected. The 2-year local regrowth rate, organ-preservation rate, colostomy-free rate, metastatic progression-free rate and 2- and 5-year overall survival were analysed. RESULTS After a median follow-up period of 35 months, local regrowth was observed in 17 patients (40.5%). Nine patients underwent subsequent total mesorectal excision, resulting in a permanent colostomy in four patients. The 2-year local regrowth rate was 39.9%, the 2-year organ-preservation rate was 77.1%, the 2-year colostomy-free rate was 88.1%, and the 2-year metastatic progression-free rate was 46.7%. The 2- and 5-year overall survival rates were 92.0% and 67.5%. CONCLUSION The watch-and-wait approach can be considered as an alternative to total mesorectal excision in a selected group of stage IV rectal cancer patients with a (near-)complete response following pelvic radiotherapy. Despite a relatively high regrowth rate, total mesorectal excision and a permanent colostomy can be avoided in the majority of these patients.
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Affiliation(s)
- Petra A. Custers
- Department of SurgeryNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands,GROW School for Oncology and Developmental Biology – Maastricht UniversityMaastrichtThe Netherlands
| | - Britt J. P. Hupkens
- Department of RadiotherapyMaastricht University Medical Centre (MAASTRO)MaastrichtThe Netherlands
| | - Brechtje A. Grotenhuis
- Department of SurgeryNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Koert F. D. Kuhlmann
- Department of SurgeryNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | | | - Geerard L. Beets
- Department of SurgeryNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands,GROW School for Oncology and Developmental Biology – Maastricht UniversityMaastrichtThe Netherlands
| | - Jarno Melenhorst
- Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
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10
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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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11
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Verweij ME, Hoendervangers S, Couwenberg AM, Burbach JPM, Berbee M, Buijsen J, Roodhart J, Reerink O, Pronk A, Consten ECJ, Smits AB, Heikens JT, van Grevenstein WMU, Intven MPW, Verkooijen HM. Impact of dose-escalated chemoradiation on quality of life in patients with locally advanced rectal cancer: two year follow-up of the randomized RECTAL-BOOST trial. Int J Radiat Oncol Biol Phys 2021; 112:694-703. [PMID: 34634436 DOI: 10.1016/j.ijrobp.2021.09.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dose-escalated chemoradiation (CRT) for locally advanced rectal cancer (LARC) did not result in higher complete response rates, but initiated more tumor regression in the randomized XXXXX trial (Clinicaltrials.gov XXXXX). This study compared patient reported outcomes (PROs) between patients who received dose-escalated CRT (5 × 3Gy boost + CRT) or standard CRT for two years following randomization. METHODS Patients with LARC, participating in the XXXXX trial, filled out EORTC QLQ-C30 and CR29 questionnaires on quality of life (QoL) and symptoms at baseline, 3, 6, 12, 18 and 24 months following start of treatment. Between-group differences in functional QoL domains were estimated using a linear mixed-effects model and expressed as effect size (ES). Symptom scores were compared using Mann-Whitney U test. RESULTS Patients treated with dose-escalated CRT (boost group, n=51) experienced a significantly stronger decline in global health at 3 and 6 months (ES -0,4 and ES -0,4), physical functioning at 6 months (ES -1,1), role functioning at 3 and 6 months (ES -0,8 and ES -0,6) and social functioning at 6 months (ES -0,6) compared to patients treated with standard CRT (control group, n=64). The boost group reported significantly more fatigue at 3 and 6 months (83% vs. 66% resp. 89% vs. 76%), pain at 3 and 6 months (67% vs. 36% resp. 80% vs. 44%) and diarrhea at 3 months (45% vs. 29%) compared to the control group. From 12 months onwards, QoL and symptoms were similar between groups, apart from more blood/mucus in stool in the boost group. CONCLUSION In patients with LARC, dose-escalated CRT resulted in a transient deterioration in global health, physical, role, and social functioning and more pain, fatigue and diarrhea at 3 and 6 months following start of treatment compared to standard CRT. From 12 months onwards, the impact of dose-escalated CRT on QoL largely resolved.
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Affiliation(s)
- M E Verweij
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S Hoendervangers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A M Couwenberg
- Department of Radiation Oncology, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - J P M Burbach
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - M Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Buijsen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - O Reerink
- Department of Radiation Oncology, Isala Clinic, Zwolle, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J T Heikens
- Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands
| | | | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, 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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Jones RR, Ward MH, Deziel NC, Medgyesi DN, Pronk A, Nuckols JR, Fisher JA. Residential Proximity to Dioxin-emitting Facilities and Risk of Non-Hodgkin Lymphoma in the NIH-AARP Diet and Health Study. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1055-9965.epi-21-0219] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Few studies have investigated the relationship between risk of non-Hodgkin lymphoma (NHL) and residential proximity to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) emitted from industrial combustion and manufacturing sources. Methods: We evaluated this relationship among participants of the NIH-AARP Diet and Health Study, a prospective cohort (N = 548,845) in 6 states and 2 cities in the U.S. We linked geocoded enrollment addresses (1995–1996) with a U.S. Environmental Protection Agency database of 4,478 historical PCDD/F sources, which contained toxic equivalency quotient (TEQ) emissions estimates from 1995. Exposure metrics indicated presence/absence of any facility within 3 and 5km of participant homes, overall and by type of facility (e.g., coal-fired power plants, waste incinerators), which vary in emissions levels and constituency. We also calculated exposure as a distance- and toxicity-weighted average emissions index (AEI [g TEQ]). We used Cox regression to estimate associations (hazard ratios; HR and 95% confidence intervals; CI) with NHL and major subtypes, adjusting for and by strata of sociodemographic and lifestyle characteristics. Results: With 6,747 incident cases through 2011, we found no association between living near any or specific types of PCDD/F-emitting facilities and NHL risk. However, participants with an AEI >95th percentile within 5km had increased risk of NHL compared to unexposed (HR = 1.28; CI = 1.05–1.55; p-trend = 0.01). Specifically, we observed increased risk for lymphoplasmacytic lymphoma (HR = 2.98, CI = 1.16–7.63; p-trend = 0.03) and diffuse large B-cell lymphoma (HR = 1.65, CI = 1.11–2.46; p-trend = 0.01). Non-Hispanic blacks were nearly three times as likely as whites to live <5 km of a facility, although we had limited power to evaluate heterogeneity in associations by race/ethnicity. Associations did not vary by age, smoking status, body mass index, or urbanicity of residence. Conclusions: Using an exposure metric accounting for distance and the toxicity of emissions, we found significant positive associations between residential exposure to high PCDD/F emissions and risk of NHL and two subtypes. Our results underscore the hazard for populations living near sources of these persistent organic pollutants.
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15
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Filipe MD, van Deukeren D, Kip M, Doeksen A, Pronk A, Verheijen PM, Heikens JT, Witkamp AJ, Richir MC. Effect of the COVID-19 Pandemic on Surgical Breast Cancer Care in the Netherlands: A Multicenter Retrospective Cohort Study. Clin Breast Cancer 2020; 20:454-461. [PMID: 32888855 PMCID: PMC7413119 DOI: 10.1016/j.clbc.2020.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/24/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has put a strain on regular healthcare worldwide. In the Netherlands, the national screening programs, including for breast cancer, were halted temporarily. This posed a challenge to breast cancer care, because ∼40% of cases are detected through national screening. Therefore, the aim of the present study was to evaluate the effects of the COVID-19 pandemic on the surgical care of patients with breast cancer in the Netherlands. Materials and Methods The present multicenter retrospective cohort study investigated the effects of COVID-19 on patients with breast cancer who had undergone surgery from March 9 to May 17, 2020. The primary endpoints were the number of surgical procedures performed during the study period, tumor characteristics, surgery type, and route of referral. The secondary endpoint was the incidence of postoperative complications during the study period. Results A total of 217 consecutive patients with breast cancer requiring surgery were included. We found an overall decrease in the number of patients with breast cancer who were undergoing surgery. The most significant decline was seen in surgery for T1-T2 and N0 tumors. A decline in the number of referrals from both the national screening program and general practitioners was observed. The incidence of postoperative complications remained stable during the study period. Conclusions The temporary halt of the national screening program for breast cancer resulted in fewer surgical procedures during the study period and a pronounced decrease in surgery of the lower tumor stages.
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Affiliation(s)
- Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, Utrecht, Netherlands.
| | | | - Marijn Kip
- Department of Surgery, Diakonessenhuis, Utrecht, Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, Netherlands
| | - Joost T Heikens
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands; Department of Surgery, Rivierenland Hospital, Tiel, Netherlands
| | - Arjen J Witkamp
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, Utrecht, Netherlands
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16
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Dekkers N, Boonstra JJ, Moons LMG, Hompes R, Bastiaansen BA, Tuynman JB, Koch AD, Weusten BLAM, Pronk A, Neijenhuis PA, Westerterp M, van den Hout WB, Langers AMJ, van der Kraan J, Alkhalaf A, Lai JYL, Ter Borg F, Fabry H, Halet E, Schwartz MP, Nagengast WB, Straathof JWA, Ten Hove RWR, Oterdoom LH, Hoff C, Belt EJT, Zimmerman DDE, Hadithi M, Morreau H, de Cuba EMV, Leijtens JWA, Vasen HFA, van Leerdam ME, de Graaf EJR, Doornebosch PG, Hardwick JCH. Transanal minimally invasive surgery (TAMIS) versus endoscopic submucosal dissection (ESD) for resection of non-pedunculated rectal lesions (TRIASSIC study): study protocol of a European multicenter randomised controlled trial. BMC Gastroenterol 2020; 20:225. [PMID: 32660488 PMCID: PMC7359465 DOI: 10.1186/s12876-020-01367-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In the recent years two innovative approaches have become available for minimally invasive en bloc resections of large non-pedunculated rectal lesions (polyps and early cancers). One is Transanal Minimally Invasive Surgery (TAMIS), the other is Endoscopic Submucosal Dissection (ESD). Both techniques are standard of care, but a direct randomised comparison is lacking. The choice between either of these procedures is dependent on local expertise or availability rather than evidence-based. The European Society for Endoscopy has recommended that a comparison between ESD and local surgical resection is needed to guide decision making for the optimal approach for the removal of large rectal lesions in Western countries. The aim of this study is to directly compare both procedures in a randomised setting with regard to effectiveness, safety and perceived patient burden. METHODS Multicenter randomised trial in 15 hospitals in the Netherlands. Patients with non-pedunculated lesions > 2 cm, where the bulk of the lesion is below 15 cm from the anal verge, will be randomised between either a TAMIS or an ESD procedure. Lesions judged to be deeply invasive by an expert panel will be excluded. The primary endpoint is the cumulative local recurrence rate at follow-up rectoscopy at 12 months. Secondary endpoints are: 1) Radical (R0-) resection rate; 2) Perceived burden and quality of life; 3) Cost effectiveness at 12 months; 4) Surgical referral rate at 12 months; 5) Complication rate; 6) Local recurrence rate at 6 months. For this non-inferiority trial, the total sample size of 198 is based on an expected local recurrence rate of 3% in the ESD group, 6% in the TAMIS group and considering a difference of less than 6% to be non-inferior. DISCUSSION This is the first European randomised controlled trial comparing the effectiveness and safety of TAMIS and ESD for the en bloc resection of large non-pedunculated rectal lesions. This is important as the detection rate of these adenomas is expected to further increase with the introduction of colorectal screening programs throughout Europe. This study will therefore support an optimal use of healthcare resources in the future. TRIAL REGISTRATION Netherlands Trial Register, NL7083 , 06 July 2018.
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Affiliation(s)
- Nik Dekkers
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jurjen J Boonstra
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Barbara A Bastiaansen
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making & Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra M J Langers
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jolein van der Kraan
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Alaa Alkhalaf
- Department of Gastroenterology & Hepatology, Isala hospital, Zwolle, The Netherlands
| | - Jonathan Y L Lai
- Department of Gastroenterology & Hepatology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frank Ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Hans Fabry
- Department of Surgery, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Eric Halet
- Department of Gastroenterology & Hepatology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Matthijs P Schwartz
- Departmet of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology & Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Willem A Straathof
- Department of Gastroenterology & Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rogier W R Ten Hove
- Department of Gastroenterology & Hepatology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Leendert H Oterdoom
- Department of Gastroenterology & Hepatology, Hagaziekenhuis, The Hague, The Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Eric J Th Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Eindhoven, The Netherlands
| | - Muhammed Hadithi
- Department of Gastroenterology & Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Hans F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - James C H Hardwick
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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17
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Wasmann KA, de Groof EJ, Stellingwerf ME, D’Haens GR, Ponsioen CY, Gecse KB, Dijkgraaf MGW, Gerhards MF, Jansen JM, Pronk A, van Tuyl SAC, Zimmerman DDE, Bruin KF, Spinelli A, Danese S, van der Bilt JDW, Mundt MW, Bemelman WA, Buskens CJ. Treatment of Perianal Fistulas in Crohn's Disease, Seton Versus Anti-TNF Versus Surgical Closure Following Anti-TNF [PISA]: A Randomised Controlled Trial. J Crohns Colitis 2020; 14:1049-1056. [PMID: 31919501 PMCID: PMC7476637 DOI: 10.1093/ecco-jcc/jjaa004] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Most patients with perianal Crohn's fistula receive medical treatment with anti-tumour necrosis factor [TNF], but the results of anti-TNF treatment have not been directly compared with chronic seton drainage or surgical closure. The aim of this study was to assess if chronic seton drainage for patients with perianal Crohn's disease fistulas would result in less re-interventions, compared with anti-TNF and compared with surgical closure. METHODS This randomised trial was performed in 19 European centres. Patients with high perianal Crohn's fistulas with a single internal opening were randomly assigned to: i] chronic seton drainage for 1 year; ii] anti-TNF therapy for 1 year; and iii] surgical closure after 2 months under a short course anti-TNF. The primary outcome was the cumulative number of patients with fistula-related re-intervention[s] at 1.5 years. Patients declining randomisation due to a specific treatment preference were included in a parallel prospective PISA registry cohort. RESULTS Between September 14, 2013 and November 20, 2017, 44 of the 126 planned patients were randomised. The study was stopped by the data safety monitoring board because of futility. Seton treatment was associated with the highest re-intervention rate [10/15, versus 6/15 anti-TNF and 3/14 surgical closure patients, p = 0.02]. No substantial differences in perianal disease activity and quality of life between the three treatment groups were observed. Interestingly, in the PISA prospective registry, inferiority of chronic seton treatment was not observed for any outcome measure. CONCLUSIONS The results imply that chronic seton treatment should not be recommended as the sole treatment for perianal Crohn's fistulas.
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Affiliation(s)
- Karin A Wasmann
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands,Corresponding author: Dr Christianne J. Buskens, MD PhD, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | | | - Geert R D’Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Karlien F Bruin
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Antonino Spinelli
- Department of Surgery, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | | | - Marco W Mundt
- Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, The Netherlands
| | | | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands,Corresponding author: Dr Christianne J. Buskens, MD PhD, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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18
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Stevens LJ, van Lipzig MMH, Erpelinck SLA, Pronk A, van Gorp J, Wortelboer HM, van de Steeg E. A higher throughput and physiologically relevant two-compartmental human ex vivo intestinal tissue system for studying gastrointestinal processes. Eur J Pharm Sci 2019; 137:104989. [PMID: 31301485 DOI: 10.1016/j.ejps.2019.104989] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/04/2019] [Revised: 05/14/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023]
Abstract
A majority of the preclinical intestinal screening models do not properly reflect the complex physiology of the human intestinal tract, resulting in low translational value to the clinical situation. The often used cell lines such as Caco-2 or HT-29 are not well suited to investigate the different processes that predict oral bioavailability in real life, or processes involved in general gut health aspects. Therefore, highly realistic models resembling the human in vivo situation are needed; application of ex vivo intestinal tissue is an interesting and feasible alternative. After previously using porcine intestinal tissue as a predictive model for human intestinal absorption, we now have successfully applied human intestinal tissue into a newly developed InTESTine™ two-compartmental disposable device suitable for standard 6- or 24-well plate format. With this set-up we demonstrated (regional differences in) drug absorption, by using a subset of compounds with known varying Fa (fraction absorbed) values. A rank-order relationship of R2 = 0.85 could be established between the Fa and Papp of these commercially available drugs. Additionally, comparison between the InTESTine system and the established Ussing chamber technology showed a correlation of R2 = 0.94 (10 drugs) with respect to Papp values, indicating good comparison of both models. Besides absorption, intestinal wall metabolism of testosterone (CYP3A4) was determined by showing a linear formation (R2 = 0.99; up to 165 min) of the main metabolites androstenedione and 6Beta-hydroxytestosterone, indicating no loss of metabolic capacity of the intestinal tissue within the system. Enteroendocrine responses were assessed of the satiety hormones GLP-1 and PYY after stimulation with rebaudioside A and casein, resulting in significantly increased secretion to the luminal side as well as to the basolateral side. Incubation with the probiotic strain LGG showed to enhance the viability of the tissue by showing to decrease the LDH secretion compared to blank intestinal tissue. In conclusion, we show that human ex vivo intestinal tissue mounted in the higher throughput InTESTine 6- 24-transwell plate system is easy to handle and a suitable system to study diverse functional GI processes.
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Affiliation(s)
- Lianne J Stevens
- The Netherlands Organization for Applied Scientific Research (TNO), Utrechtseweg 48, 3704 HE Zeist, the Netherlands.
| | - Marola M H van Lipzig
- The Netherlands Organization for Applied Scientific Research (TNO), Utrechtseweg 48, 3704 HE Zeist, the Netherlands.
| | - Steven L A Erpelinck
- The Netherlands Organization for Applied Scientific Research (TNO), Utrechtseweg 48, 3704 HE Zeist, the Netherlands.
| | - Apollo Pronk
- Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands.
| | - Joost van Gorp
- Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands.
| | - Heleen M Wortelboer
- The Netherlands Organization for Applied Scientific Research (TNO), Utrechtseweg 48, 3704 HE Zeist, the Netherlands.
| | - Evita van de Steeg
- The Netherlands Organization for Applied Scientific Research (TNO), Utrechtseweg 48, 3704 HE Zeist, the Netherlands.
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19
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Souwer E, Hultink D, Bastiaannet E, Hamaker M, Schiphorst A, Pronk A, van der Bol J, Steup W, Dekker J, Portielje J, van der Bos F. The prognostic value of a geriatric risk score for older patients with colorectal cancer. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Souwer ETD, Hultink D, Bastiaannet E, Hamaker ME, Schiphorst A, Pronk A, van der Bol JM, Steup WH, Dekker JWT, Portielje JEA, van den Bos F. The Prognostic Value of a Geriatric Risk Score for Older Patients with Colorectal Cancer. Ann Surg Oncol 2018; 26:71-78. [PMID: 30362061 PMCID: PMC6338720 DOI: 10.1245/s10434-018-6867-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery. METHODS All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival. RESULTS Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p < 0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7; high sumscore OR 2.4; 95% CI 1.02-5.5). CONCLUSIONS This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.
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Affiliation(s)
- E T D Souwer
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.
| | - D Hultink
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - A Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - J M van der Bol
- Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - W H Steup
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F van den Bos
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA, Kelder JC, Donkervoort SC, van Geloven AA, Kruyt PM, Roos D, Kortram K, Kornmann VN, Pronk A, van der Peet DL, Crolla RM, van Ramshorst B, Bollen TL, Boerma D. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ 2018; 363:k3965. [PMID: 30297544 PMCID: PMC6174331 DOI: 10.1136/bmj.k3965] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To assess whether laparoscopic cholecystectomy is superior to percutaneous catheter drainage in high risk patients with acute calculous cholecystitis. DESIGN Multicentre, randomised controlled, superiority trial. SETTING 11 hospitals in the Netherlands, February 2011 to January 2016. PARTICIPANTS 142 high risk patients with acute calculous cholecystitis were randomly allocated to laparoscopic cholecystectomy (n=66) or to percutaneous catheter drainage (n=68). High risk was defined as an acute physiological assessment and chronic health evaluation II (APACHE II) score of 7 or more. MAIN OUTCOME MEASURES The primary endpoints were death within one year and the occurrence of major complications, defined as infectious and cardiopulmonary complications within one month, need for reintervention (surgical, radiological, or endoscopic that had to be related to acute cholecystitis) within one year, or recurrent biliary disease within one year. RESULTS The trial was concluded early after a planned interim analysis. The rate of death did not differ between the laparoscopic cholecystectomy and percutaneous catheter drainage group (3% v 9%, P=0.27), but major complications occurred in eight of 66 patients (12%) assigned to cholecystectomy and in 44 of 68 patients (65%) assigned to percutaneous drainage (risk ratio 0.19, 95% confidence interval 0.10 to 0.37; P<0.001). In the drainage group 45 patients (66%) required a reintervention compared with eight patients (12%) in the cholecystectomy group (P<0.001). Recurrent biliary disease occurred more often in the percutaneous drainage group (53% v 5%, P<0.001), and the median length of hospital stay was longer (9 days v 5 days, P<0.001). CONCLUSION Laparoscopic cholecystectomy compared with percutaneous catheter drainage reduced the rate of major complications in high risk patients with acute cholecystitis. TRIAL REGISTRATION Dutch Trial Register NTR2666.
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Affiliation(s)
- Charlotte S Loozen
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Marc Gh Besselink
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Johannes C Kelder
- Department of Clinical Epidemiology, St Antonius Hospital, Nieuwegein, Netherlands
| | | | | | - Philip M Kruyt
- Department of Surgery, Gelderse Vallei Hospital, Amsterdam, Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaff Hospital, Delft, Netherlands
| | - Kirsten Kortram
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Verena Nn Kornmann
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, Netherlands
| | | | | | - Bert van Ramshorst
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Djamila Boerma
- Department of Surgery, St Antonius Hospital, 3435CM, PO box 2500, Nieuwegein, Netherlands
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22
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Verhagen HJM, Heijnen-Snyder GJ, Vink T, Pronk A, Vroonhoven TJMVV, Eikelboom BC, Sixma JJ, Groot PGD. Tissue Factor Expression on Mesothelial Cells is Induced during in vitro Culture – Manipulation of Culture Conditions Creates Perspectives for Mesothelial Cells as a Source for Cell Seeding Procedures on Vascular Grafts. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryLining the luminal surface of prosthetic small diameter bypasses with endothelial cells (EC) will lower its thrombogenicity. Unfortunately, human EC are only scarcely available. Mesotheliai cells (MC) have antithrombotic properties in vivo and can be harvested in large numbers, from the omentum. Recent work demonstrated that the expression of tissue factor (TF) is induced in MC after isolation and culture. Different culture conditions were studied to suppress TF-expression.MC grown in pooled human serum (HS) are procoagulant (717 ± 119 pM factor Xa/min.105 cells). Replacing HS for fetal calf serum, precoating the surface with extracellular matrix and the addition of the xanthine-oxidase inhibitor allopurinol, inhibited TF expression by 90% (p <0.001). Allopurinol clearly reduced TF-mRNA levels.TF expression on cultured MC is an in-vitro effect due to culture conditions and the formation of oxygen free radicals. By reducing TF expression by 90%, we have established conditions in which MC are a good alternative for EC for seeding on synthetic grafts.
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Affiliation(s)
- Hence J M Verhagen
- The Department of Surgery, University Hospital Utrecht, The Netherlands
- The Department of Haematology, University Hospital Utrecht, The Netherlands
| | | | - Tom Vink
- The Department of Haematology, University Hospital Utrecht, The Netherlands
| | - Apollo Pronk
- The Department of Surgery, University Hospital Utrecht, The Netherlands
| | | | - Bert C Eikelboom
- The Department of Surgery, University Hospital Utrecht, The Netherlands
| | - Jan J Sixma
- The Department of Haematology, University Hospital Utrecht, The Netherlands
| | - Philip G de Groot
- The Department of Haematology, University Hospital Utrecht, The Netherlands
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23
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Roerink SF, Sasaki N, Lee-Six H, Young MD, Alexandrov LB, Behjati S, Mitchell TJ, Grossmann S, Lightfoot H, Egan DA, Pronk A, Smakman N, van Gorp J, Anderson E, Gamble SJ, Alder C, van de Wetering M, Campbell PJ, Stratton MR, Clevers H. Intra-tumour diversification in colorectal cancer at the single-cell level. Nature 2018; 556:457-462. [DOI: 10.1038/s41586-018-0024-3] [Citation(s) in RCA: 338] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/05/2018] [Indexed: 01/08/2023]
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24
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Verweij NM, Bonhof CS, Schiphorst AHW, Maas HA, Mols F, Pronk A, Hamaker ME. Quality of life in elderly patients with an ostomy - a study from the population-based PROFILES registry. Colorectal Dis 2018; 20:O92-O102. [PMID: 29243393 DOI: 10.1111/codi.13989] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 04/28/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023]
Abstract
AIM Ostomies are being placed frequently in surgically treated elderly patients with colorectal cancer (CRC). An insight into the (potential) impact of ostomies on quality of life (QoL) could be useful in patient counselling as well as in the challenging shared treatment decision-making. METHOD Patients with CRC diagnosed between 2000 and 2009 and registered in the population-based Eindhoven Cancer Registry received a QoL questionnaire (EORTC QLQ-C30) in 2010. In addition, QoL was compared with an age- and sex-matched normative population. RESULTS The study included 2299 CRC patients, of whom 494 had an ostomy. No differences were found in reported ostomy-related problems between patients aged ≤65, 66-75 and ≥76 years. Ostomy patients aged 66-75 and ≥76 years reported significantly lower physical functioning compared with those without an ostomy. In the elderly (those aged ≥76 years) ostomates reported a worse physical and social functioning compared with the normative population. All these differences were of small clinical relevance. The impact of an ostomy seems to be more prominent in younger (≤75 years old) ostomates, as they experience more functional limitations and a decrease in global health status compared with younger nonostomy patients and the normative population. CONCLUSION Although elderly (≥76 years old) patients with an ostomy report significantly more limitations in functioning compared with a normative population and elderly CRC patients without an ostomy, the clinical relevance of this finding is limited. In contrast, the impact of an ostomy is more prominent in younger patients. Thus, age itself is not a reason for withholding an ostomy.
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Affiliation(s)
- N M Verweij
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands.,Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - C S Bonhof
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - A H W Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - H A Maas
- Department of Geriatric Medicine, Elisabeth - Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - F Mols
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands Cancer Registry, Eindhoven, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands
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25
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Sier MF, Oostenbroek RJ, Dijkgraaf MGW, Veldink GJ, Bemelman WA, Pronk A, Spillenaar-Bilgen EJ, Kelder W, Hoff C, Ubbink DT. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial. Colorectal Dis 2017; 19:739-749. [PMID: 28192627 DOI: 10.1111/codi.13630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/12/2016] [Indexed: 12/13/2022]
Abstract
AIM Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost. METHOD Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care. RESULTS The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P < 0.001). In the SP more patients required extra care at home for their ostomy than in the NP (60.6% vs 33.7%, respectively; risk difference 26.9%, 95% CI: 13.5-40.4%). Stoma revision was done more often in the SP (n = 11) than in the NP (n = 2). Total costs in the SP did not differ significantly from the NP. CONCLUSION The NP did not reduce the number of stoma-related complications but did lead to improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended.
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Affiliation(s)
- M F Sier
- Department of Surgery, University Medical Centre Leiden, Leiden, The Netherlands
| | - R J Oostenbroek
- Department of Surgery, Albert Schweitzer Hospital Dordrecht, Dordrecht, The Netherlands
| | - M G W Dijkgraaf
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - G J Veldink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessen Hospital Utrecht, Utrecht, The Netherlands
| | | | - W Kelder
- Department of Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - C Hoff
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - D T Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Bakker IS, Morks AN, ten Cate Hoedemaker HO, Burgerhof JGM, Leuvenink HG, van Praagh JB, Ploeg RJ, Havenga K, Bakker IS, Morks AN, ten Cate Hoedemaker HO, Leuvenink HG, Ploeg RJ, Havenga K, van Etten B, Lange JFM, Hemmer PHJ, Burgerhof JGM, Sonneveld DJA, Tanis PJ, Wegdam JA, Jonk A, Lutke Holzik MF, Bosker RJI, Lamme B, Spillenaar Bilgen EJ, Bremers AJ, van der Mijle HC, Hoff C, de Vries DP, Logeman F, Sietses C, Lesanka Versluijs-Ossewaarde FN, Leijtens JW, Tobon Morales RE, Neijenhuis PA, Kloppenberg FW, Schasfoort R, Bleeker WA, Hess D, Rosman C, Wit F, Ton van Engelenburg KC, Pronk A, Bonsing BA, Dekker JW, Consten EC, Patijn GA, Bogdan Rajcs S, Csapó Z, Bálint A, Harsányi L, István G, Horisberger K, Bader F, Kutup A, Mariette C, Cebrián F. Randomized clinical trial of biodegradeable intraluminal sheath to prevent anastomotic leak after stapled colorectal anastomosis. Br J Surg 2017; 104:1010-1019. [DOI: 10.1002/bjs.10534] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/09/2016] [Accepted: 02/08/2017] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Anastomotic leakage is a potential major complication after colorectal surgery. The C-seal was developed to help reduce the clinical leakage rate. It is an intraluminal sheath that is stapled proximal to a colorectal anastomosis, covering it intraluminally and thus preventing intestinal leakage in case of anastomotic dehiscence. The C-seal trial was initiated to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses.
Methods
This RCT was performed in 41 hospitals in the Netherlands, Germany, France, Hungary and Spain. Patients undergoing elective surgery with a stapled colorectal anastomosis less than 15 cm from the anal verge were eligible. Included patients were randomized to the C-seal and control groups, stratified for centre, anastomotic height and intention to create a defunctioning stoma. Primary outcome was anastomotic leakage requiring invasive treatment.
Results
Between December 2011 and December 2013, 402 patients were included in the trial, 202 in the C-seal group and 200 in the control group. Anastomotic leakage was diagnosed in 31 patients (7·7 per cent), with a 10·4 per cent leak rate in the C-seal group and 5·0 per cent in the control group (P = 0·060). Male sex showed a trend towards a higher leak rate (P = 0·055). Construction of a defunctioning stoma led to a lower leakage rate, although this was not significant (P = 0·095).
Conclusion
C-seal application in stapled colorectal anastomoses does not reduce anastomotic leakage. Registration number: NTR3080 (http://www.trialregister.nl/trialreg/index.asp).
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Affiliation(s)
- I S Bakker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A N Morks
- Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - H O ten Cate Hoedemaker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J G M Burgerhof
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H G Leuvenink
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J B van Praagh
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - K Havenga
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - I S Bakker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A N Morks
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H O ten Cate Hoedemaker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H G Leuvenink
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K Havenga
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B van Etten
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J F M Lange
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P H J Hemmer
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J G M Burgerhof
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - P J Tanis
- Academic Medical Centre, Amsterdam, The Netherlands
| | - J A Wegdam
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - A Jonk
- Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | | | | | - B Lamme
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - A J Bremers
- Radboud University, Nijmegen Medical Centre, The Netherlands
| | | | - C Hoff
- Medical Centre, Leeuwarden, The Netherlands
| | - D P de Vries
- Ommelander Ziekenhuis Group, Winschoten, The Netherlands
| | - F Logeman
- Beatrix Hospital, Gorinchem, The Netherlands
| | - C Sietses
- Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | | | | | | | | | | | - D Hess
- Antonius Hospital, Sneek, The Netherlands
| | - C Rosman
- Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Wit
- Tjongerschans Hospital, Heerenveen, The Netherlands
| | | | - A Pronk
- Diakonessenhuis, Utrecht, The Netherlands
| | - B A Bonsing
- Leiden University Medical Centre, The Netherlands
| | - J W Dekker
- Reinier de Graaf Hospital, Delft, The Netherlands
| | - E C Consten
- Meander Medical Centre, Amersfoort, The Netherlands
| | | | - S Bogdan Rajcs
- Szabolcs-Szatmár-Bereg County Hospitals, Jósa András University Teaching Hospital, Nyíregyháza, Hungary
| | - Z Csapó
- Flór Ferenc Hospital of County Pest, Kistarcsa, Hungary
| | - A Bálint
- Szent Imre Hospital, Budapest, Hungary
| | - L Harsányi
- Semmelweis University, First Department of surgery, Budapest, Hungary
| | - G István
- Semmelweis University, Second Department of Surgery, Budapest, Hungary
| | - K Horisberger
- University Medical Centre Mannheim, University of Heidelberg, Germany
| | - F Bader
- Klinikum Rechts der Isar, Technische Universität München, Germany
| | - A Kutup
- University Medical Centre Hamburg–Eppendorf, Germany
| | - C Mariette
- Claude Huriez University Hospital, Lille, France
| | - F Cebrián
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Verweij NM, Hamaker ME, Zimmerman DDE, van Loon YT, van den Bos F, Pronk A, Borel Rinkes IHM, Schiphorst AHW. The impact of an ostomy on older colorectal cancer patients: a cross-sectional survey. Int J Colorectal Dis 2017; 32:89-94. [PMID: 27722790 DOI: 10.1007/s00384-016-2665-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ostomies are being placed in 35 % of patients after colorectal cancer surgery. As decision-making regarding colorectal surgery is challenging in the older patients, it is important to have insight in the potential impact due to ostomies. METHODS An internet-based survey was sent to all members with registered email addresses of the Dutch Ostomy Patient Association. RESULTS The response rate was 49 %; 932 cases were included of whom 526 were aged <70 years old ("younger respondents"), 301 were aged between 70 and 79 years old ("the elderly"), and 105 were aged ≥80 years old ("oldest old"). Ostomy-related limitations were similar in the different age groups, just as uncertainty (8-10 %) and dependency (18-22 %) due to the ostomy. A reduced quality of life was experienced least in the oldest old group (24 % vs 37 % of the elderly and 46 % of the younger respondents, p < 0.001). Over time, a decrease of limitations and impact due to the ostomy was observed. CONCLUSION Older ostomates do not experience more limitations or psychosocial impact due to the ostomy compared to their younger counterparts. Over the years, impact becomes less distinct. Treatment decision-making is challenging in the older colorectal cancer patients but ostomy placement should not be withheld based on age alone.
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Affiliation(s)
- N M Verweij
- Department of Geriatric Medicine/Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582KE, Utrecht, The Netherlands.
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - D D E Zimmerman
- Department of Surgery, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Y T van Loon
- Department of Surgery, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - F van den Bos
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - A H W Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
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Verweij NM, Schiphorst AHW, Pronk A, van den Bos F, Hamaker ME. Physical performance measures for predicting outcome in cancer patients: a systematic review. Acta Oncol 2016; 55:1386-1391. [PMID: 27718777 DOI: 10.1080/0284186x.2016.1219047] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Decision making regarding cancer treatment is challenging and there is a need for clinical parameters that can guide these decisions. As physical performance appears to be a reflection of health status, the aim of this systematic review is to assess whether physical performance tests (PPTs) are predictive of the clinical outcome and treatment tolerance in cancer patients. METHODS A literature search was conducted on 2 April 2015 in the electronic databases Medline and Embase to identify studies focusing on the association between objectively measured PPTs and outcome. No limitations in language or publication dates were applied. RESULTS The search retrieved 9680 articles, 16 publications were included involving 4187 patients with various cancer types and different treatments. Reported median or mean age varied from 58 to 78 years. Nine studies used the Timed Up & Go (TUG) test, five the Short Physical Performance Battery (SPPB) and five studies focused on gait speed. Poorer TUG, SPPB and gait speed outcome were associated with decreased survival. TUG, SPPB and gait speed were also associated with treatment-related complications. Furthermore, two studies reported an association between poorer TUG and SPPB outcome with higher rates of functional decline. CONCLUSION PPTs appear to show a significant correlation with survival and these tests could be used as a prognostic tool, particular for older adult patients. A less explicit correlation for treatment-related complications and functional decline was also found. To optimize decision making, future research should focus on developing and validating individualized treatment algorithms that incorporate PPTs in addition to cancer- and treatment-related variables.
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Affiliation(s)
- Norbert M. Verweij
- Department of geriatric medicine/department of surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Apollo Pronk
- Department of surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Marije E. Hamaker
- Department of geriatric medicine, Diakonessenhuis, Utrecht, The Netherlands
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Borstlap WAA, Tanis PJ, Koedam TWA, Marijnen CAM, Cunningham C, Dekker E, van Leerdam ME, Meijer G, van Grieken N, Nagtegaal ID, Punt CJA, Dijkgraaf MGW, De Wilt JH, Beets G, de Graaf EJ, van Geloven AAW, Gerhards MF, van Westreenen HL, van de Ven AWH, van Duijvendijk P, de Hingh IHJT, Leijtens JWA, Sietses C, Spillenaar-Bilgen EJ, Vuylsteke RJCLM, Hoff C, Burger JWA, van Grevenstein WMU, Pronk A, Bosker RJI, Prins H, Smits AB, Bruin S, Zimmerman DD, Stassen LPS, Dunker MS, Westerterp M, Coene PP, Stoot J, Bemelman WA, Tuynman JB. A multi-centred randomised trial of radical surgery versus adjuvant chemoradiotherapy after local excision for early rectal cancer. BMC Cancer 2016; 16:513. [PMID: 27439975 PMCID: PMC4955121 DOI: 10.1186/s12885-016-2557-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/13/2016] [Indexed: 12/13/2022] Open
Abstract
Background Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5–20 %) suggesting that local excision alone is not sufficient, while completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients. Methods/Study design In this multicentre randomised trial, patients with an intermediate risk T1-2 rectal cancer, that has been locally excised using an endoluminal technique, will be randomized between adjuvant chemo-radiotherapylimited to the mesorectum and standard completion total mesorectal excision (TME). To strictly monitor the risk of locoregional recurrence in the experimental arm and enable early salvage surgery, there will be additional follow up with frequent MRI and endoscopy. The primary outcome of the study is three-year local recurrence rate. Secondary outcomes are morbidity, disease free and overall survival, stoma rate, functional outcomes, health related quality of life and costs. The design is a non inferiority study with a total sample size of 302 patients. Discussion The results of the TESAR trial will potentially demonstrate that adjuvant chemoradiotherapy is an oncological safe treatment option in patients who are confronted with the difficult clinical dilemma of a radically removed intermediate risk early rectal cancer by polypectomy or transanal surgery that is conventionally treated with subsequent radical surgery. Preserving the rectum using adjuvant radiotherapy is expected to significantly improve morbidity, function and quality of life if compared to completion TME surgery. Trial registration NCT02371304, registration date: February 2015
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Affiliation(s)
- W A A Borstlap
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T W A Koedam
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - C A M Marijnen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - C Cunningham
- Department of Surgery, Oxford University Hospital, Oxford, UK
| | - E Dekker
- Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M E van Leerdam
- Department of Gastroenterology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - G Meijer
- Department of Pathology, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - N van Grieken
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - I D Nagtegaal
- Department of Pathology, RadboudUMC, Nijmegen, The Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J H De Wilt
- Department of Surgery, RadboudUMC, Nijmegen, The Netherlands
| | - G Beets
- Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - E J de Graaf
- Department of Surgery, IJselland Hospital, Capelle aan de Ijssel, The Netherlands
| | | | - M F Gerhards
- Department of surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | | | | | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - J W A Leijtens
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - C Sietses
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | - C Hoff
- Department of Surgery, Medisch Centrum Leewarden, Leeuwarden, The Netherlands
| | - J W A Burger
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - A Pronk
- Department of Surgery, Diaconessenziekehuis, Utrecht, The Netherlands
| | - R J I Bosker
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | - H Prins
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - A B Smits
- Department of Surgery, Sint. Antonius Hospital, Nieuwegein, The Netherlands
| | - S Bruin
- Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands
| | - D D Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - L P S Stassen
- Department of Surgery, MUMC, Maastricht, The Netherlands
| | - M S Dunker
- Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - M Westerterp
- Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - P P Coene
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - J Stoot
- Department of Surgery, Zuyderland Hospital, Sittard, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.
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Verweij NM, Schiphorst AHW, Maas HA, Zimmerman DDE, van den Bos F, Pronk A, Borel Rinkes IHM, Hamaker ME. Colorectal Cancer Resections in the Oldest Old Between 2011 and 2012 in The Netherlands. Ann Surg Oncol 2016; 23:1875-82. [DOI: 10.1245/s10434-015-5085-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Indexed: 12/27/2022]
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Verweij NM, Schiphorst AHW, Maas HA, Zimmerman DDE, van den Bos F, Pronk A, Borel Rinkes IHM, Hamakers ME. [Colorectal cancer surgery in the oldest Dutch patients: retrospective analysis of two national databases covering 2011 and 2012]. Ned Tijdschr Geneeskd 2016; 160:D517. [PMID: 27966402] [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: 06/06/2023]
Abstract
OBJECTIVE Adequate decision-making concerning elderly patients with colorectal cancer requires accurate information regarding the risks of treatment. We analysed the post-operative outcomes and survival following colorectal resections in the oldest old patients (≥ 85 years old). DESIGN Retrospective study. METHOD We analysed the data from 2011 and 2012 of all patients with colorectal carcinoma, stage I-III, from two national databases, namely the Dutch Surgical Colorectal Audit registry (DSCA) and the Netherlands Cancer Registry (NKR). RESULTS The study included over 1200 elderly patients. The postoperative complication rate was 41%. The frequency of cardiopulmonary complications rose rapidly with age, from 11% in those < 70 years to 38% in those aged > 85 years. The postoperative 30-day mortality rate was 10% for the oldest old patients, whereas it was 14% after three months, 24% after one year and 36% after two years. After correction for expected mortality in the general population, excess mortality for the oldest old was 12% in the first year and 3% in the second year. CONCLUSION For patients aged ≥ 85 years who undergo surgical resection for colorectal carcinoma, high rates of cardiopulmonary complications and excess mortality in the first year after surgery are observed. We propose that these data could be analysed together with information regarding individual patients' health status, to enable optimisation of future decision-making regarding potential surgical intervention in elderly patients.
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Affiliation(s)
- N M Verweij
- *Dit onderzoek werd eerder gepubliceerd in Annals of Surgical Oncology (2016;23:1875-82) met als titel 'Colorectal cancer resections in the oldest old between 2011 and 2012 in the Netherlands'. Afgedrukt met toestemming
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Walma MS, Burbach JPM, Verheijen PM, Pronk A, van Grevenstein WMU. Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study. Int J Surg 2015; 26:18-24. [PMID: 26718610 DOI: 10.1016/j.ijsu.2015.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR. METHODS Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy. RESULTS Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739). DISCUSSION AND CONCLUSION In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'.
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Affiliation(s)
- M S Walma
- Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - J P M Burbach
- Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P M Verheijen
- Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - W M U van Grevenstein
- Department of Surgery, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Nguyen AL, Pronk AA, Furnée EJB, Pronk A, Davids PHP, Smakman N. Local administration of gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a systematic review and meta-analysis of the literature. Tech Coloproctol 2015; 20:91-100. [PMID: 26546004 DOI: 10.1007/s10151-015-1381-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 08/18/2015] [Indexed: 11/29/2022]
Abstract
Surgical site infections occur in up to 24 % of patients after surgical excision of sacrococcygeal pilonidal sinus disease with primary wound closure. Local administration of antibiotics by a gentamicin collagen sponge could reduce this infection rate. The objective of this systematic review and meta-analysis was to evaluate the effect of a gentamicin collagen sponge on outcome after surgical excision in patients with sacrococcygeal pilonidal sinus disease. A structured literature search was performed in the PubMed, Embase, The Cochrane Library, and Scopus databases. Studies comparing surgical excision of sacrococcygeal pilonidal sinus disease with versus without a gentamicin collagen sponge were included. Outcome measures were surgical site infection, wound healing, and recurrence. The search strategy yielded six studies with a total of 669 patients. Three randomized controlled trials, comparing excision of pilonidal sinus disease and primary wound closure with versus without gentamicin collagen sponge, were eligible for inclusion in the meta-analysis (319 patients), demonstrating a trend towards reduced surgical site infections after administration of gentamicin collagen sponge [absolute risk reduction 20 %, 95 %-confidence interval (CI) 1-41 %, p = 0.06]. The wound healing (absolute risk reduction 22 %, 95 % CI 32-77 %, p = 0.42) and recurrence rate (absolute risk reduction 8 %, 95 % CI 7-22 %, p = 0.30) were not significantly different between both groups. Administration of a gentamicin collagen sponge after surgical excision of sacrococcygeal pilonidal sinus disease showed no significant influence on wound healing and recurrence rate, but a trend towards a reduced incidence of surgical site infections. Therefore, additional larger well-designed randomized controlled trials are required.
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Affiliation(s)
- A L Nguyen
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands
| | - A A Pronk
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands
| | - E J B Furnée
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands
| | - P H P Davids
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands
| | - N Smakman
- Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands.
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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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Schiphorst A, Ten Bokkel Huinink D, Breumelhof R, Burgmans J, Pronk A, Hamaker M. Geriatric consultation can aid in complex treatment decisions for elderly cancer patients. Eur J Cancer Care (Engl) 2015. [DOI: 10.1111/ecc.12349] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A.H.W. Schiphorst
- Department of Colorectal Surgery; Diakonessenhuis; Utrecht the Netherlands
| | | | - R. Breumelhof
- Department of Gastroenterology; Diakonessenhuis; Utrecht the Netherlands
| | - J.P.J. Burgmans
- Department of Surgical Oncology; Diakonessenhuis; Utrecht the Netherlands
| | - A. Pronk
- Department of Colorectal Surgery; Diakonessenhuis; Utrecht the Netherlands
| | - M.E Hamaker
- Department of Geriatric Medicine; Diakonessenhuis; Utrecht the Netherlands
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Schiphorst AHW, Verweij NM, Pronk A, Borel Rinkes IHM, Hamaker ME. Non-surgical complications after laparoscopic and open surgery for colorectal cancer - A systematic review of randomised controlled trials. Eur J Surg Oncol 2015; 41:1118-27. [PMID: 25980746 DOI: 10.1016/j.ejso.2015.04.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/03/2015] [Accepted: 04/14/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiac and pulmonary complications account for a large part of postoperative mortality, especially in the growing number of elderly patients. This review studies the effect of laparoscopic surgery for colorectal cancer on short term non-surgical morbidity. METHODS A literature search was conducted to identify randomised trials on laparoscopic compared to open surgery for colorectal cancer with reported cardiac or pulmonary complications. RESULTS The search retrieved 3302 articles; 18 studies were included with a total of 6153 patients. Reported median or mean age varied from 56 years to 72 years. The percentage of included patients with ASA-scores ≥ 3 ranged from 7% to 38%. Morbidity was poorly defined. Overall reported incidence of postoperative cardiac complications was low for both laparoscopic and open colorectal resection (median 2%). There was a trend towards fewer cardiac complications following laparoscopic surgery (OR 0.66, 95% CI 0.41-1.06, p = 0.08), and this effect was most marked for laparoscopic colectomy (OR 0.28, 95% CI 0.11-0.71, p = 0.007). Incidence of pulmonary complications ranged from 0 to 11% and no benefit was found for laparoscopic surgery, although a possible trend was seen in favour of laparoscopic colectomy (OR 0.78, 95% CI 0.53-1.13, p = 0.19). Overall morbidity rates varied from 11% to 69% with a median of 33%. CONCLUSION Although morbidity was poorly defined, for laparoscopic colectomies, significantly less cardiac complications occurred compared with open surgery and a trend towards less pulmonary complications was observed. Subgroup analysis from two RCTs suggests that elderly patients benefit most from a laparoscopic approach based on overall morbidity rates.
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Affiliation(s)
| | - N M Verweij
- Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A Pronk
- Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M E Hamaker
- Dept. of Geriatric Medicine, Diakonessenhuis, Utrecht and Zeist, The Netherlands
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Furnée EJB, Davids PHP, Pronk A, Smakman N. Pit excision with phenolisation of the sinus tract versus radical excision in sacrococcygeal pilonidal sinus disease: study protocol for a single centre randomized controlled trial. Trials 2015; 16:92. [PMID: 25872666 PMCID: PMC4359780 DOI: 10.1186/s13063-015-0613-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/15/2014] [Accepted: 02/18/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Excision of the pit of the sinus with phenolisation of the sinus tract and surgical excision are two treatment modalities for patients with sacrococcygeal pilonidal sinus disease. Phenolisation seems to have advantages over local sinus excision as it is performed under local anaesthesia with a relatively small surgical procedure, less postoperative pain, minor risk of surgical site infection (8.7%), and only a few days being unable to perform normal activity (mean of 2.3 days). The disadvantage may be the higher risk of recurrence (13%) and the necessity to perform a second phenolisation in a subgroup of patients. Wide surgical excision of sacrococcygeal pilonidal sinus disease has a recurrence rate of 4 to 11%. The disadvantages, however, are postoperative pain, high risk of surgical site infection, and a longer period being unable to perform normal activity (mean of 10 days). The objective of this study is to show that excision of the pit of the sinus of sacrococcygeal pilonidal sinus disease with phenolisation of the sinus tract is a successful first-time treatment modality for sacrococcygeal pilonidal sinus disease accompanied by a quicker return to normal daily activity compared to local excision of the sinus. METHODS/DESIGN Patients with sacrococcygeal pilonidal sinus disease will be randomly allocated to excision of the pit of the sinus followed by phenol applications of the sinus tract or radical surgical excision of the sinus. Patients are recruited from a single Dutch teaching, non-university hospital. The primary endpoint is loss of days of normal activity/working days. Secondary endpoints are anatomic recurrence rate, symptomatic recurrence rate, quality of life, surgical site infection, time to wound closure, symptoms related to treatment, pain, usage of pain medication and total treatment time. To demonstrate a reduction of return to normal activity from 7.5 days in the excision group to 4 days in the phenolisation group, with 80% power at 5% alpha, a total sample size of 100 is required. DISCUSSION This study is a randomised controlled trial to provide evidence that phenolisation of the sinus tract compared to radical excision reduces the total number of days unable to perform normal activity. TRIAL REGISTRATION Dutch trial register NTR4043 , registered on 24 June 2013.
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Affiliation(s)
- Edgar J B Furnée
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Paul H P Davids
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Apollo Pronk
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Niels Smakman
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
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Schiphorst AHW, Pronk A, Borel Rinkes IHM, Hamaker ME. Representation of the elderly in trials of laparoscopic surgery for colorectal cancer. Colorectal Dis 2014; 16:976-83. [PMID: 25331635 DOI: 10.1111/codi.12806] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 03/31/2014] [Accepted: 08/06/2014] [Indexed: 02/08/2023]
Abstract
AIM Most patients with colorectal cancer are elderly, but there are few data on the optimal surgical treatment for this age group and most studies are observational. We have reviewed the characteristics of randomized trials reporting laparoscopic surgery for colorectal cancer to determine the degree to which the elderly are represented. METHOD A search was conducted of the NIH clinical trial registry and the ISRCTN register for randomized trials on laparoscopic surgery for colorectal cancer. Trial characteristics and end-points were extracted from the registry website and supplemented by published results where available. RESULTS Of 52 trial protocols the majority did not state any restrictions regarding cardiac [40 (77%)] or pulmonary function [41 (79%)]. More than half [30 (58%)] had no restrictions regarding American Society of Anesthesiologists score. Twenty-three (44%) trials excluded the elderly either simply on age or by comorbidity or organ function. When an upper age limit was set, half of the studies had no restriction regarding organ function, indicating that chronological age rather than physical condition was taken as the reason for exclusion. In 45 (86%) of the trials the average age of participants was < 70 years, and no details of concurrent disease were given. CONCLUSION Participation of the elderly in trials of laparoscopic surgery for colorectal cancer is very limited. This should be remedied in future trials if adequate information on the majority of patients with colorectal cancer is to be obtained.
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Affiliation(s)
- A H W Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
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Hamaker ME, Prins MC, Schiphorst AH, van Tuyl SAC, Pronk A, van den Bos F. Long-term changes in physical capacity after colorectal cancer treatment. J Geriatr Oncol 2014; 6:153-64. [PMID: 25454769 DOI: 10.1016/j.jgo.2014.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/19/2014] [Accepted: 10/05/2014] [Indexed: 11/18/2022]
Abstract
Older patients with colorectal cancer are faced with the dilemma of choosing between the short-term risks of treatment and the long-term risks of insufficiently treated disease. In addition to treatment-related morbidity and mortality, patients may suffer from loss of physical capacity. The purpose of this review was to gather all available evidence regarding long-term changes in physical functioning and role functioning after colorectal cancer treatment, by performing a systematic Medline and Embase search. This search yielded 27 publications from 23 studies. In 16 studies addressing physical functioning after rectal cancer treatment, a median drop of 10% (range -26% to -5%) in the mean score for this item at three months. At six months, mean score was still 7% lower than baseline (range -18% to 0%) and at twelve months 5% lower (range -13% to +5%). For role functioning (i.e. ability to perform daily activities) after rectal cancer treatment, scores were -18% (range -39% to -2%), -8% (range -23% to +6%) and -5% (range -17% to +10%) respectively. Elderly patients experience the greatest and most persistent decline in self-care capacity (up to 61% at one year). This systematic review demonstrates that both physical functioning and role functioning are significantly affected by colorectal cancer surgery. Although initial losses are recovered partially during follow-up, there is a permanent loss in both aspects of physical capacity, in patients of all ages but especially in the elderly. This aspect should be included in patient counselling regarding surgery.
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Affiliation(s)
- Marije E Hamaker
- Diakonessenhuis Utrecht/Zeist/Doorn, Department of Geriatric Medicine, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - Meike C Prins
- Diakonessenhuis Utrecht/Zeist/Doorn, Department of Geriatric Medicine, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | | | | | - Apollo Pronk
- Department of Surgery, Diakonessenhuis Utrecht, The Netherlands
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Hamaker ME, Schiphorst AH, Verweij NM, Pronk A. Improved survival for older patients undergoing surgery for colorectal cancer between 2008 and 2011. Int J Colorectal Dis 2014; 29:1231-6. [PMID: 25024043 DOI: 10.1007/s00384-014-1959-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Older colorectal cancer patients have a higher risk of postoperative complications, and the impact of adverse events on survival is also significantly higher. Innovations like laparoscopic surgery which improve short-term outcome for older patients can also benefit their overall prognosis. We set out to analyse the impact of an increased utilisation of laparoscopic surgery for colorectal cancer in the Netherlands on overall survival. METHODS All patients diagnosed with stages I-III colorectal cancer in the Netherlands between 2008 and 2011 were selected from the Netherlands Cancer Registry. Changes in perioperative mortality, 3-month mortality and 1-year mortality rates were analysed using year of diagnosis as an instrumental variable. RESULTS Over 33,000 patients were included in the analyses. Data on surgical approach were not precisely known for 2008 and 2009; in 2010, 36.6 % of definitive surgical procedures were performed laparoscopically and 45.9 % in 2011. A laparoscopic approach was used less frequently in the patients aged ≥75 years (in 2011, 40.3 versus 49.2 % of younger patients; p < 0.001). Between 2008 and 2011, perioperative mortality decreased from 2.0 to 1.5 % (p = 0.02), 3-month mortality from 4.8 to 3.9 % (p = 0.01) and 1-year mortality from 9.6 to 8.3 % (p < 0.001). The absolute risk reduction was greatest for patients aged ≥75 years, reaching 2.1 % for 1-year mortality. CONCLUSION Between 2008 and 2011, the utilisation of a laparoscopic approach increases significantly, resulting in reduced mortality rates, particularly for the elderly. Therefore, a laparoscopic approach should be used whenever possible, which may allow for further improvement of outcomes.
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Affiliation(s)
- M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Professor Lorentzlaan 76, Zeist, Utrecht, 3707 HL, The Netherlands,
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Hamaker ME, Acampo T, Remijn JA, van Tuyl SA, Pronk A, van der Zaag ES, Paling HA, Smorenburg CH, de Rooij SE, van Munster BC. Diagnostic Choices and Clinical Outcomes in Octogenarians and Nonagenarians with Iron-Deficiency Anemia in the Netherlands. J Am Geriatr Soc 2013; 61:495-501. [DOI: 10.1111/jgs.12168] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marije E. Hamaker
- Department of Geriatric Medicine; Diakonessenhuis Utrecht/Zeist/Doorn; Utrecht the Netherlands
| | - Tessa Acampo
- Department of Geriatric Medicine; Gelre Hospitals; Apeldoorn the Netherlands
| | - Jasper A. Remijn
- Department of Clinical Chemistry and Hematology; Gelre Hospitals; Apeldoorn the Netherlands
| | | | - Apollo Pronk
- Department of Surgery; Diakonessenhuis; Utrecht The Netherlands
| | | | - Heleen A. Paling
- Department of Geriatric Medicine; Gelre Hospitals; Apeldoorn the Netherlands
| | | | - Sophia E. de Rooij
- Department of Internal Medicine; Academic Medical Center; Amsterdam the Netherlands
| | - Barbara C. van Munster
- Department of Geriatric Medicine; Gelre Hospitals; Apeldoorn the Netherlands
- Department of Internal Medicine; Academic Medical Center; Amsterdam the Netherlands
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Deziel NC, Nuckols JR, Colt JS, De Roos AJ, Pronk A, Gourley C, Severson RK, Cozen W, Cerhan JR, Hartge P, Ward MH. Determinants of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans in house dust samples from four areas of the United States. Sci Total Environ 2012; 433:516-22. [PMID: 22832089 PMCID: PMC3431600 DOI: 10.1016/j.scitotenv.2012.06.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/25/2012] [Accepted: 06/27/2012] [Indexed: 11/06/2023]
Abstract
Determinants of levels of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/F) in dust in U.S. homes are not well characterized. We conducted a pilot study to evaluate the relationship between concentrations of PCDD/F in house dust and residential proximity to known sources, including industrial facilities and traffic. Samples from vacuum bag dust from homes of 40 residents of Detroit, Los Angeles, Seattle, or Iowa who participated in a population-based case-control study of non-Hodgkin lymphoma conducted in 1998-2000 were analyzed using high resolution gas chromatography/high resolution mass spectrometry for 7 PCDD and 10 PCDF congeners considered toxic by the U.S. Environmental Protection Agency (EPA). Locations of 10 types of PCDD/F-emitting facilities were obtained from the EPA; however only 4 types were located near study homes (non-hazardous waste cement kilns, coal-fired power plants, sewage sludge incinerators, and medical waste incinerators). Relationships between concentrations of each PCDD/F and proximity to industrial facilities, freight routes, and major roads were evaluated using separate multivariate regression models for each congener. The median (inter-quartile range [IQR]) toxic equivalence (TEQ) concentration of these congeners in the house dust was 20.3 pg/g (IQR=14.3, 32.7). Homes within 3 or 5 km of a cement kiln had 2 to 9-fold higher concentrations of 5 PCDD and 5 PCDF (p<0.1 in each model). Proximity to freight routes and major roads was associated with elevated concentrations of 1 PCDD and 8 PCDF. Higher concentrations of certain PCDD/F in homes near cement kilns, freight routes, and major roads suggest that these outdoor sources are contributing to indoor environmental exposures. Further study of the contribution of these sources and other facility types to total PCDD/F exposure in a larger number of homes is warranted.
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Affiliation(s)
- N C Deziel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Rockville, MD, United States.
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Abstract
INTRODUCTION An accelerated multi-modal rehabilitation programme may improve the recuperation and reduce the complication rate in patients undergoing colorectal surgery. The aim of this study was to see whether fast-track recovery is feasible in various patient groups. PATIENTS AND METHODS Data on all patients operated for intestinal pathology from July 2006-April 2008 were prospectively collected for this prospective study. All included patients entered a multi-modal rehabilitation programme. Peri- and postoperative complications and readmissions, pathology reports and operation characteristics were recorded prospectively. RESULTS Three hundred and forty-eight patients underwent colorectal surgery. No difference in readmission rate was found between various patient groups. The only significant differences after multivariate regression analysis were in re-operation rate and length of stay in favour of the elective surgery group. CONCLUSIONS Fast-track modalities can be introduced with a low complication rate in all patient groups. Length of stay in elderly patients averages 10 days, implying that this group cannot be considered as "fast track", although the same protocol can also be applied in this group. Better organization of the aftercare might however considerably change the length of stay of elderly patients, since postoperative complications do not differ between old and young patients.
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Affiliation(s)
- Paul M Verheijen
- Department of General Surgery, Meander Medisch Centrum, Postbus 1502, 3500 BM, Amersfoort, The Netherlands.
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Post IL, Verheijen PM, Pronk A, Siccama I, Houweling PL. Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis 2012; 27:765-72. [PMID: 22297862 PMCID: PMC3359451 DOI: 10.1007/s00384-011-1381-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Anastomotic leakage is a serious complication after colorectal surgery. Pre- and intraoperative factors may contribute to failure of colorectal anastomosis. In this study we have tried to determine risk factors for anastomotic leakage, with special emphasis on intraoperative blood pressure changes. METHODS During a 24-month period, patients receiving a colorectal anastomosis were prospectively evaluated. For each patient preoperative characteristics, intraoperative adverse events and surgical outcome data were collected. Blood pressure changes were calculated as a relative decrease (>25% and >40%) from preoperative baseline values. RESULTS During the study period, 285 patients underwent colorectal surgery with an anastomosis. Fifteen patients developed an anastomotic leakage (5.3%). All patients who developed a leakage had a left-sided procedure (P < 0.001). When blood loss was more than 250 mL (P = 0.003) or an intraoperative adverse event occurred (P = 0.050), the risk for developing an anastomotic leakage was significantly increased. A preoperative high diastolic blood pressure of ≥90 mmHg (P = 0.008) and severe intraoperative hypotension [>40% decrease in diastolic blood pressure (P = 0.049)] were identified as univariate risk factors for anastomotic leakage. CONCLUSIONS The development of an anastomotic leakage after colorectal surgery is related to surgical, patient and anaesthetic risk factors. A high preoperative diastolic blood pressure and profound intraoperative hypotension combined with complex surgery, marked by a blood loss of ≥250 mL and the occurrence of intraoperative adverse events, is associated with an increased risk of developing anastomotic leakage.
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Affiliation(s)
- I L Post
- Department of Anesthesiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Schiphorst AHW, Pronk A. [A woman with a perianal skin disease]. Ned Tijdschr Geneeskd 2012; 156:A4093. [PMID: 23009819] [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: 06/01/2023]
Abstract
A 69-year-old woman presented with a large pigmented perianal ulcer and inguinal lymphomas. The ulcer was fixed to the rectovaginal septum and the anal sphincter. Histological examination of a perianal skin biopsy revealed an anorectal melanoma. Prognosis is poor in these patients, median survival being less than 20 months.
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Bökkerink GMJ, de Graaf EJR, Punt CJA, Nagtegaal ID, Rütten H, Nuyttens JJME, van Meerten E, Doornebosch PG, Tanis PJ, Derksen EJ, Dwarkasing RS, Marijnen CAM, Cats A, Tollenaar RAEM, de Hingh IHJT, Rutten HJT, van der Schelling GP, Ten Tije AJ, Leijtens JWA, Lammering G, Beets GL, Aufenacker TJ, Pronk A, Manusama ER, Hoff C, Bremers AJA, Verhoef C, de Wilt JHW. The CARTS study: Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery. BMC Surg 2011; 11:34. [PMID: 22171697 PMCID: PMC3295682 DOI: 10.1186/1471-2482-11-34] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [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: 06/25/2011] [Accepted: 12/15/2011] [Indexed: 12/15/2022] Open
Abstract
Background The CARTS study is a multicenter feasibility study, investigating the role of rectum saving surgery for distal rectal cancer. Methods/Design Patients with a clinical T1-3 N0 M0 rectal adenocarcinoma below 10 cm from the anal verge will receive neoadjuvant chemoradiation therapy (25 fractions of 2 Gy with concurrent capecitabine). Transanal Endoscopic Microsurgery (TEM) will be performed 8 - 10 weeks after the end of the preoperative treatment depending on the clinical response. Primary objective is to determine the number of patients with a (near) complete pathological response after chemoradiation therapy and TEM. Secondary objectives are the local recurrence rate and quality of life after this combined therapeutic modality. A three-step analysis will be performed after 20, 33 and 55 patients to ensure the feasibility of this treatment protocol. Discussion The CARTS-study is one of the first prospective multicentre trials to investigate the role of a rectum saving treatment modality using chemoradiation therapy and local excision. The CARTS study is registered at clinicaltrials.gov (NCT01273051)
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Affiliation(s)
- Guus M J Bökkerink
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Sato T, Stange DE, Ferrante M, Vries RGJ, Van Es JH, Van den Brink S, Van Houdt WJ, Pronk A, Van Gorp J, Siersema PD, Clevers H. Long-term expansion of epithelial organoids from human colon, adenoma, adenocarcinoma, and Barrett's epithelium. Gastroenterology 2011; 141:1762-72. [PMID: 21889923 DOI: 10.1053/j.gastro.2011.07.050] [Citation(s) in RCA: 2368] [Impact Index Per Article: 182.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/01/2011] [Accepted: 07/27/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS We previously established long-term culture conditions under which single crypts or stem cells derived from mouse small intestine expand over long periods. The expanding crypts undergo multiple crypt fission events, simultaneously generating villus-like epithelial domains that contain all differentiated types of cells. We have adapted the culture conditions to grow similar epithelial organoids from mouse colon and human small intestine and colon. METHODS Based on the mouse small intestinal culture system, we optimized the mouse and human colon culture systems. RESULTS Addition of Wnt3A to the combination of growth factors applied to mouse colon crypts allowed them to expand indefinitely. Addition of nicotinamide, along with a small molecule inhibitor of Alk and an inhibitor of p38, were required for long-term culture of human small intestine and colon tissues. The culture system also allowed growth of mouse Apc-deficient adenomas, human colorectal cancer cells, and human metaplastic epithelia from regions of Barrett's esophagus. CONCLUSIONS We developed a technology that can be used to study infected, inflammatory, or neoplastic tissues from the human gastrointestinal tract. These tools might have applications in regenerative biology through ex vivo expansion of the intestinal epithelia. Studies of these cultures indicate that there is no inherent restriction in the replicative potential of adult stem cells (or a Hayflick limit) ex vivo.
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Affiliation(s)
- Toshiro Sato
- Hubrecht Institute, KNAW and University Medical Centre Utrecht, Utrecht, The Netherlands.
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Van Houdt WJ, Emmink BL, Pham TV, Piersma SR, Verheem A, Vries RG, Fratantoni SA, Pronk A, Clevers H, Borel Rinkes IHM, Jimenez CR, Kranenburg O. Comparative proteomics of colon cancer stem cells and differentiated tumor cells identifies BIRC6 as a potential therapeutic target. Mol Cell Proteomics 2011; 10:M111.011353. [PMID: 21788403 DOI: 10.1074/mcp.m111.011353] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Patients with liver metastases from colon carcinoma show highly variable responses to chemotherapy and tumor recurrence is frequently observed. Therapy-resistant cancer stem cells have been implicated in drug resistance and tumor recurrence. However, the factors determining therapy resistance and tumor recurrence are poorly understood. The aim of this study was to gain insight into these mechanisms by comparing the proteomes of patient-derived cancer stem cell cultures and their differentiated isogenic offspring. We established colonosphere cultures derived from resection specimens of liver metastases in patients with colon cancer. These colonospheres, enriched for colon cancer stem cells, were used to establish isogenic cultures of stably differentiated nontumorigenic progeny. Proteomics based on one-dimensional gel electrophoresis coupled to nano liquid chromatography tandem MS was used to identify proteome differences between three of these paired cultures. The resulting data were analyzed using Ingenuity Pathway Software. Out of a total data set of 3048 identified proteins, 32 proteins were at least twofold up-regulated in the colon cancer stem cells when compared with the differentiated cells. Pathway analysis showed that "cell death " regulation is strikingly different between the two cell types. Interestingly, one of the top-up-regulated proteins was BIRC6, which belongs to the class of Inhibitor of Apoptosis Proteins. Knockdown of BIRC6 sensitized colon cancer stem cells against the chemotherapeutic drugs oxaliplatin and cisplatin. This study reveals that differentiation of colon cancer stem cells is accompanied by altered regulation of cell death pathways. We identified BIRC6 as an important mediator of cancer stem cell resistance against cisplatin and oxaliplatin. Targeting BIRC6, or other Inhibitors of Apoptosis Proteins, may help eradicating colon cancer stem cells.
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Affiliation(s)
- W J Van Houdt
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands
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Van Houdt WJ, Emmink BL, Pham TV, Piersma SR, Verheem A, Vries RG, Fratantoni SA, Pronk A, Clevers H, Borel Rinkes IHM, Jimenez CR, Kranenburg O. Comparative proteomics of colon cancer stem cells and differentiated tumor cells identifies BIRC6 as a potential therapeutic target. Mol Cell Proteomics 2011. [PMID: 21788403 DOI: 10.1074/mcp.m111.011353-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Patients with liver metastases from colon carcinoma show highly variable responses to chemotherapy and tumor recurrence is frequently observed. Therapy-resistant cancer stem cells have been implicated in drug resistance and tumor recurrence. However, the factors determining therapy resistance and tumor recurrence are poorly understood. The aim of this study was to gain insight into these mechanisms by comparing the proteomes of patient-derived cancer stem cell cultures and their differentiated isogenic offspring. We established colonosphere cultures derived from resection specimens of liver metastases in patients with colon cancer. These colonospheres, enriched for colon cancer stem cells, were used to establish isogenic cultures of stably differentiated nontumorigenic progeny. Proteomics based on one-dimensional gel electrophoresis coupled to nano liquid chromatography tandem MS was used to identify proteome differences between three of these paired cultures. The resulting data were analyzed using Ingenuity Pathway Software. Out of a total data set of 3048 identified proteins, 32 proteins were at least twofold up-regulated in the colon cancer stem cells when compared with the differentiated cells. Pathway analysis showed that "cell death " regulation is strikingly different between the two cell types. Interestingly, one of the top-up-regulated proteins was BIRC6, which belongs to the class of Inhibitor of Apoptosis Proteins. Knockdown of BIRC6 sensitized colon cancer stem cells against the chemotherapeutic drugs oxaliplatin and cisplatin. This study reveals that differentiation of colon cancer stem cells is accompanied by altered regulation of cell death pathways. We identified BIRC6 as an important mediator of cancer stem cell resistance against cisplatin and oxaliplatin. Targeting BIRC6, or other Inhibitors of Apoptosis Proteins, may help eradicating colon cancer stem cells.
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Affiliation(s)
- W J Van Houdt
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands
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Zimmerman DDE, Pronk A. Endorectal advancement flap repair in patients with Crohn's disease: a word of caution! Dis Colon Rectum 2011; 54:648; author reply 648. [PMID: 21471770 DOI: 10.1007/dcr.0b013e31820ce829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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