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Ketel MHM, Klarenbeek BR, Abma I, Belgers EHJ, Coene PPLO, Dekker JWT, van Duijvendijk P, Emous M, Gisbertz SS, Haveman JW, Heisterkamp J, Nieuwenhuijzen GAP, Ruurda JP, van Sandick JW, van der Sluis PC, van Det MJ, van Esser S, Law S, de Steur WO, Sosef MN, Wijnhoven B, Hannink G, Rosman C, van Workum F. Nationwide Association of Surgical Performance of Minimally Invasive Esophagectomy With Patient Outcomes. JAMA Netw Open 2024; 7:e246556. [PMID: 38639938 PMCID: PMC11031683 DOI: 10.1001/jamanetworkopen.2024.6556] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/31/2024] [Indexed: 04/20/2024] Open
Abstract
Importance Suboptimal surgical performance is hypothesized to be associated with less favorable patient outcomes in minimally invasive esophagectomy (MIE). Establishing this association may lead to programs that promote better surgical performance of MIE and improve patient outcomes. Objective To investigate associations between surgical performance and postoperative outcomes after MIE. Design, Setting, and Participants In this nationwide cohort study of 15 Dutch hospitals that perform more than 20 MIEs per year, 7 masked expert MIE surgeons assessed surgical performance using videos and a previously developed and validated competency assessment tool (CAT). Each hospital submitted 2 representative videos of MIEs performed between November 4, 2021, and September 13, 2022. Patients registered in the Dutch Upper Gastrointestinal Cancer Audit between January 1, 2020, and December 31, 2021, were included to examine patient outcomes. Exposure Hospitals were divided into quartiles based on their MIE-CAT performance score. Outcomes were compared between highest (top 25%) and lowest (bottom 25%) performing quartiles. Transthoracic MIE with gastric tube reconstruction. Main Outcome and Measure The primary outcome was severe postoperative complications (Clavien-Dindo ≥3) within 30 days after surgery. Multilevel logistic regression, with clustering of patients within hospitals, was used to analyze associations between performance and outcomes. Results In total, 30 videos and 970 patients (mean [SD] age, 66.6 [9.1] years; 719 men [74.1%]) were included. The mean (SD) MIE-CAT score was 113.6 (5.5) in the highest performance quartile vs 94.1 (5.9) in the lowest. Severe postoperative complications occurred in 18.7% (41 of 219) of patients in the highest performance quartile vs 39.2% (40 of 102) in the lowest (risk ratio [RR], 0.50; 95% CI, 0.24-0.99). The highest vs the lowest performance quartile showed lower rates of conversions (1.8% vs 8.9%; RR, 0.21; 95% CI, 0.21-0.21), intraoperative complications (2.7% vs 7.8%; RR, 0.21; 95% CI, 0.04-0.94), and overall postoperative complications (46.1% vs 65.7%; RR, 0.54; 95% CI, 0.24-0.96). The R0 resection rate (96.8% vs 94.2%; RR, 1.03; 95% CI, 0.97-1.05) and lymph node yield (mean [SD], 38.9 [14.7] vs 26.2 [9.0]; RR, 3.20; 95% CI, 0.27-3.21) increased with oncologic-specific performance (eg, hiatus dissection, lymph node dissection). In addition, a high anastomotic phase score was associated with a lower anastomotic leakage rate (4.6% vs 17.7%; RR, 0.14; 95% CI, 0.06-0.31). Conclusions and Relevance These findings suggest that better surgical performance is associated with fewer perioperative complications for patients with esophageal cancer on a national level. If surgical performance of MIE can be improved with MIE-CAT implementation, substantially better patient outcomes may be achievable.
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Affiliation(s)
- Mirte H. M. Ketel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Inger Abma
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | | | - Marloes Emous
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Twee-Steden Hospital, Tilburg, the Netherlands
| | | | - Jelle P. Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Pieter C. van der Sluis
- Department of Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marc J. van Det
- Department of Surgery, Hospital Group Twente (ZGT), Almelo, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | - Simon Law
- Department of Surgery, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, China
| | - Wobbe O. de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bas Wijnhoven
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
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2
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Geerts JFM, van der Zijden CJ, van der Sluis PC, Spaander MCW, Nieuwenhuijzen GAP, Rosman C, van Laarhoven HWM, Verhoeven RHA, Wijnhoven BPL, Lagarde SM, Mostert B. Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT. Cancers (Basel) 2024; 16:1291. [PMID: 38610969 PMCID: PMC11011191 DOI: 10.3390/cancers16071291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The FLOT4-AIO trial (2019) showed improved survival with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) compared to anthracyclin triplets in gastric cancer treatment. It is unclear whether these results extend to real-world scenarios in the Netherlands. This study aimed to compare outcomes of perioperative FLOT to anthracyclin triplets in a real-world Dutch gastric cancer population. Methods: Patients diagnosed with resectable (cT2-4a/cTxN0-3/NxM0) gastric or gastro-esophageal junction carcinoma between 2015-2021 who received neoadjuvant FLOT or anthracyclin triplets were selected from the Netherlands Cancer Registry. The primary outcome was overall survival (OS), analyzed through multivariable Cox regression. Secondary outcomes included pathological complete response (pCR), neoadjuvant chemotherapy cycle completion, surgical resection rates, and adjuvant therapy. Results: Adjusted OS showed no significant survival benefit (HR = 0.88, 95% CI 0.77-1.01, p = 0.07), even though the median OS was numerically improved by 8 months with FLOT compared to anthracyclin triplets (48.1 vs. 39.9 months, p = 0.16). FLOT patients were more likely to undergo diagnostic staging laparoscopies (74.2% vs. 44.1%, p < 0.001), had higher rates of completing neoadjuvant chemotherapy (OR = 1.35, 95% CI 1.09-1.68, p = 0.007), receiving adjuvant therapy (OR = 1.34, 95% CI 1.08-1.66, p = 0.08), and achieving pCR (OR = 1.52, 95% CI 1.05-2.20, p = 0.03). No significant differences were observed in (radical) resection rates. Conclusion(s): Real-world data showed no significant OS improvement for FLOT-treated patients compared to anthracyclin triplets, despite more staging laparoscopies. However, FLOT patients demonstrated higher rates of neoadjuvant therapy completion, proceeding to adjuvant therapy, and increased pCR rates. Therefore, we recommend the continued use of neoadjuvant FLOT therapy in the current clinical setting.
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Affiliation(s)
- Julie F M Geerts
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
- Department of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | | | | | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1105 AZ Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1105 AZ Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 LC Utrecht, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Bianca Mostert
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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3
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Ketel MHM, Klarenbeek BR, Eddahchouri Y, Cheong E, Cuesta MA, van Daele E, Ferri LE, Gisbertz SS, Gutschow CA, Hubka M, Hölscher AH, Law S, Luyer MDP, Merritt RE, Morse CR, Mueller CL, Nieuwenhuijzen GAP, Nilsson M, Pattyn P, Shen Y, van den Wildenberg FJH, Abma IL, Rosman C, van Workum F. A Video-Based Procedure-Specific Competency Assessment Tool for Minimally Invasive Esophagectomy. JAMA Surg 2024; 159:297-305. [PMID: 38150247 PMCID: PMC10753443 DOI: 10.1001/jamasurg.2023.6522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
Importance Minimally invasive esophagectomy (MIE) is a complex procedure with substantial learning curves. In other complex minimally invasive procedures, suboptimal surgical performance has convincingly been associated with less favorable patient outcomes as assessed by peer review of the surgical procedure. Objective To develop and validate a procedure-specific competency assessment tool (CAT) for MIE. Design, Setting, and Participants In this international quality improvement study, a procedure-specific MIE-CAT was developed and validated. The MIE-CAT contains 8 procedural phases, and 4 quality components per phase are scored with a Likert scale ranging from 1 to 4. For evaluation of the MIE-CAT, intraoperative MIE videos performed by a single surgical team in the Esophageal Center East Netherlands were peer reviewed by 18 independent international MIE experts (with more than 120 MIEs performed). Each video was assessed by 2 or 3 blinded experts to evaluate feasibility, content validity, reliability, and construct validity. MIE-CAT version 2 was composed with refined content aimed at improving interrater reliability. A total of 32 full-length MIE videos from patients who underwent MIE between 2011 and 2020 were analyzed. Data were analyzed from January 2021 to January 2023. Exposure Performance assessment of transthoracic MIE with an intrathoracic anastomosis. Main Outcomes and Measures Feasibility, content validity, interrater and intrarater reliability, and construct validity, including correlations with both experience of the surgical team and clinical parameters, of the developed MIE-CAT. Results Experts found the MIE-CAT easy to understand and easy to use to grade surgical performance. The MIE-CAT demonstrated good intrarater reliability (range of intraclass correlation coefficients [ICCs], 0.807 [95% CI, 0.656 to 0.892] for quality component score to 0.898 [95% CI, 0.846 to 0.932] for phase score). Interrater reliability was moderate (range of ICCs, 0.536 [95% CI, -0.220 to 0.994] for total MIE-CAT score to 0.705 [95% CI, 0.473 to 0.846] for quality component score), and most discrepancies originated in the lymphadenectomy phases. Hypothesis testing for construct validity showed more than 75% of hypotheses correct: MIE-CAT performance scores correlated with experience of the surgical team (r = 0.288 to 0.622), blood loss (r = -0.034 to -0.545), operative time (r = -0.309 to -0.611), intraoperative complications (r = -0.052 to -0.319), and severe postoperative complications (r = -0.207 to -0.395). MIE-CAT version 2 increased usability. Interrater reliability improved but remained moderate (range of ICCs, 0.666 to 0.743), and most discrepancies between raters remained in the lymphadenectomy phases. Conclusions and Relevance The MIE-CAT was developed and its feasibility, content validity, reliability, and construct validity were demonstrated. By providing insight into surgical performance of MIE, the MIE-CAT might be used for clinical, training, and research purposes.
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Affiliation(s)
- Mirte H. M. Ketel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Yassin Eddahchouri
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Edward Cheong
- The PanAsia Surgery Group, Mount Elizabeth Hospital, Singapore
| | - Miguel A. Cuesta
- Department of Surgery, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - Elke van Daele
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lorenzo E. Ferri
- Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Suzanne S. Gisbertz
- Amsterdam UMC location University of Amsterdam, Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Christian A. Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Michal Hubka
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Arnulf H. Hölscher
- Department for General, Visceral and Trauma Surgery, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany
| | - Simon Law
- Department of Surgery, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Misha D. P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Robert E. Merritt
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | | | - Carmen L. Mueller
- Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | | | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Inger L. Abma
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
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4
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Henckens SPG, Liu D, Gisbertz SS, Kalff MC, Anderegg MCJ, Crull D, Daams F, van Dalsen AD, Dekker JWT, van Det MJ, van Duijvendijk P, Eshuis WJ, Groenendijk RPR, Haveman JW, van Hillegersberg R, Luyer MDP, Olthof PB, Pierie JPEN, Plat VD, Rosman C, Ruurda JP, van Sandick JW, Sosef MN, Voeten DM, Vijgen GHEJ, Bijlsma MF, Meijer SL, Hulshof MCCM, Oyarce C, Lagarde SM, van Laarhoven HWM, van Berge Henegouwen MI. Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma. Br J Surg 2024; 111:znae034. [PMID: 38387083 PMCID: PMC10883709 DOI: 10.1093/bjs/znae034] [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: 09/20/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma. METHODS This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesophageal or gastro-oesophageal junctional adenocarcinoma between 2007 and 2016. The primary endpoint was the association of Mandard score and TRG-ypN score with recurrence patterns (rate, location, and time to recurrence). The secondary endpoint was overall survival. RESULTS Among 2746 inclusions, recurrence rates increased with higher Mandard scores (TRG1 30.6%, TRG2 44.9%, TRG3 52.9%, TRG4 61.4%, TRG5 58.2%; P < 0.001). Among patients with recurrent disease, the distribution (locoregional versus distant) was the same for the different TRG groups. Patients with TRG1 developed more brain recurrences (17.7 versus 9.8%; P = 0.001) and had a longer mean overall survival (44 versus 35 months; P < 0.001) than those with TRG>1. The TRG>1-ypN+ group had the highest recurrence rate (64.9%) and worst overall survival (mean 27 months). Compared with the TRG>1-ypN0 group, patients with TRG1-ypN+ had a higher risk of recurrence (51.9 versus 39.6%; P < 0.001) and worse mean overall survival (33 versus 41 months; P < 0.001). CONCLUSION Improved tumour response to neoadjuvant therapy was associated with lower recurrence rates and higher overall survival rates. Among patients with recurrent disease, TRG1 was associated with a higher incidence of brain recurrence than TRG>1. Residual nodal disease influenced prognosis more negatively than residual disease at the primary tumour site.
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Affiliation(s)
- Sofie P G Henckens
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Dajia Liu
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Centre for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marianne C Kalff
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Maarten C J Anderegg
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - David Crull
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | | | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | | | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Pim B Olthof
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | | | - Victor D Plat
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | | | - Daan M Voeten
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Guy H E J Vijgen
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Maarten F Bijlsma
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Centre for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Oncode Institute, Amsterdam, the Netherlands
| | - Sybren L Meijer
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Pathology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Radiotherapy, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Cesar Oyarce
- Centre for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Oncode Institute, Amsterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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5
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Leijte E, De Blaauw I, Rosman C, Botden SMBI. Transferability of the robot assisted and laparoscopic suturing learning curves. J Robot Surg 2024; 18:56. [PMID: 38280121 PMCID: PMC10821960 DOI: 10.1007/s11701-023-01753-1] [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: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 01/29/2024]
Abstract
Robot assisted surgery (RAS) is increasingly used, and besides conventional minimally invasive surgery (cMIS) surgeons are challenged to learn an increased array of skills. This study aimed to assess the influence of both learning curves on each other. A prospective randomized crossover study was performed. Participants without cMIS or RAS experience (Groups 1 and 2), and cMIS experienced, (Group 3) were recruited. Three suturing tasks (intracorporal suturing, tilted plane and anastomosis needle transfer) were performed on the EoSim cMIS simulator or RobotiX RAS simulator up to twenty repetitions. Subsequently, Groups 1 and 2 performed the tasks on the other modality. Outcomes were simulator parameters, validated composite and pass/fail scores. In total forty-three participants were recruited. Overall RAS suturing was better in Group 1 (cMIS followed by RAS tasks) and 3 (RAS tasks) versus Group 2 (RAS followed by cMIS tasks) for time (163 s and 157 s versus 193 s p = 0.004, p = 0.001) and composite scores (92/100 and 91/100 versus 89/100 p = 0.008, p = 0.020). The cMIS suturing was better for Group 2 versus 1 (time 287 s versus 349 s p = 0.005, composite score 96/100 versus 94/100 p = 0.002). Significant differences from the RAS suturing pass/fail were reached earlier by Group 3, followed by Groups 1 and 2 (repetition six, nine and twelve). In cMIS suturing Group 2 reached significant differences from the pass/fail earlier than Group 1 (repetition four versus six). Transferability of skills was shown for cMIS and RAS, indicating that suturing experience on cMIS or RAS is beneficial in learning either approach.
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Affiliation(s)
- E Leijte
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands.
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - I De Blaauw
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
| | - S M B I Botden
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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6
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van Erning FN, Nieuwenhuijzen GAP, van Laarhoven HWM, Rosman C, Gisbertz SS, Heisterkamp J, Lagarde SM, Slingerland M, van den Berg JW, Kouwenhoven EA, Verhoeven RHA, Vissers PAJ. ASO Visual Abstract: Gastrointestinal Symptoms After Resection of Esophagogastric Cancer: A Longitudinal Study on Their Incidence and Impact on Patient-Reported Outcomes. Ann Surg Oncol 2023; 30:8602-8603. [PMID: 37624517 DOI: 10.1245/s10434-023-14102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Felice N van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | | | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem van den Berg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Hermus M, van der Wilk BJ, Dekker JWT, Nieuwenhuijzen GAP, Rosman C, Timmermans L, Wijnhoven BPL, van der Zijden CJ, van Lanschot JJB, Busschbach JJ, Lagarde SM, Kranenburg LW. Developing an e-learning tool for clinicians to take patient preferences into account in esophageal cancer treatment decision-making. Health Sci Rep 2023; 6:e1725. [PMID: 38111742 PMCID: PMC10726811 DOI: 10.1002/hsr2.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/24/2023] [Accepted: 11/02/2023] [Indexed: 12/20/2023] Open
Affiliation(s)
- Merel Hermus
- Section of Medical Psychology and Psychotherapy, Department of PsychiatryErasmus University Medical CenterRotterdamThe Netherlands
| | - Berend J. van der Wilk
- Department of Surgery, Erasmus Cancer InstituteErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Camiel Rosman
- Department of SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Bas P. L. Wijnhoven
- Department of Surgery, Erasmus Cancer InstituteErasmus University Medical CenterRotterdamThe Netherlands
| | - Charlène J. van der Zijden
- Department of Surgery, Erasmus Cancer InstituteErasmus University Medical CenterRotterdamThe Netherlands
| | - J. Jan B. van Lanschot
- Department of Surgery, Erasmus Cancer InstituteErasmus University Medical CenterRotterdamThe Netherlands
| | - Jan J. Busschbach
- Section of Medical Psychology and Psychotherapy, Department of PsychiatryErasmus University Medical CenterRotterdamThe Netherlands
| | - Sjoerd M. Lagarde
- Department of Surgery, Erasmus Cancer InstituteErasmus University Medical CenterRotterdamThe Netherlands
| | - Leonieke W. Kranenburg
- Section of Medical Psychology and Psychotherapy, Department of PsychiatryErasmus University Medical CenterRotterdamThe Netherlands
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8
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van Erning FN, Nieuwenhuijzen GAP, van Laarhoven HWM, Rosman C, Gisbertz SS, Heisterkamp J, Lagarde SM, Slingerland M, van den Berg JW, Kouwenhoven EA, Verhoeven RHA, Vissers PAJ. Gastrointestinal Symptoms After Resection of Esophagogastric Cancer: A Longitudinal Study on Their Incidence and Impact on Patient-Reported Outcomes. Ann Surg Oncol 2023; 30:8203-8215. [PMID: 37523120 DOI: 10.1245/s10434-023-13952-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND This study assesses the incidence of gastrointestinal symptoms in the first year after resection of esophageal or gastric cancer and its association with health-related quality of life (HRQoL), functioning, work productivity, and daily activities. PATIENTS AND METHODS Patients diagnosed with esophageal or gastric cancer between 2015 and 2021, who underwent a resection, and completed ≥ 2 questionnaires from the time intervals prior to resection and 0-3, 3-6, 6-9, and 9-12 months after resection were included. Multivariable generalized linear mixed models were used to assess changes in gastrointestinal symptoms over time and the impact of the number of gastrointestinal symptoms on HRQoL, functioning, work productivity, and daily activities for patients who underwent an esophagectomy or gastrectomy separately. RESULTS The study population consisted of 961 (78.8%) and 259 (21.2%) patients who underwent an esophagectomy and gastrectomy, respectively. For both groups, the majority of gastrointestinal symptoms changed significantly over time. Most clinically relevant differences were observed 0-3 after resection compared with prior to resection and included increased diarrhea, appetite loss, and eating restrictions, and specifically after esophagectomy dry mouth, trouble with coughing, and trouble talking. At 9-12 after resection one or more severe gastrointestinal symptoms were reported by 38.9% after esophagectomy and 33.7% after gastrectomy. A higher number of gastrointestinal symptoms was associated with poorer functioning, lower HRQoL, higher impairment in daily activities, and lower work productivity. CONCLUSIONS This study shows that gastrointestinal symptoms are frequently observed and burdensome after esophagectomy or gastrectomy, highlighting the importance to address these sequelae for high quality survivorship.
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Affiliation(s)
- Felice N van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | | | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem van den Berg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, de Wilt JHW. Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients. Br J Surg 2023; 110:1863-1876. [PMID: 37819790 PMCID: PMC10638542 DOI: 10.1093/bjs/znad311] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. METHODS Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1). RESULTS Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). CONCLUSION Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
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Affiliation(s)
- Nynke G Greijdanus
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kiedo Wienholts
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kevin Talboom
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - F Borja de Lacy
- Gastrointestinal Surgery Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jérémie H Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Michael Solomon
- Department of Surgery, University of Sydney Central Clinical School, Camperdown, New South Wales, Australia
| | - Matteo Frasson
- Department of Surgery, Valencia University Hospital La Fe, Valencia, Spain
| | | | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - Rodrigo O Perez
- Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Anderson, Texas, USA
| | - Yves Panis
- Colorectal Surgery Centre, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France
| | - Martin Rutegård
- Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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10
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, de Wilt JH. Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort. Ann Surg 2023; 278:772-780. [PMID: 37498208 PMCID: PMC10549897 DOI: 10.1097/sla.0000000000006043] [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] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL). BACKGROUND AL after RC resection often results in a permanent stoma. METHODS This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated. RESULTS This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76). CONCLUSIONS The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.
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Affiliation(s)
- Nynke G. Greijdanus
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kiedo Wienholts
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Kevin Talboom
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Francisco B. de Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jérémie H. Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Michael Solomon
- Department of Surgery, University of Sydney Central Clinical School, Camperdown, New South Wales, Australia
| | - Matteo Frasson
- Department of Surgery, Valencia University Hospital La Fe, Valencia, Spain
| | | | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - Rodrigo O. Perez
- Department of Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yves Panis
- Department of Colorectal Surgery, Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France
| | - Martin Rutegård
- Department of Surgery, Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Johannes H.W. de Wilt
- Department of Surgery, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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11
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Ketel MHM, Klarenbeek BR, Eddahchouri Y, Cuesta MA, van Daele E, Gutschow CA, Hölscher AH, Hubka M, Luyer MDP, Merritt RE, Nieuwenhuijzen GAP, Shen Y, Abma IL, Rosman C, van Workum F. Crowd-sourced and expert video assessment in minimally invasive esophagectomy. Surg Endosc 2023; 37:7819-7828. [PMID: 37605010 PMCID: PMC10520122 DOI: 10.1007/s00464-023-10297-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/02/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Video-based assessment by experts may structurally measure surgical performance using procedure-specific competency assessment tools (CATs). A CAT for minimally invasive esophagectomy (MIE-CAT) was developed and validated previously. However, surgeon's time is scarce and video assessment is time-consuming and labor intensive. This study investigated non-procedure-specific assessment of MIE video clips by MIE experts and crowdsourcing, collective surgical performance evaluation by anonymous and untrained laypeople, to assist procedure-specific expert review. METHODS Two surgical performance scoring frameworks were used to assess eight MIE videos. First, global performance was assessed with the non-procedure-specific Global Operative Assessment of Laparoscopic Skills (GOALS) of 64 procedural phase-based video clips < 10 min. Each clip was assessed by two MIE experts and > 30 crowd workers. Second, the same experts assessed procedure-specific performance with the MIE-CAT of the corresponding full-length video. Reliability and convergent validity of GOALS for MIE were investigated using hypothesis testing with correlations (experience, blood loss, operative time, and MIE-CAT). RESULTS Less than 75% of hypothesized correlations between GOALS scores and experience of the surgical team (r < 0.3), blood loss (r = - 0.82 to 0.02), operative time (r = - 0.42 to 0.07), and the MIE-CAT scores (r = - 0.04 to 0.76) were met for both crowd workers and experts. Interestingly, experts' GOALS and MIE-CAT scores correlated strongly (r = 0.40 to 0.79), while crowd workers' GOALS and experts' MIE-CAT scores correlations were weak (r = - 0.04 to 0.49). Expert and crowd worker GOALS scores correlated poorly (ICC ≤ 0.42). CONCLUSION GOALS assessments by crowd workers lacked convergent validity and showed poor reliability. It is likely that MIE is technically too difficult to assess for laypeople. Convergent validity of GOALS assessments by experts could also not be established. GOALS might not be comprehensive enough to assess detailed MIE performance. However, expert's GOALS and MIE-CAT scores strongly correlated indicating video clip (instead of full-length video) assessments could be useful to shorten assessment time.
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Affiliation(s)
- Mirte H M Ketel
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Yassin Eddahchouri
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miguel A Cuesta
- Department of Surgery, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Elke van Daele
- Department of Digestive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Christian A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Arnulf H Hölscher
- Department for General, Visceral and Trauma Surgery, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany
| | - Michal Hubka
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, SE, USA
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Robert E Merritt
- Department of Surgery, Ohio State University - Wexner Medical Center, Columbus, OH, USA
| | | | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Inger L Abma
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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12
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Vissers PAJ, Luijten JCHBM, Lemmens VEPP, van Laarhoven HWM, Slingerland M, Wijnhoven BPL, Rosman C, Mook S, Heisterkamp J, Hendriksen EM, Gisbertz SS, Nieuwenhuijzen GAP, Verhoeven RHA. The association between hospital variation in curative treatment for esophagogastric cancer and health-related quality of life and survival. Eur J Surg Oncol 2023; 49:107019. [PMID: 37659340 DOI: 10.1016/j.ejso.2023.107019] [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: 05/11/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND As previous studies showed significant hospital variation in curative treatment of esophagogastric cancer, this study assesses the association between this variation and overall, cancer-specific and recurrence-free survival, and Health-Related Quality of Life (HRQoL). METHODS Patients diagnosed with potentially curable esophageal or gastric cancer between 2015 and 2018 as registered in the Netherlands Cancer Registry were included. Data on overall survival was available for all patients, data on cancer-specific and recurrence-free survival and HRQoL was available for subgroups. Patients were classified according to diagnosis in hospitals with low, medium or high probability of treatment with curative intent (LP, MP or HP). Multivariable models were used to assess the association between LP, MP and HP hospitals and HRQoL and survival. RESULTS This study includes 7,199 patients with esophageal, and 2,407 with gastric cancer. Overall and cancer-specific survival was better for patients diagnosed in HP versus LP hospitals for both esophageal (HR = 0.82, 95%CI:0.77-0.88 and HR = 0.82, 95%CI:0.75-0.91, respectively), and gastric cancer (HR = 0.82, 95%CI:0.73-0.92 and HR = 0.74, 95%CI:0.64-0.87, respectively). These differences disappeared after adjustments for treatment. Recurrence-free survival was worse for gastric cancer patients diagnosed in HP hospitals (HR = 1.50, 95%CI:1.14-1.96), which disappeared after adjustment for radicality of surgery. Minor, but no clinically relevant, differences in HRQoL were observed. CONCLUSIONS Patients diagnosed in hospitals with a high probability of treatment with curative intent have a better overall and cancer-specific but not recurrence-free survival, while minor differences in HRQoL were observed.
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Affiliation(s)
- Pauline A J Vissers
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research & Development, Utrecht, the Netherlands; Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands.
| | - Josianne C H B M Luijten
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research & Development, Utrecht, the Netherlands; Rijnstate Hospital, Department of Surgery, Arnhem, the Netherlands
| | - Valery E P P Lemmens
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research & Development, Utrecht, the Netherlands; Erasmus University Medical Centre, Department of Public Health, Rotterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC Location University of Amsterdam, Medical Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Marije Slingerland
- Leiden University Medical Center, Department of Medical Oncology, Leiden, the Netherlands
| | - Bas P L Wijnhoven
- Erasmus University Medical Centre, Department of Surgery, Rotterdam, the Netherlands
| | - C Rosman
- Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands
| | - Stella Mook
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht University, Utrecht, the Netherlands
| | - Joos Heisterkamp
- Elisabeth-Tweesteden Ziekenhuis, Department of Surgery, Tilburg, the Netherlands
| | - Ellen M Hendriksen
- Medisch Spectrum Twente, Department of Radiation Oncology, Enschede, the Netherlands
| | - Suzanne S Gisbertz
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | | | - Rob H A Verhoeven
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research & Development, Utrecht, the Netherlands; Amsterdam UMC Location University of Amsterdam, Medical Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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13
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Doeve BH, Bakx JAC, Siersema PD, Rosman C, van Grieken NCT, van Berge Henegouwen MI, van Sandick JW, Verheij M, Bijlsma MF, Verhoeven RHA, van Laarhoven HWM. The impact of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer. J Gastroenterol 2023; 58:965-977. [PMID: 37523094 PMCID: PMC10522512 DOI: 10.1007/s00535-023-02009-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the entire global healthcare system, including oncological care. This study investigated the effects of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer in the Netherlands. METHODS Patients diagnosed in 2020 were divided into 5 periods, based on the severity of the COVID-19 pandemic in the Netherlands, and compared to patients diagnosed in the same period in the years 2017-2019. Patient characteristics and treatments were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. RESULTS The number of esophagogastric cancer diagnoses decreased prominently during the first 2 months of the COVID-19 pandemic. During this period, a significantly higher percentage of GC patients was diagnosed with incurable disease (52.5% in 2017-2019 and 67.7% in 2020, p = 0.011). We observed a significant reduction in the percentage of patients with potentially curable EC treated with resection and neoadjuvant chemoradiotherapy (from 35.0% in 2017-2019 to 27.3% in 2020, p < 0.001). Also, patients diagnosed with incurable GC were treated less frequently with a resection (from 4.6% in 2017-2019 to 1.5% in 2020, p = 0.009) in the second half of 2020. CONCLUSIONS Compared to previous years, the number of esophagogastric cancer diagnoses decreased in the first 2 months of the COVID-19 pandemic, while an increased percentage of patients was diagnosed with incurable disease. Both in the curative and palliative setting, patients were less likely to be treated with a surgical resection.
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Affiliation(s)
- Benthe H Doeve
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
- Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Oncode Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Jeanne A C Bakx
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Nicole C T van Grieken
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC, Location Vrije Universteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni Van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Maarten F Bijlsma
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Oncode Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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14
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Lemmens J, Klarenbeek B, Verstegen M, van Workum F, Hannink G, Ubels S, Rosman C. Performance of a consensus-based algorithm for diagnosing anastomotic leak after minimally invasive esophagectomy for esophageal cancer. Dis Esophagus 2023; 36:doad016. [PMID: 36988007 PMCID: PMC10543373 DOI: 10.1093/dote/doad016] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/17/2023] [Indexed: 03/30/2023]
Abstract
Anastomotic leak (AL) is a common and severe complication after esophagectomy. This study aimed to assess the performance of a consensus-based algorithm for diagnosing AL after minimally invasive esophagectomy. This study used data of the ICAN trial, a multicenter randomized clinical trial comparing cervical and intrathoracic anastomosis, in which a predefined diagnostic algorithm was used to guide diagnosing AL. The algorithm identified patients suspected of AL based on clinical signs, blood C-reactive protein (cut-off value 200 mg/L), and/or drain amylase (cut-off value 200 IU/L). Suspicion of AL prompted evaluation with contrast swallow computed tomography and/or endoscopy to confirm AL. Primary outcome measure was algorithm performance in terms of sensitivity, specificity, and positive and negative predictive values (PPV, NPV), respectively. AL was defined according to the definition of the Esophagectomy Complications Consensus Group. 245 patients were included, and 125 (51%) patients were suspected of AL. The algorithm had a sensitivity of 62% (95% confidence interval [CI]: 46-75), a specificity of 97% (95% CI: 89-100), and a PPV and NPV of 94% (95% CI: 79-99) and 77% (95% CI: 66-86), respectively, on initial assessment. Repeated assessment in 19 patients with persisting suspicion of AL despite negative or inconclusive initial assessment had a sensitivity of 100% (95% CI: 77-100). The algorithm showed poor performance because the low sensitivity indicates the inability of the algorithm to confirm AL on initial assessment. Repeated assessment using the algorithm was needed to confirm remaining leaks.
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Affiliation(s)
- Jobbe Lemmens
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Ubels S, Matthée E, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen MI, Daams F, Dekker JWT, van Det MJ, van Esser S, Griffiths EA, Haveman JW, Nieuwenhuijzen G, Siersema PD, Wijnhoven B, Hannink G, van Workum F, Rosman C. Erratum to "Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue" [Eur J Surg Oncol 49 (5) (May 2023) 974-982]. Eur J Surg Oncol 2023; 49:106993. [PMID: 37572559 DOI: 10.1016/j.ejso.2023.106993] [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: 08/14/2023]
Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Eric Matthée
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group, Almelo, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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16
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Lof S, Claassen L, Hannink G, Al-Sarireh B, Björnsson B, Boggi U, Burdio F, Butturini G, Capretti G, Casadei R, Dokmak S, Edwin B, Esposito A, Fabre JM, Ferrari G, Fretland AA, Ftériche FS, Fusai GK, Giardino A, Groot Koerkamp B, D’Hondt M, Jah A, Kamarajah SK, Kauffmann EF, Keck T, van Laarhoven S, Manzoni A, Marino MV, Marudanayagam R, Molenaar IQ, Pessaux P, Rosso E, Salvia R, Soonawalla Z, Souche R, White S, van Workum F, Zerbi A, Rosman C, Stommel MWJ, Abu Hilal M, Besselink MG. Learning Curves of Minimally Invasive Distal Pancreatectomy in Experienced Pancreatic Centers. JAMA Surg 2023; 158:927-933. [PMID: 37378968 PMCID: PMC10308297 DOI: 10.1001/jamasurg.2023.2279] [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: 11/22/2022] [Accepted: 03/23/2023] [Indexed: 06/29/2023]
Abstract
Importance Understanding the learning curve of a new complex surgical technique helps to reduce potential patient harm. Current series on the learning curve of minimally invasive distal pancreatectomy (MIDP) are mostly small, single-center series, thus providing limited data. Objective To evaluate the length of pooled learning curves of MIDP in experienced centers. Design, Setting, and Participants This international, multicenter, retrospective cohort study included MIDP procedures performed from January 1, 2006, through June 30, 2019, in 26 European centers from 8 countries that each performed more than 15 distal pancreatectomies annually, with an overall experience exceeding 50 MIDP procedures. Consecutive patients who underwent elective laparoscopic or robotic distal pancreatectomy for all indications were included. Data were analyzed between September 1, 2021, and May 1, 2022. Exposures The learning curve for MIDP was estimated by pooling data from all centers. Main Outcomes and Measures The learning curve was assessed for the primary textbook outcome (TBO), which is a composite measure that reflects optimal outcome, and for surgical mastery. Generalized additive models and a 2-piece linear model with a break point were used to estimate the learning curve length of MIDP. Case mix-expected probabilities were plotted and compared with observed outcomes to assess the association of changing case mix with outcomes. The learning curve also was assessed for the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C. Results From a total of 2610 MIDP procedures, the learning curve analysis was conducted on 2041 procedures (mean [SD] patient age, 58 [15.3] years; among 2040 with reported sex, 1249 were female [61.2%] and 791 male [38.8%]). The 2-piece model showed an increase and eventually a break point for TBO at 85 procedures (95% CI, 13-157 procedures), with a plateau TBO rate at 70%. The learning-associated loss of TBO rate was estimated at 3.3%. For conversion, a break point was estimated at 40 procedures (95% CI, 11-68 procedures); for operation time, at 56 procedures (95% CI, 35-77 procedures); and for intraoperative blood loss, at 71 procedures (95% CI, 28-114 procedures). For postoperative pancreatic fistula, no break point could be estimated. Conclusion and Relevance In experienced international centers, the learning curve length of MIDP for TBO was considerable with 85 procedures. These findings suggest that although learning curves for conversion, operation time, and intraoperative blood loss are completed earlier, extensive experience may be needed to master the learning curve of MIDP.
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Affiliation(s)
- Sanne Lof
- Amsterdam UMC, Department of Surgery, University of Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
- Department of Surgery, Fondazione Poliambulanza–Istituto Ospedaliero, Brescia, Italy
| | - Linda Claassen
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bilal Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Italy
| | | | | | - Giovanni Capretti
- Department of Surgery, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Riccardo Casadei
- Department of Surgery, S Orsola-Malpighi Hospital, Bologna, Italy
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Bjørn Edwin
- The Intervention Center and Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Jean M. Fabre
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | - Giovanni Ferrari
- Department of Oncologic and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Asmund A. Fretland
- The Intervention Center and Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Fadhel S. Ftériche
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Giuseppe K. Fusai
- Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Asif Jah
- Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sivesh K. Kamarajah
- Department of Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | | | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Germany
| | - Stijn van Laarhoven
- Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Alberto Manzoni
- Department of Surgery, Fondazione Poliambulanza–Istituto Ospedaliero, Brescia, Italy
| | - Marco V. Marino
- Department of Emergency and General Surgery, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Ravi Marudanayagam
- Department of Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom
| | - Izaak Q. Molenaar
- Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, the Netherlands
| | - Patrick Pessaux
- Department of Viscerale and Digestive Surgery, Nouvel Hôpital Civil–IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Edoardo Rosso
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Zahir Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Regis Souche
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | - Steven White
- Department of Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Frans van Workum
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Alessandro Zerbi
- Department of Surgery, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza–Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation, Southampton, United Kingdom
| | - Marc G. Besselink
- Amsterdam UMC, Department of Surgery, University of Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
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17
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Brandsma HT, Hansson BM, Aufenacker TJ, de Jong N, V Engelenburg KC, Mahabier C, Donders R, Steenvoorde P, de Vries Reilingh TS, Leendert van Westreenen H, Wiezer MJ, de Wilt JHW, Rovers M, Rosman C. Prophylactic Mesh Placement During Formation of an End-colostomy: Long-term Randomized Controlled Trial on Effectiveness and Safety. Ann Surg 2023; 278:e440-e446. [PMID: 36727747 DOI: 10.1097/sla.0000000000005801] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term. BACKGROUND A PSH is the most frequent complication after stoma formation. Prophylactic placement of a mesh has been suggested to prevent PSH, but long-term evidence to support this approach is scarce. METHODS In this multicentre superiority trial patients undergoing the formation of a permanent colostomy were randomly assigned to either retromuscular polypropylene mesh reinforcement or conventional colostomy formation. Primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life, and cost-effectiveness. RESULTS A total of 150 patients were randomly assigned to the mesh group (n = 72) or nonmesh group (n = 78). For the long-term follow-up, 113 patients were analyzed, and 37 patients were lost to follow-up. After a median follow-up of 60 months (interquartile range: 48.6-64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the nonmesh group ( P = 0.22; RD: -9.4%; 95% CI: -24, 5.5). The cost related to the meshing strategy was € 2.239 lower than the nonmesh strategy (95% CI: 491.18, 3985.49), and quality-adjusted life years did not differ significantly between groups ( P = 0.959; 95% CI: -0.066, 0.070). CONCLUSIONS Prophylactic mesh placement during the formation of an end-colostomy is a safe procedure but does not reduce the incidence of PSH after 5 years of follow-up. It does, however, delay the onset of PSH without a significant difference in morbidity, mortality, or quality of life, and seems to be cost-effective.
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Affiliation(s)
| | - Birgitta Me Hansson
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Nienke de Jong
- Department of Surgery, Bernhoven Hospital, Uden, The Netherlands
| | | | - Chander Mahabier
- Department of Surgery, Albert Schweitzer Hospital Dordrecht, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pascal Steenvoorde
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Marinus J Wiezer
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maroeska Rovers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of operating rooms, Radboud university medical centre, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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18
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Klarenbeek BR, Fujiwara H, Scholte M, Rovers M, Shiozaki A, Rosman C. Introduction of Minimally Invasive transCervical oEsophagectomy (MICE) according to the IDEAL framework. Br J Surg 2023; 110:1096-1099. [PMID: 36960594 PMCID: PMC10416700 DOI: 10.1093/bjs/znad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/03/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Affiliation(s)
| | - Hitoshi Fujiwara
- Department of Surgery, Kyoto Prefectural University of Medicine Hospital, Kyoto, Japan
| | - Mirre Scholte
- Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maroeska Rovers
- Department of Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Atsushi Shiozaki
- Department of Surgery, Kyoto Prefectural University of Medicine Hospital, Kyoto, Japan
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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19
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Hermus M, van der Wilk BJ, Chang R, Dekker JWT, Coene PLO, Nieuwenhuijzen GAP, Rosman C, Heisterkamp J, Hartgrink HH, Timmermans L, Wijnhoven BPL, van der Zijden CJ, van Lanschot JJB, Busschbach J, Lagarde SM, Kranenburg LW. Esophageal cancer patients' need for information and support in making a treatment decision between standard surgery and active surveillance. Cancer Med 2023; 12:17266-17272. [PMID: 37392175 PMCID: PMC10501224 DOI: 10.1002/cam4.6308] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND This study explores patients' need for information and support in deciding on esophageal cancer treatment, when experimental active surveillance and standard surgery are both feasible. METHODS This psychological companion study was conducted alongside the Dutch SANO-trial (Surgery As Needed for Oesophageal cancer). In-depth interviews and questionnaires were used to collect data from patients who declined participation in the trial because they had a strong preference for either active surveillance (n = 20) or standard surgery (n = 20). Data were analyzed using both qualitative and quantitative techniques. RESULTS Patients prefer to receive information directly from their doctors and predominantly rely on this information to make a treatment decision. Other information resources are largely used to confirm their treatment decision. Patients highly value support from their loved ones and appreciate emphatic doctors to actively involve them in the decision-making process. Overall, patients' needs for information and support during decision-making were met. CONCLUSIONS The importance of shared decision-making and the role doctors have in this process is underlined. The role of doctors is essential at the initial phase of decision-making: Once patients seem to have formed their treatment preference for either active surveillance or surgery, the influence of external resources (including doctors) may be limited.
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Affiliation(s)
- Merel Hermus
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
| | - Berend J. van der Wilk
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Rebecca Chang
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | | | - Camiel Rosman
- Department of SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Joos Heisterkamp
- Department of SurgeryElisabeth Tweesteden HospitalTilburgThe Netherlands
| | - Henk H. Hartgrink
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Bas P. L. Wijnhoven
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Charlène J. van der Zijden
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Jan J. B. van Lanschot
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Jan Busschbach
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
| | - Sjoerd M. Lagarde
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Leonieke W. Kranenburg
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
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20
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Hiensch A, Steenhagen E, van Vulpen JK, Ruurda JP, Nieuwenhuijzen GAP, Kouwenhoven EA, Groenendijk RPR, van der Peet DL, Rosman C, Wijnhoven BPL, van Berge Henegouwen MI, van Laarhoven HWM, van Hillegersberg R, Siersema PD, May AM. Effects of exercise after oesophagectomy on body composition and adequacy of energy and protein intake: PERFECT multicentre randomized controlled trial. BJS Open 2023; 7:zrad057. [PMID: 37527034 PMCID: PMC10392959 DOI: 10.1093/bjsopen/zrad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/31/2023] [Accepted: 04/29/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Anouk Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elles Steenhagen
- Department of Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonna K van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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21
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Ubels S, Verstegen MHP, Klarenbeek BR, Bouwense S, van Berge Henegouwen MI, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Nieuwenhuijzen G, Polat F, Schouten J, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C. Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study. Br J Surg 2023; 110:852-863. [PMID: 37196149 PMCID: PMC10364505 DOI: 10.1093/bjs/znad123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. METHODS A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011-2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. RESULTS Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. -1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. -1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. -21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. CONCLUSION Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Moniek H P Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT Hospital Group, Almelo, The Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital, Guildford, UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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22
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Fransen LFC, Verhoeven RHA, Janssen THJB, van Det MJ, Gisbertz SS, van Hillegersberg R, Klarenbeek B, Kouwenhoven EA, Nieuwenhuijzen GAP, Rosman C, Ruurda JP, van Berge Henegouwen MI, Luyer MDP. The association between postoperative complications and long-term survival after esophagectomy: a multicenter cohort study. Dis Esophagus 2023; 36:6874520. [PMID: 36477850 DOI: 10.1093/dote/doac086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 05/30/2023]
Abstract
Conflicting results are reported on the association between post-esophagectomy complications and long-term survival. This multicenter study assesses the association between complications after an esophagectomy and long-term overall survival. Five Dutch high-volume centers collected data from consecutive patients undergoing esophagectomy between 2010 and 2016 and merged these with long-term survival data from the Netherlands Cancer Registry. Exclusion criteria were non-curative resections and 90-day mortality, among others. Primary outcome was overall survival related to the presence of a postoperative complication in general. Secondary outcomes analyzed the presence of anastomotic leakage and cardiopulmonary complications. Propensity score matching was performed and the outcomes were analyzed via Log-Rank test and Kaplan Meier analysis. Among the 1225 patients included, a complicated course occurred in 719 patients (59.0%). After matching for baseline characteristics, 455 pairs were successfully balanced. Patients with an uncomplicated postoperative course had a 5-year overall survival of 51.7% versus 44.4% in patients with complications (P = 0.011). Anastomotic leakage occurred in 18.4% (n = 226), and in 208 matched pairs, it was shown that the 5-year overall survival was 57.2% in patients without anastomotic leakage versus 44.0% in patients with anastomotic leakage (P = 0.005). Overall cardiopulmonary complication rate was 37.1% (n = 454), and in 363 matched pairs, the 5-year overall survival was 52.1% in patients without cardiopulmonary complications versus 45.3% in patients with cardiopulmonary complications (P = 0.019). Overall postoperative complication rate, anastomotic leakage, and cardiopulmonary complications were associated with a decreased long-term survival after an esophagectomy. Efforts to reduce complications might further improve the overall survival for patients treated for esophageal carcinoma.
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Affiliation(s)
- Laura F C Fransen
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands
| | - Suzanne S Gisbertz
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bastiaan Klarenbeek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark I van Berge Henegouwen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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23
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Ubels S, Matthée E, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen MI, Daams F, Dekker JWT, van Det MJ, van Esser S, Griffiths EA, Haveman JW, Nieuwenhuijzen G, Siersema PD, Wijnhoven B, Hannink G, van Workum F, Rosman C, Heisterkamp J, Polat F, Schouten J, Singh P, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, Van Etten B, Poelmann F, Vuurberg N, Willem van den Berg J, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TC, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JW, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CM, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RP, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJ, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MA, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Koshy R, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Constantinoiu S, Birla R, Achim F, Rosianu CG, Hoara P, Castro RG, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Koshy R, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Ahmed HA, Elhadi A, Elnagar FA, Msherghi AA, Wills V, Campbell C, Cerdeira MP, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Barbosa JA, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZ, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler M, Schofield W, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Fernández SL, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Ben Taher FA, Ekheel M, Msherghi AA. Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue. Eur J Surg Oncol 2023; 49:974-982. [PMID: 36732207 DOI: 10.1016/j.ejso.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences. METHODS TENTACLE - Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20-60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment. RESULTS FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2-0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5-1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4-1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5-1.4). CONCLUSION Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Eric Matthée
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group, Almelo, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Fatih Polat
- Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Jeroen Schouten
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pritam Singh
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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24
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Reijnders-Boerboom GT, Albers KI, Jacobs LM, van Helden E, Rosman C, Díaz-Cambronero O, Mazzinari G, Scheffer GJ, Keijzer C, Warlé MC. Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:1400-1411. [PMID: 37026807 PMCID: PMC10389627 DOI: 10.1097/js9.0000000000000289] [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: 07/24/2022] [Accepted: 02/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group. MATERIALS AND METHODS We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10 mmHg) with standard IAP (10 mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay. RESULTS Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10 mmHg) leads to a lower incidence of mild (Clavien-Dindo grade 1-2) postoperative complications (RR=0.68, 95% CI: 0.53-0.86), lower pain scores (MD=-0.68, 95% CI: -0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51-0.88), and a reduced length of hospital stay (MD=-0.29, 95% CI: -0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77-1.73). CONCLUSIONS Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.
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Affiliation(s)
| | - Kim I. Albers
- Departments of Anesthesiology
- Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Oscar Díaz-Cambronero
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
| | - Guido Mazzinari
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
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25
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Kalff MC, van Berge Henegouwen MI, Baas PC, Bahadoer RR, Belt EJT, Brattinga B, Claassen L, Ćosović A, Crull D, Daams F, van Dalsen AD, Dekker JWT, van Det MJ, Drost M, van Duijvendijk P, Eshuis WJ, van Esser S, Gaspersz MP, Görgec B, Groenendijk RPR, Hartgrink HH, van der Harst E, Haveman JW, Heisterkamp J, van Hillegersberg R, Kelder W, Kingma BF, Koemans WJ, Kouwenhoven EA, Lagarde SM, Lecot F, van der Linden PP, Luyer MDP, Nieuwenhuijzen GAP, Olthof PB, van der Peet DL, Pierie JPEN, Pierik EGJMR, Plat VD, Polat F, Rosman C, Ruurda JP, van Sandick JW, Scheer R, Slootmans CAM, Sosef MN, Sosef OV, de Steur WO, Stockmann HBAC, Stoop FJ, Voeten DM, Vugts G, Vijgen GHEJ, Weeda VB, Wiezer MJ, van Oijen MGH, Gisbertz SS. Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care: The Dutch Nationwide Ivory Study. Ann Surg 2023; 277:619-628. [PMID: 35129488 DOI: 10.1097/sla.0000000000005292] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer. SUMMARY OF BACKGROUND DATA The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer. METHODS Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007-2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods. RESULTS Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% ( P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 ( P <0.001), and median survival increased from 35 to 41 months ( P = 0.027). CONCLUSION In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.
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Affiliation(s)
- Marianne C Kalff
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Peter C Baas
- Department of Surgery, Martini Ziekenhuis, Groningen, the Netherlands
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Baukje Brattinga
- Department of Surgery, MC Leeuwarden, Leeuwarden, the Netherlands
| | - Linda Claassen
- Department of Surgery, Gelre Ziekenhuis, Apeldoorn, the Netherlands
| | - Admira Ćosović
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - David Crull
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Freek Daams
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Manon Drost
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | | | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | | | - Burak Görgec
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | | | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | | | - Wendy Kelder
- Department of Surgery, Martini Ziekenhuis, Groningen, the Netherlands
| | - B Feike Kingma
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Willem J Koemans
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | | | | | - Frederik Lecot
- Department of Surgery, Zuyderland, Heerlen, the Netherlands
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Pim B Olthof
- Department of Surgery, Reinier de Graaf Groep, Delft, the Netherlands
| | | | | | | | - Victor D Plat
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Fatih Polat
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - Rene Scheer
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Odin V Sosef
- Department of Surgery, Zuyderland, Heerlen, the Netherlands
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Fanny J Stoop
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Daan M Voeten
- Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Víola B Weeda
- Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Martijn G H van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Brenkman HJF, Claassen L, Hannink G, van der Werf LR, Ruurda JPH, Nieuwenhuizen GAP, Luyer MDP, Kouwenhoven EA, van Det MJ, van Berge Henegouwen MI, Gisbertz SS, Stoot JHMB, Hulsewé KWE, van Workum F, van Hillegersberg R, Rosman C. Learning Curve of Laparoscopic Gastrectomy: A Multicenter Study. Ann Surg 2023; 277:e808-e816. [PMID: 35801714 DOI: 10.1097/sla.0000000000005479] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the learning curve of laparoscopic gastrectomy (LG) after an implementation program. BACKGROUND Although LG is increasingly being performed worldwide, little is known about the learning curve. METHODS Consecutive patients who underwent elective LG for gastric adenocarcinoma with curative intent in each of the 5 highest-volume centers in the Netherlands were enrolled. Generalized additive models and a 2-piece model with a break point were used to determine the learning curve length. Analyses were corrected for casemix and were performed for LG and for the subgroups distal gastrectomy (LDG) and total gastrectomy (LTG). The learning curve effect was assessed for (1) anastomotic leakage; and (2) the occurrence of postoperative complications, conversions to open surgery, and short-term oncological parameters. RESULTS In total 540 patients were included for analysis, 108 patients from each center; 268 patients underwent LDG and 272 underwent LTG. First, for LG, no learning effect regarding anastomotic leakage could be identified: the rate of anastomotic leakage initially increased, then reached a plateau after 36 cases at 10% anastomotic leakage. Second, the level of overall complications reached a plateau after 20 cases, at 38% overall complications, and at 5% conversions. For both LDG and LTG, each considered separately, fluctuations in secondary outcomes and anastomotic leakage followed fluctuations in casemix. CONCLUSION On the basis of our study of the first 108 procedures of LG in 5 high-volume centers with well-trained surgeons, no learning curve effect could be identified regarding anastomotic leakage. A learning curve effect was found with respect to overall complications and conversion rate.
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Affiliation(s)
| | - Linda Claassen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leonie R van der Werf
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | | | | | | | | | | | - Suzanne S Gisbertz
- Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Camiel Rosman
- Radboud University Medical Center, Nijmegen, The Netherlands
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27
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Valkema MJ, Vos A, van der Post RS, Ooms AHAG, Oudijk L, Eyck BM, Lagarde SM, Wijnhoven BPL, Klarenbeek BR, Rosman C, van Lanschot JJB, Doukas M. The effectiveness of neoadjuvant chemoradiotherapy in oesophageal adenocarcinoma with presence of extracellular mucin, signet‐ring cells, and/or poorly cohesive cells. The Journal of Pathology CR 2023. [DOI: 10.1002/cjp2.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/24/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023]
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28
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Hermus M, van der Wilk BJ, Chang RTH, Collee G, Noordman BJ, Coene PPLO, Dekker JWT, Hartgrink HH, Heisterkamp J, Nieuwenhuijzen GAP, Rosman C, Timmermans L, Wijnhoven BPL, van der Zijden CJ, Busschbach JJ, van Lanschot JJB, Lagarde SM, Kranenburg LW. Patient preferences for active surveillance vs standard surgery after neoadjuvant chemoradiotherapy in oesophageal cancer treatment: The NOSANO-study. Int J Cancer 2023; 152:1183-1190. [PMID: 36250325 PMCID: PMC10092042 DOI: 10.1002/ijc.34327] [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: 05/27/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 01/21/2023]
Abstract
Active surveillance may be a safe and effective treatment in oesophageal cancer patients with a clinically complete response after neoadjuvant chemoradiotherapy (nCRT). In the NOSANO-study we gained insight in patients' motive to opt for either an experimental treatment called active surveillance or for standard immediate surgery. Both qualitative and quantitative analyses methods were used. Forty patients were interviewed about their treatment preference, 3 months after completion of nCRT (T1). Data were recorded, transcribed verbatim and analysed according to the principles of grounded theory. In addition, at T1 and T2 (12 months after completion of nCRT) questionnaires on health-related quality of life, coping, anxiety and decisional regret (only T2) were administered. Interview data analyses resulted in a conceptual model with 'dealing with threat of cancer' as the central theme. Patients preferring active surveillance tend to cope with this threat by confiding in their bodies and good outcomes. Their mind-set is one of 'enjoy life now'. Patients preferring surgery tend to cope by minimizing uncertainty and eliminating the source of cancer. Their mind-set is one of 'don't give up, act now'. Furthermore, questionnaire results showed that patients with a preference for standard surgery had a lower quality of life. Patient preferences are individualized and thus difficult to predict. Our model can help healthcare professionals to determine patient preferences for treatment. Coping style and mind-set seem to be determining factors here.
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Affiliation(s)
- Merel Hermus
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Berend J van der Wilk
- Department of Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rebecca T H Chang
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gerlise Collee
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bo J Noordman
- Department of Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joos Heisterkamp
- Department of surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Charlène J van der Zijden
- Department of Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Jan B van Lanschot
- Department of Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
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29
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Ketel M, Eddahchouri Y, Klarenbeek B, MIE-CAT Collaboration Group, Hannink G, Rosman C, van Workum F. Competency assessment tool for Minimally Invasive Esophagectomy: development, construct validity, reliability and version 2. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.197] [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: 02/23/2023]
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30
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Ketel M, Klarenbeek B, Eddahchouri Y, Group MIEGOALSC, Abma I, Rosman C, van Workum F. Validity and reliability of crowd-sourced and expert video assessment in Minimally Invasive Esophagectomy using Global Rating Scales. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.498] [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: 02/23/2023]
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31
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Luijten JCHBM, Verstegen MHP, van Workum F, Nieuwenhuijzen GAP, van Berge Henegouwen MI, Gisbertz SS, Wijnhoven BPL, Verhoeven RHA, Rosman C. Survival after Ivor Lewis versus McKeown esophagectomy for cancer: propensity score matched analysis. Dis Esophagus 2023:6972913. [PMID: 36617230 DOI: 10.1093/dote/doac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023]
Abstract
It is unknown whether Ivor Lewis (IL) or McKeown (McK) esophagectomy is preferred in patients with potentially curable esophageal or gastro-esophageal junction (GEJ) cancer. Patients with mid- and distal esophageal and GEJ cancer without distant metastases who underwent IL or McK esophagectomy in the Netherlands between 2015 and 2017, were selected from the Netherlands Cancer Registry. Patients were propensity score matched for sex, age, American Society of Anesthesiologist classification, comorbidity, tumor type, tumor location, clinical stage, neoadjuvant treatment and year of diagnosis. The primary outcome was a 3-year relative survival (RS). Secondary outcome parameters were number of lymph nodes examined, number of positive lymph nodes, radical resection rate, tumor regression grade, post-operative complications and mortality. A total of 1627 patients who underwent IL (n = 1094) or McK (n = 533) esophagectomy were included. Patient and tumor characteristics were balanced after propensity score matching, leaving 658 patients to be compared. The 3-year RS was 54% after IL and 50% after McK esophagectomy, P = 0.140. The median number of lymph nodes examined, median number of positive lymph nodes, radical resection rate and tumor regression grade were comparable between both groups. Recurrent laryngeal nerve palsy (2 vs. 5%, P = 0.006) occurred less frequently after IL esophagectomy. No differences were observed in post-operative anastomotic leakage rate, pulmonary complication rate and mortality rates. There was no statistically significant difference in the 3-year RS between IL and McK esophagectomy. Based on these results, both IL and McK esophagectomy can be performed in patients with mid to distal esophageal and GEJ cancer.
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Affiliation(s)
- J C H B M Luijten
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht 3501, The Netherlands.,Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - M H P Verstegen
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands.,Imperial College London, London SW7 2AZ, UK
| | - F van Workum
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands.,Imperial College London, London SW7 2AZ, UK
| | | | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC-Location AMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam 1081, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC-Location AMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam 1081, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, Rotterdam 3015, The Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht 3501, The Netherlands.,Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen 6525, The Netherlands
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32
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Ubels S, Lubbers M, Verstegen MHP, Bouwense SAW, van Daele E, Ferri L, Gisbertz SS, Griffiths EA, Grimminger P, Hanna G, Hubka M, Law S, Low D, Luyer M, Merritt RE, Morse C, Mueller CL, Nieuwenhuijzen GAP, Nilsson M, Reynolds JV, Ribeiro U, Rosati R, Shen Y, Wijnhoven BPL, Klarenbeek BR, van Workum F, Rosman C. Treatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions. Dis Esophagus 2022; 35:6566833. [PMID: 35411928 DOI: 10.1093/dote/doac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/11/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Anastomotic leak (AL) is a severe complication after esophagectomy. Clinical presentation of AL is diverse and there is large practice variation regarding treatment of AL. This study aimed to explore different AL treatment strategies and their underlying rationale. This mixed-methods study consisted of an international survey among upper gastro-intestinal (GI) surgeons and focus groups with expert upper GI surgeons. The survey included 10 case vignettes and data sources were integrated after separate analysis. The survey was completed by 188 respondents (completion rate 69%) and 6 focus groups were conducted with 20 international experts. Prevention of mortality was the most important goal of primary treatment. Goals of secondary treatment were to promote tissue healing, return to oral feeding and safe hospital discharge. There was substantial variation in the preferred treatment principles (e.g. drainage or defect closure) and modalities (e.g. stent or endoVAC) within different presentations of AL. Patients with local symptoms were treated by supportive means only or by non-surgical drainage and/or defect closure. Drainage was routinely performed in patients with intrathoracic collections and often combined with defect closure. Patients with conduit necrosis were predominantly treated by resection and reconstruction of the anastomosis or by esophageal diversion. This mixed-methods study shows that overall treatment strategies for AL are determined by vitality of the conduit and presence of intrathoracic collections. There is large variation in preferred treatment principles and modalities. Future research may investigate optimal treatment for specific AL presentations and aim to develop consensus-based treatment guidelines for AL after esophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Merel Lubbers
- Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands
| | - Moniek H P Verstegen
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elke van Daele
- Department of Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lorenzo Ferri
- Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Peter Grimminger
- Department of Surgery, University Medical Center Mainz, Mainz, Germany
| | - George Hanna
- Department of Surgery, Imperial College, London, UK
| | - Michal Hubka
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, SE USA
| | - Simon Law
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Donald Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, SE USA
| | - Misha Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Robert E Merritt
- Department of Surgery, Ohio State University - Wexner Medical Center, Columbus, OH, USA
| | - Christopher Morse
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Carmen L Mueller
- Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | | | - Magnus Nilsson
- Department of Surgery, Department of Upper Abdominal Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - John V Reynolds
- Department of Surgery, Trinity St. James's Cancer Institute, Dublin, Ireland
| | - Ulysses Ribeiro
- Department of Gastroenterology, University of Sao Paulo, Sao Paulo, Brazil
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bastiaan R Klarenbeek
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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33
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Ubels S, Klarenbeek B, Verstegen M, Bouwense S, Griffiths EA, van Workum F, Rosman C, Hannink G. Predicting mortality in patients with anastomotic leak after esophagectomy: development of a prediction model using data from the TENTACLE-Esophagus study. Dis Esophagus 2022; 36:6862938. [PMID: 36461788 PMCID: PMC10150169 DOI: 10.1093/dote/doac081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/22/2022] [Revised: 09/28/2022] [Accepted: 10/25/2022] [Indexed: 12/04/2022]
Abstract
Anastomotic leak (AL) is a common but severe complication after esophagectomy, and over 10% of patients with AL suffer mortality. Different prognostic factors in patients with AL are known, but a tool to predict mortality after AL is lacking. This study aimed to develop a prediction model for postoperative mortality in patients with AL after esophagectomy. TENTACLE-Esophagus is an international retrospective cohort study, which included 1509 patients with AL after esophagectomy. The primary outcome was 90-day postoperative mortality. Previously identified prognostic factors for mortality were selected as predictors: patient-related (e.g. comorbidity, performance status) and leak-related predictors (e.g. leucocyte count, overall gastric conduit condition). The prediction model was developed using multivariable logistic regression and validated internally using bootstrapping. Among the 1509 patients with AL, 90-day mortality was 11.7%. Sixteen predictors were included in the prediction model. The model showed good performance after internal validation: the c-index was 0.79 (95% confidence interval 0.75-0.83). Predictions for mortality by the internally validated model aligned well with observed 90-day mortality rates. The prediction model was incorporated in an online tool for individual use and can be found at: https://www.tentaclestudy.com/prediction-model. The developed prediction model combines patient-related and leak-related factors to accurately predict postoperative mortality in patients with AL after esophagectomy. The model is useful for clinicians during counselling of patients and their families and may aid identification of high-risk patients at diagnosis of AL. In the future, the tool may guide clinical decision-making; however, external validation of the tool is warranted.
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Affiliation(s)
- Sander Ubels
- Address correspondence to: Sander Ubels, Radboud university medical center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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de Graaff MR, Hogenbirk RNM, Janssen YF, Elfrink AKE, Liem RSL, Nienhuijs SW, de Vries JPPM, Elshof JW, Verdaasdonk E, Melenhorst J, van Westreenen HL, Besselink MGH, Ruurda JP, van Berge Henegouwen MI, Klaase JM, den Dulk M, van Heijl M, Hegeman JH, Braun J, Voeten DM, Würdemann FS, Warps ALK, Alberga AJ, Suurmeijer JA, Akpinar EO, Wolfhagen N, van den Boom AL, Bolster-van Eenennaam MJ, van Duijvendijk P, Heineman DJ, Wouters MWJM, Kruijff S, Koningswoud-Terhoeve CL, Belt E, van der Hoeven JAB, Marres GMH, Tozzi F, von Meyenfeldt EM, Coebergh RRJ, van den Braak, Huisman S, Rijken AM, Balm R, Daams F, Dickhoff C, Eshuis WJ, Gisbertz SS, Zandbergen HR, Hartemink KJ, Keessen SA, Kok NFM, Kuhlmann KFD, van Sandick JW, Veenhof AA, Wals A, van Diepen MS, Schoonderwoerd L, Stevens CT, Susa D, Bendermacher BLW, Olofsen N, van Himbeeck M, de Hingh IHJT, Janssen HJB, Luyer MDP, Nieuwenhuijzen GAP, Ramaekers M, Stacie R, Talsma AK, Tissink MW, Dolmans D, Berendsen R, Heisterkamp J, Jansen WA, de Kort-van Oudheusden M, Matthijsen RM, Grünhagen DJ, Lagarde SM, Maat APWM, van der Sluis PC, Waalboer RB, Brehm V, van Brussel JP, Morak M, Ponfoort ED, Sybrandy JEM, Klemm PL, Lastdrager W, Palamba HW, van Aalten SM, Tseng LNL, van der Bogt KEA, de Jong WJ, Oosterhuis JWA, Tummers Q, van der Wilden GM, Ooms S, Pasveer EH, Veger HTC, Molegraafb MJ, Nieuwenhuijs VB, Patijn GA, van der Veldt MEV, Boersma D, van Haelst STW, van Koeverden ID, Rots ML, Bonsing BA, Michiels N, Bijlstra OD, Braun J, Broekhuis D, Brummelaar HW, Hartgrink HH, Metselaar A, Mieog JSD, Schipper IB, de Steur WO, Fioole B, Terlouw EC, Biesmans C, Bosmans JWAM, Bouwense SAW, Clermonts SHEM, Coolsen MME, Mees BME, Schurink GWH, Duijff JW, van Gent T, de Nes LCF, Toonen D, Beverwijk MJ, van den Hoed E, Keizers B, Kelder W, Keller BPJA, Pultrum BB, van Rosum E, Wijma AG, van den Broek F, Leclercq WKG, Loos MJA, Sijmons JML, Vaes RHD, Vancoillie PJ, Consten ECJ, Jongen JMJ, Verheijen PM, van Weel V, Arts CHP, Jonker J, Murrmann-Boonstra G, Pierie JPEN, Swart J, van Duyn EB, Geelkerken RH, de Groot R, Moekotte NL, Stam A, Voshaar A, van Acker GJD, Bulder RMA, Swank DJ, Pereboom ITA, Hoffmann WH, Orsini M, Blok JJ, Lardenoije JHP, Reijne MMPJ, van Schaik P, Smeets L, van Sterkenburg SMM, Harlaar NJ, Mekke S, Verhaakt T, Cancrinus E, van Lammeren GW, Molenaar IQ, van Santvoort HC, Vos AWF, Schouten- van der Velden AP, Woensdregt K, Mooy-Vermaat SP, Scharn DM, Marsman HA, Rassam F, Halfwerk FR, Andela AJ, Buis CI, van Dam GM, ten Duis K, van Etten B, Lases L, Meerdink M, de Meijer VE, Pranger B, Ruiter S, Rurenga M, Wiersma A, Wijsmuller AR, Albers KI, van den Boezem PB, Klarenbeek B, van der Kolk BM, van Laarhoven CJHM, Matthée E, Peters N, Rosman C, Schroen AMA, Stommel MWJ, Verhagen AFTM, van der Vijver R, Warlé MC, de Wilt JHW, van den Berg JW, Bloemert T, de Borst GJ, van Hattum EH, Hazenberg CEVB, van Herwaarden JA, van Hillegerberg R, Kroese TE, Petri BJ, Toorop RJ, Aarts F, Janssen RJL, Janssen-Maessen SHP, Kool M, Verberght H, Moes DE, Smit JW, Wiersema AM, Vierhout BP, de Vos B, den Boer FC, Dekker NAM, Botman JMJ, van Det MJ, Folbert EC, de Jong E, Koenen JC, Kouwenhoven EA, Masselink I, Navis LH, Belgers HJ, Sosef MN, Stoot JHMB. Impact of the COVID-19 pandemic on surgical care in the Netherlands. Br J Surg 2022; 109:1282-1292. [PMID: 36811624 PMCID: PMC10364688 DOI: 10.1093/bjs/znac301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/14/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. METHODS A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. RESULTS Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001). CONCLUSION The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.
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Affiliation(s)
- Michelle R de Graaff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.,Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Rianne N M Hogenbirk
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Yester F Janssen
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Arthur K E Elfrink
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ronald S L Liem
- Department of Surgery, Dutch Obesity Clinic, Gouda, the Netherlands.,Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jan-Willem Elshof
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Emiel Verdaasdonk
- Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Marc G H Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Johannes H Hegeman
- Department of Surgery, Ziekenhuisgroep Twente Almelo-Hengelo, Almelo, Hengelo, the Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Daan M Voeten
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Franka S Würdemann
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anne-Loes K Warps
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anna J Alberga
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J Annelie Suurmeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Erman O Akpinar
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nienke Wolfhagen
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | | | - David J Heineman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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Luijten J, Westerman M, Nieuwenhuijzen G, Walraven J, Sosef M, Beerepoot L, van Hillegersberg R, Muller K, Hoekstra R, Bergman J, Siersema P, van Laarhoven H, Rosman C, Brom L, Vissers P, Verhoeven R. Team dynamics and clinician’s experience influence decision-making during Upper-GI multidisciplinary team meetings: A multiple case study. Front Oncol 2022; 12:1003506. [DOI: 10.3389/fonc.2022.1003506] [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] [Received: 07/26/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundThe probability of undergoing treatment with curative intent for esophagogastric cancer has been shown to vary considerately between hospitals of diagnosis. Little is known about the factors that attribute to this variation. Since clinical decision making (CDM) partially takes place during an MDTM, the aim of this qualitative study was to assess clinician’s perspectives regarding facilitators and barriers associated with CDM during MDTM, and second, to identify factors associated with CDM during an MDTM that may potentially explain differences in hospital practice.MethodsA multiple case study design was conducted. The thematic content analysis of this qualitative study, focused on 16 MDTM observations, 30 semi-structured interviews with clinicians and seven focus groups with clinicians to complement the collected data. Interviews were transcribed ad verbatim and coded.ResultsFactors regarding team dynamics that were raised as aspects attributing to CDM were clinician’s personal characteristics such as ambition and the intention to be innovative. Clinician’s convictions regarding a certain treatment and its outcomes and previous experiences with treatment outcomes, and team dynamics within the MDTM influenced CDM. In addition, a continuum was illustrated. At one end of the continuum, teams tended to be more conservative, following the guidelines more strictly, versus the opposite in which hospitals tended towards a more invasive approach maximizing the probability of curation.ConclusionThis study contributes to the awareness that variation in team dynamics influences CDM during an MDTM.
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Hofste LSM, Geerlings MJ, von Rhein D, Tolmeijer SH, Weiss MM, Gilissen C, Hofste T, Garms LM, Janssen MJR, Rütten H, Rosman C, van der Post RS, Klarenbeek BR, Ligtenberg MJL. Circulating Tumor DNA-Based Disease Monitoring of Patients with Locally Advanced Esophageal Cancer. Cancers (Basel) 2022; 14:cancers14184417. [PMID: 36139577 PMCID: PMC9497103 DOI: 10.3390/cancers14184417] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary The standard of care for patients diagnosed with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy followed by surgery. There is a high clinical need to monitor response to neoadjuvant treatment and recognize patients at risk for recurrence to enable individual treatment strategies. Ultradeep sequencing-based detection of circulating tumor DNA in preoperative plasma of patients with locally advanced esophageal cancer can predict which patients have a high risk of recurrence after neoadjuvant chemoradiotherapy and surgery. Circulating tumor DNA-based prediction of the presence of distant metastasis might eventually be used to reconsider surgery and its associated morbidity in patients with detected circulating tumor DNA or stratify patients for adjuvant treatment. Abstract Patients diagnosed with locally advanced esophageal cancer are often treated with neoadjuvant chemoradiotherapy followed by surgery. This study explored whether detection of circulating tumor DNA (ctDNA) in plasma can be used to predict residual disease during treatment. Diagnostic tissue biopsies from patients with esophageal cancer receiving neoadjuvant chemoradiotherapy and surgery were analyzed for tumor-specific mutations. These tumor-informed mutations were used to measure the presence of ctDNA in serially collected plasma samples using hybrid capture-based sequencing. Plasma samples were obtained before chemoradiotherapy, and prior to surgery. The association between ctDNA detection and progression-free and overall survival was measured. Before chemoradiotherapy, ctDNA was detected in 56% (44/78) of patients and detection was associated with tumor stage and volume (p = 0.05, Fisher exact and p = 0.02, Mann-Whitney, respectively). After chemoradiotherapy, ctDNA was detected in 10% (8/78) of patients. This preoperative detection of ctDNA was independently associated with recurrent disease (hazard ratio 2.8, 95% confidence interval 1.1–6.8, p = 0.03, multivariable Cox-regression) and worse overall survival (hazard ratio 2.9, 95% confidence interval 1.2–7.1, p = 0.02, multivariable Cox-regression).Ultradeep sequencing-based detection of ctDNA in preoperative plasma of patients with locally advanced esophageal cancer may help to assess which patients have a high risk of recurrence after neoadjuvant chemoradiotherapy and surgery.
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Affiliation(s)
- Lisa S. M. Hofste
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Maartje J. Geerlings
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Daniel von Rhein
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Sofie H. Tolmeijer
- Department of Medical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Marjan M. Weiss
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Christian Gilissen
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Tom Hofste
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Linda M. Garms
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Marcel J. R. Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Rachel S. van der Post
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Bastiaan R. Klarenbeek
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Marjolijn J. L. Ligtenberg
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-0024-3617-749
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37
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Talboom K, Greijdanus NG, van Workum F, Ubels S, Rosman C, Hompes R, de Wilt JHW, Tanis PJ. International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study. Int J Colorectal Dis 2022; 37:2049-2059. [PMID: 36002748 PMCID: PMC9436864 DOI: 10.1007/s00384-022-04240-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Little is known about the optimal treatment of anastomotic leakage after low anterior resection (LAR) for rectal cancer and whether treatment strategy depends on leakage features and patient characteristics. The objective of this study was to determine which treatment principles are used by expert colorectal surgeons worldwide. METHODS In this international case-vignette study, participants completed a survey on their preferred treatment for 11 clinical cases with varying leakage features and two patient scenarios depending on surgical risk (a total of 22 cases). RESULTS In total, 42 of 64 invited surgeons completed the survey from 18 countries worldwide. The majority worked at a university training hospital (62%) and had more than 15 years of experience performing LAR for rectal cancer (52%). Early leaks in septic patients were preferably treated by major salvage surgery, to some extent depending on the patient scenario. In early leaks in non-septic patients, drainage and faecal diversion were the cornerstones of the proposed treatment. Endoscopic vacuum therapy was more often proposed than percutaneous drainage. A minority proposed anastomotic reconstruction, more often for larger defects. Treatment of late leaks ranged from watchful waiting, drainage, or transanal repair to major (non-)restorative salvage surgery, with minimal influence of the degree of symptoms on the proposed strategy. Leaks of the blind loop and rectovaginal fistulae showed high variability in the proposed treatment strategy. CONCLUSION This TENTACLE-Rectum case-vignette study demonstrates tailored treatment strategies depending on the clinical type of leak and patient characteristics, with variable degrees of consensus and knowledge gaps which should be addressed in future studies.
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Affiliation(s)
- Kevin Talboom
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Nynke G Greijdanus
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Sander Ubels
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022; 109:864-871. [PMID: 35759409 PMCID: PMC10364775 DOI: 10.1093/bjs/znac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. METHODS This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. RESULTS Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. CONCLUSION The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group, Almelo, the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust, Newcastle upon Tyne, UK.,Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital, Guildford, UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Bakx J, Doeve B, Siersema P, Rosman C, Grieken N, van Berge Henegouwen M, van Sandick J, Verheij M, Bijlsma M, Verhoeven R, van Laarhoven H. PD-1 The impact of COVID-19 on diagnosis, stage and treatment of esophageal and gastric cancer. Ann Oncol 2022. [PMCID: PMC9250150 DOI: 10.1016/j.annonc.2022.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Al-Kaabi A, Baranov NS, van der Post RS, Schoon EJ, Rosman C, van Laarhoven HWM, Verheij M, Verhoeven RHA, Siersema PD. Age-specific incidence, treatment, and survival trends in esophageal cancer: a Dutch population-based cohort study. Acta Oncol 2022; 61:545-552. [PMID: 35112634 DOI: 10.1080/0284186x.2021.2024878] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Data on the age-specific incidence of esophageal cancer are lacking. Our aim was to investigate the age-stratified incidence, treatment, and survival trends of esophageal cancer in the Netherlands, with a focus on adults <50 years. MATERIAL AND METHODS Patients diagnosed with esophageal cancer were included from the nationwide Netherlands Cancer Registry (1989-2018). Follow-up data were available until 31 December 2018. Annual percentage changes of incidence were analyzed according to age group (<50, 50-74, and ≥75 years) and histology type: adenocarcinoma (EAC) and squamous cell carcinoma (ESCC). Treatment trends and relative survival rates (RSR) were estimated by age and stage grouping. RESULTS A total 59,584 patients were included. In adults <50 years, EAC incidence tripled (mean increase per year: males 1.5%, females 3%), while the incidence of ESCC decreased (mean decrease per year: males -5.3%, females -4.3%). Patients <50 years more often presented with advanced disease stages compared to older patients and were more likely to receive multimodality treatments. Most patients <50 years with potentially curable disease were treated with neoadjuvant chemoradiotherapy followed by surgery compared to patients 50-74 and ≥75 years (74% vs. 55% vs. 15%, respectively; p < .001), and received more frequent systemic therapy once staged with palliative disease (72% vs. 54% vs. 19%, respectively; p < .001). The largest RSR improvement was seen in patients <50 years with early-stage (five years: +47%), potentially curable (five years: +22%), and palliative disease (one year: +11%). Over time, a trend of increasing survival difference was seen between patients <50 and ≥75 years with potentially curable (five-year difference: 17% to 27%) and palliative disease (one-year difference: 11% to 20%). CONCLUSION The incidence of EAC is increasing in adults <50 years in the Netherlands. Differences in the use of multimodality treatments with curative or life-prolonging intent in different age categories may account for increasing survival gaps.
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Affiliation(s)
- Ali Al-Kaabi
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nikolaj S. Baranov
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erik J. Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands and GROW: School of Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rob H. A. Verhoeven
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Luijten JCHBM, Vissers PAJ, Brom L, de Bièvre M, Buijsen J, Rozema T, Mohammad NH, van Duijvendijk P, Kouwenhoven EA, Eshuis WJ, Rosman C, Siersema PD, van Laarhoven HWM, Verhoeven RHA, Nieuwenhuijzen GAP, Westerman MJ. Clinical variation in the organization of clinical pathways in esophagogastric cancer, a mixed method multiple case study. BMC Health Serv Res 2022; 22:527. [PMID: 35449018 PMCID: PMC9022421 DOI: 10.1186/s12913-022-07845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Among esophagogastric cancer patients, the probability of having undergone treatment with curative intent has been shown to vary, depending on the hospital of diagnosis. However, little is known about the factors that contribute to this variation. In this study, we sought to understand the organization of clinical pathways and their association with variation in practice. Methods A mixed-method study using quantitative and qualitative data was conducted. Quantitative data were obtained from the Netherlands Cancer Registry (e.g., outpatient clinic consultations and diagnostic procedures). For qualitative data, thematic content analysis was performed using semi-structured interviews (n = 30), observations of outpatient clinic consultations (n = 26), and multidisciplinary team meetings (MDTM, n = 16) in eight hospitals, to assess clinicians’ perspectives regarding the clinical pathways. Results Quantitative analyses showed that patients more often underwent surgical consultation prior to the MDTM in hospitals associated with a high probability of receiving treatment with curative intent, but more often consulted with a geriatrician in hospitals associated with a low probability of such treatment. The organization of clinical pathways was analyzed quantitatively at three levels: regional, local, and patient levels. At a regional level, hospitals differed in terms of the number of patients discussed during the MDTM. At the local level, the revision of radiological images and restaging after neoadjuvant treatment varied. At the patient level, some hospitals routinely conduct fitness tests, whereas others estimated the patient’s physical fitness during an outpatient clinic consultation. Few clinicians performed a standard geriatric consultation in older patients to assess their mental fitness and frailty. Conclusion Surgical consultation prior to MDTM was more often conducted in hospitals associated with a high probability of receiving treatment with curative intent, whereas a geriatrician was consulted more often in hospitals associated with a low probability of receiving such treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07845-2.
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Affiliation(s)
- J C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - P A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.,Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - L Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands
| | - M de Bièvre
- Department of Gastroenterology, Viecuri Medical Center, Venlo, The Netherlands
| | - J Buijsen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - T Rozema
- Department of Radiation Oncology, Verbeten Insitute, Tilburg, The Netherlands
| | - N Haj Mohammad
- Department of Medical Oncology, Utrecht UMC, Utrecht University, Utrecht, The Netherlands
| | | | | | - W J Eshuis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rosman
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - P D Siersema
- Department of Gastroenterology, Radboudumc, Nijmegen, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands. .,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - M J Westerman
- Department of Epidemiology and Datascience, Amsterdam UMC, Amsterdam, The Netherlands
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac016] [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: 11/06/2022]
Abstract
Abstract
Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).
Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.
Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022; 109:439-449. [PMID: 35194634 DOI: 10.1093/bjs/znac016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. METHODS Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). RESULTS Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. CONCLUSION Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Graham Martínez C, Kus Öztürk S, Al-Kaabi A, Valkema MJ, Bokhorst JM, Rosman C, Rütten H, Wauters CAP, Doukas M, van Lanschot JJB, Siersema PD, Nagtegaal ID, van der Post RS. Shrinkage versus fragmentation response in neoadjuvantly treated oesophageal adenocarcinoma: significant prognostic relevance. Histopathology 2022; 80:982-994. [PMID: 35352847 PMCID: PMC9325353 DOI: 10.1111/his.14644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/23/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
Aims No consensus exists on the clinical value of tumour regression grading (TRG) systems for therapy effects of neoadjuvant chemoradiotherapy (nCRT) in oesophageal adenocarcinoma. Existing TRG systems lack standardization and reproducibility, and do not consider the morphological heterogeneity of tumour response. Therefore, we aim to identify morphological tumour regression patterns of oesophageal adenocarcinoma after nCRT and their association with survival. Methods and results Patients with oesophageal adenocarcinoma, who underwent nCRT followed by surgery and achieved a partial response to nCRT, were identified from two Dutch upper‐gastrointestinal (GI) centres (2005–18; test cohort). Resection specimens were scored for regression patterns by two independent observers according to a pre‐defined three‐step flowchart. The results were validated in an external cohort (2001–17). In total, 110 patients were included in the test cohort and 115 in the validation cohort. In the test cohort, two major regression patterns were identified: fragmentation (60%) and shrinkage (40%), with an excellent interobserver agreement (κ = 0.87). Here, patients with a fragmented pattern had a significantly higher pathological stage (stages III/IV: 52 versus 16%; P < 0.001), less downstaging (48 versus 91%; P < 0.001), a higher risk of recurrence [risk ratio (RR) = 2.9, 95% confidence interval (CI) = 1.5–5.6] and poorer 5‐year overall survival (30 versus 80% respectively, P = 0.001). Conclusions The validation cohort confirmed these findings, although had more advanced cases (case‐stages = III/IV 91 versus 73%, P = 0.005) and a higher prevalence of fragmented‐pattern cases (80 versus 60%, P = 0.002). When combining the cohorts in multivariate analysis, the pattern of response was an independent prognostic factor [hazard ratio (HR) = 1.76, 95% CI = 1.0–3.0]. In conclusion, we established an externally validated, reproducible and clinically relevant classification of tumour response.
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Affiliation(s)
| | - Sonay Kus Öztürk
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ali Al-Kaabi
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maria J Valkema
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - John-Melle Bokhorst
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Heidi Rütten
- Department of Radiotherapy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carla A P Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Michail Doukas
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - J Jan B van Lanschot
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Kroese TE, van Hillegersberg R, Schoppmann S, Deseyne PR, Nafteux P, Obermannova R, Nordsmark M, Pfeiffer P, Hawkings MA, Smyth E, Markar S, Hanna GB, Cheong E, Chaudry A, Elme A, Adenis A, Piessen G, Gani C, Bruns CJ, Moehler M, Liakakos T, Reynolds J, Morganti A, Rosati R, Castoro C, D'Ugo D, Roviello F, Bencivenga M, de Manzoni G, Jeene P, van Sandick JW, Muijs C, Slingerland M, Nieuwenhuijzen G, Wijnhoven B, Beerepoot LV, Kolodziejczyk P, Polkowski WP, Alsina M, Pera M, Kanonnikoff TF, Nilsson M, Guckenberger M, Monig S, Wagner D, Wyrwicz L, Berbee M, Gockel I, Lordick F, Griffiths EA, Verheij M, van Rossum PS, van Laarhoven HW, Rosman C, Rütten H, Gootjes EC, Vonken FE, van Dieren JM, Vollebergh MA, van der Sangen M, Creemers GJ, Zander T, Schlößer H, Cascinu S, Mazza E, Nicoletti R, Damascelli A, Slim N, Passoni P, Cossu A, Puccetti F, Barbieri L, Fanti L, Azzolini F, Ventoruzzo F, Szczepanik A, Visa L, Reig A, Roques T, Harrison M, Ciseł B, Pikuła A, Skórzewska M, Vanommeslaeghe H, Van Daele E, Pattyn P, Geboes K, Callebout E, Ribeiro S, van Duijvendijk P, Tromp C, Sosef M, Warmerdam F, Heisterkamp J, Heisterkamp J, Vera A, Jordá E, López-Mozos F, Fernandez-Moreno MC, Barrios-Carvajal M, Huerta M, de Steur W, Lips I, Diez M, Castro S, O'Neill R, Holyoake D, Hacker U, Denecke T, Kuhnt T, Hoffmeister A, Kluge R, Bostel T, Grimminger P, Jedlička V, Křístek J, Pospíšil P, Mourregot A, Maurin C, Starling N, Chong I. Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe. Eur J Cancer 2022; 164:18-29. [DOI: 10.1016/j.ejca.2021.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 12/17/2022]
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Luijten JCHBM, Brom L, Vissers PAJ, van de Wouw YAJ, Warmerdam FARM, Heisterkamp J, Mook S, Oulad Hadj J, van Det MJ, Timmermans L, Hulshof MCCM, van Laarhoven HWM, Rosman C, Siersema PD, Westerman MJ, Verhoeven RHA, Nieuwenhuijzen GAP. Treatment decision-making during outpatient clinic visit of patients with esophagogastric cancer. The perspectives of clinicians and patients, a mixed method, multiple case study. Cancer Med 2022; 11:2427-2444. [PMID: 35166037 PMCID: PMC9189462 DOI: 10.1002/cam4.4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The probability of undergoing treatment with curative intent according to the hospital of diagnosis varies for esophagogastric cancer in the Netherlands. Little is known about the factors contributing to this variation. This study aimed to improve the understanding of the differences between the multidisciplinary team meeting treatment proposal and the treatment that was actually carried out and to qualitatively investigate the differences in treatment decision-making after the multidisciplinary team meeting treatment proposal between hospitals. METHODS To gain an in-depth understanding of treatment decision-making, quantitative data (i.e., multidisciplinary team meeting proposal and treatment that was carried out) were collected from the Netherlands Cancer Registry. Changes in the multidisciplinary team meeting proposal and applied treatment comprised changes in the type of treatment option (i.e., curative or palliative, or no change) and were calculated according to the multivariable multilevel probability of undergoing treatment with curative intent (low, middle, and high). Qualitative data were collected from eight hospitals, including observations of 26 outpatient clinic consultations, 30 in-depth interviews with clinicians, seven focus groups with clinicians, and three focus groups with patients. Clinicians and patients' perspectives were assessed using thematic content analysis. RESULTS The multidisciplinary team meeting proposal and applied treatment were concordant in 97% of the cases. Clinicians' implementation of treatment decision-making in clinical practice varied, which was mentioned by the clinicians to be due to the clinician's personality and values. Differences between clinicians consisted of discussing all treatment options versus only the best fitting treatment option and the extent of discussing the benefits and harms. Most patients aimed to undergo curative treatment regardless of the consequences, since they believed this could prolong their life. CONCLUSION Since changes in the multidisciplinary team meeting-proposed treatment and actual treatment were rarely observed, this study emphasizes the importance of an adequately formulated multidisciplinary team meeting proposal.
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Affiliation(s)
- Josianne C H B M Luijten
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Pauline A J Vissers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Yes A J van de Wouw
- Department of Medical Oncology, Viecuri Medical Centre, Venlo, The Netherlands
| | | | - Joos Heisterkamp
- Department of Surgery, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jamal Oulad Hadj
- Department of Medical Oncology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Marc J van Det
- Department of Surgery, Hospital group Twente, Almelo, The Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.,SPKS Leven met maag- of slokdarmkanker, Utrecht, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Westerman
- Department of Epidemiology and Biostatistics Amsterdam UMC, Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Ubels S, Verstegen M, Bouwense S, Hannink G, Siersema P, Klarenbeek B, van Workum F, Rosman C. TreatmENT of AnastomotiC LEakage after esophagectomy (TENTACLE - Esophagus) study: efficacy of different initial treatment strategies for anastomotic leakage. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.451] [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: 10/19/2022]
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Hermus M, van der Wilk B, Collee G, Chang R, Noordman B, Dekker JW, van Esser S, Nieuwenhuijzen G, Luyer M, Rosman C, Klarenbeek B, Coene PP, van der Harst E, Wijnhoven B, van Busschbach J, van Lanschot J, Lagarde S, Kranenburg L. Patient preferences for active surveillance versus standard surgery after neoadjuvant chemoradiotherapy in esophageal cancer treatment. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.362] [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: 12/01/2022] Open
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