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Groenen H, Bontekoning N, Jalalzadeh H, Buis DR, Dreissen YEM, Goosen JHM, Graveland H, Griekspoor M, IJpma FFA, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, Orsini RG, Eskes AM, Wolfhagen N, de Jonge SW, Boermeester MA. Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis. JAMA Surg 2024:2817941. [PMID: 38656408 PMCID: PMC11044014 DOI: 10.1001/jamasurg.2024.0775] [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: 10/09/2023] [Accepted: 01/06/2024] [Indexed: 04/26/2024]
Abstract
Importance Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use. Objective To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery. Data Sources PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023. Study Selection Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded. Data Extraction and Synthesis This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported. Main Outcome and Measure The primary study outcome was SSI. Results A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty). Conclusions and Relevance This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.
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Affiliation(s)
- Hannah Groenen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Nathan Bontekoning
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Hasti Jalalzadeh
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Dennis R. Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Yasmine E. M. Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Jon H. M. Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Haitske Graveland
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - Frank F. A. IJpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten J. van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Roald R. Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
- Dutch Association of Anaesthesiology (NVA), the Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Wil C. van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ricardo G. Orsini
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
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Groenen H, Jalalzadeh H, Buis DR, Dreissen YE, Goosen JH, Griekspoor M, Harmsen WJ, IJpma FF, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, de Jonge SW, Orsini RG, Eskes AM, Wolfhagen N, Boermeester MA. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine 2023; 62:102105. [PMID: 37538540 PMCID: PMC10393772 DOI: 10.1016/j.eclinm.2023.102105] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Background The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA). Methods PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995. Findings We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. Interpretation In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence. Funding Dutch Association for Quality Funds Medical Specialists.
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Affiliation(s)
- Hannah Groenen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Hasti Jalalzadeh
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Dennis R. Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Yasmine E.M. Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jon H.M. Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Wouter J. Harmsen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Frank F.A. IJpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Division of Trauma Surgery, Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Maarten J. van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Roald R. Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, Netherlands
- Dutch Association of Anesthesiology (NVA), Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wil C. van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, Maastricht, Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Ricardo G. Orsini
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
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Ketelaers SHJ, van Heinsbergen M, Orsini RG, Vogelaar FJ, Konsten JLM, Nieuwenhuijzen GAP, Rutten HJT, Burger JWA, Bloemen JG. Functional Bowel Complaints and the Impact on Quality of Life After Colorectal Cancer Surgery in the Elderly. Front Oncol 2022; 12:832377. [PMID: 35242714 PMCID: PMC8886503 DOI: 10.3389/fonc.2022.832377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
Background The Low Anterior Resection Syndrome (LARS) is commonly reported after colorectal cancer surgery and significantly impairs quality of life. The prevalence and impact of LARS in the elderly after rectal cancer as well as colon cancer surgery is unclear. We aimed to describe the prevalence of LARS complaints and the impact on quality of life in the elderly after colorectal cancer surgery. Materials and Methods Patients were included from seven Dutch hospitals if they were at least one year after they underwent colorectal cancer surgery between 2008 and 2015. Functional bowel complaints were assessed by the LARS score. Quality of life was assessed by the EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Outcomes in patients ≥70 years were compared to a reference group of patients <70 years. Results In total 440 rectal cancer and 1183 colon cancer patients were eligible for analyses, of whom 133 (30.2%) rectal and 536 (45.3%) colon cancer patients were ≥70 years. Major LARS was reported by 40.6% of rectal cancer and 22.2% of colon cancer patients ≥70 years. In comparison, patients <70 years reported major LARS in 57.3% after rectal cancer surgery (p=0.001) and in 20.4% after colon cancer surgery (p=0.41). Age ≥70 years was independently associated with reduced rates of major LARS after rectal cancer surgery (OR 0.63, p=0.04). Patients with major LARS reported significantly impaired quality of life on almost all domains. Conclusion Elderly should not be withheld a restorative colorectal cancer resection based on age alone. However, a substantial part of the elderly colorectal cancer patients develops major LARS after surgery, which often severely impairs quality of life. Since elderly frequently consider quality of life and functional outcomes as one of the most important outcomes after treatment, major LARS and its impact on quality of life should be incorporated in the decision-making process.
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Affiliation(s)
| | | | - Ricardo G Orsini
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
| | | | - Joop L M Konsten
- Department of Surgery, VieCuri Medical Centre, Venlo, Netherlands
| | | | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands.,GROW, School for Developmental Biology & Oncology, Maastricht University, Maastricht, Netherlands
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4
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Ketelaers S, van Heinsbergen M, Orsini RG, Vogelaar J, Konsten JL, Nieuwenhuijzen GA, Rutten HJ, Burger JW, Bloemen JG. Functional bowel complaints and the impact on quality of life after colorectal cancer surgery in the elderly. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ketelaers SHJ, Orsini RG, Nieuwenhuijzen GAP, Rutten HJT, Burger JWA, Bloemen JG. Outcomes on diverting ostomy formation and reversal after low anterior resection in the older more advanced rectal cancer patient. Eur J Surg Oncol 2021; 48:1414-1420. [PMID: 35000819 DOI: 10.1016/j.ejso.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To decrease morbidity caused by anastomotic leakages after a low anterior resection (LAR) with primary anastomosis, a diverting ostomy is often created. Reversal of a diverting ostomy is associated with morbidity, which may result in non-reversal, particularly in the elderly. This study aimed to describe the diverting ostomy-related outcomes in elderly patients with more advanced rectal cancer after LAR. MATERIALS AND METHODS All rectosigmoid and rectal cancer patients ≥70 years who underwent LAR with primary anastomosis between 2006 and 2019 in the Catharina Hospital (Eindhoven, The Netherlands) were included for analyses. Reversal rates, ostomy-related complications, morbidity and mortality after ostomy reversal, and definitive ostomy rates were evaluated. RESULTS In total 164 patients were included, of which 150 (91.5%) underwent primary or secondary ostomy creation. Ostomy-related complications were reported in 34.7% (95%-CI 27.1-42.9%). In total, 72.5% (95%-CI 64.2-79.7%) reversed their diverting ostomy. Non-reversal was mostly due to relapsing disease (52.6%). Median time to ostomy reversal was 3.2 months (IQR 2.3-5.0). No or minor complications after ostomy reversal were observed in 84.0% (95%-CI 75.3-90.6%). Over time, ostomy recreation was performed in 15.0% (95%-CI 8.6-23.5%), and ultimately 65.8% (95%-CI 57.8-73.2%) were ostomy-free after the median follow-up of 3.8 years. CONCLUSION Although most elderly successfully reversed their diverting ostomy after LAR with limited morbidity, attention should be paid for the risk of non-reversal and ostomy recreation over time. Preoperative patient counselling is important in every individual to be able to decide if LAR with primary anastomosis or a permanent end colostomy is preferred.
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Affiliation(s)
- S H J Ketelaers
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
| | - R G Orsini
- Department of Surgery, ETZ (Elisabeth-TweeSteden) Hospital, Tilburg, the Netherlands
| | | | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; Department of GROW, School for Developmental Biology & Oncology, Maastricht University, Maastricht, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - J G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
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6
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Scheijmans JCG, Borgstein ABJ, Puylaert CAJ, Bom WJ, Bachiri S, van Bodegraven EA, Brandsma ATA, Ter Brugge FM, de Castro SMM, Couvreur R, Franken LC, Gaspersz MP, de Graaff MR, Groenen H, Kleipool SC, Kuypers TJL, Martens MH, Mens DM, Orsini RG, Reneerkens NJMM, Schok T, Sedee WJA, Tavakoli Rad S, Volders JH, Weeder PD, Prins JM, Gietema HA, Stoker J, Gisbertz SS, Besselink MGH, Boermeester MA. Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020. BMC Emerg Med 2021; 21:61. [PMID: 33980150 PMCID: PMC8114672 DOI: 10.1186/s12873-021-00454-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background During the COVID-19 pandemic, a decrease in the number of patients presenting with acute appendicitis was observed. It is unclear whether this caused a shift towards more complicated cases of acute appendicitis. We compared a cohort of patients diagnosed with acute appendicitis during the 2020 COVID-19 pandemic with a 2019 control cohort. Methods We retrospectively included consecutive adult patients in 21 hospitals presenting with acute appendicitis in a COVID-19 pandemic cohort (March 15 – April 30, 2020) and a control cohort (March 15 – April 30, 2019). Primary outcome was the proportion of complicated appendicitis. Secondary outcomes included prehospital delay, appendicitis severity, and postoperative complication rates. Results The COVID-19 pandemic cohort comprised 607 patients vs. 642 patients in the control cohort. During the COVID-19 pandemic, a higher proportion of complicated appendicitis was seen (46.9% vs. 38.5%; p = 0.003). More patients had symptoms exceeding 24 h (61.1% vs. 56.2%, respectively, p = 0.048). After correction for prehospital delay, presentation during the first wave of the COVID-19 pandemic was still associated with a higher rate of complicated appendicitis. Patients presenting > 24 h after onset of symptoms during the COVID-19 pandemic were older (median 45 vs. 37 years; p = 0.001) and had more postoperative complications (15.3% vs. 6.7%; p = 0.002). Conclusions Although the incidence of acute appendicitis was slightly lower during the first wave of the 2020 COVID-19 pandemic, more patients presented with a delay and with complicated appendicitis than in a corresponding period in 2019. Spontaneous resolution of mild appendicitis may have contributed to the increased proportion of patients with complicated appendicitis. Late presenting patients were older and experienced more postoperative complications compared to the control cohort. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00454-y.
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Affiliation(s)
- Jochem C G Scheijmans
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Alexander B J Borgstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter J Bom
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Said Bachiri
- Department of Surgery, Noordwest Hospital Group, Alkmaar, the Netherlands
| | | | | | | | | | - Roy Couvreur
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lotte C Franken
- Departement of Surgery, Flevo Hospital, Almere, the Netherlands
| | - Marcia P Gaspersz
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Hannah Groenen
- Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands
| | | | - Toon J L Kuypers
- Department of Surgery, Elisabeth - Tweesteden Hospital, Tilburg, the Netherlands
| | - Milou H Martens
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - David M Mens
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Ricardo G Orsini
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | | | - Thomas Schok
- Department of Surgery, VieCuri Medisch Centrum for Noord-Limburg, Venlo, the Netherlands
| | - Wouter J A Sedee
- Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | | | - José H Volders
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Pepijn D Weeder
- Department of Surgery, Spaarne Gasthuis, Haarlem, and Hoofddorp, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G H Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Ketelaers SHJ, Voogt ELK, Simkens GA, Bloemen JG, Nieuwenhuijzen GAP, de Hingh IHJ, Rutten HJT, Burger JWA, Orsini RG. Age-related differences in morbidity and mortality after surgery for primary clinical T4 and locally recurrent rectal cancer. Colorectal Dis 2021; 23:1141-1152. [PMID: 33492750 DOI: 10.1111/codi.15542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
AIM Outcomes in elderly patients (≥75 years) with non-advanced colorectal cancer have improved. It is unclear whether this is also true for elderly patients with clinical T4 rectal cancer (cT4RC) or locally recurrent rectal cancer (LRRC). We aimed to compare age-related differences in morbidity and mortality after curative treatment for cT4RC and LRRC. METHODS All cT4RC and LRRC patients without distant metastasis who underwent curative surgery between 2005 and 2017 in the Catharina Hospital (Eindhoven, The Netherlands) were included. Morbidity and mortality were evaluated based on age (<75 and ≥75 years) and date of surgery (2005-2011 and 2012-2017). RESULTS Overall, 72 of 474 (15.2%) cT4RC and 53 of 293 (18.1%) LRRC patients were ≥75 years. No significant differences in the incidence of Clavien-Dindo I-IV complications were observed between age groups. However, in elderly cT4RC patients, cerebrovascular accidents occurred more frequently (4.2% vs. 0.5%, P = 0.03). Between 2005-2011 and 2012-2017, 30-day mortality improved from 7.5% to 3.1% and from 10.0% to 0.0% in elderly cT4RC and LRRC patients, respectively. The 1-year mortality during 2012-2017 was worse in elderly than in younger patients (28.1% vs. 6.2%, P = 0.001 for cT4RC and 27.3% vs. 13.8%, P = 0.06 for LRRC). In elderly cT4RC and LRRC patients, 44.4% and 46.2% died due to non-cancer-related causes, while only 27.8% and 23.1% died due to disease recurrence, respectively. CONCLUSION Although the 30-day mortality in elderly cT4RC and LRRC patients improved after curative treatment, the 1-year mortality in elderly patients continued to be high, which requires more awareness for the elderly after hospitalization.
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Affiliation(s)
- S H J Ketelaers
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - E L K Voogt
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - G A Simkens
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - J G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - I H J de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - R G Orsini
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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8
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van Riet YE, Schipper RJ, van Merrienboer F, Orsini RG, Bloemen JG, Jansen FH, Nieuwenhuijzen GAP. Is specimen radiography still necessary in patients with non-palpable breast cancer undergoing breast-conserving surgery using radioactive I-125 seed localization? Clin Imaging 2020; 69:311-317. [PMID: 33045475 DOI: 10.1016/j.clinimag.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/25/2020] [Accepted: 10/01/2020] [Indexed: 12/09/2022]
Abstract
AIM To evaluate the diagnostic performance for margin assessment of specimen radiography (SR) in breast conserving surgery (BCS) using radioactive I125-seed localization (RSL). METHODS The clinical, radiographic and histopathological data of women who underwent BCS after pre-operative RSL with intraoperative SR during nine consecutive years were analyzed. The histological margin and radiographic margin outcomes on SR were compared and results of intraoperative re-excisions were investigated. RESULTS A consecutive series of 448 women with invasive carcinoma (n = 211), ductal carcinoma in situ (DCIS) (n = 79) and a combination of DCIS and invasive carcinoma (n = 158) were included. The median minimal margins for the radiological masses and microcalcifications measured on SR were 14 mm and 11 mm, respectively. Based on a radiological cut-off SR margin value of 1 mm, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 21.0%, 95.0%, 26.0%, and 94.0%, respectively. The area under the receiver-operating curve was 0.73. Intraoperative re-excisions based on SR were performed in 31 (6.9%) patients; histopathological examination of the additional excised tissue revealed DCIS or invasive carcinoma in 6 (19.4%) patients. Hence, SR was beneficial for 6/448 patients (1.3%), and unnecessary intraoperative re-excisions were performed in 20/448 patients (4.5%). The number need to treat is 75; this implies that per 75-SR one resection with involved margins is prevented. CONCLUSION SR has a moderate diagnostic performance for margin involvement using RSL. A more accurate intraoperative margin assessment tool is warranted.
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Affiliation(s)
- Yvonne E van Riet
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
| | | | - Ricardo G Orsini
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
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Ketelaers SHJ, Fahim M, Rutten HJT, Smits AB, Orsini RG. When and how should surgery be performed in senior colorectal cancer patients? Eur J Surg Oncol 2020; 46:326-332. [PMID: 31955993 DOI: 10.1016/j.ejso.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022] Open
Abstract
Older studies reported high rates of postoperative morbidity and mortality in the senior population, which lead to a tendency to withhold curative surgery in the older population. However, more recent studies showed impressing developments in postoperative outcomes in seniors. Probably, these improvements are due to enhancements in both surgical and non-surgical aspects in the pre-, peri- and postoperative period, such as minimally invasive techniques and anesthesiological insights. The postoperative survival gap seen earlier between younger and older patients is fading. For optimal treatment in the older population, special awareness and care on several aspects is needed. As only a minority of the seniors are frail, a quick frailty assessment is crucial to distinguish the fit from the frail in the decision-making process. In addition, it could be valuable to improve the lacks in physical condition in the preoperative period with the use of prehabilitation programs. Furthermore, it is important to evolve an emergency to an elective setting by postponing emergency surgery to prevent any high-risk situation. In conclusion, based on modern insights, surgery is a valid option in the curative treatment of colorectal cancer in seniors, however individual attention and care is required.
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Affiliation(s)
- S H J Ketelaers
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands.
| | - M Fahim
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands; GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - R G Orsini
- Department of Surgery, Catharina Hospital Eindhoven, the Netherlands
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10
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Vermeer TA, Orsini RG, Nieuwenhuijzen GAP, Rutten HJT, Daams F. Stoma placement in obstructive rectal cancer prior to neo-adjuvant treatment and definitive surgery: A practical guideline. Eur J Surg Oncol 2015; 42:273-80. [PMID: 26681383 DOI: 10.1016/j.ejso.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/01/2015] [Accepted: 11/09/2015] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Mechanical bowel obstruction in rectal cancer is a common problem, requiring stoma placement to decompress the colon and permit neo-adjuvant treatment. The majority of patients operated on in our hospital are referred; after stoma placement at the referring centre without overseeing final type of surgery. Stoma malpositioning and its effects on rectal cancer care are described. METHODS All patients who underwent surgery for locally advanced or locally recurrent rectal cancer between 2000 and 2013 in our tertiary referral centre were reviewed and included if they received a stoma before curative surgery. Patients with recurrent rectal cancer were only included if the stomas from the primary surgery had been restored. The main outcome measures are stoma malpositioning, postoperative and stoma-related complications. RESULTS A total of 726 patients were included; of these, 156 patients (21%) had a stoma before curative surgery. In the majority of patients, acute or pending large bowel obstruction was the main indication for emergent stoma creation; some of the patients had tumour-related fistulae. In 53 patients (34%), the stoma required revision during definitive surgery. No significant differences were found regarding postoperative complications. CONCLUSION One-third of the previously placed emergency stomas were considered to be located inappropriately and required revision. We were able to avoid increased complication rates in patients with a malpositioned stoma, however unnecessary surgery for an inappropriately placed stoma should be avoided to decrease patient inconvenience and risks. An algorithm is proposed for the placement of a suitable stoma.
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Affiliation(s)
- T A Vermeer
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
| | - R G Orsini
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
| | - G A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
| | - F Daams
- Department of Surgery, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Orsini RG, Verhoeven RH, Lemmens VE, van Steenbergen LN, de Hingh IH, Nieuwenhuijzen GA, Rutten HJ. Comparable survival for young rectal cancer patients, despite unfavourable morphology and more advanced-stage disease. Eur J Cancer 2015; 51:1675-82. [DOI: 10.1016/j.ejca.2015.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 01/26/2023]
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Affiliation(s)
- R G Orsini
- Catharina Hospital, Eindhoven, The Netherlands
| | - T Wiggers
- University Medical Centre Groningen, Groningen, The Netherlands
| | - M C DeRuiter
- Leiden University Medical Centre, Leiden, The Netherlands
| | - P Quirke
- Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - R G Beets-Tan
- GROW School for Oncology & Developmental Biology, Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - H J T Rutten
- Catharina Hospital, Eindhoven, The Netherlands ; GROW School for Oncology & Developmental Biology, Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Traa MJ, Braeken J, De Vries J, Roukema JA, Orsini RG, Den Oudsten BL. Evaluating quality of life and response shift from a couple-based perspective: a study among patients with colorectal cancer and their partners. Qual Life Res 2014; 24:1431-41. [PMID: 25429822 DOI: 10.1007/s11136-014-0872-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine (1) measurement invariance of quality of life (QoL) domains over time for patients with colorectal cancer and partners (i.e., response shift--recalibration, reprioritization, and reconceptualization), (2) between dyad-member measurement invariance and (3) QoL trajectories. METHODS Participants completed the WHOQOL-Bref preoperative (Time-0) and 3 (Time-1) and 6 months (Time-2) postoperative. A stepwise procedure, using nested factor models, examined the viability of restricting specific model parameters to be equal across measurements and between dyad members. FINDINGS No reconceptualization and reprioritization was detected, but indications for recalibration were present. Therefore, comparisons were restricted to group-level statistics at factor level. For patients, a decrease in the Physical Health domain occurred at Time-1 (p < 0.001), with partial recovery to baseline at Time-2 (p = 0.055). For partners, factor means in this domain remained constant (p's > 0.05) and were at each time point higher than patients' factor means (p's < 0.05). Patients' and partners' Psychological Health decreased at Time-1 (p's < 0.05), with stabilization at Time-2 (p's > 0.05). Patients and partners' factor means were comparable (p's > 0.05). Patients and partners' Social Relationship factor means decreased at Time-1 (p's < 0.05), which decreased further for patients (p = 0.011) but stabilized for partners (p = 0.214). Partners' factor means were only lower than patients' factor means at Time-1. A similar decrease in the Environmental domain factor means occurred for both patients and partners at Time-1 (p's < 0.05), with stabilization at Time-2 (p's > 0.05). CONCLUSION Since both patients and partners are affected by the patients' disease and treatment, we recommend that attention is paid to the couple instead of solely the patient.
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Affiliation(s)
- Marjan J Traa
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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Traa MJ, Orsini RG, Oudsten BLD, Vries JD, Roukema JA, Bosman SJ, Dudink RL, Rutten HJ. Measuring the health-related quality of life and sexual functioning of patients with rectal cancer: Does type of treatment matter? Int J Cancer 2013; 134:979-87. [DOI: 10.1002/ijc.28430] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/25/2013] [Accepted: 06/26/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Marjan J. Traa
- CoRPS - Center of Research on Psychology in Somatic Diseases; Department of Medical Psychology; Tilburg University; Tilburg The Netherlands
| | - Ricardo G. Orsini
- Department of Surgery; Catharina Hospital; Eindhoven The Netherlands
| | - Brenda L. Den Oudsten
- CoRPS - Center of Research on Psychology in Somatic Diseases; Department of Medical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Education and Research; St. Elisabeth Hospital; Tilburg The Netherlands
| | - Jolanda De Vries
- CoRPS - Center of Research on Psychology in Somatic Diseases; Department of Medical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Medical Psychology; St. Elisabeth Hospital; Tilburg The Netherlands
| | - Jan A. Roukema
- CoRPS - Center of Research on Psychology in Somatic Diseases; Department of Medical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Surgery; St. Elisabeth Hospital; Tilburg The Netherlands
| | - Sietske J. Bosman
- Department of Surgery; Catharina Hospital; Eindhoven The Netherlands
| | - Ralph L. Dudink
- Department of Surgery; Catharina Hospital; Eindhoven The Netherlands
| | - Harm J.T. Rutten
- Department of Surgery; Catharina Hospital; Eindhoven The Netherlands
- Research Institute Growth and Development; Maastricht University Medical Center; The Netherlands
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van Steenbergen LN, de Hingh IHJT, Rutten HJT, Rijk MCM, Orsini RG, Coebergh JWW, Lemmens VEPP. Large variation between hospitals in follow-up for colorectal cancer in southern Netherlands. Int J Colorectal Dis 2013; 28:1257-65. [PMID: 23624873 DOI: 10.1007/s00384-013-1693-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Accepted: 03/20/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The aims of the study were to describe the follow-up of colorectal cancer (CRC) patients in southern Netherlands and examine their overall and disease-free survival. METHODS Patients newly diagnosed with CRC in 2003-2005 and 2008 with a survival of at least 1 year after diagnosis and recorded in the retrospective Eindhoven Cancer Registry were included (n = 579). Follow-up was defined as at least one liver imaging and at least two carcinoembryonic antigen (CEA) measurements. Logistic regression analyses were conducted to assess determinants of follow-up. Proportions of patients undergoing colonoscopy, CEA measurements and liver and chest imaging were calculated. Overall and disease-free survival were calculated. RESULTS Patients ≥75 years (odds ratio (OR) 0.5 (95% confidence interval (CI) 0.3-0.7)) were less likely to receive follow-up, contrasting patients <50 years (OR 3.1 (95% CI 1.3-7.4)). In 2008, follow-up intensity increased (OR 2.3 (95% CI 1.2-4.3)), especially for liver imaging and CEA measurements. There were large differences in follow-up intensity and activities between hospitals, which were unaffected by comorbidity: ranges for colonoscopy 15-73 %, CEA measurement 46-91 % and imaging of the liver 22-70 % between hospitals. No effect of follow-up intensity was found on 5-year disease-free survival for patients aged <75 years (64 vs. 68 %; p = 0.6). Similarly, no effect of follow-up intensity on 5-year overall survival was found in these patients (77 vs. 82 %; p = 0.07). CONCLUSION Large variation in follow-up was found for patients with CRC, mainly declining with age and hospital of follow-up. Over time, follow-up became more intensive, especially with respect to liver imaging and CEA measurements. However, follow-up consisting of at least one liver imaging and at least two CEA measurements did not improve overall and disease-free survival.
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Affiliation(s)
- L N van Steenbergen
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, the Netherlands.
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