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1. Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

Author

Aalbers, Arend G.J., van Aalten, Susanna M., Amelung, Femke J., Ankersmit, Marjolein, Antonisse, Imogeen E., Ashruf, Jesse F., Aukema, Tjeerd S., Avenarius, Henk, Bahadoer, Renu R., Bakers, Frans C.H., Bakker, Ilsalien S., Bangert, Fleur, Barendse, Renée M., Beekhuis, Heleen M.D., Beets, Geerard L., Bemelman, Willem A., Berbée, Maaike, de Bie, Shira H., Bisschops, Robert H.C., Blok, Robin D., van Bockel, Liselotte W., Boer, Anniek H., den Boer, Frank C., Boerma, Evert-Jan G., Boogerd, Leonora S.F., Borstlap, Jaap, Borstlap, Wernard A.A., Bouwman, Johanna E., Braak, Sicco J., Braat, Manon N.G.J.A., Bradshaw, Jennifer, Brandsma, Amarins T.A., van Breest Smallenburg, Vivian, van den Broek, Wim T., van der Burg, Sjirk W., Burger, Jacobus W.A., Burghgraef, Thijs A., ten Cate, David W.G., Ceha, Heleen M., Cnossen, Jeltsje S., Coebergh van den Braak, Robert R.J., Consten, Esther C.J., Corver, Maaike, Crolla, Rogier M.P.H., Curutchet, Sam, Daniëls-Gooszen, Alette W., Davids, Paul H.P., Dekker, Emmelie N., Dekker, Jan Willem T., Demirkiran, Ahmet, Derksen, Tyche, Diederik, Arjen L., Dinaux, Anne M., Dogan, Kemal, van Dop, Ilse M., Droogh-de Greve, Kitty E., Duijsens, Hanneke M.H., Dunker, Michalda S., Duyck, Johan, van Duyn, Eino B., van Egdom, Laurentine S.E., Eijlers, Bram, El-Massoudi, Youssef, van Elderen, Saskia, Emmen, Anouk M.L.H., Engelbrecht, Marc, van Erp, Anne C., van Essen, Jeroen A., Fabry, Hans F.J., Fassaert, Thomas, Feitsma, Eline A., Feshtali, Shirin S., Frietman, Bas, Furnée, Edgar J.B., van Geel, Anne M., Geijsen, Elisabeth D., van Geloven, Anna A.W., Gerhards, Michael F., Gielkens, Hugo, van Gils, Renza A.H., Goense, Lucas, Govaert, Marc J.P.M., van Grevenstein, Wilhelmina M.U., Joline de Groof, E., de Groot, Irene, de Haas, Robbert J., Hakkenbrak, Nadia A.G., den Hartogh, Mariska D., Heesink, Vera, Heikens, Joost T., Hendriksen, Ellen M., van den Hoek, Sjoerd, van der Hoeven, Erik J.R.J., Hoff, Christiaan, Hogewoning, Anna, Hogewoning, Cornelis R.C., Hoogendoorn, Stefan, van Hoorn, Francois, van der Hul, René L., van Hulst, Rieke, Imani, Farshad, Inberg, Bas, Intven, Martijn P.W., Janssen, Pedro, de Jong, Chris E.J., Jonkers, Jacoline, Jou-Valencia, Daniela, Keizers, Bas, Ketelaers, Stijn H.J., Knöps, Eva, van Koeverden, Sebastiaan, Kok, Sylvia, Kolderman, Stephanie E.M., de Korte, Fleur I., Kortekaas, Robert T.J., Korving, Julie C., Koster, Ingrid M., Krdzalic, Jasenko, Krielen, Pepijn, Kroese, Leonard F., Krul, Eveline J.T., Lahuis, Derk H.H., Lamme, Bas, van Landeghem, An A.G., Leijtens, Jeroen W.A., Leseman-Hoogenboom, Mathilde M., de Lijster, Manou S., Marsman, Martijn S., Martens, MilouH., Masselink, Ilse, van der Meij, Wout, Meijnen, Philip, Melenhorst, Jarno, de Mey, Dietrich J.L., Moelker-Galuzina, Julia, Morsink, Linda, Mulder, Erik J., Muller, Karin, Musters, Gijsbert D., Neijenhuis, Peter A., de Nes, Lindsey C.F., Nielen, M., van den Nieuwboer, Jan B.J., Nieuwenhuis, Jonanne F., Nonner, Joost, Noordman, Bo J., Nordkamp, Stefi, Olthof, Pim B., Oosterling, Steven J., Ootes, Daan, Oppedijk, Vera, Ott, Pieter, Paulusma, Ida, Peeters, Koen C.M.J., Pereboom, Ilona T.A., Peringa, Jan, Pironet, Zoë, Plate, Joost D.J., Polat, Fatih, Poodt, Ingrid G.M., Posma, Lisanne A.E., Prette, Jeroen F., Pultrum, Bareld B., Qaderi, Seyed M., van Rees, Jan M., Renger, Rutger-Jan, Rombouts, Anouk J.M., Roosen, Lodewijk J., Roskott-ten Brinke, Ellen A., Rothbarth, Joost, Rouw, Dennis B., Rozema, Tom, Rütten, Heidi, Rutten, Harm J.T., van der Sande, Marit E., Schaafsma, Boudewijn E., Schasfoort, Renske A., Scheurkogel, Merel M., Schouten van der Velden, Arjan P., Schreurs, Wilhelmina H., Schuivens, Puck M.E., Sietses, Colin, Simons, Petra C.G., Slob, Marjan J., Slooter, Gerrit D., van der Sluis, Martsje, Smalbroek, Bo P., Smits, Anke B., Spillenaar-Bilgen, Ernst J., Spruit, Patty H., Stam, Tanja C., Stoker, Jaap, Talsma, Aaldert K., Temmink, Sofieke J.D., The, G.Y. Mireille, Tielbeek, Jeroen A.W., van Tilborg, Aukje A.J.M., van Tilborg, Fiek, van Trier, Dorothée, Tuynman, Jurriaan B., van der Valk, Maxime J.M., Vanhooymissen, Inge J.S., Vasbinder, G. Boudewijn C., Veeken, Cornelis J., Velema, Laura A., van de Ven, Anthony W.H., Verdaasdonk, Emiel G.G., Verduin, Wouter M., Verhagen, Tim, Verheijen, Paul M., Vermaas, Maarten, Verrijssen, An-Sofie E., Verschuur, Anna V.D., Schaik, Harmke Verwoerd-van, Vliegen, Roy F.A., Voets, Sophie, Vogelaar, F. Jeroen, Vogelij, Clementine L.A., Vos-Westerman, Johanna, de Vries, Marianne, Vroemen, Joy C., van Vugt, Bas S.T., Wegdam, Johannes A., van Wely, Bob J., Westerterp, Marinke, van Westerveld, Paul P., van Westreenen, Henderik L., Wijma, Allard G., de Wilt, Johannes H.W., de Wit, Bart W.K., Wit, Fennie, Woensdregt, Karlijn, van Woerden, Victor, van der Wolf, Floor S.W., van der Wolk, Sander, Wybenga, Johannes M., van der Zaag, Edwin S., Zamaray, Bobby, Zandvoort, Herman J.A., van der Zee, Dennis, Zeilstra, Annette P., Zheng, Kang J., Zimmerman, David D.E., Zorgdrager, Marcel, Geffen, Eline G.M. van, Nederend, Joost, Sluckin, Tania C., Hazen, Sanne-Marije J.A., Horsthuis, Karin, Beets-Tan, Regina G.H., Marijnen, Corrie A.M., Tanis, Pieter J., and Kusters, Miranda

Published
2024
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2. Practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer: A nationwide cohort study

Author

Groen, Jesse V., Michiels, Nynke, Besselink, Marc G., Bosscha, Koop, Busch, Olivier R., van Dam, Ronald, van Eijck, Casper H.J., Koerkamp, Bas Groot, van der Harst, Erwin, de Hingh, Ignace H., Karsten, Tom M., Lips, Daan J., de Meijer, Vincent E., Molenaar, Isaac Q., Nieuwenhuijs, Vincent B., Roos, Daphne, van Santvoort, Hjalmar C., Wijsman, Jan H., Wit, Fennie, Zonderhuis, Babs M., de Vos-Geelen, Judith, Wasser, Martin N., Bonsing, Bert A., Stommel, Martijn W.J., and Mieog, J Sven D.

Published
2023
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3. Risk Models for Developing Pancreatic Fistula After Pancreatoduodenectomy: Validation in a Nationwide Prospective Cohort

Author

Schouten, Thijs J., Henry, Anne Claire, Smits, Francina J., Besselink, Marc G., Bonsing, Bert A., Bosscha, Koop, Busch, Olivier R., van Dam, Ronald M., van Eijck, Casper H., Festen, Sebastiaan, Groot Koerkamp, Bas, van der Harst, Erwin, de Hingh, Ignace H.J.T., Kazemier, Geert, Liem, Mike S.L., de Meijer, Vincent E., Patijn, Gijs A., Roos, Daphne, Schreinemakers, Jennifer M.J., Stommel, Martijn W.J., Wit, Fennie, Daamen, Lois A., Molenaar, Izaak Q., and van Santvoort, Hjalmar C.

Published
2023
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4. Fistula Risk Score for Auditing Pancreatoduodenectomy: The Auditing-FRS

Author

van Dongen, Jelle C., van Dam, Jacob L., Besselink, Marc G., Bonsing, Bert A., Bosscha, Koop, Busch, Olivier R., van Dam, Ronald M., Festen, Sebastiaan, van der Harst, Erwin, de Hingh, Ignace H., Kazemier, Geert, Liem, Mike S.L., de Meijer, Vincent E., Mieog, Jan S.D., Molenaar, Izaak.Q., Patijn, Gijs A., van Santvoort, Hjalmar C., Wijsman, Jan H., Stommel, Martijn W.J., Wit, Fennie, De Wilde, Roeland F., van Eijck, Casper H.J., and Groot Koerkamp, Bas

Published
2023
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5. Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

Author

Suurmeijer, J. Annelie, Henry, Anne Claire, Bonsing, Bert A., Bosscha, Koop, van Dam, Ronald M., van Eijck, Casper H., Gerhards, Michael F., van der Harst, Erwin, de Hingh, Ignace H., Intven, Martijn P., Kazemier, Geert, Wilmink, Johanna W., Lips, Daan J., Wit, Fennie, de Meijer, Vincent E., Molenaar, I. Quintus, Patijn, Gijs A., van der Schelling, George P., Stommel, Martijn W.J., Busch, Olivier R., Groot Koerkamp, Bas, van Santvoort, Hjalmar C., and Besselink, Marc G.

Published
2023
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6. Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: an open-label, nationwide, stepped-wedge cluster-randomised trial

Author

Blomjous, JG, de Boer, MT, van den Boezem, P, Bouwense, S, Bruijnen, R, Buis, CI, del Chiaro, M, Coene, PP, Coolsen, M, Daams, F, Dejong, K, Draaisma, W, Eker, HH, Elsen, AH, Gerhards, MF, Hartog, H, Hoogwater, FJ, Imani, F, Jenniskens, S, de Jong, KP, Karsten, TM, Klaase, JM, de Kleine, RHJ, van Laarhoven, CJ, van der Lelij, H, Manusama, ER, Meerdink, M, Meijerink, M, Nederend, J, Nijkamp, MW, Nota, CL, Porte, RJ, Reef, J, de Reuver, P, van Rijswijk, C, Romkens, T, Rupert, C, van der Schelling, GP, Serafino, JP, Vos, LD, Vriens, MR, Beers-Vural, E, Wagtenberg, JM, Wijsman, JH, de Wilde, RF, Wolfgang, CL, Zeh, HJ, III, Smits, F Jasmijn, Henry, Anne Claire, Besselink, Marc G, Busch, Olivier R, van Eijck, Casper H, Arntz, Mark, Bollen, Thomas L, van Delden, Otto M, van den Heuvel, Daniel, van der Leij, Christiaan, van Lienden, Krijn P, Moelker, Adriaan, Bonsing, Bert A, Borel Rinkes, Inne H, Bosscha, Koop, van Dam, Ronald M, Derksen, Wouter J M, den Dulk, Marcel, Festen, Sebastiaan, Groot Koerkamp, Bas, de Haas, Robbert J, Hagendoorn, Jeroen, van der Harst, Erwin, de Hingh, Ignace H, Kazemier, Geert, van der Kolk, Marion, Liem, Mike, Lips, Daan J, Luyer, Misha D, de Meijer, Vincent E, Mieog, J Sven, Nieuwenhuijs, Vincent B, Patijn, Gijs A, te Riele, Wouter W, Roos, Daphne, Schreinemakers, Jennifer M, Stommel, Martijn W J, Wit, Fennie, Zonderhuis, Babs A, Daamen, Lois A, van Werkhoven, C Henri, Molenaar, I Quintus, and van Santvoort, Hjalmar C

Published
2022
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8. Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): a multicentre, open-label, randomised trial

Author

Andeweg, Caroline S., Bastiaenen, Vivian P., Bemelman, Willem A., van der Bilt, Jarmila D.W., Bloemen, Johanne, den Boer, Frank C., Boerma, Djamila, ten Bokkel Huinink, Daan, Brokelman, Walter J.A., Cense, Huib A., Consten, Esther C.J., Creemers, Geert-Jan, Crolla, Rogier M.P.H., Dekker, Jan-Willem T., Demelinne, Jennifer, van Det, Marc J., van Diepen, Karin K., Diepeveen, Marjolein, van Duyn, Eino B., van den Ende, Esther D., Evers, Pauline, van Geloven, Anna A.W., van der Harst, Erwin, Heemskerk, Jeroen, Heikens, Joost T., Hess, Daniel A., Inberg, Bas, Jansen, Jan, Kloppenberg, Frank W.H., Kootstra, Thomas J.M., Kortekaas, R.T.J., Los, Maartje, Madsen, Eva V.E., van der Mijle, H.C.J., Mol, Linda, Neijenhuis, Peter A., Nienhuijs, Simon W., van den Nieuwenhof, Loes, Peeters, Koen C.M.J., Polle, Sebastiaan W., Pon, Jolien, Poortman, Pieter, Radema, Sandra A., van Ramshorst, Bert, de Reuver, Philip R., Rovers, Koen P., Schmitz, Roderick F., Sluiter, Nina, Sommeijer, Dirkje W., Sonneveld, D.J.A., van Sprundel, T.C., Veltkamp, Sanne C., Vermaas, Maarten, Verwaal, Victor J., Wassenaar, Emma, Wegdam, Johannes A., de Wilt, Johannes H.W., Westerterp, Marinke, Wit, Fennie, Witkamp, Arjen J., van Woensdregt, Karlijn, van der Zaag, Edwin S., Zournas, Mandy, Klaver, Charlotte E L, Wisselink, Daniel D, Punt, Cornelis J A, Snaebjornsson, Petur, Crezee, Johannes, Aalbers, Arend G J, Brandt, Alexandra, Bremers, Andre J A, Burger, Jacobus W A, Fabry, Hans F J, Ferenschild, Floris, Festen, Sebastiaan, van Grevenstein, Wilhelmina M U, Hemmer, Patrick H J, de Hingh, Ignace H J T, Kok, Niels F M, Musters, Gijsbert D, Schoonderwoerd, Lotte, Tuynman, Jurriaan B, van de Ven, Anthony W H, van Westreenen, Henderik L, Wiezer, Marinus J, Zimmerman, David D E, van Zweeden, Annette A, Dijkgraaf, Marcel G W, and Tanis, Pieter J

Published
2019
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9. Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission: Analysis of a Nationwide Audit

Author

Smits, F. Jasmijn, Verweij, Maaike E., Daamen, Lois A., van Werkhoven, C. Henri, Goense, Lucas, Besselink, Marc G., Bonsing, Bert A., Busch, Olivier R., van Dam, Ronald M., van Eijck, Casper H. J., Festen, Sebastiaan, Koerkamp, Bas Groot, van der Harst, Erwin, de Hingh, Ignace H., Kazemier, Geert, Klaase, Joost M., van der Kolk, Marion, Liem, Mike, Luyer, Misha D. P., Meerdink, Mark, Mieog, J. Sven D., Nieuwenhuijs, Vincent B., Roos, Daphne, Schreinemakers, Jennifer M., Stommel, Martijn W., Wit, Fennie, Zonderhuis, Babs M., de Meijer, Vincent E., van Santvoort, Hjalmar C., and Molenaar, I. Quintus

Published
2022
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10. The Difficulty of Detecting Occult Metastases in Patients with Potentially Resectable Pancreatic Cancer: Development and External Validation of a Preoperative Prediction Model.

Author

Walma, Marieke, Maggino, Laura, Smits, F. Jasmijn, Borggreve, Alicia S., Daamen, Lois A., Groot, Vincent P., Casciani, Fabio, de Meijer, Vincent E., Wessels, Frank J., van der Schelling, George P., Nieuwenhuijs, Vincent B., Bosscha, Koop, Harst, Erwin van der, Dam, Ronald van, Liem, Mike S., Festen, Sebastiaan, Stommel, Martijn W. J., Roos, Daphne, Wit, Fennie, and Hingh, Ignace H. de

Subjects
PANCREATIC cancer, CARCINOGENESIS, PREDICTION models, METASTASIS, PANCREATIC intraepithelial neoplasia, INDEPENDENT variables
Abstract

Occult metastases are detected in 10–15% of patients during exploratory laparotomy for pancreatic cancer. This study developed and externally validated a model to predict occult metastases in patients with potentially resectable pancreatic cancer. Model development was performed within the Dutch Pancreatic Cancer Audit, including all patients operated for pancreatic cancer (January 2013–December 2017). Multivariable logistic regression analysis based on the Akaike Information Criteria was performed with intraoperative pathologically proven metastases as the outcome. The model was externally validated with a cohort from the University Hospital of Verona (January 2013–December 2017). For model development, 2262 patients were included of whom 235 (10%) had occult metastases, located in the liver (n = 143, 61%), peritoneum (n = 73, 31%), or both (n = 19, 8%). The model included age (OR 1.02, 95% CI 1.00–1.03), BMI (OR 0.96, 95% CI 0.93–0.99), preoperative nutritional support (OR 1.73, 95% CI 1.01–2.74), tumor diameter (OR 1.60, 95% CI 1.04–2.45), tumor composition (solid vs. cystic) (OR 2.33, 95% CI 1.20–4.35), and indeterminate lesions on preoperative imaging (OR 4.01, 95% CI 2.16–7.43). External validation showed poor discrimination with a C-statistic of 0.56. Although some predictor variables were significantly associated with occult metastases, the model performed insufficiently at external validation. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Textbook Outcome: Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery

Author

van Roessel, Stijn, Mackay, Tara M., van Dieren, Susan, van der Schelling, George P., Nieuwenhuijs, Vincent B., Bosscha, Koop, van der Harst, Edwin, van Dam, Ronald M., Liem, Mike S. L., Festen, Sebastiaan, Stommel, Martijn W. J., Roos, Daphne, Wit, Fennie, Molenaar, I. Quintus, de Meijer, Vincent E., Kazemier, Geert, de Hingh, Ignace H. J. T., van Santvoort, Hjalmar C., Bonsing, Bert A., Busch, Olivier R., Groot Koerkamp, Bas, and Besselink, Marc G.

Published
2020
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12. Fistula Risk Score for Auditing Pancreatoduodenectomy: The Auditing FRS

Author

van Dongen, Jelle C, van Dam, Jacob L, Besselink, Marc G, Bonsing, Bert A, Bosscha, Koop, Busch, Olivier R, van Dam, Ronald M, Festen, Sebastiaan, van der Harst, Erwin, de Hingh, Ignace H, Kazemier, Geert, Liem, Mike S L, de Meijer, Vincent E, Mieog, J Sven D, Molenaar, I Q, Patijn, Gijs A, van Santvoort, Hjalmar C, Wijsman, Jan H, Stommel, Martijn W J, Wit, Fennie, De Wilde, Roeland F, van Eijck, Casper H J, Groot Koerkamp, Bas, Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy

Subjects
SDG 3 - Good Health and Well-being
Abstract

OBJECTIVE: To develop a fistula risk score for auditing, to be able to compare postoperative pancreatic fistula (POPF) after pancreatoduodenectomy among hospitals. BACKGROUND: For proper comparisons of outcomes in surgical audits, case-mix variation should be accounted for. METHODS: This study included consecutive patients after pancreatoduodenectomy from the mandatory nationwide Dutch Pancreatic Cancer Audit. Derivation of the score was performed with the data from 2014 to 2018 and validation with 2019 to 2020 data. The primary endpoint of the study was POPF (grade B or C). Multivariable logistic regression analysis was performed for case-mix adjustment of known risk factors. RESULTS: In the derivation cohort, 3271 patients were included, of whom 479 (14.6%) developed POPF. Male sex [odds ratio (OR)=1.34; 95% confidence interval (CI): 1.09-1.66], higher body mass index (OR=1.07; 95% CI: 1.05-1.10), a final diagnosis other than pancreatic ductal adenocarcinoma/pancreatitis (OR=2.41; 95% CI: 1.90-3.06), and a smaller duct diameter (OR=1.43/mm decrease; 95% CI: 1.32-1.55) were independently associated with POPF. Diabetes mellitus (OR=0.73; 95% CI: 0.55-0.98) was independently associated with a decreased risk of POPF. Model discrimination was good with a C-statistic of 0.73 in the derivation cohort and 0.75 in the validation cohort (n=913). Hospitals differed in particular in the proportion of pancreatic ductal adenocarcinoma/pancreatitis patients, ranging from 36.0% to 58.1%. The observed POPF risk per center ranged from 2.9% to 25.4%. The expected POPF rate based on the 5 risk factors ranged from 11.6% to 18.0% among hospitals. CONCLUSIONS: The auditing fistula risk score was successful in case-mix adjustment and enables fair comparisons of POPF rates among hospitals.

Published
2022

15. Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis.

Author

Groen, Jesse V., Michiels, Nynke, van Roessel, Stijn, Besselink, Marc G., Bosscha, Koop, Busch, Olivier R., van Dam, Ronald, van Eijck, Casper H. J., Koerkamp, Bas Groot, van der Harst, Erwin, de Hingh, Ignace H., Karsten, Tom M., Lips, Daan J., de Meijer, Vincent E., Molenaar, Isaac Q., Nieuwenhuijs, Vincent B., Roos, Daphne, van Santvoort, Hjalmar C., Wijsman, Jan H., and Wit, Fennie

Subjects
PANCREATIC surgery, PANCREATIC cancer, MESENTERIC veins, PANCREATICODUODENECTOMY, COHORT analysis, WEDGES
Abstract

Background: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival. Methods: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013-2017). Results: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P<0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P<0.001) and worse overall survival (median 12 versus 16 versus 20months, respectively; P<0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio=1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio=1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33months, respectively; P=0.470), although there was a difference in majormorbidity rates (52 versus 19 versus 21 per cent, respectively; P =0.012). Conclusion: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection. [ABSTRACT FROM AUTHOR]

Published
2022
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16. Perineural Invasion is an Important Prognostic Factor in Patients With Radically Resected (R0) and Node-negative (pN0) Pancreatic Cancer.

Author

Schouten TJ, Kroon VJ, Besselink MG, Bosscha K, Busch OR, Crobach ASLP, van Dam RM, Doukas M, Fariña Sarasquesta A, Festen S, Groot Koerkamp B, van der Harst E, Heij LR, de Hingh IHJT, Kazemier G, Liem MSL, de Meijer VE, Mieog JSD, Patijn GA, Raicu GM, Roos D, Schreinemakers JMJ, Stommel MWJ, Wilmink HJ, Wit F, Brosens LAA, van Santvoort HC, Molenaar IQ, and Daamen LA

Abstract

Objective: To investigate the association between perineural invasion (PNI) and overall survival (OS) in a nationwide cohort of patients with resected pancreatic ductal adenocarcinoma (PDAC), stratified for margin negative (R0) or positive (R1) resection and absence or presence of lymph node metastasis (pN0 or pN1-N2, respectively)., Background: Patients with R0 and pN0 resected PDAC have a relatively favorable prognosis. As PNI is associated with worse OS, this might be a useful factor to provide further prognostic information for patients counselling., Methods: A nationwide observational cohort study was performed including all patients who underwent PDAC resection in the Netherlands (2014-2019) with complete information on relevant pathological features (PNI, R status, and N status). OS was assessed using Kaplan-Meier curves, and Cox-proportional hazard analyses were performed to calculate hazard ratio's (HR) with corresponding 95% confidence intervals (CI)., Results: In total, 1630 patients were included with a median follow-up of 43 (interquartile range 33-58) months. PNI was independently associated with worse OS in both R0 patients (HR 1.49 [95%CI 1.18-1.88]; P<0.001) and R1 patients (HR 1.39 [95% CI 1.06-1.83]; P=0.02), as well as in pN0 patients (HR 1.75 [95%CI 1.27-2.41]; P<0.001) and pN1-N2 patients (HR 1.35 [95% CI 1.10-1.67]; P<0.01). In 315 patients with R0N0, multivariable analysis showed that PNI was the strongest predictor of OS (HR 2.24 [95% CI 1.52-3.30]; P<0.001)., Conclusion: PNI is strongly associated with worse survival in patients with resected PDAC, in particular in patients with relatively favorable pathological features. These findings may aid patient stratification and counselling and help guide treatment strategies., Competing Interests: The authors report  no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2024
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17. The Effect of a Temporary Stoma on Long-term Functional Outcomes Following Surgery for Rectal Cancer.

Author

Verkuijl SJ, Jonker JE, Furnée EJB, Kelder W, Hoff C, Hess DA, Wit F, Zijlstra RJ, Trzpis M, and Broens PMA

Subjects
Humans, Cross-Sectional Studies, Postoperative Complications epidemiology, Postoperative Complications etiology, Low Anterior Resection Syndrome, Ileostomy adverse effects, Colostomy, Constipation etiology, Retrospective Studies, Rectal Neoplasms surgery, Rectal Neoplasms etiology, Fecal Incontinence epidemiology, Fecal Incontinence etiology
Abstract

Background: Patients with rectal cancer may undergo surgical resection with or without a temporary stoma., Objective: This study primarily aimed to compare long-term functional outcomes between patients with and without a temporary stoma after surgery for rectal cancer. The secondary aim was to investigate the effect of time to stoma reversal on functional outcomes., Design: This was a multicenter, cross-sectional study., Settings: This study was conducted at 7 Dutch hospitals., Patients: Included were patients who had undergone rectal cancer surgery (2009-2015). Excluded were deceased patients, who were deceased, had a permanent stoma, or had intellectual disability., Main Outcome Measures: Functional outcomes were measured using the Rome IV criteria for constipation and fecal incontinence and the low anterior resection syndrome score., Results: Of 656 patients, 32% received a temporary ileostomy and 20% a temporary colostomy (86% response). Follow-up was at 56 (interquartile range, 38.5-79) months. Patients who had a temporary ileostomy experienced less constipation, more fecal incontinence, and more major low anterior resection syndrome than those without a temporary stoma. Patients who had a temporary colostomy experienced more major low anterior resection syndrome than those without a temporary stoma. A temporary ileostomy or colostomy was not associated with constipation or fecal incontinence after correction for confounding factors (eg, anastomotic height, anastomotic leakage, radiotherapy). Time to stoma reversal was not associated with constipation, fecal incontinence, or major low anterior resection syndrome., Limitations: Cross-sectional design., Conclusions: Although patients with a temporary ileostomy or colostomy have worse functional outcomes in the long term, it seems that the reason for creating a temporary stoma, rather than the stoma itself, underlies this phenomenon. Time to reversal of a temporary stoma does not influence functional outcomes. See Video Abstract ., El Efecto Del Estoma Temporal Sobre Los Resultados Funcionales a Largo Plazo Despus De La Ciruga Por Cncer De Recto: ANTECEDENTES:Los pacientes con cáncer de recto pueden someterse a resección quirúrgica con o sin un estoma temporal.OBJETIVO:El objetivo principal de este estudio fue comparar los resultados funcionales a largo plazo entre pacientes con y sin estoma temporal después de cirugía por cáncer de recto. El objetivo secundario fue investigar el efecto del tiempo transcurrido hasta la reversión del estoma sobre los resultados funcionales.DISEÑO:Este fue un estudio transversal multicéntrico.ESCENARIO:Este estudio se llevó a cabo en siete hospitales holandeses.PACIENTES:Se incluyeron pacientes sometidos a cirugía de cáncer de recto (2009-2015). Se excluyeron pacientes fallecidos, pacientes con estoma permanente o discapacidad intelectual.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados funcionales se midieron utilizando los criterios de Roma IV para el estreñimiento y la incontinencia fecal y la puntuación del síndrome de resección anterior baja (LARS).RESULTADOS:De 656 pacientes, el 32% recibió una ileostomía temporal y el 20% una colostomía temporal (respuesta del 86%). El seguimiento fue de 56.0 (RIQ 38.5-79.0) meses. Los pacientes a los que se les realizó una ileostomía temporal experimentaron menos estreñimiento, más incontinencia fecal y más LARS mayor que los pacientes sin un estoma temporal. Los pacientes que tuvieron una colostomía temporal experimentaron más LARS mayor que los pacientes sin un estoma temporal. Una ileostomía o colostomía temporal no se asoció con estreñimiento o incontinencia fecal después de la corrección de factores de confusión (p. ej., altura anastomótica, fuga anastomótica, radioterapia). El tiempo hasta la reversión del estoma no se asoció con estreñimiento, incontinencia fecal o LARS mayor.LIMITACIONES:El presente estudio está limitado por su diseño transversal.CONCLUSIONES:Aunque los pacientes con una ileostomía o colostomía temporal tienen peores resultados funcionales a largo plazo, parece que la razón para crear un estoma temporal, más que el estoma en sí, se asocia a este fenómeno. El tiempo hasta la reversión de un estoma temporal no influye en los resultados funcionales. (Traducción-Dr. Jorge Silva Velazco )., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons.)

Published
2024
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18. Impact of complications after resection of pancreatic cancer on disease recurrence and survival, and mediation effect of adjuvant chemotherapy: nationwide, observational cohort study.

Author

Henry AC, van Dongen JC, van Goor IWJM, Smits FJ, Nagelhout A, Besselink MG, Busch OR, Bonsing BA, Bosscha K, van Dam RM, Festen S, Groot Koerkamp B, van der Harst E, de Hingh IH, van der Kolk M, Liem MSL, de Meijer VE, Patijn GA, Roos D, Schreinemakers JM, Wit F, Daamen LA, van Santvoort HC, Molenaar IQ, and van Eijck CHJ

Subjects
Humans, Prospective Studies, Pancreas surgery, Pancreatectomy adverse effects, Pancreatic Neoplasms, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms surgery
Abstract

Background: The causal pathway between complications after pancreatic cancer resection and impaired long-term survival remains unknown. The aim of this study was to investigate the impact of complications after pancreatic cancer resection on disease-free interval and overall survival, with adjuvant chemotherapy as a mediator., Methods: This observational study included all patients undergoing pancreatic cancer resection in the Netherlands (2014-2017). Clinical data were extracted from the prospective Dutch Pancreatic Cancer Audit. Recurrence and survival data were collected additionally. In causal mediation analysis, direct and indirect effect estimates via adjuvant chemotherapy were calculated., Results: In total, 1071 patients were included. Major complications (hazards ratio 1.22 (95 per cent c.i. 1.04 to 1.43); P = 0.015 and hazards ratio 1.25 (95 per cent c.i. 1.08 to 1.46); P = 0.003) and organ failure (hazards ratio 1.86 (95 per cent c.i. 1.32 to 2.62); P < 0.001 and hazards ratio 1.89 (95 per cent c.i. 1.36 to 2.63); P < 0.001) were associated with shorter disease-free interval and overall survival respectively. The effects of major complications and organ failure on disease-free interval (-1.71 (95 per cent c.i. -2.27 to -1.05) and -3.05 (95 per cent c.i. -4.03 to -1.80) respectively) and overall survival (-1.92 (95 per cent c.i. -2.60 to -1.16) and -3.49 (95 per cent c.i. -4.84 to -2.03) respectively) were mediated by adjuvant chemotherapy. Additionally, organ failure directly affected disease-free interval (-5.38 (95 per cent c.i. -9.27 to -1.94)) and overall survival (-6.32 (95 per cent c.i. -10.43 to -1.99)). In subgroup analyses, the association was found in patients undergoing pancreaticoduodenectomy, but not in patients undergoing distal pancreatectomy., Conclusion: Major complications, including organ failure, negatively impact survival in patients after pancreatic cancer resection, largely mediated by adjuvant chemotherapy. Prevention or adequate treatment of complications and use of neoadjuvant treatment may improve oncological outcomes., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)

Published
2023
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19. Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: an open-label, nationwide, stepped-wedge cluster-randomised trial.

Author

Smits FJ, Henry AC, Besselink MG, Busch OR, van Eijck CH, Arntz M, Bollen TL, van Delden OM, van den Heuvel D, van der Leij C, van Lienden KP, Moelker A, Bonsing BA, Borel Rinkes IH, Bosscha K, van Dam RM, Derksen WJM, den Dulk M, Festen S, Groot Koerkamp B, de Haas RJ, Hagendoorn J, van der Harst E, de Hingh IH, Kazemier G, van der Kolk M, Liem M, Lips DJ, Luyer MD, de Meijer VE, Mieog JS, Nieuwenhuijs VB, Patijn GA, Te Riele WW, Roos D, Schreinemakers JM, Stommel MWJ, Wit F, Zonderhuis BA, Daamen LA, van Werkhoven CH, Molenaar IQ, and van Santvoort HC

Subjects
Algorithms, Hemorrhage, Humans, Netherlands epidemiology, Postoperative Complications epidemiology, Postoperative Complications therapy, Treatment Outcome, Drainage, Pancreatectomy adverse effects
Abstract

Background: Early recognition and management of postoperative complications, before they become clinically relevant, can improve postoperative outcomes for patients, especially for high-risk procedures such as pancreatic resection., Methods: We did an open-label, nationwide, stepped-wedge cluster-randomised trial that included all patients having pancreatic resection during a 22-month period in the Netherlands. In this trial design, all 17 centres that did pancreatic surgery were randomly allocated for the timing of the crossover from usual care (the control group) to treatment given in accordance with a multimodal, multidisciplinary algorithm for the early recognition and minimally invasive management of postoperative complications (the intervention group). Randomisation was done by an independent statistician using a computer-generated scheme, stratified to ensure that low-medium-volume centres alternated with high-volume centres. Patients and investigators were not masked to treatment. A smartphone app was designed that incorporated the algorithm and included the daily evaluation of clinical and biochemical markers. The algorithm determined when to do abdominal CT, radiological drainage, start antibiotic treatment, and remove abdominal drains. After crossover, clinicians were trained in how to use the algorithm during a 4-week wash-in period; analyses comparing outcomes between the control group and the intervention group included all patients other than those having pancreatic resection during this wash-in period. The primary outcome was a composite of bleeding that required invasive intervention, organ failure, and 90-day mortality, and was assessed by a masked adjudication committee. This trial was registered in the Netherlands Trial Register, NL6671., Findings: From Jan 8, 2018, to Nov 9, 2019, all 1805 patients who had pancreatic resection in the Netherlands were eligible for and included in this study. 57 patients who underwent resection during the wash-in phase were excluded from the primary analysis. 1748 patients (885 receiving usual care and 863 receiving algorithm-centred care) were included. The primary outcome occurred in fewer patients in the algorithm-centred care group than in the usual care group (73 [8%] of 863 patients vs 124 [14%] of 885 patients; adjusted risk ratio [RR] 0·48, 95% CI 0·38-0·61; p<0·0001). Among patients treated according to the algorithm, compared with patients who received usual care there was a decrease in bleeding that required intervention (47 [5%] patients vs 51 [6%] patients; RR 0·65, 0·42-0·99; p=0·046), organ failure (39 [5%] patients vs 92 [10%] patients; 0·35, 0·20-0·60; p=0·0001), and 90-day mortality (23 [3%] patients vs 44 [5%] patients; 0·42, 0·19-0·92; p=0·029)., Interpretation: The algorithm for the early recognition and minimally invasive management of complications after pancreatic resection considerably improved clinical outcomes compared with usual care. This difference included an approximate 50% reduction in mortality at 90 days., Funding: The Dutch Cancer Society and UMC Utrecht., Competing Interests: Declaration of interests CvdL is the Secretary of the Dutch Society of Interventional Radiology (unpaid position). CHvW's institution received payments from Pfizer, Biomerieux, Da Volterra, and MSD and he has a European Patent Application with Da Volterrra, University Antwerp, and University Medical Centre Utrecht Holdings. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Published
2022
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20. Venous wedge and segment resection during pancreatoduodenectomy for pancreatic cancer: impact on short- and long-term outcomes in a nationwide cohort analysis.

Author

Groen JV, Michiels N, van Roessel S, Besselink MG, Bosscha K, Busch OR, van Dam R, van Eijck CHJ, Koerkamp BG, van der Harst E, de Hingh IH, Karsten TM, Lips DJ, de Meijer VE, Molenaar IQ, Nieuwenhuijs VB, Roos D, van Santvoort HC, Wijsman JH, Wit F, Zonderhuis BM, de Vos-Geelen J, Wasser MN, Bonsing BA, Stommel MWJ, and Mieog JSD

Subjects
Aged, Female, Humans, Male, Middle Aged, Pancreas surgery, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy mortality, Retrospective Studies, Survival Analysis, Treatment Outcome, Mesenteric Veins surgery, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Portal Vein surgery
Abstract

Background: Venous resection of the superior mesenteric or portal vein is increasingly performed in pancreatic cancer surgery, whereas results of studies on short- and long-term outcomes are contradictory. The aim of this study was to evaluate the impact of the type of venous resection in pancreatoduodenectomy for pancreatic cancer on postoperative morbidity and overall survival., Methods: This nationwide retrospective cohort study included all patients who underwent pancreatoduodenectomy for pancreatic cancer in 18 centres (2013-2017)., Results: A total of 1311 patients were included, of whom 17 per cent underwent wedge resection and 10 per cent segmental resection. Patients with segmental resection had higher rates of major morbidity (39 versus 20 versus 23 per cent, respectively; P < 0.001) and portal or superior mesenteric vein thrombosis (18 versus 5 versus 1 per cent, respectively; P < 0.001) and worse overall survival (median 12 versus 16 versus 20 months, respectively; P < 0.001), compared to patients with wedge resection and those without venous resection. Multivariable analysis showed patients with segmental resection, but not those who had wedge resection, had higher rates of major morbidity (odds ratio = 1.93, 95 per cent c.i. 1.20 to 3.11) and worse overall survival (hazard ratio = 1.40, 95 per cent c.i. 1.10 to 1.78), compared to patients without venous resection. Among patients who received neoadjuvant therapy, there was no difference in overall survival among patients with segmental and wedge resection and those without venous resection (median 32 versus 25 versus 33 months, respectively; P = 0.470), although there was a difference in major morbidity rates (52 versus 19 versus 21 per cent, respectively; P  = 0.012)., Conclusion: In pancreatic surgery, the short- and long-term outcomes are worse in patients with venous segmental resection, compared to patients with wedge resection and those without venous resection., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)

Published
2021
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21. Care after pancreatic resection according to an algorithm for early detection and minimally invasive management of pancreatic fistula versus current practice (PORSCH-trial): design and rationale of a nationwide stepped-wedge cluster-randomized trial.

Author

Smits FJ, Henry AC, van Eijck CH, Besselink MG, Busch OR, Arntz M, Bollen TL, van Delden OM, van den Heuvel D, van der Leij C, van Lienden KP, Moelker A, Bonsing BA, Borel Rinkes IHM, Bosscha K, van Dam RM, Festen S, Groot Koerkamp B, van der Harst E, de Hingh IH, Kazemier G, Liem M, van der Kolk BM, de Meijer VE, Patijn GA, Roos D, Schreinemakers JM, Wit F, van Werkhoven CH, Molenaar IQ, and van Santvoort HC

Subjects
Algorithms, Cost-Benefit Analysis, Delivery of Health Care economics, Disease Management, Early Diagnosis, Female, Health Resources economics, Hemorrhage etiology, Humans, Male, Multiple Organ Failure etiology, Netherlands epidemiology, Pancreatic Fistula mortality, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Pancreas surgery, Pancreatectomy adverse effects, Pancreatic Fistula complications, Pancreatic Fistula surgery
Abstract

Background: Pancreatic resection is a major abdominal operation with 50% risk of postoperative complications. A common complication is pancreatic fistula, which may have severe clinical consequences such as postoperative bleeding, organ failure and death. The objective of this study is to investigate whether implementation of an algorithm for early detection and minimally invasive management of pancreatic fistula may improve outcomes after pancreatic resection., Methods: This is a nationwide stepped-wedge, cluster-randomized, superiority trial, designed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. During a period of 22 months, all Dutch centers performing pancreatic surgery will cross over in a randomized order from current practice to best practice according to the algorithm. This evidence-based and consensus-based algorithm will provide daily multilevel advice on the management of patients after pancreatic resection (i.e. indication for abdominal imaging, antibiotic treatment, percutaneous drainage and removal of abdominal drains). The algorithm is designed to aid early detection and minimally invasive step-up management of postoperative pancreatic fistula. Outcomes of current practice will be compared with outcomes after implementation of the algorithm. The primary outcome is a composite of major complications (i.e. post-pancreatectomy bleeding, new-onset organ failure and death) and will be measured in a sample size of at least 1600 patients undergoing pancreatic resection. Secondary endpoints include the individual components of the primary endpoint and other clinical outcomes, healthcare resource utilization and costs analysis. Follow up will be up to 90 days after pancreatic resection., Discussion: It is hypothesized that a structured nationwide implementation of a dedicated algorithm for early detection and minimally invasive step-up management of postoperative pancreatic fistula will reduce the risk of major complications and death after pancreatic resection, as compared to current practice., Trial Registration: Netherlands Trial Register: NL 6671. Registered on 16 December 2017.

Published
2020
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22. The risk of not receiving adjuvant chemotherapy after resection of pancreatic ductal adenocarcinoma: a nationwide analysis.

Author

Mackay TM, Smits FJ, Roos D, Bonsing BA, Bosscha K, Busch OR, Creemers GJ, van Dam RM, van Eijck CHJ, Gerhards MF, de Groot JWB, Groot Koerkamp B, Haj Mohammad N, van der Harst E, de Hingh IHJT, Homs MYV, Kazemier G, Liem MSL, de Meijer VE, Molenaar IQ, Nieuwenhuijs VB, van Santvoort HC, van der Schelling GP, Stommel MWJ, Ten Tije AJ, de Vos-Geelen J, Wit F, Wilmink JW, van Laarhoven HWM, and Besselink MG

Subjects
Age Factors, Aged, Carcinoma, Pancreatic Ductal mortality, Female, Hospital Mortality, Hospitals, Low-Volume, Humans, Logistic Models, Male, Middle Aged, Neoplasm Grading, Netherlands, Odds Ratio, Pancreatic Neoplasms mortality, Postoperative Complications epidemiology, Retrospective Studies, Risk Factors, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal surgery, Chemotherapy, Adjuvant, Pancreatectomy, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms surgery
Abstract

Background: The relation between type of postoperative complication and not receiving chemotherapy after resection of pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim was to investigate which patient factors and postoperative complications were associated with not receiving adjuvant chemotherapy., Methods: Patients who underwent resection (2014-2017) for PDAC were identified from the nationwide mandatory Dutch Pancreatic Cancer Audit. The association between patient-, tumor-, center-, treatment characteristics, and the risk of not receiving adjuvant chemotherapy was analyzed with multivariable logistic regression., Results: Overall, of 1306 patients, 24% (n = 312) developed postoperative Clavien Dindo ≥3 complications. In-hospital mortality was 3.5% (n = 46). Some 433 patients (33%) did not receive adjuvant chemotherapy. Independent predictors (all p < 0.050) for not receiving adjuvant chemotherapy were older age (odds ratio (OR) 0.96), higher ECOG performance status (OR 0.57), postoperative complications (OR 0.32), especially grade B/C pancreatic fistula (OR 0.51) and post-pancreatectomy hemorrhage (OR 0.36), poor tumor differentiation grade (OR 0.62), and annual center volume of <40 pancreatoduodenectomies (OR 0.51)., Conclusions: This study demonstrated that a third of patients do not receive chemotherapy after resection of PDAC. Next to higher age, worse performance status and lower annual surgical volume, this is mostly related to surgical complications, especially postoperative pancreatic fistula and post-pancreatectomy hemorrhage., (Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Published
2020
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23. Blockade of the mental nerve for lower lip surgery as a safe alternative to general anesthesia in two very old patients.

Author

Tan FF, Schiere S, Reidinga AC, Wit F, and Veldman PH

Abstract

Purpose: Regional anesthesia is gaining popularity with anesthesiologists as it offers superb postoperative analgesia. However, as the sole anesthetic technique in high-risk patients in whom general anesthesia is not preferred, some regional anesthetic possibilities may be easily overlooked. By presenting two cases of very old patients with considerable comorbidities, we would like to bring the mental nerve field block under renewed attention as a safe alternative to general anesthesia and to achieve broader application of this simple nerve block., Patients and Methods: Two very old male patients (84 and 91 years) both presented with an ulcerative lesion at the lower lip for which surgical removal was scheduled. Because of their considerable comorbidities and increased frailty, bilateral blockade of the mental nerve was considered superior to general anesthesia. As an additional advantage for the 84-year-old patient, who had a pneumonectomy in his medical history, the procedure could be safely performed in a beach-chair position to prevent atelectasis and optimize the ventilation/perfusion ratio of the single lung. The mental nerve blockades were performed intraorally in a blind fashion, after eversion of the lip and identifying the lower canine. A 5 mL syringe with a 23-gauge needle attached was passed into the buccal mucosa until it approximated the mental foramen, where 2 mL of lidocaine 2% with adrenaline 1:100.000 was injected. The other side was anesthetized in a similar fashion., Results: Both patients underwent the surgical procedure uneventfully under a bilateral mental nerve block and were discharged from the hospital on the same day., Conclusion: A mental nerve block is an easy-to-perform regional anesthetic technique for lower lip surgery. This technique might be especially advantageous in the very old, frail patient.

Published
2015
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