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1. Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy Results of the Multicenter, Prospective, Cross-Sectional FANCY Study

Author

Bastiaenen, Vivian P., de Jonge, Joske, Corten, Bartholomeus J. G. A., de Savornin Lohman, Elise A. J., Kraima, Anne C., Swank, Hilko A., van Vliet, Jaap L. P., van Acker, Gijs J. D., van Geloven, Anna A. W., in'tHof, Klaas H., Koens, Lianne, de Reuver, Philip R., van Rossem, Charles C., Slooter, Gerrit D., Tanis, Pieter J., Terpstra, Valeska, Dijkgraaf, Marcel G. W., Bemelman, Willem A., Amelung, F. J., Atema, J. J., Bessems, S., Beunders, A. A. M., Bodewes, T. C. F., den Boer, F. C., Boerma, D., Boerma, E. G., van den Boezem, P., Bökkerink, W. J. V., van den Boogaart, D., Boogerd, L. S. F., Bouwman, H., Broos, A., Brueren, L. O., Bruinsma, W. E., Bruns, E. R. C., Castelijns, P. S. S., de Castro, S. M. M., Consten, E. C. J., Crolla, R. M. P. H., Dam, M. J., Dang, Q., Dekker, J. W. T., Deroose, J. P., Devriendt, S., Dijkema, E. J., Dijkstra, N., Driessen, M. L. S., van Duijvendijk, P., Duinhouwer, L. E., van Duyn, E. B., el-Massoudi, Y., Elfrink, A. K. E., Elschot, J. H., van Essen, J. A., Ferenschild, F. T. J., Gans, S. L., Gaznay, C., Geraedts, A. C. M., van Gessel, B. S. H., Giesen, L. J. X., van Gils, N., Gorgec, B., Gorter, R. R., Govaert, K. M., Greuter, G. N., van Grevenstein, W. M. U., Groot, L., Hardy, J. C. A., Heemskerk, J., Heeren, J. F., Heidotting, J., Heikens, J. T., Hosseinzoi, E., van Iersel, J. J., Inberg, B., Jansen, L. J., Jens, A. J. T., Jilesen, A. P. J., Joosten, M., de Jong, L., Keijzers, M., Klicks, R. J., Kloppenberg, F. W. H., Koedam, T. W. A., Koëter, T., Konsten, J. L. M., Koolen, L. J. E. R., Kruyt, Ph. M., Lange, J. F. M., Lavrijssen, B. D. A., de Leede, E. M., Leliefeld, P. H. C., Linnemann, R. J. A., Lo, G. C., van de Loo, M., Lubbert, P. H. W., Holzik, M. F. Lutke, Manusama, E., Masselink, I., Matthée, E. P. C., Matthijsen, R. A., Mearadji, A., Melenhorst, J., Merkus, J. W. S., Michiels, T. D., Moes, D. E., Moossdorff, M., Mulder, E., Nallayici, E. G., Neijenhuis, P. A., Nielsen, K., Nieuwenhuijzen, G. A. P., Nijhuis, J., Okkema, S., Olthof, P. B., van Onkelen, R. S., van Oostendorp, S. E., Plaisier, P. W., Polle, S. W., Reiber, B. M. M., Reichert, F. C. M., van Rest, K. L. C., van Rijn, R., Roozendaal, N. C., de Ruijter, W. M. J., Schat, E., Scheerhoorn, J., Scheijmans, J. C. G., Schimmer, J., Schipper, R. J., Schouten, R., Schreurs, W. H., Schrijver, W. A. M. E., Shapiro, J., Siemons, A., Silvis, R., Simkens, G. A., Smakman, N., Smeets, B. J. J., Sonneveld, D. J. A., van Suijlichem, M., Talsma, A. K., Thoolen, J. M. M., van Tol, R. R., Tournoij, E., Tseng, L. N. L., Tuynman, J. B., van der Velde, K., Veltkamp, S. C., Verbeek, F. P. R., Verdaasdonk, E., Verhaak, T., Verheuvel, N. C., Vermaas, M., Verseveld, M., Vlek, S., Vogels, S., van de Voort, E. M. F., van Vugt, S. T., Wegdam, J. A., Wennekers, M. M., Wiering, B., de Wijkerslooth, E. M. L., Wijkmans, A. A., Wijnhoven, B. P. L., Witjes, C. D. M., Wolfhagen, N., de Zeeuw, S., van Zoonen, G., Surgery, Erasmus MC other, Obstetrics & Gynecology, Department of Strategic Management and Entrepreneurship, Neurology, Rotterdam School of Management, Cardiology, Gastroenterology & Hepatology, Radiology & Nuclear Medicine, Otorhinolaryngology and Head and Neck Surgery, Emergency Medicine, Public Health, Plastic and Reconstructive Surgery and Hand Surgery, Dermatology, Clinical Chemistry, Internal Medicine, Erasmus School of Social and Behavioural Sciences, General Practice, Radiotherapy, Research & Education, Rehabilitation Medicine, Urology, Pathology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Hematology laboratory, VU University medical center, CCA - Cancer Treatment and quality of life, and CCA - Imaging and biomarkers

Subjects
medicine.medical_specialty, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], All institutes and research themes of the Radboud University Medical Center, business.industry, General surgery, Medicine, Surgery, Histopathological examination, business, Cost savings
Abstract

Objective: To investigate the oncological safety and potential cost savings of selective histopathological examination after appendectomy. Background: The necessity of routine histopathological examination after appendectomy has been questioned, but prospective studies investigating the safety of a selective policy are lacking. Methods: In this multicenter, prospective, cross-sectional study, inspection and palpation of the (meso)appendix was performed by the surgeon in patients with suspected appendicitis. The surgeon's opinion on additional value of histopathological examination was reported before sending all specimens to the pathologist. Main outcomes were the number of hypothetically missed appendiceal neoplasms with clinical consequences benefiting the patient (upper limit two-sided 95% confidence interval below 3:1000 considered oncologically safe) and potential cost savings after selective histopathological examination. Results: Seven thousand three hundred thirty-nine patients were included. After a selective policy, 4966/7339 (67.7%) specimens would have been refrained from histopathological examination. Appendiceal neoplasms with clinical consequences would have been missed in 22/4966 patients. In 5/22, residual disease was completely resected during additional surgery. Hence, an appendiceal neoplasm with clinical consequences benefiting the patient would have been missed in 1.01:1000 patients (upper limit 95% confidence interval 1.61:1000). In contrast, twice as many patients (10/22) would not have been exposed to potential harm due to re-resections without clear benefit, whereas consequences were neither beneficial nor harmful in the remaining seven. Estimated cost savings established by replacing routine for selective histopathological examination were 725,400 per 10,000 patients. Conclusions: Selective histopathological examination after appendectomy for suspected appendicitis is oncologically safe and will likely result in a reduction of pathologists' workload, less costs, and fewer re-resections without clear benefit.

Published
2023

2. Creation of a universal language for surgical procedures using the step-by-step framework

Author

Nazari, T., Vlieger, E. J., Dankbaar, M. E. W., van Merriënboer, J. J. G., Lange, J. F., and Wiggers, T.

Subjects
Original Article, Original Articles
Abstract

Background Learning of surgical procedures is traditionally based on a master–apprentice model. Segmenting procedures into steps is commonly used to achieve an efficient manner of learning. Existing methods of segmenting procedures into steps, however, are procedure‐specific and not standardized, hampering their application across different specialties and thus worldwide uptake. The aim of this study was to establish consensus on the step‐by‐step framework for standardizing the segmentation of surgical procedures into steps. Methods An international expert panel consisting of general, gastrointestinal and oncological surgeons was approached to establish consensus on the preciseness, novelty, usefulness and applicability of the proposed step‐by‐step framework through a Delphi technique. All statements were rated on a five‐point Likert scale. A statement was accepted when the lower confidence limit was 3·00 or more. Qualitative comments were requested when a score of 3 or less was given. Results In round one, 20 of 49 experts participated. Eighteen of 19 statements were accepted; the ‘novelty’ statement needed further exploration (mean 3·05, 95 per cent c.i. 2·45 to 3·65). Based on the qualitative comments of round one, five clarifying statements were formulated for more specific statements in round two. Twenty‐two experts participated and accepted all statements. Conclusion The international expert panel consisting of general, gastrointestinal and oncological surgeons supported the preciseness, usefulness and applicability of the step‐by‐step framework. This framework creates a universal language by standardizing the segmentation of surgical procedures into step‐by‐step descriptions based on anatomical structures, and may facilitate education, communication and assessment.

Published
2017

4. Erratum to: Imaging for Quality Control: Comparison of Systematic Video Recording to the Operative Note in Colorectal Cancer Surgery. A Pilot Study

Author

van de Graaf, F. W., Lange, M. M., Menon, A. G., O’Mahoney, P. R. A., Milsom, J. W., and Lange, J. F.

Subjects
Aged, 80 and over, Male, Quality Control, Rectal Neoplasms, Video Recording, Pilot Projects, Documentation, Middle Aged, Quality Improvement, Checklist, Postoperative Complications, Oncology, Colonic Neoplasms, Feasibility Studies, Humans, Female, Surgery, Prospective Studies, Erratum, Colectomy, Aged
Abstract

Oncological and functional results after colorectal cancer surgery vary considerably between hospitals and surgeons. At present, the only source of technical information about the surgical procedure is the operative note, which is subjective and omits critical information. This study aimed to evaluate the feasibility of operative video recording in demonstrating both objective information concerning the surgical procedure and surgical quality, as using a systematic approach might improve surgical performance.From July 2015 through November 2015, patients aged ≥18 years undergoing elective colorectal cancer surgery were prospectively included in a single-institution trial. Video recording of key moments was performed peroperatively and analyzed for adequacy. The study cases were compared with a historic cohort. Video was compared with the operative note using the amount of adequate steps and a scoring system.This study compared 15 cases to 32 cases from the historic control group. Compared to the written operative note alone, significant differences in availability of information were seen in favor of video as well as using a combination of video plus the operative note (N adequate steps p = .024; p = .001. Adequacy score: p = .039; p = .001, both respectively).Systematic video registration is feasible and seems to improve the availability of essential information after colorectal cancer surgery. In this respect, combining video with a traditional operative note would be the best option. A multicenter international study is being organized to further evaluate the effect of operative video capture on surgical outcomes.

Published
2016

5. COLOR II - A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer

Author

Bonjer, H. J., Cuesta, M. A., Lacy, A. M., Haglind, E., Fuerst, A., Lange, J. F., Hop, W. C. J., Buunen, M., D Hoore, A., Inglis, K., Jess, P., Bulut, O., Rosenberg, J., Peiman, Christensen, M. Mark, Isalnieks, I., Jaeger, C., Kreis, M., Jeekel, J., Harst, E., Coenen, P. P. L. O., Gerhards, M. F., Bemelman, W., Jakimowicz, J. J., Riet, Y. E. A., Hansson, B. M. E., camiel rosman, Neijenhuis, P. A., Den Outer, A. J., Targarona, E. M., Balague, C., Delgado, S., Lujan, J., Garcia Molina, F. J., Skullman, S., Kurlberg, G., Lackberg, Z., Pahlman, L., Kressner, U., Matthiessen, P., Kim, Seon-Hahn, Surgery, Epidemiology, and CCA - Innovative therapy

Subjects
SDG 3 - Good Health and Well-being
Abstract

Introduction: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial. Methods: The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy analysis. Results: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the mid-rectum (41%). Conclusion: Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial. Completion of inclusion is expected by the end of 2009. Trial registration: Clinicaltrials.gov, identifier: NCT00297791 (www.clinicaltrials.gov).

6. 'Humbilical & epigastric hernia'

Author

A. L. Faye, J. N. Tendeng, Y. Imorou Souaibou, E. Safronova, JoAnn Carbray, C. C. Kersten, Ismaïl Lawani, F. C. Campanile, Woody Denham, M. Denakpo, I. Gögenur, A. Iossa, A. A. Sankale, V. Subramanian, E. Drabble, G. Ngom, M. L. Diao, M. Ndoye, A. K. Agossou-Voyeme, P. Daneiii, An P. Jairam, V. Petrakova, F. Helgstrand, G. Djrouo, A. Bondurri, F. C. de Carvalho, R. R. Soton, C. T. Toure, Stephen P. Haggerty, Johan F. Lange, John G. Linn, E. D. Mensah, Francis Moïse Dossou, Sarah Khan, F. De Angelis, O. Ndour, M. Rizzello, S. Chao, R. Harcubova, N. Leone, G. Arlt, H. Sjølander, Dunja Kokotovic, F. B. Toure, P. Gwiti, M. Zaki, J. Skach, S. Devadhar, A. O. Toure, Jean Leon Olory-Togbe, W. Trukhalev, M. Kukosh, A. Panyushkin, Giuseppe Cavallaro, Dansou Gaspard Gbessi, F. Froghi, O. Iorio, U. Volmer, P. Munipalle, G. Cesana, I. Gnangnon, F. Manoocheri, R. Kaufmann, Michael B. Ujiki, S. Olmi, L. Raparelli, Johannes Jeekel, A. A. Hadonou, Brittany Lapin, Gianfranco Silecchia, Francis J. DeAsis, F. Greco, I. Konate, V. Kanakala, P. Gogan, G. Baldazzi, L. Salimin, Y. Viswanath, G. Hounnou, M. Cisse, Matthew E. Gitelis, A. Ballerini, O. T. A. Elegbede, J. Danga Mandoboy, Surgery, Neurosciences, Deasis, F, Gitelis, M, Chao, S, Lapin, B, Linn, J, Denham, W, Haggerty, S, Carbray, J, Ujiki, M, Olory-Togbe, J L, Gbessi, D G, Dossou, F M, Lawani, I, Souaibou, Y Imorou, Gnangnon, I, Denakpo, M, Soton, R R, Djrouo, G, Gogan, P, Trukhalev, W, Kukosh, M, Panyushkin, A, Safronova, E, Jairam, A, Kaufmann, R, Jeekel, J, Lange, J F, Volmer, U, Kersten, C C, Arlt, G, Skach, J, Harcubova, R, Petrakova, V, Mandoboy, J Danga, Ngom, G, Faye, A L, Ndour, O, Sankale, A A, Ndoye, M, Daneiii, P, Leone, N, Ballerini, A, Bondurri, A, Cavallaro, G, Silecchia, G, Raparelli, L, Greco, F, Iorio, O, Iossa, A, De Angelis, F, Rizzello, M, Olmi, S, Cesana, G, Baldazzi, G, Manoocheri, F, Campanile, F C, Munipalle, P, Khan, S, Gwiti, P, Kanakala, V, Viswanath, Y, Kokotovic, D, Sjølander, H, Gögenur, I, Helgstrand, F, Devadhar, S, Hounnou, G, Elegbede, O T A, Hadonou, A A, Mensah, E D, Agossou-Voyeme, A K, Konate, I, Toure, A O, Cisse, M, Zaki, M, Diao, M L, Tendeng, J N, Toure, F B, Toure, C T, Subramanian, V, Froghi, F, de Carvalho, F C, Salimin, L, and Drabble, E

Subjects
Adult, child, medicine.medical_specialty, Hernia, Umbilical hernia, business.industry, General surgery, Epigastric hernia, medicine.disease, Surgery, therapeutic, Umbilical, medicine, epidemiology, clinic, Mesh Button, business, Abdominal surgery
Published
2015

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