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21 results on '"Verheijen, P.M."'

2. Treatment and survival of locally recurrent rectal cancer: A cross-sectional population study 15 years after the Dutch TME trial

Author

Aalbers, A.G.J., Acherman, Y., Algie, G.D., Alting von Geusau, B., Amelung, F., Aukema, T.S., Bakker, I.S., Bartels, S.A., Basha, S., Bastiaansen, A.J.N.M., Belgers, E., Bleeker, W., Blok, J., Bosker, R.J.I., Bosmans, J.W., Boute, M.C., Bouvy, N.D., Bouwman, H., Brandt-Kerkhof, A., Brinkman, D.J., Bruin, S., Bruns, E.R.J., Burbach, J.P.M., Burger, J.W.A., Buskens, C.J., Clermonts, S., Coene, P.P.L.O., Compaan, C., Consten, E.C.J., Darbyshire, T., de Mik, S.M.L., de Graaf, E.J.R., de Groot, I., tot Nederveen Cappel, RJ de Vos, de Wilt, J.H.W., van der Wolde, J., Boer, FC den, Dekker, J.W.T., Demirkiran, A., Derkx-Hendriksen, M., Dijkstra, F.R., van Duijvendijk, P., Dunker, M.S., Eijsbouts, Q.E., Fabry, H., Ferenschild, F., Foppen, J.W., Furnee, E.J.B., Gerhards, M.F., Gerven, P., Gooszen, J.A.H., Govaert, J.A., Van Grevenstein, W.M.U., Haen, R., Harlaar, J.J., van der Harst, E., Havenga, K., Heemskerk, J., Heeren, J.F., Heijnen, B., Heres, P., Hoff, C., Hogendoorn, W., Hoogland, P., Huijbers, A., Janssen, P., Jongen, A.C., Jonker, F.H., Karthaus, E.G., Keijzer, A., Ketel, J.M.A., Klaase, J., Kloppenberg, F.W.H., Kool, M.E., Kortekaas, R., Kruyt, P.M., Kuiper, J.T., Lamme, B., Lange, J.F., Lettinga, T., Lips, D.J., Logeman, F., Lutke Holzik, M.F., Madsen, E., Mamound, A., Marres, C.C., Masselink, I., Meerdink, M., Menon, A.G., Mieog, J.S., Mierlo, D., Musters, G.D., Nieuwenhuijzen, G.A.P., Neijenhuis, P.A., Nonner, J., Oostdijk, M., Oosterling, S.J., Paul, P.M.P., Peeters, K.C.M.J., Pereboom, I.T.A., Polat, F., Poortman, P., Raber, M., Reiber, B.M.M., Renger, R.J., van Rossem, C.C., Rutten, H.J., Rutten, A., Schaapman, R., Scheer, M., Schoonderwoerd, L., Schouten, N., Schreuder, A.M., Schreurs, W.H., Simkens, G.A., Slooter, G.D., Sluijmer, H.C.E., Smakman, N., Smeenk, R., Snijders, H.S., Sonneveld, D.J.A., Spaansen, B., Bilgen, EJ Spillenaar, Steller, E., Steup, W.H., Steur, C., Stortelder, E., Straatman, J., Swank, H.A., Sietses, C., Groen, H.A., Hoeve, HG ten, Riele, WW ter, Thorensen, I.M., Tip-Pluijm, B., Toorenvliet, B.R., Tseng, L., Tuynman, J.B., van Bastelaar, J., van Beek, S.C., van de Ven, A.W.H., van de Weijer, M.A.J., van den Berg, C., van den Bosch, I., van der Bilt, J.D.W., van der Hagen, S.J., van der Hul, R., van der Schelling, G., van der Spek, A., van der Wielen, N., van Duyn, E., van Eekelen, C., van Essen, J.A., van Gangelt, K., van Geloven, A.A.W., van Kessel, C., van Loon, Y.T., van Rijswijk, A., van Rooijen, S.J., van Sprundel, T., van Steensel, L., van Tets, W.F., van Westreenen, H.L., Veltkamp, S., Verhaak, T., Verheijen, P.M., Versluis-Ossenwaarde, L., Vijfhuize, S., Vles, W.J., Voeten, S.C., Vogelaar, F.J., Vrijland, W.W., Westerduin, E., Westerterp, M.E., Wetzel, M., Wevers, K.P., Wiering, B., Witjes, C.D.M., Wouters, M.W., Yauw, S.T.K., van der Zaag, E.S., Zeestraten, E.C., Zimmerman, D.D.E., Zwieten, T., Detering, Robin, Karthaus, Eleonora G., Borstlap, Wernard A.A., Marijnen, Corrie A.M., van de Velde, Cornelis J.H., Bemelman, Willem A., Beets, Geerard L., Tanis, Pieter J., and Aalbers, Arend G.J.

Published
2019
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3. Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency

Author

Burghgraef, T.A., Sikkenk, D.J., Crolla, R.M.P.H., Fahim, M., Melenhorst, J., Moumni, M.E., van der Schelling, G., Smits, A.B., Stassen, L.P.S., Verheijen, P.M., Consten, E.C.J., RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, MUMC+: MA Heelkunde (9), RS: SHE - R1 - Research (OvO), and RS: NUTRIM - R2 - Liver and digestive health

Subjects
RISK, RESECTION, SURGERY, Gastroenterology, Robot-assisted surgery, Rectal cancer, Learning curve, RECTAL-CANCER, Total mesorectal excision
Abstract

Purpose Evidence regarding the learning curve of robot-assisted total mesorectal excision is scarce and of low quality. Case-mix is mostly not taken into account, and learning curves are based on operative time, while preferably clinical outcomes and literature-based limits should be used. Therefore, this study aims to assess the learning curve of robot-assisted total mesorectal excision. Methods A retrospective study was performed in four Dutch centers. The primary aim was to assess the safety of the individual and institutional learning curves using a RA-CUSUM analysis based on intraoperative complications, major postoperative complications, and compound pathological outcome (positive circumferential margin or incomplete TME specimen). The learning curve for efficiency was assessed using a LC-CUSUM analysis for operative time. Outcomes of patients before and after the learning curve were compared. Results In this study, seven participating surgeons performed robot-assisted total mesorectal excisions in 531 patients. Learning curves for intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined literature-based limits. The LC-CUSUM for operative time showed lengths of the learning curve ranging from 12 to 35 cases. Intraoperative, postoperative, and pathological outcomes did not differ between patients operated during and after the learning curve. Conclusion The learning curve of robot-assisted total mesorectal excision based on intraoperative complications, postoperative complications, and compound pathological outcome did not exceed predefined limits and is therefore suggested to be safe. Using operative time as a surrogate for efficiency, the learning curve is estimated to be between 12 and 35 procedures.

Published
2023

5. Treatment and survival of locally recurrent rectal cancer: A cross-sectional population study 15 years after the Dutch TME trial

Author

Detering, Robin, primary, Karthaus, Eleonora G., additional, Borstlap, Wernard A.A., additional, Marijnen, Corrie A.M., additional, van de Velde, Cornelis J.H., additional, Bemelman, Willem A., additional, Beets, Geerard L., additional, Tanis, Pieter J., additional, Aalbers, Arend G.J., additional, Aalbers, A.G.J., additional, Acherman, Y., additional, Algie, G.D., additional, Alting von Geusau, B., additional, Amelung, F., additional, Aukema, T.S., additional, Bakker, I.S., additional, Bartels, S.A., additional, Basha, S., additional, Bastiaansen, A.J.N.M., additional, Belgers, E., additional, Bleeker, W., additional, Blok, J., additional, Bosker, R.J.I., additional, Bosmans, J.W., additional, Boute, M.C., additional, Bouvy, N.D., additional, Bouwman, H., additional, Brandt-Kerkhof, A., additional, Brinkman, D.J., additional, Bruin, S., additional, Bruns, E.R.J., additional, Burbach, J.P.M., additional, Burger, J.W.A., additional, Buskens, C.J., additional, Clermonts, S., additional, Coene, P.P.L.O., additional, Compaan, C., additional, Consten, E.C.J., additional, Darbyshire, T., additional, de Mik, S.M.L., additional, de Graaf, E.J.R., additional, de Groot, I., additional, tot Nederveen Cappel, RJ de Vos, additional, de Wilt, J.H.W., additional, van der Wolde, J., additional, Boer, FC den, additional, Dekker, J.W.T., additional, Demirkiran, A., additional, Derkx-Hendriksen, M., additional, Dijkstra, F.R., additional, van Duijvendijk, P., additional, Dunker, M.S., additional, Eijsbouts, Q.E., additional, Fabry, H., additional, Ferenschild, F., additional, Foppen, J.W., additional, Furnee, E.J.B., additional, Gerhards, M.F., additional, Gerven, P., additional, Gooszen, J.A.H., additional, Govaert, J.A., additional, Van Grevenstein, W.M.U., additional, Haen, R., additional, Harlaar, J.J., additional, van der Harst, E., additional, Havenga, K., additional, Heemskerk, J., additional, Heeren, J.F., additional, Heijnen, B., additional, Heres, P., additional, Hoff, C., additional, Hogendoorn, W., additional, Hoogland, P., additional, Huijbers, A., additional, Janssen, P., additional, Jongen, A.C., additional, Jonker, F.H., additional, Karthaus, E.G., additional, Keijzer, A., additional, Ketel, J.M.A., additional, Klaase, J., additional, Kloppenberg, F.W.H., additional, Kool, M.E., additional, Kortekaas, R., additional, Kruyt, P.M., additional, Kuiper, J.T., additional, Lamme, B., additional, Lange, J.F., additional, Lettinga, T., additional, Lips, D.J., additional, Logeman, F., additional, Lutke Holzik, M.F., additional, Madsen, E., additional, Mamound, A., additional, Marres, C.C., additional, Masselink, I., additional, Meerdink, M., additional, Menon, A.G., additional, Mieog, J.S., additional, Mierlo, D., additional, Musters, G.D., additional, Nieuwenhuijzen, G.A.P., additional, Neijenhuis, P.A., additional, Nonner, J., additional, Oostdijk, M., additional, Oosterling, S.J., additional, Paul, P.M.P., additional, Peeters, K.C.M.J., additional, Pereboom, I.T.A., additional, Polat, F., additional, Poortman, P., additional, Raber, M., additional, Reiber, B.M.M., additional, Renger, R.J., additional, van Rossem, C.C., additional, Rutten, H.J., additional, Rutten, A., additional, Schaapman, R., additional, Scheer, M., additional, Schoonderwoerd, L., additional, Schouten, N., additional, Schreuder, A.M., additional, Schreurs, W.H., additional, Simkens, G.A., additional, Slooter, G.D., additional, Sluijmer, H.C.E., additional, Smakman, N., additional, Smeenk, R., additional, Snijders, H.S., additional, Sonneveld, D.J.A., additional, Spaansen, B., additional, Bilgen, EJ Spillenaar, additional, Steller, E., additional, Steup, W.H., additional, Steur, C., additional, Stortelder, E., additional, Straatman, J., additional, Swank, H.A., additional, Sietses, C., additional, Groen, H.A., additional, Hoeve, HG ten, additional, Riele, WW ter, additional, Thorensen, I.M., additional, Tip-Pluijm, B., additional, Toorenvliet, B.R., additional, Tseng, L., additional, Tuynman, J.B., additional, van Bastelaar, J., additional, van Beek, S.C., additional, van de Ven, A.W.H., additional, van de Weijer, M.A.J., additional, van den Berg, C., additional, van den Bosch, I., additional, van der Bilt, J.D.W., additional, van der Hagen, S.J., additional, van der Hul, R., additional, van der Schelling, G., additional, van der Spek, A., additional, van der Wielen, N., additional, van Duyn, E., additional, van Eekelen, C., additional, van Essen, J.A., additional, van Gangelt, K., additional, van Geloven, A.A.W., additional, van Kessel, C., additional, van Loon, Y.T., additional, van Rijswijk, A., additional, van Rooijen, S.J., additional, van Sprundel, T., additional, van Steensel, L., additional, van Tets, W.F., additional, van Westreenen, H.L., additional, Veltkamp, S., additional, Verhaak, T., additional, Verheijen, P.M., additional, Versluis-Ossenwaarde, L., additional, Vijfhuize, S., additional, Vles, W.J., additional, Voeten, S.C., additional, Vogelaar, F.J., additional, Vrijland, W.W., additional, Westerduin, E., additional, Westerterp, M.E., additional, Wetzel, M., additional, Wevers, K.P., additional, Wiering, B., additional, Witjes, C.D.M., additional, Wouters, M.W., additional, Yauw, S.T.K., additional, van der Zaag, E.S., additional, Zeestraten, E.C., additional, Zimmerman, D.D.E., additional, and Zwieten, T., additional

Published
2019
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6. Influence of Conversion and Anastomotic Leakage on Survival in Rectal Cancer Surgery; Retrospective Cross-sectional Study

Author

Furnee, E.J.B., Aukema, T.S., Oosterling, S.J., Borstlap, W.A.A., Bemelman, W.A., Tanis, P.J., Aalbers, A., Acherman, Y., Algie, G.D., Geusau, B.A. von, Amelung, F., Bartels, S.A., Basha, S., Bastiaansen, A.J.N.M., Belgers, E., Bleeker, W., Blok, J., Bosker, R.J.I., Bosmans, J.W., Boute, M.C., Bouvy, N.D., Bouwman, H., Brandt-Kerkhof, A., Brinkman, D.J., Bruin, S., Bruns, E.R.J., Burbach, J.P.M., Burger, J.W.A., Buskens, C.J., Clermonts, S., Coene, P.P.L.O., Compaan, C., Consten, E.C.J., Darbyshire, T., Mik, S.M.L. de, Graaf, E.J.R. de, Groot, I. de, Cappel, R.J.L.D.N., Wilt, J.H.W. de, Wolde, J. van der, Boer, F.C. den, Dekker, J.W.T., Demirkiran, A., Derkx-Hendriksen, M., Dijkstra, F.R., Duijvendijk, P. van, Dunker, M.S., Eijsbouts, Q.E., Fabry, H., Ferenschild, F., Foppen, J.W., Gerhards, M.F., Gerven, P., Gooszen, J.A.H., Govaert, J.A., Grevenstein, W.M.U. van, Haen, R., Harlaar, J.J., Harst, E., Havenga, K., Heemskerk, J., Heeren, J.F., Heijnen, B., Heres, P., Hoff, C., Hogendoorn, W., Hoogland, P., Huijbers, A., Janssen, P., Jongen, A.C., Jonker, F.H., Karthaus, E.G., Keijzer, A., Ketel, J.M.A., Klaase, J., Kloppenberg, F.W.H., Kool, M.E., Kortekaas, R., Kruyt, P.M., Kuiper, J.T., Lamme, B., Lange, J.F., Lettinga, T., Lips, D.J., Logeman, F., Holzik, M.F.L., Madsen, E., Mamound, A., Marres, C.C., Masselink, I., Meerdink, M., Menon, A.G., Mieog, J.S., Mierlo, D., Musters, G.D., Nieuwenhuijzen, G.A.P., Neijenhuis, P.A., Nonner, J., Oostdijk, M., Paul, P.M.P., Peeters, K.C.M.J., Pereboom, I.T.A., Polat, F., Poortman, P., Raber, M., Reiber, B.M.M., Renger, R.J., Rossem, C.C. van, Rutten, H.J., Rutten, A., Schaapman, R., Scheer, M., Schoonderwoerd, L., Schouten, N., Schreuder, A.M., Schreurs, W.H., Simkens, G.A., Slooter, G.D., Sluijmer, H.C.E., Smakman, N., Smeenk, R., Snijders, H.S., Sonneveld, D.J.A., Spaansen, B., Bilgen, E.J.S., Steller, E., Steup, W.H., Steur, C., Stortelder, E., Straatman, J., Swank, H.A., Sietses, C., Berge, H.A. ten, Hoeve, H.G. ten, Riele, W.W. ter, Thorensen, I.M., Tip-Pluijm, B., Toorenvliet, B.R., Tseng, L., Tuynman, J.B., Bastelaar, J. van, Beek, S.C. van, Ven, A.W.H. van de, Weijer, M.A.J. van de, Berg, C. van den, Bosch, I. van den, Bilt, J.D.W. van der, Hagen, S.J. van der, Hul, R. van der, Schelling, G. van der, Spek, A. van der, Wielen, N. van der, Duyn, E. van, Eekelen, C. van, Essen, J.A. van, Gangelt, K. van, Geloven, A.A.W. van, Kessel, C. van, Loon, Y.T. van, Rijswijk, A. van, Rooijen, S.J. van, Sprundel, T. van, Steensel, L. van, Tets, W.F. van, Westreenen, H.L. van, Veltkamp, S., Verhaak, T., Verheijen, P.M., Versluis-Ossenwaarde, L., Vijfhuize, S., Vles, W.J., Voeten, S., Vogelaar, F.J., Vrijland, W.W., Westerduin, E., Westerterp, M.E., Wetzel, M., Wevers, K.P., Wiering, B., Witjes, C.D.M., Wouters, M.W., Yauw, S.T.K., Zaag, E.S. van der, Zeestraten, E.C., Zimmerman, D.D., Zwieten, T., and Dutch Snapshot Res Grp

Subjects
Survival, Anastomosis, Laparoscopy, Conversion, Rectal cancer
Published
2019

7. Cross-Sectional Study on MRI Restaging After Chemoradiotherapy and Interval to Surgery in Rectal Cancer: Influence on Short- and Long-Term Outcomes

Author

Detering, R., Borstlap, W.A.A., Broeders, L., Hermus, L., Marijnen, C.A.M., Beets-Tan, R.G.H., Bemelman, W.A., Westreenen, H.L. van, Tanis, P.J., Aalbers, A., Acherman, Y., Algie, G.D., Geusau, B.A. von, Amelung, F., Bartels, S.A., Basha, S., Bastiaansen, A.J.N.M., Belgers, E., Bleeker, W., Blok, J., Bosker, R.J.I., Bosmans, J.W., Boute, M.C., Bouvy, N.D., Bouwman, H., Brandt-Kerkhof, A., Brinkman, D.J., Bruin, S., Bruns, E.R.J., Burbach, J.P.M., Burger, J.W.A., Buskens, C.J., Clermonts, S., Coene, P.P.L.O., Compaan, C., Consten, E.C.J., Darbyshire, T., Mik, S.M.L. de, Graaf, E.J.R. de, Groot, I. de, Cappel, R.J.L.D.T.N., Wilt, J.H.W. de, Wolde, J. van der, Boer, F.C. den, Dekker, J.W.T., Demirkiran, A., Derkx-Hendriksen, M., Dijkstra, F.R., Duijvendijk, P. van, Dunker, M.S., Eijsbouts, Q.E., Fabry, H., Ferenschild, F., Foppen, J.W., Gerhards, M.F., Gerven, P., Gooszen, J.A.H., Govaert, J.A., Grevenstein, W.M.U. van, Haen, R., Harlaar, J.J., Harst, E., Havenga, K., Heemskerk, J., Heeren, J.F., Heijnen, B., Heres, P., Hoff, C., Hogendoorn, W., Hoogland, P., Huijbers, A., Janssen, P., Jongen, A.C., Jonker, F.H., Karthaus, E.G., Keijzer, A., Ketel, J.M.A., Klaase, J., Wit, F., Kloppenberg, H., Kool, M.E., Kortekaas, R., Kruyt, P.M., Kuiper, J.T., Lamme, B., Lange, J.F., Lettinga, T., Lips, D.J., Logeman, F., Holzik, M.F.L., Madsen, E., Mamound, A., Marres, C.C., Masselink, I., Meerdink, M., Menon, A.G., Mieog, J.S., Mierlo, D., Musters, G.D., Nieuwenhuijzen, G.A.P., Neijenhuis, P.A., Nonner, J., Oostdijk, M., Paul, P.M.P., Peeters, K.C.M.J., Pereboom, I.T.A., Polat, F., Poortman, P., Raber, M., Reiber, B.M.M., Renger, R.J., Rossem, C.C. van, Rutten, H.J., Rutten, A., Schaapman, R., Scheer, M., Schoonderwoerd, L., Schouten, N., Schreuder, A.M., Schreurs, W.H., Simkens, G.A., Slooter, G.D., Sluijmer, H.C.E., Smakman, N., Smeenk, R., Snijders, H.S., Sonneveld, D.J.A., Spaansen, B., Bilgen, E.J.S., Steller, E., Steup, W.H., Steur, C., Stortelder, E., Straatman, J., Swank, H.A., Sietses, C., Berge, H.A. ten, Hoeve, H.G. ten, Riele, W.W. ter, Thorensen, I.M., Tip-Pluijm, B., Toorenvliet, B.R., Tseng, L., Tuynman, J.B., Bastelaar, J. van, Beek, S.C. van, Ven, A.W.H. van de, Weijer, M.A.J. van de, Berg, C. van den, Bosch, I. van den, Bilt, J.D.W. van der, Hagen, S.J. van der, Hul, R. van der, Schelling, G. van der, Spek, A. van der, Wielen, N. van der, Duyn, E. van, Eekelen, C. van, Essen, J.A. van, Gangelt, K. van, Geloven, A.A.W. van, Kessel, C. van, Loon, Y.T. van, Rijswijk, A. van, Rooijen, S.J. van, Sprundel, T. van, Steensel, L. van, Tets, W.F. van, Veltkamp, S., Verhaak, T., Verheijen, P.M., Versluis-Ossenwaarde, L., Vijfhuize, S., Vles, W.J., Voeten, S.C., Vogelaar, F.J., Vrijland, W.W., Westerduin, E., Westerterp, M.E., Wetzel, M., Wevers, K.P., Wiering, B., Witjes, C.D.M., Wouters, M.W., Yauw, S.T.K., Zaag, E.S. van der, Zeestraten, E.C., Zimmerman, D.D., Zwieten, T., Dutch Snapshot Res Grp, Groningen Institute for Organ Transplantation (GIOT), Value, Affordability and Sustainability (VALUE), ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), CCA - Cancer Treatment and quality of life, Surgery, Amsterdam Reproduction & Development (AR&D), and Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, IMPACT, medicine.medical_treatment, THERAPY, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], CHEMORADIATION, 0302 clinical medicine, ADJUVANT CHEMOTHERAPY, Interquartile range, Medicine, PATHOLOGICAL COMPLETE RESPONSE, Stage (cooking), Neoadjuvant therapy, Netherlands, Aged, 80 and over, medicine.diagnostic_test, Incidence, ASO Author Reflections, Chemoradiotherapy, Middle Aged, Magnetic Resonance Imaging, Neoadjuvant Therapy, Survival Rate, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Surgical Procedures, Operative, SURVIVAL, 030211 gastroenterology & hepatology, Female, TIME-INTERVAL, RADIOTHERAPY, medicine.medical_specialty, RESECTION, Preoperative care, Time-to-Treatment, 03 medical and health sciences, Preoperative Care, Humans, Survival rate, Aged, Neoplasm Staging, Retrospective Studies, business.industry, Rectal Neoplasms, Magnetic resonance imaging, Retrospective cohort study, NEOADJUVANT CHEMORADIOTHERAPY, Surgery, Cross-Sectional Studies, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

Contains fulltext : 215772.pdf (Publisher’s version ) (Open Access) BACKGROUND: The time interval between CRT and surgery in rectal cancer patients is still the subject of debate. The aim of this study was to first evaluate the nationwide use of restaging magnetic resonance imaging (MRI) and its impact on timing of surgery, and, second, to evaluate the impact of timing of surgery after chemoradiotherapy (CRT) on short- and long-term outcomes. METHODS: Patients were selected from a collaborative rectal cancer research project including 71 Dutch centres, and were subdivided into two groups according to time interval from the start of preoperative CRT to surgery (< 14 and >/= 14 weeks). RESULTS: From 2095 registered patients, 475 patients received preoperative CRT. MRI restaging was performed in 79.4% of patients, with a median CRT-MRI interval of 10 weeks (interquartile range [IQR] 8-11) and a median MRI-surgery interval of 4 weeks (IQR 2-5). The CRT-surgery interval groups consisted of 224 (< 14 weeks) and 251 patients (>/= 14 weeks), and the long-interval group included a higher proportion of cT4 stage and multivisceral resection patients. Pathological complete response rate (n = 34 [15.2%] vs. n = 47 [18.7%], p = 0.305) and CRM involvement (9.7% vs. 15.9%, p = 0.145) did not significantly differ. Thirty-day surgical complications were similar (20.1% vs. 23.1%, p = 0.943), however no significant differences were found for local and distant recurrence rates, disease-free survival, and overall survival. CONCLUSIONS: These real-life data, reflecting routine daily practice in The Netherlands, showed substantial variability in the use and timing of restaging MRI after preoperative CRT for rectal cancer, as well as time interval to surgery. Surgery before or after 14 weeks from the start of CRT resulted in similar short- and long-term outcomes.

Published
2019

8. Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials

Author

Borstlap, W.A., Deijen, C.L., Dulk, M. den, Bonjer, H.J., Velde, C.J. van de, Bemelman, W.A., Tanis, P.J., Aalbers, A., Acherman, Y., Algie, G.D., Geu-sau, B. von, Amelung, F., Aukema, T.S., Bakker, I.S., Bartels, S.A., Basha, S., Bastiaansen, A.J., Belgers, E.H.J., Bleeker, W., Blok, J., Bosker, R.J.I., Bosmans, J.W., Boute, M.C., Bouvy, N.D., Bouwman, H., Brandt-Kerkhof, A., Brinkman, D.J., Bruin, S., Bruns, E.R.J., Burbach, J.P.M., Burger, J.W., Buskens, C.J., Clermonts, S., Coene, P.P.L.O., Compaan, C., Consten, E.C., Darbyshire, T., Mik, S.M.L. de, Graaf, E.J. de, Groot, I de, Cappel de Vos Tot Nederveen, R.J.L., Wilt, J.H.W. de, Wolde, J. van der, Boer, F.C. den, Dekker, J.W.T., Demirkiran, A., Derkx-Hendriksen, M., Dijkstra, F.R., Duijvendijk, P. van, Dunker, M.S., Eijsbouts, Q.E., Fabry, H., Ferenschild, F.T.J., Foppen, J.W., Furnee, E.J.B., Gerhards, M.F., Gerven, P, Gooszen, J.A.H., Govaert, J.A., Grevenstein, W.M. van, Haen, R., Harlaar, J.J., Harst, E, Havenga, K., Heemskerk, J., Heeren, J.F., Heijnen, B., Heres, P., Hoff, C., Hogendoorn, W., Hoogland, P., Huijbers, A, Janssen, P., Jongen, A.C., Jonker, F.H., Karthaus, E.G., Keijzer, A, Ketel, J.M.A., Klaase, J., Kloppenberg, F.W.H., Kool, M.E., Kortekaas, R., Kruyt, P.M., Kuiper, J.T., Lamme, B., Lange, J.F., Lettinga, T., Lips, D.J., Logeman, F., Holzik, M.F., Madsen, E., Mamound, A., Marres, C.C., Masselink, I., Meerdink, M., Menon, A.G., Mieog, J.S., Mierlo, D. van, Musters, G.D., Neijenhuis, P.A., Nonner, J., Oostdijk, M, Oosterling, S.J., Paul, P.M.P., Peeters, K.C., Pereboom, I.T.A., Polat, F., Poortman, P., Raber, M., Reiber, B.M.M., Renger, R.J., Rossem, C.C. van, Rutten, H.J., Rutten, A., Schaapman, R., Scheer, M.G.W., Schoonderwoerd, L., Schouten, N., Schreuder, A.M., Schreurs, W.H., Simkens, G.A., Slooter, G.D., Sluijmer, H.C.E., Smakman, N., Smeenk, R., Snijders, H.S., Sonneveld, D.J.A., Spaansen, B., Spillenaar Bilgen, E.J., Steller, E., Steup, W.H., Steur, C., Stortelder, E., Straatman, J., Swank, H.A., Sietses, C., Berge, H.A. ten, Hoeve, H.G. ten, Riele, W.W. ter, Thorensen, I.M., Tip-Pluijm, B., Toorenvliet, B.R., Tseng, L., Tuynman, J.B., Bastelaar, J. van, Beek, S.V. van, Ven, A.W.H. van de, Weijer, M.A.J. van de, Berg, C. van den, Bosch, I. van den, Bilt, J.D.W. van der, Hagen, S.J. van der, Hul, R. van der, Schelling, G.P. van der, Spek, A van der, Wielen, N. van der, Duyn, E. van, Eekelen, C. van, Essen, J.A. van, Gangelt, K. van, Geloven, A.A. van, Kessel, C. Van, Loon, Y.T. van, Rijswijk, A. van, Rooijen, S.J. van, Sprundel, T. van, Steensel, L. van, Tets, W.F van, Westreenen, H.L. van, Veltkamp, S., Verhaak, T., Verheijen, P.M., Versluis-Ossenwaarde, L., Vijfhuize, S., Vles, W.J., Voeten, S., Vogelaar, F.J., Vrijland, W.W., Westerduin, E., Westerterp, M., Wetzel, M., Wevers, K., Wiering, B., Witjes, A.C., Wouters, M.W., Yauw, S.T.K., Zeestraten, E.C., Zimmerman, D., Zwieten, T., Groningen Institute for Organ Transplantation (GIOT), Value, Affordability and Sustainability (VALUE), ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), Surgery, CCA - Cancer Treatment and quality of life, APH - Quality of Care, APH - Global Health, Anatomy and neurosciences, VU University medical center, AGEM - Re-generation and cancer of the digestive system, AGEM - Digestive immunity, Neurology, Internal medicine, ACS - Microcirculation, MUMC+: MA Heelkunde (9), RS: MHeNs - R2 - Mental Health, Psychiatrie & Neuropsychologie, Promovendi MHN, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: NUTRIM - R1 - Metabolic Syndrome, RS: NUTRIM - R2 - Liver and digestive health, Revalidatie, RS: CARIM - R1.03 - Cell biochemistry of thrombosis and haemostasis, Biochemie, Promovendi CD, Ondersteunend personeel NTM, Promovendi NTM, Promovendi PHPC, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: MA AIOS Heelkunde (9), Promovendi ODB, MUMC+: MA AIOS Anesthesiologie (9), Pathologie, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Graduate School, and Other departments

Subjects
Male, Transanal Endoscopic Microsurgery, Colorectal cancer, medicine.medical_treatment, NETHERLANDS, law.invention, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, ADJUVANT CHEMOTHERAPY, Randomized controlled trial, law, Interquartile range, Prospective Studies, Registries, Rectal cancer, Intersectoral Collaboration, Randomized Controlled Trials as Topic, Aged, 80 and over, Medical Audit, Gastroenterology, Margins of Excision, Chemoradiotherapy, Benchmarking, Middle Aged, Total mesorectal excision, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Treatment Outcome, snapshot study, 030220 oncology & carcinogenesis, OPEN SURGERY, Cohort, Female, 030211 gastroenterology & hepatology, RADIOTHERAPY, medicine.medical_specialty, Disease-Free Survival, 03 medical and health sciences, ANTERIOR RESECTION, medicine, Humans, Aged, Retrospective Studies, oncologic outcomes, Rectal Neoplasms, business.industry, General surgery, TOTAL MESORECTAL EXCISION, medicine.disease, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Radiation therapy, Cross-Sectional Studies, Circumferential resection margin, Neoplasm Recurrence, Local, business
Abstract

Aim A Snapshot study design eliminates changes in treatment and outcome over time. This population based Snapshot study aimed to determine current practice and outcome of rectal cancer treatment with published landmark randomized controlled trials as a benchmark.Method In this collaborative research project, the dataset of the Dutch Surgical Colorectal Audit was extended with additional treatment and long-term outcome data. All registered patients who underwent resection for rectal cancer in 2011 were eligible. Baseline characteristics and outcome were evaluated against the results of the Dutch TME trial and the COLOR II trial from which the original datasets were obtained.Results A total of 71 hospitals participated, and data were completed for 2102 out of the potential 2633 patients (79.8%). Median follow-up was 41 (interquartile range 25-47) months. Overall circumferential resection margin (CRM) involvement was 9.3% in the Snapshot cohort and 18.5% in the Dutch TME trial. CRM positivity after laparoscopic resection was 7.8% in the Snapshot and 9.5% in the COLOR II trial. Three-year overall local recurrence rate in the Snapshot was 5.9%, with a disease-free survival of 67.1% and overall survival of 79.5%. Benchmarking with the randomized controlled trials revealed an overall favourable long-term outcome of the Snapshot cohort.Conclusion This study showed that current rectal cancer care in a large unselected Dutch population is of high quality, with less positive CRM since the TME trial and oncologically safe implementation of minimally invasive surgery after the COLOR II trial.

Published
2017

9. Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials

Author

Borstlap, W.A.A., Deijen, C.L., Dulk, M. den, Bonjer, H.J., Velde, C.J. van de, Bemelman, W.A., Tanis, P.J., Aalbers, A., Acherman, Y., Algie, G.D., Geu-sau, B.A. von, Amelung, F., Aukema, T.S., Bakker, I.S., Bartels, S.A., Basha, S., Bastiaansen, A.J.N.M., Belgers, E., Bleeker, W., Blok, J., Bosker, R.J.I., Bosmans, J.W., Boute, M.C., Bouvy, N.D., Bouwman, H., Brandt-Kerkhof, A., Brinkman, D.J., Bruin, S., Bruns, E.R.J., Burbach, J.P.M., Burger, J.W.A., Buskens, C.J., Clermonts, S., Coene, P.P.L.O., Compaan, C., Consten, E.C.J., Darbyshire, T., Mik, S.M.L. de, Graaf, E.J.R. de, Groot, I. de, Cappel, R.J.L.D.T.N., Wilt, J.H.W. de, Wolde, J. van der, Boer, F.C. den, Dekker, J.W.T., Demirkiran, A., Derkx-Hendriksen, M., Dijkstra, F.R., Duijvendijk, P. van, Dunker, M.S., Eijsbouts, Q.E., Fabry, H., Ferenschild, F., Foppen, J.W., Furnee, E.J.B., Gerhards, M.F., Gerven, P., Gooszen, J.A.H., Govaert, J.A., Grevenstein, W.M.U. van, Haen, R., Harlaar, J.J., Harst, E., Havenga, K., Heemskerk, J., Heeren, J.F., Heijnen, B., Heres, P., Hoff, C., Hogendoorn, W., Hoogland, P., Huijbers, A., Janssen, P., Jongen, A.C., Jonker, F.H., Karthaus, E.G., Keijzer, A., Ketel, J.M.A., Klaase, J., Kloppenberg, F.W.H., Kool, M.E., Kortekaas, R., Kruyt, P.M., Kuiper, J.T., Lamme, B., Lange, J.F., Lettinga, T., Lips, D.J., Logeman, F., Holzik, M.F.L., Madsen, E., Mamound, A., Marres, C.C., Masselink, I., Meerdink, M., Menon, A.G., Mieog, J.S., Mierlo, D., Musters, G.D., Neijenhuis, P.A., Nonner, J., Oostdijk, M., Oosterling, S.J., Paul, P.M.P., Peeters, K.C.M.J.C., Pereboom, I.T.A., Polat, F., Poortman, P., Raber, M., Reiber, B.M.M., Renger, R.J., Rossem, C.C. van, Rutten, H.J., Rutten, A., Schaapman, R., Scheer, M., Schoonderwoerd, L., Schouten, N., Schreuder, A.M., Schreurs, W.H., Simkens, G.A., Slooter, G.D., Sluijmer, H.C.E., Smakman, N., Smeenk, R., Snijders, H.S., Sonneveld, D.J.A., Spaansen, B., Bilgen, E.J.S., Steller, E., Steup, W.H., Steur, C., Stortelder, E., Straatman, J., Swank, H.A., Sietses, C., Berge, H.A. ten, Hoeve, H.G. ten, Riele, W.W. ter, Thorensen, I.M., Tip-Pluijm, B., Toorenvliet, B.R., Tseng, L., Tuynman, J.B., Bastelaar, J. van, Beek, S.V. van, Ven, A.W.H. van de, Weijer, M.A.J. van de, Berg, C. van den, Bosch, I. van den, Bilt, J.D.W. van der, Hagen, S.J. van der, Hul, R. van der, Schelling, G. van der, Spek, A. van der, Wielen, N. van der, Duyn, E. van, Eekelen, C. van, Essen, J.A. van, Gangelt, K. van, Geloven, A.A.W. van, Kessel, C. van, Loon, Y.T. van, Rijswijk, A. van, Rooijen, S.J. van, Sprundel, T. van, Steensel, L. van, Tets, W.F. van, Westreenen, H.L. van, Veltkamp, S., Verhaak, T., Verheijen, P.M., Versluis-Ossenwaarde, L., Vijfhuize, S., Vles, W.J., Voeten, S., Vogelaar, F.J., Vrijland, W.W., Westerduin, E., Westerterp, M.E., Wetzel, M., Wevers, K., Wiering, B., Witjes, A.C., Wouters, M.W., Yauw, S.T.K., Zeestraten, E.C., Zimmerman, D.D., Zwieten, T., and Dutch Snapshot Res Grp

Subjects
oncologic outcomes, snapshot study, Rectal cancer
Abstract

Aim A Snapshot study design eliminates changes in treatment and outcome over time. This population based Snapshot study aimed to determine current practice and outcome of rectal cancer treatment with published landmark randomized controlled trials as a benchmark.Method In this collaborative research project, the dataset of the Dutch Surgical Colorectal Audit was extended with additional treatment and long-term outcome data. All registered patients who underwent resection for rectal cancer in 2011 were eligible. Baseline characteristics and outcome were evaluated against the results of the Dutch TME trial and the COLOR II trial from which the original datasets were obtained.Results A total of 71 hospitals participated, and data were completed for 2102 out of the potential 2633 patients (79.8%). Median follow-up was 41 (interquartile range 25-47) months. Overall circumferential resection margin (CRM) involvement was 9.3% in the Snapshot cohort and 18.5% in the Dutch TME trial. CRM positivity after laparoscopic resection was 7.8% in the Snapshot and 9.5% in the COLOR II trial. Three-year overall local recurrence rate in the Snapshot was 5.9%, with a disease-free survival of 67.1% and overall survival of 79.5%. Benchmarking with the randomized controlled trials revealed an overall favourable long-term outcome of the Snapshot cohort.Conclusion This study showed that current rectal cancer care in a large unselected Dutch population is of high quality, with less positive CRM since the TME trial and oncologically safe implementation of minimally invasive surgery after the COLOR II trial.

Published
2017

10. Comparison of dynamic magnetic resonance defaecography with rectal contrast and conventional defaecography for posterior pelvic floor compartment prolapse

Author

Iersel, J.J. van, Formijne Jonkers, H.A., Verheijen, P.M., Broeders, I.A.M.J., Heggelman, B.G., Sreetharan, V., Futterer, J.J., Somers, I., Leest, M.M. van der, Consten, E.C., Iersel, J.J. van, Formijne Jonkers, H.A., Verheijen, P.M., Broeders, I.A.M.J., Heggelman, B.G., Sreetharan, V., Futterer, J.J., Somers, I., Leest, M.M. van der, and Consten, E.C.

Abstract

Item does not contain fulltext, AIM: This study compared the diagnostic capabilities of dynamic magnetic resonance defaecography (D-MRI) with conventional defaecography (CD, reference standard) in patients with symptoms of prolapse of the posterior compartment of the pelvic floor. METHOD: Forty-five consecutive patients underwent CD and D-MRI. Outcome measures were the presence or absence of rectocele, enterocele, intussusception, rectal prolapse and the descent of the anorectal junction on straining, measured in millimetres. Cohen's Kappa, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the positive and negative likelihood ratio of D-MRI were compared with CD. Cohen's Kappa and Pearson's correlation coefficient were calculated and regression analysis was performed to determine inter-observer agreement. RESULTS: Forty-one patients were available for analysis. D-MRI underreported rectocele formation with a difference in prevalence (CD 77.8% vs D-MRI 55.6%), mean protrusion (26.4 vs 22.7 mm, P = 0.039) and 11 false negative results, giving a low sensitivity of 0.62 and a NPV of 0.31. For the diagnosis of enterocele, D-MRI was inferior to CD, with five false negative results, giving a low sensitivity of 0.17 and high specificity (1.0) and PPV (1.0). Nine false positive intussusceptions were seen on D-MRI with only two missed. CONCLUSION: The accuracy of D-MRI for diagnosing rectocele and enterocele is less than that of CD. D-MRI, however, appears superior to CD in identifying intussusception. D-MRI and CD are complementary imaging techniques in the evaluation of patients with symptoms of prolapse of the posterior compartment.

Published
2017

11. Imatinib treatment of poor prognosis mesenchymal-type primary colon cancer: A proof-of-concept study in the preoperative window period (ImPACCT)

Author

Ubink, I., Bloemendal, H.J. (Haiko), Elias, S.G. (Sjoerd), Brink, M.A. (Menno), Schwartz, M.P. (Matthijs), Holierhoek, Y.C.W., Verheijen, P.M., Boerman, A.W., Mathijssen, A.H.J. (Ron), Leng, W.W.J. (Wendy) de, Weger, R.A. (Roel) de, Grevenstein, H.M.U. (Helma) van, Koopman, M. (Miriam), Lolkema, M.P. (Martijn), Kranenburg, O. (Onno), Borel Rinkes, I.H.M. (Inne), Ubink, I., Bloemendal, H.J. (Haiko), Elias, S.G. (Sjoerd), Brink, M.A. (Menno), Schwartz, M.P. (Matthijs), Holierhoek, Y.C.W., Verheijen, P.M., Boerman, A.W., Mathijssen, A.H.J. (Ron), Leng, W.W.J. (Wendy) de, Weger, R.A. (Roel) de, Grevenstein, H.M.U. (Helma) van, Koopman, M. (Miriam), Lolkema, M.P. (Martijn), Kranenburg, O. (Onno), and Borel Rinkes, I.H.M. (Inne)

Abstract

Background: The identification of four Consensus Molecular Subtypes (CMS1-4) of colorectal cancer forms a new paradigm for the design and evaluation of subtype-directed therapeutic strategies. The most aggressive subtype - CMS4 - has the highest chance of disease recurrence. Novel adjuvant therapies for patients with CMS4 tumours are therefore urgently needed. CMS4 tumours are characterized by expression of mesenchymal and stem-like genes. Previous pre-clinical work has shown that targeting Platelet-Derived Growth Factor Receptors (PDGFRs) and the related KIT receptor with imatinib is potentially effective against mesenchymal-type colon cancer

Published
2017
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13. Robotic transanal total mesorectal excision for rectal cancer: experience with a first case

Author

Verheijen, P.M., Consten, E.C.J., and Broeders, Ivo Adriaan Maria Johannes

Subjects
METIS-309890, TME, rectum, transanal, IR-94237, EWI-25715, Robotic
Abstract

Background: A transanal approach for total mesorectal excision (TME) using a single incision port is feasible. The disadvantages are technical difficulties associated with limited manoeuvrability. Methods: We present our first experience with robotic-assisted transanal total mesorectal excision. A 48 year-old woman with a tumour 8 cm from the anal verge was successfully operated using a transanal approach. A complete mesorectal excision was performed through a single incision port, using two robot arms. Results: TME was performed successfully and the patient recovered quickly without any complications. The histological report showed a complete mesorectal excision with free distal and circumferential margins. A sigmoidoscopy showed an intact anastomosis and the patient was planned for reversal of her ileostomy. Conclusions: Transanal total mesorectal excision using the robot is feasible. Robotics may help to overcome technical difficulties associated with the single incision port.

Published
2014

15. Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates

Author

Amelung, F.J., Beaufort, H.W. de, Siersema, P.D., Verheijen, P.M., Consten, E.C., Amelung, F.J., Beaufort, H.W. de, Siersema, P.D., Verheijen, P.M., and Consten, E.C.

Abstract

16 februari 2016, Contains fulltext : 152183.pdf (publisher's version ) (Closed access), PURPOSE: No consensus exists on the optimal treatment of acute malignant right-sided colonic obstruction (RSCO). This systematic review aims to compare procedure-related mortality and morbidity rates between primary resection and stent placement as a bridge to surgery followed by elective resection for patients with acute RSCO. METHODS: PubMed, Embase and Cochrane library were searched for all relevant literature. Primary endpoints were procedure-related mortality and morbidity. Methodological quality of the included studies was assessed using the MINORS criteria. RESULTS: Fourteen cohort studies were eligible for analysis. A total of 2873 patients were included in the acute resection group and 155 patients in the stent group. Mean mortality rate for patients who underwent acute resection with primary anastomosis was 10.8% (8.1-18.5%). Overall mortality for patients initially treated with a colonic stent followed with elective resection was 0%. Major morbidity was 23.9% (9.3-35.6%) and 0.8% (0-4.8%), respectively. Both mortality and major morbidity were significantly different. In addition, stent placement shows lower rates of anastomotic leakages (0 vs 9.1%) and fewer permanent ileostomies (0 vs 1.0%). CONCLUSION: Primary resection for patients with acute RSCO seems to be associated with higher mortality and major morbidity rates than stent placement and elective resection. In addition, stent placement resulted in fewer anastomotic leakages and permanent ileostomies. However, as no high-level studies are available on the optimal treatment of RSCO and proximal stenting is considered technically challenging, future comparative studies are warranted for the development of an evidence-based clinical decision guideline.

Published
2015

16. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: Systematic review and meta-analysis

Author

Amelung, F.J., Mulder, C.L., Verheijen, P.M., Draaisma, W.A., Siersema, P.D., Consten, E.C., Amelung, F.J., Mulder, C.L., Verheijen, P.M., Draaisma, W.A., Siersema, P.D., and Consten, E.C.

Abstract

Item does not contain fulltext, BACKGROUND: Currently, no consensus exists on the best treatment strategy for acute malignant left-sided colonic obstruction. This systematic review and meta-analysis aims to compare the outcomes following the two surgical treatment options; primary resection versus colostomy creation as bridge to surgery. METHODS: This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to minimize risk of bias. Pubmed, Embase and Cochrane Library were searched for all relevant literature. Methodological quality of included studies was assessed using the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95%CI) were calculated using random effects models. RESULTS: Eight comparative studies were included, reporting on 2424 patients; 1973 patients were treated with primary resection and 451 patients with colostomy construction followed by elective resection. Meta-analysis showed no significant differences between both treatment groups regarding 30-day mortality and morbidity (OR = 0.77, 95%CI 0.3-1.96 and OR = 0.76, 95%CI 0.51-1.13, respectively). However, patients treated with a colostomy followed by elective resection had significantly more primary anastomoses constructed and were less likely to be left with a permanent colostomy (OR = 0.17, 95%CI 0.11-0.26 and OR = 0.22, 95%CI 0.11-0.46, respectively). CONCLUSION: This systematic review provides an overview of all available literature on primary resection versus colostomy creation as bridge to surgery in patients with acute LSCO. Keeping the limitations of this study in mind, we conclude that a diverting colostomy as bridge to surgery is a safe and valid alternative for primary resection.

Published
2015

20. Altered fetal circulation in type-1 daibetic pregnancies.

Author

Lisowski, L.A., Verheijen, P.M., De Smedt, M.M.C., Visser, G.H.A., and Meijboom, E.J.

Subjects
*PREGNANCY complications, *GESTATIONAL diabetes, *GLUCOSE, *INSULIN, *BLOOD flow
Abstract

Objective Type-I diabetic pregnancies are associated with congenital cardiac malformations, fetal cardiomyopathy, venous thrombosis and altered placental vascularization, even with tight maternal glucose control. The aim of this study was to investigate if, with good glucose control achieved with continuous subcutaneous insulin infusion, normal blood flow within the fetal heart can be achieved. Methods Seventeen fetuses of women with wellcontrolled type-I diabetes were studied longitudinally to evaluate effects on the fetal circulation. Doppler frequency shift tracings, valve diameters and intercept angles were measured at right and left atrioventricular valve orifices at 4-week intervals starting at 15 weeks' gestation. Atrioventricular valve flow was calculated and compared to normal fetal data obtained in previous studies. Results Maximum and mean temporal velocities across the atrioventricular valves increased in both groups during gestation but significantly more in fetuses of type-I diabetic pregnancies. Combined ventricular output, both absolute and per kg estimated fetal weight, were also greater in these fetuses. In the normal group the ratio of the left/right ventricular output decreased significantly during gestation (from 1.34 ± 0.28 to 1.08 ± 0.28 standard deviations), but in type-I diabetic pregnancies this decrease did not occur (1.2 ± 0.26 to 1.25 ± 0.29 standard deviations). Conclusions These data indicate that there are significant differences in the fetal circulation between normal pregnancy and well-controlled type-I diabetic pregnancy, suggesting the existence of a compensatory mechanism which increases fetal cardiac output and causes cardiac hypertrophy. [ABSTRACT FROM AUTHOR]

Published
2003
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