17 results on '"Besselink, Marc G H"'
Search Results
2. The effect of liver surgery and fluid strategy on renin activity and aldosterone and anti-diuretic hormone levels: a secondary analysis of the GALILEO trial.
- Author
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Klompmaker P, Mungroop TH, Jongerius I, Nieveen van Dijkum EJM, Besselink MGH, Erdmann JI, van Gulik TM, Hollmann MW, Vogt L, Tuinman PR, and Veelo DP
- Abstract
Background: It is unknown whether liver surgery leads to increased RAAS activity and anti-diuretic hormone (ADH) levels and subsequent fluid accumulation. Furthermore, it is unknown whether the peri-operative fluid strategy changes this effect., Methods: This is a pre-planned post hoc analysis of a randomised controlled trial which compared restrictive (n = 20) versus liberal fluid strategy (n = 20) in patients undergoing liver surgery. Primary outcomes for the current study were the difference in hormone levels after anaesthesia induction and after liver resection. Fluid overload was defined as a ≥10% increase in weight., Results: Renin activity (6 [2.1-15.5] vs. 12 [4.6-33.5]) and ADH levels (6.0 [1.7-16.3] vs. 3.8 [1.6-14.7]) did not differ significantly before and after resection. However, aldosterone levels were significantly higher after resection (0.30 [0.17-0.49] vs. 0.69 [0.31-1.21] ). Renin activity and aldosterone levels did not differ between the groups. ADH was significantly higher in the restrictive strategy group (1.6 [1.1-2.1] vs 5.9 [3.8-16.0]). No differences in hormone levels were found in patients with and without fluid overload., Discussion: Aldosterone levels increased after liver surgery but renin activity and ADH levels did not. ADH levels were higher in the restrictive group. Development of post-operative fluid overload was not associated with RAAS activity or ADH levels., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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3. The yield of staging laparoscopy for resectable and borderline resectable pancreatic cancer in the PREOPANC randomized controlled trial.
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van Dongen JC, Versteijne E, Bonsing BA, Mieog JSD, de Hingh IHJT, Festen S, Patijn GA, van Dam R, van der Harst E, Wijsman JH, Bosscha K, van der Kolk M, de Meijer VE, Liem MSL, Busch OR, Besselink MGH, van Tienhoven G, Groot Koerkamp B, van Eijck CHJ, and Suker M
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- Humans, Neoplasm Staging, Pancreatic Neoplasms, Peritoneal Neoplasms pathology, Pancreatic Neoplasms surgery, Pancreatic Neoplasms pathology, Laparoscopy methods, Liver Neoplasms surgery
- Abstract
Background: The necessity of the staging laparoscopy in patients with pancreatic cancer is still debated. The objective of this study was to assess the yield of staging laparoscopy for detecting occult metastases in patients with resectable or borderline resectable pancreatic cancer., Method: This was a post-hoc analysis of the randomized controlled PREOPANC trial in which patients with resectable or borderline resectable pancreatic cancer were randomized between preoperative chemoradiotherapy or immediate surgery. Patients assigned to preoperative treatment underwent a staging laparoscopy prior to preoperative treatment according to protocol, to avoid unnecessary chemoradiotherapy in patients with occult metastatic disease., Results: Of the 246 included patients, 7 did not undergo surgery. A staging laparoscopy was performed in 133 patients (55.6%) and explorative laparotomy in 106 patients (44.4%). At staging laparoscopy, occult metastases were detected in 13 patients (9.8%); 12 liver metastases and 1 peritoneal metastasis. At direct explorative laparotomy, occult metastases were found in 9 patients (8.5%); 6 with liver metastases, 1 with peritoneal metastases, and 2 with metastases at multiple sites. One patient had peritoneal metastases at exploration after a negative staging laparoscopy. Patients with occult metastases were more likely to receive palliative chemotherapy if found with staging laparoscopy compared to laparotomy (76.9% vs. 30.0%, p = 0.040)., Conclusions: Staging laparoscopy detected occult metastases in about 10% of patients with resectable or borderline resectable pancreatic cancer. These patients were more likely to receive palliative systemic chemotherapy compared to patients in whom occult metastases were detected with laparotomy. A staging laparoscopy is recommended before planned resection., (Copyright © 2022. Published by Elsevier Ltd.)
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- 2023
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4. Delivery of hepato-pancreato-biliary surgery during the COVID-19 pandemic: an European-African Hepato-Pancreato-Biliary Association (E-AHPBA) cross-sectional survey.
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Balakrishnan A, Lesurtel M, Siriwardena AK, Heinrich S, Serrablo A, Besselink MGH, Erkan M, Andersson B, Polak WG, Laurenzi A, Olde Damink SWM, Berrevoet F, Frigerio I, Ramia JM, Gallagher TK, Warner S, Shrikhande SV, Adam R, Smith MD, and Conlon KC
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- Africa epidemiology, Biliary Tract Neoplasms complications, COVID-19, Coronavirus Infections epidemiology, Cross-Sectional Studies, Delivery of Health Care methods, Europe epidemiology, Female, Humans, Liver Neoplasms complications, Male, Pancreatic Neoplasms complications, Pandemics, Pneumonia, Viral epidemiology, SARS-CoV-2, Societies, Medical, Betacoronavirus, Biliary Tract Neoplasms surgery, Coronavirus Infections complications, Digestive System Surgical Procedures methods, Liver Neoplasms surgery, Pancreatic Neoplasms surgery, Pneumonia, Viral complications
- Abstract
Background: The extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery., Methods: An online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects of service delivery., Results: Overall, 145 (25%) members responded. Most units, particularly in COVID-high countries (>100,000 cases) reported insufficient critical care capacity and reduced HPB operating sessions compared to COVID-low countries. Delayed access to cancer surgery necessitated alternatives including increased neoadjuvant chemotherapy for pancreatic cancer and colorectal liver metastases, and locoregional treatments for hepatocellular carcinoma. Other aspects of service delivery including COVID-19 screening and personal protective equipment varied between units and countries., Conclusion: This study demonstrates that the COVID-19 pandemic has had a profound adverse impact on the delivery of HPB cancer care across the continents of Europe and Africa. The findings illustrate the need for safe resumption of cancer surgery in a "new" normal world with screening of patients and staff for COVID-19., (Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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5. Worldwide survey on opinions and use of minimally invasive pancreatic resection.
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van Hilst J, de Rooij T, Abu Hilal M, Asbun HJ, Barkun J, Boggi U, Busch OR, Conlon KC, Dijkgraaf MG, Han HS, Hansen PD, Kendrick ML, Montagnini AL, Palanivelu C, Røsok BI, Shrikhande SV, Wakabayashi G, Zeh HJ, Vollmer CM, Kooby DA, and Besselink MG
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- Adult, Attitude of Health Personnel, Clinical Competence, Education, Medical, Continuing, Education, Medical, Graduate, Health Care Surveys, Health Knowledge, Attitudes, Practice, Humans, Laparoscopy education, Middle Aged, Pancreatectomy education, Pancreaticoduodenectomy education, Robotic Surgical Procedures education, Surgeons psychology, Laparoscopy trends, Pancreatectomy trends, Pancreaticoduodenectomy trends, Practice Patterns, Physicians' trends, Robotic Surgical Procedures trends, Surgeons trends
- Abstract
Background: The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown., Methods: An anonymous survey on MIPR was sent to the members of six international associations of Hepato-Pancreato-Biliary (HPB) surgery., Results: The survey was completed by 435 surgeons from 50 countries, with each surgeon performing a median of 22 (IQR 12-40) pancreatic resections annually. Minimally invasive distal pancreatectomy (MIDP) was performed by 345 (79%) surgeons and minimally invasive pancreatoduodenectomy (MIPD) by 124 (29%). The median total personal experience was 20 (IQR 10-50) MIDPs and 12 (IQR 4-40) MIPDs. Current superiority for MIDP was claimed by 304 (70%) and for MIPD by 44 (10%) surgeons. The most frequently mentioned reason for not performing MIDP (54/90 (60%)) and MIPD (193/311 (62%)) was lack of specific training. Most surgeons (394/435 (90%)) would consider participating in an international registry on MIPR., Discussion: This worldwide survey showed that most participating HPB surgeons value MIPR as a useful development, especially for MIDP, but the role and implementation of MIPD requires further assessment. Most HPB surgeons would welcome specific training in MIPR and the establishment of an international registry., (Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2017
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6. Recent Advances in Pancreatic Cancer Surgery of Relevance to the Practicing Pathologist.
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van Rijssen LB, Rombouts SJ, Walma MS, Vogel JA, Tol JA, Molenaar IQ, van Eijck CH, Verheij J, van de Vijver MJ, Busch OR, and Besselink MG
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- Antineoplastic Combined Chemotherapy Protocols, Catheter Ablation trends, Combined Modality Therapy trends, Electrochemotherapy trends, Humans, Neoadjuvant Therapy, Pancreatic Neoplasms pathology, Survival Rate, Catheter Ablation mortality, Electrochemotherapy methods, Lymph Nodes pathology, Lymphatic Metastasis pathology, Pancreatic Neoplasms surgery, Pathology
- Abstract
Recent advances in pancreatic surgery have the potential to improve outcomes for patients with pancreatic cancer. We address 3 new, trending topics in pancreatic surgery that are of relevance to the pathologist. First, increasing awareness of the prognostic impact of intraoperatively detected extraregional and regional lymph node metastases and the international consensus definition on lymph node sampling and reporting. Second, neoadjuvant chemotherapy, which is capable of changing 10% to 20% of initially unresectable, to resectable disease. Third, in patients who remain unresectable following neoadjuvant chemotherapy, local ablative therapies may change indications for treatment and improve outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
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7. Long-term outcomes of resection in patients with symptomatic benign liver tumours.
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van Rosmalen BV, Bieze M, Besselink MG, Tanis P, Verheij J, Phoa SS, Busch O, and van Gulik TM
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- Adenoma, Liver Cell pathology, Adult, Aged, Cicatrix etiology, Cross-Sectional Studies, Female, Focal Nodular Hyperplasia pathology, Hemangioma pathology, Humans, Incisional Hernia etiology, Liver Neoplasms pathology, Male, Middle Aged, Pain Measurement, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Patient Satisfaction, Time Factors, Treatment Outcome, Adenoma, Liver Cell surgery, Focal Nodular Hyperplasia surgery, Hemangioma surgery, Hepatectomy adverse effects, Liver Neoplasms surgery
- Abstract
Background: Benign liver tumours (e.g., hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH), and haemangioma) are occasionally resected for alleged symptoms, although data on long-term outcomes is lacking. The aim of this cross-sectional study was to assess long-term outcomes of surgical intervention., Methods: Forty patients with benign tumours (HCA 20, FNH 12, giant haemangioma 4, cysts 4) were included. Patients filled in Validated McGill Pain Questionnaires, preoperatively and after a median of 54 months after resection. Outcomes were evaluated using paired sample t-test and (M) ANOVA., Results: Relief of symptoms sustained in 30/40 patients, within a follow-up of 54 (24-148) months after resection. VAS scores were reduced from 5.5 preoperatively to 1.6 postoperatively (p < 0.001). Patients with left-sided tumours had higher postoperative Pain Rating Index (PRI), compared to patients with right-sided tumours: 15.3 vs. 5.8 (p = 0.018). If patients could reconsider undergoing surgery, 34/38 would again choose resection. Discomfort at the operative scar was the most common complaint: 8/40 patients, all after open surgery, of whom 3/40 had an incisional hernia. 7/40 patients had a laparoscopic resection., Conclusion: Resection relieved symptoms in 30/40 patients. The operative scar was a frequent source for remaining postoperative complaints, suggesting an advantage for a laparoscopic approach when feasible., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2016
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8. Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis.
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van Rijssen LB, Narwade P, van Huijgevoort NC, Tseng DS, van Santvoort HC, Molenaar IQ, van Laarhoven HW, van Eijck CH, Busch OR, and Besselink MG
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- Ampulla of Vater pathology, Carcinoma, Pancreatic Ductal mortality, Common Bile Duct Neoplasms mortality, Hepatic Artery pathology, Hepatic Artery surgery, Humans, Kaplan-Meier Estimate, Lymph Node Excision, Lymphatic Metastasis, Neoplasm Staging, Pancreatic Neoplasms mortality, Predictive Value of Tests, Risk Factors, Treatment Outcome, Ampulla of Vater surgery, Carcinoma, Pancreatic Ductal secondary, Carcinoma, Pancreatic Ductal surgery, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms surgery, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy mortality
- Abstract
Background: Hepatic-artery and para-aortic lymph node metastases (LNM) may be detected during surgical exploration for pancreatic (PDAC) or periampullary cancer. Some surgeons will continue the resection while others abort the exploration., Methods: A systematic search was performed in PubMed, EMBASE and Cochrane Library for studies investigating survival in patients with intra-operatively detected hepatic-artery or para-aortic LNM. Survival was stratified for node positive (N1) disease., Results: After screening 3088 studies, 13 studies with 2045 patients undergoing pancreatoduodenectomy were included. No study reported survival data after detection of LNM and aborted surgical exploration. In 110 patients with hepatic-artery LNM, median survival ranged between 7 and 17 months. Estimated pooled mean survival in 84 patients with hepatic-artery LNM was 15 [95%CI 12-18] months (13 months in PDAC), compared to 19 [16-22] months in 270 patients with N1-disease without hepatic-artery LNM (p = 0.020). In 192 patients with para-aortic LNM, median survival ranged between 5 and 32 months. Estimated pooled mean survival in 169 patients with para-aortic LNM was 13 [8-17] months (11 months in PDAC), compared to 17 (6-27) months in 506 patients with N1-disease without para-aortic LNM (p < 0.001). Data on the impact of (neo)adjuvant therapy on survival were lacking., Conclusion: Survival after pancreatoduodenectomy in patients with intra-operatively detected hepatic-artery and especially para-aortic LNM is inferior to patients undergoing pancreatoduodenectomy with other N1 disease. It remains unclear what the consequence of this should be since data on (neo-)adjuvant therapy and survival after aborted exploration are lacking., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2016
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9. Volume-outcome relationships in pancreatoduodenectomy for cancer.
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van der Geest LG, van Rijssen LB, Molenaar IQ, de Hingh IH, Groot Koerkamp B, Busch OR, Lemmens VE, and Besselink MG
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- Aged, Ampulla of Vater pathology, Chi-Square Distribution, Common Bile Duct Neoplasms mortality, Common Bile Duct Neoplasms pathology, Female, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Netherlands, Odds Ratio, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Proportional Hazards Models, Registries, Risk Factors, Time Factors, Treatment Outcome, Ampulla of Vater surgery, Common Bile Duct Neoplasms surgery, Hospitals, High-Volume, Hospitals, Low-Volume, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy mortality
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Background: Volume-outcome relationships in pancreatic surgery are well established, but an optimal volume remains to be determined. Studies analyzing outcomes in volume categories exceeding 20 procedures annually are lacking., Study Design: A consecutive 3420 patients underwent PD for primary pancreatic or periampullary carcinoma (2005-2013) and were registered in the Netherlands Cancer Registry. Relationships between hospital volume (< 5, 5-19, 20-39 and ≥ 40 PDs/year) and mortality and survival were explored., Results: There was a non-significant decrease in 90-day mortality from 8.1 to 6.7% during the study period (p = 0.23). Ninety-day mortality was 9.7% in centers performing < 5 PDs/year (n = 185 patients), 8.9% for 5-19 PDs/year (n = 1432), 7.3% for 20-39 PDs/year (n = 240) and 4.3% for ≥ 40 PDs/year (n = 562, p = 0.004). Within volume categories, 90-day mortality did not change over time. After adjustment for confounding factors, significantly lower mortality was found in the ≥ 40 category compared to 20-39 PDs/year (OR = 1.72 (1.08-2.74)). Overall survival adjusted for confounding factors was better in the ≥ 40 category compared to categories under 20 PDs/year: HR (≥ 40 vs 5-19/year) = 1.24 (1.09-1.42). In the ≥ 40 category significantly more patients received adjuvant chemotherapy and had > 10 lymph nodes retrieved compared to lower volume categories., Conclusions: Volume-outcome relationships in pancreatic surgery persist in centers performing ≥ 40 PDs annually, regarding both mortality and survival. The volume plateau for pancreatic surgery has yet to be determined., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2016
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10. External biliary drainage following major liver resection for perihilar cholangiocarcinoma: impact on development of liver failure and biliary leakage.
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Olthof PB, Coelen RJ, Wiggers JK, Besselink MG, Busch OR, and van Gulik TM
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- Adult, Aged, Aged, 80 and over, Anastomotic Leak diagnosis, Bile Duct Neoplasms pathology, Chi-Square Distribution, Drainage methods, Female, Humans, Klatskin Tumor pathology, Liver Failure diagnosis, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retrospective Studies, Risk Factors, Treatment Outcome, Anastomotic Leak etiology, Bile Duct Neoplasms surgery, Biliary Tract Surgical Procedures adverse effects, Drainage adverse effects, Hepatectomy adverse effects, Klatskin Tumor surgery, Liver Failure etiology
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Background: Preoperative biliary drainage is considered essential in perihilar cholangiocarcinoma (PHC) requiring major hepatectomy with biliary-enteric reconstruction. However, evidence for postoperative biliary drainage as to protect the anastomosis is currently lacking. This study investigated the impact of postoperative external biliary drainage on the development of post-hepatectomy biliary leakage and liver failure (PHLF)., Methods: All patients who underwent major liver resection for suspected PHC between 2000 and 2015 were retrospectively analyzed. Biliary leakage and PHLF was defined as grade B or higher according to the International Study Group of Liver Surgery (ISGLS) criteria., Results: Eighty-nine out of 125 (71%) patients had postoperative external biliary drainage. PHLF was more prevalent in the drain group (29% versus 6%; P = 0.004). There was no difference in the incidence of biliary leakage (32% versus 36%). On multivariable analysis, postoperative external biliary drainage was identified as an independent risk factor for PHLF (Odds-ratio 10.3, 95% confidence interval 2.1-50.4; P = 0.004)., Conclusions: External biliary drainage following major hepatectomy for PHC was associated with an increased incidence of PHLF. It is therefore not recommended to routinely use postoperative external biliary drainage, especially as there is no evidence that this decreases the risk of biliary anastomotic leakage., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2016
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11. Perioperative blood transfusion is not associated with overall survival or time to recurrence after resection of perihilar cholangiocarcinoma.
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Dekker AM, Wiggers JK, Coelen RJ, van Golen RF, Besselink MG, Busch OR, Verheij J, Hollmann MW, and van Gulik TM
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- Aged, Bile Duct Neoplasms mortality, Bile Duct Neoplasms pathology, Biliary Tract Surgical Procedures mortality, Blood Loss, Surgical mortality, Chi-Square Distribution, Databases, Factual, Disease-Free Survival, Female, Hepatectomy mortality, Humans, Kaplan-Meier Estimate, Klatskin Tumor mortality, Klatskin Tumor pathology, Male, Middle Aged, Multivariate Analysis, Netherlands, Postoperative Hemorrhage etiology, Postoperative Hemorrhage mortality, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Transfusion Reaction, Treatment Outcome, Bile Duct Neoplasms surgery, Biliary Tract Surgical Procedures adverse effects, Blood Loss, Surgical prevention & control, Blood Transfusion mortality, Hepatectomy adverse effects, Klatskin Tumor surgery, Neoplasm Recurrence, Local, Postoperative Hemorrhage therapy
- Abstract
Background: Perioperative blood transfusions have been associated with worse oncological outcome in several types of cancer. The objective of this study was to assess the effect of perioperative blood transfusions on time to recurrence and overall survival (OS) in patients who underwent curative-intent resection of perihilar cholangiocarcinoma (PHC)., Methods: This retrospective cohort study included consecutive patients with resected PHC between 1992 and 2013 in a specialized center. Patients with 90-day mortality after surgery were excluded. Patients who did and did not receive perioperative blood transfusions were compared using univariable Kaplan-Meier analysis and multivariable Cox regression., Results: Of 145 included patients, 80 (55.2%) received perioperative blood transfusions. The median OS was 49 months for patients without and 41 months for patients with blood transfusions (P = 0.46). In risk-adjusted multivariable Cox regression analysis, blood transfusion was not associated with OS (HR 1.00, 95% CI 0.59-1.68, P = 0.99) or time to recurrence (HR 1.00, 95% CI 0.57-1.78, P = 0.99). In addition, no differences in effect were found between different types of blood products transfused., Conclusion: Blood transfusion was not associated with survival or time to recurrence after curative resection of PHC in this series. The alleged association is presumably related to the circumstances necessitating blood transfusions., (Copyright © 2015. Published by Elsevier Ltd.)
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- 2016
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12. Systematic review on the use of matrix-bound sealants in pancreatic resection.
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Smits FJ, van Santvoort HC, Besselink MG, Borel Rinkes IH, and Molenaar IQ
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- Humans, Intraoperative Period, Pancreatectomy methods, Pancreatic Fistula prevention & control, Pancreatic Neoplasms surgery, Postoperative Complications prevention & control, Tissue Adhesives therapeutic use
- Abstract
Background: Pancreatic fistula is a potentially life-threatening complication after a pancreatic resection. The aim of this systematic review was to evaluate the role of matrix-bound sealants after a pancreatic resection in terms of preventing or ameliorating the course of a post-operative pancreatic fistula., Methods: A systematic search was performed in the literature from May 2005 to April 2015. Included were clinical studies using matrix-bound sealants after a pancreatic resection, reporting a post-operative pancreatic fistula (POPF) according to the International Study Group on Pancreatic Fistula classification, in which grade B and C fistulae were considered clinically relevant., Results: Two were studies on patients undergoing pancreatoduodenectomy (sealants n = 67, controls n = 27) and four studies on a distal pancreatectomy (sealants n = 258, controls n = 178). After a pancreatoduodenectomy, 13% of patients treated with sealants versus 11% of patients without sealants developed a POPF (P = 0.76), of which 4% versus 4% were clinically relevant (P = 0.87). After a distal pancreatectomy, 42% of patients treated with sealants versus 52% of patients without sealants developed a POPF (P = 0.03). Of these, 9% versus 12% were clinically relevant (P = 0.19)., Conclusions: The present data do not support the routine use of matrix-bound sealants after a pancreatic resection, as there was no effect on clinically relevant POPF. Larger, well-designed studies are needed to determine the efficacy of sealants in preventing POPF after a pancreatoduodenectomy., (© 2015 International Hepato-Pancreato-Biliary Association.)
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- 2015
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13. Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity.
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Gerritsen A, Wennink RA, Besselink MG, van Santvoort HC, Tseng DS, Steenhagen E, Borel Rinkes IH, and Molenaar IQ
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- Aged, Case-Control Studies, Eating, Enteral Nutrition adverse effects, Female, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Pancreaticoduodenectomy adverse effects, Postoperative Complications etiology, Prospective Studies, Recovery of Function, Risk Factors, Time Factors, Treatment Outcome, Enteral Nutrition methods
- Abstract
Objective: The aim of this study was to evaluate whether a change in the routine feeding strategy applied after pancreatoduodenectomy (PD) from nasojejunal tube (NJT) feeding to early oral feeding improved clinical outcomes., Methods: An observational cohort study was performed in 102 consecutive patients undergoing PD. In period 1 (n = 51, historical controls), the routine postoperative feeding strategy was NJT feeding. This was changed to a protocol of early oral feeding with on-demand NJT feeding in period 2 (n = 51, consecutive prospective cohort). The primary outcome was time to resumption of adequate oral intake., Results: The baseline characteristics of study subjects in both periods were comparable. In period 1, 98% (n = 50) of patients received NJT feeding, whereas in period 2, 53% (n = 27) of patients did so [for delayed gastric empting (DGE) (n = 20) or preoperative malnutrition (n = 7)]. The time to resumption of adequate oral intake significantly decreased from 12 days in period 1 to 9 days in period 2 (P = 0.015), and the length of hospital stay shortened from 18 days in period 1 to 13 days in period 2 (P = 0.015). Overall, there were no differences in the incidences of complications of Clavien-Dindo Grade III or higher, DGE, pancreatic fistula, postoperative haemorrhage and mortality between the two periods., Conclusions: The introduction of an early oral feeding strategy after PD reduced the time to resumption of adequate oral intake and length of hospital stay without negatively impacting postoperative morbidity., (© 2013 International Hepato-Pancreato-Biliary Association.)
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- 2014
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14. Early management of acute pancreatitis.
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Schepers NJ, Besselink MG, van Santvoort HC, Bakker OJ, and Bruno MJ
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- Acute Disease, Cholangiography, Cholangiopancreatography, Endoscopic Retrograde, Fluid Therapy, Humans, Pancreatitis classification, Pancreatitis diagnosis, Pancreatitis therapy
- Abstract
Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2013
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15. Splanchnic vein thrombosis complicating severe acute pancreatitis.
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Besselink MG
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- Female, Humans, Male, Esophageal and Gastric Varices etiology, Gastrointestinal Hemorrhage etiology, Mesenteric Veins, Pancreatitis complications, Pancreatitis, Acute Necrotizing complications, Portal Vein, Splenic Vein, Venous Thrombosis etiology
- Published
- 2011
- Full Text
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16. The 'step-up approach' to infected necrotizing pancreatitis: delay, drain, debride.
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Besselink MG
- Subjects
- Debridement, Drainage, Humans, Minimally Invasive Surgical Procedures, Pancreatitis, Acute Necrotizing complications, Pancreatitis, Acute Necrotizing therapy, Sepsis etiology, Sepsis therapy, Pancreatitis, Acute Necrotizing surgery
- Published
- 2011
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17. Interim analysis in randomized trials: DAMOCLES' sword?
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Besselink MG, van der Graaf Y, and Gooszen HG
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- Humans, Pancreatitis therapy, Clinical Trials Data Monitoring Committees standards, Early Termination of Clinical Trials standards, Pancreatitis mortality, Probiotics adverse effects, Randomized Controlled Trials as Topic
- Published
- 2010
- Full Text
- View/download PDF
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