39 results on '"Kazemier G"'
Search Results
2. MicroRNA Profiles in Graft Preservation Solution Are Predictive for Biliary Strictures after Liver Transplantation.
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Verhoeven, C. J., Metselaar, H. J., Farid, W. R.r., De Ruiter, P. E., De Jonge, J., Kwekkeboom, J., Tilanus, H. W., Kazemier, G., and Van Der Laan, L. J.w.
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- 2012
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3. Genetic Variance in ABCB1 and CYP3A5 Does Not Contribute to the Development of Chronic Kidney Disease after Liver Transplantation.
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Hesselink, D. A., Tapirdamaz, O., El Bouazzaoui, S., Azimpour, M., Hansen, B., Van Der Laan, L. W.j., Kazemier, G., Kwekkeboom, J., Van Schaik, R. H.n., Van Gelder, T., and Metselaar, H. J.
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- 2012
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4. DETAILED KINETICS OF T-CELLS WITH DIRECT ALLOSPECIFICITY AFTER LIVER TRANSPLANTATION: A NOVEL ASSAY.
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Tapirdamaz, O., Mancham, S., Laan, L. V.d., Kazemier, G., Thielemans, K., Metselaar, H. J., and Kwekkeboom, J.
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- 2010
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5. Complex liver trauma with bilhemia treated with perihepatic packing and endovascular stent in the vena cava.
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Hommes M, Kazemier G, van Dijk L, Kuipers EJ, van Ijsseldijk A, Vogels LM, and Schipper IB
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- 2009
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6. LARGE NUMBERS OF IMMATURE DENDRITIC CELLS DETACH FROM THE HUMAN DONOR LIVER PRE-TRANSPLANTATION.
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Bosma, B M., Metselaar, H J., Mancham, S, Boor, P P.c., Kusters, J G., Kazemier, G, Tilanus, H W., Kuipers, E J., and Kwekkeboom, J
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- 2004
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7. HEPATIC ANATOMY.
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Kazemier, G., Hesselink, E. J., and Terpstra, O. T.
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- 1990
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8. Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients with Intestinal- and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study.
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Uijterwijk BA, Moekotte A, Boggi U, Mazzola M, Koerkamp BG, Valle RD, Mazzotta A, Luyer M, Kazemier G, Ielpo B, Suarez Muñoz MA, Bolm L, Björnsson B, Pessaux P, Kleeff J, Fusai GK, Sparrelid E, Zerbi A, Lemmers DH, Alseidi A, Vladimirov M, Roberts KJ, Salvia R, Soonawalla Z, Korkolis D, Serradilla-Martín M, Mavroeidis VK, Bouwense SAW, Besselink MG, and Abu Hilal M
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Objective: To compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma., Summary Background Data: Ampullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking., Methods: This is an international cohort study, encompassing 27 centers from 12 countries. Outcome of MIPD and open pancreatoduodenectomy (OPD) were compared in patients with AAC-IT and AAC-PB. Primary end points were R1 rate, lymph node yield, and 5-year overall survival (5yOS)., Results: Overall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD, 510 OPD) and 615 with AAC-PB (41 MIPD and 574 OPD). The rate of R1 resection was not significantly different between MIPD and OPD for both AAC-IT (3.4% vs 6.9%, P=0,425) and AAC-PB (9.8% vs 14.9%, P=0,625). AAC-IT, more lymph nodes were resected with MIPD group (19 vs 16, P=0.007), compared to OPD. The 5y-OS did not differ after MIPD and OPD for both AAC-IT (56.8% vs 59.5%, P=0.827 and AAC-PB (52.5% vs 44.4%, P=0.357). The rates of surgical complication between MIPD and OPD did not differ between AmpIT and AmpPB., Discussion: This international multicenter study found no differences in outcomes between MIPD and OPD for AAC-IT and AAC-PB. MIPD and OPD demonstrated comparable outcomes in oncological resection, survival and surgical outcomes for both subtypes of AAC., Competing Interests: Conflicts of interests: Mario Serradilla-Martín received research funding from Baxter S.L.. Patrick Pessaux is co-founder of Virtualisurg; Geert Kazemier is Chairman of the Advisory Board of Renovaro Inc.; Marc G. Besselink has received grants from Intuitive for the LEARNBOT European robot Whipple training program, the DIPLOMA-2 trial, and the E-MIPS quality registry, from Medtronic for the investigator-initiated DIPLOMA trial and from Ethicon for the PANDORA trial and the E-MIPS quality registry; Mohammed Abu Hilal received funding from Associazione Italiana per la Ricerca sul Cancro (AIRC); All remaining authors claim no conflicts of interests and no disclosures., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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9. Risk Factor Targeted Perioperative Care Reduces Anastomotic Leakage after Colorectal Surgery: The DoubleCheck study.
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de Wit A, Bootsma BT, Huisman DE, van Wely B, van Hoogstraten J, Sonneveld DJA, Moes D, Wegdam JA, Feo CV, Verdaasdonk EGG, Brokelman WJA, Ten Cate DWG, Lubbers T, Lagae E, Roks DJGH, Kazemier G, Stens J, Slooter GD, and Daams F
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Objective: The DoubleCheck study aimed to introduce pre- and perioperative interventions minimizing exposure to modifiable risk factors and determine its effect on CAL., Summary Background Data: Colorectal anastomotic leakage (CAL) is a severe complication. In order to predict and prevent its occurrence, the LekCheck study identified intraoperative modifiable risk factors for CAL: anemia, hyperglycemia, hypothermia, incorrect timing of antibiotic prophylaxis, administration of vasopressors and epidural analgesia., Methods: This international open-labelled interventional study was performed between September 2021 and December 2023. An enhanced care bundle consisting of anemia correction, glucose measurement, attaining normothermia, antibiotics administration within 60 to 15 minutes preoperatively, refraining from vasopressors and epidural analgesia was introduced. Primary outcome was the occurrence of intraoperative risk factors just prior to the anastomosis creation. Secondary outcomes were CAL and mortality. Univariate and multivariate regression analysis were performed to establish the relationship between the enhanced care bundle, exposure to the six factors and CAL., Results: The historical LekCheck group consisted of 1572 patients versus 902 in the DoubleCheck. The LekCheck group had a mean of 1.84 risk factors versus 1.63 in DoubleCheck ( P <0.001). In the DoubleCheck significantly less patients had ≥3 risk factors ( P <0.001). CAL was significantly lower in the DoubleCheck group (8.6% vs. 6.2%, P =0.039). The reduction of CAL was associated with the enhanced care bundle in multivariate regression analysis (OR 1.521, 95% CI 1.01-2.29, P =0.045). The mortality rate did not differ significantly (1.3%, vs. 0.8%, P =0.237)., Conclusions: The DoubleCheck study showed that optimization of modifiable risk factors reduced CAL in colorectal surgery., Competing Interests: Conflicts of Interest and Source of Funding: FD received an educational grant from Medtronic. All other authors declare no competing interests. Medtronic had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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10. Perineural Invasion is an Important Prognostic Factor in Patients With Radically Resected (R0) and Node-negative (pN0) Pancreatic Cancer.
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Schouten TJ, Kroon VJ, Besselink MG, Bosscha K, Busch OR, Crobach ASLP, van Dam RM, Doukas M, Fariña Sarasquesta A, Festen S, Groot Koerkamp B, van der Harst E, Heij LR, de Hingh IHJT, Kazemier G, Liem MSL, de Meijer VE, Mieog JSD, Patijn GA, Raicu GM, Roos D, Schreinemakers JMJ, Stommel MWJ, Wilmink HJ, Wit F, Brosens LAA, van Santvoort HC, Molenaar IQ, and Daamen LA
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Objective: To investigate the association between perineural invasion (PNI) and overall survival (OS) in a nationwide cohort of patients with resected pancreatic ductal adenocarcinoma (PDAC), stratified for margin negative (R0) or positive (R1) resection and absence or presence of lymph node metastasis (pN0 or pN1-N2, respectively)., Background: Patients with R0 and pN0 resected PDAC have a relatively favorable prognosis. As PNI is associated with worse OS, this might be a useful factor to provide further prognostic information for patients counselling., Methods: A nationwide observational cohort study was performed including all patients who underwent PDAC resection in the Netherlands (2014-2019) with complete information on relevant pathological features (PNI, R status, and N status). OS was assessed using Kaplan-Meier curves, and Cox-proportional hazard analyses were performed to calculate hazard ratio's (HR) with corresponding 95% confidence intervals (CI)., Results: In total, 1630 patients were included with a median follow-up of 43 (interquartile range 33-58) months. PNI was independently associated with worse OS in both R0 patients (HR 1.49 [95%CI 1.18-1.88]; P<0.001) and R1 patients (HR 1.39 [95% CI 1.06-1.83]; P=0.02), as well as in pN0 patients (HR 1.75 [95%CI 1.27-2.41]; P<0.001) and pN1-N2 patients (HR 1.35 [95% CI 1.10-1.67]; P<0.01). In 315 patients with R0N0, multivariable analysis showed that PNI was the strongest predictor of OS (HR 2.24 [95% CI 1.52-3.30]; P<0.001)., Conclusion: PNI is strongly associated with worse survival in patients with resected PDAC, in particular in patients with relatively favorable pathological features. These findings may aid patient stratification and counselling and help guide treatment strategies., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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11. Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma: A Nationwide Cohort Study.
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van Goor IWJM, Schouten TJ, Verburg DN, Besselink MG, Bonsing BA, Bosscha K, Brosens LAA, Busch OR, Cirkel GA, van Dam RM, Festen S, Koerkamp BG, van der Harst E, de Hingh IHJT, Intven MPW, Kazemier G, Los M, Meijer GJ, de Meijer VE, Nieuwenhuijs VB, Roos D, Schreinemakers JMJ, Stommel MWJ, Verdonk RC, van Santvoort HC, Daamen LA, and Molenaar IQ
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- Humans, Cohort Studies, Disease-Free Survival, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local pathology, Prognosis, Retrospective Studies, Pancreatic Neoplasms, Carcinoma, Pancreatic Ductal
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Objective: To develop a prediction model for long-term (≥5 years) disease-free survival (DFS) after the resection of pancreatic ductal adenocarcinoma (PDAC)., Background: Despite high recurrence rates, ~10% of patients have long-term DFS after PDAC resection. A model to predict long-term DFS may aid individualized prognostication and shared decision-making., Methods: This nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best-performing prognostic model was selected by Cox-proportional hazard analysis and Akaike's Information Criterion, presented by hazard ratios (HRs) with 95% confidence intervals (CIs). Internal validation was performed, and discrimination and calibration indices were assessed., Results: In all, 836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. Long-term DFS was seen in 118 patients (14%). Factors predictive of long-term DFS were low preoperative carbohydrate antigen 19-9 (logarithmic; HR 1.21; 95% CI 1.10-1.32), no vascular resection (HR 1.33; 95% CI 1.12-1.58), T1 or T2 tumor stage (HR 1.52; 95% CI 1.14-2.04, and HR 1.17; 95% CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR 1.44; 95% CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR 1.42; 95% CI 1.11-1.81 and HR 1.14; 95% CI 0.96-1.36, respectively), N0 or N1 nodal status (HR 1.92; 95% CI 1.54-2.40, and HR 1.33; 95% CI 1.11-1.60, respectively), R0 resection margin status (HR 1.25; 95% CI 1.07-1.46), no major complications (HR 1.14; 95% CI 0.97-1.35) and adjuvant chemotherapy (HR 1.74; 95% CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (slope 0.99) was achieved., Conclusions: The developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of long-term DFS after resection of pancreatic ductal adenocarcinoma., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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12. Risk Models for Developing Pancreatic Fistula After Pancreatoduodenectomy: Validation in a Nationwide Prospective Cohort.
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Schouten TJ, Henry AC, Smits FJ, Besselink MG, Bonsing BA, Bosscha K, Busch OR, van Dam RM, van Eijck CH, Festen S, Groot Koerkamp B, van der Harst E, de Hingh IHJT, Kazemier G, Liem MSL, de Meijer VE, Patijn GA, Roos D, Schreinemakers JMJ, Stommel MWJ, Wit F, Daamen LA, Molenaar IQ, and van Santvoort HC
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- Humans, Male, Pancreaticoduodenectomy adverse effects, Prospective Studies, Risk Assessment, Risk Factors, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Neoplasms pathology
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Objective: To evaluate the performance of published fistula risk models by external validation, and to identify independent risk factors for postoperative pancreatic fistula (POPF)., Background: Multiple risk models have been developed to predict POPF after pancreatoduodenectomy. External validation in high-quality prospective cohorts is, however, lacking or only performed for individual models., Methods: A post hoc analysis of data from the stepped-wedge cluster cluster-randomized Care After Pancreatic Resection According to an Algorithm for Early Detection and Minimally Invasive Management of Pancreatic Fistula versus Current Practice (PORSCH) trial was performed. Included were all patients undergoing pancreatoduodenectomy in the Netherlands (January 2018-November 2019). Risk models on POPF were identified by a systematic literature search. Model performance was evaluated by calculating the area under the receiver operating curves (AUC) and calibration plots. Multivariable logistic regression was performed to identify independent risk factors associated with clinically relevant POPF., Results: Overall, 1358 patients undergoing pancreatoduodenectomy were included, of whom 341 patients (25%) developed clinically relevant POPF. Fourteen risk models for POPF were evaluated, with AUCs ranging from 0.62 to 0.70. The updated alternative fistula risk score had an AUC of 0.70 (95% confidence intervals [CI]: 0.69-0.72). The alternative fistula risk score demonstrated an AUC of 0.70 (95% CI: 0.689-0.71), whilst an AUC of 0.70 (95% CI: 0.699-0.71) was also found for the model by Petrova and colleagues. Soft pancreatic texture, pathology other than pancreatic ductal adenocarcinoma or chronic pancreatitis, small pancreatic duct diameter, higher body mass index, minimally invasive resection and male sex were identified as independent predictors of POPF., Conclusion: Published risk models predicting clinically relevant POPF after pancreatoduodenectomy have a moderate predictive accuracy. Their clinical applicability to identify high-risk patients and guide treatment strategies is therefore questionable., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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13. Long-term Outcomes After Laparoscopic, Robotic, and Open Pancreatoduodenectomy for Distal Cholangiocarcinoma: An International Propensity Score-matched Cohort Study.
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Uijterwijk BA, Lemmers DHL, Bolm L, Luyer M, Koh YX, Mazzola M, Webber L, Kazemier G, Bannone E, Ramaekers M, Ielpo B, Wellner U, Koek S, Giani A, Besselink MG, and Abu Hilal M
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- Humans, Cohort Studies, Pancreaticoduodenectomy, Propensity Score, Length of Stay, Bile Ducts, Intrahepatic surgery, Postoperative Complications epidemiology, Postoperative Complications surgery, Retrospective Studies, Robotic Surgical Procedures, Cholangiocarcinoma surgery, Laparoscopy, Bile Duct Neoplasms surgery, Pancreatic Neoplasms surgery
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Objective: This study aimed to compare surgical and oncological outcomes after minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) for distal cholangiocarcinoma (dCCA)., Background: A dCCA might be a good indication for MIPD, as it is often diagnosed as primary resectable disease. However, multicenter series on MIPD for dCCA are lacking., Methods: This is an international multicenter propensity score-matched cohort study including patients after MIPD or OPD for dCCA in 8 centers from 5 countries (2010-2021). Primary outcomes included overall survival (OS) and disease-free interval (DFI). Secondary outcomes included perioperative and postoperative complications and predictors for OS or DFI. Subgroup analyses included robotic pancreatoduodenectomy (RPD) and laparoscopic pancreatoduodenectomy (LPD)., Results: Overall, 478 patients after pancreatoduodenectomy for dCCA were included of which 97 after MIPD (37 RPD, 60 LPD) and 381 after OPD. MIPD was associated with less blood loss (300 vs 420 mL, P =0.025), longer operation time (453 vs 340 min; P <0.001), and less surgical site infections (7.8% vs 19.3%; P =0.042) compared with OPD. The median OS (30 vs 25 mo) and DFI (29 vs 18) for MIPD did not differ significantly between MIPD and OPD. Tumor stage (Hazard ratio: 2.939, P <0.001) and administration of adjuvant chemotherapy (Hazard ratio: 0.640, P =0.033) were individual predictors for OS. RPD was associated with a higher lymph node yield (18.0 vs 13.5; P =0.008) and less major morbidity (Clavien-Dindo 3b-5; 8.1% vs 32.1%; P =0.005) compared with LPD., Discussion: Both surgical and oncological outcomes of MIPD for dCCA are acceptable as compared with OPD. Surgical outcomes seem to favor RPD as compared with LPD but more data are needed. Randomized controlled trials should be performed to confirm these findings., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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14. Fistula Risk Score for Auditing Pancreatoduodenectomy: The Auditing-FRS.
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van Dongen JC, van Dam JL, Besselink MG, Bonsing BA, Bosscha K, Busch OR, van Dam RM, Festen S, van der Harst E, de Hingh IH, Kazemier G, Liem MSL, de Meijer VE, Mieog JSD, Molenaar IQ, Patijn GA, van Santvoort HC, Wijsman JH, Stommel MWJ, Wit F, De Wilde RF, van Eijck CHJ, and Groot Koerkamp B
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- Humans, Male, Pancreaticoduodenectomy adverse effects, Risk Assessment, Risk Factors, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula surgery, Postoperative Complications etiology, Retrospective Studies, Pancreatic Neoplasms, Pancreatic Neoplasms surgery, Pancreatic Neoplasms complications, Carcinoma, Pancreatic Ductal surgery, Pancreatitis surgery
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Objective: To develop a fistula risk score for auditing, to be able to compare postoperative pancreatic fistula (POPF) after pancreatoduodenectomy among hospitals., Background: For proper comparisons of outcomes in surgical audits, case-mix variation should be accounted for., Methods: This study included consecutive patients after pancreatoduodenectomy from the mandatory nationwide Dutch Pancreatic Cancer Audit. Derivation of the score was performed with the data from 2014 to 2018 and validation with 2019 to 2020 data. The primary endpoint of the study was POPF (grade B or C). Multivariable logistic regression analysis was performed for case-mix adjustment of known risk factors., Results: In the derivation cohort, 3271 patients were included, of whom 479 (14.6%) developed POPF. Male sex [odds ratio (OR)=1.34; 95% confidence interval (CI): 1.09-1.66], higher body mass index (OR=1.07; 95% CI: 1.05-1.10), a final diagnosis other than pancreatic ductal adenocarcinoma/pancreatitis (OR=2.41; 95% CI: 1.90-3.06), and a smaller duct diameter (OR=1.43/mm decrease; 95% CI: 1.32-1.55) were independently associated with POPF. Diabetes mellitus (OR=0.73; 95% CI: 0.55-0.98) was independently associated with a decreased risk of POPF. Model discrimination was good with a C -statistic of 0.73 in the derivation cohort and 0.75 in the validation cohort (n=913). Hospitals differed in particular in the proportion of pancreatic ductal adenocarcinoma/pancreatitis patients, ranging from 36.0% to 58.1%. The observed POPF risk per center ranged from 2.9% to 25.4%. The expected POPF rate based on the 5 risk factors ranged from 11.6% to 18.0% among hospitals., Conclusions: The auditing fistula risk score was successful in case-mix adjustment and enables fair comparisons of POPF rates among hospitals., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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15. Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group.
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Suurmeijer JA, Henry AC, Bonsing BA, Bosscha K, van Dam RM, van Eijck CH, Gerhards MF, van der Harst E, de Hingh IH, Intven MP, Kazemier G, Wilmink JW, Lips DJ, Wit F, de Meijer VE, Molenaar IQ, Patijn GA, van der Schelling GP, Stommel MWJ, Busch OR, Groot Koerkamp B, van Santvoort HC, and Besselink MG
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- Humans, Aged, Cohort Studies, Pancreatectomy adverse effects, Pancreaticoduodenectomy adverse effects, Postoperative Complications etiology, Hospital Mortality, Retrospective Studies, Pancreatic Neoplasms, Pancreatic Neoplasms surgery, Pancreatic Neoplasms complications
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Objective: To describe outcome after pancreatic surgery in the first 6 years of a mandatory nationwide audit., Background: Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described., Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014-December 2019). Patient, tumor, and treatment characteristics were compared between 3 time periods (2014-2015, 2016-2017, and 2018-2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue (FTR) and in-hospital mortality., Results: Overall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.50-0.80, P <0.001] and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95% CI 0.54-0.86, P =0.001), despite operating on more patients with age >75 years (18%-22%, P =0.006), American Society of Anesthesiologists score ≥3 (19%-31%, P <0.001) and Charlson comorbidity score ≥2 (24%-34%, P <0.001). The rates of textbook outcome (57%-55%, P =0.283) and major complications remained stable (31%-33%, P =0.207), whereas complication-related intensive care admission decreased (13%-9%, P =0.002). After distal pancreatectomy, improvements in FTR from 8.8% to 5.9% (OR 0.65, 95% CI 0.30-1.37, P =0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95% CI 0.45-1.72, P =0.711) were not statistically significant., Conclusions: During the first 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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16. Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands: A Nationwide Analysis.
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Daamen LA, Groot VP, Besselink MG, Bosscha K, Busch OR, Cirkel GA, van Dam RM, Festen S, Groot Koerkamp B, Haj Mohammad N, van der Harst E, de Hingh IHJT, Intven MPW, Kazemier G, Los M, Meijer GJ, de Meijer VE, Nieuwenhuijs VB, Pranger BK, Raicu MG, Schreinemakers JMJ, Stommel MWJ, Verdonk RC, Verkooijen HM, Molenaar IQ, and van Santvoort HC
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- Humans, Neoplasm Recurrence, Local epidemiology, Netherlands epidemiology, Prospective Studies, Retrospective Studies, Pancreatic Neoplasms, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal surgery, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery
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Objective: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival., Summary of Background Data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence., Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014-2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence., Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5-17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42-0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29-0.70); P < 0.001]., Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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17. Imaging-based Machine-learning Models to Predict Clinical Outcomes and Identify Biomarkers in Pancreatic Cancer: A Scoping Review.
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Janssen BV, Verhoef S, Wesdorp NJ, Huiskens J, de Boer OJ, Marquering H, Stoker J, Kazemier G, and Besselink MG
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- Biomarkers, Tumor, Humans, Prognosis, Treatment Outcome, Pancreatic Neoplasms, Adenocarcinoma diagnostic imaging, Adenocarcinoma therapy, Machine Learning, Models, Theoretical, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms therapy
- Abstract
Objective: To perform a scoping review of imaging-based machine-learning models to predict clinical outcomes and identify biomarkers in patients with PDAC., Summary of Background Data: Patients with PDAC could benefit from better selection for systemic and surgical therapy. Imaging-based machine-learning models may improve treatment selection., Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses-scoping review guidelines in the PubMed and Embase databases (inception-October 2020). The review protocol was prospectively registered (open science framework registration: m4cyx). Included were studies on imaging-based machine-learning models for predicting clinical outcomes and identifying biomarkers for PDAC. The primary outcome was model performance. An area under the curve (AUC) of ≥0.75, or a P-value of ≤0.05, was considered adequate model performance. Methodological study quality was assessed using the modified radiomics quality score., Results: After screening 1619 studies, 25 studies with 2305 patients fulfilled the eligibility criteria. All but 1 study was published in 2019 and 2020. Overall, 23/25 studies created models using radiomics features, 1 study quantified vascular invasion on computed tomography, and one used histopathological data. Nine models predicted clinical outcomes with AUC measures of 0.78-0.95, and C-indices of 0.65-0.76. Seventeen models identified biomarkers with AUC measures of 0.68-0.95. Adequate model performance was reported in 23/25 studies. The methodological quality of the included studies was suboptimal, with a median modified radiomics quality score score of 7/36., Conclusions: The use of imaging-based machine-learning models to predict clinical outcomes and identify biomarkers in patients with PDAC is increasingly rapidly. Although these models mostly have good performance scores, their methodological quality should be improved., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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18. Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence.
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Koedam TWA, Bootsma BT, Deijen CL, van de Brug T, Kazemier G, Cuesta MA, Fürst A, Lacy AM, Haglind E, Tuynman JB, Daams F, and Bonjer HJ
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- Aged, Colonic Neoplasms mortality, Digestive System Surgical Procedures, Female, Humans, Male, Rectal Neoplasms mortality, Risk Assessment, Survival Rate, Treatment Outcome, Anastomotic Leak, Colonic Neoplasms surgery, Laparoscopy, Neoplasm Recurrence, Local epidemiology, Rectal Neoplasms surgery
- Abstract
Objective: The aim of this study was to evaluate oncological outcome for patients with and without anastomotic leakage after colon or rectal cancer surgery., Summary of Background Data: The role of anastomotic leakage in oncological outcome after colorectal cancer surgery is still topic of debate and impact on follow-up and consideration for further treatment remains unclear., Methods: Patients included in the international, multicenter, non-inferior, open label, randomized, controlled trials COLOR and COLOR II, comparing laparoscopic surgery for curable colon (COLOR) and rectal (COLOR II) cancer with open surgery, were analyzed. Patients operated by abdominoperineal excision were excluded. Both univariate and multivariate analyses were performed to investigate the impact of leakage on overall survival, disease-free survival, local and distant recurrences, adjusted for possible confounders. Primary endpoints in the COLOR and COLOR II trial were disease-free survival and local recurrence at 3-year follow-up, respectively, and secondary endpoints included anastomotic leakage rate., Results: For colon cancer, anastomotic leakage was not associated with increased percentage of local recurrence or decreased disease-free-survival. For rectal cancer, an increase of local recurrences (13.3% vs 4.6%; hazard ratio 2.96; 95% confidence interval 1.38-6.34; P = 0.005) and a decrease of disease-free survival (53.6% vs 70.9%; hazard ratio 1.67; 95% confidence interval 1.16-2.41; P = 0.006) at 5-year follow-up were found in patients with anastomotic leakage., Conclusion: Short-term morbidity, mortality, and long-term oncological outcomes are negatively influenced by the occurrence of anastomotic leakage after rectal cancer surgery. For colon cancer, no significant effect was observed; however, due to low power, no conclusions on the influence of anastomotic leakage on outcomes after colon surgery could be reached. Clinical awareness of increased risk of local recurrence after anastomotic leakage throughout the follow-up is mandatory.Trial Registration: Registered with ClinicalTrials.gov, number NCT00387842 and NCT00297791., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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19. Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission: Analysis of a Nationwide Audit.
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Smits FJ, Verweij ME, Daamen LA, van Werkhoven CH, Goense L, Besselink MG, Bonsing BA, Busch OR, van Dam RM, van Eijck CHJ, Festen S, Koerkamp BG, van der Harst E, de Hingh IH, Kazemier G, Klaase JM, van der Kolk M, Liem M, Luyer MDP, Meerdink M, Mieog JSD, Nieuwenhuijs VB, Roos D, Schreinemakers JM, Stommel MW, Wit F, Zonderhuis BM, de Meijer VE, van Santvoort HC, and Molenaar IQ
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- Aged, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Incidence, Length of Stay, Male, Middle Aged, Netherlands epidemiology, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms mortality, Patient Readmission trends, Retrospective Studies, Risk Factors, Survival Rate trends, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy adverse effects, Postoperative Complications epidemiology
- Abstract
Objective: To quantify the impact of individual complications on mortality, organ failure, hospital stay, and readmission after pancreatoduodenectomy., Summary of Background Data: An initial complication may provoke a sequence of adverse events potentially leading to mortality after pancreatoduodenectomy. This study was conducted to aid prioritization of quality improvement initiatives., Methods: Data from consecutive patients undergoing pancreatoduodenectomy (2014-2017) were extracted from the Dutch Pancreatic Cancer Audit. Population attributable fractions (PAF) were calculated for the association of each complication (ie, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, delayed gastric emptying, wound infection, and pneumonia) with each unfavorable outcome [ie, in-hospital mortality, organ failure, prolonged hospital stay (>75th percentile), and unplanned readmission), whereas adjusting for confounders and other complications. The PAF represents the proportion of an outcome that could be prevented if a complication would be eliminated completely., Results: Overall, 2620 patients were analyzed. In-hospital mortality occurred in 95 patients (3.6%), organ failure in 198 patients (7.6%), and readmission in 427 patients (16.2%). Postoperative pancreatic fistula and postpancreatectomy hemorrhage had the greatest independent impact on mortality [PAF 25.7% (95% CI 13.4-37.9) and 32.8% (21.9-43.8), respectively] and organ failure [PAF 21.8% (95% CI 12.9-30.6) and 22.1% (15.0-29.1), respectively]. Delayed gastric emptying had the greatest independent impact on prolonged hospital stay [PAF 27.6% (95% CI 23.5-31.8)]. The impact of individual complications on unplanned readmission was smaller than 11%., Conclusion: Interventions focusing on postoperative pancreatic fistula and postpancreatectomy hemorrhage may have the greatest impact on in-hospital mortality and organ failure. To prevent prolonged hospital stay, initiatives should in addition focus on delayed gastric emptying., Competing Interests: The author reports no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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20. Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT): Multicenter Study.
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Puylaert CAJ, Scheijmans JCG, Borgstein ABJ, Andeweg CS, Bartels-Rutten A, Beets GL, van Berge Henegouwen MI, Braak SJ, Couvreur R, Daams F, van Es HW, Franken LC, Grotenhuis BA, Hendriks ER, de Hingh IHJT, Hoeijmakers F, Ten Holder JT, Huisman PM, Kazemier G, van Kesteren F, van Kesteren J, Keywani K, Kuiper SZ, Lange MDJ, Lobatto ME, du Mée AWF, Poeze M, van Praag EM, van Rossen J, van Santvoort HC, Sedee WJA, Seelen LWF, Sharabiany S, Sosef NL, Quanjel MJR, Veltman J, Verhagen T, van de Vlasakker VCJ, Weeder PD, van Werven JR, Wesdorp NJ, van Dieren S, Han AX, Russell CA, de Jong MD, Bossuyt PMM, Quarles van Ufford JME, Prokop MW, Gisbertz SS, Prins JM, Besselink MG, Boermeester MA, Gietema HA, and Stoker J
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- Elective Surgical Procedures, Humans, Retrospective Studies, Asymptomatic Infections, COVID-19 diagnosis, Emergency Treatment, Mass Screening statistics & numerical data, Preoperative Care methods, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, Surgical Procedures, Operative, Thorax diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Objective: To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms., Summary of Background Data: Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown., Methods: This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia., Results: A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8-2.1]. Individual yields were 0.7% (95% CI: 0.2-1.1) for chest CT and 1.1% (95% CI: 0.6-1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence., Conclusions: One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.
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- 2020
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21. Plasma miR-181a-5p Downregulation Predicts Response and Improved Survival After FOLFIRINOX in Pancreatic Ductal Adenocarcinoma.
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Meijer LL, Garajová I, Caparello C, Le Large TYS, Frampton AE, Vasile E, Funel N, Kazemier G, and Giovannetti E
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- Adult, Aged, Antineoplastic Agents therapeutic use, Biomarkers, Tumor blood, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal mortality, Female, Fluorouracil therapeutic use, Humans, Immunohistochemistry, Irinotecan therapeutic use, Leucovorin therapeutic use, Male, MicroRNAs genetics, Middle Aged, Netherlands epidemiology, Oxaliplatin therapeutic use, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms mortality, Survival Rate trends, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Pancreatic Ductal blood, Down-Regulation, MicroRNAs blood, Pancreatic Neoplasms blood
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Objective: The aim of the study was to identify plasma microRNA (miRNA) biomarkers for stratifying and monitoring patients with locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) treated with FOLFIRINOX, and to investigate their functional roles., Summary Background Data: FOLFIRINOX has become a standard therapy for patients with advanced PDAC and can be used to potentially downstage disease. However, only a subset of patients respond, and biomarkers to guide decision-making are urgently needed., Methods: We used microarray-based profiling to discover deregulated miRNAs in pre- and postchemotherapy plasma samples from patients based on their progression-free survival (PFS) after FOLFIRINOX. Nine candidate plasma miRNAs were validated in an independent cohort (n = 43). The most discriminative plasma miRNA was correlated with clinicopathological factors and survival, and also investigated in an additional cohort treated with gemcitabine plus nab-paclitaxel. Expression patterns were further evaluated in matched tumor tissues. In vitro studies explored its function, key downstream gene-targets, and interaction with 5-fluorouracil, irinotecan, and oxaliplatin., Results: Plasma miR-181a-5p was significantly downregulated in non-progressive patients after FOLFIRINOX. In multivariate analysis, this decline correlated with improved PFS and overall survival, especially when combined with CA19-9 decline [hazard ratio (HR) = 0.153, 95% confidence interval (CI), 0.067-0.347 and HR = 0.201, 95% CI, 0.070-0.576, respectively]. This combination did not correlate with survival in patients treated with gemcitabine plus nab-paclitaxel. Tissue expression of miR-181a-5p reflected plasma levels. Inhibition of miR-181a-5p coupled with oxaliplatin exposure in pancreatic cell lines decreased cell viability., Conclusions: Plasma miR-181a-5p is a specific biomarker for monitoring FOLFIRINOX response. Decline in plasma miR-181a-5p and CA19-9 levels is associated with better prognosis after FOLFIRINOX and may be useful for guiding therapeutic choices and surgical exploration.
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- 2020
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22. Textbook Outcome: Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery.
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van Roessel S, Mackay TM, van Dieren S, van der Schelling GP, Nieuwenhuijs VB, Bosscha K, van der Harst E, van Dam RM, Liem MSL, Festen S, Stommel MWJ, Roos D, Wit F, Molenaar IQ, de Meijer VE, Kazemier G, de Hingh IHJT, van Santvoort HC, Bonsing BA, Busch OR, Groot Koerkamp B, and Besselink MG
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- Aged, Female, Hospital Mortality trends, Humans, Incidence, Male, Middle Aged, Netherlands epidemiology, Pancreatic Neoplasms mortality, Retrospective Studies, Pancreatectomy methods, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Postoperative Complications epidemiology, Quality Indicators, Health Care, Registries, Textbooks as Topic
- Abstract
Background: Textbook outcome (TO) is a multidimensional measure for quality assurance, reflecting the "ideal" surgical outcome., Methods: Post-hoc analysis of patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between 2014 and 2017, queried from the nationwide prospective Dutch Pancreatic Cancer Audit. An international survey was conducted among 24 experts from 10 countries to reach consensus on the requirements for TO in pancreatic surgery. Univariable and multivariable logistic regression was performed to identify TO predictors. Between-hospital variation in TO rates was compared using observed-versus-expected rates., Results: Based on the survey (92% response rate), TO was defined by the absence of postoperative pancreatic fistula, bile leak, postpancreatectomy hemorrhage (all ISGPS grade B/C), severe complications (Clavien-Dindo ≥III), readmission, and in-hospital mortality. Overall, 3341 patients were included (2633 (79%) PD and 708 (21%) DP) of whom 60.3% achieved TO; 58.3% for PD and 67.4% for DP. On multivariable analysis, ASA class 3 predicted a worse TO rate after PD (ASA 3 OR 0.59 [0.44-0.80]), whereas a dilated pancreatic duct (>3 mm) and pancreatic ductal adenocarcinoma (PDAC) were associated with a better TO rate (OR 2.22 [2.05-3.57] and OR 1.36 [1.14-1.63], respectively). For DP, female sex and the absence of neoadjuvant therapy predicted better TO rates (OR 1.38 [1.01-1.90] and OR 2.53 [1.20-5.31], respectively). When comparing institutions, the observed-versus-expected rate for achieving TO varied from 0.71 to 1.46 per hospital after casemix-adjustment., Conclusions: TO is a novel quality measure in pancreatic surgery. TO varies considerably between pancreatic centers, demonstrating the potential benefit of quality assurance programs.
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- 2020
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23. Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation.
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Mungroop TH, van Rijssen LB, van Klaveren D, Smits FJ, van Woerden V, Linnemann RJ, de Pastena M, Klompmaker S, Marchegiani G, Ecker BL, van Dieren S, Bonsing B, Busch OR, van Dam RM, Erdmann J, van Eijck CH, Gerhards MF, van Goor H, van der Harst E, de Hingh IH, de Jong KP, Kazemier G, Luyer M, Shamali A, Barbaro S, Armstrong T, Takhar A, Hamady Z, Klaase J, Lips DJ, Molenaar IQ, Nieuwenhuijs VB, Rupert C, van Santvoort HC, Scheepers JJ, van der Schelling GP, Bassi C, Vollmer CM, Steyerberg EW, Abu Hilal M, Groot Koerkamp B, and Besselink MG
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- Aged, Female, Humans, Internationality, Male, Middle Aged, Pancreatic Fistula epidemiology, Pancreaticoduodenectomy, Postoperative Complications epidemiology, Risk Assessment methods
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Objective: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor., Background: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations., Methods: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS., Results: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05)., Conclusion: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.
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- 2019
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24. Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial.
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de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, van Dam R, Dejong C, van Duyn E, Dijkgraaf M, van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, de Hingh I, Kazemier G, Klaase J, de Kleine R, van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, and Besselink M
- Subjects
- Female, Follow-Up Studies, Humans, Laparoscopy methods, Male, Middle Aged, Quality of Life, Retrospective Studies, Robotic Surgical Procedures methods, Treatment Outcome, Minimally Invasive Surgical Procedures methods, Pancreatectomy methods, Pancreatic Neoplasms surgery, Recovery of Function
- Abstract
Objective: This trial followed a structured nationwide training program in minimally invasive distal pancreatectomy (MIDP), according to the IDEAL framework for surgical innovation, and aimed to compare time to functional recovery after minimally invasive and open distal pancreatectomy (ODP)., Background: MIDP is increasingly used and may enhance postoperative recovery as compared with ODP, but randomized studies are lacking., Methods: A multicenter patient-blinded randomized controlled superiority trial was performed in 14 centers between April 2015 and March 2017. Adult patients with left-sided pancreatic tumors confined to the pancreas without vascular involvement were randomly assigned (1:1) to undergo MIDP or ODP. Patients were blinded for type of surgery using a large abdominal dressing. The primary endpoint was time to functional recovery. Analysis was by intention to treat. This trial was registered with the Netherlands Trial Register (NTR5689)., Results: Time to functional recovery was 4 days [interquartile range (IQR) 3-6) in 51 patients after MIDP versus 6 days (IQR 5-8) in 57 patients after ODP (P < 0.001). The conversion rate of MIDP was 8%. Operative blood loss was less after MIDP (150 vs 400 mL; P < 0.001), whereas operative time was longer (217 vs 179 minutes; P = 0.005). The Clavien-Dindo grade ≥III complication rate was 25% versus 38% (P = 0.21). Delayed gastric emptying grade B/C was seen less often after MIDP (6% vs 20%; P = 0.04). Postoperative pancreatic fistulas grade B/C were seen in 39% after MIDP versus 23% after ODP (P = 0.07), without difference in percutaneous catheter drainage (22% vs 20%; P = 0.77). Quality of life (day 3-30) was better after MIDP as compared with ODP, and overall costs were non-significantly less after MIDP. No 90-day mortality was seen after MIDP versus 2% (n = 1) after ODP., Conclusions: In patients with left-sided pancreatic tumors confined to the pancreas, MIDP reduces time to functional recovery compared with ODP. Although the overall rate of complications was not reduced, MIDP was associated with less delayed gastric emptying and better quality of life without increasing costs.
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- 2019
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25. The Dutch Pancreas Biobank Within the Parelsnoer Institute: A Nationwide Biobank of Pancreatic and Periampullary Diseases.
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Strijker M, Gerritsen A, van Hilst J, Bijlsma MF, Bonsing BA, Brosens LA, Bruno MJ, van Dam RM, Dijk F, van Eijck CH, Farina Sarasqueta A, Fockens P, Gerhards MF, Groot Koerkamp B, van der Harst E, de Hingh IH, van Hooft JE, Huysentruyt CJ, Kazemier G, Klaase JM, van Laarhoven CJ, van Laarhoven HW, Liem MS, de Meijer VE, van Rijssen LB, van Santvoort HC, Suker M, Verhagen JH, Verheij J, Verspaget HW, Wennink RA, Wilmink JW, Molenaar IQ, Boermeester MA, Busch OR, and Besselink MG
- Subjects
- Academic Medical Centers, Aged, Ampulla of Vater pathology, Female, Humans, Male, Middle Aged, Netherlands, Pancreas surgery, Pancreatic Neoplasms surgery, Prospective Studies, Translational Research, Biomedical methods, Biological Specimen Banks, Pancreas pathology, Pancreatic Neoplasms pathology, Tissue and Organ Procurement methods
- Abstract
Objectives: Large biobanks with uniform collection of biomaterials and associated clinical data are essential for translational research. The Netherlands has traditionally been well organized in multicenter clinical research on pancreatic diseases, including the nationwide multidisciplinary Dutch Pancreatic Cancer Group and Dutch Pancreatitis Study Group. To enable high-quality translational research on pancreatic and periampullary diseases, these groups established the Dutch Pancreas Biobank., Methods: The Dutch Pancreas Biobank is part of the Parelsnoer Institute and involves all 8 Dutch university medical centers and 5 nonacademic hospitals. Adult patients undergoing pancreatic surgery (all indications) are eligible for inclusion. Preoperative blood samples, tumor tissue from resected specimens, pancreatic cyst fluid, and follow-up blood samples are collected. Clinical parameters are collected in conjunction with the mandatory Dutch Pancreatic Cancer Audit., Results: Between January 2015 and May 2017, 488 patients were included in the first 5 participating centers: 4 university medical centers and 1 nonacademic hospital. Over 2500 samples were collected: 1308 preoperative blood samples, 864 tissue samples, and 366 follow-up blood samples., Conclusions: Prospective collection of biomaterials and associated clinical data has started in the Dutch Pancreas Biobank. Subsequent translational research will aim to improve treatment decisions based on disease characteristics.
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- 2018
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26. Fecal Elastase Fails to Detect Steatorrhea in Patients With Locally Advanced Pancreatic Cancer.
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Witvliet-van Nierop JE, Wierdsma NJ, Ottens-Oussoren K, Meijerink MR, Bouma G, Kazemier G, and de van der Schueren MAE
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- Aged, Enzyme Replacement Therapy methods, Exocrine Pancreatic Insufficiency diagnosis, Female, Humans, Male, Middle Aged, Pilot Projects, Steatorrhea complications, Feces enzymology, Pancreatic Elastase metabolism, Pancreatic Neoplasms complications, Steatorrhea diagnosis
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- 2018
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27. Early and Late Complications After Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors.
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Nell S, Borel Rinkes IHM, Verkooijen HM, Bonsing BA, van Eijck CH, van Goor H, de Kleine RHJ, Kazemier G, Nieveen van Dijkum EJ, Dejong CHC, Valk GD, and Vriens MR
- Subjects
- Adult, Aged, Databases, Factual, Female, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Multiple Endocrine Neoplasia Type 1 surgery, Pancreatectomy, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy, Postoperative Complications epidemiology
- Abstract
Objective: To estimate short and long-term morbidity after pancreatic surgery for multiple endocrine neoplasia type 1 (MEN1)-related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs)., Background: Fifty percent of the MEN1 patients harbor multiple NF-pNETs. The decision to proceed to NF-pNET surgery is a balance between the risk of disease progression versus the risk of surgery-related morbidity. Currently, there are insufficient data on the surgical complications after MEN1 NF-pNET surgery., Methods: MEN1 patients diagnosed with a NF-pNET who underwent surgery were selected from the DutchMEN1 study group database, including >90% of the Dutch MEN1 population. Early postoperative complications, new-onset diabetes mellitus, and exocrine pancreatic insufficiency were captured., Results: Sixty-one patients underwent NF-pNET surgery at 1 of the 8 Dutch academic centers. Patients were young (median age 41 years) with low American Society of Anesthesiologists scores. Median NF-pNET size on imaging was 22 mm (3-157). Thirty-three percent (19/58) of the patients developed major early-Clavien-Dindo grade III to IV-complications mainly consisting International Study Group of Pancreatic Surgery grade B/C pancreatic fistulas. Twenty-three percent of the patients (14/61) developed endocrine or exocrine pancreas insufficiency. The development of major early postoperative complications was independent of the NF-pNET tumor size. Twenty-one percent of the patients (12/58) developed multiple major early complications., Conclusions: MEN1 NF-pNET surgery is associated with high rates of major short and long-term complications. Current findings should be taken into account in the shared decision-making process when MEN1 NF-pNET surgery is considered.
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- 2018
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28. Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS).
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de Rooij T, van Hilst J, Boerma D, Bonsing BA, Daams F, van Dam RM, Dijkgraaf MG, van Eijck CH, Festen S, Gerhards MF, Koerkamp BG, van der Harst E, de Hingh IH, Kazemier G, Klaase J, de Kleine RH, van Laarhoven CJ, Lips DJ, Luyer MD, Molenaar IQ, Patijn GA, Roos D, Scheepers JJ, van der Schelling GP, Steenvoorde P, Vriens MR, Wijsman JH, Gouma DJ, Busch OR, Hilal MA, and Besselink MG
- Subjects
- Adult, Aged, Cohort Studies, Controlled Before-After Studies, Feasibility Studies, Female, Humans, Male, Middle Aged, Netherlands, Pancreatectomy methods, Treatment Outcome, Laparoscopy education, Pancreatectomy education, Pancreatic Neoplasms surgery, Pancreatitis, Chronic surgery, Robotic Surgical Procedures education
- Abstract
Objective: To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP)., Summary of Background Data: Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown., Methods: From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015)., Results: In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P < 0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P < 0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score ≥III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P < 0.001). Thirty-day mortality was 3% vs 0% (P = 0.12)., Conclusion: A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.
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- 2016
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29. Effect of Individual Surgeons and Anesthesiologists on Operating Room Time.
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van Eijk RP, van Veen-Berkx E, Kazemier G, and Eijkemans MJ
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- Efficiency, Efficiency, Organizational, Humans, Linear Models, Operating Room Information Systems, Time Factors, Anesthesia Department, Hospital organization & administration, Anesthesiologists organization & administration, Appointments and Schedules, General Surgery organization & administration, Operating Rooms organization & administration, Operative Time, Personnel Staffing and Scheduling organization & administration, Surgeons organization & administration, Workload
- Abstract
Background: Variability in operating room (OR) time causes overutilization and underutilization of the available ORs. There is evidence that for a given type of procedure, the surgeon is the major source of variability in OR time. The primary aim was to quantify the variability between surgeons and anesthesiologists. As illustration, the value of modeling the individual surgeons and anesthesiologist for OR time prediction was estimated., Methods: OR data containing 16,480 cases were obtained from a general surgery department. The total amount of variability in OR time accounted for by the type of procedure, first and second surgeon, and the anesthesiologist was determined with the use of linear mixed models. The effect on OR time prediction was evaluated as reduction in overtime and idle time per case., Results: Differences between first surgeons can account for only 2.9% (2.0%-4.2%) of the variability in OR time. Differences between anesthesiologists can account for 0.1% (0.0%-0.3%) of the variability in OR time. Incorporating the individual surgeons and anesthesiologists led to an average reduction of overtime and idle time of 1.8 (95% confidence interval, 1.7-2.0, 10.5% reduction) minutes and 3.0 (95% confidence interval, 2.8%-3.2, 17.0% reduction) minutes, respectively., Conclusions: In comparison with the type of procedure, differences between surgeons account for a small part of OR time variability. The impact of differences between anesthesiologists on OR time is negligible. A prediction model incorporating the individual surgeons and anesthesiologists has an increased precision, but improvements are likely too marginal to have practical consequences for OR scheduling.
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- 2016
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30. Clinicopathological Parameters in Patient Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer Metastases: A Meta-analysis.
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Kwakman R, Schrama AM, van Olmen JP, Otten RH, de Lange-de Klerk ES, de Cuba EM, Kazemier G, and Te Velde EA
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- Humans, Survival Analysis, Chemotherapy, Cancer, Regional Perfusion, Colorectal Neoplasms pathology, Cytoreduction Surgical Procedures, Hyperthermia, Induced, Patient Selection, Peritoneal Neoplasms secondary, Peritoneal Neoplasms therapy
- Abstract
Objective: To improve patient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by evaluating various preoperatively assessable clinicopathological parameters as markers for survival after CRS and HIPEC., Summary Background Data: Peritoneal metastases (PMs) originating from colorectal cancer are treated with CRS and HIPEC. Despite increasing survival, high morbidity and mortality warrant selection of patients with optimal benefit from this treatment. Many studies report a number of variables to be associated with survival after CRS and HIPEC, but no definitive analysis has been made to validate various markers., Methods: In concordance with PRISMA guidelines, we performed a literature search encompassing 4110 articles to select 50 articles that reported the influence of 1 or more clinicopathological variables on overall survival after CRS and HIPEC. In absence of RCTs, 25 cohort studies could be used to perform a meta-analysis on 10 prognostic variables., Results: We determined that concurrent liver metastasis, lymph node metastasis, Eastern Cooperative Oncology Group score, tumor differentiation, and signet ring cell histology are all negative prognostic variables on overall survival after CRS and HIPEC. Conversely, sex and location of primary could not be validated as prognostic markers. More research is required to make definitive conclusions about neoadjuvant chemotherapy, onset of PMs, and mucinous histology., Conclusions: Current clinical practice, which selects patients based on extraperitoneal metastasis, lymph node stage, performance status, and tumor histology, is validated by our pooled analysis. Our data merit further research into neoadjuvant chemotherapy in the setting of CRS and HIPEC for PMs.
- Published
- 2016
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31. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcome from a single center.
- Author
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Dubbeld J, van Hoek B, Ringers J, Metselaar H, Kazemier G, van den Berg A, and Porte RJ
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- Female, Humans, Male, Biliary Tract Diseases etiology, Brain Death, Death, Liver Transplantation adverse effects
- Published
- 2015
- Full Text
- View/download PDF
32. Significant contribution of the portal vein to blood flow through the common bile duct.
- Author
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Slieker JC, Farid WR, van Eijck CH, Lange JF, van Bommel J, Metselaar HJ, de Jonge J, and Kazemier G
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- Arteries physiology, Duodenum blood supply, Hepatic Artery physiology, Humans, Microvessels, Stomach blood supply, Common Bile Duct blood supply, Portal Vein physiology, Regional Blood Flow
- Abstract
Objective: The aim of this study was to determine the contribution of the hepatic artery, gastroduodenal artery, and portal vein to the microvascular blood flow in the common bile duct (CBD)., Background: Biliary complications are a common cause of graft loss after liver transplantation. The occurrence is, partly, attributed to hepatic artery thrombosis, which is considered to be the sole provider of blood flow to the bile ducts. However, the contribution of the portal vein and the gastroduodenal artery to the bile ducts is unknown., Methods: Microvascular blood flow in the CBD was determined in 15 patients who underwent a pancreaticoduodenectomy with a combination of laser Doppler flowmetry and reflectance spectrophotometry. Microvascular blood flow was measured at baseline, during clamping the portal vein, during clamping the hepatic artery, and during clamping both. After transection of the CBD, these 4 measurements were repeated., Results: Compared with baseline measurements, the microvascular blood flow through the CBD decreased to 62% after clamping the portal vein, 51% after clamping the hepatic artery, and 31% after clamping both. After the CBD was transected, these 3 measurements were 60%, 31%, and 20%, respectively., Conclusions: : Historically, the hepatic artery has been considered mainly responsible for biliary blood flow. We show that after transection of the CBD, mimicking the situation after liver transplantation, the contribution of the portal vein to the microvascular blood flow through the CBD is 40%. This study emphasizes the importance of the portal vein, and disturbances in portal venous blood flow could contribute to the formation of biliary complications after liver transplantation.
- Published
- 2012
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33. Laparoscopic umbilical hernia repair in the presence of extensive paraumbilical collateral veins: a case report.
- Author
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Lases SS, Eker HH, Pierik EG, Klitsie PJ, de Goede B, Peeters MP, Kazemier G, and Lange JF
- Subjects
- Humans, Male, Middle Aged, Collateral Circulation, Hernia, Umbilical surgery, Herniorrhaphy methods, Intraoperative Complications prevention & control, Laparoscopy methods, Umbilical Veins
- Abstract
A patient with an umbilical hernia presenting with collateral veins in the abdominal wall and umbilicus is a case that every hernia surgeon has to deal with occasionally. Several underlying diseases have been described to provoke collateral veins in the abdominal wall. However, the treatment strategy should be uniform. We herein report a case of a successful laparoscopic umbilical hernia repair in a patient with collateral veins in the abdominal wall and umbilicus. A 63-year-old man was referred to the surgical outpatient clinic with a large symptomatic umbilical hernia and collateral veins in the abdominal wall, secondary to an occlusion of both common iliac veins. Because of collateral veins in the umbilicus and the size of the hernial defect, he was offered laparoscopic hernia repair without compromising these veins. Because of the extensive abdominal wall collaterals, duplex sonography vein mapping was performed preoperatively to mark a safe collateral-free area for trocar introduction. The defect was repaired by mesh prosthesis.
- Published
- 2011
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34. Adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled trial.
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Morak MJ, van der Gaast A, Incrocci L, van Dekken H, Hermans JJ, Jeekel J, Hop WC, Kazemier G, and van Eijck CH
- Subjects
- Adenocarcinoma drug therapy, Adenocarcinoma radiotherapy, Adenocarcinoma surgery, Adult, Aged, Chemotherapy, Adjuvant, Common Bile Duct Neoplasms drug therapy, Common Bile Duct Neoplasms radiotherapy, Cycloleucine administration & dosage, Cycloleucine analogs & derivatives, Disease Progression, Female, Humans, Infusions, Intra-Arterial, Lead, Male, Middle Aged, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms radiotherapy, Pancreatic Neoplasms surgery, Prognosis, Prospective Studies, Radiotherapy, Adjuvant, Sulfides, Treatment Outcome, Adenocarcinoma mortality, Adenocarcinoma therapy, Ampulla of Vater, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Common Bile Duct Neoplasms mortality, Common Bile Duct Neoplasms surgery, Common Bile Duct Neoplasms therapy, Fluorouracil administration & dosage, Mitoxantrone administration & dosage, Pancreatic Neoplasms mortality, Pancreatic Neoplasms therapy
- Abstract
Background: Success of surgical treatment for pancreatic and periampullary cancer is often limited due to locoregional recurrence and/or the development of distant metastases., Objective: The survival benefit of celiac axis infusion (CAI) and radiotherapy (RT) versus observation after resection of pancreatic or periampullary cancer was investigated., Methods: In a randomized controlled trial, 120 consecutive patients with histopathologically proven pancreatic or periampullary cancer received either adjuvant treatment consisting of intra-arterial mitoxantrone, 5-FU, leucovorin, and cisplatinum in combination with 30 x 1.8 Gy radiotherapy (group A) or no adjuvant treatment (group B). Groups were stratified for tumor type (pancreatic vs. periampullary tumors)., Results: After surgery, 120 patients were randomized (59 patients in the treatment group, 61 in the observation group). The median follow-up was 17 months. No significant overall survival benefit was seen (median, 19 vs. 18 months resp.). Progressive disease was seen in 86 patients: in 37 patients in the CAI/RT group, and in 49 patients in the observation group (log-rank P < 0.02). Subgroup analysis showed significantly less liver metastases after adjuvant treatment in periampullary tumors (log-rank P < 0.03) without effect on local recurrence. Nonetheless, there was no significant effect on overall survival in these patients (log-rank P = 0.15). In patients with pancreatic cancer, CAI/RT had no significant effect on local recurrence (log-rank P = 0.12) neither on the development of liver metastases (log-rank P = 0.76) and consequently, no effect on overall survival., Conclusion: This adjuvant treatment schedule results in a prolonged time to progression. For periampullary tumors, CAI/RT induced a significant reduction in the development of liver metastases, with a possible effect on overall survival. Especially in these tumors, CAI/RT might prove beneficial in larger groups and further research is warranted.
- Published
- 2008
- Full Text
- View/download PDF
35. A simulation model for determining the optimal size of emergency teams on call in the operating room at night.
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van Oostrum JM, Van Houdenhoven M, Vrielink MM, Klein J, Hans EW, Klimek M, Wullink G, Steyerberg EW, and Kazemier G
- Subjects
- Circadian Rhythm, Computer Simulation, Humans, Models, Theoretical, Patient Care Team statistics & numerical data, Personnel, Hospital standards, Workforce, Emergencies epidemiology, Emergency Service, Hospital standards, Operating Rooms, Personnel, Hospital statistics & numerical data, Safety
- Abstract
Background: Hospitals that perform emergency surgery during the night (e.g., from 11:00 pm to 7:30 am) face decisions on optimal operating room (OR) staffing. Emergency patients need to be operated on within a predefined safety window to decrease morbidity and improve their chances of full recovery. We developed a process to determine the optimal OR team composition during the night, such that staffing costs are minimized, while providing adequate resources to start surgery within the safety interval., Methods: A discrete event simulation in combination with modeling of safety intervals was applied. Emergency surgery was allowed to be postponed safely. The model was tested using data from the main OR of Erasmus University Medical Center (Erasmus MC). Two outcome measures were calculated: violation of safety intervals and frequency with which OR and anesthesia nurses were called in from home. We used the following input data from Erasmus MC to estimate distributions of all relevant parameters in our model: arrival times of emergency patients, durations of surgical cases, length of stay in the postanesthesia care unit, and transportation times. In addition, surgeons and OR staff of Erasmus MC specified safety intervals., Results: Reducing in-house team members from 9 to 5 increased the fraction of patients treated too late by 2.5% as compared to the baseline scenario. Substantially more OR and anesthesia nurses were called in from home when needed., Conclusion: The use of safety intervals benefits OR management during nights. Modeling of safety intervals substantially influences the number of emergency patients treated on time. Our case study showed that by modeling safety intervals and applying computer simulation, an OR can reduce its staff on call without jeopardizing patient safety.
- Published
- 2008
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36. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling.
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Van Houdenhoven M, van Oostrum JM, Hans EW, Wullink G, and Kazemier G
- Subjects
- Computer Simulation, Hospital Costs, Hospitals, University economics, Hospitals, University statistics & numerical data, Humans, Models, Organizational, Netherlands, Operating Rooms economics, Operating Rooms statistics & numerical data, Organizational Innovation, Prospective Studies, Time Management, Waiting Lists, Algorithms, Appointments and Schedules, Efficiency, Organizational economics, Hospitals, University organization & administration, Operating Room Information Systems, Operating Rooms organization & administration, Process Assessment, Health Care, Surgical Procedures, Operative economics
- Abstract
Background: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques., Methods: We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data. The setting is the main inpatient OR department of a university hospital, which sets its surgical case schedules 2 wk in advance using a block planning method. The main outcome measures are the number of freed OR blocks and OR utilization., Results: Lowering organizational barriers and applying mathematical algorithms can yield a 4.5% point increase in OR utilization (95% confidence interval 4.0%-5.0%). This is obtained by reducing the total required OR time., Conclusions: Efficient OR departments can further improve their efficiency. The paper shows that a radical cultural change that comprises the use of mathematical algorithms and lowering organizational barriers improves OR utilization.
- Published
- 2007
- Full Text
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37. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors.
- Author
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Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, Terpstra OT, Zijlstra JA, Klinkert P, and Jeekel H
- Subjects
- Adenocarcinoma mortality, Adult, Aged, Blood Loss, Surgical, Common Bile Duct Neoplasms mortality, Disease-Free Survival, Female, Gastric Emptying, Humans, Length of Stay, Male, Middle Aged, Pancreatic Neoplasms mortality, Pancreaticoduodenectomy adverse effects, Postoperative Complications, Reoperation, Survival Rate, Adenocarcinoma surgery, Ampulla of Vater, Common Bile Duct Neoplasms surgery, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Pylorus surgery
- Abstract
Objective: A prospective randomized multicenter study was performed to assess whether the results of pylorus-preserving pancreaticoduodenectomy (PPPD) equal those of the standard Whipple (SW) operation, especially with respect to duration of surgery, blood loss, hospital stay, delayed gastric emptying (DGE), and survival., Summary Background Data: PPPD has been associated with a higher incidence of delayed gastric emptying, resulting in a prolonged period of postoperative nasogastric suctioning. Another criticism of the pylorus-preserving pancreaticoduodenectomy for patients with a malignancy is the radicalness of the resection. On the other hand, PPPD might be associated with a shorter operation time and less blood loss., Methods: A prospective randomized multicenter study was performed in a nonselected series of 170 consecutive patients. All patients with suspicion of pancreatic or periampullary tumor were included and randomized for a SW or a PPPD resection. Data concerning patients' demographics, intraoperative and histologic findings, as well as postoperative mortality, morbidity, and follow-up up to 115 months after discharge, were analyzed., Results: There were no significant differences noted in age, sex distribution, tumor localization, and staging. There were no differences in median blood loss and duration of operation between the 2 techniques. DGE was observed equally in the 2 groups. There was only a marginal difference in postoperative weight loss in favor of the standard Whipple procedure. Overall operative mortality was 5.3%. Tumor positive resection margins were found for 12 patients of the SW group and 19 patients of the PPPD group (P < 0.23). Long-term follow-up showed no significant statistical differences in survival between the 2 groups (P < 0.90)., Conclusions: The SW and PPPD operations were associated with comparable operation time, blood loss, hospital stay, mortality, morbidity, and incidence of DGE. The overall long-term and disease-free survival was comparable in both groups. Both surgical procedures are equally effective for the treatment of pancreatic and periampullary carcinoma.
- Published
- 2004
- Full Text
- View/download PDF
38. The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life.
- Author
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Van Heek NT, De Castro SM, van Eijck CH, van Geenen RC, Hesselink EJ, Breslau PJ, Tran TC, Kazemier G, Visser MR, Busch OR, Obertop H, and Gouma DJ
- Subjects
- Aged, Common Bile Duct Neoplasms mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Survival Rate, Ampulla of Vater, Common Bile Duct Neoplasms surgery, Gastrostomy, Jejunostomy, Quality of Life
- Abstract
Objective: To evaluate the effect of a prophylactic gastrojejunostomy on the development of gastric outlet obstruction and quality of life in patients with unresectable periampullary cancer found during explorative laparotomy., Summary Background Data: Several studies, including one randomized trial, propagate to perform a prophylactic gastrojejunostomy routinely in patients with periampullary cancer found to be unresectable during laparotomy. Others suggest an increase of postoperative complications. Controversy still exists in general surgical practice if a double bypass should be performed routinely in these patients., Methods: Between December 1998 and March 2002, patients with a periampullary carcinoma who were found to be unresectable during exploration were randomized to receive a double bypass (hepaticojejunostomy and a retrocolic gastrojejunostomy) or a single bypass (hepaticojejunostomy). Randomization was stratified for center and presence of metastases. Patients with gastrointestinal obstruction and patients treated endoscopically for more than 3 months were excluded. Primary endpoints were development of clinical gastric outlet obstruction and surgical intervention for gastric outlet obstruction. Secondary endpoints were mortality, morbidity, hospital stay, survival, and quality of life, measured prospectively by the EORTC-C30 and Pan26 questionnaires. It was decided to perform an interim analysis after inclusion of 50% of the patients (n = 70)., Results: Five of the 70 patients randomized were lost to follow-up. From the remaining 65 patients, 36 patients underwent a double and 29 a single bypass. There were no differences in patient demographics, preoperative symptoms, and surgical findings between the groups. Clinical symptoms of gastric outlet obstruction were found in 2 of the 36 patients (5.5%) with a double bypass, and in 12 of the 29 patients (41.4%) with a single bypass (P = 0.001). In the double bypass group, one patient (2.8%) and in the single bypass group 6 patients (20.7%) required (re-)gastrojejunostomy during follow-up (P = 0.04). The absolute risk reduction for reoperation in the double bypass group was 18%, and the numbers needed to treat was 6. Postoperative morbidity rates, including delayed gastric emptying, were 31% in the double versus 28% in the single bypass group (P = 0.12). Median postoperative length of stay was 11 days (range 4-76 days) in the double versus 9 days (range 6-20 days) in the single bypass group (P = 0.06); median survival was 7.2 months in the double versus 8.4 months in the single bypass group (P = 0.15). No differences were found in the quality of life between both groups. After surgery most quality of life scores deteriorated temporarily and were restored to their baseline score (t = -1) within 4 months., Conclusions: Prophylactic gastrojejunostomy significantly decreases the incidence of gastric outlet obstruction without increasing complication rates. There were no differences in quality of life between the two groups. Together with the previous randomized trial from the Hopkins group, this study provides sufficient evidence to state that a double bypass consisting of a hepaticojejunostomy and a prophylactic gastrojejunostomy is preferable to a single bypass consisting of only a hepaticojejunostomy in patients undergoing surgical palliation for unresectable periampullary carcinoma. Therefore, the trial was stopped earlier than planned.
- Published
- 2003
- Full Text
- View/download PDF
39. Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases.
- Author
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Bonjer HJ, Sorm V, Berends FJ, Kazemier G, Steyerberg EW, de Herder WW, and Bruining HA
- Subjects
- Adolescent, Adrenal Gland Diseases pathology, Adrenal Gland Diseases physiopathology, Adrenal Gland Neoplasms pathology, Adrenal Gland Neoplasms physiopathology, Adrenal Gland Neoplasms surgery, Adrenalectomy adverse effects, Adult, Aged, Aged, 80 and over, Female, Hemodynamics, Humans, Laparoscopy adverse effects, Male, Middle Aged, Retroperitoneal Space, Time Factors, Adrenal Gland Diseases surgery, Adrenalectomy methods, Laparoscopy methods
- Abstract
Objective: To evaluate the effectiveness of endoscopic retroperitoneal adrenalectomy (ERA)., Summary Background Data: Minimally invasive adrenalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors., Methods: Clinical characteristics and outcomes of 111 ERAs from January 1994 to December 1999 were evaluated., Results: Ninety-five patients underwent 111 ERAs (79 unilateral, 16 bilateral). Indications were Cushing syndrome (n = 22), Cushing disease (n = 8), ectopic adrenocorticotropic hormone syndrome (n = 6), Conn's adenoma (n = 25), pheochromocytoma (n = 19), incidentaloma (n = 11), and other (n = 4). Tumor size varied from 0.1 to 8 cm. Median age was 50 years. Unilateral ERA required 114 minutes, with median blood loss of 65 mL. Bilateral ERA lasted 214 minutes, with median blood loss of 121 mL. The conversion rate to open surgery was 4.5%. The complication rate was 11%. Median postoperative hospital stay was 2 days for unilateral ERA and 5 days for bilateral ERA. The death rate was 0.9%. At a median follow-up of 14 months, the recurrence rate of disease was 0.9%., Conclusion: For benign adrenal tumors less than 6 cm, ERA is recommended.
- Published
- 2000
- Full Text
- View/download PDF
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