5 results on '"Rauws, Erik A J"'
Search Results
2. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma.
- Author
-
Kloek JJ, van der Gaag NA, Aziz Y, Rauws EA, van Delden OM, Lameris JS, Busch OR, Gouma DJ, and van Gulik TM
- Subjects
- Adult, Aged, Catheterization adverse effects, Drainage adverse effects, Endoscopy adverse effects, Female, Hepatectomy, Humans, Male, Middle Aged, Stents, Bile Duct Neoplasms surgery, Bile Ducts, Intrahepatic, Cholangiocarcinoma surgery, Drainage methods, Preoperative Care
- Abstract
Introduction: Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA., Methods: One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or PTBD., Results: Of these patients, 101 (88%) underwent PBD; 90 patients underwent EBD as primary procedure, and 11 PTBD. The technical success rate of initial drainage was 81% in the EBD versus 100% in the PTBD group (P = 0.20). Stent dislocation was similar in the EBD and PTBD groups (23% vs. 20%, P = 0.70). Infectious complications were significantly more common in the endoscopic group (48% vs. 9%, P < 0.05). Patients in the EBD group underwent more drainage procedures (2.8 vs. 1.4, P < 0.01) and had a significantly longer drainage period until laparotomy (mean 15 weeks vs. 11 weeks in the PTBD group; P < 0.05). In 30 patients, EBD was converted to PTBD due to failure of the endoscopic approach., Conclusions: Preoperative percutaneous drainage could outperform endoscopic stent placement in patients with resectable HCCA, showing fewer infectious complications, using less procedures.
- Published
- 2010
- Full Text
- View/download PDF
3. [Improved treatment results in hilar cholangiocarcinoma after transition to more extensive procedure: 20 years experience AMC].
- Author
-
van Gulik TM, Kloek JJ, Ruys AT, Busch OR, van Tienhoven G, Lameris JS, Rauws EA, and Gouma DJ
- Subjects
- Adult, Aged, Bile Duct Neoplasms mortality, Bile Ducts, Intrahepatic pathology, Biliary Tract Surgical Procedures, Cholangiocarcinoma mortality, Female, Follow-Up Studies, Humans, Klatskin Tumor mortality, Klatskin Tumor surgery, Male, Middle Aged, Retrospective Studies, Risk Factors, Survival Analysis, Time Factors, Treatment Outcome, Young Adult, Bile Duct Neoplasms surgery, Bile Ducts, Intrahepatic surgery, Cholangiocarcinoma surgery
- Abstract
Objective: To determine the result of surgical treatment of patients with hilar cholangiocarcinoma (HCCA) before and after the transition from predominantly local bile duct resections to more extensive resections including partial liver resection in order to achieve complete tumour resection in the Academic Medical Center, Amsterdam (The Netherlands)., Design: Retrospective and descriptive., Methods: In the period 1988-2003, 117 consecutive patients underwent resection due to suspected HCCA. Preoperative work-up included staging laparoscopy, preoperative biliary drainage and short-course radiation therapy (3 x 3.5 Gy) to prevent seeding metastases. A more extended multidisciplinary surgical approach combining bile duct resection with partial liver resection was applied as of 1998. Outcomes of resection including 5-year survival were assessed in patients who had undergone resection before (1988-1997; period 1) and after (1998-2003; period 2) this change in surgical approach., Results: In 18 patients (15.3%) a benign lesion was found in the resection specimen. Among the other 99 patients with microscopically confirmed HCCA, 21 (72%) of 29 patients had undergone bile duct resection in combination with partial liver resection in period 2 as compared to 17 (24%) of 70 patients in period 1. The margin tumour free resection rate increased from 20% in period 1 to 59% in period 2. Five-year survival increased from 20% (SE: 5) in period 1, to 33% (SE: 9) in period 2. Morbidity and mortality in period 2 were 69% and 10%, respectively, as compared to 64% and 17% in period 1., Conclusion: More extensive resection of HCCA in combination with partial liver resection in the setting of a multidisciplinary approach led to a higher rate of margin free resections and improved 5-year survival.
- Published
- 2010
4. Reinterpretation of radiological imaging in patients referred to a tertiary referral centre with a suspected pancreatic or hepatobiliary malignancy: impact on treatment strategy.
- Author
-
Tilleman EH, Phoa SS, Van Delden OM, Rauws EA, van Gulik TM, Laméris JS, and Gouma DJ
- Subjects
- Adult, Aged, Aged, 80 and over, Bile Duct Neoplasms mortality, Bile Duct Neoplasms therapy, Cholangiocarcinoma mortality, Cholangiocarcinoma therapy, Diagnosis, Differential, Diagnostic Errors, Female, Follow-Up Studies, Humans, Liver Neoplasms mortality, Liver Neoplasms therapy, Male, Middle Aged, Netherlands, Pancreatic Neoplasms mortality, Pancreatic Neoplasms therapy, Survival Analysis, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler, Bile Duct Neoplasms diagnosis, Bile Ducts, Intrahepatic diagnostic imaging, Bile Ducts, Intrahepatic pathology, Cholangiocarcinoma diagnosis, Image Interpretation, Computer-Assisted, Liver Neoplasms diagnosis, Pancreatic Neoplasms diagnosis, Referral and Consultation
- Abstract
Our objective was to determine the clinical importance of reinterpretation of radiological investigations performed in a referring hospital and the value of additional investigations in a referral centre. A panel of four experts retrospectively evaluated the technical quality of radiological investigations and made reinterpretation reports, of 78 patients referred with a suspected pancreatic or hepatobiliary malignancy. The value of additional radiological investigations performed in the referral centre was assessed. The quality of ultrasound and CT examinations was sufficient for reinterpretation in (36 of 69) 52% and (42 of 60) 70%, respectively. The reinterpretation reports of the ultrasound investigations were scored as "in accordance" in (30 of 36) 83%, as "minor discordance" in (3 of 36) 8% and as "major discordance" in (3 of 36) 8%. For CT proportions of (29 of 42) 69%, (8 of 42) 19% and (5 of 42) 12%, respectively, were found. Additional ultrasound ( n=55) showed no additional findings in 16%, minor additional findings in 53% and major additional findings in 31% of cases. For additional spiral CT scan ( n=47) results were of 21, 47 and, 32%, respectively. Reinterpretation of ultrasound and CT resulted in a change in treatment strategy for 7 patients (9%). Additional ultrasound or CT resulted in a change in treatment strategy for 24 patients (30%). Improved communication and reinterpretation of radiological investigations may reduce unnecessary referral.
- Published
- 2003
- Full Text
- View/download PDF
5. Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma.
- Author
-
Gerhards MF, van Gulik TM, González González D, Rauws EA, and Gouma DJ
- Subjects
- Abdominal Pain etiology, Bile Duct Neoplasms mortality, Bile Duct Neoplasms surgery, Cholangiocarcinoma mortality, Cholangiocarcinoma surgery, Cholangitis etiology, Female, Hospital Mortality, Humans, Jejunostomy, Male, Middle Aged, Prognosis, Radiotherapy, Adjuvant, Survival Analysis, Treatment Outcome, Bile Duct Neoplasms radiotherapy, Bile Ducts, Intrahepatic, Brachytherapy, Cholangiocarcinoma radiotherapy
- Abstract
The aim of this study was to assess the value of radiotherapy, and especially intraluminal brachytherapy, after resection of hilar cholangiocarcinoma by analyzing long-term complications and survival. Between 1983 and 1998, 112 patients underwent resection of a hilar cholangiocarcinoma. Of the 91 patients who survived the postoperative period, 20 patients had no additional radiotherapy, 30 patients had only external radiotherapy (46 +/- 11 Gy), and 41 patients had a combination of external (42 +/- 5 Gy) and intraluminal brachytherapy (10 +/- 2 Gy). Overall, 88% of the patients had late complications, with a significantly higher rate of complications occurring among patients receiving external beam irradiation and brachytherapy. Second to abdominal pain (56%), cholangitis (49%) was the most frequent complication and occurred significantly more often in patients who had received brachytherapy. Retrograde bile leakage after closure of the temporary jejunostomy was a troublesome complication in 24% of patients treated with brachytherapy. Overall median survival after treatment with adjuvant radiotherapy was longer than after resection without additional radiation (24 months versus 8 months, respectively). There was, however, no significant benefit from the use of intraluminal brachytherapy. In conclusion, additional radiotherapy after resection of hilar cholangiocarcinoma significantly improved survival and is recommended by giving external beam irradiation but not intraluminal brachytherapy.
- Published
- 2003
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.