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Staging laparoscopy is a common diagnostic tool in gastric cancer, but its performance varies widely. The aim of this study was to gain Dutch nationwide consensus regarding the indications for and execution of staging laparoscopy in patients with gastric cancer. All surgeons in the Netherlands specialized in gastric cancer surgery (n = 52) were asked to participate in a Delphi consensus study. The study involved an initial questionnaire with a 3-point Likert scale, an online consensus meeting, and a second questionnaire using a 2-point Likert scale (agree/disagree). Consensus was defined as 70% or more agreement among participants. In total, 45 experts completed both questionnaires (87% response rate). Consensus was reached on the indication to perform staging laparoscopy in cT3-4 or cN + or diffuse-type gastric cancer, including Siewert type III oesophagogastric junctional cancer. The experts agreed that if preoperative scans suggest infiltration of surrounding organs (cT4), the tumour's resectability should explicitly be investigated. Consensus was also reached for a systematic peritoneal cavity inspection according to Sugarbaker's Peritoneal Cancer Index (PCI) score. All regions should be inspected routinely, although the omental bursa may be inspected on indication. Aspiration of ascites or peritoneal washing should be performed for cytology. The experts agreed that restaging laparoscopy should be performed before resection in case of progressive disease on preoperative imaging. Without progression, global inspection was considered sufficient. The results of this Dutch nationwide Delphi consensus study exposed the variability of performing staging laparoscopy in patients with gastric cancer and provided the concept for a standardized protocol. [ABSTRACT FROM AUTHOR]

Background Surgical treatment of oesophageal cancer in the Netherland is performed in high volume centres. However, the decision to refer patients for curative surgery is made in the referring hospital of diagnosis. The objective of this study was to determine the influence of hospital of diagnosis on the probability of receiving a curative treatment and survival. Material and method All patients with resectable oesophageal cancer (cT1-3, cN0-3, cM0-1A) diagnosed between 2003 and 2010 ( n = 849) were selected from the population-based Eindhoven Cancer Registry, an area with ten non-academic hospitals. Multivariate logistic regression analysis was conducted to examine the independent influence of hospital of diagnosis on the probability to receive curative treatment. Furthermore, the effect of hospital of diagnosis on overall survival was examined using multivariate Cox regression analysis. Results 849 patients were included in the study. A difference in proportion of patients referred for surgery was observed ranging from 33% to 67% ( p = 0.002) between hospitals of diagnosis. Multivariate logistic regression analysis confirmed the effect of hospital of diagnosis on the chance of undergo curative treatment (OR 0.1, 95% CI 0.1–0.4). Multivariate Cox regression analysis showed that hospital of diagnosis also had an effect on overall survival, up to hazard ratio (HR) 2.2 (95% CI 1.3–3.7). Conclusion There is a strong relation between hospital of diagnosis and the chance of referring patients with oesophageal cancer for a curative treatment as well as overall survival. Patients diagnosed with oesophageal cancer should be discussed within a regional multidisciplinary expert panel. [ABSTRACT FROM AUTHOR]

We assessed dietary exposure of the little owl Athene noctua to trace metal contamination in a Dutch Rhine River floodplain area. Diet composition was calculated per month for three habitat types, based on the population densities of six prey types (earthworms, ground beetles and four small mammal species) combined with the little owl’s functional response to these prey types. Exposure levels showed a strong positive relationship with the dietary fraction of earthworms, but also depended on the dietary fraction of common voles, with higher common vole fractions resulting in decreasing exposure levels. Spatio-temporal changes in the availability of earthworms and common voles in particular resulted in considerable variation in exposure, with peaks in exposure exceeding a tentative toxicity threshold. These findings imply that wildlife exposure assessments based on a predefined, average diet composition may considerably underestimate local or intermittent peaks in exposure. [Copyright &y& Elsevier]

The article focuses on a study on the patterns and developments in macrozoobenthic compositions in the open system of the Rhine-Meuse estuary. The study offers an analysis of macrozoobenthic assemblages in terms of community descriptors and proportional distributions over feeding guilds. The researchers examined the value of an undisturbed estuary in terms of total macrozoonbenthic diversity as compared to the series of fresh water lakes that are separated from the Voordelta system. Questions on future plans for a regulated salt water inlet that will be restricted to 11.5 kilometers (km) inland are raised.

The article presents a study on the transmission and control of the haplosporidian parasite Bonamia ostreae (B. ostreae) which is infecting the European flat oysters Ostrea edulis (O. edulis) from Lake Grevelingen, The Netherlands. The study utilizes histopathological data from annual shellfish disease monitoring from 1988 to 2006 to measure the prevalence of the parasite in the flat oyster stocks relative to O. edulis density, biomass, and various environmental parameters. The findings of the study reveal that the parasite's prevalence depends on oyster age but independent of oyster density and total biomass and that flat oyster mortality increases at higher water temperatures. Moreover, O. edulis appeared to be vulnerable to B. ostreae when food availability and salinities are low.