293 results on '"Besselink, Marc G H"'
Search Results
52. Case on recurrence of infection after video-assisted retroperitoneal debridement
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Besselink, Marc G. H., Cuesta, Miguel A., Bonjer, Hendrik J., Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, and Surgery
- Published
- 2014
53. Case on necrotizing acute pancreatitis: 'Infection is not found but patient is becoming worse'
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Besselink, Marc G. H., Cuesta, Miguel A., Bonjer, Hendrik J., Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, and Surgery
- Published
- 2014
54. The Influence of a Metal Stent on the Distribution of Thermal Energy during Irreversible Electroporation
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Scheffer, Hester J., primary, Vogel, Jantien A., additional, van den Bos, Willemien, additional, Neal, Robert E., additional, van Lienden, Krijn P., additional, Besselink, Marc G. H., additional, van Gemert, Martin J. C., additional, van der Geld, Cees W. M., additional, Meijerink, Martijn R., additional, Klaessens, John H., additional, and Verdaasdonk, Rudolf M., additional
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- 2016
- Full Text
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55. Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands
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van der Geest, Lydia G. M., primary, Besselink, Marc G. H., additional, van Gestel, Yvette R. B. M., additional, Busch, Olivier R. C., additional, de Hingh, Ignace H. J. T., additional, de Jong, Koert P., additional, Molenaar, I. Quintus, additional, and Lemmens, Valery E. P. P., additional
- Published
- 2015
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56. Bestaat 'passend' bewijs?
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Bossuyt, Patrick M. M., Besselink, Marc G. H., Amsterdam Public Health, Epidemiology and Data Science, 10 Public Health & Methodologie, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, and Surgery
- Abstract
The 'levels of evidence' system, which dates back to the 1980s, ranks studies based on the strength of the corresponding study design. Level sets have been developed for studies of interventions, for test accuracy research, and many other forms of clinical research. For some authors, practicing evidence-based medicine has become identical to assigning levels of evidence. This is unfortunate, because more modern systems to come out of the evidence-based medicine movement, such as GRADE, distinguish between the credibility of evidence (which is not just affected by the selected design), the magnitude of the effect, and the applicability of the findings to the clinical question at hand. A new system - :fitting evidence" - has recently been developed by the Dutch Health Care Insurance Board, to evaluate evidence for reimbursement decisions. That system, with an 18-item checklist, looks at threats to the internal validity of studies as well as to the feasibility of randomized comparisons, to see whether it is "fitting" to design a randomized trial. It is unclear yet how these evaluations can and should be combined in the appraisal of the strength of the existing evidence
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- 2013
57. Nationwide trends in chemotherapy use and survival of elderly patients with metastatic pancreatic cancer.
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Geest, Lydia G. M., Haj Mohammad, Nadia, Besselink, Marc G. H., Lemmens, Valery E. P. P., Portielje, Johanneke E. A., Laarhoven, Hanneke W. M., and Wilmink, J. (Hanneke) W.
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OLDER patients ,CANCER patients ,PANCREATIC cancer ,ADENOCARCINOMA ,CANCER chemotherapy ,CANCER treatment ,PROGRESSION-free survival - Abstract
Despite an aging population and underrepresentation of elderly patients in clinical trials, studies on elderly patients with metastatic pancreatic cancer are scarce. This study investigated the use of chemotherapy and survival in elderly patients with metastatic pancreatic cancer. From the Netherlands Cancer Registry, all 9407 patients diagnosed with primary metastatic pancreatic adenocarcinoma in 2005-2013 were selected to investigate chemotherapy use and overall survival ( OS), using Kaplan-Meier and Cox proportional hazard regression analyses. Over time, chemotherapy use increased in all age groups (<70 years: from 26 to 43%, 70-74 years: 14 to 25%, 75-79 years: 5 to 13%, all P < 0.001, and ≥80 years: 2 to 3% P = 0.56). Median age of 2,180 patients who received chemotherapy was 63 years (range 21-86 years, 1.6% was ≥80 years). In chemotherapy-treated patients, with rising age (<70, 70-74, 75-79, ≥80 years), microscopic tumor verification occurred less frequently (91-88-87-77%, respectively, P = 0.009) and OS diminished (median 25-26-19-16 weeks, P = 0.003). After adjustment for confounding factors, worse survival of treated patients ≥75 years persisted. Despite limited chemotherapy use in elderly age, suggestive of strong selection, elderly patients (≥75 years) who received chemotherapy for metastatic pancreatic cancer exhibited a worse survival compared to younger patients receiving chemotherapy. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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58. The Effect of Renin Angiotensin System Genetic Variants in Acute Pancreatitis
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Skipworth, James R. A., primary, Nijmeijer, Rian M., additional, van Santvoort, Hjalmar C., additional, Besselink, Marc G. H., additional, Schulz, Hans-Ulrich, additional, Kivimaki, Mika, additional, Kumari, Meena, additional, Cooper, Jackie A., additional, Acharya, Jay, additional, Shankar, Arjun, additional, Malago, Massimo, additional, Humphries, Steve E., additional, Olde Damink, Steven W. M., additional, and Montgomery, Hugh E., additional
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- 2015
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59. Ablation of Locally Advanced Pancreatic Cancer with Percutaneous Irreversible Electroporation: Results of the Phase I/II PANFIRE Study
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Scheffer, Hester J., Vroomen, Laurien G. P. H., Jong, Marcus C. de, Melenhorst, Marleen C. A. M., Zonderhuis, Babs M., Daams, Freek, Vogel, Jantien A., Besselink, Marc G. H., Kuijk, Cornelis van, Witvliet, Jill, Schueren, Marian A. E. de van der, Gruijl, Tanja D. de, Stam, Anita G. M., Tol, Petrousjka M. P. van den, Delft, Foke van, Kazemier, Geert, and Meijerink, Martijn R.
- Abstract
Percutaneous irreversible electroporation for locally advanced pancreatic cancer is generally well tolerated, although major adverse events can occur.
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- 2018
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60. Preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC trial): study protocol for a multicentre randomized controlled trial.
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Versteijne, Eva, van Eijck, Casper H. J., Punt, Cornelis J. A., Suker, Mustafa, Zwinderman, Aeilko H., Dohmen, Miriam A. C., Groothuis, Karin B. C., Busch, Oliver R. C., Besselink, Marc G. H., de Hingh, Ignace H. J. T., ten Tije, Albert J., Patijn, Gijs A., Bonsing, Bert A., de Vos-Geelen, Judith, Klaase, Joost M., Festen, Sebastiaan, Boerma, Djamila, Erdmann, Joris I., Quintus. Molenaar, I., and van der Harst, Erwin
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PANCREATIC cancer diagnosis ,PANCREATIC cancer treatment ,PREANESTHETIC medication ,CHEMORADIOTHERAPY ,ABDOMINAL surgery ,CANCER treatment ,ADENOCARCINOMA ,ANTHROPOMETRY ,ANTIMETABOLITES ,ANTINEOPLASTIC agents ,CANCER relapse ,CLINICAL trials ,COMBINED modality therapy ,COMPARATIVE studies ,DRUG administration ,EXPERIMENTAL design ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH protocols ,PANCREATIC tumors ,PANCREATECTOMY ,PROGNOSIS ,RESEARCH ,TIME ,TUMOR classification ,EVALUATION research ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,DEOXYCYTIDINE ,KAPLAN-Meier estimator ,ARTHRITIS Impact Measurement Scales ,TUMOR treatment - Abstract
Background: Pancreatic cancer is the fourth largest cause of cancer death in the United States and Europe with over 100,000 deaths per year in Europe alone. The overall 5-year survival ranges from 2-7 % and has hardly improved over the last two decades. Approximately 15 % of all patients have resectable disease at diagnosis, and of those, only a subgroup has a resectable tumour at surgical exploration. Data from cohort studies have suggested that outcome can be improved by preoperative radiochemotherapy, but data from well-designed randomized studies are lacking. Our PREOPANC phase III trial aims to test the hypothesis that median overall survival of patients with resectable or borderline resectable pancreatic cancer can be improved with preoperative radiochemotherapy.Methods/design: The PREOPANC trial is a randomized, controlled, multicentric superiority trial, initiated by the Dutch Pancreatic Cancer Group. Patients with (borderline) resectable pancreatic cancer are randomized to A: direct explorative laparotomy or B: after negative diagnostic laparoscopy, preoperative radiochemotherapy, followed by explorative laparotomy. A hypofractionated radiation scheme of 15 fractions of 2.4 gray (Gy) is combined with a course of gemcitabine, 1,000 mg/m(2)/dose on days 1, 8 and 15, preceded and followed by a modified course of gemcitabine. The target volumes of radiation are delineated on a 4D CT scan, where at least 95 % of the prescribed dose of 36 Gy in 15 fractions should cover 98 % of the planning target volume. Standard adjuvant chemotherapy is administered in both treatment arms after resection (six cycles in arm A and four in arm B). In total, 244 patients will be randomized in 17 hospitals in the Netherlands. The primary endpoint is overall survival by intention to treat. Secondary endpoints are (R0) resection rate, disease-free survival, time to locoregional recurrence or distant metastases and perioperative complications. Secondary endpoints for the experimental arm are toxicity and radiologic and pathologic response.Discussion: The PREOPANC trial is designed to investigate whether preoperative radiochemotherapy improves overall survival by means of increased (R0) resection rates in patients with resectable or borderline resectable pancreatic cancer.Trial Registration: Trial open for accrual: 3 April 2013 The Netherlands National Trial Register - NTR3709 (8 November 2012) EU Clinical Trials Register - 2012-003181-40 (11 December 2012). [ABSTRACT FROM AUTHOR]- Published
- 2016
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61. Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands.
- Author
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van der Geest, Lydia G. M., Besselink, Marc G. H., van Gestel, Yvette R. B. M., Busch, Olivier R. C., de Hingh, Ignace H. J. T., de Jong, Koert P., Molenaar, I. Quintus, and Lemmens, Valery E. P. P.
- Abstract
Background: At a national level, it is unknown to what degree elderly patients with pancreatic or periampullary carcinoma benefit from surgical treatment compared to their younger counterparts. We investigated resection rates and outcomes after surgical treatment among elderly patients. Methods: From the Netherlands Cancer Registry, 20 005 patients diagnosed with primary pancreatic or periampullary cancer in 2005–2013 were selected. The associations between age (<70, 70–74, 75–79, ≥80 years) and resection rates were investigated using χ2tests, and surgical outcomes (30-, 90-day mortality) were evaluated using logistic regression analysis. Overall survival after resection was investigated by means of Kaplan-Meier and Cox proportional hazard regression analysis. Results: During the study period, resection rates increased in all age groups (<70 years: 20–30%,p < 0.001; ≥80 years: 2–8%,p < 0.001). Of 3845 patients who underwent tumour resection for pancreatic or periampullary carcinoma, the proportion of octogenarians increased from 3.5% to 5.5% (p = 0.03), whereas postoperative mortality did not increase (30-day: 6–3%, p = 0.06; 90-day: 9–8%, p = 0.21). With rising age, 30-day postoperative mortality increased (4–5–7–8%, respectively,p < 0.001), while 90-day mortality was 6–10–13–12% (p < 0.001) and three-year overall survival rates after surgery were 35–33–28–31%, respectively (p < 0.001). After adjustment for confounding factors, octogenarians who survived 90 days postoperative exhibited an overall survival close to younger patients [hazard ratio (≥80 vs. <70 years) = 1.21, 95% confidence interval (0.99–1.47), p = 0.07]. Conclusion: Despite higher short-term mortality, octogenarians who underwent pancreatic resection showed long-term survival similar to younger patients. With careful patient screening and counselling of elderly patients, a further increase of resection rates may be combined with improved outcomes. [ABSTRACT FROM PUBLISHER]
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- 2016
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62. Electromagnetic-Guided Versus Endoscopic Placement of Nasojejunal Feeding Tubes After Pancreatoduodenectomy.
- Author
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Gerritsen, Arja, Duflou, Ann, Ramali, Max, Busch, Olivier R. C., Gouma, Dirk J., van Gulik, Thomas M., Nieveen van Dijkum, Els J. M., Mathus-Vliegen, Elisabeth M. H., and Besselink, Marc G. H.
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- 2016
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63. Early biliary decompression versus conservative treatment in acute biliary pancreatitis (APEC trial): study protocol for a randomized controlled trial.
- Author
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Schepers, Nicolien J., Bakker, Olaf J., Besselink, Marc G. H., Bollen, Thomas L., Dijkgraaf, Marcel G. W., van Eijck, Casper H. J., Fockens, Paul, van Geenen, Erwin J. M., van Grinsven, Janneke, Hallensleben, Nora D. L., Hansen, Bettina E., van Santvoort, Hjalmar C., Timmer, Robin, Anten, Marie-Paule G. F., Bolwerk, Clemens J. M., van Delft, Foke, van Dullemen, Hendrik M., Erkelens, G. Willemien, van Hooft, Jeanin E., and Laheij, Robert
- Subjects
SURGICAL decompression ,PANCREATITIS ,RANDOMIZED controlled trials ,ENDOSCOPY ,CHOLANGIOGRAPHY ,CHOLANGITIS ,SPHINCTER surgery ,APACHE (Disease classification system) ,BILIARY tract surgery ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH protocols ,QUESTIONNAIRES ,RESEARCH ,OPERATIVE surgery ,SAMPLE size (Statistics) ,EVALUATION research ,ACUTE diseases ,ENDOSCOPIC gastrointestinal surgery ,SURGERY - Abstract
Background: Acute pancreatitis is mostly caused by gallstones or sludge. Early decompression of the biliary tree by endoscopic retrograde cholangiography (ERC) with sphincterotomy may improve outcome in these patients. Whereas current guidelines recommend early ERC in patients with concomitant cholangitis, early ERC is not recommended in patients with mild biliary pancreatitis. Evidence on the role of routine early ERC with endoscopic sphincterotomy in patients without cholangitis but with biliary pancreatitis at high risk for complications is lacking. We hypothesize that early ERC with sphincterotomy improves outcome in these patients.Methods/design: The APEC trial is a randomized controlled, parallel group, superiority multicenter trial. Within 24 hours after presentation to the emergency department, patients with biliary pancreatitis without cholangitis and at high risk for complications, based on an Acute Physiology and Chronic Health Evaluation (APACHE-II) score of 8 or greater, Modified Glasgow score of 3 or greater, or serum C-reactive protein above 150 mg/L, will be randomized. In 27 hospitals of the Dutch Pancreatitis Study Group, 232 patients will be allocated to early ERC with sphincterotomy or to conservative treatment. The primary endpoint is a composite of major complications (that is, organ failure, pancreatic necrosis, pneumonia, bacteremia, cholangitis, pancreatic endocrine, or exocrine insufficiency) or death within 180 days after randomization. Secondary endpoints include ERC-related complications, infected necrotizing pancreatitis, length of hospital stay and an economical evaluation.Discussion: The APEC trial investigates whether an early ERC with sphincterotomy reduces the composite endpoint of major complications or death compared with conservative treatment in patients with biliary pancreatitis at high risk of complications.Trial Registration: Current Controlled Trials ISRCTN97372133 (date registration: 17-12-2012). [ABSTRACT FROM AUTHOR]- Published
- 2016
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64. Preoperative biliary drainage in perihilar cholangiocarcinoma: identifying patients who require percutaneous drainage after failed endoscopic drainage.
- Author
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Wiggers, Jimme K., Koerkamp, Bas Groot, Coelen, Robert J., Rauws, Erik A., Schattner, Mark A., C. Yung Nio, Brown, Karen T., Gonen, Mithat, van Dieren, Susan, van Lienden, Krijn P., Allen, Peter J., Besselink, Marc G. H., Busch, Olivier R. C., D'Angelica, Michael I., DeMatteo, Robert P., Gouma, Dirk J., Kingham, T. Peter, Jarnagin, William R., van Gulik, Thomas M., and Groot Koerkamp, Bas
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BILIARY tract surgery ,ENDOSCOPIC retrograde cholangiopancreatography ,CHOLESTASIS ,PREOPERATIVE care ,PROGNOSIS ,RESEARCH evaluation ,RESEARCH funding ,RISK assessment ,OPERATIVE surgery ,BILE duct tumors ,MEDICAL drainage ,CHOLANGITIS ,PREVENTION ,DIAGNOSIS - Abstract
Background and Study Aims: Preoperative biliary drainage is often initiated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with potentially resectable perihilar cholangiocarcinoma (PHC), but additional percutaneous transhepatic catheter (PTC) drainage is frequently required. This study aimed to develop and validate a prediction model to identify patients with a high risk of inadequate ERCP drainage.Patients and Methods: Patients with potentially resectable PHC and (attempted) preoperative ERCP drainage were included from two specialty center cohorts between 2001 and 2013. Indications for additional PTC drainage were failure to place an endoscopic stent, failure to relieve jaundice, cholangitis, or insufficient drainage of the future liver remnant. A prediction model was derived from the European cohort and externally validated in the USA cohort.Results: Of the 288 patients, 108 (38%) required additional preoperative PTC drainage after inadequate ERCP drainage. Independent risk factors for additional PTC drainage were proximal biliary obstruction on preoperative imaging (Bismuth 3 or 4) and predrainage total bilirubin level. The prediction model identified three subgroups: patients with low risk (7%), moderate risk (40%), and high risk (62%). The high-risk group consisted of patients with a total bilirubin level above 150 µmol/L and Bismuth 3a or 4 tumors, who typically require preoperative drainage of the angulated left bile ducts. The prediction model had good discrimination (area under the curve 0.74) and adequate calibration in the external validation cohort.Conclusions: Selected patients with potentially resectable PHC have a high risk (62%) of inadequate preoperative ERCP drainage requiring additional PTC drainage. These patients might do better with initial PTC drainage instead of ERCP. [ABSTRACT FROM AUTHOR]- Published
- 2015
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65. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial
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Kortram, Kirsten, primary, van Ramshorst, Bert, additional, Bollen, Thomas L, additional, Besselink, Marc G H, additional, Gouma, Dirk J, additional, Karsten, Tom, additional, Kruyt, Philip M, additional, Nieuwenhuijzen, Grard A P, additional, Kelder, Johannes C, additional, Tromp, Ellen, additional, and Boerma, Djamila, additional
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- 2012
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66. Influence of Prophylactic Probiotics and Selective Decontamination on Bacterial Translocation in Patients Undergoing Pancreatic Surgery
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Diepenhorst, Gwendolyn M. P., primary, van Ruler, Oddeke, additional, Besselink, Marc G. H., additional, van Santvoort, Hjalmar C., additional, Wijnandts, Paul R., additional, Renooij, Willem, additional, Gouma, Dirk J., additional, Gooszen, Hein G., additional, and Boermeester, Marja A., additional
- Published
- 2011
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67. Draining sterile fluid collections in acute pancreatitis? Primum non nocere!
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Besselink, Marc G. H., primary, van Santvoort, Hjalmar C., additional, Bakker, Olaf J., additional, Bollen, Thomas L., additional, and Gooszen, Hein G., additional
- Published
- 2010
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68. Intestinal Permeability in Irritable Bowel Syndrome Patients: Effects of NSAIDs
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Kerckhoffs, Angèle P. M., primary, Akkermans, Louis M. A., additional, de Smet, Martin B. M., additional, Besselink, Marc G. H., additional, Hietbrink, Falco, additional, Bartelink, Imke H., additional, Busschers, Wim B., additional, Samsom, Melvin, additional, and Renooij, Willem, additional
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- 2009
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69. Early Endoscopic Retrograde Cholangiopancreatography Versus Conservative Management in Acute Biliary Pancreatitis Without Cholangitis
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Petrov, Maxim S., primary, van Santvoort, Hjalmar C., additional, Besselink, Marc G. H., additional, van der Heijden, Geert J. M. G., additional, van Erpecum, Karel J., additional, and Gooszen, Hein G., additional
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- 2008
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70. DESCRIBING CT FINDINGS IN ACUTE NECROTIZING PANCREATITIS WITH THE ATLANTA CLASSIFICATION
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Besselink, Marc G. H., primary, van Santvoort, Hjalmar C., additional, Bollen, Thomas L., additional, van Leeuwen, Maarten S., additional, and Gooszen, Hein G., additional
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- 2006
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71. Describing Computed Tomography Findings in Acute Necrotizing Pancreatitis With the Atlanta Classification
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Besselink, Marc G. H., primary, van Santvoort, Hjalmar C., additional, Bollen, Thomas L., additional, van Leeuwen, Maarten S., additional, Lam??ris, Jan S., additional, van der Jagt, Eric J., additional, Strijk, Simon P., additional, Buskens, Erik, additional, Freeny, Patrick C., additional, and Gooszen, Hein G., additional
- Published
- 2006
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72. Evidence-Based Treatment of Acute Pancreatitis: Antibiotic Prophylaxis in Necrotizing Pancreatitis
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Besselink, Marc G. H., primary, van Santvoort, Hjalmar C., additional, Buskens, Erik, additional, and Gooszen, Hein G., additional
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- 2006
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73. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711].
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van Brunschot, Sandra, van Grinsven, Janneke, Voermans, Rogier P., Bakker, Olaf J., Besselink, Marc G. H., Boermeester, Marja A., Bollen, Thomas L., Bosscha, Koop, Bouwense, Stefan A., Bruno, Marco J., Cappendijk, Vincent C., Consten, Esther C., Dejong, Cornelis H., Dijkgraaf, Marcel G. W., van Eijck, Casper H., Erkelens, G. Willemien, van Goor, Harry, Hadithi, Mohammed, Haveman, Jan-Willem, and Hofker, Sijbrand H.
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RANDOMIZED controlled trials ,LENGTH of stay in hospitals ,LASER endoscopy ,TRANSLUMINAL angioplasty ,EXOCRINE glands - Abstract
Background Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage followed, if necessary, by (minimally invasive) surgical necrosectomy has become the standard of care. A promising minimally invasive alternative is the endoscopic transluminal step-up approach. This approach consists of endoscopic transluminal drainage followed, if necessary, by endoscopic transluminal necrosectomy. We hypothesise that the less invasive endoscopic step-up approach is superior to the surgical step-up approach in terms of clinical and economic outcomes. Methods/design The TENSION trial is a randomised controlled, parallel-group superiority multicenter trial. Patients with (suspected) infected necrotising pancreatitis with an indication for intervention and in whom both treatment modalities are deemed possible, will be randomised to either an endoscopic transluminal or a surgical step-up approach. During a 4 year study period, 98 patients will be enrolled from 24 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite of death and major complications within 6 months following randomisation. Secondary endpoints include complications such as pancreaticocutaneous fistula, exocrine or endocrine pancreatic insufficiency, need for additional radiological, endoscopic or surgical intervention, the need for necrosectomy after drainage, the number of (re-)interventions, quality of life, and total direct and indirect costs. Discussion The TENSION trial will answer the question whether an endoscopic step-up approach reduces the combined primary endpoint of death and major complications, as well as hospital stay and related costs compared with a surgical step-up approach in patients with infected necrotising pancreatitis. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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74. Early management of acute pancreatitis.
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Schepers, Nicolien J., Besselink, Marc G. H., van Santvoort, Hjalmar C., Bakker, Olaf J., and Bruno, Marco J.
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PANCREATITIS treatment ,DISEASE incidence ,MORTALITY ,MULTIPLE organ failure ,FLUID therapy - Abstract
Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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75. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial).
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van der Sluis, Pieter C., Ruurda, Jelle P., der Horst, Sylvia van, Verhage, Roy J. J., Besselink, Marc G. H., Prins, Margriet J. D., Haverkamp, Leonie, Schippers, Carlo, Borel Rinkes, Inne H. M., Joore, Hans C. A., ten Kate, Fiebo J. W., Koffijberg, Hendrik, Kroese, Christiaan C., van Leeuwen, Maarten S., Lolkema, Martijn P. J. K., Reerink, Onne, Schipper, Marguerite E. I., Steenhagen, Elles, Vleggaar, Frank P., and Voest, Emile E.
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ESOPHAGEAL cancer ,ESOPHAGECTOMY ,LYMPH nodes ,ESOPHAGEAL surgery ,CANCER treatment complications ,CLINICAL trials ,RANDOMIZED controlled trials - Abstract
Background: For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%). Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. Methods/design: This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ⩾18 and ⩽80 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112) with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56) or open three-stage transthoracic esophageal resection (n = 56). The primary outcome of this study is the percentage of overall complications (grade 2 and higher) as stated by the modified Clavien-Dindo classification of surgical complications. Discussion: This is the first randomized controlled trial designed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer. If our hypothesis is proven correct, RATE will result in a lower percentage of postoperative complications, lower blood loss, and shorter hospital stay, but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy. The study started in January 2012. Follow-up will be 5 years. Short-term results will be analyzed and published after discharge of the last randomized patient. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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76. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial.
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Besselink, Marc G. H., van Santvoort, Hjalmar C., Buskens, Erik, Boemeester, Marja A., van Goor, Harry, Timmerman, Harro M., Nieuwenhuijs, Vincent B., Bollen, Thomas L., van Ramshorst, Bert, Rosman, Camiel, Ploeg, Rutger J., Brink, Menno A., Schaapherder, Alexander F. M., Dejong, Cornelis H. C., Wahab, Peter J., van Laarhoven, Cees J. H. M., van der Harst, Erwin, jan Eijick, Casper H., Cuesta, Miguel A., and Akkermans, Louis M. A.
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PANCREATITIS , *PANCREATIC diseases , *PROBIOTICS , *THERAPEUTICS research , *INFECTION prevention , *MEDICAL research , *PATIENTS - Abstract
The article focuses on research which examined probiotic prophylaxis in predicted severe acute pancreatitis. In the research 298 patients with predicted severe acute pancreatitis were studied. researchers found that in patients with predicted severe acute pancreatitis, probiotic prophylaxis with a combination of probiotic strains did not reduce the risk of infectious complications and was also associated with an increased risk of mortality. Researchers suggested that probiotic prophylaxis should not be administered in patients with predicted severe acute pancreatitis.
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- 2008
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77. Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN38327949].
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Besselink, Marc G. H., van Santvoort, Hjalmar C., Nieuwenhuijs, Vincent B., Boermeester, Marja A., Bollen, Thomas L., Buskens, Erik, Dejong, Cornelis H. C., van Eijck, Casper H. J., van Goor, Harry, Hofker, Sijbrand S., Lameris, Johan S., van Leeuwen, Maarten S., Ploeg, Rutger J., van Ramshorst, Bert, Schaapherder, Alexander F. M., Cuesta, Miguel A., Consten, Esther C. J., Gouma, Dirk J., van der Harst, Erwin, and Hesselink, Eric J.
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NECROTIZING pancreatitis ,ABDOMINAL surgery ,CLINICAL trials ,IRRIGATION (Medicine) ,DEBRIDEMENT ,THERAPEUTICS - Abstract
Background: The initial treatment of acute necrotizing pancreatitis is conservative. Intervention is indicated in patients with (suspected) infected necrotizing pancreatitis. In the Netherlands, the standard intervention is necrosectomy by laparotomy followed by continuous postoperative lavage (CPL). In recent years several minimally invasive strategies have been introduced. So far, these strategies have never been compared in a randomised controlled trial. The PANTER study (PAncreatitis, Necrosectomy versus sTEp up appRoach) was conceived to yield the evidence needed for a considered policy decision. Methods/design: 88 patients with (suspected) infected necrotizing pancreatitis will be randomly allocated to either group A) minimally invasive 'step-up approach' starting with drainage followed, if necessary, by videoscopic assisted retroperitoneal debridement (VARD) or group B) maximal necrosectomy by laparotomy. Both procedures are followed by CPL. Patients will be recruited from 20 hospitals, including all Dutch university medical centres, over a 3-year period. The primary endpoint is the proportion of patients suffering from postoperative major morbidity and mortality. Secondary endpoints are complications, new onset sepsis, length of hospital and intensive care stay, quality of life and total (direct and indirect) costs. To demonstrate that the 'step-up approach' can reduce the major morbidity and mortality rate from 45 to 16%, with 80% power at 5% alpha, a total sample size of 88 patients was calculated. Discussion: The PANTER-study is a randomised controlled trial that will provide evidence on the merits of a minimally invasive 'step-up approach' in patients with (suspected) infected necrotizing pancreatitis. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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78. Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics.
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Besselink, Marc G. H., Timmerman, Harro M., Van Minnen, L. Paul, Akkermans, Louis M. A., and Gooszen, Hein G.
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IMMUNE system , *PANCREATITIS , *INFLAMMATION , *PANCREATIC diseases , *CHROMOSOMAL translocation - Abstract
Infectious complications in surgical patients often originate from the intestinal microflora. In the critically ill patient, small bowel motility is disturbed, leading to bacterial overgrowth and subsequent bacterial translocation due to dysfunction of the gut mucosal barrier. The optimal prophylactic strategy should act on all these factors, but such a strategy is not yet available. For several decades, antibiotic prophylaxis to prevent translocation of pathogenic bacteria has been studied with conflicting results. Selective decontamination of the digestive tract has shown good results, but fear for bacterial multiresistance has prevented worldwide implementation. In recent years, probiotics, living bacteria with a potential beneficial effect to their host, have shown promising results in several randomized placebo-controlled trials. Currently, in vitro and experimental research focuses on the effects of probiotics on the microflora responsible for gut-derived infections, structural mucosal barrier function and the immune system. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Published
- 2005
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79. Probiotic prophylaxis in patients with predicted severe acute pancreatitis (PROPATRIA): design and rationale of a double-blind, placebo-controlled randomised multicenter trial [ISRCTN38327949].
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Besselink, Marc G. H., Timmerman, Harro M., Buskens, Erik, Nieuwenhuijs, Vincent B., Akkermans, Louis M. A., and Gooszen, Hein G.
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PROBIOTICS ,INFECTION prevention ,PANCREATITIS ,PLACEBOS ,UNIVERSITY hospitals - Abstract
Background: Infectious complications are the major cause of death in acute pancreatitis. Small bowel bacterial overgrowth and subsequent bacterial translocation are held responsible for the vast majority of these infections. Goal of this study is to determine whether selected probiotics are capable of preventing infectious complications without the disadvantages of antibiotic prophylaxis; antibiotic resistance and fungal overgrowth. Methods/design: PROPATRIA is a double-blind, placebo-controlled randomised multicenter trial in which 200 patients will be randomly allocated to a multispecies probiotic preparation (Ecologic 641) or placebo. The study is performed in all 8 Dutch University Hospitals and 7 non-University hospitals. The study-product is administered twice daily through a nasojejunal tube for 28 days or until discharge. Patients eligible for randomisation are adult patients with a first onset of predicted severe acute pancreatitis: Imrie criteria 3 or more, CRP 150 mg/L or more, APACHE II score 8 or more. Exclusion criteria are post-ERCP pancreatitis, malignancy, infection/sepsis caused by a second disease, intra-operative diagnosis of pancreatitis and use of probiotics during the study. Administration of the study product is started within 72 hours after onset of abdominal pain. The primary endpoint is the total number of infectious complications. Secondary endpoints are mortality, necrosectomy, antibiotic resistance, hospital stay and adverse events. To demonstrate that probiotic prophylaxis reduces the proportion of patients with infectious complications from 50% to 30%, with alpha 0,05 and power 80%, a total sample size of 200 patients was calculated. Conclusion: The PROPATRIA study is aimed to show a reduction in infectious complications due to early enteral use of multispecies probiotics in severe acute pancreatitis. [ABSTRACT FROM AUTHOR]
- Published
- 2004
80. Clinical trial registration and the ICMJE.
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Dresser R, Khalil O, Govindarajan R, Safar M, Hutchins L, Mehta P, Besselink MGH, Gooszen HG, Buskens E, DeAngelis CD, Besselink, Marc G H, Gooszen, Hein G, and Buskens, Erik
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- 2005
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81. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial.
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Wiggers, Jimme K, Coelen, Robert Js, Rauws, Erik Aj, van Delden, Otto M, van Eijck, Casper Hj, de Jonge, Jeroen, Porte, Robert J, Buis, Carlijn I, Dejong, Cornelis Hc, Molenaar, I Quintus, Besselink, Marc Gh, Busch, Olivier Rc, Dijkgraaf, Marcel Gw, van Gulik, Thomas M, Coelen, Robert J S, Rauws, Erik A J, van Eijck, Casper H J, Dejong, Cornelis H C, Besselink, Marc G H, and Busch, Olivier R C
- Abstract
Background: Liver surgery in perihilar cholangiocarcinoma (PHC) is associated with high postoperative morbidity because the tumor typically causes biliary obstruction. Preoperative biliary drainage is used to create a safer environment prior to liver surgery, but biliary drainage may be harmful when severe drainage-related complications deteriorate the patients' condition or increase the risk of postoperative morbidity. Biliary drainage can cause cholangitis/cholecystitis, pancreatitis, hemorrhage, portal vein thrombosis, bowel wall perforation, or dehydration. Two methods of preoperative biliary drainage are mostly applied: endoscopic biliary drainage, which is currently used in most regional centers before referring patients for surgical treatment, and percutaneous transhepatic biliary drainage. Both methods are associated with severe drainage-related complications, but two small retrospective series found a lower incidence in the number of preoperative complications after percutaneous drainage compared to endoscopic drainage (18-25% versus 38-60%, respectively). The present study randomizes patients with potentially resectable PHC and biliary obstruction between preoperative endoscopic or percutaneous transhepatic biliary drainage.Methods/design: The study is a multi-center trial with an "all-comers" design, randomizing patients between endoscopic or percutaneous transhepatic biliary drainage. All patients selected to potentially undergo a major liver resection for presumed PHC are eligible for inclusion in the study provided that the biliary system in the future liver remnant is obstructed (even if they underwent previous inadequate endoscopic drainage). Primary outcome measure is the total number of severe preoperative complications between randomization and exploratory laparotomy. The study is designed to detect superiority of percutaneous drainage: a provisional sample size of 106 patients is required to detect a relative decrease of 50% in the number of severe preoperative complications (alpha = 0.95; beta = 0.8). Interim analysis after inclusion of 53 patients (50%) will provide the definitive sample size. Secondary outcome measures encompass the success of biliary drainage, quality of life, and postoperative morbidity and mortality.Discussion: The DRAINAGE trial is designed to identify a difference in the number of severe drainage-related complications after endoscopic and percutaneous transhepatic biliary drainage in patients selected to undergo a major liver resection for perihilar cholangiocarcinoma.Trial Registration: Netherlands Trial Register [ NTR4243 , 11 October 2013]. [ABSTRACT FROM AUTHOR]- Published
- 2015
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82. Association Analysis of Genetic Variants in the Myosin IXB Gene in Acute Pancreatitis.
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Nijmeijer, Rian M., van Santvoort, Hjalmar C., Zhernakova, Alexandra, Teller, Steffen, Scheiber, Jonas A., de Kovel, Carolien G., Besselink, Marc G. H., Visser, Jeroen T. J., Lutgendorff, Femke, Bollen, Thomas L., Boermeester, Marja A., Rijkers, Ger T., Weiss, Frank U., Mayerle, Julia, Lerch, Markus M., Gooszen, Hein G., Akkermans, Louis M. A., and Wijmenga, Cisca
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GENETIC polymorphisms ,MYOSIN ,PANCREATITIS ,MUCOUS membrane diseases ,PATHOLOGICAL physiology ,TIGHT junctions ,CELIAC disease - Abstract
Introduction:Impairment of the mucosal barrier plays an important role in the pathophysiology of acute pancreatitis. The myosin IXB (MYO9B) gene and the two tight-junction adaptor genes, PARD3 and MAGI2, have been linked to gastrointestinal permeability. Common variants of these genes are associated with celiac disease and inflammatory bowel disease, two other conditions in which intestinal permeability plays a role. We investigated genetic variation in MYO9B, PARD3 and MAGI2 for association with acute pancreatitis. Methods:Five single nucleotide polymorphisms (SNPs) in MYO9B, two SNPs in PARD3, and three SNPs in MAGI2 were studied in a Dutch cohort of 387 patients with acute pancreatitis and over 800 controls, and in a German cohort of 235 patients and 250 controls. Results:Association to MYO9B and PARD3 was observed in the Dutch cohort, but only one SNP in MYO9B and one in MAGI2 showed association in the German cohort (p < 0.05). Joint analysis of the combined cohorts showed that, after correcting for multiple testing, only two SNPs in MYO9B remained associated (rs7259292, p = 0.0031, odds ratio (OR) 1.94, 95% confidence interval (95% CI) 1.35-2.78; rs1545620, p = 0.0006, OR 1.33, 95% CI 1.16-1.53). SNP rs1545620 is a non-synonymous SNP previously suspected to impact on ulcerative colitis. None of the SNPs showed association to disease severity or etiology. Conclusion:Variants in MYO9B may be involved in acute pancreatitis, but we found no evidence for involvement of PARD3 or MAGI2. [ABSTRACT FROM AUTHOR]
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- 2013
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83. Long-term outcomes of resection in patients with symptomatic benign liver tumours.
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van Rosmalen, Belle V., Bieze, Matthanja, Besselink, Marc G. H., Tanis, Pieter, Verheij, Joanne, Phoa, Saffire S. K. S., Busch, Olivier, and van Gulik, Thomas M.
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HYPERPLASIA , *LIVER tumors , *HERNIA , *LAPAROSCOPIC surgery , *SURGICAL excision - Abstract
Background: Benign liver tumours (e.g., hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH), and haemangioma) are occasionally resected for alleged symptoms, although data on long-term outcomes is lacking. The aim of this cross-sectional study was to assess long-term outcomes of surgical intervention. Methods: Forty patients with benign tumours (HCA 20, FNH 12, giant haemangioma 4, cysts 4) were included. Patients filled in Validated McGill Pain Questionnaires, preoperatively and after a median of 54 months after resection. Outcomes were evaluated using paired sample t-test and (M) ANOVA. Results: Relief of symptoms sustained in 30/40 patients, within a follow-up of 54 (24-148) months after resection. VAS scores were reduced from 5.5 preoperatively to 1.6 postoperatively (p < 0.001). Patients with left-sided tumours had higher postoperative Pain Rating Index (PRI), compared to patients with right-sided tumours: 15.3 vs. 5.8 (p = 0.018). If patients could reconsider undergoing surgery, 34/38 would again choose resection. Discomfort at the operative scar was the most common complaint: 8/40 patients, all after open surgery, of whom 3/40 had an incisional hernia. 7/40 patients had a laparoscopic resection. Conclusion: Resection relieved symptoms in 30/40 patients. The operative scar was a frequent source for remaining postoperative complaints, suggesting an advantage for a laparoscopic approach when feasible. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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84. Innovations in diagnosis and management of pancreatobiliary diseases
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Gorris, M., Besselink, Marc G. H., van Hooft, Jeanin E., Dijk, Frederike, Voermans, Rogier P., AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Graduate School, Gastroenterology and Hepatology, CCA - Imaging and biomarkers, CCA - Cancer biology and immunology, Besselink, M.G.H., van Hooft, J.E., Dijk, F., Voermans, R.P., and Faculteit der Geneeskunde
- Abstract
Pancreatobiliary diseases compromise a heterogeneous group of lesions, ranging from benign to malignant entities. The aim of this thesis is to improve diagnosis and management in these patients, with a specific focus on pancreatic cystic neoplasms (PCN). This thesis therefore describes the results of an international study on the outcomes of spleen-preserving distal pancreatectomy (SPDP) in patients with intraductal papillary mucinous neoplasm (IPMN). Although current guidelines recommend DP including splenectomy in these patients, this study found that SPDP appears to be oncologically safe in patients without preoperative suspicion of malignancy, and improved short-term outcomes after surgery. This thesis also includes the results of a nationwide registry-based study investigating overall survival after resection in patients with PCN-associated pancreatic cancer compared to patients with pancreatic cancer without this association. This study found that patients with PCN-associated pancreatic cancer had better estimated median overall survival when compared to patients with pancreatic cancer not associated with PCN. This thesis also describes the results of the randomised controlled BRIX-trial, which investigates the sensitivity of brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected malignant pancreatobiliary strictures. Brush cytology is commonly performed during ERCP, yet its sensitivity to diagnose malignancy remains poor. This study therefore compared the sensitivity of a dense brush cytology device to a conventional brush device. The dense brush did not yield higher sensitivity when compared to the conventional brush in diagnosing suspected malignant pancreatobiliary strictures. As a consequence, the study was ended prematurely because of futility.
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- 2023
85. The Dutch pancreatic cancer project: Improving outcome in pancreatic surgery
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Suurmeijer, J.A., Besselink, Marc G. H., Eijck, Casper H. J., Busch, Olivier R. C., de Hingh, I. H. J. T., AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Surgery, Graduate School, Besselink, M.G.H., van Eijck, C.H.J., Busch, O.R.C., de Hingh, Ignace H J T, and Faculteit der Geneeskunde
- Abstract
Pancreatic surgery is complex and carries a high risk of complications. This thesis entitled “The Dutch Pancreatic Cancer Project: improving outcome in pancreatic surgery”, aims to identify factors adding to the improvement of clinical outcome of patients after pancreatic surgery, first by focusing on the reduction of complications (Part I) and secondly by identifying leads to improve survival (Part II). In part I of this thesis, the leakage of pancreatic fluid after pancreatic surgery, i.e. postoperative pancreatic fistula (POPF, i.e. grade B/C), was addressed as the most feared complication in pancreatic surgery. Furthermore, the need for preventive measures was emphasized. In pancreatic cancer patients who received preoperative chemoradiotherapy, the rate of POPF was significantly lower compared to patients after immediate surgery (i.e., without preoperative therapy) after pancreatoduodenectomy. Changes in acinar cell function and pancreatic texture caused by radiotherapy may play a role in this declined risk of POPF. However, preoperative chemoradiotherapy is only indicated for patients undergoing PD for patients with pancreatic cancer, while this thesis concluded that patients with periampullary tumors have a much higher risk of developing POPF. It was hypothesized that a single dose of preoperative radiotherapy targeting the intended site of the pancreatic anastomosis induces local fibrosis of the pancreatic tissue, potentially reducing the risk of pancreatic fistula after pancreatoduodenectomy in patients at high risk of POPF. The FIBROPANC study protocol was presented, in which the safety and feasibility of this hypothesis will be investigated. Additionally, it was concluded that several national efforts have resulted in a significant decrease in in-hospital mortality and an improvement in failure to rescue after pancreatoduodenectomy in the Netherlands. In part II of this thesis, a unified variable list for reporting patient characteristics and outcome measures in randomized trials in patients with pancreatic cancer was presented, enabling better comparison between trials. It was also concluded that the basal-like molecular subtype of pancreatic carcinoma is associated with poor survival after pancreatic resection. In addition, involvement of the para-aortic lymph node station 16b1 is also associated with poor survival in patients with pancreatic or periampullary carcinoma. The role of direct resection in these groups was discussed.
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- 2023
86. Minimally invasive distal pancreatectomy: International collaboration to improve surgical treatment of left-sided pancreatic neoplasms
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Korrel, M., Besselink, M.G.H., Abu Hilal, M., Busch, O.R.C., van Hilst, J., Faculteit der Geneeskunde, Besselink, Marc G. H., Busch, Olivier R. C., van Hilst, Jony, Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, and Graduate School
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In this thesis, international collaborative efforts have been made to investigate the feasibility, safety, and outcomes of minimally invasive distal pancreatectomy. The minimally invasive approach towards distal pancreatectomy is increasingly integrated into standard surgical treatment for left-sided benign and pre-malignant neoplasms. Spleen-preserving minimally invasive distal pancreatectomy has shown superior outcomes compared to an open approach in terms of technical outcomes such as splenic preservation rates and long-term sequalae of esophageal varices. Both Warshaw and Kimura techniques can be performed minimally invasive with low rates of splenic infarction requiring reinterventions. On the longer term, quality of life is comparable between minimally invasive and open distal pancreatectomy. The role of a minimally invasive approach to resectable pancreatic cancer has been debated because of the expectation of inferior oncological outcomes in the absence of randomized trials. This thesis reports a randomized trial performed in 35 centers from 12 countries, which showed that the minimally invasive approach is non-inferior to open distal pancreatectomy in this patient group and may be considered a safe alternative to an open approach. Considering the arguably high-complex nature of distal pancreatectomy, a step-wise approach is crucial for the implementation of such procedure. In the Netherlands, a safe and sustained implementation was observed after the completion of a nationwide training program and randomized trial. Approximately two-thirds of patients are currently operated on using a minimally invasive approach. For the further nationwide and worldwide implementation, dedicated training curricula and registration of outcomes in (inter)national registries is advised.
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- 2023
87. Multidisciplinary management of severe acute pancreatitis
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Boxhoorn, L., Fockens, P., Besselink, M.G.H., Voermans, R.P., van Santvoort, H.C., Faculteit der Geneeskunde, Fockens, Paul, Besselink, Marc G. H., Voermans, Rogier P., van Santvoort, Hjalmar C., Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, and Graduate School
- Abstract
The aim of the studies described in this thesis is to improve the treatment of patients with severe acute pancreatitis. Patients with infected necrotizing pancreatitis are best treated with a minimally invasive step-up approach. Until recently, there was no worldwide consensus on the best timing of treatment. This thesis therefore includes the results of the multicenter randomized POINTER trial, which demonstrated that drainage directly after diagnosing infected necrosis did not lower mortality or complications. However, when the intervention was postponed, less interventions for infected necrosis were required and more than one-third of patients were successfully treated with antibiotics. We know from previous literature (TENSION trial) that the endoscopic step-up approach has important advantages over the surgical step-up approach. Consequently, lumen-apposing metal stents (LAMS) were developed to improve endoscopic drainage. This thesis describes the results of the prospective multicenter AXIOMA study, in which the use of LAMS for endoscopic drainage was investigated. The results were compared to endoscopy group of TENSION trial, in which plastic stents were used. Our comparison showed no differences in clinical outcomes or healthcare costs. However, in contrast to previous literature, we found that LAMS did not cause more complications. This thesis also describes the results of the ExTENSION study, in which the long-term clinical outcomes of patients who participated in the TENSION trial were investigated. The results of this study indicated that patients treated with endoscopy suffered from fewer pancreaticocutaneous fistulas and needed fewer re-interventions during long-term follow-up, in comparison to patients that were treated surgically.
- Published
- 2022
88. Staging and surgical treatment of gastric cancer: Surgery during the COVID-19 pandemic
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Borgstein, Alexander B. J., van Berge Henegouwen, Mark I., Besselink, Marc G. H., Gisbertz, Suzanne S., Eshuis, Wietse J., and Graduate School
- Published
- 2022
89. Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis.
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van Rijssen, Lennart B., Narwade, Poorvi, van Huijgevoort, Nadine C. M., Tseng, Dorine S. J., van Santvoort, Hjalmar C., Molenaar, Isaac Q., van Laarhoven, Hanneke W. M., van Eijck, Casper H. J., Busch, Olivier R. C., and Besselink, Marc G. H.
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PROGNOSTIC tests , *LYMPH nodes , *METASTASIS , *PANCREATIC cancer treatment , *META-analysis , *ONCOLOGIC surgery - Abstract
Background: Hepatic-artery and para-aortic lymph node metastases (LNM) may be detected during surgical exploration for pancreatic (PDAC) or periampullary cancer. Some surgeons will continue the resection while others abort the exploration. Methods: A systematic search was performed in PubMed, EMBASE and Cochrane Library for studies investigating survival in patients with intra-operatively detected hepatic-artery or para-aortic LNM. Survival was stratified for node positive (N1) disease. Results: After screening 3088 studies, 13 studies with 2045 patients undergoing pancreatoduodenectomy were included. No study reported survival data after detection of LNM and aborted surgical exploration. In 110 patients with hepatic-artery LNM, median survival ranged between 7 and 17 months. Estimated pooled mean survival in 84 patients with hepatic-artery LNM was 15 [95%CI 12-18] months (13 months in PDAC), compared to 19 [16-22] months in 270 patients with N1-disease without hepaticartery LNM (p = 0.020). In 192 patients with para-aortic LNM, median survival ranged between 5 and 32 months. Estimated pooled mean survival in 169 patients with para-aortic LNM was 13 [8-17] months (11 months in PDAC), compared to 17 (6-27) months in 506 patients with N1-disease without para-aortic LNM (p < 0.001). Data on the impact of (neo)adjuvant therapy on survival were lacking. Conclusion: Survival after pancreatoduodenectomy in patients with intra-operatively detected hepaticartery and especially para-aortic LNM is inferior to patients undergoing pancreatoduodenectomy with other N1 disease. It remains unclear what the consequence of this should be since data on (neo-) adjuvant therapy and survival after aborted exploration are lacking. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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90. External biliary drainage following major liver resection for perihilar cholangiocarcinoma: impact on development of liver failure and biliary leakage.
- Author
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Olthof, Pim B., Coelen, Robert J. S., Wiggers, Jimme K., Besselink, Marc G. H., Busch, Olivier R. C., and van Gulik, Thomas M.
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CHOLANGIOCARCINOMA , *HEPATECTOMY , *LIVER diseases , *SURGICAL excision , *SURGICAL anastomosis - Abstract
Background: Preoperative biliary drainage is considered essential in perihilar cholangiocarcinoma (PHC) requiring major hepatectomy with biliary-enteric reconstruction. However, evidence for postoperative biliary drainage as to protect the anastomosis is currently lacking. This study investigated the impact of postoperative external biliary drainage on the development of post-hepatectomy biliary leakage and liver failure (PHLF). Methods: All patients who underwent major liver resection for suspected PHC between 2000 and 2015 were retrospectively analyzed. Biliary leakage and PHLF was defined as grade B or higher according to the International Study Group of Liver Surgery (ISGLS) criteria. Results: Eighty-nine out of 125 (71%) patients had postoperative external biliary drainage. PHLF was more prevalent in the drain group (29% versus 6%; P = 0.004). There was no difference in the incidence of biliary leakage (32% versus 36%). On multivariable analysis, postoperative external biliary drainage was identified as an independent risk factor for PHLF (Odds-ratio 10.3, 95% confidence interval 2.1-50.4; P = 0.004). Conclusions: External biliary drainage following major hepatectomy for PHC was associated with an increased incidence of PHLF. It is therefore not recommended to routinely use postoperative external biliary drainage, especially as there is no evidence that this decreases the risk of biliary anastomotic leakage. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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91. Volume-outcome relationships in pancreatoduodenectomy for cancer.
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van der Geest, Lydia G. M., van Rijssen, L. Bengt, Molenaar, I. Quintus, de Hingh, Ignace H., Koerkamp, Bas Groot, Busch, Olivier R. C., Lemmens, Valery E. P. P., and Besselink, Marc G. H.
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PANCREATIC surgery , *CANCER research , *HOSPITAL care , *CANCER chemotherapy , *CANCER patient medical care - Abstract
Background: Volume-outcome relationships in pancreatic surgery are well established, but an optimal volume remains to be determined. Studies analyzing outcomes in volume categories exceeding 20 procedures annually are lacking. Study design: A consecutive 3420 patients underwent PD for primary pancreatic or periampullary carcinoma (2005-2013) and were registered in the Netherlands Cancer Registry. Relationships between hospital volume (<5, 5-19, 20-39 and ≥40 PDs/year) and mortality and survival were explored. Results: There was a non-significant decrease in 90-day mortality from 8.1 to 6.7% during the study period (p = 0.23). Ninety-day mortality was 9.7% in centers performing <5 PDs/year (n = 185 patients), 8.9% for 5-19 PDs/year (n = 1432), 7.3% for 20-39 PDs/year (n = 240) and 4.3% for ≥40 PDs/year (n = 562, p = 0.004). Within volume categories, 90-day mortality did not change over time. After adjustment for confounding factors, significantly lower mortality was found in the ≥40 category compared to 20-39 PDs/year (OR = 1.72 (1.08-2.74)). Overall survival adjusted for confounding factors was better in the ≥40 category compared to categories under 20 PDs/year: HR (≥40 vs 5-19/ year) = 1.24 (1.09-1.42). In the ≥40 category significantly more patients received adjuvant chemotherapy and had >10 lymph nodes retrieved compared to lower volume categories. Conclusions: Volume-outcome relationships in pancreatic surgery persist in centers performing ≥40 PDs annually, regarding both mortality and survival. The volume plateau for pancreatic surgery has yet to be determined. [ABSTRACT FROM AUTHOR]
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- 2016
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92. Perioperative blood transfusion is not associated with overall survival or time to recurrence after resection of perihilar cholangiocarcinoma.
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Dekker, Annemiek M., Wiggers, Jimme K., Coelen, Robert J., van Golen, Rowan F., Besselink, Marc G. H., Busch, Olivier R. C., Verheij, Joanne, Hollmann, Markus W., and van Gulik, Thomas M.
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BLOOD transfusion , *ONCOLOGY research , *PERIOPERATIVE care , *SURGICAL excision , *CHOLANGIOCARCINOMA , *KAPLAN-Meier estimator - Abstract
Background: Perioperative blood transfusions have been associated with worse oncological outcome in several types of cancer. The objective of this study was to assess the effect of perioperative blood transfusions on time to recurrence and overall survival (OS) in patients who underwent curative-intent resection of perihilar cholangiocarcinoma (PHC). Methods: This retrospective cohort study included consecutive patients with resected PHC between 1992 and 2013 in a specialized center. Patients with 90-day mortality after surgery were excluded. Patients who did and did not receive perioperative blood transfusions were compared using univariable Kaplan-Meier analysis and multivariable Cox regression. Results: Of 145 included patients, 80 (55.2%) received perioperative blood transfusions. The median OS was 49 months for patients without and 41 months for patients with blood transfusions (P = 0.46). In risk-adjusted multivariable Cox regression analysis, blood transfusion was not associated with OS (HR 1.00, 95% CI 0.59-1.68, P = 0.99) or time to recurrence (HR 1.00, 95% CI 0.57-1.78, P = 0.99). In addition, no differences in effect were found between different types of blood products transfused. Conclusion: Blood transfusion was not associated with survival or time to recurrence after curative resection of PHC in this series. The alleged association is presumably related to the circumstances necessitating blood transfusions. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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93. Laparoscopic versus open resections in the posterosuperior liver segments within an enhanced recovery programme (ORANGE Segments): study protocol for a multicentre randomised controlled trial
- Author
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Christoph, Kuemmerli, Robert S, Fichtinger, Alma, Moekotte, Luca A, Aldrighetti, Somaiah, Aroori, Marc G H, Besselink, Mathieu, D'Hondt, Rafael, Díaz-Nieto, Bjørn, Edwin, Mikhail, Efanov, Giuseppe M, Ettorre, Krishna V, Menon, Aali J, Sheen, Zahir, Soonawalla, Robert, Sutcliffe, Roberto I, Troisi, Steven A, White, Lloyd, Brandts, Gerard J P, van Breukelen, Jasper, Sijberden, Siân A, Pugh, Zina, Eminton, John N, Primrose, Ronald, van Dam, Mohammed Abu, Hilal, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: KIO Kemta (9), RS: GROW - R1 - Prevention, RS: CAPHRI - R1 - Ageing and Long-Term Care, RS: CAPHRI - R6 - Promoting Health & Personalised Care, FPN Methodologie & Statistiek, FHML Methodologie & Statistiek, RS: FPN M&S I, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: MA Heelkunde (9), Kuemmerli, C., Fichtinger, R. S., Moekotte, A., Aldrighetti, L. A., Aroori, S., Besselink, M. G. H., D'Hondt, M., Diaz-Nieto, R., Edwin, B., Efanov, M., Ettorre, G. M., Menon, K. V., Sheen, A. J., Soonawalla, Z., Sutcliffe, R., Troisi, R., White, S. A., Brandts, L., van Breukelen, G. J. P., Sijberden, J., Pugh, S. A., Eminton, Z., Primrose, J. N., van Dam, R., Hilal, M. A., Kuemmerli, Christoph, Fichtinger, Robert S, Moekotte, Alma, Aldrighetti, Luca A, Aroori, Somaiah, Besselink, Marc G H, D'Hondt, Mathieu, Díaz-Nieto, Rafael, Edwin, Bjørn, Efanov, Mikhail, Ettorre, Giuseppe M, Menon, Krishna V, Sheen, Aali J, Soonawalla, Zahir, Sutcliffe, Robert, Troisi, Roberto I, White, Steven A, Brandts, Lloyd, van Breukelen, Gerard J P, Sijberden, Jasper, Pugh, Siân A, Eminton, Zina, Primrose, John N, van Dam, Ronald, and Hilal, Mohammed Abu
- Subjects
CLINICAL-OUTCOMES ,SURGERY ,Medicine (miscellaneous) ,BODY-IMAGE ,Hepatectomy/adverse effects ,Liver Neoplasms/surgery ,PROGNOSTIC-FACTORS ,QUALITY-OF-LIFE ,HEPATOCELLULAR-CARCINOMA ,Hepatectomy ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,Liver surgery ,Enhanced recovery ,Randomized Controlled Trials as Topic ,Randomised controlled trial ,Liver Neoplasms ,SEVERITY GRADING SYSTEM ,PARENCHYMAL-SPARING RESECTIONS ,Length of Stay ,Posterosuperior segments ,Posterosuperior segment ,METASTASES ,Treatment Outcome ,Laparoscopy/adverse effects ,DIFFICULTY ,Quality of Life ,Laparoscopy ,Human - Abstract
Background A shift towards parenchymal-sparing liver resections in open and laparoscopic surgery emerged in the last few years. Laparoscopic liver resection is technically feasible and safe, and consensus guidelines acknowledge the laparoscopic approach in the posterosuperior segments. Lesions situated in these segments are considered the most challenging for the laparoscopic approach. The aim of this trial is to compare the postoperative time to functional recovery, complications, oncological safety, quality of life, survival and costs after laparoscopic versus open parenchymal-sparing liver resections in the posterosuperior liver segments within an enhanced recovery setting. Methods The ORANGE Segments trial is an international multicentre randomised controlled superiority trial conducted in centres experienced in laparoscopic liver resection. Eligible patients for minor resections in the posterosuperior segments will be randomised in a 1:1 ratio to undergo laparoscopic or open resections in an enhanced recovery setting. Patients and ward personnel are blinded to the treatment allocation until postoperative day 4 using a large abdominal dressing. The primary endpoint is time to functional recovery. Secondary endpoints include intraoperative outcomes, length of stay, resection margin, postoperative complications, 90-day mortality, time to adjuvant chemotherapy initiation, quality of life and overall survival. Laparoscopic liver surgery of the posterosuperior segments is hypothesised to reduce time to functional recovery by 2 days in comparison with open surgery. With a power of 80% and alpha of 0.04 to adjust for interim analysis halfway the trial, a total of 250 patients are required to be randomised. Discussion The ORANGE Segments trial is the first multicentre international randomised controlled study to compare short- and long-term surgical and oncological outcomes of laparoscopic and open resections in the posterosuperior segments within an enhanced recovery programme. Trial registration ClinicalTrials.gov NCT03270917. Registered on September 1, 2017. Before start of inclusion. Protocol version: version 12, May 9, 2017
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- 2021
94. The impact of minimally invasive pancreatic surgery: Improving outcome
- Author
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Lof, S., Besselink, M.G.H., Abu Hilal, M., Faculteit der Geneeskunde, Besselink, Marc G. H., and Graduate School
- Abstract
Keyhole i.e. minimally invasive, including laparoscopy or robotic, surgery has brought a revolutionary change in the surgical field and is associated with less surgical trauma to tissue, less intra-operative blood loss, pain reduction, shorter time to functional recovery and shorter hospital stay. For pancreatic surgery the use of keyhole surgery is still in development. Randomized data, published in recent years created mixed signals. Hereby hampering the widespread dissemination of keyhole pancreatic surgery. This thesis emphasises the importance of understanding the potential drawbacks of the minimally invasive technique by looking into the learning curve of minimally invasive distal pancreatectomy (MIDP), the surgical outcomes following conversion to open surgery during MIDP and minimally invasive pancreatoduodenectomy (MIPD) and in addition into the selection criteria for suitable patients for the minimally invasive technique. Choosing the right patient for the technique is important, as poor selection may result in poor outcome and the described risk factors for conversion should be considered. Furthermore, this thesis describes how keyhole surgery is applied best. It showed that robotic distal pancreatectomy (RDP) has some advantages over laparoscopy in terms of spleen-preservation and conversion rates. Laparoscopic distal pancreatectomy with spleen-preservation results in similar short-term surgical outcomes when compared to laparoscopic distal pancreatectomy with splenectomy. Whether MIDP for pancreatic ductal adenocarcinoma results in comparable oncological outcomes as open surgery will be proven by the DIPLOMA randomized controlled trial. Finally, in order to further improve the outcomes of pancreatic surgery, this thesis highlights the importance of multidisciplinary collaboration.
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- 2021
95. Crossing borders in minimally invasive pancreatic and liver surgery
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van der Heijde, Nicky, Besselink, M.G.H., Abu Hilal, M., Faculteit der Geneeskunde, Besselink, Marc G. H., Abu Hilal, Mohammed, Surgery, and Graduate School
- Abstract
This thesis aims to assess and improve outcomes in minimally invasive pancreas and liver surgery with a focus on international multicenter collaboration. Included in this thesis are evidence-based guidelines within minimally invasive pancreatic surgery which were lacking and therefore a consensus meeting was organized in Miami in March 2019 where all evidence to date was summarized and guidelines were established with the aim to optimize patient safety and operative outcomes. The need for national and international registries in minimally invasive pancreatic surgery was highlighted and therefore E-MIPS decided to set up such a registry. Data of this first year was included in this thesis and were used to provide an overview of minimally invasive pancreatic surgery practice across Europe and additionally to show differences between the laparoscopic and robotic approach for distal pancreatectomy and pancreatoduodenectomy. For this thesis, several studies were performed comparing different approaches in pancreas and liver surgery. The robotic and laparoscopic approach in distal pancreatectomy were compared, as were laparoscopic and open right posterior sectionectomy. Additionally, a systematic review on both elderly and obese patients undergoing either minimally invasive distal pancreatectomy or pancreatoduodenectomy is included. In minimally invasive liver surgery, most studies only include high volume expert centers and therefore might not be easily translated to general practice. Some nationwide or international registries collect data prospectively on minimally invasive liver resections. A study was included in this thesis comparing the design and included variables of these large nationwide registries.
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- 2021
96. Risk-stratification and management of pancreatic neuroendocrine tumors
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Heidsma, Charlotte M., Nieveen van Dijkum, Els J. M., Besselink, Marc G. H., van Eijck, C. H. J., Engelsman, Anton F., Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Treatment and quality of life, and Graduate School
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- 2021
97. Complicated acute pancreatitis: Interventions and timing of treatment
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van Dijk, Sven M., Besselink, Marc G. H., Fockens, Paul, van Santvoort, Hjalmar C., Voermans, Rogier P., Amsterdam Gastroenterology Endocrinology Metabolism, and Graduate School
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- 2021
98. Clinical course and treatment of chronic pancreatitis
- Author
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Kempeneers, Rens A., Boermeester, Marie A., Besselink, Marc G. H., van Santvoort, Hjalmar C., Issa, Yama, Amsterdam Gastroenterology Endocrinology Metabolism, AII - Inflammatory diseases, and Graduate School
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- 2021
99. Optimizing strategies in pancreatic and hepato-biliary surgery
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Mungroop, Timothy H., Besselink, Marc G. H., Hollmann, Markus W., Busch, Olivier R. C., Veelo, Denise P., Surgery, Graduate School, Amsterdam Gastroenterology Endocrinology Metabolism, APH - Quality of Care, ACS - Heart failure & arrhythmias, and ACS - Diabetes & metabolism
- Published
- 2020
100. Improving outcomes of minimally invasive pancreas surgery and ampullary cancer
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Moekotte, Alma L., Besselink, Marc G. H., Abu Hilal, M., Wilmink, Johanna W., Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Treatment and quality of life, and Graduate School
- Published
- 2020
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