412 results on '"Bemelman, W.A."'
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2. Curative-intent surgery for isolated locoregional recurrence of colon cancer: Review of the literature and institutional experience
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Wisselink, D.D., Klaver, C.E.L., Hompes, R., Bemelman, W.A., and Tanis, P.J.
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- 2020
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3. Long-term outcomes after close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis for ulcerative colitis.
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Reijntjes, M.A., Jong, D.C. de, Bartels, S., Wessels, E.M., Bocharewicz, E.K., Hompes, R., Buskens, C.J., D'Haens, G.R.A.M., Duijvestein, M., Bemelman, W.A., Reijntjes, M.A., Jong, D.C. de, Bartels, S., Wessels, E.M., Bocharewicz, E.K., Hompes, R., Buskens, C.J., D'Haens, G.R.A.M., Duijvestein, M., and Bemelman, W.A.
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01 april 2023, Item does not contain fulltext, BACKGROUND: During ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC), rectal dissection can be performed via close rectal dissection (CRD) or in a total mesorectal excision plane (TME). Although CRD should protect autonomic nerve function, this technique may be more challenging than TME. The aim of this study was to compare long-term outcomes of patients undergoing CRD and TME. METHODS: This single-centre retrospective cohort study included consecutive patients who underwent IPAA surgery for UC between January 2002 and October 2017. Primary outcomes were chronic pouch failure (PF) among patients who underwent CRD and TME and the association between CRD and developing chronic PF. Chronic PF was defined as a pouch-related complication occurring ≥ 3 months after primary IPAA surgery requiring redo pouch surgery, pouch excision or permanent defunctioning ileostomy. Secondary outcomes were risk factors and causes for chronic PF. Pouch function and quality of life were assessed via the Pouch dysfunction score and Cleveland global quality of life score. RESULTS: Out of 289 patients (155 males, median age 37 years [interquartile range 26.5-45.5 years]), 128 underwent CRD. There was a shorter median postoperative follow-up for CRD patients than for TME patients (3.7 vs 10.9 years, p < 0.01). Chronic PF occurred in 6 (4.7%) CRD patients and 20 (12.4%) TME patients. The failure-free pouch survival rate 3 years after IPAA surgery was comparable among CRD and TME patients (96.1% vs. 93.5%, p = 0.5). CRD was a no predictor for developing chronic PF on univariate analyses (HR 0.7 CI-95 0.3-2.0, p = 0.54). A lower proportion of CRD patients developed chronic PF due to a septic cause (1% vs 6%, p = 0.03). CONCLUSIONS: Although differences in chronic PF among CRD and TME patients were not observed, a trend toward TME patients developing chronic pelvic sepsis was detected. Surgeons may consider performing CRD during IPAA surgery for UC.
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- 2023
4. Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy Results of the Multicenter, Prospective, Cross-Sectional FANCY Study
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Bastiaenen, V.P., Jonge, J de, Corten, B.J., Savornin Lohman, E.A.J. de, Kraima, A.C., Swank, H.A., Reuver, P.R. de, Dijkgraaf, Marcel G.W., Bemelman, W.A., Bastiaenen, V.P., Jonge, J de, Corten, B.J., Savornin Lohman, E.A.J. de, Kraima, A.C., Swank, H.A., Reuver, P.R. de, Dijkgraaf, Marcel G.W., and Bemelman, W.A.
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Item does not contain fulltext
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- 2023
5. Endoscopic Recurrence or Anastomotic Wound Healing Phenomenon after Ileocolic Resection for Crohn's Disease: The Challenges of Accurate Endoscopic Scoring.
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Does de Willebois, E.M.L. van der, Duijvestein, M., Wasmann, Karin A.T.G.M., D'Haens, G.R.A.M., Bilt, J.D.W. van der, Mundt, M.W., Hompes, R., Vlugt, M. van der, Buskens, C.J., Bemelman, W.A., Does de Willebois, E.M.L. van der, Duijvestein, M., Wasmann, Karin A.T.G.M., D'Haens, G.R.A.M., Bilt, J.D.W. van der, Mundt, M.W., Hompes, R., Vlugt, M. van der, Buskens, C.J., and Bemelman, W.A.
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Item does not contain fulltext, BACKGROUND AND AIMS: Adequate endoscopic scoring in Crohn's disease [CD] is crucial, as it dictates the need for initiating postoperative medical therapy and is utilized as an outcome parameter in clinical trials. Here we aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses. METHODS: Two prospective patient cohorts were included: ileocolic resection [ICR] for CD, and right-sided colon resection for colorectal cancer [CRC]. Videos taken during colonoscopy 6 months postoperatively were evaluated. The Simplified Endoscopic Activity Score for Crohn's Disease and modified Rutgeerts score were determined. The primary outcome was the presence of ulcerations in CD patients on both the inverted and the everted stapled lines. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line. RESULTS: Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 [76.8%] at the inverted- vs 1/71 [1.4%] at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 [67.7%] at the inverted vs 0/6 [0%] at the everted stapled line. In total, 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line. CONCLUSION: Inverted stapled lines heal with ulcerations, whereas everted stapled lines heal without any ulcerations, in both CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients' quality of life and on healthcare costs if postoperative treatment is initiated incorrectly.
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- 2023
6. Classification of surgical causes of and approaches to the chronically failing ileoanal pouch
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Meima-van Praag, E.M., Reijntjes, M.A., Hompes, R., Buskens, C.J., Duijvestein, M., Bemelman, W.A., Meima-van Praag, E.M., Reijntjes, M.A., Hompes, R., Buskens, C.J., Duijvestein, M., and Bemelman, W.A.
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Item does not contain fulltext, BACKGROUND: Although there are various surgical causes of and therapeutic approaches to the chronically failing ileoanal pouch (PF), cases are often detailed without distinguishing the exact cause and corresponding treatment. The aim of our study was to classify causes of PF and corresponding surgical treatment options, and to establish efficacy of surgical approach per cause. METHODS: This retrospective study included all consecutive adult patients with chronic PF surgically treated at our tertiary hospital between July 2014 and March 2021. Patients were classified according to a proposed sub-classification for surgical related chronic PF. Results were reported accordingly. RESULTS: A total of 59 procedures were completed in 50 patients (64% male, median age 45 years [IQR 34.5-54.3]) for chronic PF. Most patients had refractory ulcerative colitis as indication for their restorative proctocolectomy (68%). All patients could be categorized according to the sub-classification. Reasons for chronic PF were septic complications (n = 25), pouch body complications (n = 12), outlet problems (n = 11), cuff problems (n = 8), retained rectum (n = 2), and inlet problems (n = 1). For these indications, 17 pouches were excised, 10 pouch reconstructions were performed, and 32 pouch revision procedures were performed. The various procedures had different complication rates. Technical success rates of redo surgery for the different causes varied from 0 to 100%, with a 75% success rate for septic causes. CONCLUSIONS: Our sub-classification for chronic PF and corresponding treatments is suitable for all included patients. Outcomes varied between causes and subsequent management. Chronic PF was predominantly caused by septic complications with redo surgery achieving a 75% technical success rate.
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- 2023
7. Endoscopic and surgical treatment outcomes of colitis-associated advanced colorectal neoplasia: a multicenter cohort study.
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Derks, M.E.W., Groen, M. te, Peters, C.P., Dijkstra, G., Vries, A.C. de, Romkens, T.E., Horjus, C.S., Boer, N.K. de, Bemelman, W.A., Nagtegaal, I.D., Derikx, L.A.A.P., Hoentjen, F., Derks, M.E.W., Groen, M. te, Peters, C.P., Dijkstra, G., Vries, A.C. de, Romkens, T.E., Horjus, C.S., Boer, N.K. de, Bemelman, W.A., Nagtegaal, I.D., Derikx, L.A.A.P., and Hoentjen, F.
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Contains fulltext : 295956.pdf (Publisher’s version ) (Open Access), BACKGROUND: Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (high-grade dysplasia or colorectal cancer). The authors aimed to (1) assess synchronous and metachronous neoplasia following (sub)total or proctocolectomy, partial colectomy or endoscopic resection for advanced neoplasia in IBD, and (2) identify factors associated with treatment choice. MATERIAL AND METHODS: In this retrospective multicenter cohort study, the authors used the Dutch nationwide pathology databank (PALGA) to identify patients diagnosed with IBD and colonic advanced neoplasia (AN) between 1991 and 2020 in seven hospitals in the Netherlands. Logistic and Fine & Gray's subdistribution hazard models were used to assess adjusted subdistribution hazard ratios for metachronous neoplasia and associations with treatment choice. RESULTS: The authors included 189 patients (high-grade dysplasia n =81; colorectal cancer n =108). Patients were treated with proctocolectomy ( n =33), (sub)total colectomy ( n =45), partial colectomy ( n =56) and endoscopic resection ( n =38). Partial colectomy was more frequently performed in patients with limited disease and older age, with similar patient characteristics between Crohn's disease and ulcerative colitis. Synchronous neoplasia was found in 43 patients (25.0%; (sub)total or proctocolectomy n =22, partial colectomy n =8, endoscopic resection n =13). The authors found a metachronous neoplasia rate of 6.1, 11.5 and 13.7 per 100 patient-years after (sub)total colectomy, partial colectomy and endoscopic resection, respectively. Endoscopic resection, but not partial colectomy, was associated with an increased metachronous neoplasia risk (adjusted subdistribution hazard ratios 4.16, 95% CI 1.64-10.54, P <0.01) compared with (sub)total colectomy. CONCLUSION: After confounder adjustment, partial colectomy yielded a similar metachronous neoplasia risk compared to (sub)total colectomy. High metachronous neoplasia rates after endoscopic
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- 2023
8. Predicting Mortality Within 90 Days of First Intervention in Patients With Left-Sided Obstructive Colon Cancer.
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Burghgraef, T.A., Bakker, I.S., Veld, J.V., Wijsmuller, A.R., Amelung, F.J., Bemelman, W.A., Borg, F. ter, Hooft, J.E. van, Siersema, P.D., Tanis, P.J., Consten, E.C.J., Burghgraef, T.A., Bakker, I.S., Veld, J.V., Wijsmuller, A.R., Amelung, F.J., Bemelman, W.A., Borg, F. ter, Hooft, J.E. van, Siersema, P.D., Tanis, P.J., and Consten, E.C.J.
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Contains fulltext : 296545.pdf (Publisher’s version ) (Closed access), BACKGROUND: Acute resection for left-sided obstructive colon carcinoma is thought to be associated with a higher mortality risk than a bridge-to-surgery approach using decompressing stoma or self-expandable metal stent, but prediction models are lacking. OBJECTIVE: This study aimed to determine the influence of treatment strategy on mortality within 90 days from the first intervention in patients presenting with left-sided obstructive colon carcinoma. DESIGN: This was a national multicenter cohort study that used data from a prospective national audit. SETTINGS: The study was performed in 75 Dutch hospitals. PATIENTS: Patients were included if they underwent resection with curative intent for left-sided obstructive colon carcinoma between 2009 and 2016. INTERVENTIONS: First intervention was either acute resection, bridge to surgery with self-expandable metallic stent, or bridge to surgery with decompressing stoma. MAIN OUTCOME MEASURES: The main outcome measure was 90-day mortality after the first intervention. Risk factors were identified using multivariable logistic analysis. Subsequently, a risk model was developed. RESULTS: In total, 2395 patients were included, with the first intervention consisting of acute resection in 1848 patients (77%), stoma as bridge to surgery in 332 patients (14%), and stent as bridge to surgery in 215 patients (9%). Overall, 152 patients (6.3%) died within 90 days from the first intervention. A decompressing stoma was independently associated with lower 90-day mortality risk (HR, 0.27; 95% CI, 0.094-0.62). Other independent predictors for mortality were age, ASA classification, tumor location, and index levels of serum creatinine and C-reactive protein. The constructed risk model had an area under the curve of 0.84 (95% CI, 0.81-0.87). LIMITATIONS: Only patients who underwent surgical resection were included. CONCLUSIONS: Treatment strategy had a significant impact on 90-day mortality. A decompressing stoma considerably lowers the ris
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- 2023
9. Increased Proportion of Colorectal Cancer in Patients with Ulcerative Colitis undergoing Surgery in the Netherlands
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Heuthorst, L., primary, Harbech, H., additional, Snijder, H.J., additional, Mookhoek, A., additional, D’Haens, G.R., additional, Vermeire, S., additional, D’Hoore, A., additional, Bemelman, W.A., additional, and Buskens, C.J., additional
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- 2022
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10. Feasibility of adjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in a short stay setting in patients with colorectal cancer at high risk of peritoneal carcinomatosis
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Sloothaak, D.A.M., Gardenbroek, T.J., Crezee, J., Bemelman, W.A., Punt, C.J.A., Buskens, C.J., and Tanis, P.J.
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- 2014
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11. 24 Colon en rectum
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Bemelman, W.A., Gooszen, H.G., editor, Blankensteijn, J.D., editor, Borel Rinkes, I.H.M., editor, Dejong, C.H.C., editor, Gouma, D.J., editor, Heineman, E., editor, Lange, J.F., editor, and Schipper, I.B., editor
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- 2012
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12. The surgical intervention: Earlier or never?
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Bemelman, W.A. and Allez, M.
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- 2014
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13. The prognostic value of micrometastases and isolated tumour cells in histologically negative lymph nodes of patients with colorectal cancer: A systematic review and meta-analysis
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Sloothaak, D.A.M., Sahami, S., van der Zaag-Loonen, H.J., van der Zaag, E.S., Tanis, P.J., Bemelman, W.A., and Buskens, C.J.
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- 2014
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14. Laparoscopy for colorectal cancer
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Tanis, P.J., Buskens, C.J., and Bemelman, W.A.
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- 2014
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15. 1 Toegang
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Wind, J., Bemelman, W.A., Broeders, Ivo A.M.J., editor, and Kalisingh, Sandy S., editor
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- 2009
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16. The Dutch Surgical Colorectal Audit
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Bemelman, W.A., van Dam, R.M., Elferink, M.A., Karsten, Th.M., van Krieken, J.H.J.M., Lemmens, V.E.P.P., Rutten, H.J.T., Manusama, E.R., van de Velde, C.J.H., Meijerink, W.J.H.J., Wiggers, Th., van der Harst, E., Dekker, J.W.T., Boerma, D., Van Leersum, N.J., Snijders, H.S., Henneman, D., Kolfschoten, N.E., Gooiker, G.A., ten Berge, M.G., Eddes, E.H., Wouters, M.W.J.M., and Tollenaar, R.A.E.M.
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- 2013
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17. Follow-up after colon cancer treatment in the Netherlands; a survey of patients, GPs, and colorectal surgeons
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Wind, J., Duineveld, L.A., van der Heijden, R.P., van Asselt, K.M., Bemelman, W.A., and van Weert, H.C.
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- 2013
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18. Safety and economic analysis of selective histopathology following cholecystectomy: multicentre, prospective, cross-sectional FANCY study
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Bastiaenen, V.P., Vliet, J.L. van, Savornin Lohman, E.A.J. de, Corten, B.J., Jonge, J de, Kraima, A.C., Reuver, P.R. de, Dijkgraaf, Marcel G.W., Bemelman, W.A., Bastiaenen, V.P., Vliet, J.L. van, Savornin Lohman, E.A.J. de, Corten, B.J., Jonge, J de, Kraima, A.C., Reuver, P.R. de, Dijkgraaf, Marcel G.W., and Bemelman, W.A.
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Item does not contain fulltext
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- 2022
19. In-hospital Delay of Appendectomy in Acute, Complicated Appendicitis
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Bolmers, M.D., Jonge, J de, Bom, W.J., Rossem, C.C. van, Rosman, C., Geloven, A. A. W. van, Bemelman, W.A., Bolmers, M.D., Jonge, J de, Bom, W.J., Rossem, C.C. van, Rosman, C., Geloven, A. A. W. van, and Bemelman, W.A.
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Item does not contain fulltext, BACKGROUND: Present theory is that uncomplicated and complicated appendicitis are different entities. Recent studies suggest it is safe to delay surgery in patients with uncomplicated appendicitis. We hypothesize that patients with complicated appendicitis are at higher risk for postoperative complications when surgery is delayed. METHODS: Data was used from the multicenter, prospective SNAPSHOT appendicitis study of 1975 patients undergoing surgery for suspected appendicitis. Adult patients (≥ 18 years) who underwent appendectomy for appendicitis were included in this study. The primary outcome was the difference in postoperative complications between patients with complicated appendicitis who were operated within and after 8 h after hospital presentation. Secondary outcomes were the incidence of both uncomplicated and complicated appendicitis in relationship to delay of appendectomy. Follow-up was 30 days. A multivariable analysis was performed. RESULTS: Of 1341 adult patients with appendicitis, 34.3% had complicated appendicitis. In patients with complicated appendicitis, 22.8% developed a postoperative complication compared to 8.2% for uncomplicated appendicitis (P < 0.001). Delay in surgery (> 8 h) increased the complication rate in patients with complicated appendicitis (28.1%) compared to surgery within 8 h (18.3%; P = 0.01). Multivariate analysis showed a delay in surgery as an independent predictor for a postoperative complication in patients with complicated appendicitis (OR 1.71; 95%CI 1.01-2.68, P = 0.02). CONCLUSION: In-hospital delay of surgery (> 8 h) in patients with complicated appendicitis is associated with a higher risk of a postoperative complication. It is important that we recognize and treat these patients early.
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- 2022
20. Accuracy of imaging in discriminating complicated from uncomplicated appendicitis in daily clinical practice
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Bolmers, M.D., Bom, W.J., Scheijmans, J.C.G., Geloven, A. A. W. van, Boermeester, Marja A., Goor, H. van, Bemelman, W.A., Rossem, C.C. van, Bolmers, M.D., Bom, W.J., Scheijmans, J.C.G., Geloven, A. A. W. van, Boermeester, Marja A., Goor, H. van, Bemelman, W.A., and Rossem, C.C. van
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Contains fulltext : 251504.pdf (Publisher’s version ) (Open Access), BACKGROUND: Radiologic imaging can accurately diagnose acute appendicitis, but little is known about its discriminatory capacity between complicated and uncomplicated appendicitis. OBJECTIVE: This study aims to investigate the accuracy of imaging in discriminating complicated from uncomplicated appendicitis. METHODS: Data was used from the prospective, nationwide, observational SNAPSHOT appendicitis database, including patients with suspected acute appendicitis who were planned for an appendectomy. Usage of ultrasound (US), CT, MRI or a combination was recorded. Radiological reports were used to group for complicated or uncomplicated appendicitis. The reference standard was based on operative and pathological findings. Primary outcomes were sensitivity and specificity in discriminating complicated from uncomplicated appendicitis. Secondary outcomes were diagnostic accuracy results per imaging modality and for the subgroups age, BMI, and sex. RESULTS: Preoperative imaging was performed in 1964 patients. In 1434 patients (73%), only US was used; in 109 (6%) patients, only CT was used; and 421 (21%) patients underwent US followed by CT or MRI. Overall, imaging workup as practiced, following the national guideline, had a poor sensitivity for complicated appendicitis of only 35%, although specificity was as high as 93%. For US, accuracy for complicated appendicitis was higher in children than in adults; sensitivity 41.2% vs. 26.4% and specificity 94.6% vs. 93.4%, respectively, p = 0.003. For relevant subgroups such as age, sex and BMI, no other differences in the discriminatory performance were found. CONCLUSION: A diagnostic workup with stepwise imaging, using a conditional CT or MRI strategy, poorly discriminates between complicated and uncomplicated appendicitis in daily practice.
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- 2022
21. Mesenteric SParIng versus extensive mesentereCtomY in primary ileocolic resection for ileocaecal Crohn's disease (SPICY): study protocol for randomized controlled trial
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Does de Willebois, E.M.L. van der, Bemelman, W.A., Buskens, C.J., D’Haens, G., D’Hoore, A., Danese, S., Duijvestein, M., Gecse, K.B., Hompes, R., Koot, B.G., Indemans, F., Lightner, A.L., Mundt, M.W., Spinelli, A., Bilt, J.D.W. van der, Dongen, K.W. van, Vermeire, S., Zwaveling, S., Does de Willebois, E.M.L. van der, Bemelman, W.A., Buskens, C.J., D’Haens, G., D’Hoore, A., Danese, S., Duijvestein, M., Gecse, K.B., Hompes, R., Koot, B.G., Indemans, F., Lightner, A.L., Mundt, M.W., Spinelli, A., Bilt, J.D.W. van der, Dongen, K.W. van, Vermeire, S., and Zwaveling, S.
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Contains fulltext : 252173.pdf (Publisher’s version ) (Open Access), BACKGROUND: There is emerging evidence to suggest that Crohn's disease (CD) may be a disease of the mesentery, rather than of the bowel alone. A more extensive mesenteric resection, removing an increased volume of mesentery and lymph nodes to prevent recurrence of CD, may improve clinical outcomes. This study aims to analyse whether more extensive 'oncological' mesenteric resection reduces the recurrence rate of CD. METHODS: This is an international multicentre randomized controlled study, allocating patients to either group 1-mesenteric sparing ileocolic resection (ICR), the current standard procedure for CD, or group 2-extensive mesenteric ICR, up to the level of the ileocolic trunk. To detect a clinically relevant difference of 25 per cent in endoscopic recurrence at 6 months, a total of 138 patients is required (including 10 per cent dropout). Patients aged over 16 with CD undergoing primary ICR are eligible. Primary outcome is 6-month postoperative endoscopic recurrence rate (modified Rutgeerts score of greater than or equal to i2b). Secondary outcomes are postoperative morbidity, clinical recurrence, quality of life, and the need for (re)starting immunosuppressive medication. For long-term results, patients will be followed up for up to 5 years to determine the reoperation rate for recurrence of disease at the anastomotic site. CONCLUSION: Analysing these two treatment strategies in a head-to-head comparison will allow an objective evaluation of the clinical relevance of extensive mesenteric resection in CD. If a clinical benefit can be demonstrated, this could result in changes to guidelines which currently recommend close bowel resection. REGISTRATION NUMBER: NCT00287612 (http://www.clinicaltrials.gov).
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- 2022
22. Re-Assessment in Patients with Suspected Acute Appendicitis
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Bom, W.J., Scheijmans, J.C.G., Geloven, A. A. W. van, Gans, S.L., Boermeester, Marja A., Goor, H. van, Rosman, C., Bemelman, W.A., Rossem, C.C. van, Bom, W.J., Scheijmans, J.C.G., Geloven, A. A. W. van, Gans, S.L., Boermeester, Marja A., Goor, H. van, Rosman, C., Bemelman, W.A., and Rossem, C.C. van
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Item does not contain fulltext, Background: The effect of diagnosing appendicitis at re-assessment on post-operative outcomes is not clear. This study aims to compare patients diagnosed with appendicitis at initial presentation versus patients who were diagnosed at re-assessment. Patients and Methods: Data from the Dutch SNAPSHOT appendicitis collaborative was used. Patients with appendicitis who underwent appendectomy were included. Effects of diagnosis at re-assessment were compared with diagnosis at initial presentation. Primary outcomes were the proportion of patients with complicated appendicitis and the post-operative complication rate. Results: Of 1,832 patients, 245 (13.4%) were diagnosed at re-assessment. Re-assessed patients had a post-operative complication rate comparable to those diagnosed with appendicitis at initial presentation (15.1% vs. 12.7%; p = 0.29) and no substantial difference was found in the proportion of patients with complicated appendicitis (27.9% vs. 33.5%; p = 0.07). For patients with complicated appendicitis, more post-operative complications were seen if diagnosed at re-assessment than if diagnosed initially (38.2% vs. 22.9%; p = 0.006). Conclusions: For patients in whom appendicitis was not diagnosed at first presentation, but at re-assessment, both the proportion of complicated appendicitis and the post-operative complication rate were comparable to those who were diagnosed with appendicitis at initial presentation. However, re-assessed patients with complicated appendicitis encountered more post-operative complications.
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- 2022
23. Diagnosing occult tumour cells and their predictive value in sentinel nodes of histologically negative patients with colorectal cancer
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van der Zaag, E.S., Kooij, N., van de Vijver, M.J., Bemelman, W.A., Peters, H.M., and Buskens, C.J.
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- 2010
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24. Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands: A Propensity Score-Matched Comparison with Conventional Laparoscopic Total Mesorectal Excision
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Detering, R., Roodbeen, S.X., Oostendorp, S.E. van, Dekker, J.W.T., Sietses, C., Bemelman, W.A., Tanis, P.J., Hompes, R., Tuynman, J.B., Aalbers, A.G.J., Leeuwenhoek, A. van, Beets-Tan, R.G.H., Boer, F.C. den, Breukink, S.O., Coene, P.P.L.O., Doornebosch, P.G., Gelderblom, A.J., Karsten, T.M., Ledeboer, M., Manusama, E.R., Marijnen, C.A.M., Nagtegaal, I.D., Peeters, K.C.M.J., Tollenaar, R.A.E.M., Velde, C.J.H.V. de, Wagner, A., Westerterp, M., Westreenen, H.L. van, Dutch ColoRectal Canc Audit Grp, Clinical Genetics, CCA - Cancer Treatment and Quality of Life, Surgery, AGEM - Digestive immunity, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism
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Male ,CLINICAL-OUTCOMES ,medicine.medical_specialty ,ANASTOMOTIC LEAKAGE ,Colorectal cancer ,Operative Time ,Postoperative Complications ,Primary outcome ,SDG 3 - Good Health and Well-being ,PATHOLOGICAL OUTCOMES ,medicine ,Humans ,TATME ,Propensity Score ,RECURRENCE ,Aged ,Netherlands ,Retrospective Studies ,Transanal Endoscopic Surgery ,ASSISTED RESECTION ,Rectal Neoplasms ,Abdominoperineal resection ,business.industry ,General surgery ,TME ,Margins of Excision ,Odds ratio ,Middle Aged ,medicine.disease ,Total mesorectal excision ,CONVERSION ,Treatment Outcome ,Baseline characteristics ,Propensity score matching ,Female ,Laparoscopy ,Surgery ,Circumferential resection margin ,business - Abstract
BACKGROUND: Transanal total mesorectal excision (TaTME) is a relatively new and demanding technique for rectal cancer treatment. Results from national datasets are absent and comparative data with laparoscopic TME (lapTME) are scarce. Therefore, this study aimed to evaluate the initial TaTME experience in the Netherlands, by comparing outcomes with conventional lapTME.STUDY DESIGN: Patients with rectal cancer who underwent curative TaTME or lapTME were selected from the nationwide and mandatory Dutch ColoRectal Audit (DCRA), between January 2015 and December 2017. Primary outcome was circumferential resection margin (CRM) involvement. Secondary outcomes included operative details and short-term (RESULTS: There were 3,777 patients included for analysis (TaTME, n = 416, lapTME, n = 3361). Transanal TME was performed in 38 hospitals and lapTME in 90 hospitals. Before matching, the patient category within the TaTME group was technically more challenging in terms of tumor height and preoperative threatened margins. After 1: 1 matching, 396 patients were included in each group, with comparable baseline characteristics. Circumferential resection margin involvement was 4.3% after TaTME and 4.0% after lapTME (p = 1.000). Conversion rate was significantly lower in TaTME (1.5% vs 8.6%, p CONCLUSIONS: This first nationwide study shows early experience with adoption of TaTME in the Netherlands. Considering that current data represent initial TaTME experience, acceptable short-term outcomes were demonstrated when compared with the well-established lapTME. (C) 2019 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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- 2019
25. Improving staging accuracy in colon and rectal cancer by sentinel lymph node mapping: A comparative study
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van der Zaag, E.S., Buskens, C.J., Kooij, N., Akol, H., Peters, H.M., Bouma, W.H., and Bemelman, W.A.
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- 2009
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26. Circulating tumour cells during laparoscopic and open surgery for primary colonic cancer in portal and peripheral blood
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Wind, J., Tuynman, J.B., Tibbe, A.G.J., Swennenhuis, J.F., Richel, D.J., van Berge Henegouwen, M.I., and Bemelman, W.A.
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- 2009
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27. Anastomotic leak following oesophagectomy: research priorities from an international Delphi consensus study
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Jonge, J de, Scheijmans, J.C.G., Rossem, C.C. van, Geloven, A. A. W. van, Rosman, C., Boermeester, M.A., Bemelman, W.A., Jonge, J de, Scheijmans, J.C.G., Rossem, C.C. van, Geloven, A. A. W. van, Rosman, C., Boermeester, M.A., and Bemelman, W.A.
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Item does not contain fulltext
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- 2021
28. Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis
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Jonge, J de, Scheijmans, J.C.G., Rossem, C.C. van, Geloven, A. A. W. van, Goor, H. van, Boermeester, M.A., Bemelman, W.A., Jonge, J de, Scheijmans, J.C.G., Rossem, C.C. van, Geloven, A. A. W. van, Goor, H. van, Boermeester, M.A., and Bemelman, W.A.
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Item does not contain fulltext, PURPOSE: For the diagnosis of acute appendicitis, the combination of clinical and laboratory variables achieves high diagnostic accuracy. Nevertheless, appendicitis can present with normal laboratory tests of inflammation. The aim of this study was to investigate the incidence of normal inflammatory markers in patients operated for acute appendicitis. METHODS: This is an analysis of data from a prospective, multicentre SNAPSHOT cohort study of patients with suspected acute appendicitis. Only patients with histopathologically proven acute appendicitis were included. Adult patients with acute appendicitis and normal preoperative inflammatory markers were explored further in terms of abdominal complaints, preoperative imaging results and intraoperative assessment of the degree of inflammation and compared to those with elevated inflammatory markers. RESULTS: Between June and July 2014, 1303 adult patients with histopathologically proven acute appendicitis were included. In only 23 of 1303 patients (1.8%) with proven appendicitis, both preoperative white blood cell count and C-reactive protein levels were normal. Migration of pain was reported less frequently in patients with normal inflammatory markers compared to those with elevated inflammatory marker levels (17.4% versus 43.0%, p = 0.01). Characteristics like fever, duration of symptoms and localized peritonitis were comparable. Only 4 patients with normal inflammatory markers (0.3% overall) had complicated appendicitis at histopathological evaluation. CONCLUSION: Combined normal WBC and CRP levels are seen in about 2 per 100 patients with confirmed acute appendicitis and can, although rarely, be found in patients with complicated appendicitis.
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- 2021
29. Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?
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Roodbeen, S.X., Blok, R.D., Borstlap, W.A.A., Bemelman, W.A., Wilt, J.H.W. de, Hompes, R., Tanis, P.J., Roodbeen, S.X., Blok, R.D., Borstlap, W.A.A., Bemelman, W.A., Wilt, J.H.W. de, Hompes, R., and Tanis, P.J.
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Contains fulltext : 239366.pdf (Publisher’s version ) (Open Access), AIM: Nonrestorative low anterior resection (n-rLAR) (also known as low Hartmann's) is performed for rectal cancer when a poor functional outcome is anticipated or there have been problems when constructing the anastomosis. Compared with restorative LAR (rLAR), little oncological outcome data are available for n-rLAR. The aim of this study was to compare oncological outcomes between rLAR and n-rLAR for primary rectal cancer. METHOD: This was a nationwide cross-sectional comparative study including all elective sphincter-saving LAR procedures for nonmetastatic primary rectal cancer performed in 2011 in 71 Dutch hospitals. Oncological outcomes of patients undergoing rLAR and n-rLAR were collected in 2015; the data were evaluated using Kaplan-Meier survival analysis and the results compared using log-rank testing. Uni- and multivariable Cox regression analysis was used to evaluate the association between the type of LAR and oncological outcome measures. RESULTS: A total of 1197 patients were analysed, of whom 892 (75%) underwent rLAR and 305 (25%) underwent n-rLAR. The 3-year local recurrence (LR) rate was 3% after rLAR and 8% after n-rLAR (P < 0.001). The 3-year disease-free survival and overall survival rates were 77% (rLAR) vs 62% (n-rLAR) (P < 0.001) and 90% (rLAR) vs 75% (n-rLAR) (P < 0.001), respectively. In multivariable Cox analysis, n-rLAR was independently associated with a higher risk of LR (OR = 2.95) and worse overall survival (OR = 1.72). CONCLUSION: This nationwide study revealed that n-rLAR for rectal cancer was associated with poorer oncological outcome than r-LAR. This is probably a noncausal relationship, and might reflect technical difficulties during low pelvic dissection in a subset of those patients, with oncological implications.
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- 2021
30. Fluorescence angiography after vascular ligation to make the ileo-anal pouch reach
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Joosten, J.J., Reijntjes, M.A., Slooter, M.D., Duijvestein, M., Buskens, C.J., Bemelman, W.A., Hompes, R., Joosten, J.J., Reijntjes, M.A., Slooter, M.D., Duijvestein, M., Buskens, C.J., Bemelman, W.A., and Hompes, R.
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Item does not contain fulltext, The two most essential technical aspects of any gastrointestinal anastomosis are adequate perfusion and sufficient reach. For ileal pouch-anal anastomosis (IPAA), a trade-off exists between these two factors, as lengthening manoeuvers to avoid tension may require vascular ligation. In this technical note, we describe two cases in which we used indocyanine green (ICG) fluorescence angiography (FA) to assess perfusion of the pouch after vascular ligation to acquire sufficient reach. In both cases, FA allowed us to distinguish better between an arterial inflow problem and venous congestion than white light assessment. Both pouches remained viable and no anastomotic leakage occurred. Our results indicate that ICG FA is of great value after vascular ligation to obtain reach during IPAA.
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- 2021
31. Time interval between self-expandable metal stent placement or creation of a decompressing stoma and elective resection of left-sided obstructive colon cancer
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Veld, J.V., Kumcu, A., Amelung, F.J., Borstlap, W.A.A., Consten, E.C., Dekker, J.W.T., Westreenen, H.L. van, Siersema, P.D., Borg, F. ter, Kusters, M., Bemelman, W.A., Wilt, J.H.W. de, Hooft, Jeanin E. van, Tanis, P.J., Veld, J.V., Kumcu, A., Amelung, F.J., Borstlap, W.A.A., Consten, E.C., Dekker, J.W.T., Westreenen, H.L. van, Siersema, P.D., Borg, F. ter, Kusters, M., Bemelman, W.A., Wilt, J.H.W. de, Hooft, Jeanin E. van, and Tanis, P.J.
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Contains fulltext : 238480.pdf (Publisher’s version ) (Closed access), BACKGROUND: The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5 - 10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma. METHODS: This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria. RESULTS: 510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13 - 31) for SEMS and 36 days (IQR 22 - 65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11 - 17 days compared with 5 - 10 days. Of SEMS-related complications, 48 % occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14 - 28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated. CONCLUSIONS: Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2 - 4 weeks after decompressing stoma further optimizes surgical conditions for laparoscop
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- 2021
32. European evidence-based Consensus on the management of ulcerative colitis: Current management
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Travis, S.P.L., Stange, E.F., Lémann, M., Øresland, T., Bemelman, W.A., Chowers, Y., Colombel, J.F., D'Haens, G., Ghosh, S., Marteau, P., Kruis, W., Mortensen, N.J.McC., Penninckx, F., and Gassull, M.
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- 2008
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33. The prognostic significance of extracapsular lymph node involvement in node positive patients with colonic cancer
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Wind, J., ten Kate, F.J.W., Kiewiet, J.J.S., Lagarde, S.M., Slors, J.F.M., van Lanschot, J.J.B., and Bemelman, W.A.
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- 2008
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34. IMARI: multi-Interventional program for prevention and early Management of Anastomotic leakage after low anterior resection in Rectal cancer patIents: rationale and study protocol
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Slooter, M.D., Talboom, K., Sharabiany, S., Helsdingen, C.P.M. van, Dieren, S. van, Ponsioen, C.Y., Nio, C.Y., Consten, E.C., Wijsman, J.H., Boermeester, M.A., Derikx, J.P.M., Musters, G.D., Bemelman, W.A., Wilt, J.H.W. de, Tanis, P.J., Hompes, R., Pediatrics, Surgery, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, Graduate School, APH - Methodology, Gastroenterology and Hepatology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Radiology and Nuclear Medicine, Paediatric Surgery, ARD - Amsterdam Reproduction and Development, CCA - Cancer Treatment and Quality of Life, Tytgat Institute for Liver and Intestinal Research, and Robotics and image-guided minimally-invasive surgery (ROBOTICS)
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medicine.medical_specialty ,Colorectal cancer ,Anastomotic salvage ,lcsh:Surgery ,Anastomotic Leak ,Total Mesorectal excision ,Anastomosis ,Stoma ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Study Protocol ,COLORECTAL SURGERY ,Quality of life ,medicine ,SURGICAL SITE INFECTION ,Humans ,Anastomotic leakage ,Prospective Studies ,Rectal cancer ,METAANALYSIS ,REDUCE ,MECHANICAL BOWEL PREPARATION ,COMPLICATIONS ,Proctectomy ,business.industry ,Rectal Neoplasms ,Incidence (epidemiology) ,Prevention ,Anastomosis, Surgical ,lcsh:RD1-811 ,General Medicine ,medicine.disease ,Total mesorectal excision ,C-REACTIVE PROTEIN ,Surgery ,ORAL ANTIBIOTICS ,Cohort ,Quality of Life ,business ,Complication - Abstract
Background Anastomotic leakage (AL) is still a common and feared complication after low anterior resection (LAR) for rectal cancer. The multifactorial pathophysiology of AL and lack of standardised treatment options requires a multi-modal approach to improve long-term anastomotic integrity. The objective of the IMARI-trial is to determine whether the one-year anastomotic integrity rate in patients undergoing LAR for rectal cancer can be improved using a multi-interventional program. Methods IMARI is a multicentre prospective clinical effectiveness trial, whereby current local practice (control cohort) will be evaluated, and subsequently compared to results after implementation of the multi-interventional program (intervention cohort). Patients undergoing LAR for rectal cancer will be included. The multi-interventional program includes three preventive interventions (mechanical bowel preparation with oral antibiotics, tailored full splenic flexure mobilization and intraoperative fluorescence angiography using indocyanine green) combined with a standardised pathway for early detection and active management of AL. The primary outcome is anastomotic integrity, confirmed by CT-scan at one year postoperatively. Secondary outcomes include incidence of AL, protocol compliance and association with AL, temporary and permanent stoma rate, reintervention rate, quality of life and functional outcome. Microbiome analysis will be conducted to investigate the role of the rectal microbiome in AL. In a Dutch nationwide study, the AL rate was 20%, with anastomotic integrity of 90% after one year. Based on an expected reduction of AL due to the preventive approaches of 50%, and increase of anastomotic integrity by a standardised pathway for early detection and active management of AL, we hypothesised that the anastomotic integrity rate will increase from 90 to 97% at one year. An improvement of 7% in anastomotic integrity at one year was considered clinically relevant. A total number of 488 patients (244 per cohort) are needed to detect this difference, with 80% statistical power. Discussion The IMARI-trial is designed to evaluate whether a multi-interventional program can improve long-term anastomotic integrity after rectal cancer surgery. The uniqueness of IMARI lies in the multi-modal design that addresses the multifactorial pathophysiology for prevention, and a standardised pathway for early detection and active treatment of AL. Trial registration Trialregister.nl (NL8261), January 2020.
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- 2020
35. Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis The ESCAPE Randomized Clinical Trial
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Issa, Y., Kempeneers, M.A., Bruno, M.J., Fockens, P., Poley, J.W., Ali, U.A., Bollen, T.L., Busch, O.R., Dejong, C.H., Duijvendijk, P. van, Dullemen, H.M. van, Eijck, C.H. van, Goor, H. van, Hadithi, M., Haveman, J.W., Keulemans, Y., Nieuwenhuijs, V.B., Poen, A.C., Rauws, E.A., Tan, A.C., Thijs, W., Timmer, R., Witteman, B.J., Besselink, M.G., Hooft, J.E. van, Santvoort, H.C. van, Dijkgraaf, M.G., Boermeester, M.A., Honkoop, P., Thijssen, A.Y., Kooistra, T., Balkema, S., Bekkali, N., Boparai, K.S., Kager, L.M., Kloek, J.J., Takkenberg, R.B., Gouma, D.J., Gulik, T.M. van, Bemelman, W.A., Zwinderman, A.H., Bodelier, A.G.L., Seerden, T.C.J., Enckevort, C. van, Gils, N. van, Schoon, E., Vogelaar, L., Vries, R.S. de, Voorburg, A.M., Heisterkamp, J., Bezemer, G., Braat, H., Didden, P., Farahani, N., Flink, H.J., Koch, A.D., Postma, C., Putten, P.G. van, Reijnders, J.G.P., Roomer, R., Wiersema, U., Homans, G.L., Mares, W.G.N., Meiland, R., Erkelens, G.W., Maanen, H. van, Muller, G., Geenen, E. van, Perk, L.E., Raaf, J. de, Fransen, K., Hoedemaker, R., Meijssen, M.A.C., Hergelink, D.O., Munster, I.P. van, Romkes, T.E.H., Braat, A.E., Schaapherder, A.F.M., Kubben, F.J.G.M., Hoge, C., Masclee, A., Stassen, L.P.S., Brink, M.A., Vlerken, L. van, Kolkman, J.J., Venneman, N.G., Houdijk, A.P.J., Spek, B. van der, Jansen, J.M., The, O., Gerhards, M.F., Gooszen, H.G., Wilder-Smith, O., Hoekstra, J., Josemanders, D.F.G.M., Spanier, B.W.M., Boer, S.Y. de, Vries, E. de, Al-toma, A., Ramshorst, B. van, Weusten, B.L.A.M., Boerma, D., Bijlsma, A.R., Festen, E.A.M., Kerkhof, I., Kleibeuker, J.H., Kouw, E., Hofker, H.S., Ploeg, R., Beese, U., Siersema, P.D., Vleggaar, F.P., Molenaar, I.Q., Aktas, H., Guchelaar, I., Dutch Pancreatitis Study Grp, Gastroenterology & Hepatology, Surgery, RS: NUTRIM - R2 - Liver and digestive health, and MUMC+: MA Heelkunde (9)
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medicine.medical_specialty ,Randomization ,diagnosis ,SURGICAL DRAINAGE ,duodenum-preserving resection ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,duct ,GUIDELINES ,01 natural sciences ,law.invention ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Superiority Trial ,All institutes and research themes of the Radboud University Medical Center ,Quality of life ,Randomized controlled trial ,law ,Internal medicine ,medicine ,MANAGEMENT ,030212 general & internal medicine ,0101 mathematics ,Pancreatitis, chronic ,therapy ,medicine.diagnostic_test ,business.industry ,010102 general mathematics ,General Medicine ,head ,medicine.disease ,Endoscopy ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Pancreatitis ,Observational study ,business - Abstract
Importance: For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. Objective: To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. Design, Setting, and Participants: The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for ≤2 months or weak opioids for ≤6 months) were included. The 18-month follow-up period ended in March 2018. Interventions: There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. Main Outcomes and Measures: The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P =.02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P =.10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P
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- 2020
36. Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis
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Bolmers, M.D., Jonge, J de, Rossem, C.C. van, Geloven, A. A. W. van, Rosman, C., Bemelman, W.A., Bolmers, M.D., Jonge, J de, Rossem, C.C. van, Geloven, A. A. W. van, Rosman, C., and Bemelman, W.A.
- Abstract
Contains fulltext : 229842.pdf (Publisher’s version ) (Open Access), INTRODUCTION: In patients treated with an appendectomy for acute appendicitis, the specimen is generally sent for histological evaluation. In an era of increasing non-operative treatment for acute appendicitis, it is important to know the incidence, the diagnostic accuracy, and treatment consequences of appendicular neoplasms that are found in acute appendicitis. We hypothesize that pre- and intra-operative parameters might predict an appendicular neoplasm. METHODS: Data was used from our previous prospective observational cohort study. All patients undergoing surgery for suspected acute appendicitis were included. The primary outcome was the incidence of appendicular neoplasms in patients operated for acute appendicitis. Secondary outcomes were pre-operative diagnostics and imaging outcomes, intra-operative surgical judgment, and postoperative management and outcome. Possible predictors of an appendicular neoplasm were identified and used in multivariable logistic regression. Patients with an appendicular neoplasm were followed for 3 years after initial appendectomy. RESULTS: A total of 1975 patients underwent surgery for suspected acute appendicitis and in 98.3% (1941/1975) the appendix was removed. In 1.5% (30/1941) of these patients, an appendicular neoplasm was found. Among the malignant neoplasms, the majority were grade 1 neuroendocrine tumors (NET) in 65% (13/20). On pre-operative imaging, there was no suspicion of malignancy. In three cases, there was an intra-operative suspicion of malignancy. Multivariable analysis showed only age as an independent predictor for appendicular neoplasms. No recurrent or new malignancy was found during follow-up. DISCUSSION: The incidence of appendicular neoplasm in patients undergoing an acute appendectomy is very low and clinical risk factors could not be identified.
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- 2020
37. Effect of understaging on local recurrence of rectal cancer
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Giesen, L.J.X., Borstlap, W.A.A. (Wernard), Bemelman, W.A. (Willem), Tanis, P.J. (Pieter), Verhoef, C. (Kees), Olthof, P.B., Giesen, L.J.X., Borstlap, W.A.A. (Wernard), Bemelman, W.A. (Willem), Tanis, P.J. (Pieter), Verhoef, C. (Kees), and Olthof, P.B.
- Abstract
Background and Objectives: Magnetic resonance imaging of the pelvis has a limited accuracy to detect positive lymph nodes but does dictate neoadjuvant treatment in rectal cancer. This study aimed to investigate preoperative lymph node understaging and its effects on postoperative local recurrence rate. Methods: Patients were selected from a retrospective cross‐sectional snapshot study. Patients with emergency surgery, cM1 disease, or unknown cN‐ or (y)pN category were excluded. Clinical and pathologic N‐categories were compared and the impact on local recurrence was determined by multivariable analysis. Results: Out of 1548 included patients, 233 had preoperatively underestimated lymph node staging based on (y)pN category. Out of the 695 patients staged cN0, 168 (24%) had positive lymph nodes at pathology, and out of the 594 patients staged cN1, 65 (11%) were (y)pN2. Overall 3‐year local recurrence rate was 5%. Clinical N‐category was not associated with local recurrence when corrected for pT‐category, neoadjuvant therapy, and resection margin, neither in patients with
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- 2020
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38. A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer
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R.D. Blok (Robin), Hagemans, J.A.W. (Jan), Klaver, C.E.L. (Charlotte), J. Hellinga (Joke), Etten, B. (Boudewijn) van, Burger, J.W.A. (Jacobus), Verhoef, C. (Kees), R. Hompes (Roel), Bemelman, W.A. (Willem), Tanis, P.J. (Pieter), R.D. Blok (Robin), Hagemans, J.A.W. (Jan), Klaver, C.E.L. (Charlotte), J. Hellinga (Joke), Etten, B. (Boudewijn) van, Burger, J.W.A. (Jacobus), Verhoef, C. (Kees), R. Hompes (Roel), Bemelman, W.A. (Willem), and Tanis, P.J. (Pieter)
- Abstract
Objective: The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer. Background: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications. Methods: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model. Results: Fourteen studies comprising 1894 patients (n ¼ 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79–1.56), nor in planned subgroup analysis (n ¼ 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68–1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92–1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53–2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80– 1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26–2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%– 8.6%). Conclusions: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.
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- 2020
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39. Sigmoid resection with primary anastomosis versus the Hartmann’s procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis
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Lambrichts, D.P.V. (Daniël), Edomskis, P.P. (Pim P), Bogt, R.D. van der, Kleinrensink, G.J. (Gert Jan), Bemelman, W.A., Lange, J.F. (Johan), Lambrichts, D.P.V. (Daniël), Edomskis, P.P. (Pim P), Bogt, R.D. van der, Kleinrensink, G.J. (Gert Jan), Bemelman, W.A., and Lange, J.F. (Johan)
- Abstract
Purpose: The optimal surgical approach for perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV) remains debated. In recent years, accumulating evidence comparing sigmoid resection with primary anastomosis (PA) with the Hartmann’s procedure (HP) was presented. Therefore, the aim was to provide an updated and extensive synthesis of the available evidence. Methods: A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies comparing PA to HP for adult patients with Hinchey III or IV diverticulitis were included. Data on mortality, morbidity, stoma reversal, and patient-reported and cost-related outcomes were extracted. Random effects models were used to pool data and estimate odds ratios (ORs). Results: From a total of 1560 articles, four randomized controlled trials and ten observational studies were identified, reporting on 1066 Hinchey III/IV patients. Based on trial outcomes, PA was found to be favorable over HP in terms of stoma reversal rates (OR 2.62, 95% CI 1.29, 5.31) and reversal-related morbidity (OR 0.33, 95% CI 0.16, 0.69). No differences in mortality (OR 0.83, 95% CI 0.32, 2.19), morbidity (OR 0.99, 95% CI 0.65, 1.51), and reintervention rates (OR 0.90, 95% CI 0.39, 2.11) after the index procedure were demonstrated. Data on patient-reported and cost-related outcomes were scarce, as well as outcomes in PA patients with or without ileostomy construction and Hinchey IV patients. Conclusion: Although between-study heterogeneity needs to be taken into account, the present results indicate that primary anastomosis seems to be the preferred option over Hartmann’s procedure in selected patients with Hinchey III or IV diverticulitis.
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- 2020
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40. Cost-effectiveness of sigmoid resection with primary anastomosis or end colostomy for perforated diverticulitis: an analysis of the randomized Ladies trial
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Lambrichts, D.P.V. (Daniël), Van Dieren, S. (Susan), Bemelman, W.A., Lange, J.F. (Johan), Lambrichts, D.P.V. (Daniël), Van Dieren, S. (Susan), Bemelman, W.A., and Lange, J.F. (Johan)
- Abstract
Background: Several studies have been published favouring sigmoidectomy with primary anastomosis over Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis (Hinchey grade III or IV), but cost-related outcomes were rarely reported. The present study aimed to evaluate costs and cost-effectiveness within the DIVA arm of the Ladies trial. Methods: This was a cost-effectiveness analysis of the DIVA arm of the multicentre randomized Ladies trial, comparing primary anastomosis over Hartmann's procedure for Hinchey grade III or IV diverticulitis. During 12-month follow-up, data on resource use, indirect costs (Short Form Health and Labour Questionnaire) and quality of life (EuroQol Five Dimensions) were collected prospectively, and analysed according to the modified intention-to-treat principle. Main outcomes were incremental cost-effectiveness (ICER) and cost–utility (ICUR) ratios, expressed as the ratio of incremental costs and the incremental probability of being stoma-free or incremental quality-adjusted life-years respectively. Results: Overall, 130 patients were included, of whom 64 were allocated to primary anastomosis (46 and 18 with Hinchey III and IV disease respectively) and 66 to Hartmann's procedure (46 and 20 respectively). Overall mean costs per patient were lower for primary anastomosis (€20 544, 95 per cent c.i. 19 569 to 21 519) than Hartmann's procedure (€28 670, 26 636 to 30 704), with a mean difference of €–8126 (–14 660 to –1592). The ICER was €–39 094 (95 per cent bias-corrected and accelerated (BCa) c.i. –1213 to –116), indicating primary anastomosis to be more cost-effective. The ICUR was €–101 435 (BCa c.i. –1 113 264 to 251 840). Conclusion: Primary anastomosis is more cost-effective than Hartmann's procedure for perforated diverticulitis with purulent or faecal peritonitis.
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- 2020
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41. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon
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Schultz, J.K. (J. K.), Azhar, N. (N.), Binda, G.A. (G. A.), Barbara, G. (G.), Biondo, S. (S.), Boermester, M.A. (M. A.), Chabok, A. (A.), Consten, E.C. (Esther), Dijk, S.M. (Sven) van, Johanssen, A. (A.), Kruis, W. (W.), Lambrichts, D.P.V. (Daniël), Post, S. (S.), Ris, F. (F.), Rockall, T.A. (T. A.), Samuelsson, A. (A.), Di Saverio, S. (Salomone), Tartaglia, D. (D.), Thorisson, A. (A.), Winter, D.C. (D. C.), Bemelman, W.A., Angenete, E. (E.), Schultz, J.K. (J. K.), Azhar, N. (N.), Binda, G.A. (G. A.), Barbara, G. (G.), Biondo, S. (S.), Boermester, M.A. (M. A.), Chabok, A. (A.), Consten, E.C. (Esther), Dijk, S.M. (Sven) van, Johanssen, A. (A.), Kruis, W. (W.), Lambrichts, D.P.V. (Daniël), Post, S. (S.), Ris, F. (F.), Rockall, T.A. (T. A.), Samuelsson, A. (A.), Di Saverio, S. (Salomone), Tartaglia, D. (D.), Thorisson, A. (A.), Winter, D.C. (D. C.), Bemelman, W.A., and Angenete, E. (E.)
- Abstract
Aim: The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods: The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results: This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion: This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.
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- 2020
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42. Perineal wound closure using gluteal turnover flap or primary closure after abdominoperineal resection for rectal cancer: study protocol of a randomised controlled multicentre trial (BIOPEX-2 study)
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Sharabiany, S. (Sarah), Blok, R.D. (Robin D.), Lapid, O. (Oren), Hompes, R. (Roel), Bemelman, W.A. (Wilhelmus A.), Alberts, V.P., Lamme, B. (Bas), Wijsman, J.H.H. (Jan), Tuynman, J.B., Aalbers, A.G.J. (Arend), Beets, G.L. (Geerard), Fabry, H.F.J. (Hans F J), Cherepanin, I.M. (Ivan M.), Polat, F. (Fatih), Burger, J.W.A. (Jacobus), Rutten, H.J.T. (Harm), Bosker, R.J.I. (Robbert), Talsma, A.K. (Aaldert), Rothbarth, Ph.H. (Philip), Verhoef, C. (Kees), Van De Ven, A. (Anthony), van der Bilt, J.D.W. (Jarmila D.W.), Graaf, E.J.R. (Eelco) de, Doornebosch, P. (Pascal), Leijtens, J.W.A. (Jeroen), Heemskerk, J., Singh, B. (Baljit), Chaudhri, S. (Sanjay), Gerhards, M.F. (Michael), Karsten, T.M. (Thomas), Wilt, J.H.W. (Johannes) de, Bremers, A.J.A. (Andreas), Vuylsteke, R.J.C.L.M. (Ronald J C L M), Heuff, G. (Gijsbert), Geloven, A.A. (Anna) van, Tanis, P.J. (Pieter), Musters, G.D. (Gijsbert), Sharabiany, S. (Sarah), Blok, R.D. (Robin D.), Lapid, O. (Oren), Hompes, R. (Roel), Bemelman, W.A. (Wilhelmus A.), Alberts, V.P., Lamme, B. (Bas), Wijsman, J.H.H. (Jan), Tuynman, J.B., Aalbers, A.G.J. (Arend), Beets, G.L. (Geerard), Fabry, H.F.J. (Hans F J), Cherepanin, I.M. (Ivan M.), Polat, F. (Fatih), Burger, J.W.A. (Jacobus), Rutten, H.J.T. (Harm), Bosker, R.J.I. (Robbert), Talsma, A.K. (Aaldert), Rothbarth, Ph.H. (Philip), Verhoef, C. (Kees), Van De Ven, A. (Anthony), van der Bilt, J.D.W. (Jarmila D.W.), Graaf, E.J.R. (Eelco) de, Doornebosch, P. (Pascal), Leijtens, J.W.A. (Jeroen), Heemskerk, J., Singh, B. (Baljit), Chaudhri, S. (Sanjay), Gerhards, M.F. (Michael), Karsten, T.M. (Thomas), Wilt, J.H.W. (Johannes) de, Bremers, A.J.A. (Andreas), Vuylsteke, R.J.C.L.M. (Ronald J C L M), Heuff, G. (Gijsbert), Geloven, A.A. (Anna) van, Tanis, P.J. (Pieter), and Musters, G.D. (Gijsbert)
- Abstract
BACKGROUND: Abdominoperineal resection (APR) for rectal cancer is associated with high morbidity of the perineal wound, and controversy exists about the optimal closure technique. Primary perineal wound closure is still the standard of care in the Netherlands. Biological mesh closure did not improve wound healing in our previous randomised controlled trial (BIOPEX-study). It is suggested, based on meta-analysis of cohort studies, that filling of the perineal defect with well-vascularised tissue improves perineal wound healing. A gluteal turnover flap seems to be a promising method for this purpose, and with the advantage of not having a donor site scar. The aim of this study is to investigate whether a gluteal turnover flap improves the uncomplicated perineal wound healing after APR for rectal cancer. METHODS: Patients with primary or recurrent rectal cancer who are planned for APR will be considered eligible in this multicentre randomised controlled trial. Exclusion criteria are total exenteration, sacral resection above S4/S5, intersphincteric APR, biological mesh closure of the pelvic floor, collagen disorders, and severe systemic diseases. A total of 160 patients will be randomised between gluteal turnover flap (experimental arm) and primary closure (control arm). The total follow-up duration is 12 months, and outcome assessors and patients will be blinded for type of perineal wound closure. The primary outcome is the percentage of uncomplicated perineal wound healing on day 30, defined as a Southampton wound score of less than two. Secondary outcomes include time to perineal wound closure, incidence of perineal hernia, the number, duration and nature of the complications, re-interventions, quality of life and urogenital function. DISCUSSION: The uncomplicated perineal wound healing rate is expected to increase from 65 to 85% by using the gluteal turnover flap. With proven effectiveness, a quick implementation of this relatively simple surgical technique is expe
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- 2020
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43. Discrepancies between Intraoperative and Histological Evaluation of the Appendix in Acute Appendicitis
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Bolmers, M.D., Jonge, J de, Rossem, C.C. van, Geloven, A. A. W. van, Rosman, C., Bemelman, W.A., Bolmers, M.D., Jonge, J de, Rossem, C.C. van, Geloven, A. A. W. van, Rosman, C., and Bemelman, W.A.
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Contains fulltext : 226478.pdf (Publisher’s version ) (Closed access), PURPOSE: To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome. METHODS: Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery. RESULTS: A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)). CONCLUSIONS: There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved f
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- 2020
44. Decompressing Stoma a s Bridge to Elective Surgery is an Effective Strategy for Left-sided Obstructive Colon Cancer: A National, Propensity-score Matched Study
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Veld, J.V., Amelung, F.J., Borstlap, W.A.A., Halsema, E.E. van, Consten, E.C., Dekker, J.W.T., Siersema, P.D., Borg, F. ter, Zaag, E.S. van der, Fockens, P., Bemelman, W.A., Wilt, J.H.W. de, Hooft, Jeanin E. van, Tanis, P.J., Veld, J.V., Amelung, F.J., Borstlap, W.A.A., Halsema, E.E. van, Consten, E.C., Dekker, J.W.T., Siersema, P.D., Borg, F. ter, Zaag, E.S. van der, Fockens, P., Bemelman, W.A., Wilt, J.H.W. de, Hooft, Jeanin E. van, and Tanis, P.J.
- Abstract
Contains fulltext : 229393.pdf (Publisher’s version ) (Closed access), OBJECTIVE: The purpose of this population-based study was to compare decompressing stoma (DS) as bridge to surgery (BTS) with emergency resection (ER) for left-sided obstructive colon cancer (LSOCC) using propensity-score matching. SUMMARY BACKGROUND DATA: Recently, an increased use of DS as BTS for LSOCC has been observed in the Netherlands. Unfortunately, good quality comparative analyses with ER are scarce. METHODS: Patients diagnosed with nonlocally advanced LSOCC between 2009 and 2016 in 75 Dutch hospitals, who underwent DS or ER in the curative setting, were propensity-score matched in a 1:2 ratio. The primary outcome measure was 90-day mortality, and main secondary outcomes were 3-year overall survival and permanent stoma rate. RESULTS: Of 2048 eligible patients, 236 patients who underwent DS were matched with 472 patients undergoing ER. After DS, more laparoscopic resections were performed (56.8% vs 9.2%, P < 0.001) and more primary anastomoses were constructed (88.5% vs 40.7%, P < 0.001). DS resulted in significantly lower 90-day mortality compared to ER (1.7% vs 7.2%, P = 0.006), and this effect could be mainly attributed to the subgroup of patients over 70 years (3.5% vs 13.7%, P = 0.027). Patients treated with DS as BTS had better 3-year overall survival (79.4% vs 73.3%, hazard ratio 0.36, 95% confidence interval 0.20-0.65) and fewer permanent stomas (23.4% vs 42.4%, P < 0.001). CONCLUSIONS: In this nationwide propensity-score matched study, DS as a BTS for LSOCC was associated with lower 90-day mortality and better 3-year overall survival compared to ER, especially in patients over 70 years of age.
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- 2020
45. International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits
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Detering, R., Saraste, D., Babberich, M.P.M.D.T., Dekker, J.W.T., Wouters, M.W.J.M., Geloven, A.A.W. van, Bemelman, W.A., Tanis, P.J., Martling, A., Westerterp, M., Aalbers, A., Beets-Tan, R., Boer, F. den, Breukink, S., Coene, P.P., Doornebosch, P., Gelderblom, H., Karsten, T., Ledeboer, M., Manusama, E., Marijnen, C., Nagtegaal, I., Peeters, K., Tollenaar, R., Velde, C. van de, Wagner, A., Westreenen, E. van, Swedish ColoRectal Canc Registry, Dutch ColoRectal Audit, Graduate School, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Gastroenterology and Hepatology, Surgery, MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health
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INVOLVEMENT ,medicine.medical_specialty ,Surgical margin ,EUROPE ,Colorectal cancer ,SURGERY ,EXTRALEVATOR ABDOMINOPERINEAL EXCISION ,Rectal neoplasms ,Disease ,Audit ,Logistic regression ,Resection ,COLORECTAL-CANCER ,03 medical and health sciences ,0302 clinical medicine ,All institutes and research themes of the Radboud University Medical Center ,Internal medicine ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Humans ,Medicine ,EPIDEMIOLOGY ,Stage (cooking) ,Neoplasm Staging ,Retrospective Studies ,PREOPERATIVE RADIOTHERAPY ,Netherlands ,Sweden ,Proctectomy ,Neoplasia ,business.industry ,STATEMENT ,TOTAL MESORECTAL EXCISION ,Gastroenterology ,Margins of Excision ,Original Articles ,medicine.disease ,surgical margin ,Colorectal surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,SURVIVAL ,Original Article ,030211 gastroenterology & hepatology ,colorectal surgery ,business ,hospitals - Abstract
Aim This study aimed to determine predictive factors for the circumferential resection margin (CRM) within two northern European countries with supposed similarity in providing rectal cancer care. Method Data for all patients undergoing rectal resection for clinical tumour node metastasis (TNM) stage I–III rectal cancer were extracted from the Swedish ColoRectal Cancer Registry and the Dutch ColoRectal Audit (2011–2015). Separate analyses were performed for cT1–3 and cT4 stage. Predictive factors for the CRM were determined using univariable and multivariable logistic regression analyses. Results A total of 6444 Swedish and 12 089 Dutch patients were analysed. Over time the number of hospitals treating rectal cancer decreased from 52 to 42 in Sweden, and 82 to 79 in the Netherlands. In the Swedish population, proportions of cT4 stage (17% vs 8%), multivisceral resection (14% vs 7%) and abdominoperineal excision (APR) (37% vs 31%) were higher. The overall proportion of patients with a positive CRM (CRM+) was 7.8% in Sweden and 5.4% in the Netherlands. In both populations with cT1–3 stage disease, common independent risk factors for CRM+ were cT3, APR and multivisceral resection. No common risk factors for CRM+ in cT4 stage disease were found. An independent impact of hospital volume on CRM+ could be demonstrated for the cT1–3 Dutch population. Conclusion Within two northern European countries with implemented clinical auditing, rectal cancer care might potentially be improved by further optimizing the treatment of distal and locally advanced rectal cancer.
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- 2019
46. Laparoscopic Vascular Surgery: A Systematic Review
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Nio, D., Diks, J., Bemelman, W.A., Wisselink, W., and Legemate, D.A.
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- 2007
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47. A systematic review on the significance of extracapsular lymph node involvement in gastrointestinal malignancies
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Wind, J., Lagarde, S.M., ten Kate, F.J.W., Ubbink, D.T., Bemelman, W.A., and van Lanschot, J.J.B.
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- 2007
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48. Randomised controlled trial of transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND Study)
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Barendse, R.M., Musters, G.D., Graaf, E.J.R. de, Broek, F.J.C. van den, Consten, E.C.J., Doornebosch, P.G., Hardwick, J.C., Hingh, I.H.J.T. de, Hoff, C., Jansen, J.M., Wit, A.W.M.V. de, Schelling, G.P. van der, Schoon, E.J., Schwartz, M.P., Weusten, B.L.A.M., Dijkgraaf, M.G., Fockens, P., Bemelman, W.A., Dekker, E., TREND Study Grp, CCA - Cancer Treatment and quality of life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Surgery, CCA - Cancer Treatment and Quality of Life, Other departments, Gastroenterology and Hepatology, APH - Methodology, Clinical Research Unit, and APH - Quality of Care
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Adenoma ,Male ,Transanal Endoscopic Microsurgery ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,Cost effectiveness ,medicine.medical_treatment ,Cost-Benefit Analysis ,health care facilities, manpower, and services ,Endoscopic mucosal resection ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Belgium ,law ,health services administration ,Medicine ,Humans ,Major complication ,health care economics and organizations ,Aged ,Netherlands ,business.industry ,Rectal Neoplasms ,Gastroenterology ,Cancer ,Microsurgery ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Quality of Life ,030211 gastroenterology & hepatology ,Female ,Neoplasm Recurrence, Local ,Complication ,business ,Precancerous Conditions ,Follow-Up Studies - Abstract
ObjectiveNon-randomised studies suggest that endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM), but EMR might be more cost-effective and safer. This trial compares the clinical outcome and cost-effectiveness of TEM and EMR for large rectal adenomas.DesignPatients with rectal adenomas ≥3 cm, without malignant features, were randomised (1:1) to EMR or TEM, allowing endoscopic removal of residual adenoma at 3 months. Unexpected malignancies were excluded postrandomisation. Primary outcomes were recurrence within 24 months (aiming to demonstrate non-inferiority of EMR, upper limit 10%) and the number of recurrence-free days alive and out of hospital.ResultsTwo hundred and four patients were treated in 18 university and community hospitals. Twenty-seven (13%) had unexpected cancer and were excluded from further analysis. Overall recurrence rates were 15% after EMR and 11% after TEM; statistical non-inferiority was not reached. The numbers of recurrence-free days alive and out of hospital were similar (EMR 609±209, TEM 652±188, p=0.16). Complications occurred in 18% (EMR) versus 26% (TEM) (p=0.23), with major complications occurring in 1% (EMR) versus 8% (TEM) (p=0.064). Quality-adjusted life years were equal in both groups. EMR was approximately €3000 cheaper and therefore more cost-effective.ConclusionUnder the statistical assumptions of this study, non-inferiority of EMR could not be demonstrated. However, EMR may have potential as the primary method of choice due to a tendency of lower complication rates and a better cost-effectiveness ratio. The high rate of unexpected cancers should be dealt with in further studies.
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- 2018
49. Live donor nephrectomy and return to work
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Lind, M.Y., Liem, Y.S., Bemelman, W.A., Dooper, P.M.M., Hop, W.C.J., Weimar, W., and IJzermans, J.N.M.
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- 2003
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50. Efficiency of manual versus robotical (Zeus) assisted laparoscopic surgery in the performance of standardized tasks
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Nio, D., Bemelman, W.A., Boer, K.T., Dunker, M.S., Gouma, D.J., and Gulik, T.M.
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- 2002
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