46 results on '"Dikken, J.L."'
Search Results
2. Time interval between neoadjuvant chemoradiotherapy and surgery for oesophageal or junctional cancer: A nationwide study
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Bosscha, K., van Grieken, N.C.T., Hartgrink, H.H., van Hillegersberg, R., Lemmens, V.E.P.P., Plukker, J.T., Rosman, C., van Sandick, J.W., Siersema, P.D., Tetteroo, G., Veldhuis, P.M.J.F., Voncken, F.E.M., van der Werf, L.R., Dikken, J.L., van der Willik, E.M., van Berge Henegouwen, M.I., Nieuwenhuijzen, G.A.P., and Wijnhoven, B.P.L.
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- 2018
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3. Common data items in seven European oesophagogastric cancer surgery registries: Towards a European Upper GI cancer audit (EURECCA Upper GI)
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de Steur, W.O., Henneman, D., Allum, W.H., Dikken, J.L., van Sandick, J.W., Reynolds, J., Mariette, C., Jensen, L., Johansson, J., Kolodziejczyk, P., Hardwick, R.H., and van de Velde, C.J.H.
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- 2014
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4. Conventional regression analysis and machine learning in prediction of anastomotic leakage and pulmonary complications after esophagogastric cancer surgery
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Kooten, R.T. van, Bahadoer, R.R., Vries, B.T. de, Wouters, M.W.J.M., Tollenaar, R.A.E.M., Hartgrink, H.H., Putter, H., and Dikken, J.L.
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Esophageal Neoplasms ,complications ,Anastomotic Leak ,General Medicine ,mortality ,Postoperative Complications ,machine learning ,Oncology ,Stomach Neoplasms ,Humans ,Regression Analysis ,cancer ,risk factors ,Surgery ,upper gastrointestinal surgery ,Retrospective Studies - Abstract
Background and Objectives: With the current advanced data-driven approach to health care, machine learning is gaining more interest. The current study investigates the added value of machine learning to linear regression in predicting anastomotic leakage and pulmonary complications after upper gastrointestinal cancer surgery. Methods: All patients in the Dutch Upper Gastrointestinal Cancer Audit undergoing curatively intended esophageal or gastric cancer surgeries from 2011 to 2017 were included. Anastomotic leakage was defined as any clinically or radiologically proven anastomotic leakage. Pulmonary complications entailed: pneumonia, pleural effusion, respiratory failure, pneumothorax, and/or acute respiratory distress syndrome. Different machine learning models were tested. Nomograms were constructed using Least Absolute Shrinkage and Selection Operator. Results: Between 2011 and 2017, 4228 patients underwent surgical resection for esophageal cancer, of which 18% developed anastomotic leakage and 30% a pulmonary complication. Of the 2199 patients with surgical resection for gastric cancer, 7% developed anastomotic leakage and 15% a pulmonary complication. In all cases, linear regression had the highest predictive value with the area under the curves varying between 61.9 and 68.0, but the difference with machine learning models did not reach statistical significance. Conclusion: Machine learning models can predict postoperative complications in upper gastrointestinal cancer surgery, but they do not outperform the current gold standard, linear regression
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- 2022
5. Preoperative chemotherapy does not influence the number of evaluable lymph nodes in resected gastric cancer
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Dikken, J.L., van Grieken, N.C.T., Krijnen, P., Gönen, M., Tang, L.H., Cats, A., Verheij, M., Brennan, M.F., van de Velde, C.J.H., and Coit, D.G.
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- 2012
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6. International comparison of treatment strategy and survival in metastatic gastric cancer
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Claassen, Y.H.M., Bastiaannet, E., Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Slingerland, M., Verhoeven, R.H.A., Eycken, E. van, Schutter, H. de, Lindblad, M., Hedberg, J., Johnson, E., Hjortland, G.O., Jensen, L.S., Larsson, H.J., Koessler, T., Chevallay, M., Allum, W.H., Velde, C.J.H. van de, Oncology, and CCA - Cancer Treatment and Quality of Life
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Adult ,Aged, 80 and over ,Male ,Cancer och onkologi ,Antineoplastic Agents ,Original Articles ,Middle Aged ,Survival Analysis ,Drug Utilization ,Europe ,Gastrectomy ,Stomach Neoplasms ,Cancer and Oncology ,Humans ,Original Article ,Female ,Registries ,Neoplasm Metastasis ,Aged - Abstract
Background: In the randomized Asian REGATTA trial, no survival benefit was shown for additional gastrectomy over chemotherapy alone in patients with advanced gastric cancer with a single incurable factor, thereby discouraging surgery for these patients. The purpose of this study was to evaluate treatment strategies for patients with metastatic gastric cancer in daily practice in five European countries, along with relative survival in each country. Methods: Nationwide population‐based data from Belgium, Denmark, the Netherlands, Norway and Sweden were combined. Patients with primary metastatic gastric cancer diagnosed between 2006 and 2014 were included. The proportion of gastric resections performed and the administration of chemotherapy (irrespective of surgery) within each country were determined. Relative survival according to country was calculated. Results: Overall, 15 057 patients with gastric cancer were included. The proportion of gastric resections varied from 8·1 per cent in the Netherlands and Denmark to 18·3 per cent in Belgium. Administration of chemotherapy was 39·2 per cent in the Netherlands, compared with 63·2 per cent in Belgium. The 6‐month relative survival rate was between 39·0 (95 per cent c.i. 37·8 to 40·2) per cent in the Netherlands and 54·1 (52·1 to 56·9) per cent in Belgium. Conclusion: There is variation in the use of gastrectomy and chemotherapy in patients with metastatic gastric cancer, and subsequent differences in survival.
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- 2019
7. International benchmarking in oesophageal and gastric cancer surgery
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Busweiler, L.A.D., Jeremiasen, M., Wijnhoven, B.P.L., Lindblad, M., Lundell, L., Velde, C.J.H. van de, Tollenaar, R.A.E.M., Wouters, M.W.J.M., Sandick, J.W. van, Johansson, J., Dikken, J.L., and Surgery
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SDG 3 - Good Health and Well-being - Published
- 2019
8. Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial
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Claassen, Y.H.M., Hartgrink, H.H., Steur, W.O. de, Dikken, J.L., Sandick, J.W. van, Grieken, N.C. van, Cats, A., Trip, A.K., Jansen, E.P.M., Kranenbarg, W.M.M., Braak, J., Putter, H., Henegouwen, M.I. van Berge, Verheij, M., Velde, C.J. van de, Claassen, Y.H.M., Hartgrink, H.H., Steur, W.O. de, Dikken, J.L., Sandick, J.W. van, Grieken, N.C. van, Cats, A., Trip, A.K., Jansen, E.P.M., Kranenbarg, W.M.M., Braak, J., Putter, H., Henegouwen, M.I. van Berge, Verheij, M., and Velde, C.J. van de
- Abstract
Contains fulltext : 203168.pdf (publisher's version ) (Open Access), BACKGROUND: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1-9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. METHODS: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of >/= 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the 'Maruyama Index of Unresected disease' (MI) was evaluated in both study arms, and validated with overall survival. RESULTS: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8% vs 70.9%, P = 0.324), surgical compliance (43.2% vs 39.2%, P = 0.381), and surgical contamination (59.4% vs 59.9%, P = 0.567). Median MI was 1 in both groups (range CT 0-88 and CRT 0-136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). CONCLUSION: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.
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- 2019
9. Effect of Hospital Volume With Respect to Performing Gastric Cancer Resection on Recurrence and Survival Results From the CRITICS Trial
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Claassen, Y.H.M., Amelsfoort, R.M. van, Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Sandick, J.W. van, Verheij, M., Velde, C.J. van de, Claassen, Y.H.M., Amelsfoort, R.M. van, Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Sandick, J.W. van, Verheij, M., and Velde, C.J. van de
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Item does not contain fulltext
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- 2019
10. International benchmarking in oesophageal and gastric cancer surgery
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Busweiler, L.A.D. (Linde), Jeremiasen, M., Wijnhoven, B.P.L. (Bas), Lindblad, M., Lundell, L. (Lars), Velde, C.J.H. (Cornelis) van de, Tollenaar, R.A.E.M. (Robertus A. E. M.), Wouters, M.W.J.M. (Michel), Sandick, J.W. (J.) van, Johansson, J. (Johan), Dikken, J.L. (Johan), Busweiler, L.A.D. (Linde), Jeremiasen, M., Wijnhoven, B.P.L. (Bas), Lindblad, M., Lundell, L. (Lars), Velde, C.J.H. (Cornelis) van de, Tollenaar, R.A.E.M. (Robertus A. E. M.), Wouters, M.W.J.M. (Michel), Sandick, J.W. (J.) van, Johansson, J. (Johan), and Dikken, J.L. (Johan)
- Abstract
Background: Benchmarking on an international level might lead to improved outcomes at a national level. The aim of this study was to compare treatment and surgical outcome data from the Swedish National Register for Oesophageal and Gastric Cancer (NREV) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Methods: All patients with primary oesophageal or gastric cancer who underwent a resection and were registered in NREV or DUCA between 2012 and 2014 were included. Differences in 30-day mortality were analysed using case mix-adjusted multivariable logistic regression. Results: In total, 4439 patients underwent oesophagectomy (2509 patients) or gastrectomy (1930 patients). Estimated resection rates were comparable. Swedish patients were older but had less advanced disease and less co-morbidity than Dutch patients. Neoadjuvant treatment rates were lower in Sweden than in the Netherlands, both for patients who underwent oesophagectomy (68⋅6 versus 90⋅0 per cent respectively; P < 0⋅001) and for those having gastrectomy (38⋅3 versus 56⋅6 per cent; P < 0⋅001). In Sweden, transthoracic oesophagectomy was performed in 94⋅7 per cent of patients, whereas in the Netherlands, a transhiatal approach was undertaken in 35⋅8 per cent. Higher annual procedural volumes per hospital were observed in the Netherlands. Adjusted 30-day and/or in-hospital mortality after gastrectomy was statistically significantly lower in Sweden than in the Netherlands (odds ratio 0⋅53, 95 per cent c.i. 0⋅29 to 0⋅95). Conclusion: For oesophageal and gastric cancer, there are dif
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- 2019
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11. A Population-based Study on Lymph Node Retrieval in Patients with Esophageal Cancer: Results from the Dutch Upper Gastrointestinal Cancer Audit
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Werf, L.R. van der, Dikken, J.L., Berge Henegouwen, M.I. van, Lemmens, V., Nieuwenhuijzen, G.A., Wijnhoven, B.P., Siersema, P.D., Rosman, C., Veldhuis, P.M., Voncken, F.E., Surgery, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Pathology, CCA - Cancer biology and immunology, CCA - Imaging and biomarkers, and VU University medical center
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Male ,Esophageal Neoplasms ,medicine.medical_treatment ,Comorbidity ,030230 surgery ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Hospital Mortality ,Child ,Lymph node ,Neoadjuvant therapy ,Netherlands ,Medical Audit ,education.field_of_study ,ASO Author Reflections ,Middle Aged ,Esophageal cancer ,Neoadjuvant Therapy ,medicine.anatomical_structure ,Oncology ,Chemotherapy, Adjuvant ,Esophagectomy ,Child, Preschool ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Female ,Radiology ,Adult ,medicine.medical_specialty ,Adolescent ,Population ,Young Adult ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Weight Loss ,medicine ,Humans ,education ,Aged ,Quality of Health Care ,Retrospective Studies ,business.industry ,Carcinoma ,Infant, Newborn ,Infant ,Retrospective cohort study ,Chemoradiotherapy, Adjuvant ,Odds ratio ,medicine.disease ,Lymph Node Excision ,Surgery ,Lymph Nodes ,business ,Hospitals, High-Volume ,Chemoradiotherapy - Abstract
Contains fulltext : 193343.pdf (Publisher’s version ) (Open Access) BACKGROUND: For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. STUDY DESIGN: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with >/= 15 LNs. PATIENTS AND RESULTS: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with >/= 15 LNs were: 0-10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57-0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63-0.92]), cN2 category (reference: cN0, 1.32 [1.05-1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29-2.32] and 2.15 [1.54-3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15-1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23-0.36] and 0.43 [0.32-0.59]), hospital volume of 26-50 or > 50 resections/year (reference: 0-25, 1.94 [1.55-2.42] and 3.01 [2.36-3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of >/= 15 LNs with short-term outcomes. CONCLUSIONS: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yield. Retrieval of >/= 15 LNs was not associated with increased postoperative morbidity/mortality.
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- 2018
12. Time interval between neoadjuvant chemoradiotherapy and surgery for oesophageal or junctional cancer: A nationwide study
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Werf, L.R. van der, Dikken, J.L., Willik, E.M. van der, Berge Henegouwen, M.I. van, Nieuwenhuijzen, G.A., Wijnhoven, B.P., Siersema, P.D., Rosman, C., Veldhuis, P.M., Voncken, F.E., Werf, L.R. van der, Dikken, J.L., Willik, E.M. van der, Berge Henegouwen, M.I. van, Nieuwenhuijzen, G.A., Wijnhoven, B.P., Siersema, P.D., Rosman, C., Veldhuis, P.M., and Voncken, F.E.
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Contains fulltext : 193307.pdf (publisher's version ) (Closed access), INTRODUCTION: The optimal time between end of neoadjuvant chemoradiotherapy (nCRT) and oesophagectomy is unknown. The aim of this study was to assess the association between this interval and pathologic complete response rate (pCR), morbidity and 30-day/in-hospital mortality. METHODS: Patients with oesophageal cancer treated with nCRT and surgery between 2011 and 2016 were selected from a national database: the Dutch Upper Gastrointestinal Cancer Audit (DUCA). The interval between end of nCRT and surgery was divided into six periods: 0-5 weeks (n = 157;A), 6-7 weeks (n = 878;B), 8-9 weeks (n = 972;C), 10-12 weeks (n = 720;D), 13-14 weeks (n = 195;E) and 15 or more weeks (n = 180;F). The association between these interval groups and outcomes was investigated using univariable and multivariable analysis with group C (8-9 weeks) as reference. RESULTS: In total, 3102 patients were included. The pCR rate for the groups A to F was 31%, 28%, 26%, 31%, 40% and 37%, respectively. A longer interval was associated with a higher probability of pCR (>/=10 weeks for adenocarcinoma: odds ratio [95% confidence interval]: 1.35 [1.00-1.83], 1.95 [1.24-3.07], 1.64 [0.99-2.71] and >/=13 weeks for squamous cell carcinoma: 2.86 [1.23-6.65], 2.67 [1.29-5.55]. Patients operated >/=10 weeks after nCRT had the same probability for intraoperative/postoperative complications. Patients from groups D and F had a higher 30-day/in-hospital mortality (1.80 [1.08-3.00], 3.19 [1.66-6.14]). CONCLUSION: An interval of >/=10 weeks for adenocarcinoma and >/=13 weeks for squamous cell carcinoma between nCRT and oesophagectomy was associated with a higher probability of having a pCR. Longer intervals were not associated with intraoperative/postoperative complications. The 30-day/in-hospital mortality was higher in patients with extended intervals (10-12 and >/=15 weeks); however, this might have been due to residual confounding.
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- 2018
13. Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial
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Claassen, Y.H.M., Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Sandick, J.W. van, Grieken, N.C. van, Cats, A., Trip, A.K., Jansen, E.P.W.A., Meershoek-Klein Kranenbarg, W.M., Braak, J., Putter, H., Berge Henegouwen, M.I. van, Verheij, M., Velde, C.J. van de, Claassen, Y.H.M., Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Sandick, J.W. van, Grieken, N.C. van, Cats, A., Trip, A.K., Jansen, E.P.W.A., Meershoek-Klein Kranenbarg, W.M., Braak, J., Putter, H., Berge Henegouwen, M.I. van, Verheij, M., and Velde, C.J. van de
- Abstract
Item does not contain fulltext, BACKGROUND: In order to determine the optimal combination of perioperative chemotherapy and chemoradiotherapy for Western patients with advanced resectable gastric cancer, the international multicentre CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) was initiated. In this trial, patients with resectable gastric cancer were randomised before start of treatment between adjuvant chemotherapy or adjuvant chemoradiotherapy following neoadjuvant chemotherapy plus gastric cancer resection. The purpose of this study was to report on surgical morbidity and mortality in this trial, and to identify factors associated with surgical morbidity. METHODS: Patients who underwent a gastrectomy with curative intent were selected. Logistic regression analyses were used to assess risk factors for developing postoperative complications. RESULTS: Between 2007 and 2015, 788 patients were included in the CRITICS trial, of whom 636 patients were eligible for current analyses. Complications occurred in 296 patients (47%). Postoperative mortality was 2.2% (n = 14). Complications due to anastomotic leakage was cause of death in 5 patients. Failure to complete preoperative chemotherapy (OR = 2.09, P = 0.004), splenectomy (OR = 2.82, P = 0.012), and male sex (OR = 1.55, P = 0.020) were associated with a greater risk for postoperative complications. Total gastrectomy and oesophago-cardia resection were associated with greater risk for morbidity compared with subtotal gastrectomy (OR = 1.88, P = 0.001 and OR = 1.89, P = 0.038). CONCLUSION: Compared to other Western studies, surgical morbidity in the CRITICS trial was slightly higher whereas mortality was low. Complications following anastomotic leakage was the most important factor for postoperative mortality. Important proxies for developing postoperative complications were failure to complete preoperative chemotherapy, splenectomy, male sex, total gastrectomy, and oesophago-cardia resection.
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- 2018
14. Surgicopathological Quality Control and Protocol Adherence to Lymphadenectomy in the CRITICS Gastric Cancer Trial
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Claassen, Y.H.M., Steur, W.O. de, Hartgrink, H.H., Dikken, J.L., Sandick, J.W. van, Grieken, N.C. van, Cats, A., Trip, A.K., Jansen, E.P.M., Kranenbarg, W.M.M., Braak, J., Putter, H., Berge Henegouwen, M.I. van, Verheij, M., Velde, C.J. van de, Claassen, Y.H.M., Steur, W.O. de, Hartgrink, H.H., Dikken, J.L., Sandick, J.W. van, Grieken, N.C. van, Cats, A., Trip, A.K., Jansen, E.P.M., Kranenbarg, W.M.M., Braak, J., Putter, H., Berge Henegouwen, M.I. van, Verheij, M., and Velde, C.J. van de
- Abstract
Item does not contain fulltext, OBJECTIVE: The purpose of this study was to evaluate surgicopathological quality and protocol adherence for lymphadenectomy in the CRITICS trial. SUMMARY OF BACKGROUND DATA: Surgical quality assurance is a key element in multimodal studies for gastric cancer. In the multicenter CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients with resectable gastric cancer were randomized for preoperative chemotherapy, followed by gastrectomy with a D1+ lymphadenectomy (removal of stations 1 to 9 and 11), followed by either chemotherapy or chemoradiotherapy. METHODS: Surgicopathological compliance was defined as removal of >/=15 lymph nodes. Surgical compliance was defined as removal of the indicated lymph node stations. Surgical contamination was defined as removal of lymph node stations that should be left in situ. The Maruyama Index (MI, lower is better), which has proven to be an indicator of surgical quality and is strongly associated with survival, was analyzed. RESULTS: Between 2007 and 2015, 788 patients were randomized, of whom 636 patients underwent a gastrectomy with curative intent. Surgicopathological compliance occurred in 72.8% (n = 460) of the patients and improved from 55.0% (2007) to 90.0% (2015). Surgical compliance occurred in 41.1% (n = 256). Surgical contamination occurred in 59.6% (n = 371). Median MI was 1 (range 0 to 136). CONCLUSION: Surgical quality in the CRITICS trial was excellent, with a MI of 1. Surgicopathological compliance improved over the years. This might be explained by the quality assurance program within the study and centralization of gastric cancer surgery in the Netherlands.
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- 2018
15. Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial
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Claassen, Y.H.M., Sandick, J.W. van, Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Grieken, N.C. van, Boot, H., Cats, A., Trip, A.K., Jansen, E.P.M., Meershoek-Klein Kranenbarg, W.M., Braak, J., Putter, H., Berge Henegouwen, M.I. van, Verheij, M., Velde, C.J. van de, Claassen, Y.H.M., Sandick, J.W. van, Hartgrink, H.H., Dikken, J.L., Steur, W.O. de, Grieken, N.C. van, Boot, H., Cats, A., Trip, A.K., Jansen, E.P.M., Meershoek-Klein Kranenbarg, W.M., Braak, J., Putter, H., Berge Henegouwen, M.I. van, Verheij, M., and Velde, C.J. van de
- Abstract
Item does not contain fulltext, BACKGROUND: Studies investigating the association between hospital volume and quality of gastric cancer surgery are lacking. In the present study, the effect of hospital volume on quality of gastric cancer surgery was evaluated by analysing data from the CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial. METHODS: Patients who underwent gastrectomy with curative intent in the Netherlands were selected from the CRITICS trial database. Annual hospital volume of participating centres was derived from the Netherlands Cancer Registry. Hospital volume was categorized into very low (1-10 gastrectomies per year per institution), low (11-20), medium (21-30) and high (31 or more), and linked to the CRITICS database. Quality of surgery was analysed by surgicopathological compliance (removal of at least 15 lymph nodes), surgical compliance (removal of indicated lymph node stations) and the Maruyama Index. Postoperative morbidity and mortality were also compared between hospital categories. RESULTS: Between 2007 and 2015, 788 patients were included in the CRITICS study, of whom 494 were analysed. Surgicopathological compliance was higher (86.7 versus 50.4 per cent; P < 0.001), surgical compliance was greater (52.9 versus 19.8 per cent; P < 0.001) and median Maruyama Index was lower (0 versus 6; P = 0.006) in high-volume hospitals compared with very low-volume hospitals. There was no statistically significant difference in postoperative complications or mortality between the hospital volume categories. CONCLUSION: Surgery performed in high-volume hospitals was associated with better surgical quality than surgery carried out in lower-volume hospitals.
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- 2018
16. A Population-based Study on Lymph Node Retrieval in Patients with Esophageal Cancer: Results from the Dutch Upper Gastrointestinal Cancer Audit
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van der Werf, L.R. (L. R.), Dikken, J.L. (Johan), van Berge Henegouwen, M.I., Lemmens, V.E.P.P. (Valery), Nieuwenhuijzen, G.A.P. (Gerard), Wijnhoven, B.P.L. (Bas), Bosscha, K. (Koop), Grieken, N.C.T. (Nicole), Hartgrink, H.H. (H. H.), Hillegersberg, R. (Richard) van, Lemmens, V.E.P.P. (V. E.P.P.), Plukker, J.T. (John), Rosman, C. (Camiel), Sandick, J.W. (J.) van, Siersema, P.D. (Peter), Tetteroo, G.W.M. (Geert), Veldhuis, P.M.J.F. (P. M.J.F.), Voncken, F.E.M. (F. E.M.), van der Werf, L.R. (L. R.), Dikken, J.L. (Johan), van Berge Henegouwen, M.I., Lemmens, V.E.P.P. (Valery), Nieuwenhuijzen, G.A.P. (Gerard), Wijnhoven, B.P.L. (Bas), Bosscha, K. (Koop), Grieken, N.C.T. (Nicole), Hartgrink, H.H. (H. H.), Hillegersberg, R. (Richard) van, Lemmens, V.E.P.P. (V. E.P.P.), Plukker, J.T. (John), Rosman, C. (Camiel), Sandick, J.W. (J.) van, Siersema, P.D. (Peter), Tetteroo, G.W.M. (Geert), Veldhuis, P.M.J.F. (P. M.J.F.), and Voncken, F.E.M. (F. E.M.)
- Abstract
Background: For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. Study Design: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with ≥ 15 LNs. Patients and Results: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57–0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63–0.92]), cN2 category (reference: cN0, 1.32 [1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29–2.32] and 2.15 [1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23–0.36] and 0.43 [0.32–0.59]), hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94 [1.55–2.42] and 3.01 [2.36–3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of ≥ 15 LNs with short-term outcomes. Conclusions: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yiel
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- 2018
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17. Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial
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Claassen, Y.H.M., primary, Hartgrink, H.H., additional, Dikken, J.L., additional, de Steur, W.O., additional, van Sandick, J.W., additional, van Grieken, N.C.T., additional, Cats, A., additional, Trip, A.K., additional, Jansen, E.P.M., additional, Meershoek-Klein Kranenbarg, W.M., additional, Braak, J.P.B.M., additional, Putter, H., additional, van Berge Henegouwen, M.I., additional, Verheij, M., additional, and van de Velde, C.J.H., additional
- Published
- 2018
- Full Text
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18. Time interval between neoadjuvant chemoradiotherapy and surgery for oesophageal or junctional cancer: A nationwide study
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van der Werf, L.R., primary, Dikken, J.L., additional, van der Willik, E.M., additional, van Berge Henegouwen, M.I., additional, Nieuwenhuijzen, G.A.P., additional, Wijnhoven, B.P.L., additional, Bosscha, K., additional, van Grieken, N.C.T., additional, Hartgrink, H.H., additional, van Hillegersberg, R., additional, Lemmens, V.E.P.P., additional, Plukker, J.T., additional, Rosman, C., additional, van Sandick, J.W., additional, Siersema, P.D., additional, Tetteroo, G., additional, Veldhuis, P.M.J.F., additional, and Voncken, F.E.M., additional
- Published
- 2018
- Full Text
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19. Factors contributing to variation in the use of multimodality treatment in patients with gastric cancer: A Dutch population based study
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Beck, N., primary, Busweiler, L.A.D., additional, Schouwenburg, M.G., additional, Fiocco, M., additional, Cats, A., additional, Voncken, F.E.M., additional, Wijnhoven, B.P.L., additional, van Berge Henegouwen, M.I., additional, Wouters, M.W.J.M., additional, van Sandick, J.W., additional, Bosscha, K., additional, Dikken, J.L., additional, van Duijvendijk, P., additional, van Grieken, N.C.T., additional, Gisbertz, S.S., additional, Hartgrink, H.H., additional, Hartemink, K.J., additional, Van Hillegersberg, R., additional, Hulsewé, K., additional, Kouwenhoven, E., additional, Lemmens, V.E.P.P., additional, Nieuwenhuijzen, G.A.P., additional, Ooijen, B., additional, Plukker, J.T., additional, Rosman, C., additional, Scheepers, J., additional, Siersema, P.D., additional, de Steur, W.O., additional, Tetteroo, G., additional, and Veldhuis, P.M.J.F., additional
- Published
- 2018
- Full Text
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20. Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer
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Busweiler, L.A., Henneman, D., Dikken, J.L., Fiocco, M., Berge Henegouwen, M.I. van, Wijnhoven, B.P., Hillegersberg, R. van, Rosman, C., Wouters, M.W., Sandick, J.W. van, Bosscha, K., Cats, A., Grieken, N.C. van, Hartgrink, H.H., Lemmens, V.E., Nieuwenhuijzen, G.A., Plukker, J.T., Siersema, P.D., Tetteroo, G., Busweiler, L.A., Henneman, D., Dikken, J.L., Fiocco, M., Berge Henegouwen, M.I. van, Wijnhoven, B.P., Hillegersberg, R. van, Rosman, C., Wouters, M.W., Sandick, J.W. van, Bosscha, K., Cats, A., Grieken, N.C. van, Hartgrink, H.H., Lemmens, V.E., Nieuwenhuijzen, G.A., Plukker, J.T., Siersema, P.D., and Tetteroo, G.
- Abstract
Contains fulltext : 177731.pdf (publisher's version ) (Closed access), BACKGROUND: Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. METHODS: All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included. Primary outcomes were (major) postoperative complications, postoperative mortality and FTR. To investigate groups' effect on the outcomes of interest a mixed model was used. RESULTS: Overall, 2644 patients with esophageal cancer and 1584 patients with gastric cancer were included in this study. In patients with gastric cancer, postoperative mortality (7.7% in 2011 vs. 3.8% in 2014) and FTR (38% in 2011 and 19% in 2014) decreased significantly over the years. The adjusted risk of developing a major postoperative complication was lower (OR 0.54; 95% CI 0.42-0.70), but the risk of FTR was higher (OR 1.85; 95% CI 1.05-3.27) in patients with gastric cancer compared to patients with esophageal cancer. CONCLUSION: Once a postoperative complication occurred, patients with gastric cancer were more likely to die compared to patients with esophageal cancer. Underlying mechanisms like patient selection, and differences in structure and organization of care should be investigated. Next to morbidity and mortality, failure-to-rescue should be considered as an important outcome measure after esophagogastric cancer resections.
- Published
- 2017
21. Textbook outcome as a composite measure in oesophagogastric cancer surgery
- Author
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Busweiler, L.A., Schouwenburg, M.G., Berge Henegouwen, M.I. van, Kolfschoten, N.E., Jong, P.C. de, Rozema, T., Wijnhoven, B.P., Hillegersberg, R. van, Wouters, M.W., Sandick, J.W. van, Bosscha, K., Cats, A., Dikken, J.L., Grieken, N.C. van, Hartgrink, H.H., Lemmens, V.E., Nieuwenhuijzen, G.A., Plukker, J.T., Rosman, C., Siersema, P.D., Tetteroo, G., Veldhuis, P.M., Voncken, F.E., Busweiler, L.A., Schouwenburg, M.G., Berge Henegouwen, M.I. van, Kolfschoten, N.E., Jong, P.C. de, Rozema, T., Wijnhoven, B.P., Hillegersberg, R. van, Wouters, M.W., Sandick, J.W. van, Bosscha, K., Cats, A., Dikken, J.L., Grieken, N.C. van, Hartgrink, H.H., Lemmens, V.E., Nieuwenhuijzen, G.A., Plukker, J.T., Rosman, C., Siersema, P.D., Tetteroo, G., Veldhuis, P.M., and Voncken, F.E.
- Abstract
Contains fulltext : 174840.pdf (publisher's version ) (Closed access), BACKGROUND: Quality assurance is acknowledged as a crucial factor in the assessment of oncological surgical care. The aim of this study was to develop a composite measure of multiple outcome parameters defined as 'textbook outcome', to assess quality of care for patients undergoing oesophagogastric cancer surgery. METHODS: Patients with oesophagogastric cancer, operated on with the intent of curative resection between 2011 and 2014, were identified from a national database (Dutch Upper Gastrointestinal Cancer Audit). Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. Hospital variation in textbook outcome was analysed after adjustment for case-mix factors. RESULTS: In total, 2748 patients with oesophageal cancer and 1772 with gastric cancer were included in this study. A textbook outcome was achieved in 29.7 per cent of patients with oesophageal cancer and 32.1 per cent of those with gastric cancer. Adjusted textbook outcome rates varied from 8.5 to 52.4 per cent between hospitals. The outcome parameter 'at least 15 lymph nodes examined' had the greatest negative impact on a textbook outcome both for patients with oesophageal cancer and for those with gastric cancer. CONCLUSION: Most patients did not achieve a textbook outcome and there was wide variation between hospitals.
- Published
- 2017
22. The influence of a composite hospital volume of upper gastrointestinal cancer resections on outcomes of gastric cancer surgery
- Author
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Busweiler, L.A.D., Dikken, J.L., Henegouwen, M.I.V., Ho, V.K.Y., Henneman, D., Tollenaar, R.A.E.M., Wouters, M.W.J.M., and Sandick, J.W. van
- Published
- 2016
23. Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer
- Author
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Busweiler, L.A., primary, Henneman, D., additional, Dikken, J.L., additional, Fiocco, M., additional, van Berge Henegouwen, M.I., additional, Wijnhoven, B.P., additional, van Hillegersberg, R., additional, Rosman, C., additional, Wouters, M.W., additional, van Sandick, J.W., additional, Bosscha, K., additional, Cats, A., additional, van Grieken, N.C., additional, Hartgrink, H.H., additional, Lemmens, V.E., additional, Nieuwenhuijzen, G.A., additional, Plukker, J.T., additional, Siersema, P.D., additional, Tetteroo, G., additional, Veldhuis, P.M., additional, and Voncken, F.E., additional
- Published
- 2017
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24. Surgicopathological quality control in the CRITICS gastric cancer trial
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Claassen, Y.H.M., primary, De Steur, W.O., additional, Hartgrink, H.H., additional, Van Sandick, J.W., additional, Dikken, J.L., additional, Meershoek-Klein Kranenberg, E., additional, Braak, J., additional, Jansen, E.P.M., additional, Van Grieken, N.C.T., additional, Putter, H., additional, Trip, A., additional, Boot, H., additional, Cats, A., additional, Sikorska, K., additional, Van Tinteren, H., additional, Verheij, M., additional, and Van de Velde, C.J.H., additional
- Published
- 2017
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25. Common data items in seven European oesophagogastric cancer surgery registries : towards a European Upper GI cancer audit (EURECCA Upper GI)
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Steur, W.O. de, Henneman, D., Allum, W.H., Dikken, J.L., Sandick, J.W. van, Reynolds, J., Mariette, C., Jensen, L., Johansson, J., Kolodziejczyk, P., Hardwick, R.H., Velde, C.J.H. van de, and EURECCA Upper GI Grp
- Subjects
Male ,medicine.medical_specialty ,European level ,Esophageal Neoplasms ,Quality Assurance, Health Care ,Denmark ,International Cooperation ,Patient characteristics ,Upper gastro intestinal surgery ,Audit ,Esophgeal cancer ,Neoadjuvant treatment ,Stomach Neoplasms ,medicine ,Humans ,European Union ,Registries ,Netherlands ,Sweden ,Medical Audit ,business.industry ,Cancer ,General Medicine ,medicine.disease ,United Kingdom ,Quality assurance ,Surgery ,Oncology ,Databases as Topic ,Family medicine ,Upper GI cancer ,Female ,Esophagogastric Junction ,France ,Poland ,EURECCA ,business ,Gastric cancer ,Cancer surgery - Abstract
Aims Seven countries (Denmark, France, Ireland, the Netherlands, Poland, Sweden, United Kingdom) collaborated to initiate a EURECCA (European Registration of Cancer Care) Upper GI project. The aim of this study was to identify a core dataset of shared items in the different data registries which can be used for future collaboration between countries. Methods Item lists from all participating Upper GI cancer registries were collected. Items were scored ‘present’ when included in the registry, or when the items could be deducted from other items in the registry. The definition of a common item was that it was present in at least six of the seven participating countries. Results The number of registered items varied between 40 (Poland) and 650 (Ireland). Among the 46 shared items were data on patient characteristics, staging and diagnostics, neoadjuvant treatment, surgery, postoperative course, pathology, and adjuvant treatment. Information on non-surgical treatment was available in only 4 registries. Conclusions A list of 46 shared items from seven participating Upper GI cancer registries was created, providing a basis for future quality assurance and research in Upper GI cancer treatment on a European level.
- Published
- 2014
26. 77. Failure-to-rescue as outcome measure after surgery for esophagogastric cancer
- Author
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Busweiler, L.A.D., primary, Henneman, D., additional, Dikken, J.L., additional, Fiocco, M., additional, Van Berge Henegouwen, M.I., additional, Wijnhoven, B.P.L., additional, Van Hillegersberg, R., additional, Rosman, C., additional, Wouters, M.W.J.M., additional, and Van Sandick, J.W., additional
- Published
- 2016
- Full Text
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27. 78. Surgicopathological quality control in the CRITICS gastric cancer trial
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Claassen, Y.H.M., primary, De Steur, W.O., additional, Dikken, J.L., additional, Hartgrink, H.H., additional, Jansen, E.P.M., additional, Trip, A.K., additional, Van Grieken, N.C.T., additional, Putter, H., additional, Meershoek – Klein Kranenberg, E., additional, Van Sandick, J.W., additional, Boot, H., additional, Cats, A., additional, Aaronson, N.K., additional, Sikorska, K., additional, Van Tinteren, H., additional, Verheij, M., additional, and Van de Velde, C.J.H., additional
- Published
- 2016
- Full Text
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28. Changes in treatment patterns and their influence on long-term survival in patients with stages I-III gastric cancer in The Netherlands
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Dassen, A.E., Dikken, J.L., Velde, C.J.H. van de, Wouters, M.W.J.M., Bosscha, K., and Lemmens, V.E.P.P.
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postoperative mortality ,gastric cancer ,survival - Published
- 2013
29. Failure-to-rescue after gastric and oesophageal cancer resection: Results of the Dutch Upper GI Cancer Audit (DUCA)
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Henneman, D., Sandick, J.W. van, Henegouwen, M.I.V., Bosscha, K., Cats, A., Dikken, J.L., Grieken, N.C.T. van, Hartgrink, H.H., Hillegersberg, R. van, Jong, P. de, Lemmens, V.E.P.P., Nieuwenhuijzen, G.A.P., Plukker, J.T., Rosman, C., Rozema, T., Siersema, P.D., Tetteroo, G.W.M., Veldhuis, P.M.J.F., Wijnhoven, B.P.L., and DUCA Working Grp
- Published
- 2013
30. Recent trends in multidisciplinary treatment of oesophageal and gastric cancer in The Netherlands
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Trip, A., Dikken, J.L., Visser, O., Stiekema, J., Cats, A., Boot, H., Sandick, J.W. van, Jansen, E.P.M., and Verheij, M.
- Published
- 2013
31. Quality assurance in lymphadenectomy for gastric cancer in the Dutch randomized gastric cancer trial
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Steur, W.O. de, Dikken, J.L., Putter, H., Hartgrink, H.H., and Velde, C.J.H. van de
- Published
- 2013
32. Pilot study for a European upper GI cancer audit (EURECCA Upper GI)
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Dikken, J.L., Sandick, J.W. van, Allum, W.H., Johansson, J., Jensen, L.S., Putter, H., Coupland, V.H., Wouters, M.W.J.M., Lemmens, V.E.P.P., and Velde, C.J.H. van de
- Published
- 2013
33. Centralization of esophagectomy for cancer: How far should we go?
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Dikken, J.L., Henneman, D., Putter, H., Lemmens, V.E.P.P., Geest, L.G. van der, Hillegersberg, R. van, Velde, C.J.H. van de, and Wouters, M.W.J.M.
- Published
- 2013
34. Randomized trials and quality assurance in gastric cancer surgery
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Dikken, J.L., Cats, A., Verheij, M., and Velde, C.J.H. van de
- Abstract
A D2 lymphadenectomy can be considered standard of surgical care for advanced resectable gastric cancer. Currently, several multimodality strategies are used, including postoperative monochemotherapy in Asia, postoperative chemoradiotherapy in the United States, and perioperative chemotherapy in Europe. As the majority of gastric cancer patients are treated outside the framework of clinical trials, quality assurance programs, including referral to high-volume centers and clinical auditing are needed to improve gastric cancer care on a nationwide level. J. Surg. Oncol. 2013;107:298-305. © 2012 Wiley Periodicals, Inc.
- Published
- 2013
35. Gastric cancer : staging, treatment, and surgical quality assurance
- Author
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Dikken, J.L., Velde, C.J.H. van de, Verheij, M., Cats, A., Lemmens, V.E.P.P, and Leiden University
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surgery ,quality assurance, health care ,stomach neoplasms ,lymph nodes ,esophageal neoplasms ,epidemiology ,netherlands ,quality assurance ,neoplasm staging ,chemotherapy ,health care ,radiotherapy ,nomograms - Abstract
Research described in this thesis focuses on several aspects of gastric cancer care: staging and prognostication, multimodality treatment, and surgical quality assurance. PART I - STAGING AND PROGNOSTICATION Cancer staging is one of the fundamental activities in oncology.6,7 For over 50 years, the TNM classification has been a standard in classifying the anatomic extent of disease.8 In order to maintain the staging system relevant, the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) have collaborated on periodic revisions of this staging system, leading to the 7th edition in 2010.65 In Chapter 2, differences between the 6th and 7th edition TNM classification for gastric cancer are described, and both staging systems are compared with regards to complexity and predictive accuracy. In the 7th edition TNM classification, nodal status cut-off values were changed, leading to a more even distribution for the redefined nodal classification groups. This increased the predictive accuracy of N-classification. Overall, the TNM staging system became more complex, with an increase in the number of TNM groupings from 56 to 80, which did not result in an increased predictive accuracy. Future refinements of the TNM-classification should consider whether increased complexity is balanced by improved prognostic accuracy. Another change that was incorporated in the 7th edition TNM classification was the addition of tumor grade as an independent determinant of stage grouping in early stage tumors. With the significantly lower prognosis of poorly differentiated early stage adenocarcinomas, these tumors might become candidate for neoadjuvant therapy, given an accurate identification of these tumors with preoperative staging. In Chapter 3, the accuracy of preoperative histopathologic grading in adenocarcinomas of the gastroesophageal junction (GEJ) was evaluated. The overall accuracy of tumor grade assessment was 73%. However, in early stage tumors the sensitivity to detect a poorly differentiated tumor was only 43%, and 21% of patients with an early stage GEJ tumor were assigned to an incorrect stage/prognostic group based on preoperative tumor grading. Caution should therefore be exhibited in staging patients with esophageal adenocarcinoma based on preoperative biopsy data. Although the TNM classification can be used to assess a patient__s prognosis, tools for individual patient prognostication have been developed that significantly outperform the TNM-classification in prognostic accuracy. For gastric cancer, a nomogram has been developed based on a single US-institution database,12,13 and has been validated in several international patient cohorts.14-16 Chapter 4 describes the development of a new gastric cancer nomogram that not only can predict survival for patients directly after an R0 gastrectomy, but also for patients alive at time points after surgery. This conditional probability of survival nomogram was highly discriminating (concordance index: 0.772), and surviving one, two, or three years from surgery showed a median improvement of 5-year disease-specific survival of 7.2%, 19.1%, and 31.6%, as compared to the baseline prediction directly after surgery. This nomogram was based on variables available directly after surgery, while variables available with follow-up (such as weight loss and performance status) did not further improve the predictive accuracy of this nomogram. In Chapter 5, the performance of the original gastric cancer nomogram, which was based on patients who underwent surgery without multimodality therapy, was assessed in a group of patients who received postoperative chemoradiotherapy after an R0 resection for gastric cancer. The nomogram significantly underpredicted 5-year survival for patients who received postoperative chemoradiotherapy, indicating a benefit in survival for patients who receive postoperative chemoradiation after an R0 resection for gastric cancer. Furthermore, this study stresses the need for updating nomograms that incorporate multimodality therapy use. PART II - MULTIMODALITY TREATMENT Over the past decade, many trials have been performed in which the effect of multimodality treatment on survival for resectable gastric cancer was evaluated. In Chapter 6, an overview of the literature on the treatment of gastric cancer is presented, and the available multimodality strategies are discussed. Currently accepted regimens include postoperative monochemotherapy with S-1 in Asia,66 and perioperative chemotherapy and postoperative chemoradiotherapy in the Western world.57,58 In Chapter 7, patterns of recurrence and survival of patients who received postoperative chemoradiotherapy were compared to recurrence and survival patterns of patients who only underwent surgery. The local recurrence rate was significantly lower in the chemoradiotherapy group (5% versus 17%, P = 0.0015). Subgroup analysis revealed that this difference was even stronger in patients who underwent a gastrectomy with a limited (D1) lymph node dissection (2% versus 18%, P = 0.001), while no difference was found for patients who underwent an extended (D2) lymph node dissection. Additional analysis with prolonged follow-up showed a higher 2-year overall survival for patients who received postoperative chemoradiotherapy after a D1 lymphadenectomy compared to surgery alone, and no difference in overall survival for patients who received a D2 dissection. Postoperative chemoradiotherapy was also significantly associated with higher two-year overall survival for patients who underwent a microscopically irradical (R1) resection (66% versus 29%, P = 0.02). Results from this study indicate that, especially after a gastrectomy with a limited lymph node dissection, postoperative chemoradiotherapy has a major impact on local recurrence and overall survival. Postoperative chemoradiotherapy should be offered to patients who undergo a microscopically irradical (R1) resection. In Chapter 8, the results of a study on lymph node yield after gastric cancer resections are described. While it is suggested that more than 15 lymph nodes (LNs) should be evaluated for accurate staging of gastric cancer, LN yield in Western countries is generally low. The effect of preoperative chemotherapy on LN yield in gastric cancer is unknown. In this study, LN yields of patients who received preoperative chemotherapy and patients who only underwent surgery were compared. Preoperative chemotherapy was not associated with a decrease in LN yield, indicating that evaluating more than 15 LNs after gastrectomy is feasible, also after administration of preoperative chemotherapy. In Chapter 9, the final chapter of part II of this thesis, the study protocol of the currently accruing Dutch-Swedish-Danish CRITICS trial is described. This trial was initiated to determine which of the two currently used standard regimens for the multimodality treatment of gastric cancer in the Western world, postoperative chemoradiotherapy, or perioperative chemotherapy, should be preferred. In this trial, all patients receive three cycles of preoperative ECC (epirubicin, cisplatin, and capecitabine), followed by D1+ surgery (D2 dissection without splenectomy or pancreatectomy). Postoperative therapy consists of another three cycles of ECC, or chemoradiotherapy with capecitabine and cisplatin without epirubicine. Results of this study will play a key role in the future management of patients with resectable gastric cancer. PART III - SURGICAL QUALITY ASSURANCE As an introduction to part III of this thesis, in Chapter 10, the results of a systematic review of the literature on quality of care indicators for gastric cancer surgery are described. The availability of specific literature on quality of care indicators was limited, but several indicators could be identified in more general literature on gastric cancer surgery. High hospital volume was found to be strongly related to lower postoperative mortality and higher long-term survival. Several quality indicators regarding operative technique were identified, including the performance of an extended lymphadenectomy, avoiding a routine spleen and pancreatic tail resection, and the use of a pouch reconstruction. Free resection margins were also found to be strongly associated with improved long-term survival. In Chapter 11 and Chapter 12, incidence and survival patterns for tumors of the esophagus, GEJ, and stomach in the Netherlands over the past 20 years are described. While the incidence of esophageal adenocarcinoma has doubled, the incidence of both tumors of the GEJ and stomach has decreased. These findings most likely reflect true changes in disease burden, rather than being the result of changes in diagnosis or reclassification. The increasing incidence of esophageal adenocarcinoma can be attributed to the increasing incidence of obesity and gastroesophageal reflux disease.67,68 Over the study period, five-year survival for non-metastatic esophageal cancer strongly improved (12% to 25% for adenocarcinoma, 12% to 19% for squamous cell carcinoma), while five-year survival for non-metastatic GEJ cancer (20%) and stomach cancer (32%) remained stable. In Chapter 13, patterns of care for gastric cancer in the Netherlands over the past 20 years are described. Whereas resection rates for stage I-III gastric cancer have remained stable at about 85%, the use of preoperative and/or postoperative chemotherapy has strongly increased since 2005. In 2008, nearly 40% of the patients with stage I-III gastric cancer received preoperative or postoperative chemotherapy with curative intent, and it is likely that since then, this percentage has further increased. In Chapter 14, the results of a study on hospital volumes, mortality, and long-term survival for esophagogastric cancer surgery in the Netherlands between 1989 and 2009 are described. In the Netherlands, a minimum hospital volume standard of at least 10 esophagectomies per year was introduced in 2006, while during the study period, no such standard was present for gastrectomies. During the study period, esophagectomy was effectively centralized in the Netherlands, and in 2009, 64% of all esophagectomies were performed in annual volumes of __21/year. Gastrectomy has not been centralized, and in 2009 only 5% of all gastrectomies were performed in annual volumes of __21/year. Whereas short-term and long-term survival after esophagectomy and gastrectomy improved over the years, this improvement was significantly stronger for esophagectomy. High hospital volume was associated with lower 6-month mortality (HR 0.48, P < 0.001) and longer 3-year survival (HR 0.77, P < 0.001) after esophagectomy, but not after gastrectomy. However, for gastrectomy, the number of high volume resections in the current study was too low to detect a statistical significant difference in outcomes when compared with low volume resections. This study indicates an urgent need for improvement in the treatment of resectable gastric cancer in the Netherlands. Chapter 15 describes the results of a study on the effect of hospital type on outcomes after esophagectomy and gastrectomy in the Netherlands. Hospitals were categorized into university hospitals, teaching non-university hospitals, and non-teaching hospitals. Three-month mortality after esophagectomy in university hospitals was 2.5%, compared to above 4% in non-university hospitals (P = 0.006). After gastrectomy, three-month mortality was 4.9% in university hospitals, and 8.7% in non-university hospitals (P < 0.001). Both after esophagectomy and gastrectomy, three-year survival was higher in university hospitals compared to non-university hospitals. No differences in mortality or survival were found between teaching and non-teaching non-university hospitals. However, when analyzing differences between individual hospitals, there were non-university hospitals with excellent outcomes. Therefore, it can be concluded that centers of excellence can not be designated solely by hospital type, and that detailed information on case-mix and outcomes is needed to identify centers of excellence. In Chapter 16, the results of an international study on esophagogastric cancer surgery between 2004 and 2009 in several European countries are described. Differences in resection rates, postoperative mortality, survival and hospital volumes were compared between the Netherlands, Sweden, Denmark, and England. In the Netherlands, postoperative mortality was average after esophagectomy (4.6%), but significantly higher after gastrectomy (6.9%) when compared to the other countries. Although increasing hospital volume was associated with lower 30-day mortality both after esophagectomy and gastrectomy, differences in outcomes between countries could not just be explained by existing differences in hospital volumes. To further investigate the differences in outcomes, a European upper GI audit is currently initiated.
- Published
- 2012
36. Centralization for Esophagectomy but Not for Gastrectomy in the Netherlands, the Relation Between Annual Hospital Volume, Postoperative Mortality and Long Term Survival
- Author
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Dikken, J.L., Dassen, A.E., Lemmens, V.E.P., Geest, L. van der, Bosscha, K., Verheij, M., Velde, C.J.H. van de, and Wouters, M.W.J.M.
- Published
- 2011
37. The effect of preoperative chemotherapy on lymph node yield in gastric cancer
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Dikken, J.L., Krijnen, P., Velde, C.J. van de, Verheij, M., Gonen, M., Grieken, N.C. van, Tang, L.H., Brennan, M.F., and Colt, D.G.
- Published
- 2011
38. Postoperative Chemoradiotherapy or Surgery Alone for Gastric Cancer: The Plausibility of the Question and Pertinence of the Answer Reply
- Author
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Dikken, J.L., Jansen, E.P.M., Cats, A., Bakker, B., Hartgrink, H.H., Kranenbarg, E.M.K., Boot, H., Putter, H., Peeters, K.C.M.J., Velde, C.J.H. van de, and Verheij, M.
- Subjects
adenocarcinoma chemotherapy stomach - Published
- 2010
39. 7BA - Surgicopathological quality control in the CRITICS gastric cancer trial
- Author
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Claassen, Y.H.M., De Steur, W.O., Hartgrink, H.H., Van Sandick, J.W., Dikken, J.L., Meershoek-Klein Kranenberg, E., Braak, J., Jansen, E.P.M., Van Grieken, N.C.T., Putter, H., Trip, A., Boot, H., Cats, A., Sikorska, K., Van Tinteren, H., Verheij, M., and Van de Velde, C.J.H.
- Published
- 2017
- Full Text
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40. Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer.
- Author
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Wouters, M.W., Busweiler, L.A., Henneman, D., van Sandick, J.W., Dikken, J.L., Fiocco, M., van Berge Henegouwen, M.I., Wijnhoven, B.P., van Hillegersberg, R., and Rosman, C.
- Subjects
ONCOLOGIC surgery complications ,ESOPHAGEAL cancer patients ,STOMACH cancer patients ,ESOPHAGECTOMY ,GASTRECTOMY ,MORTALITY risk factors ,HEALTH outcome assessment - Abstract
Background Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. Methods All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included. Primary outcomes were (major) postoperative complications, postoperative mortality and FTR. To investigate groups' effect on the outcomes of interest a mixed model was used. Results Overall, 2644 patients with esophageal cancer and 1584 patients with gastric cancer were included in this study. In patients with gastric cancer, postoperative mortality (7.7% in 2011 vs. 3.8% in 2014) and FTR (38% in 2011 and 19% in 2014) decreased significantly over the years. The adjusted risk of developing a major postoperative complication was lower (OR 0.54; 95% CI 0.42–0.70), but the risk of FTR was higher (OR 1.85; 95% CI 1.05–3.27) in patients with gastric cancer compared to patients with esophageal cancer. Conclusion Once a postoperative complication occurred, patients with gastric cancer were more likely to die compared to patients with esophageal cancer. Underlying mechanisms like patient selection, and differences in structure and organization of care should be investigated. Next to morbidity and mortality, failure-to-rescue should be considered as an important outcome measure after esophagogastric cancer resections. [ABSTRACT FROM AUTHOR]
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- 2017
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41. Changes in treatment patterns and their influence on long-term survival in patients with stages I-III gastric cancer in The Netherlands
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Dassen, A.E., primary, Dikken, J.L., additional, van de Velde, C.J.H., additional, Wouters, M.W.J.M., additional, Bosscha, K., additional, and Lemmens, V.E.P.P., additional
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- 2013
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42. 101. Quality of care indicators for the surgical treatment of gastric cancer
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Stiekema, J., primary, Dikken, J.L., additional, van de Velde, C.J.H., additional, Verheij, M., additional, Cats, A., additional, Wouters, M.W.J.M., additional, and van Sandick, J.W., additional
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- 2012
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43. PD-0570 NOMOGRAM PREDICTING SURVIVAL AFTER R0 GASTRECTOMY: VALIDATION IN PATIENTS WITH POSTOPERATIVE CHEMORADIATION
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Dikken, J.L., primary, Coit, D.G., additional, Baser, R.E., additional, Gönen, M., additional, Brennan, M.F., additional, Jansen, E.P.M., additional, Boot, H., additional, van de Velde, C.J.H., additional, Cats, A., additional, and Verheij, M., additional
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- 2012
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44. 6633 POSTER Conditional Probability of Survival Nomogram After an R0 Resection for Gastric Cancer
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Dikken, J.L., primary, Baser, R.E., additional, Gonen, M., additional, Kattan, M.W., additional, Shah, M.A., additional, Verheij, M., additional, van de Velde, C.J.H., additional, Brennan, M.F., additional, and Coit, D.G., additional
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- 2011
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45. 6502 ORAL Preoperative Chemotherapy Does Not Influence the Number of Evaluable Lymph Nodes in Resected Gastric Cancer
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Dikken, J.L., primary, Krijnen, P., additional, van de Velde, C.J.H., additional, Gonen, M., additional, van Grieken, N.C.T., additional, Tang, L.H., additional, Brennan, M.F., additional, Coit, D.G., additional, and Verheij, M., additional
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- 2011
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46. 6503 ORAL Centralization for Esophagectomy but Not for Gastrectomy in the Netherlands, the Relation Between Annual Hospital Volume, Postoperative Mortality and Long Term Survival
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Dikken, J.L., primary, Dassen, A.E., additional, Lemmens, V.E.R., additional, van der Geest, L., additional, Bosscha, K., additional, Verhelf, M., additional, van de Velde, C.J.H., additional, and Wouters, M.W.J.M., additional
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- 2011
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