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1. Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Author

Anna J. Alberga, Jorg L. de Bruin, Frederico Bastos Gonçalves, Eleonora G. Karthaus, Janneke A. Wilschut, Joost A. van Herwaarden, Jan J. Wever, Hence J. M. Verhagen, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Bakker OJ, Balm R, Barendregt WB, Bekken JA, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Blok JJ, Bode AS, Bodegom ME, van der Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Brehm V, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buijs MA, Buimer MG, Burger DH, Buscher HC, Cancrinus E, Castenmiller PH, Cazander G, Coester AM, Cuypers PH, Daemen JH, Dawson I, Dierikx JE, Dijkstra ML, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, Drouven JW, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fokkema TM, Frans FA, Fritschy WM, Fung Kon Jin PH, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hogendoorn W, Hoksbergen AW, Hollander EJ, Hommes M, Hopmans CJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongbloed-Winkel TA, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Koedam NA, Koelemaij MJ, Kolkert JL, Koning GG, Koning OH, Konings R, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laa n MJ, van Laanen JH, van Lammeren GW, Lamprou DA, Lardenoye JH, Lauret GJ, Leenders BJ, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, van de Luijtgaarden KM, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, von Meijenfeldt GC, Menting TP, Metz R, Minnee RC, de Mol van Otterloo JC, Molegraaf MJ, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Noyez VJ, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Post IC, Poyck PP, Prent A, ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, de Ridder JA, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Saleem BR, Salemans PB, van Sambeek MR, Samyn MG, van ‘t Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Scholtes VP, Schouten O, Schreve MA, Schurink GW, Sikkink CJ, te Slaa A, Smeets HJ, Smeets L, Smeets RR, de Smet AA, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, Speijers MJ, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stokmans RA, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Teraa M, Testroote MJ, Tha-In T, The RM, Thijsse WJ, Thomassen I, Tielliu IF, van Tongeren RB, Toorop RJ, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vaes RH, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Velthuis S, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, van der Vijver-Coppen RJ, Visser MJ, van der Vliet JA, Vlijmen—van Keulen CJ, Voorhoeve R, van der Vorst JR, Vos AW, de Vos B, Vos CG, Vos GA, Voute MT, Vriens BH, Vriens PW, de Vries AC, de Vries DK, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van de Water W, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wilschut ED, Wisselink W, Witte ME, Wittens CH, Wong CY, Wouda R, Yazar O, Yeung KK, Zeebregts CJ, van Zeeland ML, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Surgery

Subjects
Radiology, Nuclear Medicine and imaging, Surgery, Cardiology and Cardiovascular Medicine
Abstract

Purpose: Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data. Methods: All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians. Results: The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8–3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2–2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1–3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8–2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4–0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4–0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6–0.8). Conclusion: Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.

Published
2022

2. Laparoscopic peritoneal lavage or sigmoidectomy for perforated diverticulitis with purulent peritonitis: a multicentre, parallel-group, randomised, open-label trial

Author

Vennix, S, Musters, Gd, Mulder, Im, Swank, Ha, Consten, Ec, Belgers, Eh, van Geloven AA, Gerhards, Mf, Govaert, Mj, van Grevenstein WM, Hoofwijk, Ag, Kruyt, Pm, Nienhuijs, Sw, Boermeester, Ma, Vermeulen, J, van Dieren, S, Lange, Jf, Bemelman, Wa, Collaborators (138) Hop WC, Ladies trial colloborators., Opmeer, Bc, Reitsma, Jb, Scholte, Ra, Waltmann, Ew, Legemate, Da, Bartelsman, Jf, Meijer, Dw, de Brouwer, M, van Dalen, J, Durbridge, M, Geerdink, M, Ilbrink, Gj, Mehmedovic, S, Middelhoek, P, Boom, Mj, van der Bilt JD, van Olden GD, Stam, Ma, Verweij, Ms, Busch, Or, Buskens, Cj, El-Massoudi, Y, Kluit, Ab, van Rossem CC, Schijven, Mp, Tanis, Pj, Unlu, C, Karsten, Tm, de Nes LC, Rijna, H, van Wagensveld BA, Koffeman, Gi, Steller, Ep, Tuynman, Jb, Bruin, Sc, van der Peet DL, Blanken-Peeters, Cf, Cense, Ha, Jutte, E, Crolla, Rm, van der Schelling GP, van Zeeland, M, de Graaf EJ, Groenendijk, Rp, Vermaas, M, Schouten, O, de Vries MR, Prins, Ha, Lips, Dj, Bosker, Rj, van der Hoeven JA, Diks, J, Plaisier, Pw, Sietses, C, Stommel, Mw, de Hingh IH, Luyer, Md, van Montfort, G, Ponten, Eh, Smulders, Jf, van Duyn EB, Klaase, Jm, Swank, Dj, Ottow, Rt, Stockmann, Hb, Vuylsteke, Jc, Belgers, Hj, Fransen, S, von Meijenfeldt EM, Sosef, Mn, Hendriks, Er, ter Horst, B, Leeuwenburgh, Mm, van Ruler, O, Vogten, Jm, Vriens, Ej, Westerterp, M, Eijsbouts, Qa, Bentohami, A, Bijlsma, Ts, de Korte, N, Nio, D, Joosten, Jj, Tollenaar, Ra, Stassen, Lp, Wiezer, Mj, Hazebroek, Ej, Smits, Ab, van Westreenen HL, Brandt, A, Nijboer, Wn, Toorenvliet, Br, Weidema, Wf, Coene, Pp, Mannaerts, Gh, den Hartog, D, de Vos RJ, Zengerink, Jf, Hulsewé, Kw, Melenhorst, J, Stoot, Jh, Steup, Wh, Huijstee, Pj, Merkus, Jw, Wever, Jj, Maring, Jk, Heisterkamp, J, Vriens, Mr, Besselink, Mg, Borel Rinkes IH, Witkamp, Aj, Slooter, Gd, Konsten, Jl, Engel, Af, Pierik, Eg, Frakking, Tg, van Geldere, D, Patijn, Ga, D'Hoore, Aj, de Buck van Overstraeten, A, Miserez, M, Terrasson, I, Wolthuis, A, Di Saverio, S, De Blasiis, Mg., Surgery, Immunology, Other departments, AII - Amsterdam institute for Infection and Immunity, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, APH - Amsterdam Public Health, Clinical Research Unit, ACS - Amsterdam Cardiovascular Sciences, 02 Surgical specialisms, Gastroenterology and Hepatology, Graduate School, and CCA -Cancer Center Amsterdam

Subjects
Male, medicine.medical_specialty, Colon, Sigmoid, Peritonitis, Research Support, law.invention, Diverticulitis, Colonic, Stoma, Colonic, Sigmoidectomy, Randomized controlled trial, law, Colon, Sigmoid, Journal Article, medicine, Clinical endpoint, Humans, Comparative Study, Peritoneal Lavage, Non-U.S. Gov't, Laparoscopy, Diverticulitis, medicine.diagnostic_test, business.industry, Research Support, Non-U.S. Gov't, Sigmoidoscopy, General Medicine, Middle Aged, medicine.disease, Surgery, Multicenter Study, Treatment Outcome, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Intestinal Perforation, Randomized Controlled Trial, Female, business
Abstract

Item does not contain fulltext BACKGROUND: Case series suggest that laparoscopic peritoneal lavage might be a promising alternative to sigmoidectomy in patients with perforated diverticulitis. We aimed to assess the superiority of laparoscopic lavage compared with sigmoidectomy in patients with purulent perforated diverticulitis, with respect to overall long-term morbidity and mortality. METHODS: We did a multicentre, parallel-group, randomised, open-label trial in 34 teaching hospitals and eight academic hospitals in Belgium, Italy, and the Netherlands (the Ladies trial). The Ladies trial is split into two groups: the LOLA group comparing laparoscopic lavage with sigmoidectomy and the DIVA group comparing Hartmann's procedure with sigmoidectomy plus primary anastomosis. The DIVA section of this trial is still underway but here we report the results of the LOLA section. Patients with purulent perforated diverticulitis were enrolled for LOLA, excluding patients with faecal peritonitis, aged older than 85 years, with high-dose steroid use (>/=20 mg daily), and haemodynamic instability. Patients were randomly assigned (2:1:1; stratified by age [/=60 years]) using secure online computer randomisation to laparoscopic lavage, Hartmann's procedure, or primary anastomosis in a parallel design after diagnostic laparoscopy. Patients were analysed according to a modified intention-to-treat principle and were followed up after the index operation at least once in the outpatient setting and after sigmoidoscopy and stoma reversal, according to local protocols. The primary endpoint was a composite endpoint of major morbidity and mortality within 12 months. This trial is registered with ClinicalTrials.gov, number NCT01317485. FINDINGS: Between July 1, 2010, and Feb 22, 2013, 90 patients were randomly assigned in the LOLA section of the Ladies trial when the study was terminated by the data and safety monitoring board because of an increased event rate in the lavage group. Two patients were excluded for protocol violations. The primary endpoint occurred in 30 (67%) of 45 patients in the lavage group and 25 (60%) of 42 patients in the sigmoidectomy group (odds ratio 1.28, 95% CI 0.54-3.03, p=0.58). By 12 months, four patients had died after lavage and six patients had died after sigmoidectomy (p=0.43). INTERPRETATION: Laparoscopic lavage is not superior to sigmoidectomy for the treatment of purulent perforated diverticulitis. FUNDING: Netherlands Organisation for Health Research and Development.

Published
2015

3. Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands.

Author

Jalalzadeh H, Indrakusuma R, Koelemay MJW, Balm R, Van den Akker LH, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Baal JG, Bakker OJ, Balm R, Barendregt WB, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Bockel JH, Bodegom ME, Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Breek JC, Brehm V, Brinckman MJ, van den Broek TH, Brom HL, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buimer MG, Burger DH, Buscher HC, den Butter G, Cancrinus E, Castenmiller PH, Cazander G, Coveliers HM, Cuypers PH, Daemen JH, Dawson I, Derom AF, Dijkema AR, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fritschy WM, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hoksbergen AW, Hollander EJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Knippenberg B, Koedam NA, Koelemay MJ, Kolkert JL, Koning GG, Koning OH, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laan MJ, van Laanen JH, Lardenoye JH, Lawson JA, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, Metz R, Minnee RC, de Mol van Otterloo JC, Moll FL, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Peterson TF, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Poyck PP, Prent A, Ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Rupert CG, Saleem BR, van Sambeek MR, Samyn MG, van 't Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Schouten O, Schreinemacher MH, Schreve MA, Schurink GW, Sikkink CJ, Siroen MP, Te Slaa A, Smeets HJ, Smeets L, de Smet AA, de Smit P, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stigter H, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Testroote MJ, The RM, Thijsse WJ, Tielliu IF, van Tongeren RB, Toorop RJ, Tordoir JH, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, Visser MJ, van der Vliet JA, Vlijmen-van Keulen CJ, Voesten HG, Voorhoeve R, Vos AW, de Vos B, Vos GA, Vriens BH, Vriens PW, de Vries AC, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wisselink W, Witte ME, Wittens CH, Wolf-de Jonge IC, Yazar O, Zeebregts CJ, and van Zeeland ML

Subjects
Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures mortality, Endovascular Procedures statistics & numerical data, Female, Guideline Adherence statistics & numerical data, Humans, Iliac Aneurysm epidemiology, Iliac Aneurysm mortality, Iliac Aneurysm pathology, Iliac Artery pathology, Iliac Artery surgery, Male, Netherlands epidemiology, Registries, Retrospective Studies, Sex Factors, Treatment Outcome, Iliac Aneurysm surgery
Abstract

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR)., Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests., Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively)., Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2020
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4. Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center.

Author

Ferenschild FT, Dawson I, de Wilt JH, de Graaf EJ, Groenendijk RP, and Tetteroo GW

Subjects
Adenocarcinoma mortality, Adenocarcinoma secondary, Adult, Age Factors, Aged, Aged, 80 and over, Databases as Topic, Disease-Free Survival, Feasibility Studies, Hospitals, Community statistics & numerical data, Hospitals, Teaching statistics & numerical data, Humans, Kaplan-Meier Estimate, Middle Aged, Neoplasm Recurrence, Local, Proportional Hazards Models, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Adenocarcinoma surgery, Digestive System Surgical Procedures adverse effects, Digestive System Surgical Procedures mortality, Digestive System Surgical Procedures statistics & numerical data, Outcome and Process Assessment, Health Care statistics & numerical data, Quality of Health Care statistics & numerical data, Rectal Neoplasms surgery, Workload statistics & numerical data
Abstract

Objective: The aim of this study was to review the results and long-term outcome after total mesorectal excision (TME) for adenocarcinoma of the rectum in an unselected population in a community teaching hospital., Materials and Methods: Between 1996 and 2003, 210 patients with rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathological reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed., Results: The mean age at diagnosis was 69 years (range 40-91 years). A total of 145 patients were treated by anterior rectal resection; 65 patients had to undergo an abdominoperineal resection (APR). Anastomotic leakage rate was 5%. Postoperative mortality was 3%. After a median follow-up of 3.6 years, the local recurrence-free rate in patients with microscopically complete resections was 91%. The 5-year overall survival rate was 58%. An increased serum carcinoembryonic antigen, an APR, positive lymph nodes, and an incomplete resection all significantly influenced the 5-year overall survival and local recurrence rate. In a multivariate analysis, age was the most important prognostic factor for overall survival., Conclusions: Patients with rectal cancer can safely be treated with TME in a community teaching hospital and leads to a good overall survival and an excellent local control. In patients aged above 80, treatment-related mortality is an important competitive risk factor, which obscures the positive effect of modern rectal cancer treatment.

Published
2009
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5. [Diagnostic image. A man with haematemesis after stent repair of the abdominal aorta].

Author

Hermsen PE and Groenendijk RP

Subjects
Acute Disease, Aged, 80 and over, Blood Vessel Prosthesis Implantation, Hematemesis etiology, Humans, Male, Necrosis, Aortic Aneurysm, Abdominal surgery, Elective Surgical Procedures adverse effects, Esophagitis diagnosis
Abstract

An 86-year-old man suffered acute necrotizing oesophagitis as a complication of elective repair of an abdominal aortic aneurysm.

Published
2009

6. Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic right lower-quadrant pain.

Author

Roumen RM, Groenendijk RP, Sloots CE, Duthoi KE, Scheltinga MR, and Bruijninckx CM

Subjects
Abdominal Pain surgery, Adolescent, Adult, Appendicitis pathology, Chronic Disease, Double-Blind Method, Female, Humans, Male, Pain Measurement, Pain, Postoperative etiology, Recurrence, Treatment Outcome, Abdominal Pain etiology, Appendectomy methods, Appendicitis surgery, Elective Surgical Procedures methods, Laparoscopy methods
Abstract

Background: It is questionable whether elective appendicectomy can effectively reduce persistent or recurrent right lower-quadrant abdominal pain due to chronic or recurrent appendicitis., Methods: This single-centre double-blind randomized clinical trial studied the effects of elective laparoscopic appendicectomy on pain 6 months after operation in patients with persistent or recurrent lower-quadrant pain. A secondary outcome evaluated was the relationship between clinical response and appendiceal histopathology. The analysis was performed on an intention-to-treat basis., Results: Forty patients were randomized to laparoscopic appendicectomy (18) or laparoscopic inspection only (22). Postoperative pain scores differed significantly between the groups, favouring appendicectomy (P = 0.005). Relative risk calculations indicated that there was a 2.4 (95 per cent confidence interval (c.i.) 1.3 to 4.0) times greater chance of improvement in pain after laparoscopic appendicectomy. The number needed to treat was 2.2 (95 per cent c.i. 1.5 to 6.5). There was no association between postoperative pain scores and histopathology findings., Conclusion: Persistent or recurrent lower abdominal pain can be treated by elective appendicectomy with significant pain reduction in properly selected cases. Histopathology may not be abnormal., Registration Number: ISRCTN48831122 (http://www.controlled-trials.com)., (2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Published
2008
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7. [Better prognosis and favorable tumor stages in patients with invasive breast mammary carcinoma after introduction of the mass screening of breast cancer in Tilburg, the Netherlands].

Author

Groenendijk RP, Bult P, and Wobbes T

Subjects
Aged, Breast Neoplasms mortality, Breast Neoplasms pathology, Carcinoma mortality, Carcinoma pathology, Data Interpretation, Statistical, Female, Humans, Mass Screening, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Prognosis, Breast Neoplasms diagnosis, Carcinoma diagnosis
Published
2004

8. Mitotic activity index in interval breast cancers.

Author

Groenendijk RP, Bult P, Noppen CM, Boetes C, Ruers TJ, and Wobbes T

Subjects
Adult, Aged, Aged, 80 and over, Biomarkers, Tumor metabolism, Breast Neoplasms metabolism, Breast Neoplasms pathology, Carcinoma, Ductal, Breast metabolism, Carcinoma, Ductal, Breast pathology, Female, Humans, Mass Screening, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Netherlands, Prognosis, Receptors, Estrogen metabolism, Sentinel Lymph Node Biopsy, Women's Health, Breast Neoplasms diagnosis, Carcinoma, Ductal, Breast diagnosis, Mitotic Index
Abstract

Aims: The Mitotic Activity Index (MAI) is a strong prognostic factor for disease free survival in breast cancer. The MAI is lower in screen detected tumours, correlating with less aggressive biological behaviour in this group. In this study the MAI is compared between screen detected, interval and symptomatic breast cancers., Methods: Between 1991 and 1999, the MAI was determined in 581 breast cancers, 160 were detected by screening, 66 were interval carcinomas, and 355 were symptomatic breast cancers. Other prognostic factors were also registered., Results: The interval group had a significantly higher median MAI (17-18, range 1-134) than the screen detected group (7-8, range 0-94,P <0.0001). There was no difference with the symptomatic group (MAI 15, range 0-149,P =0.92)., Conclusions: Interval cancers had an intermediate outcome when correlated with other prognostic factors, compared to screen detected and symptomatic cancers.

Published
2003
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9. Breast cancer screening: using familiality for earlier detection.

Author

Groenendijk RP, Rombouts MC, Ruers TJ, Boetes C, and Wobbes T

Abstract

It is the purpose of this study to investigate whether breast cancer in patients with a positive family history is detected at an earlier stage with better prognostic markers than breast cancer in patients without a positive family history. In 481 patients, tumour size, tumour type, lymph vessel invasion, blood vessel invasion, receptor state, lymphatic spread, mitotic activity index (MAI) and survival were measured and compared, according to their family history. No difference was found between patients without a family history, patients with first-degree relatives or patients with second-degree relatives with breast cancer. Tumours were detected in the same stages and prognostic factors, MAI and survival were similar in all groups. A positive family history of breast cancer does not lead to earlier detection of breast cancer or a better survival.

Published
2002
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10. Critical analysis of the treatment of non-palpable breast cancer: toward a less invasive future?

Author

Groenendijk RP, ter Horst H, Tinnemans JG, van der Sluis RF, Ruers TJ, and Wobbes T

Subjects
Adult, Aged, Breast Neoplasms mortality, Carcinoma, Ductal, Breast mortality, Chemotherapy, Adjuvant, Combined Modality Therapy, Disease-Free Survival, Female, Humans, Mastectomy, Middle Aged, Radiotherapy, Adjuvant, Retrospective Studies, Breast Neoplasms pathology, Breast Neoplasms therapy, Carcinoma, Ductal, Breast pathology, Carcinoma, Ductal, Breast therapy, Outcome and Process Assessment, Health Care, Palpation
Abstract

Results and experience with the treatment of non-palpable breast cancer are reported and related to the future of less invasive treatment of small breast cancers. The retrospective study included 102 patients treated between 1980 and 1993 at the University Hospital of Nijmegen. Most cancers were screen-detected. Tumor sizes on pathological examination proved 3 mm (SD 7.7 mm) larger than on mammography (p = 0.0029). pT1 tumors were encountered in 77 patients (75%); pT2 tumors in 17 patients (17%). Seventy-five patients were free of lymph node metastases, 26 patients showed stage pN1 (25%). Most patients had invasive ductal cancers. Only two patients died of breast cancer. A 10-year disease-free survival of 94% was calculated, after excluding four patients with known systemic disease (M1) at diagnosis. T1a, T1b, and T1c had a 10-year survival of 100%, 96%, and 96%, respectively. Early detection and multimodality treatment of breast cancer have significantly improved survival. Inpatients with small breast cancer tumors future developments in treatment must be aimed at the use of less invasive techniques, reducing morbidity while maintaining high levels of disease-free survival.

Published
2002
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11. Detection of breast cancer after biopsy for false-positive screening mammography. An increased risk?

Author

Groenendijk RP, Kochen MP, van Engelenburg KC, Boetes C, Strobbe LJ, Ruers TJ, and Wobbes T

Subjects
Adult, Aged, Breast Diseases diagnosis, Breast Neoplasms diagnostic imaging, Breast Neoplasms pathology, False Positive Reactions, Female, Follow-Up Studies, Humans, Middle Aged, Risk Factors, Biopsy, Breast Neoplasms diagnosis, Mammography
Abstract

Introduction: After false-positive screening for breast cancer, women are still at risk of developing breast cancer. In this study the incidence of breast cancer in a group of women who had a false-positive outcome is compared with the expected breast cancer incidence., Methods: Follow-up data of 188 women (mean age 58 years) with a false-positive screening result were collected and analysed for breast cancer development. The mean length of follow-up in the study was 7.4 years. The occurrence of breast cancer was compared to the expected incidence of breast cancer in an age-matched control population using figures from the local cancer registration., Results: The occurrence of breast cancer in the study population (n=7) was not significantly different from the expected incidence of breast cancer in the age-matched control group (n=5)., Conclusion: There is no relationship between false-positive findings during breast cancer screening and later development of breast cancer. Patients who do not have an increased risk of developing breast cancer (due to family history) should not be followed-up clinically, but should be returned to the screening programme., (Copyright Harcourt Publishers Limited.)

Published
2001
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12. Pain experienced by women attending breast cancer screening.

Author

Keemers-Gels ME, Groenendijk RP, van den Heuvel JH, Boetes C, Peer PG, and Wobbes TH

Subjects
Aged, Anxiety etiology, Attitude of Health Personnel, Female, Humans, Mass Screening, Middle Aged, Pain Measurement, Surveys and Questionnaires, Breast Neoplasms diagnostic imaging, Mammography adverse effects, Pain etiology
Abstract

The purpose of this study was to evaluate the pain experience of women during mammography for breast cancer screening. Possible associations with personal and medical history, sociodemographics and/or situational factors were studied. It was also investigated whether this pain influenced the intention to return for future breast cancer screening. In the Netherlands, women between 50-75 years are invited for screening every two years. A total of 1200 participants were asked to fill up a questionnaire. The response rate was 79.5% (n = 954), and 945 questionnaires contained adequate information for analyses. A total of 689 women (72.9%) described mammography as mild to severely painful. In this group, compared to the group that reported no pain, the following factors occurred significantly more often: sensitive breasts (P = 0.001), family history of breast diseases (P = 0.017); expected pain based on former mammography (P = 0.001), high education (P = 0.008), anxiety (P = 0.001), breast sensitivity in last three days (P = 0.001), insufficient attention of technologist (P = 0.001). Other factors like age, hormonal status, breast size and hormone use were not associated with the pain experienced. Thirty-two women (3.3%) indicated that they would not attend further screening, 25 (2.6%) reported that the pain might deter them, six women (0.6%) had other reasons, one woman (0.1%) was sure not to come because of severe pain. In conclusion, a large majority of women attending breast cancer screening describes mammography as painful (72.9%). Factors associated with pain were described. Relatively few women (2.7%) indicated that the pain might deter them from future mammography. Recommendations are given to reduce the pain experienced during screening mammography.

Published
2000
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13. Screen-detected breast cancers have a lower mitotic activity index.

Author

Groenendijk RP, Bult P, Tewarie L, Peer PG, van der Sluis RF, Ruers TJ, and Wobbes T

Subjects
Age Factors, Aged, Breast Neoplasms genetics, Breast Neoplasms pathology, Disease-Free Survival, Female, Humans, Middle Aged, Predictive Value of Tests, Prognosis, Retrospective Studies, Breast Neoplasms diagnosis, Mass Screening, Mitotic Index
Abstract

We know that screening for breast cancer leads to detection of smaller tumours with less lymph node metastases. Could it be possible that the decrease in mortality after screening is not only caused by this earlier stage, but also by a different mitotic activity index (MAI) of the tumours that are detected by screening? Is MAI a prognostic factor for recurrence-free survival? A retrospective study was carried out of 387 patients with breast cancer, treated at the University Hospital Nijmegen between January 1992 and September 1997. Ninety patients had screen-detected breast cancer, 297 patients had breast cancers detected outside the screening programme. The MAI, other prognostic factors and recurrence-free survival were determined. In non-screen-detected tumours the MAI is twice as high as in screen-detected tumours, even after correction for age took place. The MAI correlated well with other tumour characteristics. The MAI in itself is a prognostic factor for recurrence-free survival. Favourable outcome in screen detected breast cancer is not entirely caused by detecting cancer in early stages: quantitative features such as the MAI indicate a less malignant character of screen detected breast cancer. The MAI is an independent prognostic factor for recurrence-free survival.

Published
2000
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14. Factors related to outcome after pneumonectomy: retrospective study of 62 patients.

Author

Groenendijk RP, Croiset van Uchelen FA, Mol SJ, de Munck DR, Tan AT, and Roumen RM

Subjects
Adult, Age Distribution, Aged, Carcinoma classification, Carcinoma diagnosis, Carcinoma mortality, Carcinoma surgery, Elective Surgical Procedures adverse effects, Elective Surgical Procedures mortality, Elective Surgical Procedures statistics & numerical data, Female, Hospital Mortality, Humans, Lung Neoplasms classification, Lung Neoplasms diagnosis, Lung Neoplasms mortality, Lung Neoplasms surgery, Male, Middle Aged, Netherlands epidemiology, Postoperative Complications epidemiology, Prognosis, Retrospective Studies, Treatment Outcome, Pneumonectomy adverse effects, Pneumonectomy mortality, Pneumonectomy statistics & numerical data
Abstract

Objective: To find out which risk factors affect outcome after pneumonectomy., Design: Retrospective study., Setting: Teaching hospital, The Netherlands., Subjects: 62 patients who were treated for bronchial cancer by pneumonectomy between 1984 and 1995., Main Outcome Measure: Hospital mortality and postoperative complications., Results: Hospital mortality increased with age, being 5/51 (10%) in the 40-69 age group and 4/11 (36%) in patients aged 70 or more. In the American Society of Anesthesiologists (ASA) class I group hospital mortality was 8% (2/26), in class II 12% (3/26) and in class III 40% (4/10). Hospital mortality was highest when the FEV1:FVC-ratio was below 55%. Cardiac arrhythmias developed in 8 (13%), early bronchopleural fistulas in 7 (11%), and postpneumonectomy syndrome in 5 (8%). These major complications had a high mortality., Conclusion: Respiratory function, ASA class, and age over 70 years are the main prognostic factors for hospital morbidity and mortality after pneumonectomy.

Published
1999
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