Author: "Hagemans, JAW" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Hagemans, JAW"' showing total 23 results

Start Over Author "Hagemans, JAW"

23 results on '"Hagemans, JAW"'

1. Minimum standards of pelvic exenterative practice:PelvEx Collaborative guideline

Author: Fahy, MR, Kelly, ME, Aalbers, AGJ, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angeles, MA, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aytac, E, Aziz, O, Bacalbasa, N, Baker, RP, Bali, M, Baransi, S, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Bergzoll, C, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Brecelj, E, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Ceelan, W, Chan, KKL, Chang, GJ, Chang, M, Chew, MH, Chok, AY, Chong, P, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Constantinides, J, Corr, A, Coscia, M, Cosimelli, M, Cotsoglou, C, Coyne, PE, Croner, RS, Damjanovich, L, Daniels, IR, Davies, M, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Drozdov, E, Duff, M, Eglinton, T, Enriquez-Navascues, JM, Espín-Basany, E, Evans, MD, Eyjólfsdóttir, B, Fearnhead, NS, Ferron, G, Flatmark, K, Fleming, FJ, Flor, B, Folkesson, J, Frizelle, FA, Funder, J, Gallego, MA, Gargiulo, M, García-Granero, E, García-Sabrido, JL, Gava, VG, Gentilini, L, George, ML, George, V, Georgiou, P, Ghosh, A, Ghouti, L, Gil-Moreno, A, Giner, F, Ginther, DN, Glyn, T, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Hellawell, G, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Hornung, B, Hurton, S, Hyun, E, Ito, M, Iversen, LH, Jenkins, JT, Jourand, K, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kazi, M, Kelley, SR, Keller, DS, Ketelaers, SHJ, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kose, F, Koutra, M, Kristensen, HØ, Kroon, HM, Kumar, S, Kusters, M, Lago, V, Lampe, B, Lakkis, Z, Larach, JT, Larkin, JO, Larsen, SG, Larson, DW, Law, WL, Lee, PJ, Limbert, M, Loria, A, Lydrup, ML, Lyons, A, Lynch, AC, Maciel, J, Manfredelli, S, Mann, C, Mantyh, C, Mathis, KL, Marques, CFS, Martinez, A, Martling, A, Mehigan, BJ, Meijerink, WJHJ, Merchea, A, Merkel, S, Mehta, AM, Mikalauskas, S, McArthur, DR, McCormick, JJ, McCormick, P, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Navarro, AS, Negoi, I, Neto, JWM, Ng, JL, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, Nordkamp, S, Nugent, T, Oliver, A, O’Dwyer, ST, O’Sullivan, NJ, Paarnio, K, Palmer, G, Pappou, E, Park, J, Patsouras, D, Peacock, O, Pellino, G, Peterson, AC, Pinson, J, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Rajendran, N, Radwan, RW, Rao, C, Rasheed, S, Rausa, E, Regenbogen, SE, Reims, HM, Renehan, A, Rintala, J, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, D, Scripcariu, V, Selvasekar, C, Shaikh, I, Simpson, A, Skeie-Jensen, T, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sørensen, MM, Sorrentino, L, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Spasojevic, M, Sumrien, H, Sutton, PA, Swartking, T, Takala, H, Tan, EJ, Taylor, C, Tekin, A, Tekkis, PP, Teras, J, Thaysen, HV, Thurairaja, R, Thorgersen, EB, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Valente, M, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Vather, R, Verhoef, C, Vierimaa, M, Vizzielli, G, Voogt, ELK, Uehara, K, Urrejola, G, Wakeman, C, Warrier, SK, Wasmuth, HH, Waters, PS, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Williams, A, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, Zappa, MA, Winter, DC, Fahy, Mr, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angeles, Ma, Angenete, E, Antoniou, A, Auer, R, Austin, Kk, Aytac, E, Aziz, O, Bacalbasa, N, Baker, Rp, Bali, M, Baransi, S, Baseckas, G, Bebington, B, Bedford, M, Bednarski, Bk, Beets, Gl, Berg, Pl, Bergzoll, C, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Brecelj, E, Bremers, Ab, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, Jwa, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Ceelan, W, Chan, Kkl, Chang, Gj, Chang, M, Chew, Mh, Chok, Ay, Chong, P, Clouston, H, Codd, M, Collins, D, Colquhoun, Aj, Constantinides, J, Corr, A, Coscia, M, Cosimelli, M, Cotsoglou, C, Coyne, Pe, Croner, R, Damjanovich, L, Daniels, Ir, Davies, M, Delaney, Cp, de Wilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, Ej, Drozdov, E, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Espín-Basany, E, Evans, Md, Eyjólfsdóttir, B, Fearnhead, N, Ferron, G, Flatmark, K, Fleming, Fj, Flor, B, Folkesson, J, Frizelle, Fa, Funder, J, Gallego, Ma, Gargiulo, M, García-Granero, E, García-Sabrido, Jl, Gava, Vg, Gentilini, L, George, Ml, George, V, Georgiou, P, Ghosh, A, Ghouti, L, Gil-Moreno, A, Giner, F, Ginther, Dn, Glyn, T, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Hagemans, Jaw, Hanchanale, V, Harji, Dp, Helewa, Rm, Hellawell, G, Heriot, Ag, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Hornung, B, Hurton, S, Hyun, E, Ito, M, Iversen, Lh, Jenkins, Jt, Jourand, K, Kaffenberger, S, Kandaswamy, Gv, Kapur, S, Kanemitsu, Y, Kazi, M, Kelley, Sr, Keller, D, Ketelaers, Shj, Khan, M, Kiran, Rp, Kim, H, Kim, Hj, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kose, F, Koutra, M, Kristensen, Hø, Kroon, Hm, Kumar, S, Kusters, M, Lago, V, Lampe, B, Lakkis, Z, Larach, Jt, Larkin, Jo, Larsen, Sg, Larson, Dw, Law, Wl, Lee, Pj, Limbert, M, Loria, A, Lydrup, Ml, Lyons, A, Lynch, Ac, Maciel, J, Manfredelli, S, Mann, C, Mantyh, C, Mathis, Kl, Marques, Cf, Martinez, A, Martling, A, Mehigan, Bj, Meijerink, Wjhj, Merchea, A, Merkel, S, Mehta, Am, Mikalauskas, S, Mcarthur, Dr, Mccormick, Jj, Mccormick, P, Mcdermott, Fd, Mcgrath, J, Malde, S, Mirnezami, A, Monson, Jrt, Navarro, A, Negoi, I, Neto, Jwm, Ng, Jl, Nguyen, B, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, Nordkamp, S, Nugent, T, Oliver, A, O’Dwyer, St, O’Sullivan, Nj, Paarnio, K, Palmer, G, Pappou, E, Park, J, Patsouras, D, Peacock, O, Pellino, G, Peterson, Ac, Pinson, J, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Rajendran, N, Radwan, Rw, Rao, C, Rasheed, S, Rausa, E, Regenbogen, Se, Reims, Hm, Renehan, A, Rintala, J, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, Hjt, Safar, B, Sagar, Pm, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, Amp, Schwarzkopf, E, Scripcariu, D, Scripcariu, V, Selvasekar, C, Shaikh, I, Simpson, A, Skeie-Jensen, T, Smart, Nj, Smart, P, Smith, Jj, Solbakken, Am, Solomon, Mj, Sørensen, Mm, Sorrentino, L, Steele, Sr, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, Na, Swartling, T, Spasojevic, M, Sumrien, H, Sutton, Pa, Swartking, T, Takala, H, Tan, Ej, Taylor, C, Tekin, A, Tekkis, Pp, Teras, J, Thaysen, Hv, Thurairaja, R, Thorgersen, Eb, Toh, El, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, Jj, Turner, Wh, Tuynman, Jb, Valente, M, van Ramshorst, Gh, van Zoggel, D, Vasquez-Jimenez, W, Vather, R, Verhoef, C, Vierimaa, M, Vizzielli, G, Voogt, Elk, Uehara, K, Urrejola, G, Wakeman, C, Warrier, Sk, Wasmuth, Hh, Waters, P, Weber, K, Weiser, Mr, Wheeler, Jmd, Wild, J, Williams, A, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, Rn, Zappa, Ma, Winter, Dc, Surgery, CCA - Cancer Treatment and quality of life, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: Neoplasm Recurrence, Local/surgery, Humans, Surgery, Neoplasm Recurrence, Local, Pelvic Exenteration
Abstract: This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
Published: 2022
Full Text: View/download PDF

2. The global cost of pelvic exenteration

Author: Michael E. Kelly, J. S. McGrath, Satish K Warrier, M. Quinn, Rami Radwan, D. Dietz, P. Tsarkov, Jean-Jacques Tuech, Søren Laurberg, Y. Tsukada, M. Fahy, P. C. Rasmussen, H. J. Kim, M. Chang, M. Bedford, S. Kaffenberger, David W. Larson, Joost Rothbarth, Klaus Weber, H. H. Wasmuth, G. Baseckas, Omer Aziz, Dean A. Harris, R. P. Baker, A. Quyn, C. Wakeman, N. Rajendran, M. Abraham-Nordling, V. George, A. Bui, F. D. McDermott, Wilt Jhw, L. Ghouti, B. Eyjólfsdóttir, Tarik Sammour, V. Hanchanale, W. L. Law, Roland S. Croner, Schizas Amp, Santiago Domingo, N. Abdul Aziz, W. Vasquez-Jimenez, Ian R. Daniels, M. M. Sørensen, F. Giner, Anna Martling, Frank A. Frizelle, L. Stocchi, Margues Cfs, E. Schwarzkopf, Kok Nfm, E. Pappou, Paris P. Tekkis, T. Akiyoshi, T. Eglinton, J. L. Ng, T. Swartling, Peter M. Sagar, A. B. Bremers, Hagemans Jaw, Geerard L. Beets, K. Boyle, G. J. Chang, G. V. Kandaswamy, W. Alberda, H. Yano, A. J. Colquhoun, S. Carvalhal, V. Scripcariu, S. Rasheed, David J. Hochman, Quentin Denost, D. Proud, J. L. Garcia-Sabrido, M. Codd, R. Glynn, L. Damjanovic, K. Stitzenberg, Jurriaan B. Tuynman, P. Chong, H. Kristensen, M. Limbert, R. Rocha, Malcolm S Wilson, N. Abecasis, M. Duff, Cees Verhoef, T. Golda, Martyn Evans, Conor P. Delaney, Hidde M. Kroon, T. G. Mullaney, Bashar Safar, S. E. Regenbogen, M. Cosimelli, E. Angenete, M. S. Khan, Adele Burgess, D. Shida, A. Oliver, Raza Sayyed, R. Thurairaja, M. Davies, H. Clouston, S. Kumar, M. L. Lydrup, C. Deutsch, M. Kusters, Aalbers Agj, M. Rottoli, M. B. Nielsen, Anthony Simpson, Christopher R. Mantyh, Andrew C. Peterson, M Brunner, E. J. Tan, Monson Jrt, J. Wild, John Beynon, M. A. Gallego, L. Bordeianou, N. A. Stylianides, F. Fleming, Meijerink Wjhj, N. Ginther, Neil J. Smart, A. Caycedo-Marulanda, M. H. Chew, Neto Jwm, S. Biondo, L. Castro, Nicola S Fearnhead, Burger Jwa, Christos Kontovounisios, P. J. Lee, S. Tsukamoto, Ionut Negoi, Z. Lakkis, N. Campain, M. R. Weiser, G. Hellawell, A. M. Solbakken, E. Burns, B. Nguyen, Jüri Teras, J. M. Enrique-Navascues, M. Andric, Deena Harji, E. L. Toh, G. Palmer, Rory Kokelaar, M. Rochester, L. Gentilini, W. H. Turner, S. Malde, Roel Hompes, D. van Zoggel, Andrew G Renehan, G. Vizzielli, D. Steffens, K. Flatmark, A. Corr, C. E. Koh, D. Burling, Chelliah Selvasekar, D. Patsouras, B. Griffiths, Kay Uehara, P. Smart, K. L. Mathis, A. C. Lynch, P. L. Berg, Gianluca Pellino, Alex H. Mirnezami, Michael J. Solomon, S. R. Kelley, C. Roxburgh, H. Kim, Y. Kanemitsu, E. García-Granero, A. Merchea, Emanuele Rausa, S. R. Steele, Wheeler Jmd, D. McArthur, M. A. Zappa, Brian K. Bednarski, E. Espin-Basany, I. Shaikh, Nieuwenhuijzen Gap, A. K. Chok, S. Kapur, G. H. van Ramshorst, Chan Kkl, Eric J. Dozois, Susanne Merkel, B. Yip, J. Park, A. Sahai, Anthony Antoniou, C. Taylor, Matthew R. Albert, R. J. Davies, Sarah T O'Dwyer, Torbjörn Holm, P. A. Sutton, Albert Wolthuis, H. Sumrien, A. Lyons, J. Yip, T. Swartking, Declan Collins, M. L. George, G. Poggioli, Des C. Winter, J. Folkesson, P. Buchwald, D. S. Keller, Stein Gunnar Larsen, J. Rohila, Kirk K. S. Austin, J. Joshua Smith, P. J. Nilsson, Ramzi M. Helewa, J. R. Morton, Peter Coyne, H. K. Christensen, Rutten Hjt, John T. Jenkins, A. M. Mehta, M. Bali, R. N. Yoo, A. Saklani, Alexander G. Heriot, M. Coscia, B. Bebington, Werner Hohenberger, Víctor Lago, T. Skeie-Jensen, R. Auer, Voogt Elk, Surgery, Poggioli, G, Rottoli, M, Gentilini, L, and Coscia, M.
Subjects: medicine.medical_specialty, Pelvic exenteration, Manchester Cancer Research Centre, business.industry, General surgery, medicine.medical_treatment, ResearchInstitutes_Networks_Beacons/mcrc, advanced rectal cancer, MEDLINE, Perioperative, Global Health, Pelvic Exenteration, cost, recurrent rectal cancer, medicine, Global health, Humans, Surgery, Hospital Costs, business
Abstract: No abstract available
Published: 2020
Full Text: View/download PDF

3. Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

Author: Chok, AY, Oliver, A, Rasheed, S, Tan, EJ, Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chang, GJ, Chew, MH, Chong, P, Christensen, HK, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, IR, Davies, M, Davies, RJ, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, George, V, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Hellawell, G, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Holmstrom, A, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, G, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, Rasmussen, PC, Rausa, E, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Sumrien, H, Sutton, PA, Swartking, T, Taylor, C, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warrier, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, Winter, DC, Tekkis, PP, Chok, AY, Oliver, A, Rasheed, S, Tan, EJ, Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chang, GJ, Chew, MH, Chong, P, Christensen, HK, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, IR, Davies, M, Davies, RJ, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, George, V, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Hellawell, G, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Holmstrom, A, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, G, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, Rasmussen, PC, Rausa, E, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Sumrien, H, Sutton, PA, Swartking, T, Taylor, C, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warrier, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, Winter, DC, and Tekkis, PP
Abstract: BACKGROUND: The multidisciplinary perioperative and anaesthetic management of patients undergoing pelvic exenteration is essential for good surgical outcomes. No clear guidelines have been established, and there is wide variation in clinical practice internationally. This consensus statement consolidates clinical experience and best practice collectively, and systematically addresses key domains in the perioperative and anaesthetic management. METHODS: The modified Delphi methodology was used to achieve consensus from the PelvEx Collaborative. The process included one round of online questionnaire involving controlled feedback and structured participant response, two rounds of editing, and one round of web-based voting. It was held from December 2019 to February 2020. Consensus was defined as more than 80 per cent agreement, whereas less than 80 per cent agreement indicated low consensus. RESULTS: The final consensus document contained 47 voted statements, across six key domains of perioperative and anaesthetic management in pelvic exenteration, comprising preoperative assessment and preparation, anaesthetic considerations, perioperative management, anticipating possible massive haemorrhage, stress response and postoperative critical care, and pain management. Consensus recommendations were developed, based on consensus agreement achieved on 34 statements. CONCLUSION: The perioperative and anaesthetic management of patients undergoing pelvic exenteration is best accomplished by a dedicated multidisciplinary team with relevant domain expertise in the setting of a specialized tertiary unit. This consensus statement has addressed key domains within the framework of current perioperative and anaesthetic management among patients undergoing pelvic exenteration, with an international perspective, to guide clinical practice, and has outlined areas for future clinical research.
Published: 2021

4. Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy

Author: Kelly ME, Ryan E ´ J, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Alberda W, Antoniou A, Austin KK, Baker R, Bali M, Baseckas G, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Burger JWA, Burling D, Campain N, Chan KKL, Chang GJ, Chew MH, C Chong P, Christensen HK, Codd M, Colquhoun AJ, Corr A, Coscia M, Coyne PE, Creavin B, Damjanovic L, Daniels IR, Davies M, Davies RJ, deWilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Evans MD, Fearnhead NS, Frizelle FA, Garcia-Granero E, Garcia-Sabrido JL, GentiliniL, George ML, Glynn R, Golda T, Griffiths B, Harris DA, Evans M, Hagemans JAW, Harji DP, Heriot AG, HohenbergerW, Holm T, Humphries E, Jansson-Palmer G, Jenkins JT, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Kim H, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kroon H, Kusters M, Lago V, Larson DW, Law WL, Laurberg S, Lee P, Lydrup ML, Lynch AC, Mathis KL, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McDermott FD, McGrath JS, Mihailo A, Mirnezami A, Morton JR, Mullaney TG, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan RW, Rasheed S, Rasmussen PC, Rocha R, Rothbarth J, Roxburgh C, Rutten HJT, Sagar PM, Sammour T, Schizas AMP, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart NJ, Smith JJ, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stocchi L, Stylianides NA, Tekkis PP, Taylor C, Tsukamoto S, Turner WH, Tuynman JB, vanRamshorst GH, van Zoggel D, Vasquez-JimenezW, Verhoef C, WakemanC, Warrier S, Wasmuth HH, Weiser MR, Wheeler JMD, Wild J, Yip J, Winter DC., Gilberto Poggioli, Kelly, Me, Ryan, E ´ J, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Bremers, Ab, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, Dewilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, Ej, Duff, M, Eglinton, T, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilinil, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenbergerw, Holm, T, Humphries, E, Jansson-Palmer, G, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kroon, H, Kusters, M, Lago, V, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsukamoto, S, Turner, Wh, Tuynman, Jb, Vanramshorst, Gh, van Zoggel, D, Vasquez-JimenezW, Verhoef, C, Wakemanc, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, and Winter, Dc.
Subjects: Pelvic Neoplasm, Databases, Factual, medicine.medical_treatment, Tertiary Care Center, Kaplan-Meier Estimate, Cohort Studies, Tertiary Care Centers, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Retrospective Studie, Cause of Death, Pelvic Neoplasms, Neoadjuvant therapy, Cervical cancer, Aged, 80 and over, Mortality rate, Middle Aged, Prognosis, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Survival Analysi, Human, medicine.medical_specialty, Prognosi, Malignancy, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, SDG 3 - Good Health and Well-being, medicine, Humans, Neoplasm Invasiveness, Survival analysis, Proportional Hazards Models, Retrospective Studies, Aged, Neoplasm Staging, Neoplasm Invasivene, Pelvic exenteration, business.industry, medicine.disease, Survival Analysis, Surgery, Pelvic Exenteration, Proportional Hazards Model, Cohort Studie, Neoplasm Recurrence, Local, Ovarian cancer, business
Abstract: Item does not contain fulltext OBJECTIVE: To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy. BACKGROUND: The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes. METHODS: Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded.The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality. RESULTS: One thousand two hundred ninety-three patients were identified. 40.4% (n = 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n = 462) urological (bladder), 18.1% (n = 234) anal, and 5.7% had sarcoma (n = 74).The median age across the cohort was 63 years (range, 23-85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer.Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma. CONCLUSION: Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%-59%) reflects the diversity of tumor types.
Published: 2019

5. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

Author: Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chew, GJH, Chong, PC, Christensen, HK, Clouston, H, Codd, M, Coffins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, R, Davies, M, Davies, RJ, Delaney, CP, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, G, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mimezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, van Ramshorst, GH, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Hellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Sumrien, H, Sutton, PA, Swanking, T, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warner, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, de Wilt, JHW, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, van Zoggel, D, Winter, DC, Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chew, GJH, Chong, PC, Christensen, HK, Clouston, H, Codd, M, Coffins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, R, Davies, M, Davies, RJ, Delaney, CP, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, G, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mimezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, van Ramshorst, GH, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Hellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Sumrien, H, Sutton, PA, Swanking, T, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warner, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, de Wilt, JHW, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, van Zoggel, D, and Winter, DC
Abstract: AIM: At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD: Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS: Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION: Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
Published: 2020

6. Predicting outcomes of pelvic exenteration using machine learning

Author: Dudurych, I, Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chang, GJ, Chew, MH, Chok, AK, Chong, P, Christensen, HK, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, IR, Davies, M, Davies, RJ, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, George, V, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, Oliver, A, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Shellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Sumrien, H, Sutton, PA, Swartking, T, Tan, EJ, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warrier, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, Winter, DC, Dudurych, I, Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bedford, M, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chang, GJ, Chew, MH, Chok, AK, Chong, P, Christensen, HK, Clouston, H, Codd, M, Collins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, IR, Davies, M, Davies, RJ, Delaney, CP, de Wilt, JHW, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, George, V, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mirnezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, Oliver, A, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Shellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Swartling, T, Sumrien, H, Sutton, PA, Swartking, T, Tan, EJ, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, van Ramshorst, GH, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warrier, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, and Winter, DC
Abstract: AIM: We aim to compare machine learning with neural network performance in predicting R0 resection (R0), length of stay > 14 days (LOS), major complication rates at 30 days postoperatively (COMP) and survival greater than 1 year (SURV) for patients having pelvic exenteration for locally advanced and recurrent rectal cancer. METHOD: A deep learning computer was built and the programming environment was established. The PelvEx Collaborative database was used which contains anonymized data on patients who underwent pelvic exenteration for locally advanced or locally recurrent colorectal cancer between 2004 and 2014. Logistic regression, a support vector machine and an artificial neural network (ANN) were trained. Twenty per cent of the data were used as a test set for calculating prediction accuracy for R0, LOS, COMP and SURV. Model performance was measured by plotting receiver operating characteristic (ROC) curves and calculating the area under the ROC curve (AUROC). RESULTS: Machine learning models and ANNs were trained on 1147 cases. The AUROC for all outcome predictions ranged from 0.608 to 0.793 indicating modest to moderate predictive ability. The models performed best at predicting LOS > 14 days with an AUROC of 0.793 using preoperative and operative data. Visualized logistic regression model weights indicate a varying impact of variables on the outcome in question. CONCLUSION: This paper highlights the potential for predictive modelling of large international databases. Current data allow moderate predictive ability of both complex ANNs and more classic methods.
Published: 2020

7. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

Author: Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐Nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐Marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐Navascues, J. M., Espin‐Basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., McArthur, D. R., McDermott, F. D., McGrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐Jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, M. E., Aalbers, A. G. J., Abdul Aziz, N., Abecasis, N., Abraham‐nordling, M., Akiyoshi, T., Alberda, W., Albert, M., Andric, M., Angenete, E., Antoniou, A., Auer, R., Austin, K. K., Aziz, O., Baker, R. P., Bali, M., Baseckas, G., Bebington, B., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Boyle, K., Bordeianou, L., Bremers, A. B., Brunner, M., Buchwald, P., Bui, A., Burgess, A., Burger, J. W. A., Burling, D., Burns, E., Campain, N., Carvalhal, S., Castro, L., Caycedo‐marulanda, A., Chan, K. K. L., Chang, G. J., Chew, M. H., Chong, P. C., Christensen, H. K., Clouston, H., Codd, M., Collins, D., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Croner, R. S., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Delaney, C. P., Denost, Q., Deutsch, C., Dietz, D., Domingo, S., Dozois, E. J., Duff, M., Eglinton, T., Enrique‐navascues, J. M., Espin‐basany, E., Evans, M. D., Fearnhead, N. S., Flatmark, K., Fleming, F., Frizelle, F. A., Gallego, M. A., Garcia‐granero, E., Garcia‐sabrido, J. L., Gentilini, L., George, M. L., Ghouti, L., Giner, F., Ginther, N., Glynn, R., Golda, T., Griffiths, B., Harris, D. A., Hagemans, J. A. W., Hanchanale, V., Harji, D. P., Helewa, R. M., Heriot, A. G., Hochman, D., Hohenberger, W., Holm, T., Hompes, R., Jenkins, J. T., Kaffenberger, S., Kandaswamy, G. V., Kapur, S., Kanemitsu, Y., Kelley, S. R., Keller, D. S., Khan, M. S., Kiran, R. P., Kim, H., Kim, H. J., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kristensen, H. Ø., Kroon, H. M., Kusters, M., Lago, V., Larsen, S. G., Larson, D. W., Law, W. L., Laurberg, S., Lee, P. J., Limbert, M., Lydrup, M. L., Lyons, A., Lynch, A. C., Mantyh, C., Mathis, K. L., Margues, C. F. S., Martling, A., Meijerink, W. J. H. J., Merkel, S., Mehta, A. M., Mcarthur, D. R., Mcdermott, F. D., Mcgrath, J. S., Malde, S., Mirnezami, A., Monson, J. R. T., Morton, J. R., Mullaney, T. G., Negoi, I., Neto, J. W. M., Nguyen, B., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O’Connell, P. R., O’Dwyer, S. T., Palmer, G., Pappou, E., Park, J., Patsouras, D., Pellino, G., Peterson, A. C., Poggioli, G., Proud, D., Quinn, M., Quyn, A., Radwan, R. W., van Ramshorst, G. H., Rasheed, S., Rasmussen, P. C., Regenbogen, S. E., Renehan, A., Rocha, R., Rochester, M., Rohila, J., Rothbarth, J., Rottoli, M., Roxburgh, C., Rutten, H. J. T., Ryan, É. J., Safar, B., Sagar, P. M., Sahai, A., Saklani, A., Sammour, T., Sayyed, R., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Selvasekar, C., Shaikh, I., Hellawell, G., Shida, D., Simpson, A., Smart, N. J., Smart, P., Smith, J. J., Solbakken, A. M., Solomon, M. J., Sørensen, M. M., Steele, S. R., Steffens, D., Stitzenberg, K., Stocchi, L., Stylianides, N. A., Sumrien, H., Sutton, P. A., Swartking, T., Taylor, C., Tekkis, P. P., Teras, J., Thurairaja, R., Toh, E. L., Tsarkov, P., Tsukada, Y., Tsukamoto, S., Tuech, J. J., Turner, W. H., Tuynman, J. B., Vasquez‐jimenez, W., Verhoef, C., Vizzielli, G., Voogt, E. L. K., Uehara, K., Wakeman, C., Warrier, S., Wasmuth, H. H., Weber, K., Weiser, M. R., Wheeler, J. M. D., Wild, J., Wilson, M., de Wilt, J. H. W., Wolthuis, A., Yano, H., Yip, B., Yip, J., Yoo, R. N., van Zoggel, D., Winter, D. C., Kelly, ME, Aalbers, AGJ, Aziz, NA, Abecasis, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Albert, M, Andric, M, Angenete, E, Antoniou, A, Auer, R, Austin, KK, Aziz, O, Baker, RP, Bali, M, Baseckas, G, Bebington, B, Bednarski, BK, Beets, GL, Berg, PL, Beynon, J, Biondo, S, Boyle, K, Bordeianou, L, Bremers, AB, Brunner, M, Buchwald, P, Bui, A, Burgess, A, Burger, JWA, Burling, D, Burns, E, Campain, N, Carvalhal, S, Castro, L, Caycedo-Marulanda, A, Chan, KKL, Chew, GJH, Chong, PC, Christensen, HK, Clouston, H, Codd, M, Coffins, D, Colquhoun, AJ, Corr, A, Coscia, M, Coyne, PE, Creavin, B, Croner, RS, Damjanovic, L, Daniels, R, Davies, M, Davies, RJ, Delaney, CP, Denost, Q, Deutsch, C, Dietz, D, Domingo, S, Dozois, EJ, Duff, M, Eglinton, T, Enrique-Navascues, JM, Espin-Basany, E, Evans, MD, Fearnhead, NS, Flatmark, K, Fleming, F, Frizelle, FA, Gallego, MA, Garcia-Granero, E, Garcia-Sabrido, JL, Gentilini, L, George, ML, Ghouti, L, Giner, F, Ginther, N, Glynn, R, Golda, T, Griffiths, B, Harris, DA, Hagemans, JAW, Hanchanale, V, Harji, DP, Helewa, RM, Heriot, AG, Hochman, D, Hohenberger, W, Holm, T, Hompes, R, Jenkins, JT, Kaffenberger, S, Kandaswamy, GV, Kapur, S, Kanemitsu, Y, Kelley, SR, Keller, DS, Khan, MS, Kiran, RP, Kim, H, Kim, HJ, Koh, CE, Kok, NFM, Kokelaar, R, Kontovounisios, C, Kristensen, HO, Kroon, HM, Kusters, M, Lago, V, Larsen, SG, Larson, DW, Law, WL, Laurberg, S, Lee, PJ, Limbert, M, Lydrup, ML, Lyons, A, Lynch, AC, Mantyh, C, Mathis, KL, Margues, CFS, Martling, A, Meijerink, WJHJ, Merkel, S, Mehta, AM, McArthur, DR, McDermott, FD, McGrath, JS, Malde, S, Mimezami, A, Monson, JRT, Morton, JR, Mullaney, TG, Negoi, I, Neto, JWM, Nguyen, B, Nielsen, MB, Nieuwenhuijzen, GAP, Nilsson, PJ, O'Connell, PR, O'Dwyer, ST, Palmer, G, Pappou, E, Park, J, Patsouras, D, Pellino, G, Peterson, AC, Poggioli, G, Proud, D, Quinn, M, Quyn, A, Radwan, RW, van Ramshorst, GH, Rasheed, S, Rasmussen, PC, Regenbogen, SE, Renehan, A, Rocha, R, Rochester, M, Rohila, J, Rothbarth, J, Rottoli, M, Roxburgh, C, Rutten, HJT, Ryan, EJ, Safar, B, Sagar, PM, Sahai, A, Saklani, A, Sammour, T, Sayyed, R, Schizas, AMP, Schwarzkopf, E, Scripcariu, V, Selvasekar, C, Shaikh, I, Hellawell, G, Shida, D, Simpson, A, Smart, NJ, Smart, P, Smith, JJ, Solbakken, AM, Solomon, MJ, Sorensen, MM, Steele, SR, Steffens, D, Stitzenberg, K, Stocchi, L, Stylianides, NA, Sumrien, H, Sutton, PA, Swanking, T, Taylor, C, Tekkis, PP, Teras, J, Thurairaja, R, Toh, EL, Tsarkov, P, Tsukada, Y, Tsukamoto, S, Tuech, JJ, Turner, WH, Tuynman, JB, Vasquez-Jimenez, W, Verhoef, C, Vizzielli, G, Voogt, ELK, Uehara, K, Wakeman, C, Warner, S, Wasmuth, HH, Weber, K, Weiser, MR, Wheeler, JMD, Wild, J, Wilson, M, de Wilt, JHW, Wolthuis, A, Yano, H, Yip, B, Yip, J, Yoo, RN, van Zoggel, D, Winter, DC, Surgery, CCA - Cancer Treatment and quality of life, and Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: Male, medicine.medical_specialty, Adolescent, Colorectal cancer, survival outcomes, medicine.medical_treatment, surgical outcome, surgical outcomes, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, medicine, Humans, liver metastasi, Rectal cancer, Retrospective Studies, Pelvic exenteration, business.industry, Rectal Neoplasms, Mortality rate, Liver Neoplasms, Gastroenterology, Postoperative complication, Perioperative, medicine.disease, Surgery, Pelvic Exenteration, liver metastasis, Treatment Outcome, 030220 oncology & carcinogenesis, international collaboration, Resection margin, 030211 gastroenterology & hepatology, Hepatectomy, Neoplasm Recurrence, Local, business
Abstract: Aim: At presentation, 15–20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. Method: Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. Results: Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). Conclusion: Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
Published: 2020
Full Text: View/download PDF

8. Palliative pelvic exenteration: A systematic review of patient-centered outcomes

Author: Hidde M. Kroon, N.N. Dudi-Venkata, S. Bedrikovetski, M.L. Thomas, M.E. Kelly, A.G.J. Aalbers, N. Abdul Aziz, M. Abraham-Nordling, T. Akiyoshi, W. Alberda, M. Andric, A. Antoniou, K.K. Austin, R.P. Baker, M. Bali, G. Baseckas, B.K. Bednarski, G.L. Beets, P.L. Berg, J. Beynon, S. Biondo, L. Bordeianou, M. Brunner, P. Buchwald, J.W.A. Burger, D. Burling, N. Campain, K.K.L. Chan, G.J. Chang, M.H. Chew, P. C Chong, H.K. Christensen, M. Codd, A.J. Colquhoun, A. Corr, M. Coscia, P.E. Coyne, B. Creavin, L. Damjanovic, I.R. Daniels, M. Davies, R.J. Davies, J.H.W. de Wilt, Q. Denost, D. Dietz, E.J. Dozois, M. Duff, T. Eglinton, J.M. Enriquez-Navascues, M.D. Evans, N.S. Fearnhead, F.A. Frizelle, E. Garcia-Granero, J.L. Garcia-Sabrido, L. Gentilini, M.L. George, R. Glynn, T. Golda, B. Griffiths, D.A. Harris, M. Evans, J.A.W. Hagemans, D.P. Harji, A.G. Heriot, W. Hohenberger, T. Holm, J.T. Jenkins, S. Kapur, Y. Kanemitsu, S.R. Kelley, D.S. Keller, H. Kim, C.E. Koh, N.F.M. Kok, R. Kokelaar, C. Kontovounisios, M. Kusters, D.W. Larson, W.L. Law, S. Laurberg, P. Lee, M.L. Lydrup, A.C. Lynch, C. Mantyh, K.L. Mathis, A. Martling, W.J.H.J. Meijerink, S. Merkel, A.M. Mehta, F.D. McDermott, J.S. McGrath, A. Mirnezami, J.R. Morton, T.G. Mullaney, J.W. Mesquita-Neto, M.B. Nielsen, G.A.P. Nieuwenhuijzen, P.J. Nilsson, P.R. O'Connell, G. Palmer, D. Patsouras, G. Pellino, G. Poggioli, M. Quinn, A. Quyn, R.W. Radwan, S. Rasheed, P.C. Rasmussen, S.E. Regenbogen, R. Rocha, J. Rothbarth, C. Roxburgh, H.J.T. Rutten, É. Ryan, P.M. Sagar, A. Saklani, A.M.P. Schizas, E. Schwarzkopf, V. Scripcariu, I. Shaikh, D. Shida, A. Simpson, N.J. Smart, J.J. Smith, M.J. Solomon, M.M. Sørensen, S.R. Steele, D. Steffens, L. Stocchi, N.A. Stylianides, P.P. Tekkis, C. Taylor, P. Tsarkov, S. Tsukamoto, W.H. Turner, J.B. Tuynman, G.H. van Ramshorst, D. van Zoggel, W. Vasquez-Jimenez, C. Verhoef, M. Verstegen, C. Wakeman, S. Warrier, H.H. Wasmuth, M.R. Weiser, J.M.D. Wheeler, J. Wild, J. Yip, D.C. Winter, T. Sammour, Kroon H.M., Dudi-Venkata N.N., Bedrikovetski S., Thomas M.L., Kelly M.E., Aalbers A.G.J., Abdul Aziz N., Abraham-Nordling M., Akiyoshi T., Alberda W., Andric M., Antoniou A., Austin K.K., Baker R.P., Bali M., Baseckas G., Bednarski B.K., Beets G.L., Berg P.L., Beynon J., Biondo S., Bordeianou L., Brunner M., Buchwald P., Burger J.W.A., Burling D., Campain N., Chan K.K.L., Chang G.J., Chew M.H., C Chong P., Christensen H.K., Codd M., Colquhoun A.J., Corr A., Coscia M., Coyne P.E., Creavin B., Damjanovic L., Daniels I.R., Davies M., Davies R.J., de Wilt J.H.W., Denost Q., Dietz D., Dozois E.J., Duff M., Eglinton T., Enriquez-Navascues J.M., Evans M.D., Fearnhead N.S., Frizelle F.A., Garcia-Granero E., Garcia-Sabrido J.L., Gentilini L., George M.L., Glynn R., Golda T., Griffiths B., Harris D.A., Evans M., Hagemans J.A.W., Harji D.P., Heriot A.G., Hohenberger W., Holm T., Jenkins J.T., Kapur S., Kanemitsu Y., Kelley S.R., Keller D.S., Kim H., Koh C.E., Kok N.F.M., Kokelaar R., Kontovounisios C., Kusters M., Larson D.W., Law W.L., Laurberg S., Lee P., Lydrup M.L., Lynch A.C., Mantyh C., Mathis K.L., Martling A., Meijerink W.J.H.J., Merkel S., Mehta A.M., McDermott F.D., McGrath J.S., Mirnezami A., Morton J.R., Mullaney T.G., Mesquita-Neto J.W., Nielsen M.B., Nieuwenhuijzen G.A.P., Nilsson P.J., O'Connell P.R., Palmer G., Patsouras D., Pellino G., Poggioli G., Quinn M., Quyn A., Radwan R.W., Rasheed S., Rasmussen P.C., Regenbogen S.E., Rocha R., Rothbarth J., Roxburgh C., Rutten H.J.T., Ryan E., Sagar P.M., Saklani A., Schizas A.M.P., Schwarzkopf E., Scripcariu V., Shaikh I., Shida D., Simpson A., Smart N.J., Smith J.J., Solomon M.J., Sorensen M.M., Steele S.R., Steffens D., Stocchi L., Stylianides N.A., Tekkis P.P., Taylor C., Tsarkov P., Tsukamoto S., Turner W.H., Tuynman J.B., van Ramshorst G.H., van Zoggel D., Vasquez-Jimenez W., Verhoef C., Verstegen M., Wakeman C., Warrier S., Wasmuth H.H., Weiser M.R., Wheeler J.M.D., Wild J., Yip J., Winter D.C., Sammour T., Kroon, Hm, Dudi-Venkata, Nn, Bedrikovetski, S, Thomas, Ml, Kelly, Me, Aalbers, Agj, Abdul Aziz, N, Abraham-Nordling, M, Akiyoshi, T, Alberda, W, Andric, M, Antoniou, A, Austin, Kk, Baker, Rp, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, Gj, Chew, Mh, C Chong, P, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Enriquez-Navascues, Jm, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia- Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Harris, Da, Evans, M, Hagemans, Jaw, Harji, Dp, Heriot, Ag, Hohenberger, W, Holm, T, Jenkins, Jt, Kapur, S, Kanemitsu, Y, Kelley, Sr, Keller, D, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Law, Wl, Laurberg, S, Lee, P, Lydrup, Ml, Lynch, Ac, Mantyh, C, Mathis, Kl, Martling, A, Meijerink, Wjhj, Merkel, S, Mehta, Am, Mcdermott, Fd, Mcgrath, J, Mirnezami, A, Morton, Jr, Mullaney, Tg, Mesquita-Neto, Jw, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O’Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Regenbogen, Se, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Saklani, A, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, Jj, Solomon, Mj, Sørensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Tekkis, Pp, Taylor, C, Tsarkov, P, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez- Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Yip, J, Winter, Dc, and Sammour, T.
Subjects: medicine.medical_specialty, Pelvic Neoplasm, Palliative care, Fistula, medicine.medical_treatment, Disease, Locally advanced pelvic cancer, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Quality of life, Internal medicine, Patient-Centered Care, Outcome Assessment, Health Care, medicine, Palliative surgery, Humans, Pelvic Neoplasms, Pelvic exenteration, business.industry, Mortality rate, Patient-centered outcomes, Palliative Care, General Medicine, medicine.disease, Pelvic Exenteration, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, business, Human
Abstract: Item does not contain fulltext OBJECTIVE: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). METHODS: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. RESULTS: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13-100%), the median in-hospital mortality was 6.3% (0-66.7%), and median OS was 14 months (4-40 months). Some symptom relief was reported in a median of 79% (50-100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. CONCLUSION: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation.
Published: 2019
Full Text: View/download PDF

9. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer

Author: Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham-Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., Bali, M., Baseckas, G., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J. W. A., Burling, D., Campain, N., Chan, K. K. L., Chang, G., Chew, M. H., Chong, P. C., Christensen, H. K., Codd, M., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., de Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, M., Evans, M. D., Fearnhead, N. S., Frizelle, F. A., Garcia-Granero, E., Garcia-Sabrido, J. L., Gentilini, L., George, M. L., Glynn, R., Golda, T., Griffiths, B., Hagemans, J. A. W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O'Connell, P. R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, E., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V, Shaikh, I, Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sorensen, M. M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., van Ramshorst, Gabriëlle, van Zoggel, D., Vasquez-Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H. H., Weiser, M. R., Wheeler, J. M. D., Wild, J., Winter, D. C., Yip, J., Kelly, M. E., Aalbers, A. G. J., Aziz, N. Abdul, Abraham‐Nordling, M., Alberda, W., Antoniou, A., Austin, K. K., Baker, R., Bali, M., Baseckas, G., Bednarski, B. K., Beets, G. L., Berg, P. L., Beynon, J., Biondo, S., Bordeianou, L., Brunner, M., Buchwald, P., Burger, J. W. A., Burling, D., Campain, N., Chan, K. K. L., Chang, G., Chew, M. H., Chong, P. C., Christensen, H. K., Codd, M., Colquhoun, A. J., Corr, A., Coscia, M., Coyne, P. E., Creavin, B., Damjanovic, L., Daniels, I. R., Davies, M., Davies, R. J., Wilt, J. H. W., Denost, Q., Deutsch, C., Dietz, D., Dozois, E. J., Duff, M., Eglinton, T., Evans, M., Evans, M.D., Fearnhead, N. S., Frizelle, F. A., Garcia‐Granero, E., Garcia‐Sabrido, J. L., Gentilini, L., George, M. L., Glynn, R., Golda, T., Griffiths, B., Hagemans, J. A.W., Harji, D. P., Harris, D. A., Heriot, A. A. G., Hohenberger, W., Holm, T., Jenkins, J. T., Kanemitsu, Y., Kapur, S., Keller, D. S., Kelley, S. R., Kim, H., Koh, C. E., Kok, N. F. M., Kokelaar, R., Kontovounisios, C., Kusters, M., Larson, D. W., Laurberg, S., Law, W. L., Lee, P., Lydrup, M. L., Lynch, A. C., Martling, A., Mathis, K. L., Meijerink, W. J. H. J., Mentha, A. M., Merkel, S., McDermott, F. D., McGrath, J. S., Mihailo, A., Mirnezami, A., Morton, J. R., Mullaney, T. G., Nielsen, M. B., Nieuwenhuijzen, G. A. P., Nilsson, P. J., O'Connell, P. R., Palmer, G., Patsouras, D., Pellino, G., Poggioli, G., Quinn, M., Quyn, A., Radwan, R. W., Rasheed, S., Rasmussen, P. C., Rocha, R., Rothbarth, J., Roxburgh, C., Rutten, H. J. T., Ryan, É., Sagar, P. M., Sammour, T., Schizas, A. M. P., Schwarzkopf, E., Scripcariu, V., Shaikh, I., Shida, D., Simpson, A., Smart, N. J., Smith, J., Solomon, M. J., Sørensen, M.M., Steele, S. R., Steffens, D., Stocchi, L., Stylianides, N. A., Taylor, C., Tekkis, P. P., Tsukamoto, S., Turner, W. H., Tuynman, J. B., Ramshorst, G. H., Zoggel, D., Vasquez‐Jimenez, W., Verhoef, C., Verstegen, M., Wakeman, C., Warrier, S., Wasmuth, H. H., Weiser, M. R., Wheeler, J. M. D., Wild, J., Winter, D. C., Yip, J., Kelly, Me, Aalbers, Agj, Aziz, Na, Abraham-Nordling, M, Alberda, W, Antoniou, A, Austin, Kk, Baker, R, Bali, M, Baseckas, G, Bednarski, Bk, Beets, Gl, Berg, Pl, Beynon, J, Biondo, S, Bordeianou, L, Brunner, M, Buchwald, P, Burger, Jwa, Burling, D, Campain, N, Chan, Kkl, Chang, G, Chew, Mh, Chong, Pc, Christensen, Hk, Codd, M, Colquhoun, Aj, Corr, A, Coscia, M, Coyne, Pe, Creavin, B, Damjanovic, L, Daniels, Ir, Davies, M, Davies, Rj, de Wilt, Jhw, Denost, Q, Deutsch, C, Dietz, D, Dozois, Ej, Duff, M, Eglinton, T, Evans, M, Evans, Md, Fearnhead, N, Frizelle, Fa, Garcia-Granero, E, Garcia-Sabrido, Jl, Gentilini, L, George, Ml, Glynn, R, Golda, T, Griffiths, B, Hagemans, Jaw, Harji, Dp, Harris, Da, Heriot, Aag, Hohenberger, W, Holm, T, Jenkins, Jt, Kanemitsu, Y, Kapur, S, Keller, D, Kelley, Sr, Kim, H, Koh, Ce, Kok, Nfm, Kokelaar, R, Kontovounisios, C, Kusters, M, Larson, Dw, Laurberg, S, Law, Wl, Lee, P, Lydrup, Ml, Lynch, Ac, Martling, A, Mathis, Kl, Meijerink, Wjhj, Mentha, Am, Merkel, S, Mcdermott, Fd, Mcgrath, J, Mihailo, A, Mirnezami, A, Morton, Jr, Mullaney, Tg, Nielsen, Mb, Nieuwenhuijzen, Gap, Nilsson, Pj, O'Connell, Pr, Palmer, G, Patsouras, D, Pellino, G, Poggioli, G, Quinn, M, Quyn, A, Radwan, Rw, Rasheed, S, Rasmussen, Pc, Rocha, R, Rothbarth, J, Roxburgh, C, Rutten, Hjt, Ryan, E, Sagar, Pm, Sammour, T, Schizas, Amp, Schwarzkopf, E, Scripcariu, V, Shaikh, I, Shida, D, Simpson, A, Smart, Nj, Smith, J, Solomon, Mj, Sorensen, Mm, Steele, Sr, Steffens, D, Stocchi, L, Stylianides, Na, Taylor, C, Tekkis, Pp, Tsukamoto, S, Turner, Wh, Tuynman, Jb, van Ramshorst, Gh, van Zoggel, D, Vasquez-Jimenez, W, Verhoef, C, Verstegen, M, Wakeman, C, Warrier, S, Wasmuth, Hh, Weiser, Mr, Wheeler, Jmd, Wild, J, Winter, Dc, and Yip, J
Subjects: Male, Blood transfusion, Colorectal cancer, medicine.medical_treatment, Surgical Flaps, COLORECTAL-CANCER, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Postoperative Complications, Retrospective Studie, Medicine and Health Sciences, Mortality rate, General Medicine, Middle Aged, Treatment Outcome, medicine.anatomical_structure, HOSPITAL VOLUME, SURVIVAL, Original Article, Female, Life Sciences & Biomedicine, Human, medicine.medical_specialty, lcsh:Surgery, Rectum, Subgroup analysis, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, Retrospective Studies, Aged, Science & Technology, Pelvic exenteration, Rectal Neoplasms, business.industry, MORTALITY, PelvEx Collaborative, Retrospective cohort study, Original Articles, lcsh:RD1-811, Length of Stay, medicine.disease, SURGEON VOLUME, Pelvic Exenteration, Surgery, Surgical Flap, Postoperative Complication, Neoplasm Recurrence, Local, business, Complication
Abstract: Contains fulltext : 215764.pdf (Publisher’s version ) (Open Access) Background: Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time. Methods: This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated. Results: Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3.5 to 12.8 per cent, and from 12.0 to 29.4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0.040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62.5 to 80.0 per cent, P = 0.001; high-volume: from 83.5 to 88.4 per cent, P = 0.660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2.5 units (P < 0.001). R0 resection rates did not increase in either low-volume (from 51.7 to 60.4 per cent; P = 0.610) or higher-volume (from 48.6 to 65.5 per cent; P = 0.100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time. Conclusion: Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.
Published: 2019

10. Intraoperative Electron Beam Radiation Therapy (IOERT) Versus High-Dose-Rate Intraoperative Brachytherapy (HDR-IORT) in Patients With an R1 Resection for Locally Advanced or Locally Recurrent Rectal Cancer.

Author: Voogt ELK, van Rees JM, Hagemans JAW, Rothbarth J, Nieuwenhuijzen GAP, Cnossen JS, Peulen HMU, Dries WJF, Nuyttens J, Kolkman-Deurloo IK, Verhoef C, Rutten HJT, and Burger JWA
Subjects: Humans, Male, Female, Aged, Middle Aged, Radiotherapy Dosage, Retrospective Studies, Intraoperative Period, Margins of Excision, Aged, 80 and over, Disease-Free Survival, Adult, Treatment Outcome, Rectal Neoplasms radiotherapy, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Rectal Neoplasms mortality, Brachytherapy methods, Neoplasm Recurrence, Local, Electrons therapeutic use, Intraoperative Care
Abstract: Purpose: Intraoperative radiation therapy (IORT), delivered by intraoperative electron beam radiation therapy (IOERT) or high-dose-rate intraoperative brachytherapy (HDR-IORT), may reduce the local recurrence rate in patients with locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study was to compare the oncological outcomes between both IORT modalities in patients with LARC or LRRC who underwent a microscopic irradical (R1) resection., Methods: All consecutive patients who received IORT because of an R1 resection of LARC or LRRC between 2000 and 2016 in two tertiary referral centers were included. In LARC, a resection margin of ≤2 mm was considered R1. A resection margin of 0 mm was considered R1 in LRRC., Results: In total, 215 patients with LARC were included, of whom 151 (70%) received IOERT and 64 (30%) received HDR-IORT; in addition, 158 patients with LRRC were included, of whom 112 (71%) received IOERT and 46 (29%) received HDR-IORT. After multivariable analyses, the overall survival was not significantly different between the two IORT modalities. The local recurrence-free survival was significantly longer in patients treated with HDR-IORT, both in LARC (hazard ratio [HR], 0.496; 95% CI, 0.253-0.973; P = .041) and LRRC (HR, 0.567; 95% CI, 0.349-0.920; P = .021). In patients with LARC, major postoperative complications were similar for both IORT modalities (IOERT, 30%; HDR-IORT, 27%), whereas in patients with LRRC, the incidence of major postoperative complications was higher after HDR-IORT (IOERT, 26%; HDR-IORT, 46%)., Conclusions: This study showed a significantly better local recurrence-free survival in favor of HDR-IORT in patients with an R1 resection for LARC or LRRC. Optimization of the IOERT technique seems warranted., (Copyright © 2021 Elsevier Inc. All rights reserved.)
Published: 2021
Full Text: View/download PDF

11. The clinical relevance of indeterminate lung nodules in patients with locally recurrent rectal cancer.

Author: van Rees JM, Höppener DJ, Hagemans JAW, Rothbarth J, Grünhagen DJ, Nuyttens JJME, van Meerten E, de Vries M, and Verhoef C
Subjects: Aged, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Netherlands, Progression-Free Survival, Retrospective Studies, Lung Neoplasms diagnostic imaging, Lung Neoplasms secondary, Rectal Neoplasms pathology, Tomography, X-Ray Computed
Abstract: Aim: To evaluate the clinical relevance of indeterminate lung nodules (ILN) in patients with locally recurrent rectal cancer (LRRC) treated in a tertiary referral centre., Methods: All patients with LRRC diagnosed between 2000 and 2017 were retrospectively reviewed. Reports of staging chest CT-scans were evaluated for ILN. Patients with distant metastases including lung metastases at time of LRRC diagnosis were excluded. Overall (OS), progression-free survival (PFS) and the cumulative incidence of lung metastases were compared between patients with and without ILN., Results: In total 556 patients with LRRC were treated during the study period. In the 243 patients eligible for analysis, 68 (28%) had ILN at LRRC diagnosis. Median OS was 37 months for both the patients with and without ILN (p = 0.37). Median PFS was 14 months for the patients with ILN and 16 months for patients without ILN (p = 0.80). After correction for potential confounding, ILN present at LRRC diagnosis was not associated with impaired OS or PFS (adjusted hazards ratio [95% confidence interval]: 0.81 [0.54-1.22] and 1.09 [0.75-1.59]). The 5-year cumulative incidence of lung metastases was 31% in patients with ILN and 28% in patients without ILN (p = 0.19)., Conclusion: Our study shows that ILN are present in roughly a quarter of patients with LRRC. No differences in OS, PFS, or the cumulative incidence of lung metastases were found between patients with and without ILN at LRRC diagnosis. These results suggest that ILN are of little to no clinical relevance in patients with LRRC., (Copyright © 2020. Published by Elsevier Ltd.)
Published: 2021
Full Text: View/download PDF

12. Outcomes of urinary diversion after surgery for locally advanced or locally recurrent rectal cancer with complete cystectomy; ileal and colon conduit.

Author: Hagemans JAW, Voogt ELK, Rothbarth J, Nieuwenhuijzen GAP, Kirkels WJ, Boormans JL, Koldewijn EL, Richardson R, Verhoef C, Rutten HJT, and Burger JWA
Subjects: Aged, Anastomosis, Surgical, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local diagnosis, Neoplasm Staging, Rectal Neoplasms diagnosis, Retrospective Studies, Urinary Reservoirs, Continent, Colon surgery, Cystectomy methods, Ileum surgery, Neoplasm Recurrence, Local surgery, Rectal Neoplasms surgery, Urinary Bladder surgery, Urinary Diversion methods
Abstract: Introduction: Surgery for locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) may require total pelvic exenteration with the need for urinary diversion. The aim of this study was to describe outcomes for ileal and colon conduits after surgery for LARC and LRRC., Methods: All consecutive patients from two tertiary referral centers who underwent total pelvic exenteration for LARC or LRRC between 2000 and 2018 with cystectomy and urinary reconstruction using an ileal or colon conduit were retrospectively analyzed. Short- (≤30 days) and long-term (>30 days) complications were described for an ileal and colon conduit., Results: 259 patients with LARC (n = 131) and LRRC (n = 128) were included, of whom 214 patients received an ileal conduit and 45 patients a colon conduit. Anastomotic leakage of the ileo-ileal anastomosis occurred in 9 patients (4%) after performing an ileal conduit. Ileal conduit was associated with a higher rate of postoperative ileus (21% vs 7%, p = 0.024), but a lower proportion of wound infections than a colon conduit (14% vs 31%, p = 0.006). The latter did not remain significant in multivariate analysis. No difference was observed in the rate of uretero-enteric anastomotic leakage, urological complications, mortality rates, major complications (Clavien-Dindo≥3), or hospital stay between both groups., Conclusion: Performing a colon conduit in patients undergoing total pelvic exenteration for LARC or LRRC avoids the risks of ileo-ileal anastomotic leakage and may reduce the risk of a post-operative ileus. Besides, there are no other differences in outcome for ileal and colon conduits., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Published: 2020
Full Text: View/download PDF

13. A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer.

Author: Blok RD, Hagemans JAW, Klaver CEL, Hellinga J, van Etten B, Burger JWA, Verhoef C, Hompes R, Bemelman WA, and Tanis PJ
Subjects: Humans, Morbidity, Perineum surgery, Postoperative Complications, Wound Healing, Omentum surgery, Rectal Neoplasms surgery
Abstract: Objective: The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer., Background: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications., Methods: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model., Results: Fourteen studies comprising 1894 patients (n = 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79-1.56), nor in planned subgroup analysis (n = 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%-8.6%)., Conclusions: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.
Published: 2020
Full Text: View/download PDF

14. Locally recurrent rectal cancer; long-term outcome of curative surgical and non-surgical treatment of 447 consecutive patients in a tertiary referral centre.

Author: Hagemans JAW, van Rees JM, Alberda WJ, Rothbarth J, Nuyttens JJME, van Meerten E, Verhoef C, and Burger JWA
Subjects: Aged, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Neoadjuvant Therapy methods, Neoplasm Recurrence, Local diagnosis, Netherlands epidemiology, Rectal Neoplasms diagnosis, Retrospective Studies, Treatment Outcome, Digestive System Surgical Procedures methods, Neoplasm Recurrence, Local epidemiology, Neoplasm Staging, Rectal Neoplasms therapy, Tertiary Care Centers statistics & numerical data
Abstract: Introduction: The majority of patients with locally recurrent rectal cancer (LRRC) present with extensive metastatic disease or an unresectable recurrence, and will be treated palliatively. Only a minority of patients will be eligible for potential cure by surgical treatment. The aim of this study is to evaluate the long-term outcome of surgical treatment and non-surgical treatment of patients with LRRC., Methods: All patients with LRRC referred to our tertiary institute between 2000 and 2015 were retrospectively analysed. Patients were discussed in a multidisciplinary tumour board (MDT) and eventually received curative surgical or non-surgical treatment. Overall survival (OS) was compared by resection margin status and non-surgical treatment., Results: A total of 447 patients were discussed in our MDT of which 193 patients underwent surgical treatment and 254 patients received non-surgical treatment. Surgically treated patients were significantly younger, received less neoadjuvant therapy for the primary tumour, had less metastasis at diagnosis and more central recurrences. The 5-year OS was 51% for R0-resections and 34% for R1-resections. Although numbers with R2-resections were too small to implicate prognostic significance, there was no difference in 5-year OS between R2-resections and non-surgical treatment (10% vs. 4%, p = 0.282). In a subgroup analysis the OS of R2-patients was even poorer compared to optimal palliative treated patients with combined chemotherapy and radiotherapy (22 vs 29 months, p = 0.413)., Conclusion: R2-resections do not result in a survival benefit compared to non-surgical treatment in this non-randomized series. Patients with a high chance on a R2-resection could be offered non-surgical treatment, without local resection., Competing Interests: Declaration of competing interest None., (Copyright © 2019. Published by Elsevier Ltd.)
Published: 2020
Full Text: View/download PDF

15. Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer.

Author: Blok RD, Hagemans JAW, Burger JWA, Rothbarth J, van der Bilt JDW, Lapid O, Hompes R, and Tanis PJ
Subjects: Adult, Aged, Buttocks surgery, Feasibility Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Perineum surgery, Pilot Projects, Proctectomy methods, Prospective Studies, Surgical Flaps adverse effects, Treatment Outcome, Cicatrix prevention & control, Proctectomy adverse effects, Plastic Surgery Procedures methods, Rectal Neoplasms surgery, Surgical Flaps surgery
Abstract: Background: Abdominoperineal resection (APR) carries a high risk of perineal wound morbidity. Perineal wound closure using autologous tissue flaps has been shown to be advantageous, but there is no consensus as to the optimal method. The aim of this study was to evaluate the feasibility of a novel gluteal turnover flap (GT-flap) without donor site scar for perineal closure after APR., Methods: Consecutive patients who underwent APR for primary or recurrent rectal cancer were included in a prospective non-randomised pilot study in two academic centres. Perineal reconstruction consisted of a unilateral subcutaneous GT-flap, followed by midline closure. Feasibility was defined as uncomplicated perineal wound healing at 30 days in at least five patients, and a maximum of two flap failures., Results: Out of 17 potentially eligible patients, 10 patients underwent APR with GT-flap-assisted perineal wound closure. Seven patients had pre-operative radiotherapy. Median-added theatre time was 38 min (range 35-44 min). Two patients developed a superficial perineal wound dehiscence, most likely because of the excessive width of the skin island. Two other patients developed purulent discharge and excessive serosanguinous discharge, respectively, resulting in four complicated wounds at 30 days. No flap failure occurred, and no radiological or surgical reinterventions were performed. Median length of hospital stay was 10 days (IQR 8-12 days)., Conclusions: The GT-flap for routine perineal wound closure after APR seems feasible with limited additional theatre time, but success seems to depend on correct planning of the width of the flap. The potential for reducing perineal morbidity should be evaluated in a randomised controlled trial.
Published: 2019
Full Text: View/download PDF

16. Treatment of Inguinal Lymph Node Metastases in Patients with Rectal Adenocarcinoma.

Author: Hagemans JAW, Rothbarth J, van Bogerijen GHW, van Meerten E, Nuyttens JJME, Verhoef C, and Burger JWA
Subjects: Adenocarcinoma secondary, Adult, Aged, Female, Follow-Up Studies, Humans, Inguinal Canal pathology, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Prognosis, Rectal Neoplasms pathology, Retrospective Studies, Survival Rate, Adenocarcinoma surgery, Inguinal Canal surgery, Neoplasm Recurrence, Local surgery, Rectal Neoplasms surgery
Abstract: Background: Inguinal lymph node metastases (ILNM) from rectal adenocarcinoma are rare and staged as systemic disease. This study aimed to provide insight into the treatment and prognosis of ILNM from rectal adenocarcinoma., Methods: All patients with a diagnosis of synchronous or metachronous ILNM from rectal adenocarcinoma between January 2005 and March 2017 were retrospectively reviewed., Results: The study identified 27 patients with ILNM (15 with synchronous and 12 with metachronous disease). After discussion by a multidisciplinary tumor board, 19 patients were treated with curative intent, 17 of whom underwent inguinal lymph node dissection. Of the 17 patients, 12 had locally advanced rectal cancer (LARC) with isolated ILNM, 3 had LARC and metastases elsewhere, and 2 had locally recurrent rectal cancer (LRRC). The median overall survival (OS) for all the patients treated with curative intent was 27 months [95% confidence interval (CI) 11.6-42.4 months], with a 5-year OS rate of 34%. The median OS for the patients with LARC and isolated ILNM (n = 12) was 74 months (95% CI 18.0-130.0 months), with a 5-year OS rate of 52%. All the patients with metastases elsewhere (n = 3) or LRRC (n = 2) experienced recurrent systemic disease. Eight patients were treated with palliative intent. The median OS for this group was 13 months (95% CI 1.9-24.1 months), with a 3-year OS rate of 0%., Conclusion: Clinicians should not consider ILNM as an incurable systemic disease. Patients with primary rectal cancer and solitary ILNM who were eligible for curative surgical treatment had a 5-year survival rate of 52%. The prognosis for patients with additional systemic metastases or LRRC is worse, and the benefit of surgery is unclear.
Published: 2019
Full Text: View/download PDF

17. Hospital volume and outcome in rectal cancer patients; results of a population-based study in the Netherlands.

Author: Hagemans JAW, Alberda WJ, Verstegen M, de Wilt JHW, Verhoef C, Elferink MA, and Burger JWA
Subjects: Age Factors, Aged, Female, Humans, Male, Neoadjuvant Therapy, Neoplasm Metastasis, Neoplasm Staging, Netherlands, Proportional Hazards Models, Rectal Neoplasms therapy, Registries, Survival Rate, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Rectal Neoplasms pathology, Rectal Neoplasms surgery
Abstract: Background: Clinically staged T1-3 rectal cancer (cT1-3) is generally treated by total mesorectal excision(TME) with or without neoadjuvant therapy and sometimes requires beyond TME-surgery, whereas cT4 rectal cancer often requires both. This study evaluates the outcome of cT1-3 and cT4 rectal cancer according to hospital volume., Methods: Patients undergoing rectal cancer surgery between 2005 and 2013 in the Netherlands were included from the National Cancer Registry. Hospitals were divided into low(1-20), medium(21-50) and high(>50 resections/year) volume for cT1-3 and low(1-4), medium(5-9) and high(≥10 resections/year) volume for cT4 rectal cancer. Cox-proportional hazards model was used for multivariable analysis of overall survival (OS)., Results: A total of 14.050 confirmed cT1-3 patients and 2.104 cT4 patients underwent surgery. In cT1-3 rectal cancer, there was no significant difference in 5-year OS related to high, medium and low hospital volume (70% vs. 69% vs. 69%). In cT4 rectal cancer, treatment in a high volume cT4 hospital was associated with a survival benefit compared to low volume cT4 hospitals (HR 0.81 95%CI 0.67-0.98) adjusted for non-treatment related confounders, but this was not significant after adjustment for neoadjuvant treatment. Patients with cT4-tumours treated in high volume hospitals had a significantly lower age, more synchronous metastases, more patients treated with neoadjuvant therapy and a higher pT-stage., Conclusion: Hospital volume was not associated with survival in cT1-3 rectal cancer. In cT4 rectal cancer, treatment in high volume cT4 hospitals was associated with improved survival compared to low volume cT4 hospitals, although this association lost statistical significance after correction for neoadjuvant treatment., (Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Published: 2019
Full Text: View/download PDF

18. Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery.

Author: de Boer NL, Hagemans JAW, Schultze BTA, Brandt-Kerkhof ARM, Madsen EVE, Verhoef C, and Burger JWA
Subjects: Acute Disease, Aged, Female, Follow-Up Studies, Humans, Intestinal Obstruction diagnosis, Intestinal Obstruction surgery, Male, Middle Aged, Morbidity trends, Netherlands epidemiology, Peritoneal Neoplasms diagnosis, Peritoneal Neoplasms surgery, Retrospective Studies, Survival Rate trends, Digestive System Surgical Procedures methods, Intestinal Obstruction etiology, Palliative Care methods, Peritoneal Neoplasms complications, Postoperative Complications epidemiology
Abstract: Introduction: Patients with peritoneal carcinomatosis who do not have curative treatment options often develop acute obstructive symptoms and when conservative management fails, surgical treatment is the remaining option. However, palliative surgery is associated with high morbidity and mortality and the chance of success is unclear. The aim of this study was to evaluate outcomes of palliative surgery and to provide guidance for surgeons, medical oncologists and patients in their decision-making., Methods: All consecutive patients who underwent palliative surgery for acute obstruction caused by peritoneal carcinomatosis between January 2005 and October 2017 where identified., Results: In total 148 patients underwent surgery. Primary malignancy was colorectal cancer (28.4%), neuroendocrine tumor (20.3%), ovarian cancer (14.2%) or 'other' (37.2%). Median length of postoperative hospital stay was 16 days (IQR 9-24). More than half (58.1%) of the patients developed postoperative complications, 29.1% developed ≥2 complications. In-hospital mortality was 8.8%. Readmission (56.1%) and re-obstruction (35.0%) were common. Median overall survival was 119 days (IQR 48-420). Patients with a neuroendocrine tumor had a significantly better overall survival compared to other primary malignancies (p < 0.001). Patients who developed an obstruction during or within 6 months after treatment with chemotherapy had a worse overall survival (p < 0.001), compared to patients treated with chemotherapy longer than 6 months ago, or patients not treated with chemotherapy., Conclusion: Palliative surgery is associated with high rates of complications and readmission and re-obstruction are common. Comfort care is often a better option than surgery, especially in patients with disease progression under recent treatment with chemotherapy., (Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Published: 2019
Full Text: View/download PDF

19. ASO Author Reflections: Salvage Surgery for Anal Cancer.

Author: Hagemans JAW
Subjects: Epithelial Cells, Humans, Proctectomy, Salvage Therapy, Anus Neoplasms, Carcinoma, Squamous Cell
Published: 2018
Full Text: View/download PDF

20. Total pelvic exenteration for locally advanced and locally recurrent rectal cancer in the elderly.

Author: Hagemans JAW, Rothbarth J, Kirkels WJ, Boormans JL, van Meerten E, Nuyttens JJME, Madsen EVE, Verhoef C, and Burger JWA
Subjects: Age Factors, Aged, Anastomotic Leak etiology, Chemoradiotherapy, Adjuvant, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Invasiveness, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Neoplasm, Residual, Pelvic Exenteration mortality, Rectal Neoplasms pathology, Rectal Neoplasms therapy, Retrospective Studies, Survival Rate, Neoplasm Recurrence, Local surgery, Pelvic Exenteration adverse effects, Rectal Neoplasms surgery
Abstract: Background: Total pelvic exenteration (TPE) is a radical approach for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) in case of tumour invasion into the urogenitary tract. The aim of this study is to assess surgical and oncological outcomes of TPE for LARC and LRRC in elderly patients compared to younger patients., Methods: All patients who underwent TPE for LARC and LRRC between January 1990 and March 2017 were retrospectively analyzed. Patients aged <70 years were classified as younger and ≥70 years as elderly patients., Results: In total 126 patients underwent TPE, of whom 88 younger and 38 elderly patients. Elderly patients had a significantly higher number of ASA > II patients (p = 0.01). Indication for surgery LARC (n = 73) and LRRC (n = 53) did not differ significantly. The 30-day mortality rate was significantly higher (p = 0.01) in elderly (13%) compared to younger patients (3%). Elderly patients experienced more anastomotic leakage (p = 0.02). Median overall survival (OS) was 75 months [95%CI 37.1; 112.9] for elderly and 45 months [95%CI 22.4; 67.8] for younger patients (p = 0.77). The 5-year OS rate was 44% in both groups. Median disease specific survival (DSS) was 78 months [95%CI 69.1; 86.9] for elderly and 60 months [95%CI 36.6; 83.4] for younger patients (p = 0.34). The 5-year DSS rate was 57% and 49%, respectively., Conclusion: TPE is an invasive treatment for rectal cancer with high 30-day mortality in elderly patients. Oncological outcomes are similar in elderly and younger patients. Therefore, TPE should not be withheld because of high age only, but careful patient selection is needed., (Copyright © 2018. Published by Elsevier Ltd.)
Published: 2018
Full Text: View/download PDF

21. Salvage Abdominoperineal Resection for Squamous Cell Anal Cancer: A 30-Year Single-Institution Experience.

Author: Hagemans JAW, Blinde SE, Nuyttens JJ, Morshuis WG, Mureau MAM, Rothbarth J, Verhoef C, and Burger JWA
Subjects: Aged, Anus Neoplasms pathology, Carcinoma, Squamous Cell pathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Prognosis, Retrospective Studies, Survival Rate, Abdomen surgery, Anus Neoplasms therapy, Carcinoma, Squamous Cell therapy, Chemoradiotherapy adverse effects, Neoplasm Recurrence, Local mortality, Perineum surgery, Proctectomy mortality, Salvage Therapy mortality
Abstract: Background: Failure of chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) results in persistent or recurrent anal SCC. Treatment with salvage abdominoperineal resection (APR) can potentially achieve cure. The aims of this study are to analyze oncological and surgical outcomes of our 30-year experience with salvage APR for anal SCC after failed CRT and identify prognostic factors for overall survival (OS)., Methods: All consecutive patients who underwent salvage APR between 1990 and 2016 for histologically confirmed persistent or recurrent anal SCC after failed CRT were retrospectively analyzed., Results: Forty-seven patients underwent salvage APR for either persistent (n = 24) or recurrent SCC (n = 23). Median OS was 47 months [95% confidence interval (CI) 10.0-84.0 months] and 5-year survival was 41.6%, which did not differ significantly between persistent or recurrent disease (p = 0.551). Increased pathological tumor size (p < 0.001) and lymph node involvement (p = 0.014) were associated with impaired hazard for OS on multivariable analysis, and irradical resection only (p = 0.001) on univariable analysis. Twenty-one patients developed local recurrence after salvage APR, of whom 8 underwent repeat salvage surgery and 13 received palliative treatment. Median OS was 9 months (95% CI 7.2-10.8 months) after repeat salvage surgery and 4 months (95% CI 2.8-5.1 months) following palliative treatment (p = 0.055)., Conclusions: Salvage APR for anal SCC after failed CRT resulted in adequate survival, with 5-year survival of 41.6%. Negative prognostic factors for survival were increased tumor size, lymph node involvement, and irradical resection. Patients with recurrent anal SCC after salvage APR had poor prognosis, irrespective of performance of repeat salvage surgery, which never resulted in cure.
Published: 2018
Full Text: View/download PDF

22. The influence of hospital volume on long-term oncological outcome after rectal cancer surgery.

Author: Jonker FHW, Hagemans JAW, Burger JWA, Verhoef C, Borstlap WAA, and Tanis PJ
Subjects: Aged, Chi-Square Distribution, Cross-Sectional Studies, Digestive System Surgical Procedures adverse effects, Digestive System Surgical Procedures mortality, Disease-Free Survival, Female, Hospital Mortality trends, Humans, Kaplan-Meier Estimate, Laparoscopy adverse effects, Laparoscopy mortality, Male, Margins of Excision, Middle Aged, Multivariate Analysis, Neoadjuvant Therapy trends, Neoplasm Staging, Neoplasm, Residual, Netherlands, Proportional Hazards Models, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Registries, Risk Factors, Surgical Stomas adverse effects, Time Factors, Treatment Outcome, Digestive System Surgical Procedures trends, Hospitals, High-Volume trends, Hospitals, Low-Volume trends, Laparoscopy trends, Process Assessment, Health Care trends, Rectal Neoplasms surgery, Surgical Stomas trends
Abstract: Purpose: The association between hospital volume and outcome in rectal cancer surgery is still subject of debate. The purpose of this study was to assess the impact of hospital volume on outcomes of rectal cancer surgery in the Netherlands in 2011., Methods: In this collaborative research with a cross-sectional study design, patients who underwent rectal cancer resection in 71 Dutch hospitals in 2011 were included. Annual hospital volume was stratified as low (< 20), medium (20-50), and high (≥ 50)., Results: Of 2095 patients, 258 patients (12.3%) were treated in 23 low-volume hospitals, 1329 (63.4%) in 40 medium-volume hospitals, and 508 (24.2%) in 8 high-volume hospitals. Median length of follow-up was 41 months. Clinical tumor stage, neoadjuvant therapy, extended resections, circumferential resection margin (CRM) positivity, and 30-day or in-hospital mortality did not differ significantly between volume groups. Significantly, more laparoscopic procedures were performed in low-volume hospitals, and more diverting stomas in high-volume hospitals. Three-year disease-free survival for low-, medium-, and high-volume hospitals was 75.0, 74.8, and 76.8% (p = 0.682). Corresponding 3-year overall survival rates were 75.9, 79.1, and 80.3% (p = 0.344). In multivariate analysis, hospital volume was not associated with long-term risk of mortality., Conclusions: No significant impact of hospital volume on rectal cancer surgery outcome could be observed among 71 Dutch hospitals after implementation of a national audit, with the majority of patients being treated at medium-volume hospitals.
Published: 2017
Full Text: View/download PDF

23. The impact of hospital volume on perioperative outcomes of rectal cancer.

Author: Jonker FHW, Hagemans JAW, Verhoef C, and Burger JWA
Subjects: Aged, Female, Hospital Mortality trends, Humans, Incidence, Male, Middle Aged, Netherlands epidemiology, Outcome and Process Assessment, Health Care, Rectal Neoplasms diagnosis, Rectal Neoplasms mortality, Retrospective Studies, Survival Rate trends, Digestive System Surgical Procedures methods, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Neoplasm Staging, Postoperative Complications epidemiology, Rectal Neoplasms surgery, Registries
Abstract: Background: The purpose of this study was to investigate the impact of hospital volume on perioperative outcomes of clinical tumour stage (cT)1-3 and cT4 rectal cancer., Methods: 16.162 patients operated for rectal cancer enrolled in the Dutch Surgical Colorectal Audit were included. Hospitals were divided into low (<20 cases/year), medium (21-50 cases/year) and high (>50 cases/year) volume for cT1-3 rectal cancer, and for cT4 rectal cancer into low (1-4 cases/year), medium (5-9 cases/year) and high (≥10 cases/year) volume. The influence of hospital volume on perioperative outcomes was investigated., Results: With regards to cT1-3 tumours, low volume had lower rates of complications (33.8% vs. 36.6% and 38.1%, p = 0.009), anastomotic leakage (5.4% vs. 8.1% and 8.6%), and reinterventions (11.5% vs. 12.6% and 14.8%, p = 0.002) as compared to medium and high volume hospitals. Thirty-day mortality and R0 rates were comparable between groups. In high cT4 volume hospitals, rates of extensive resection of tumour involvement (49.4% vs. 25.4% and 15.5%, p < 0.001) and additional resection of metastasis (17.5% vs. 14.4% and 3.0%, p < 0.001) were increased as compared to medium and low volume hospitals. Thirty-day mortality and R0 rates were comparable between groups. In a sub-analysis of pathologic tumour stage 4 patients, irradical resections were increased in low volume hospitals (33.8% vs. 22.5% and 20.8% in medium and high volume hospitals, p = 0.031)., Conclusions: For cT4 rectal cancer, high volume hospitals may offer a better multimodality treatment, while for cT1-3 rectal cancer there appears no benefit for centralization., (Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Published: 2017
Full Text: View/download PDF

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources

Refine your results

23 results on '"Hagemans, JAW"'

1. Minimum standards of pelvic exenterative practice:PelvEx Collaborative guideline

2. The global cost of pelvic exenteration

3. Perioperative management and anaesthetic considerations in pelvic exenterations using Delphi methodology: results from the PelvEx Collaborative

4. Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy

5. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

6. Predicting outcomes of pelvic exenteration using machine learning

7. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

8. Palliative pelvic exenteration: A systematic review of patient-centered outcomes

9. Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer

10. Intraoperative Electron Beam Radiation Therapy (IOERT) Versus High-Dose-Rate Intraoperative Brachytherapy (HDR-IORT) in Patients With an R1 Resection for Locally Advanced or Locally Recurrent Rectal Cancer.

11. The clinical relevance of indeterminate lung nodules in patients with locally recurrent rectal cancer.

12. Outcomes of urinary diversion after surgery for locally advanced or locally recurrent rectal cancer with complete cystectomy; ileal and colon conduit.

13. A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer.

14. Locally recurrent rectal cancer; long-term outcome of curative surgical and non-surgical treatment of 447 consecutive patients in a tertiary referral centre.

15. Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer.

16. Treatment of Inguinal Lymph Node Metastases in Patients with Rectal Adenocarcinoma.

17. Hospital volume and outcome in rectal cancer patients; results of a population-based study in the Netherlands.

18. Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery.

19. ASO Author Reflections: Salvage Surgery for Anal Cancer.

20. Total pelvic exenteration for locally advanced and locally recurrent rectal cancer in the elderly.

21. Salvage Abdominoperineal Resection for Squamous Cell Anal Cancer: A 30-Year Single-Institution Experience.

22. The influence of hospital volume on long-term oncological outcome after rectal cancer surgery.

23. The impact of hospital volume on perioperative outcomes of rectal cancer.

Catalog

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Publication Type

Journal

Database

Publisher

23 results on '"Hagemans, JAW"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources