110 results on '"Liem, Mike S. L."'
Search Results
2. Nutritional support in pancreatic cancer patients and its effect on nutritional status: an observational regional HPB network study investigating current practice
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Wijma, Allard G., Hogenbirk, Rianne N. M., Driessens, Heleen, Kluifhooft, Daniëlle A., Jellema-Betten, Ellen S., Tjalsma-de Vries, Marlies, Liem, Mike S. L., Nieuwenhuijs, Vincent B., Manusama, Eric M., Hoogwater, Frederik J. H., Nijkamp, Maarten W., Beijer, Sandra, and Klaase, Joost M.
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- 2024
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3. Practice variation and outcomes of minimally invasive minor liver resections in patients with colorectal liver metastases: a population-based study
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de Graaff, Michelle R., Klaase, Joost M., de Kleine, Ruben, Elfrink, Arthur K. E., Swijnenburg, Rutger-Jan, M. Zonderhuis, Babs, D. Mieog, J. Sven, Derksen, Wouter J. M., Hagendoorn, Jeroen, van den Boezem, Peter B., Rijken, Arjen M., Gobardhan, Paul D., Marsman, Hendrik A., Liem, Mike S. L., Leclercq, Wouter K. G., van Heek, Tjarda N. T., Pantijn, Gijs A., Bosscha, Koop, Belt, Eric J. T., Vermaas, Maarten, Torrenga, Hans, Manusama, Eric R., van den Tol, Petrousjka, Oosterling, Steven J., den Dulk, Marcel, Grünhagen, Dirk J., and Kok, Niels F. M.
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- 2023
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4. Deep learning models for automatic tumor segmentation and total tumor volume assessment in patients with colorectal liver metastases
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Wesdorp, Nina J., Zeeuw, J. Michiel, Postma, Sam C. J., Roor, Joran, van Waesberghe, Jan Hein T. M., van den Bergh, Janneke E., Nota, Irene M., Moos, Shira, Kemna, Ruby, Vadakkumpadan, Fijoy, Ambrozic, Courtney, van Dieren, Susan, van Amerongen, Martinus J., Chapelle, Thiery, Engelbrecht, Marc R. W., Gerhards, Michael F., Grunhagen, Dirk, van Gulik, Thomas M., Hermans, John J., de Jong, Koert P., Klaase, Joost M., Liem, Mike S. L., van Lienden, Krijn P., Molenaar, I. Quintus, Patijn, Gijs A., Rijken, Arjen M., Ruers, Theo M., Verhoef, Cornelis, de Wilt, Johannes H. W., Marquering, Henk A., Stoker, Jaap, Swijnenburg, Rutger-Jan, Punt, Cornelis J. A., Huiskens, Joost, and Kazemier, Geert
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- 2023
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5. Intersurgeon Variability in Local Treatment Planning for Patients with Initially Unresectable Colorectal Cancer Liver Metastases: Analysis of the Liver Expert Panel of the Dutch Colorectal Cancer Group
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Bond, Marinde J. G., Kuiper, Babette I., Bolhuis, Karen, Komurcu, Aysun, van Amerongen, Martinus J., Chapelle, Thiery, Dejong, Cornelis H. C., Engelbrecht, Marc R. W., Gerhards, Michael F., Grünhagen, Dirk J., van Gulik, Thomas, Hermans, John J., de Jong, Koert P., Klaase, Joost M., Kok, Niels F. M., Leclercq, Wouter K. G., Liem, Mike S. L., van Lienden, Krijn P., Molenaar, I. Quintus, Neumann, Ulf P., Patijn, Gijs A., Rijken, Arjen M., Ruers, Theo M., Verhoef, Cornelis, de Wilt, Johannes H. W., Kazemier, Geert, May, Anne M., Punt, Cornelis J. A., and Swijnenburg, Rutger-Jan
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- 2023
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6. First-line systemic treatment strategies in patients with initially unresectable colorectal cancer liver metastases (CAIRO5): an open-label, multicentre, randomised, controlled, phase 3 study from the Dutch Colorectal Cancer Group
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Van Gulik, Thomas, Huiskens, Joost, Van Tinteren, Harm, Dejong, Cornelis H.C., Grünhagen, Dirk J., Patijn, Gijs A., Ruers, Theo J.M., Chapelle, Thiery, Hermans, John J., Leclercq, Wouter K.G., Valkenburg-van Iersel, Liselot B.J., Grootscholten, Cecile, Van Dodewaard-de Jong, Joyce M., Vincent, Jeroen, Houtsma, Danny, Los, Maartje, Den Boer, Marien, Trajkovic-Vidakovic, Marija, Van Voorthuizen, Theo, Koopman, Miriam, Vestjens, Johanneke H.M.J.V., Torrenga, Hans, Mekenkamp, Leonie J., Veldhuis, Gerrit Jan, Polee, Marco B., Dohmen, Serge E., Schut, Heidi, Vulink, Annelie J.E., Van Halteren, Henk K., Oulad Hadj, Jamal, Schiphorst, Pieter-Paul J.B.M., Hoekstra, Ronald, Bond, Marinde J G, Bolhuis, Karen, Loosveld, Olaf J L, de Groot, Jan Willem B, Droogendijk, Helga, Helgason, Helgi H, Hendriks, Mathijs P, Klaase, Joost M, Kazemier, Geert, Liem, Mike S L, Rijken, Arjen M, Verhoef, Cornelis, de Wilt, Johannes H W, de Jong, Koert P, Gerhards, Michael F, van Amerongen, Martinus J, Engelbrecht, Marc R W, van Lienden, Krijn P, Molenaar, I Quintus, de Valk, Bart, Haberkorn, Brigitte C M, Kerver, Emile D, Erdkamp, Frans, van Alphen, Robbert J, Mathijssen-van Stein, Daniëlle, Komurcu, Aysun, Lopez-Yurda, Marta, Swijnenburg, Rutger-Jan, and Punt, Cornelis J A
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- 2023
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7. A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: a multicenter EUROPEAN validation
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Manuel-Vázquez, Alba, Balakrishnan, Anita, Agami, Paul, Andersson, Bodil, Berrevoet, Frederik, Besselink, Marc G., Boggi, Ugo, Caputo, Damiano, Carabias, Alberto, Carrion-Alvarez, Lucia, Franco, Carmen Cepeda, Coppola, Alessandro, Dasari, Bobby V. M., Diaz-Mercedes, Sherley, Feretis, Michail, Fondevila, Constantino, Fusai, Giuseppe Kito, Garcea, Giuseppe, Gonzabay, Victor, Bravo, Miguel Ángel Gómez, Gorris, Myrte, Hendrikx, Bart, Hidalgo-Salinas, Camila, Kadam, Prashant, Karavias, Dimitrios, Kauffmann, Emanuele, Kourdouli, Amar, La Vaccara, Vincenzo, van Laarhoven, Stijn, Leighton, James, Liem, Mike S. L., Machairas, Nikolaos, Magouliotis, Dimitris, Mahmoud, Adel, Marino, Marco V., Massani, Marco, Requena, Paola Melgar, Mentor, Keno, Napoli, Niccolò, Nijhuis, Jorieke H. T., Nikov, Andrej, Nistri, Cristina, Nunes, Victor, Ruiz, Eduardo Ortiz, Pandanaboyana, Sanjay, Saborido, Baltasar Pérez, Pohnán, Radek, Popa, Mariuca, Pérez, Belinda Sánchez, Bueno, Francisco Sánchez, Serrablo, Alejandro, Serradilla-Martín, Mario, Skipworth, James R. A., Soreide, Kjetil, Symeonidis, Dimitris, Zacharoulis, Dimitris, Zelga, Piotr, Aliseda, Daniel, Santiago, María Jesús Castro, Mancilla, Carlos Fernández, Fragua, Raquel Latorre, Hughes, Daniel Llwyd, Llorente, Carmen Payá, Lesurtel, Mickaël, Gallagher, Tom, and Ramia, José Manuel
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- 2022
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8. Risk factors for surgery-related muscle quantity and muscle quality loss and their impact on outcome
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van Wijk, Laura, van Duinhoven, Stijn, Liem, Mike S. L., Bouman, Donald E., Viddeleer, Alain R., and Klaase, Joost M.
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- 2021
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9. The Prognostic Value of Total Tumor Volume Response Compared With RECIST1.1 in Patients With Initially Unresectable Colorectal Liver Metastases Undergoing Systemic Treatment
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Wesdorp, Nina J., Bolhuis, Karen, Roor, Joran, van Waesberghe, Jan-Hein T. M., van Dieren, Susan, van Amerongen, Martin J., Chapelle, Thiery, Dejong, Cornelis H. C., Engelbrecht, Marc R. W., Gerhards, Michael F., Grunhagen, Dirk, van Gulik, Thomas M., Hermans, John J., de Jong, Koert P., Klaase, Joost M., Liem, Mike S. L., van Lienden, Krijn P., Molenaar, I. Quintus, Patijn, Gijs A., Rijken, Arjen M., Ruers, Theo M., Verhoef, Cornelis, de Wilt, Johannes H. W., Swijnenburg, Rutger-Jan, Punt, Cornelis J. A., Huiskens, Joost, and Kazemier, Geert
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- 2021
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10. Short-Term Outcomes of Secondary Liver Surgery for Initially Unresectable Colorectal Liver Metastases Following Modern Induction Systemic Therapy in the Dutch CAIRO5 Trial
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Bolhuis, Karen, Grosheide, Lodi, Wesdorp, Nina J., Komurcu, Aysun, Chapelle, Thiery, Dejong, Cornelis H. C., Gerhards, Michael F., Grünhagen, Dirk J., van Gulik, Thomas M., Huiskens, Joost, De Jong, Koert P., Kazemier, Geert, Klaase, Joost M., Liem, Mike S. L., Molenaar, I. Quintus, Patijn, Gijs A., Rijken, Arjen M., Ruers, Theo M., Verhoef, Cornelis, de Wilt, Johannes H. W., Punt, Cornelis J. A., and Swijnenburg, Rutger-Jan
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- 2021
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11. First-line systemic treatment strategies in patients with initially unresectable colorectal cancer liver metastases (CAIRO5): an open-label, multicentre, randomised, controlled, phase 3 study from the Dutch Colorectal Cancer Group
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Bond, Marinde J G, primary, Bolhuis, Karen, additional, Loosveld, Olaf J L, additional, de Groot, Jan Willem B, additional, Droogendijk, Helga, additional, Helgason, Helgi H, additional, Hendriks, Mathijs P, additional, Klaase, Joost M, additional, Kazemier, Geert, additional, Liem, Mike S L, additional, Rijken, Arjen M, additional, Verhoef, Cornelis, additional, de Wilt, Johannes H W, additional, de Jong, Koert P, additional, Gerhards, Michael F, additional, van Amerongen, Martinus J, additional, Engelbrecht, Marc R W, additional, van Lienden, Krijn P, additional, Molenaar, I Quintus, additional, de Valk, Bart, additional, Haberkorn, Brigitte C M, additional, Kerver, Emile D, additional, Erdkamp, Frans, additional, van Alphen, Robbert J, additional, Mathijssen-van Stein, Daniëlle, additional, Komurcu, Aysun, additional, Lopez-Yurda, Marta, additional, Swijnenburg, Rutger-Jan, additional, Punt, Cornelis J A, additional, Van Gulik, Thomas, additional, Huiskens, Joost, additional, Van Tinteren, Harm, additional, Dejong, Cornelis H.C., additional, Grünhagen, Dirk J., additional, Patijn, Gijs A., additional, Ruers, Theo J.M., additional, Chapelle, Thiery, additional, Hermans, John J., additional, Leclercq, Wouter K.G., additional, Valkenburg-van Iersel, Liselot B.J., additional, Grootscholten, Cecile, additional, Van Dodewaard-de Jong, Joyce M., additional, Vincent, Jeroen, additional, Houtsma, Danny, additional, Los, Maartje, additional, Den Boer, Marien, additional, Trajkovic-Vidakovic, Marija, additional, Van Voorthuizen, Theo, additional, Koopman, Miriam, additional, Vestjens, Johanneke H.M.J.V., additional, Torrenga, Hans, additional, Mekenkamp, Leonie J., additional, Veldhuis, Gerrit Jan, additional, Polee, Marco B., additional, Dohmen, Serge E., additional, Schut, Heidi, additional, Vulink, Annelie J.E., additional, Van Halteren, Henk K., additional, Oulad Hadj, Jamal, additional, Schiphorst, Pieter-Paul J.B.M., additional, and Hoekstra, Ronald, additional
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- 2023
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12. ASO Visual Abstract: Intersurgeon Variability in Local Treatment Planning for Patients with Initially Unresectable Colorectal Cancer Liver Metastases—Analysis of the Liver Expert Panel of the Dutch Colorectal Cancer Group
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Bond, Marinde J. G., primary, Kuiper, Babette I., additional, Bolhuis, Karen, additional, Komurcu, Aysun, additional, van Amerongen, Martinus J., additional, Chapelle, Thiery, additional, Dejong, Cornelis H. C., additional, Engelbrecht, Marc R. W., additional, Gerhards, Michael F., additional, Grünhagen, Dirk J., additional, van Gulik, Thomas, additional, Hermans, John J., additional, de Jong, Koert P., additional, Klaase, Joost M., additional, Kok, Niels F. M., additional, Leclercq, Wouter K. G., additional, Liem, Mike S. L., additional, van Lienden, Krijn P., additional, Quintus Molenaar, I., additional, Neumann, Ulf P., additional, Patijn, Gijs A., additional, Rijken, Arjen M., additional, Ruers, Theo M., additional, Verhoef, Cornelis, additional, de Wilt, Johannes H. W., additional, Kazemier, Geert, additional, May, Anne M., additional, Punt, Cornelis J. A., additional, and Swijnenburg, Rutger-Jan, additional
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- 2023
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13. Axillary metastases after port site recurrences of gallbladder carcinoma: a case report
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Nijhuis, Jorieke J. H. T., Bosscher, M. R. Frederiek, and Liem, Mike S. L.
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- 2020
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14. Risk Models for Developing Pancreatic Fistula After Pancreatoduodenectomy: Validation in a Nationwide Prospective Cohort.
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Schouten, Thijs J., Henry, Anne Claire, Smits, Francina J., Besselink, Marc G., Bonsing, Bert A., Bosscha, Koop, Busch, Olivier R., van Dam, Ronald M., van Eijck, Casper H., Festen, Sebastiaan, Koerkamp, Bas Groot, van der Harst, Erwin, de Hingh, Ignace H. J. T., Kazemier, Geert, Liem, Mike S. L., de Meijer, Vincent E., Patijn, Gijs A., Roos, Daphne, Schreinemakers, Jennifer M. J., and Stommel, Martijn W. J.
- Abstract
Objective: To evaluate the performance of published fistula risk models by external validation, and to identify independent risk factors for postoperative pancreatic fistula (POPF). Background: Multiple risk models have been developed to predict POPF after pancreatoduodenectomy. External validation in high-quality prospective cohorts is, however, lacking or only performed for individual models. Methods: A post hoc analysis of data from the stepped-wedge cluster cluster-randomized Care After Pancreatic Resection According to an Algorithm for Early Detection and Minimally Invasive Management of Pancreatic Fistula versus Current Practice (PORSCH) trial was performed. Included were all patients undergoing pancreatoduodenectomy in the Netherlands (January 2018--November 2019). Risk models on POPF were identified by a systematic literature search. Model performance was evaluated by calculating the area under the receiver operating curves (AUC) and calibration plots. Multivariable logistic regression was performed to identify independent risk factors associated with clinically relevant POPF. Results: Overall, 1358 patients undergoing pancreatoduodenectomy were included, of whom 341 patients (25%) developed clinically relevant POPF. Fourteen risk models for POPF were evaluated, with AUCs ranging from 0.62 to 0.70. The updated alternative fistula risk score had an AUC of 0.70 (95% confidence intervals [CI]: 0.69--0.72). The alternative fistula risk score demonstrated an AUC of 0.70 (95% CI: 0.689--0.71), whilst an AUC of 0.70 (95% CI: 0.699--0.71) was also found for the model by Petrova and colleagues. Soft pancreatic texture, pathology other than pancreatic ductal adenocarcinoma or chronic pancreatitis, small pancreatic duct diameter, higher body mass index, minimally invasive resection and male sex were identified as independent predictors of POPF. Conclusion: Published risk models predicting clinically relevant POPF after pancreatoduodenectomy have a moderate predictive accuracy. Their clinical applicability to identify high-risk patients and guide treatment strategies is therefore questionable. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Textbook Outcome: Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery
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van Roessel, Stijn, Mackay, Tara M., van Dieren, Susan, van der Schelling, George P., Nieuwenhuijs, Vincent B., Bosscha, Koop, van der Harst, Edwin, van Dam, Ronald M., Liem, Mike S. L., Festen, Sebastiaan, Stommel, Martijn W. J., Roos, Daphne, Wit, Fennie, Molenaar, I. Quintus, de Meijer, Vincent E., Kazemier, Geert, de Hingh, Ignace H. J. T., van Santvoort, Hjalmar C., Bonsing, Bert A., Busch, Olivier R., Groot Koerkamp, Bas, and Besselink, Marc G.
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- 2020
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16. Impact of complications after resection of pancreatic cancer on disease recurrence and survival, and mediation effect of adjuvant chemotherapy: nationwide, observational cohort study
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Henry, Anne Claire, primary, van Dongen, Jelle C, additional, van Goor, Iris W J M, additional, Smits, F Jasmijn, additional, Nagelhout, Anne, additional, Besselink, Marc G, additional, Busch, Olivier R, additional, Bonsing, Bert A, additional, Bosscha, Koop, additional, van Dam, Ronald M, additional, Festen, Sebastiaan, additional, Groot Koerkamp, Bas, additional, van der Harst, Erwin, additional, de Hingh, Ignace H, additional, van der Kolk, Marion, additional, Liem, Mike S L, additional, de Meijer, Vincent E, additional, Patijn, Gijs A, additional, Roos, Daphne, additional, Schreinemakers, Jennifer M, additional, Wit, Fennie, additional, Daamen, Lois A, additional, van Santvoort, Hjalmar C, additional, Molenaar, I Quintus, additional, and van Eijck, Casper H J, additional
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- 2023
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17. Fistula Risk Score for Auditing Pancreatoduodenectomy: The Auditing FRS
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van Dongen, Jelle C, van Dam, Jacob L, Besselink, Marc G, Bonsing, Bert A, Bosscha, Koop, Busch, Olivier R, van Dam, Ronald M, Festen, Sebastiaan, van der Harst, Erwin, de Hingh, Ignace H, Kazemier, Geert, Liem, Mike S L, de Meijer, Vincent E, Mieog, J Sven D, Molenaar, I Q, Patijn, Gijs A, van Santvoort, Hjalmar C, Wijsman, Jan H, Stommel, Martijn W J, Wit, Fennie, De Wilde, Roeland F, van Eijck, Casper H J, Groot Koerkamp, Bas, Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy
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SDG 3 - Good Health and Well-being - Abstract
OBJECTIVE: To develop a fistula risk score for auditing, to be able to compare postoperative pancreatic fistula (POPF) after pancreatoduodenectomy among hospitals. BACKGROUND: For proper comparisons of outcomes in surgical audits, case-mix variation should be accounted for. METHODS: This study included consecutive patients after pancreatoduodenectomy from the mandatory nationwide Dutch Pancreatic Cancer Audit. Derivation of the score was performed with the data from 2014 to 2018 and validation with 2019 to 2020 data. The primary endpoint of the study was POPF (grade B or C). Multivariable logistic regression analysis was performed for case-mix adjustment of known risk factors. RESULTS: In the derivation cohort, 3271 patients were included, of whom 479 (14.6%) developed POPF. Male sex [odds ratio (OR)=1.34; 95% confidence interval (CI): 1.09-1.66], higher body mass index (OR=1.07; 95% CI: 1.05-1.10), a final diagnosis other than pancreatic ductal adenocarcinoma/pancreatitis (OR=2.41; 95% CI: 1.90-3.06), and a smaller duct diameter (OR=1.43/mm decrease; 95% CI: 1.32-1.55) were independently associated with POPF. Diabetes mellitus (OR=0.73; 95% CI: 0.55-0.98) was independently associated with a decreased risk of POPF. Model discrimination was good with a C-statistic of 0.73 in the derivation cohort and 0.75 in the validation cohort (n=913). Hospitals differed in particular in the proportion of pancreatic ductal adenocarcinoma/pancreatitis patients, ranging from 36.0% to 58.1%. The observed POPF risk per center ranged from 2.9% to 25.4%. The expected POPF rate based on the 5 risk factors ranged from 11.6% to 18.0% among hospitals. CONCLUSIONS: The auditing fistula risk score was successful in case-mix adjustment and enables fair comparisons of POPF rates among hospitals.
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- 2022
18. Improved preoperative aerobic fitness following a home-based bimodal prehabilitation programme in high-risk patients scheduled for liver or pancreatic resection
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van Wijk, Laura, primary, Bongers, Bart C, additional, Berkel, Annefleur E M, additional, Buis, Carlijn I, additional, Reudink, Muriël, additional, Liem, Mike S L, additional, Slooter, Gerrit D, additional, van Meeteren, Nico L U, additional, and Klaase, Joost M, additional
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- 2022
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19. Pancreatectomy with arterial resection for periampullary cancer: outcomes after planned or unplanned events in a nationwide, multicentre cohort.
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Stoop, Thomas F., Mackay, Tara M., Brada, Lilly J. H., van der Harst, Erwin, Daams, Freek, van 't Land, Freek R., Kazemier, Geert, Patijn, Gijs A., van Santvoort, Hjalmar C., de Hingh, Ignace H., Bosscha, Koop, Seelen, Leonard W. F., Nijkamp, Maarten W., Stommel, Martijn W. J., Liem, Mike S. L., Busch, Olivier R., Coene, Peter-Paul L. O., van Dam, Ronald M., de Wilde, Roeland F., and Mieog, J. Sven D.
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ONCOLOGIC surgery ,CANCER prognosis ,PANCREATECTOMY - Published
- 2023
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20. Interobserver Variability in CT-based Morphologic Tumor Response Assessment of Colorectal Liver Metastases
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Wesdorp, Nina J, Kemna, Ruby, Bolhuis, Karen, van Waesberghe, Jan H T M, Nota, Irene M G C, Struik, Femke, Oulad Abdennabi, Ikrame, Phoa, Saffire S K S, van Dieren, Susan, van Amerongen, Martinus J, Chapelle, Thiery, Dejong, Cornelis H C, Engelbrecht, Marc R W, Gerhards, Michael F, Grünhagen, Dirk, van Gulik, Thomas M, Hermans, John J, de Jong, Koert P, Klaase, Joost M, Liem, Mike S L, van Lienden, Krijn P, Molenaar, I Quintus, Patijn, Gijs A, Rijken, Arjen M, Ruers, Theo M, Verhoef, Cornelis, de Wilt, Johannes H W, Swijnenburg, Rutger-Jan, Punt, Cornelis J A, Huiskens, Joost, Stoker, Jaap, Kazemier, Geert, Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, Internal medicine, Radiology and nuclear medicine, AGEM - Re-generation and cancer of the digestive system, VU University medical center, CCA - Imaging and biomarkers, Radiology & Nuclear Medicine, Graduate School, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Radiology and Nuclear Medicine, AGEM - Digestive immunity, APH - Methodology, Oncology, Groningen Institute for Organ Transplantation (GIOT), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Value, Affordability and Sustainability (VALUE)
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Colorectal Neoplasms/diagnostic imaging ,Male ,Tumor Response ,Abdomen/Gastrointestinal ,Tomography, X-Ray Computed/methods ,Observer Performance ,Metastases ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Liver Neoplasms/diagnostic imaging ,Humans ,Prospective Studies ,Tomography ,Original Research ,Computer. Automation ,Observer Variation ,Liver Neoplasms ,General Medicine ,Middle Aged ,X-Ray Computed/methods ,Liver ,Oncology ,Female ,Human medicine ,Colorectal Neoplasms ,Tomography, X-Ray Computed ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] ,CT - Abstract
Item does not contain fulltext Purpose To evaluate interobserver variability in the morphologic tumor response assessment of colorectal liver metastases (CRLM) managed with systemic therapy and to assess the relation of morphologic response with gene mutation status, targeted therapy, and Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 measurements. Materials and Methods Participants with initially unresectable CRLM receiving different systemic therapy regimens from the randomized, controlled CAIRO5 trial (NCT02162563) were included in this prospective imaging study. Three radiologists independently assessed morphologic tumor response on baseline and first follow-up CT scans according to previously published criteria. Two additional radiologists evaluated disagreement cases. Interobserver agreement was calculated by using Fleiss κ. On the basis of the majority of individual radiologic assessments, the final morphologic tumor response was determined. Finally, the relation of morphologic tumor response and clinical prognostic parameters was assessed. Results In total, 153 participants (median age, 63 years [IQR, 56-71]; 101 men) with 306 CT scans comprising 2192 CRLM were included. Morphologic assessment performed by the three radiologists yielded 86 (56%) agreement cases and 67 (44%) disagreement cases (including four major disagreement cases). Overall interobserver agreement between the panel radiologists on morphology groups and morphologic response categories was moderate (κ = 0.53, 95% CI: 0.48, 0.58 and κ = 0.54, 95% CI: 0.47, 0.60). Optimal morphologic response was particularly observed in patients treated with bevacizumab (P = .001) and in patients with RAS/BRAF mutation (P = .04). No evidence of a relationship between RECIST 1.1 and morphologic response was found (P = .61). Conclusion Morphologic tumor response assessment following systemic therapy in participants with CRLM demonstrated considerable interobserver variability. Keywords: Tumor Response, Observer Performance, CT, Liver, Metastases, Oncology, Abdomen/Gastrointestinal Clinical trial registration no. NCT02162563 Supplemental material is available for this article. © RSNA, 2022.
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- 2022
21. Practice variation and outcomes of minimally invasive minorliver resections in patients with colorectal liver metastases: a population-based study
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de Graaff, Michelle R., Klaase, Joost M., de Kleine, Ruben, Elfrink, Arthur K. E., Swijnenburg, Rutger-Jan, M. Zonderhuis, Babs, D. Mieog, J. Sven, Derksen, Wouter J. M., Hagendoorn, Jeroen, van den Boezem, Peter B., Rijken, Arjen M., Gobardhan, Paul D., Marsman, Hendrik A., Liem, Mike S. L., Leclercq, Wouter K. G., van Heek, Tjarda N. T., Pantijn, Gijs A., Bosscha, Koop, Belt, Eric J. T., Vermaas, Maarten, Torrenga, Hans, Manusama, Eric R., van den Tol, Petrousjka, Oosterling, Steven J., den Dulk, Marcel, Grünhagen, Dirk J., and Kok, Niels F. M.
- Abstract
Introduction: In 2017, the Southampton guideline stated that minimally invasive liver resections (MILR) should considered standard practice for minor liver resections. This study aimed to assess recent implementation rates of minor MILR, factors associated with performing MILR, hospital variation, and outcomes in patients with colorectal liver metastases (CRLM). Methods: This population-based study included all patients who underwent minor liver resection for CRLM in the Netherlands between 2014 and 2021. Factors associated with MILR and nationwide hospital variation were assessed using multilevel multivariable logistic regression. Propensity-score matching (PSM) was applied to compare outcomes between minor MILR and minor open liver resections. Overall survival (OS) was assessed with Kaplan–Meier analysis on patients operated until 2018. Results: Of 4,488 patients included, 1,695 (37.8%) underwent MILR. PSM resulted in 1,338 patients in each group. Implementation of MILR increased to 51.2% in 2021. Factors associated with not performing MILR included treatment with preoperative chemotherapy (aOR 0.61 CI:0.50–0.75, p< 0.001), treatment in a tertiary referral hospital (aOR 0.57 CI:0.50–0.67, p< 0.001), and larger diameter and number of CRLM. Significant hospital variation was observed in use of MILR (7.5% to 93.0%). After case-mix correction, six hospitals performed fewer, and six hospitals performed more MILRs than expected. In the PSM cohort, MILR was associated with a decrease in blood loss (aOR 0.99 CI:0.99–0.99, p< 0.01), cardiac complications (aOR 0.29, CI:0.10–0.70, p= 0.009), IC admissions (aOR 0.66, CI:0.50–0.89, p= 0.005), and shorter hospital stay (aOR CI:0.94–0.99, p< 0.01). Five-year OS rates for MILR and OLR were 53.7% versus 48.6%, p= 0.21. Conclusion: Although uptake of MILR is increasing in the Netherlands, significant hospital variation remains. MILR benefits short-term outcomes, while overall survival is comparable to open liver surgery. Graphical abstract:
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- 2023
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22. Implementation and first results of a mandatory, nationwide audit on liver surgery
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van der Werf, Leonie R., Kok, Niels F. M., Buis, Carlijn I., Grünhagen, Dirk J., Hoogwater, Frederik J. H., Swijnenburg, Rutger Jan, Dulk, Marcel den, Dejong, Kees C. H. C., Klaase, Joost M., de Boer, Marieke T., Besselink, Marc G. H., van Gullik, Thomas M., Hagendoorn, Jeroen, van Hillegersberg, Richard, Liem, Mike S. L., Molenaar, I. Quintus, Patijn, Gijs A., Porte, Robert J., te Riele, Wouter W., van Santvoort, Hjalmar C., Verhoef, Kees, Burgmans, Marc C., van Delden, Otto M., van der Leij, Christiaan, Meijerink, Martijn R., Moelker, Adriaan, Prevoo, Warner, Surgery, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Other Research, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, CCA - Cancer Treatment and quality of life, Radiology and nuclear medicine, Groningen Institute for Organ Transplantation (GIOT), and Value, Affordability and Sustainability (VALUE)
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Male ,Liver surgery ,medicine.medical_specialty ,RESECTION ,ENHANCED RECOVERY ,MEDLINE ,Audit ,030230 surgery ,Liver resections ,MORBIDITY ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Hepatectomy ,Humans ,Medicine ,Registries ,Neoplasm Metastasis ,Aged ,Netherlands ,Quality Indicators, Health Care ,Retrospective Studies ,Clinical Audit ,Hepatology ,business.industry ,General surgery ,Liver Neoplasms ,Gastroenterology ,Outcome measures ,Retrospective cohort study ,CHEMOTHERAPY ,Middle Aged ,CANCER ,METASTASES ,Population Surveillance ,030220 oncology & carcinogenesis ,Female ,Colorectal Neoplasms ,business ,Complication ,Follow-Up Studies - Abstract
Background: The Dutch Hepato Biliary Audit (DHBA) was initiated in 2013 to assess the national quality of liver surgery. This study aimed to describe the initiation and implementation of this audit along with an overview of the results and future perspectives.Methods: Registry of patients undergoing liver surgery for all primary and secondary liver tumors in the DHBA is mandatory. Weekly, benchmarked information on process and outcome measures is reported to surgical teams. In this study, the first results of patients with colorectal liver metastases were presented, including results of data verification.Results: Between 2014 and 2017, 6241 procedures were registered, including 4261 (68%) resections for colorectal liver metastases. For minor- and major liver resections for colorectal liver metastases, the median [interquartile range] hospital stay was 6 [4-8] and 8 [6-12] days, respectively. A postoperative complicated course (complication leading to >14 days of hospital stay, reintervention or death) occurred in 26% and 43% and the 30-day/in-hospital mortality was 1% and 4%, respectively. The completeness of data was 97%. In 3.6% of patients, a complicated postoperative course was erroneously omitted.Conclusion: Nationwide implementation of the DHBA has been successful. This was the first step in creating a complete evaluation of the quality of liver surgery.
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- 2019
23. Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only
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Brada, Lilly J. H., primary, Daamen, Lois A., additional, Magermans, Lisa G., additional, Walma, Marieke S., additional, Latifi, Diba, additional, van Dam, Ronald M., additional, de Hingh, Ignace H., additional, Liem, Mike S. L., additional, de Meijer, Vincent E., additional, Patijn, Gijs A., additional, Festen, Sebastiaan, additional, Stommel, Martijn W. J., additional, Bosscha, Koop, additional, Polée, Marco B., additional, Nio, Yung C., additional, Wessels, Frank J., additional, de Vries, Jan J. J., additional, van Lienden, Krijn P., additional, Bruijnen, Rutger C., additional, Busch, Olivier R., additional, Koerkamp, Bas Groot, additional, van Eijck, Casper, additional, Molenaar, Quintus I., additional, Wilmink, Hanneke J. W., additional, van Santvoort, Hjalmar C., additional, and Besselink, Marc G., additional
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- 2021
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24. Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection
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Berkel, Annefleur E. M., primary, Wijk, Laura Van, additional, Bongers, Bart C., additional, Palen, Job Van Der, additional, Buis, Carlijn I., additional, Reudink, Muriel, additional, Liem, Mike S. L., additional, Slooter, Gerrit D., additional, Van Meeteren, Nico L. U., additional, and Klaase, Joost M., additional
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- 2020
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25. Textbook Outcome
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van Roessel, Stijn, primary, Mackay, Tara M., additional, van Dieren, Susan, additional, van der Schelling, George P., additional, Nieuwenhuijs, Vincent B., additional, Bosscha, Koop, additional, van der Harst, Edwin, additional, van Dam, Ronald M., additional, Liem, Mike S. L., additional, Festen, Sebastiaan, additional, Stommel, Martijn W. J., additional, Roos, Daphne, additional, Wit, Fennie, additional, Molenaar, I. Quintus, additional, de Meijer, Vincent E., additional, Kazemier, Geert, additional, de Hingh, Ignace H. J. T., additional, van Santvoort, Hjalmar C., additional, Bonsing, Bert A., additional, Busch, Olivier R., additional, Groot Koerkamp, Bas, additional, and Besselink, Marc G., additional
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- 2020
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26. Magnetic resonance imaging of Achilles tendon xanthomas in familial hypercholesterolemia
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Liem, Mike S. L., Leuven, Jan A. Gevers, Bloem, Johan L., and Schipper, Jaap
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- 1992
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27. Does Hypercarbia Develop Faster During Laparoscopic Herniorrhaphy Than During Laparoscopic Cholecystectomy? Assessment with Continuous Blood Gas Monitoring
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Liem, Mike S. L., Kallewaard, Jan-Willem, de Smet, Anne Marie G. A., and van Vroonhoven, Theo J. M. V.
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- 1995
28. Base Deficit-Based Predictive Modeling of Outcome in Trauma Patients Admitted to Intensive Care Units in Dutch Trauma Centers
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Kroezen, Frank, primary, Bijlsma, Taco S., additional, Liem, Mike S. L., additional, Meeuwis, J Dik, additional, and Leenen, Luke P. H., additional
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- 2007
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29. Recurrences After Conventional Anterior and Laparoscopic Inguinal Hernia Repair
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Liem, Mike S. L., primary, van Duyn, Eino B., additional, van der Graaf, Yolanda, additional, and van Vroonhoven, Theo J. M. V., additional
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- 2003
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30. Cost-Effectiveness of Extraperitoneal Laparoscopic Inguinal Hernia Repair: A Randomized Comparison With Conventional Herniorrhaphy
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Liem, Mike S. L., primary, Halsema, Joanna A. M., additional, van der Graaf, Yolanda, additional, Schrijvers, Augustinus J. P., additional, and van Vroonhoven, Theo J. M. V., additional
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- 1997
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31. Does Hypercarbia Develop Faster During Laparoscopic Herniorrhaphy than During Laparoscopic Cholecystectomy? Assessment with Continuous Blood Gas Monitoring
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LIEM, MIKE S. L., primary, KALLEWAARD, JAN-WILLEM, additional, DE SMET, ANNE MARIE G. A., additional, and VAN VROONHOVEN, THEO J. M. V., additional
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- 1996
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32. Risk Factors for Inguinal Hernia in Women: A Case-Control Study.
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Liem, Mike S. L., van der Graaf, Yolanda, Zwart, Reinder C., Geurts, Ingrid, and van Vroonhoven, Theo J. M. V.
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INGUINAL hernia ,SMOKING ,NUTRITION disorders ,PREGNANCY ,APPENDECTOMY - Abstract
Potential risk factors for inguinal hernia in women were investigated and the relative importance of these factors was quantified. In women, symptomatic but nonpalpable hernias often remain undiagnosed. However, knowledge on this subject only concerns hernia and operation characteristics, which have been obtained by review of case series. Virtually nothing is known about risk factors for inguinal hernia. The authors performed a hospital-based case-control study of 89 female patients with an incident inguinal hernia and 176 agematched female controls. Activity since birth with two validated questionnaires was measured and smoking habits, medical and operation history, Quetelet index (kg/m2, and history of pregnancies and deliveries were recorded. Response for cases was 81% and for controls 73%. Total physical activity was not associated with inguinal hernia (univariate odds ratio (OR) = 0.8, 95% confidence interval (Cl) 0.6–1.1), but high present sports activities was associated with less inguinal hernia (multivariate OR = 0.2, 95% Cl 0.1–0.7). Obesity (Quetelet index >30) was also protective for inguinal hernia (OR = 0.2, 95% Cl 0.04–1.0). Independent risk factors were positive family history (OR – 4.3, 95% Cl 1.9–9.7) and obstipation (OR – 2.5, 95% Cl 1.0–6.7). In particular, smoking, appendectomy, other abdominal operations, and multiple deliveries were not associated with inguinal hernia in females. The protective effect of present sports activity may be explained by optimizing the resistance of the abdominal musculature protecting the relatively small inguinal weak spot in the female. The individual predisposition for inguinal hernia may be quantified by these risk factors, and, with this in mind, the authors advise that further evaluation might be needed for the patient with unexplained inguinal pain. [ABSTRACT FROM AUTHOR]
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- 1997
33. Prognostic value of total tumor volume in patients with colorectal liver metastases: A secondary analysis of the randomized CAIRO5 trial with external cohort validation.
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Michiel Zeeuw J, Wesdorp NJ, Ali M, Bakker AJJ, Voigt KR, Starmans MPA, Roor J, Kemna R, van Waesberghe JHTM, van den Bergh JE, Nota IMGC, Moos SI, van Dieren S, van Amerongen MJ, Bond MJG, Chapelle T, van Dam RM, Engelbrecht MRW, Gerhards MF, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Kok NFM, Leclercq WKG, Liem MSL, van Lienden KP, Quintus Molenaar I, Patijn GA, Rijken AM, Ruers TM, de Wilt JHW, Verpalen IM, Stoker J, Grunhagen DJ, Swijnenburg RJ, Punt CJA, Huiskens J, Verhoef C, and Kazemier G
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- Humans, Male, Female, Middle Aged, Prognosis, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Adult, Liver Neoplasms secondary, Liver Neoplasms drug therapy, Liver Neoplasms diagnostic imaging, Colorectal Neoplasms pathology, Colorectal Neoplasms mortality, Tumor Burden, Neoplasm Recurrence, Local pathology
- Abstract
Background: This study aimed to assess the prognostic value of total tumor volume (TTV) for early recurrence (within 6 months) and overall survival (OS) in patients with colorectal liver metastases (CRLM), treated with induction systemic therapy followed by complete local treatment., Methods: Patients with initially unresectable CRLM from the multicenter randomized phase 3 CAIRO5 trial (NCT02162563) who received induction systemic therapy followed by local treatment were included. Baseline TTV and change in TTV as response to systemic therapy were calculated using the CT scan before and the first after systemic treatment, and were assessed for their added prognostic value. The findings were validated in an external cohort of patients treated at a tertiary center., Results: In total, 215 CAIRO5 patients were included. Baseline TTV and absolute change in TTV were significantly associated with early recurrence (P = 0.005 and P = 0.040, respectively) and OS in multivariable analyses (P = 0.024 and P = 0.006, respectively), whereas RECIST1.1 was not prognostic for early recurrence (P = 0.88) and OS (P = 0.35). In the validation cohort (n = 85), baseline TTV and absolute change in TTV remained prognostic for early recurrence (P = 0.041 and P = 0.021, respectively) and OS in multivariable analyses (P < 0.0001 and P = 0.012, respectively), and showed added prognostic value over conventional clinicopathological variables (increase C-statistic, 0.06; 95 % CI, 0.02 to 0.14; P = 0.008)., Conclusion: Total tumor volume is strongly prognostic for early recurrence and OS in patients who underwent complete local treatment of initially unresectable CRLM, both in the CAIRO5 trial and the validation cohort. In contrast, RECIST1.1 did not show prognostic value for neither early recurrence nor OS., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors of this manuscript declare relationships with the following companies: C.J.A.P. has an advisory role for Nordic Pharma; SAS Analytics paid for traveling expenses G. Kazemier. This funding is not related to the current research. The remaining authors declare no potential conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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34. Outcomes of liver surgery: A decade of mandatory nationwide auditing in the Netherlands.
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de Graaff MR, Klaase JM, Dulk MD, Buis CI, Derksen WJM, Hagendoorn J, Leclercq WKG, Liem MSL, Hartgrink HH, Swijnenburg RJ, Vermaas M, Belt EJT, Bosscha K, Verhoef C, Olde Damink S, Kuhlmann K, Marsman HM, Ayez N, van Duijvendijk P, van den Boezem P, Manusama ER, Grünhagen DJ, and Kok NFM
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- Humans, Netherlands epidemiology, Male, Female, Middle Aged, Aged, Cholangiocarcinoma surgery, Cholangiocarcinoma pathology, Bile Duct Neoplasms surgery, Bile Duct Neoplasms pathology, Failure to Rescue, Health Care, Postoperative Complications epidemiology, Medical Audit, Treatment Outcome, Klatskin Tumor surgery, Klatskin Tumor pathology, Klatskin Tumor mortality, Liver Neoplasms surgery, Liver Neoplasms secondary, Hepatectomy, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular mortality, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology
- Abstract
Background: In 2013, the nationwide Dutch Hepato Biliary Audit (DHBA) was initiated. The aim of this study was to evaluate changes in indications for and outcomes of liver surgery in the last decade., Methods: This nationwide study included all patients who underwent liver surgery for four indications, including colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), and intrahepatic- and perihilar cholangiocarcinoma (iCCA - pCCA) between 2014 and 2022. Trends in postoperative outcomes were evaluated separately for each indication using multilevel multivariable logistic regression analyses., Results: This study included 8057 procedures for CRLM, 838 for HCC, 290 for iCCA, and 300 for pCCA. Over time, these patients had higher risk profiles (more ASA-III patients and more comorbidities). Adjusted mortality decreased over time for CRLM, HCC and iCCA, respectively aOR 0.83, 95%CI 0.75-0.92, P < 0.001; aOR 0.86, 95%CI 0.75-0.99, P = 0.045; aOR 0.40, 95%CI 0.20-0.73, P < 0.001. Failure to rescue (FTR) also decreased for these groups, respectively aOR 0.84, 95%CI 0.76-0.93, P = 0.001; aOR 0.81, 95%CI 0.68-0.97, P = 0.024; aOR 0.29, 95%CI 0.08-0.84, P = 0.021). For iCCA severe complications (aOR 0.65 95%CI 0.43-0.99, P = 0.043) also decreased. No significant outcome differences were observed in pCCA. The number of centres performing liver resections decreased from 26 to 22 between 2014 and 2022, while median annual volumes did not change (40-49, P = 0.66)., Conclusion: Over time, postoperative mortality and FTR decreased after liver surgery, despite treating higher-risk patients. The DHBA continues its focus on providing feedback and benchmark results to further enhance outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)
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- 2024
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35. Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study.
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de Graaff MR, Klaase JM, den Dulk M, Te Riele WW, Hagendoorn J, van Heek NT, Vermaas M, Belt EJT, Bosscha K, Slooter GD, Leclercq WKG, Liem MSL, Mieog JSD, Swijnenburg RJ, van Dam RM, Verhoef C, Kuhlmann K, van Duijvendijk P, Gerhards MF, Gobardhan P, van den Boezem P, Manusama ER, Grünhagen DJ, and Kok NFM
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- Humans, Male, Netherlands, Female, Middle Aged, Aged, Neoplasm Recurrence, Local, Treatment Outcome, Retrospective Studies, Hospitals statistics & numerical data, Databases, Factual, Colorectal Neoplasms pathology, Colorectal Neoplasms mortality, Colorectal Neoplasms surgery, Liver Neoplasms secondary, Liver Neoplasms surgery, Liver Neoplasms mortality, Hepatectomy mortality, Hepatectomy adverse effects, Reoperation
- Abstract
Background: Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR)., Methods: This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database., Results: Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM >5 cm (aHR 1.58, 95% CI: 1.07-2.34, P = 0.023), >3 CRLM (aHR 1.33, 95% CI: 1.00-1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25-2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09-1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%)., Conclusion: Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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36. Perineural Invasion is an Important Prognostic Factor in Patients With Radically Resected (R0) and Node-negative (pN0) Pancreatic Cancer.
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Schouten TJ, Kroon VJ, Besselink MG, Bosscha K, Busch OR, Crobach ASLP, van Dam RM, Doukas M, Fariña Sarasquesta A, Festen S, Groot Koerkamp B, van der Harst E, Heij LR, de Hingh IHJT, Kazemier G, Liem MSL, de Meijer VE, Mieog JSD, Patijn GA, Raicu GM, Roos D, Schreinemakers JMJ, Stommel MWJ, Wilmink HJ, Wit F, Brosens LAA, van Santvoort HC, Molenaar IQ, and Daamen LA
- Abstract
Objective: To investigate the association between perineural invasion (PNI) and overall survival (OS) in a nationwide cohort of patients with resected pancreatic ductal adenocarcinoma (PDAC), stratified for margin negative (R0) or positive (R1) resection and absence or presence of lymph node metastasis (pN0 or pN1-N2, respectively)., Background: Patients with R0 and pN0 resected PDAC have a relatively favorable prognosis. As PNI is associated with worse OS, this might be a useful factor to provide further prognostic information for patients counselling., Methods: A nationwide observational cohort study was performed including all patients who underwent PDAC resection in the Netherlands (2014-2019) with complete information on relevant pathological features (PNI, R status, and N status). OS was assessed using Kaplan-Meier curves, and Cox-proportional hazard analyses were performed to calculate hazard ratio's (HR) with corresponding 95% confidence intervals (CI)., Results: In total, 1630 patients were included with a median follow-up of 43 (interquartile range 33-58) months. PNI was independently associated with worse OS in both R0 patients (HR 1.49 [95%CI 1.18-1.88]; P<0.001) and R1 patients (HR 1.39 [95% CI 1.06-1.83]; P=0.02), as well as in pN0 patients (HR 1.75 [95%CI 1.27-2.41]; P<0.001) and pN1-N2 patients (HR 1.35 [95% CI 1.10-1.67]; P<0.01). In 315 patients with R0N0, multivariable analysis showed that PNI was the strongest predictor of OS (HR 2.24 [95% CI 1.52-3.30]; P<0.001)., Conclusion: PNI is strongly associated with worse survival in patients with resected PDAC, in particular in patients with relatively favorable pathological features. These findings may aid patient stratification and counselling and help guide treatment strategies., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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37. Evaluation of Short- and Long-Term Outcomes After Resection in Patients with Locally Advanced versus (Borderline) Resectable Pancreatic Cancer.
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Brada LJH, Schouten TJ, Daamen LA, Seelen LWF, Walma MS, van Dam R, de Hingh IH, Liem MSL, de Meijer VE, Patijn GA, Festen S, Stommel MWJ, Bosscha K, Besselink MG, van Santvoort HC, and Molenaar IQ
- Abstract
Objective: This study aims to evaluate short- and long-term outcomes following pancreatectomy in patients with LAPC compared to (B)RPC patients., Summary Background Data: Selected patients diagnosed with locally advanced pancreatic cancer (LAPC) are increasingly undergoing resection following induction chemotherapy. To evaluate the benefit of this treatment approach, it is helpful to compare outcomes in resected patients with primary LAPC to outcomes in resected patients with primary (borderline) resectable pancreatic cancer ((B)RPC)., Methods: Two prospectively maintained nationwide databases were used for this study. Patients with (B)RPC undergoing upfront tumor resection and patients with resected LAPC after induction therapy were included. Outcomes were postoperative pancreas-specific complications, 90-day mortality, pathological outcomes, disease-free interval (DFI), and overall survival (OS)., Results: Overall, 879 patients were included; 103 with LAPC (12%) and 776 with (B)RPC (88%). LAPC patients had a lower WHO performance score and CACI. Postoperative pancreas-specific complications were comparable between groups, except delayed gastric emptying grade C, which occurred more often in LAPC patients (9% vs. 3%, P=0.03). Ninety-day mortality was comparable. About half of the patients in both groups (54% in LAPC vs. 48% in (B)RPC), P=0.21) had a radical resection (R0). DFI was 13 months in both groups (P=0.12) and OS from date of diagnosis was 24 months in LAPC patients and 19 months in (B)RPC patients (P=0.34)., Conclusions: In our nationwide prospective databases, pancreas-specific complications, mortality and survival in patients with LAPC following pancreatectomy are comparable with those undergoing resection for (B)RPC. These outcomes suggest that postoperative morbidity and mortality after tumor resection in carefully selected patients with LAPC are acceptable., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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38. Association of modified textbook outcome and overall survival after surgery for colorectal liver metastases: A nationwide analysis.
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Voigt KR, de Graaff MR, Verhoef C, Kazemier G, Swijneburg RJ, Mieog JSD, Derksen WJM, Buis CI, Gobardhan PD, Dulk MD, van Dam RM, Liem MSL, Leclercq WKG, Bosscha K, Belt EJT, Vermaas M, Kok NFM, Patijn GA, Marsman HM, van den Boezem PB, Klaase JM, and Grünhagen DJ
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- Humans, Retrospective Studies, Hepatectomy methods, Postoperative Complications etiology, Propensity Score, Colorectal Neoplasms pathology, Liver Neoplasms secondary
- Abstract
Background: Textbook outcome (TO) represents a multidimensional quality measurement, encompassing the desirable short-term outcomes following surgery. This study aimed to investigate whether achieving TO after resection of colorectal liver metastases (CRLM) surgery is related to better overall survival (OS) in a national cohort., Method: Data was retrieved from the Dutch Hepato Biliary Audit. A modified definition of TO (mTO) was used because readmissions were only recorded from 2019. mTO was achieved when no severe postoperative complications, mortality, prolonged length of hospital stay, occurred and when adequate surgical resection margins were obtained. To compare outcomes of patients with and without mTO and reduce baseline differences between both groups propensity score matching (PSM) was used for patients operated on between 2014 and 2018., Results: Out of 6525 eligible patients, 81 % achieved mTO. For the cohort between 2014 and 2018, those achieving mTO had a 5-year OS of 46.7 % (CI 44.8-48.6) while non-mTO patients had a 5-year OS of 33.7 % (CI 29.8-38.2), p < 0.001. Not achieving mTO was associated with a worse OS (aHR 1.34 (95 % CI 1.17-1.53), p < 0.001. Median follow-up was 76 months., PSM assigned 519 patients to each group. In the PSM cohort patients achieving mTO, 5-year OS was 43.6 % (95 % CI 39.2-48.5) compared to 36.4 % (95 % CI 31.9-41.2) in patients who did not achieve mTO, p = 0.006., Conclusion: Achieving mTO is associated with improved long-term survival. This emphasizes the importance of optimising perioperative care and reducing postoperative complications in surgical treatment of CRLM., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)
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- 2024
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39. Trends and overall survival after combined liver resection and thermal ablation of colorectal liver metastases: a nationwide population-based propensity score-matched study.
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de Graaff MR, Klaase JM, den Dulk M, Coolsen MME, Kuhlmann KFD, Verhoef C, Hartgrink HH, Derksen WJM, van den Boezem P, Rijken AM, Gobardhan P, Liem MSL, Leclercq WKG, Marsman HA, van Duijvendijk P, Bosscha K, Elfrink AKE, Manusama ER, Belt EJT, Doornebosch PG, Oosterling SJ, Ruiter SJS, Grünhagen DJ, Burgmans M, Meijerink M, Kok NFM, and Swijnenburg RJ
- Subjects
- Humans, Propensity Score, Retrospective Studies, Hepatectomy adverse effects, Hepatectomy methods, Treatment Outcome, Colorectal Neoplasms pathology, Liver Neoplasms secondary
- Abstract
Background: In colorectal liver metastases (CRLM) patients, combination of liver resection and ablation permit a more parenchymal-sparing approach. This study assessed trends in use of combined resection and ablation, outcomes, and overall survival (OS)., Methods: This population-based study included all CRLM patients who underwent liver resection between 2014 and 2022. To assess OS, data was linked to two databases containing date of death for patients treated between 2014 and 2018. Hospital variation in the use of combined minor liver resection and ablation versus major liver resection alone in patients with 2-3 CRLM and ≤3 cm was assessed. Propensity score matching (PSM) was applied to evaluate outcomes., Results: This study included 3593 patients, of whom 1336 (37.2%) underwent combined resection and ablation. Combined resection increased from 31.7% in 2014 to 47.9% in 2022. Significant hospital variation (range 5.9-53.8%) was observed in the use of combined minor liver resection and ablation. PSM resulted in 1005 patients in each group. Major morbidity was not different (11.6% vs. 5%, P = 1.00). Liver failure occurred less often after combined resection and ablation (1.9% vs. 0.6%, P = 0.017). Five-year OS rates were not different (39.3% vs. 33.9%, P = 0.145)., Conclusion: Combined resection and ablation should be available and considered as an alternative to resection alone in any patient with multiple metastases., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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40. Fistula Risk Score for Auditing Pancreatoduodenectomy: The Auditing-FRS.
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van Dongen JC, van Dam JL, Besselink MG, Bonsing BA, Bosscha K, Busch OR, van Dam RM, Festen S, van der Harst E, de Hingh IH, Kazemier G, Liem MSL, de Meijer VE, Mieog JSD, Molenaar IQ, Patijn GA, van Santvoort HC, Wijsman JH, Stommel MWJ, Wit F, De Wilde RF, van Eijck CHJ, and Groot Koerkamp B
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- Humans, Male, Pancreaticoduodenectomy adverse effects, Risk Assessment, Risk Factors, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula surgery, Postoperative Complications etiology, Retrospective Studies, Pancreatic Neoplasms, Pancreatic Neoplasms surgery, Pancreatic Neoplasms complications, Carcinoma, Pancreatic Ductal surgery, Pancreatitis surgery
- Abstract
Objective: To develop a fistula risk score for auditing, to be able to compare postoperative pancreatic fistula (POPF) after pancreatoduodenectomy among hospitals., Background: For proper comparisons of outcomes in surgical audits, case-mix variation should be accounted for., Methods: This study included consecutive patients after pancreatoduodenectomy from the mandatory nationwide Dutch Pancreatic Cancer Audit. Derivation of the score was performed with the data from 2014 to 2018 and validation with 2019 to 2020 data. The primary endpoint of the study was POPF (grade B or C). Multivariable logistic regression analysis was performed for case-mix adjustment of known risk factors., Results: In the derivation cohort, 3271 patients were included, of whom 479 (14.6%) developed POPF. Male sex [odds ratio (OR)=1.34; 95% confidence interval (CI): 1.09-1.66], higher body mass index (OR=1.07; 95% CI: 1.05-1.10), a final diagnosis other than pancreatic ductal adenocarcinoma/pancreatitis (OR=2.41; 95% CI: 1.90-3.06), and a smaller duct diameter (OR=1.43/mm decrease; 95% CI: 1.32-1.55) were independently associated with POPF. Diabetes mellitus (OR=0.73; 95% CI: 0.55-0.98) was independently associated with a decreased risk of POPF. Model discrimination was good with a C -statistic of 0.73 in the derivation cohort and 0.75 in the validation cohort (n=913). Hospitals differed in particular in the proportion of pancreatic ductal adenocarcinoma/pancreatitis patients, ranging from 36.0% to 58.1%. The observed POPF risk per center ranged from 2.9% to 25.4%. The expected POPF rate based on the 5 risk factors ranged from 11.6% to 18.0% among hospitals., Conclusions: The auditing fistula risk score was successful in case-mix adjustment and enables fair comparisons of POPF rates among hospitals., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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41. Early Recurrence After Resection of Locally Advanced Pancreatic Cancer Following Induction Therapy: An International Multicenter Study.
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Seelen LWF, Floortje van Oosten A, Brada LJH, Groot VP, Daamen LA, Walma MS, van der Lek BF, Liem MSL, Patijn GA, Stommel MWJ, van Dam RM, Koerkamp BG, Busch OR, de Hingh IHJT, van Eijck CHJ, Besselink MG, Burkhart RA, Borel Rinkes IHM, Wolfgang CL, Molenaar IQ, He J, and van Santvoort HC
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- Humans, Induction Chemotherapy, Neoadjuvant Therapy, Pancreas pathology, Combined Modality Therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms surgery
- Abstract
Objective: To establish an evidence-based cutoff and predictors for early recurrence in patients with resected locally advanced pancreatic cancer (LAPC)., Background: It is unclear how many and which patients develop early recurrence after LAPC resection. Surgery in these patients is probably of little benefit., Methods: We analyzed all consecutive patients undergoing resection of LAPC after induction chemotherapy who were included in prospective databases in The Netherlands (2015-2019) and the Johns Hopkins Hospital (2016-2018). The optimal definition for "early recurrence" was determined by the post-recurrence survival (PRS). Patients were compared for overall survival (OS). Predictors for early recurrence were evaluated using logistic regression analysis., Results: Overall, 168 patients were included. After a median follow-up of 28 months, recurrence was observed in 118 patients (70.2%). The optimal cutoff for recurrence-free survival to differentiate between early (n=52) and late recurrence (n=66) was 6 months ( P <0.001). OS was 8.4 months [95% confidence interval (CI): 7.3-9.6] in the early recurrence group (n=52) versus 31.1 months (95% CI: 25.7-36.4) in the late/no recurrence group (n=116) ( P <0.001). A preoperative predictor for early recurrence was postinduction therapy carbohydrate antigen (CA) 19-9≥100 U/mL [odds ratio (OR)=4.15, 95% CI: 1.75-9.84, P =0.001]. Postoperative predictors were poor tumor differentiation (OR=4.67, 95% CI: 1.83-11.90, P =0.001) and no adjuvant chemotherapy (OR=6.04, 95% CI: 2.43-16.55, P <0.001)., Conclusions: Early recurrence was observed in one third of patients after LAPC resection and was associated with poor survival. Patients with post-induction therapy CA 19-9 ≥100 U/mL, poor tumor differentiation and no adjuvant therapy were especially at risk. This information is valuable for patient counseling before and after resection of LAPC., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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42. Robot-assisted and fluorescence-guided remnant-cholecystectomy: a prospective dual-center cohort study.
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Gijsen AF, Vaassen HGM, Vahrmeijer AL, Geelkerken RH, Liem MSL, Bockhorn M, El-Sourani N, Mieog JSD, and Lips DJ
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- Humans, Prospective Studies, Cohort Studies, Cholecystectomy adverse effects, Robotics, Cholecystectomy, Laparoscopic adverse effects, Bile Ducts, Extrahepatic injuries, Gallstones surgery
- Abstract
Background: Abdominal symptoms after cholecystectomy may be caused by gallstones in a remnant gallbladder or a long cystic duct stump. Resection of a remnant gallbladder or cystic duct stump is associated with an increased risk of conversion and bile duct or vascular injuries. We prospectively investigated the additional value of robotic assistance and fluorescent bile duct illumination in redo biliary surgery., Methods: In this prospective two-centre observational cohort study, 28 patients were included with an indication for redo biliary surgery because of remnant stones in a remnant gallbladder or long cystic duct stump. Surgery was performed with the da Vinci X® and Xi® robotic system. The biliary tract was visualised in the fluorescence Firefly® mode shortly after intravenous injection of indocyanine green., Results: There were no conversions or perioperative complications, especially no vascular or bile duct injuries. Fluorescence-based illumination of the extrahepatic bile ducts was successful in all cases. Symptoms were resolved in 27 of 28 patients. Ten patients were treated in day care and 13 patients were discharged the day after surgery., Conclusion: Robot-assisted fluorescence-guided surgery for remnant gallbladder or cystic duct stump resection is safe, effective and can be done in day-care setting., Competing Interests: Conflict of interest None to declare., (Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2023
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43. The yield of staging laparoscopy for resectable and borderline resectable pancreatic cancer in the PREOPANC randomized controlled trial.
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van Dongen JC, Versteijne E, Bonsing BA, Mieog JSD, de Hingh IHJT, Festen S, Patijn GA, van Dam R, van der Harst E, Wijsman JH, Bosscha K, van der Kolk M, de Meijer VE, Liem MSL, Busch OR, Besselink MGH, van Tienhoven G, Groot Koerkamp B, van Eijck CHJ, and Suker M
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- Humans, Neoplasm Staging, Pancreatic Neoplasms, Peritoneal Neoplasms pathology, Pancreatic Neoplasms surgery, Pancreatic Neoplasms pathology, Laparoscopy methods, Liver Neoplasms surgery
- Abstract
Background: The necessity of the staging laparoscopy in patients with pancreatic cancer is still debated. The objective of this study was to assess the yield of staging laparoscopy for detecting occult metastases in patients with resectable or borderline resectable pancreatic cancer., Method: This was a post-hoc analysis of the randomized controlled PREOPANC trial in which patients with resectable or borderline resectable pancreatic cancer were randomized between preoperative chemoradiotherapy or immediate surgery. Patients assigned to preoperative treatment underwent a staging laparoscopy prior to preoperative treatment according to protocol, to avoid unnecessary chemoradiotherapy in patients with occult metastatic disease., Results: Of the 246 included patients, 7 did not undergo surgery. A staging laparoscopy was performed in 133 patients (55.6%) and explorative laparotomy in 106 patients (44.4%). At staging laparoscopy, occult metastases were detected in 13 patients (9.8%); 12 liver metastases and 1 peritoneal metastasis. At direct explorative laparotomy, occult metastases were found in 9 patients (8.5%); 6 with liver metastases, 1 with peritoneal metastases, and 2 with metastases at multiple sites. One patient had peritoneal metastases at exploration after a negative staging laparoscopy. Patients with occult metastases were more likely to receive palliative chemotherapy if found with staging laparoscopy compared to laparotomy (76.9% vs. 30.0%, p = 0.040)., Conclusions: Staging laparoscopy detected occult metastases in about 10% of patients with resectable or borderline resectable pancreatic cancer. These patients were more likely to receive palliative systemic chemotherapy compared to patients in whom occult metastases were detected with laparotomy. A staging laparoscopy is recommended before planned resection., (Copyright © 2022. Published by Elsevier Ltd.)
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- 2023
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44. The role of tumour biological factors in technical anatomical resectability assessment of colorectal liver metastases following induction systemic treatment: An analysis of the Dutch CAIRO5 trial.
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Bolhuis K, Bond MJG, Van Amerongen MJ, Komurcu A, Chapelle T, Dejong CHC, Engelbrecht MRW, Gerhards MF, Grünhagen DJ, van Gulik TM, Hermans JJ, De Jong KP, Kazemier G, Klaase JM, Kok NFM, Leclercq WKG, Liem MSL, van Lienden KP, Molenaar IQ, Neumann UP, Patijn GA, Rijken AM, Ruers TM, Verhoef C, de Wilt JHW, May AM, Punt CJA, and Swijnenburg RJ
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- Humans, Biological Factors, Hepatectomy, Treatment Outcome, Colorectal Neoplasms genetics, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology, Liver Neoplasms drug therapy, Liver Neoplasms surgery, Liver Neoplasms secondary
- Abstract
Background: Large inter-surgeon variability exists in technical anatomical resectability assessment of colorectal cancer liver-only metastases (CRLM) following induction systemic therapy. We evaluated the role of tumour biological factors in predicting resectability and (early) recurrence after surgery for initially unresectable CRLM., Methods: 482 patients with initially unresectable CRLM from the phase 3 CAIRO5 trial were selected, with two-monthly resectability assessments by a liver expert panel. If no consensus existed among panel surgeons (i.e. same vote for (un)resectability of CRLM), conclusion was based on majority. The association of tumour biological (sidedness, synchronous CRLM, carcinoembryonic antigen and RAS/BRAF
V600E mutation status) and technical anatomical factors with consensus among panel surgeons, secondary resectability and early recurrence (<6 months) without curative-intent repeat local treatment was analysed by uni- and pre-specified multivariable logistic regression., Results: After systemic treatment, 240 (50%) patients received complete local treatment of CRLM of which 75 (31%) patients experienced early recurrence without repeat local treatment. Higher number of CRLM (odds ratio 1.09 [95% confidence interval 1.03-1.15]) and age (odds ratio 1.03 [95% confidence interval 1.00-1.07]) were independently associated with early recurrence without repeat local treatment. In 138 (52%) patients, no consensus among panel surgeons was present prior to local treatment. Postoperative outcomes in patients with and without consensus were comparable., Conclusions: Almost a third of patients selected by an expert panel for secondary CRLM surgery following induction systemic treatment experience an early recurrence only amenable to palliative treatment. Number of CRLM and age, but no tumour biological factors are predictive, suggesting that until there are better biomarkers; resectability assessment remains primarily a technical anatomical decision., Competing Interests: Conflict of interest statement C.J.A.P. has an advisory role for Nordic Pharma. This funding is not related to the current research. The remaining authors declare no potential conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2023
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45. Defining Textbook Outcome in liver surgery and assessment of hospital variation: A nationwide population-based study.
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de Graaff MR, Elfrink AKE, Buis CI, Swijnenburg RJ, Erdmann JI, Kazemier G, Verhoef C, Mieog JSD, Derksen WJM, van den Boezem PB, Ayez N, Liem MSL, Leclercq WKG, Kuhlmann KFD, Marsman HA, van Duijvendijk P, Kok NFM, Klaase JM, Dejong CHC, Grünhagen DJ, and den Dulk M
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- Humans, Retrospective Studies, Hospitals, Length of Stay, Postoperative Complications epidemiology, Postoperative Complications etiology, Hepatectomy adverse effects, Liver Neoplasms surgery, Liver Neoplasms complications
- Abstract
Introduction: Textbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery., Methods: This was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment., Results: 2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51-0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44-0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34-0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54-0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36-0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed., Conclusion: TO differs between indications for liver resection and can be used to assess between hospital and network differences., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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46. A nationwide assessment of hepatocellular adenoma resection: Indications and pathological discordance.
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Haring MPD, Elfrink AKE, Oudmaijer CAJ, Andel PCM, Furumaya A, de Jong N, Willems CJJM, Huits T, Sijmons JML, Belt EJT, Bosscha K, Consten ECJ, Coolsen MME, van Duijvendijk P, Erdmann JI, Gobardhan P, de Haas RJ, van Heek T, Lam HD, Leclercq WKG, Liem MSL, Marsman HA, Patijn GA, Terkivatan T, Zonderhuis BM, Molenaar IQ, Te Riele WW, Hagendoorn J, Schaapherder AFM, IJzermans JNM, Buis CI, Klaase JM, de Jong KP, and de Meijer VE
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- Humans, Male, Adult, Middle Aged, Retrospective Studies, Magnetic Resonance Imaging methods, Adenoma, Liver Cell diagnostic imaging, Adenoma, Liver Cell surgery, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Carcinoma, Hepatocellular pathology
- Abstract
Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs < 50 mm compared to HCAs ≥ 50 mm. Changes in final postoperative diagnosis were assessed. We performed a retrospective study that included patients who underwent resection for (suspected) HCAs in the Netherlands from 2014 to 2019. Indication for resection was analyzed and stratified for small (<50 mm) and large (≥50 mm) tumors. Logistic regression analysis was performed on factors influencing change in tumor diagnosis. Out of 222 patients who underwent surgery, 44 (20%) patients had a tumor <50 mm. Median age was 46 (interquartile range [IQR], 33-56) years in patients with small tumors and 37 (IQR, 31-46) years in patients with large tumors ( p = 0.016). Patients with small tumors were more frequently men (21% vs. 5%, p = 0.002). Main indications for resection in patients with small tumors were suspicion of (pre)malignancy (55%), (previous) bleeding (14%), and male sex (11%). Patients with large tumors received operations because of tumor size >50 mm (52%), suspicion of (pre)malignancy (28%), and (previous) bleeding (5.1%). No difference was observed in HCA-subtype distribution between small and large tumors. Ninety-six (43%) patients had a postoperative change in diagnosis. Independent risk factors for change in diagnosis were tumor size <50 mm (adjusted odds ratio [aOR], 3.4; p < 0.01), male sex (aOR, 3.7; p = 0.03), and lack of hepatobiliary contrast-enhanced magnetic resonance imaging (CE-MRI) (aOR, 1.8; p = 0.04). Resection for small (suspected) HCAs was mainly indicated by suspicion of (pre)malignancy, whereas for large (suspected) HCAs, tumor size was the most prevalent indication. Male sex, tumor size <50 mm, and lack of hepatobiliary CE-MRI were independent risk factors for postoperative change in tumor diagnosis., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of the American Association for the Study of Liver Diseases.)
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- 2022
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47. Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases: a population-based study.
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Krul MF, Elfrink AKE, Buis CI, Swijnenburg RJ, Te Riele WW, Verhoef C, Gobardhan PD, Dulk MD, Liem MSL, Tanis PJ, Mieog JSD, van den Boezem PB, Leclercq WKG, Nieuwenhuijs VB, Gerhards MF, Klaase JM, Grünhagen DJ, Kok NFM, and Kuhlmann KFD
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- Hepatectomy adverse effects, Hepatectomy methods, Hospitals, Humans, Retrospective Studies, Time Factors, Treatment Outcome, Colorectal Neoplasms pathology, Liver Neoplasms secondary
- Abstract
Background: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation., Method: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated., Results: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018)., Conclusion: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands., (Copyright © 2021 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
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- 2022
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48. Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study.
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Elfrink AKE, Olthof PB, Swijnenburg RJ, den Dulk M, de Boer MT, Mieog JSD, Hagendoorn J, Kazemier G, van den Boezem PB, Rijken AM, Liem MSL, Leclercq WKG, Kuhlmann KFD, Marsman HA, Ijzermans JNM, van Duijvendijk P, Erdmann JI, Kok NFM, Grünhagen DJ, and Klaase JM
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- Aged, Aged, 80 and over, Hospital Mortality, Hospitals, Humans, Liver, Postoperative Complications etiology, Risk Factors, Failure to Rescue, Health Care
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Background: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery., Methods: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade ≥3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable logistic regression., Results: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver metastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73-6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91-10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6-51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27-5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16-5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed., Conclusion: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)
- Published
- 2021
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49. Long-term quality of life and exocrine and endocrine insufficiency after pancreatic surgery: a multicenter, cross-sectional study.
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Latenstein AEJ, Blonk L, Tjahjadi NS, de Jong N, Busch OR, de Hingh IHJT, van Hooft JE, Liem MSL, Molenaar IQ, van Santvoort HC, de van der Schueren MAE, DeVries JH, Kazemier G, and Besselink MG
- Subjects
- Cross-Sectional Studies, Humans, Pancreatectomy adverse effects, Pancreaticoduodenectomy adverse effects, Surveys and Questionnaires, Exocrine Pancreatic Insufficiency diagnosis, Exocrine Pancreatic Insufficiency etiology, Quality of Life
- Abstract
Background: Data regarding long-term quality of life and exocrine and endocrine insufficiency after pancreatic surgery for premalignant and benign (non-pancreatitis) disease are lacking., Methods: This cross-sectional study included patients ≥3 years after pancreatoduodenectomy or left pancreatectomy in six Dutch centers (2006-2016). Outcomes were measured with the EQ-5D-5L, the EORTC QLQ-C30, an exocrine and endocrine pancreatic insufficiency questionnaire, and PAID20., Results: Questionnaires were completed by 153/183 patients (response rate 84%, median follow-up 6.3 years). Surgery related complaints were reported by 72/153 patients (47%) and 13 patients (8.4%) would not undergo this procedure again. The VAS (EQ-5D-5L) was 76 ± 17 versus 82 ± 0.4 in the general population (p < 0.001). The mean global health status (QLQ-C30) was 78 ± 17 versus 78 ± 17, p = 1.000. Fatigue, insomnia, and diarrhea were clinically relevantly worse in patients. Exocrine pancreatic insufficiency was reported by 62 patients (41%) with relieve of symptoms by enzyme supplementation in 48%. New-onset diabetes mellitus was present in 22 patients (14%). The median PAID20 score was 6.9/20 (IQR 2.5-17.8)., Conclusion: Although generic quality of life after pancreatic resection for pre-malignant and benign disease was similar to the general population and diabetes-related distress was low, almost half suffered from a range of symptoms highlighting the need for long-term counseling., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2021
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50. Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study.
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Elfrink AKE, Nieuwenhuizen S, van den Tol MP, Burgmans MC, Prevoo W, Coolsen MME, van den Boezem PB, van Delden OM, Hagendoorn J, Patijn GA, Leclercq WKG, Liem MSL, Rijken AM, Verhoef C, Kuhlmann KFD, Ruiter SJS, Grünhagen DJ, Klaase JM, Kok NFM, Meijerink MR, and Swijnenburg RJ
- Subjects
- Hepatectomy adverse effects, Hospitals, Humans, Retrospective Studies, Treatment Outcome, Colorectal Neoplasms surgery, Liver Neoplasms surgery
- Abstract
Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation., Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery., Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy., Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy., (Copyright © 2020 University Medical Center Groningen. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
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