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Occult metastases are detected in 10–15% of patients during exploratory laparotomy for pancreatic cancer. This study developed and externally validated a model to predict occult metastases in patients with potentially resectable pancreatic cancer. Model development was performed within the Dutch Pancreatic Cancer Audit, including all patients operated for pancreatic cancer (January 2013–December 2017). Multivariable logistic regression analysis based on the Akaike Information Criteria was performed with intraoperative pathologically proven metastases as the outcome. The model was externally validated with a cohort from the University Hospital of Verona (January 2013–December 2017). For model development, 2262 patients were included of whom 235 (10%) had occult metastases, located in the liver (n = 143, 61%), peritoneum (n = 73, 31%), or both (n = 19, 8%). The model included age (OR 1.02, 95% CI 1.00–1.03), BMI (OR 0.96, 95% CI 0.93–0.99), preoperative nutritional support (OR 1.73, 95% CI 1.01–2.74), tumor diameter (OR 1.60, 95% CI 1.04–2.45), tumor composition (solid vs. cystic) (OR 2.33, 95% CI 1.20–4.35), and indeterminate lesions on preoperative imaging (OR 4.01, 95% CI 2.16–7.43). External validation showed poor discrimination with a C-statistic of 0.56. Although some predictor variables were significantly associated with occult metastases, the model performed insufficiently at external validation.

Het zal je maar gebeuren. Een aquarium lekt en daardoor is je winkelvloer nat en glad geworden. Om de vloer schoon te maken, ga je een emmer en een dweil pakken. Maar te laat: een medewerker is uitgegleden en voor je het weet vertrekt ze met de ambulance. Je bezoekt haar in het ziekenhuis en neemt een grote bos bloemen mee. Uiteraard erg vervelend voor je medewerker, maar ook voor jou als werkgever. Je wordt op zo’n moment geconfronteerd met extra (loon)kosten en moet op zoek naar vervanging. Terwijl dit misschien wel was te voorkomen.

Managed aquifer recharge (MAR) is increasingly used to secure drinking water supply worldwide. The city of Amsterdam (The Netherlands) depends largely on the MAR in coastal dunes for water supply. A new MAR scheme is proposed for the production of 10 × 106 m3/year, as required in the next decade. The designed MAR system consists of 10 infiltration ponds in an artificially created sandbank, and 25 recovery wells placed beneath the ponds in a productive aquifer. Several criteria were met for the design, such as a minimum residence time of 60 days and maximum drawdown of 5 cm. Steady-state and transient flow models were calibrated. The flow model computed the infiltration capacity of the ponds and drawdowns caused by the MAR. A hypothetical tracer transport model was used to compute the travel times from the ponds to the wells and recovery efficiency of the wells. The results demonstrated that 98% of the infiltrated water was captured by the recovery wells which accounted for 65.3% of the total abstraction. Other sources include recharge from precipitation (6.7%), leakages from surface water (13.1%), and natural groundwater reserve (14.9%). Sensitivity analysis indicated that the pond conductance and hydraulic conductivity of the sand aquifer in between the ponds and wells are important for the infiltration capacity. The temperature simulation showed that the recovered water in the wells has a stable temperature of 9.8–12.5 °C which is beneficial for post-treatment processes. The numerical modelling approach is useful and helps to gain insights for implementation of the MAR.

Background: The causal pathway between complications after pancreatic cancer resection and impaired long-term survival remains unknown. The aim of this study was to investigate the impact of complications after pancreatic cancer resection on disease-free interval and overall survival, with adjuvant chemotherapy as a mediator. Methods: This observational study included all patients undergoing pancreatic cancer resection in the Netherlands (2014-2017). Clinical data were extracted from the prospective Dutch Pancreatic Cancer Audit. Recurrence and survival data were collected additionally. In causal mediation analysis, direct and indirect effect estimates via adjuvant chemotherapy were calculated. Results: In total, 1071 patients were included. Major complications (hazards ratio 1.22 (95 per cent c.i. 1.04 to 1.43); P = 0.015 and hazards ratio 1.25 (95 per cent c.i. 1.08 to 1.46); P = 0.003) and organ failure (hazards ratio 1.86 (95 per cent c.i. 1.32 to 2.62); P < 0.001 and hazards ratio 1.89 (95 per cent c.i. 1.36 to 2.63); P < 0.001) were associated with shorter disease-free interval and overall survival respectively. The effects of major complications and organ failure on disease-free interval (-1.71 (95 per cent c.i. -2.27 to -1.05) and -3.05 (95 per cent c.i. -4.03 to -1.80) respectively) and overall survival (-1.92 (95 per cent c.i. -2.60 to -1.16) and -3.49 (95 per cent c.i. -4.84 to -2.03) respectively) were mediated by adjuvant chemotherapy. Additionally, organ failure directly affected disease-free interval (-5.38 (95 per cent c.i. -9.27 to -1.94)) and overall survival (-6.32 (95 per cent c.i. -10.43 to -1.99)). In subgroup analyses, the association was found in patients undergoing pancreaticoduodenectomy, but not in patients undergoing distal pancreatectomy. Conclusion: Major complications, including organ failure, negatively impact survival in patients after pancreatic cancer resection, largely mediated by adjuvant chemotherapy. Prevention or adeq

OBJECTIVE: To assess nationwide surgical outcome after pancreatoduodenectomy (PD) in patients at very high risk for postoperative pancreatic fistula (POPF), categorized as ISGPS-D.SUMMARY BACKGROUND DATA: Morbidity and mortality after ISGPS-D PD is perceived so high that a recent randomized trial advocated prophylactic total pancreatectomy (TP) as alternative aiming to lower this risk. However, current outcomes of ISGPS-D PD remain unknown as large nationwide series are lacking.METHODS: Nationwide retrospective analysis including consecutive patients undergoing ISGPS-D PD (i.e., soft texture and pancreatic duct ≤3 mm), using the mandatory Dutch Pancreatic Cancer Audit (2014-2021). Primary outcome was in-hospital mortality and secondary outcomes included major morbidity (i.e., Clavien-Dindo grade ≥IIIa) and POPF (ISGPS grade B/C). The use of prophylactic TP to avoid POPF during the study period was assessed.RESULTS: Overall, 1402 patients were included. In-hospital mortality was 4.1% (n=57), which decreased to 3.7% (n=20/536) in the last 2 years. Major morbidity occurred in 642 patients (45.9%) and POPF in 410 (30.0%), which corresponded with failure to rescue in 8.9% (n=57/642). Patients with POPF had increased rates of major morbidity (88.0% vs. 28.3%; P<0.001) and mortality (6.3% vs. 3.5%; P=0.016), compared to patients without POPF. Among 190 patients undergoing TP, prophylactic TP to prevent POPF was performed in 4 (2.1%).CONCLUSION: This nationwide series found a 4.1% in-hospital mortality after ISGPS-D PD with 45.9% major morbidity, leaving little room for improvement through prophylactic TP. Nevertheless, given the outcomes in 30% of patients who develop POPF, future randomized trials should aim to prevent and mitigate POPF in this high-risk category.

Contains fulltext : 251093.pdf (Publisher’s version ) (Closed access)

BACKGROUND: Despite the fact that primary percutaneous catheter drainage has become standard practice, some patients with pancreatic fistula after pancreatoduodenectomy ultimately undergo a relaparotomy. The aim of this study was to compare completion pancreatectomy with a pancreas-preserving procedure in patients undergoing relaparotomy for pancreatic fistula after pancreatoduodenectomy. METHODS: This retrospective cohort study of nine institutions included patients who underwent relaparotomy for pancreatic fistula after pancreatoduodenectomy from 2005-2018. Furthermore, a systematic review and meta-analysis were performed according to the PRISMA guidelines. RESULTS: From 4877 patients undergoing pancreatoduodenectomy, 786 (16 per cent) developed a pancreatic fistula grade B/C and 162 (3 per cent) underwent a relaparotomy for pancreatic fistula. Of these patients, 36 (22 per cent) underwent a completion pancreatectomy and 126 (78 per cent) a pancreas-preserving procedure. Mortality was higher after completion pancreatectomy (20 (56 per cent) versus 40 patients (32 per cent); P = 0.009), which remained after adjusting for sex, age, BMI, ASA score, previous reintervention, and organ failure in the 24 h before relaparotomy (adjusted odds ratio 2.55, 95 per cent c.i. 1.07 to 6.08). The proportion of additional reinterventions was not different between groups (23 (64 per cent) versus 84 patients (67 per cent); P = 0.756). The meta-analysis including 33 studies evaluating 745 patients, confirmed the association between completion pancreatectomy and mortality (Mantel-Haenszel random-effects model: odds ratio 1.99, 95 per cent c.i. 1.03 to 3.84). CONCLUSION: Based on the current data, a pancreas-preserving procedure seems preferable to completion pancreatectomy in patients in whom a relaparotomy is deemed necessary for pancreatic fistula after pancreatoduodenectomy.

Contains fulltext : 219277.pdf (publisher's version ) (Open Access)

Sport wordt in westerse samenlevingen veelal gebruikt als middel om maatschappelijke problemen op te lossen, zoals het integratievraagstuk. Hierbij heerst de gedachte dat deelname aan sport een positief effect heeft op de integratie van migranten. Deze gedachte valt ook terug te zien binnen de Nederlandse context. In het nationaal sportakkoord wordt de rol van sport als middel voor integratie namelijk expliciet genoemd. Vanuit de wetenschappelijke literatuur blijkt echter dat deelname aan sport ook kan leiden tot vormen van exclusie in plaats van inclusie. In dit onderzoek is daarom onderzocht in welke mate de discoursen die heersen over sport als middel voor integratie werken. Dit is gedaan door binnen het sport en ontwikkelingsproject JongGras Sportbuddies, te onderzoeken welke discoursen studentcoaches en statushouders (re)produceren over sport als middel voor integratie. Aan de hand van de theoretische lens van Michel Foucault is gekeken hoe praktijken van governmentality binnen JongGras Sportbuddies op studentcoaches en statushouders inwerkt. Om de macht van discoursen te begrijpen is hierbij gebruikt gemaakt van de vier verschillende dimensies van Dean (2010): Rationalities, technologies, culture en history. Door middel van deze vier dimensies is onderzocht hoe discoursen over sport als middel voor integratie vanuit JongGras Sportbuddies in stand worden gehouden en ge(re)produceert. Uit de resultaten blijkt dat er verschillende discoursen over sport als middel voor integratie binnen JongGras Sportbuddies aanwezig zijn. Dit zijn: sport zorgt voor meer contacten, sport verbetert de Nederlandse taal en sport is gezond. De respondenten geven aan dat sport over het algemeen leidt tot meer sociale contacten, maar dat bepaalde factoren zoals het sportniveau en de motivatie wel een rol spelen. Daarnaast geven vrijwel alle respondenten aan de sport gezien wordt als een plaats waar de taal geleerd wordt. Hierbij speelt de gezelligheidscontext een belangrijke rol. De mee