125 results on '"Inne H.M. Borel Rinkes"'
Search Results
2. Trends in blood pressure-related outcomes after adrenalectomy in patients with primary aldosteronism: A systematic review
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Inne H.M. Borel Rinkes, Diederik P. D. Suurd, Gerlof D. Valk, Wessel M.C.M. Vorselaars, Wilko Spiering, Menno R. Vriens, and Dirk-Jan van Beek
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Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,Blood Pressure ,030204 cardiovascular system & hematology ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,Primary aldosteronism ,Hyperaldosteronism ,medicine ,Humans ,In patient ,Antihypertensive Agents ,Study quality ,business.industry ,Adrenalectomy ,General Medicine ,medicine.disease ,Treatment Outcome ,Blood pressure ,030220 oncology & carcinogenesis ,Hypertension ,Surgery ,business ,Medical literature ,Systematic search - Abstract
Background Decrease in blood pressure (BP) is the major goal of adrenalectomy for primary aldosteronism. Nevertheless, the optimal timing to assess these outcomes and the needed duration of follow-up are uncertain. We systematically reviewed the literature regarding trends in BP-related outcomes during follow-up after adrenalectomy. Methods A systematic literature search of medical literature from PubMed, Embase and the Cochrane Library regarding BP-related outcomes (i.e. cure of hypertension rates, BP and antihypertensives) was performed. The Quality In Prognosis Studies risk of bias tool was used. Results Of the 2057 identified records, 13 articles met the inclusion criteria. Overall study quality was low. In multiple studies, the biggest decrease in BP was shown within the first month(s) after adrenalectomy and afterwards BP often remained stable during long-term follow-up. Conclusions Based on the available studies one might suggest that long follow-up is unnecessary, since outcomes seem to stabilize within the first months. more...
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- 2021
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3. Sentinel Lymph Node Mapping in Breast Cancer Patients Through Fluorescent Imaging Using Indocyanine Green: The INFLUENCE Trial
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Claudia A. Bargon, Anne Huibers, Danny A. Young-Afat, Britt A.M. Jansen, Inne H.M. Borel-Rinkes, Jules Lavalaye, Henk-Jan van Slooten, Helena M. Verkooijen, Christiaan F.P. van Swol, Annemiek Doeksen, and Plastic, Reconstructive and Hand Surgery more...
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Indocyanine Green ,Sentinel Lymph Node Biopsy ,Humans ,Technetium ,Surgery ,Breast Neoplasms ,Female ,Lymph Nodes ,Radiopharmaceuticals ,Sentinel Lymph Node ,Coloring Agents ,Technetium Tc 99m Aggregated Albumin ,Lymphoscintigraphy - Abstract
OBJECTIVE: The aim was to compare the (sentinel) lymph node detection rate of indocyanine green (ICG)-fluorescent imaging versus standard-of-care 99m Tc-nanocoilloid for sentinel lymph node (SLN)-mapping. BACKGROUND: The current gold standard for axillary staging in patients with breast cancer is sentinel lymph node biopsy (SLNB) using radio-guided surgery using radioisotope technetium ( 99m Tc), sometimes combined with blue dye. A promising alternative is fluorescent imaging using ICG. METHODS: In this noninferiority trial, we enrolled 102 consecutive patients with invasive early-stage, clinically node-negative breast cancer. Patients were planned for breast conserving surgery and SLNB between August 2020 and June 2021. The day or morning before surgery, patients were injected with 99m Tc-nanocolloid. In each patient, SLNB was first performed using ICG-fluorescent imaging, after which excised lymph nodes were tested with the gamma-probe for 99m Tc-uptake ex vivo, and the axilla was checked for residual 99m Tc-activity. The detection rate was defined as the proportion of patients in whom at least 1 (S)LN was detected with either tracer. RESULTS: In total, 103 SLNBs were analyzed. The detection rate of ICG-fluorescence was 96.1% [95% confidence interval (95% CI)=90.4%-98.9%] versus 86.4% (95% CI=78.3%-92.4%) for 99m Tc-nanocoilloid. The detection rate for pathological lymph nodes was 86.7% (95% CI=59.5%-98.3%) for both ICG and 99m Tc-nanocoilloid. A median of 2 lymph nodes were removed. ICG-fluorescent imaging did not increase detection time. No adverse events were observed. CONCLUSIONS: ICG-fluorescence showed a higher (S)LN detection rate than 99m Tc-nanocoilloid, and equal detection rate for pathological (S)LNs. ICG-fluorescence may be used as a safe and effective alternative to 99m Tc-nanocoilloid for SLNB in patients with early-stage breast cancer. more...
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- 2022
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4. Assessing Outcomes After Adrenalectomy for Primary Aldosteronism - Early is Accurate: Retrospective Cohort Study
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Diederik P.D. Suurd, Wessel M.C.M. Vorselaars, Dirk-Jan Van Beek, Inne H.M. Borel Rinkes, Wilko Spiering, Gerlof D. Valk, and Menno R. Vriens
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Cohort Studies ,Hyperaldosteronism ,Hypertension ,Humans ,Surgery ,Adrenalectomy ,Antihypertensive Agents ,Retrospective Studies - Abstract
We aimed to investigate the postoperative trend in blood pressure (BP)-related outcomes [BP and antihypertensive (AHT) drug use] during the year following adrenalectomy for primary aldosteronism (PA) to determine the optimal timing for outcome assessment and to determine the necessary follow-up length.Since the course of BP-related outcomes after adrenalectomy is unknown, the optimal timing of outcome assessment and follow-up duration are not clear.In this retrospective single center cohort study, we used a prospectively collected database with all patients referred for difficult-to-control-hypertension-analysis. All patients diagnosed with PA who underwent adrenalectomy were included. AHT drug use [in defined daily dose (DDD)] and home blood pressure measurements (HBPMs) during the first postoperative year were collected. A mixed-effects model was developed to assess the stability of DDD and HBPM over time and adjust for potential confounders.In total 1784 patients were assessed for difficult-to-control-hypertension of whom 41 were included. Both the DDD and HBPM showed the strongest decrease in the first postoperative month (mean 1.6DDD; mean 140/85 mm Hg) compared with preoperative values (4.5DDD; 153/92 mm Hg). Thereafter, both outcomes showed a stable course from 4 to 6 months (1.6DDD; 136/86 mm Hg) up to 12 months postoperatively (2.0DDD; 136/83 mm Hg).This study showed that AHT drug use and HBPM decreased substantially within the first month after adrenalectomy for PA and afterwards generally remained stable during the year following adrenalectomy. We propose that BP-related outcomes can be assessed reliably early after adrenalectomy and question the need for routine long-term follow-up in referral centers. more...
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- 2022
5. Robotic Distal Pancreatectomy, a Novel Standard of Care?
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Philip C. Müller, Eva Breuer, Felix Nickel, Sabino Zani, Emanuele Kauffmann, Lorenzo De Franco, Christoph Tschuor, Paul Suno Krohn, Stefan K. Burgdorf, Jan Philipp Jonas, Christian E. Oberkofler, Henrik Petrowsky, Olivier Saint-Marc, Leonard Seelen, Izaak Quintus Molenaar, Ulrich Wellner, Tobias Keck, Andrea Coratti, Coen van Dam, Roeland de Wilde, Bas Groot Koerkamp, Valentina Valle, Pier Giulianotti, Elie Ghabi, David Moskal, Harish Lavu, Dionisios Vrochides, John Martinie, Charles Yeo, Patricia Sánchez-Velázquez, Benedetto Ielpo, Pranay S. Ajay, Mihir M. Shah, David A. Kooby, Song Gao, Jihui Hao, Jin He, Ugo Boggi, Thilo Hackert, Peter Allen, Inne H.M. Borel-Rinkes, Pierre Alain Clavien, and Surgery more...
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Surgery - Abstract
BACKGROUND AND OBJECTIVE: Robotic distal pancreatectomy (DP) is an emerging attractive approach, but its role compared to laparoscopic or open surgery remains unclear. Benchmark values are novel and objective tools for such comparisons. The aim of this study was to identify benchmark cutoffs for many outcome parameters for DP with or without splenectomy beyond the learning curve.METHODS: This study analyzed outcomes from international expert centers from patients undergoing robotic DP for malignant or benign lesions. After excluding the first 10 cases in each center to reduce the effect of the learning curve, consecutive patients were included from the start of robotic DP up to June 2020. Benchmark patients had no significant comorbidities. Benchmark cutoff values were derived from the 75 th or the 25 th percentile of the median values of all benchmark centers. Benchmark values were compared to a laparoscopic control group from four high-volume centers and published open DP landmark series.RESULTS: Sixteen centers contributed 755 cases, whereof 345 benchmark patients (46%) were included the analysis. Benchmark cut-offs included: operation time ≤300min, conversion rate ≤3%, clinically relevant POPF ≤32%, 3 months major complication rate ≤26.7% and lymph node retrieval ≥9. The CCI ® at 3 months was ≤8.7 without deterioration thereafter. Compared to robotic DP, laparoscopy had significantly higher conversion rates (5x) and overall complications, while open DP was associated with more blood loss and longer hospital stay.CONCLUSION: This first benchmark study demonstrates that robotic DP provides superior postoperative outcomes compared to laparoscopic and open DP. Robotic DP may be expected to become the approach of choice in minimally invasive DP. more...
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- 2022
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6. Metastatic Patterns of Duodenopancreatic Neuroendocrine Tumors in Patients With Multiple Endocrine Neoplasia Type 1
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Wenzel M. Hackeng, Madelon van Emst, Inne H.M. Borel Rinkes, Lodewijk A.A. Brosens, Koen M.A. Dreijerink, Gerlof D. Valk, G. Johan A. Offerhaus, Mark J C van Treijen, Dirk-Jan van Beek, Folkert H.M. Morsink, Menno R. Vriens, Aranxa S M Kok, Internal medicine, CCA - Cancer biology and immunology, CCA - Imaging and biomarkers, and Amsterdam Gastroenterology Endocrinology Metabolism more...
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Adult ,Male ,endocrine system ,Pathology ,medicine.medical_specialty ,Databases, Factual ,Neuroendocrine tumors ,Pathology and Forensic Medicine ,Metastasis ,Duodenal Neoplasms ,Gastrins ,medicine ,Biomarkers, Tumor ,Multiple Endocrine Neoplasia Type 1 ,Humans ,MEN1 ,Multiple endocrine neoplasia ,Lymph node ,Aged ,Homeodomain Proteins ,Gastrinoma ,business.industry ,Middle Aged ,medicine.disease ,Carcinoma, Neuroendocrine ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Ki-67 Antigen ,Lymphatic Metastasis ,Trans-Activators ,PDX1 ,Surgery ,Female ,Anatomy ,Neoplasm Grading ,Pancreas ,business ,Transcription Factors - Abstract
Patients with multiple endocrine neoplasia 1 syndrome (MEN1) often develop multifocal duodenopancreatic neuroendocrine tumors (dpNETs). Nonfunctional pancreatic neuroendocrine tumors (PanNETs) and duodenal gastrinomas are the most frequent origins of metastasis. Current guidelines recommend surgery based on tumor functionality, size ≥ 2 cm, grade or presence of lymph node metastases. However, in case of multiple primary tumors it is often unknown which specific tumor metastasized. This study aims to unravel the relationship between primary dpNETs and metastases in patients with MEN1 by studying endocrine differentiation. First, it was shown that expression of the endocrine differentiation markers ARX and PDX1 was concordant in 18 unifocal sporadic neuroendocrine tumors (NETs) and matched metastases. Thereafter, ARX, PDX1, Ki67 and gastrin expression, and the presence of alternative lengthening of telomeres were determined in 137 microscopic and macroscopic dpNETs and 36 matched metastases in 10 patients with MEN1. ARX and PDX1 H-score clustering was performed to infer relatedness. For patients with multiple metastases, similar intrametastases transcription factor expression suggests that most metastases (29/32) originated from a single NET of origin, while few patients may have multiple metastatic primary NETs. In 6 patients with MEN1 and hypergastrinemia, periduodenopancreatic lymph node metastases expressed gastrin, and clustered with minute duodenal gastrinomas, not with larger PanNETs. PanNET metastases often clustered with high grade or alternative lengthening of telomeres-positive primary tumors. In conclusion, for patients with MEN1-related hypergastrinemia and PanNETs, a duodenal origin of periduodenopancreatic lymph node metastases should be considered, even when current conventional and functional imaging studies do not reveal duodenal tumors preoperatively. more...
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- 2021
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7. Risk factors for complications after surgery for pancreatic neuroendocrine tumors
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Dirk-Jan van Beek, Tim J. Takkenkamp, Edgar M. Wong-Lun-Hing, Ruben H.J. de Kleine, Annemiek M.E. Walenkamp, Joost M. Klaase, Maarten W. Nijkamp, Gerlof D. Valk, I. Quintus Molenaar, Jeroen Hagendoorn, Hjalmar C. van Santvoort, Inne H.M. Borel Rinkes, Frederik J.H. Hoogwater, Menno R. Vriens, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Value, Affordability and Sustainability (VALUE), and Groningen Institute for Organ Transplantation (GIOT) more...
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Cohort Studies ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,Pancreatectomy ,Risk Factors ,Multiple Endocrine Neoplasia Type 1 ,Humans ,Surgery - Abstract
BACKGROUND: Surgical resection is the only potentially curative treatment for pancreatic neuroendocrine tumors. The choice for the type of procedure is influenced by the expected oncological benefit and the anticipated risk of procedure-specific complications. Few studies have focused on complications in these patients. This cohort study aimed to assess complications and risk factors after resections of pancreatic neuroendocrine tumors.METHODS: Patients undergoing resection of a pancreatic neuroendocrine tumor were identified within 2 centers of excellence. Complications were assessed according to the Clavien-Dindo classification and the comprehensive complication index. Logistic regression was performed to compare surgical procedures with adjustment for potential confounders (Clavien-Dindo ≥3).RESULTS: The cohort comprised 123 patients, including 12 enucleations, 50 distal pancreatectomies, 51 pancreatoduodenectomies, and 10 total/combined pancreatectomies. Mortality was 0.8%, a severe complication occurred in 41.5%, and the failure-to-rescue rate was 2.0%. The median comprehensive complication index was 22.6 (0-100); the comprehensive complication index increased after more extensive resections. After adjustment, a pancreatoduodenectomy, as compared to a distal pancreatectomy, increased the risk for a severe complication (odds ratio 3.13 [95% confidence interval 1.32-7.41]). Of the patients with multiple endocrine neoplasia type 1 or von Hippel-Lindau, 51.9% developed a severe complication vs 38.5% with sporadic disease. After major resections, morbidity was significantly higher in patients with multiple endocrine neoplasia type 1/von Hippel-Lindau (comprehensive complication index 45.1 vs 28.9, P = .029).CONCLUSION: Surgery for pancreatic neuroendocrine tumors is associated with a high rate of complications but low failure-to-rescue in centers of excellence. Complications are procedure-specific. Major resections in patients with multiple endocrine neoplasia type 1/von Hippel-Lindau appear to increase the risk of complications. more...
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- 2021
8. Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis
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Lutske Lodewijk, Menno R. Vriens, Dilay Aykan, Lisa H de Vries, Johanna A A G Damen, and Inne H.M. Borel Rinkes
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Thyroid nodules ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Operative Time ,minimally invasive video assisted thyroidectomy (MIVAT) ,MEDLINE ,transoral endoscopic thyroidectomy via vestibular approach (TOETVA) ,bilateral axillo-breast approach robotic thyroidectomy (BABA-RT) ,Diseases of the endocrine glands. Clinical endocrinology ,Endocrinology ,bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET) ,Postoperative Complications ,Robotic Surgical Procedures ,Humans ,Minimally Invasive Surgical Procedures ,Medicine ,retro-auricular robotic thyroidectomy (RA-RT) ,Thyroid Neoplasms ,Thyroid Nodule ,robot assisted transaxillary surgery (RATS) ,retro-auricular endoscopic thyroidectomy (RA-ET) ,Surgical approach ,business.industry ,Significant difference ,Thyroid ,Thyroidectomy ,Standard of Care ,RC648-665 ,medicine.disease ,gasless transaxillary endoscopic thyroidectomy (GTET) ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Meta-analysis ,Systematic Review ,business ,Complication - Abstract
PurposeConventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy.MethodsA systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques.ResultsOut of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques.ConclusionsThis is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy. more...
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- 2021
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9. Early recognition of clinically relevant postoperative pancreatic fistula: a systematic review
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Olivier R. Busch, I. Quintus Molenaar, F. Jasmijn Smits, Marc G. Besselink, Hjalmar C. van Santvoort, Casper H.J. van Eijck, Inne H.M. Borel Rinkes, and Surgery
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medicine.medical_specialty ,Computed tomography ,030230 surgery ,Elevated serum ,Pancreatic Fistula ,03 medical and health sciences ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Early prediction ,Humans ,Medicine ,Elevated white blood cell count ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine.disease ,Surgery ,Early Diagnosis ,Pancreatic fistula ,030220 oncology & carcinogenesis ,business ,Systematic search - Abstract
Background: Early recognition of postoperative pancreatic fistula might decrease the risk of subsequent life threatening complications. The aim of this review was to systematically evaluate the accuracy of postoperative clinical, biochemical and radiologic variables for early recognition of clinically relevant postoperative pancreatic fistula. Methods: A systematic literature search was performed up to August 2018. Clinical studies reporting on the association between postoperative variables and clinically relevant postoperative pancreatic fistula were included. Variables were stratified: early prediction (postoperative day 1–2) versus early diagnosis (day 3) and had to be reported in 2 cohorts. Results: Overall, 37 included studies reported on 17 different diagnostic variables after 8701 pancreatic resections. Clinically relevant postoperative pancreatic fistula occurred in 1532/8701 patients (18%). Early prediction variables included elevated serum and drain amylase (day 1). Identified variables for early diagnosis were: non-serous drain efflux (day 3); positive drain culture (day 3); elevated temperature (any day); elevated C-Reactive Protein (CRP; day 4); elevated white blood cell count (day 4) and peripancreatic collections on computed tomography (CT; day 5–10). Conclusion: This review provides a comprehensive overview of postoperative variables associated with clinically relevant pancreatic fistula. Incorporation of variables in future algorithms could potentially mitigate the clinical impact of postoperative pancreatic fistula. more...
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- 2020
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10. Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands
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Moh'd Abu Hilal, Marcel J. van der Poel, Michael F. Gerhards, Marc H.A. Bemelmans, Wouter K. G. Leclercq, Andries E. Braat, Pieter J. Tanis, J. Sven D. Mieog, Marc G. Besselink, Pascal G. Doornebosch, Rutger-Jan Swijnenburg, Burak Görgec, Paul D. Gobardhan, Joost M. Klaase, Peter B. van den Boezem, Quintus Molenaar, Inne H.M. Borel Rinkes, Geert Kazemier, Cornelis H. C. Dejong, Jeroen Hagendoorn, Ronald M. van Dam, Türkan Terkivatan, Arjen M. Rijken, Koop Bosscha, S. J. Oosterling, Gerrit D. Slooter, Werner A. Draaisma, Wouter W. te Riele, Maarten Vermaas, Vincent B. Nieuwenhuijs, Petrousjka van den Tol, Christiaan Hoff, Hendrik A. Marsman, Marieke T. de Boer, Martijn W J Stommel, R. Fichtinger, Babs M Zonderhuis, Joost A B van der Hoeven, M. Liem, Carolijn L.M.A. Nota, Gijs A. Patijn, Daan J. Lips, Groningen Institute for Organ Transplantation (GIOT), Value, Affordability and Sustainability (VALUE), CCA - Cancer Treatment and quality of life, Surgery, AGEM - Re-generation and cancer of the digestive system, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, Graduate School, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, and CCA - Cancer Treatment and Quality of Life more...
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Liver surgery ,Male ,medicine.medical_specialty ,RESECTION ,Attitude of Health Personnel ,Operative Time ,Liver resections ,RECOMMENDATIONS ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Robotic Surgical Procedures ,Surveys and Questionnaires ,Operating time ,medicine ,PROGRAM ,Hepatectomy ,Humans ,Aged ,Netherlands ,Retrospective Studies ,Surgeons ,Hepatology ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,Conversion to Open Surgery ,Surgery ,MODEL ,Multicenter study ,Liver ,030220 oncology & carcinogenesis ,Operative time ,EXPERIENCE ,030211 gastroenterology & hepatology ,Female ,Laparoscopy ,LEARNING-CURVE ,business ,Learning Curve ,SYSTEM - Abstract
Background: While most of the evidence on minimally invasive liver surgery (MILS) is derived from expert centers, nationwide outcomes remain underreported. This study aimed to evaluate the implementation and outcome of MILS on a nationwide scale. Methods: Electronic patient files were reviewed in all Dutch liver surgery centers and all patients undergoing MILS between 2011 and 2016 were selected. Operative outcomes were stratified based on extent of the resection and annual MILS volume. Results: Overall, 6951 liver resections were included, with a median annual volume of 50 resections per center. The overall use of MILS was 13% (n = 916), which varied from 3% to 36% (P < 0.001) between centers. The nationwide use of MILS increased from 6% in 2011 to 23% in 2016 (P < 0.001). Outcomes of minor MILS were comparable with international studies (conversion 0–13%, mortality more...
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- 2019
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11. Recurrence after neoadjuvant therapy and resection of borderline resectable and locally advanced pancreatic cancer
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Inne H.M. Borel Rinkes, Georgios Gemenetzis, Alex B. Blair, Matthew J. Weiss, Richard A. Burkhart, John L. Cameron, Ding Ding, Christopher L. Wolfgang, Vincent P. Groot, I. Quintus Molenaar, Jun Yu, and Jin He more...
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Male ,medicine.medical_specialty ,Survival ,medicine.medical_treatment ,Perineural invasion ,Gastroenterology ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Recurrence ,Borderline resectable ,Internal medicine ,Pancreatic cancer ,medicine ,Adjuvant therapy ,Humans ,Neoadjuvant therapy ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Survival Rate ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,030211 gastroenterology & hepatology ,Surgery ,Neoplasm Recurrence, Local ,business - Abstract
Introduction The incidence, timing, and implications of recurrence in patients who underwent neoadjuvant treatment and surgical resection of borderline resectable (BRPC) or locally advanced (LAPC) pancreatic cancer are not well established. Materials and methods Patients with BRPC/LAPC who underwent post-neoadjuvant resection between 2007 and 2015 were included. Associations between clinicopathologic characteristics and specific recurrence locations, recurrence-free survival (RFS), and overall survival from resection (OS) were assessed using Cox regression analyses. Results For 231 included patients, median survival from diagnosis and resection were 28.0 and 19.8 months, respectively. After a median RFS of 7.9 months, 189 (81.8%) patients had recurred. Multiple-site (n = 87, 46.0%) and liver-only recurrence (n = 28, 14.8%) generally occurred earlier and resulted in significantly worse OS when compared to local-only (n = 52, 27.5%) or lung-only recurrence (n = 18, 9.5%). Microscopic perineural invasion, yN1-yN2 status and elevated pre-surgery CA 19-9 >100 U/mL were associated with both local-only and multiple-site/liver-only recurrence. R1-margin was associated with local-only recurrence (HR 2.03). yN1-yN2 status and microscopic perineural invasion were independent predictors for both poor RFS and OS, while yT3-yT4 tumor stage (HR 1.39) and poor tumor differentiation (HR 1.60) were only predictive of poor OS. Adjuvant therapy was independently associated with both prolonged RFS (HR 0.73; median 7.0 vs. 10.9 months) and OS (HR 0.69; median 15.4 vs. 22.7 months). Conclusion Despite neoadjuvant therapy leading to resection and relatively favorable pathologic tumor characteristics in BRPC/LAPC patients, more than 80% of patients experienced disease recurrence, 72.5% of which occurred at distant sites. more...
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- 2019
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12. Clinical outcomes after surgery for primary aldosteronism
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Rasa Zarnegar, H. Jaap Bonjer, Mark Sywak, Dirk Jan van Beek, Benjamin J. Peipert, James A. Lee, David N. Parente, Gerlof D. Valk, Jesse D. Pasternak, Marco Raffaelli, Gerardo D'Amato, Scott B. Grant, Minerva A. Romero Arenas, Hasan H. Eker, Wessel M.C.M. Vorselaars, Madelon Metman, Tanya Castelino, Q.Y. Duh, Nicole D. Bouvy, Menno R. Vriens, Els J. M. Nieveen van Dijkum, Wilko Spiering, Inne H.M. Borel Rinkes, Nancy D. Perrier, Stephanie D. Talutis, Schelto Kruijff, David McAneny, Catherine McManus, Raymon H. Grogan, Valerie Schuermans, Anton F. Engelsman, Elliot J. Mitmaker, Nina M. Vaarzon Morel, Michael N. Mongelli, Emily L. Postma, Frederick Thurston Drake, Surgery, AII - Inflammatory diseases, AGEM - Digestive immunity, CCA - Cancer Treatment and Quality of Life, Guided Treatment in Optimal Selected Cancer Patients (GUTS), APH - Quality of Care, APH - Global Health, ACS - Microcirculation, MUMC+: MA AIOS Neurochirurgie (9), MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health more...
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Adult ,Male ,Canada ,Pediatrics ,medicine.medical_specialty ,Internationality ,PRESSURE-LOWERING DRUGS ,Settore MED/18 - CHIRURGIA GENERALE ,RESOLUTION SCORE ,ADRENALECTOMY ,HYPERTENSION CURE ,Risk Assessment ,Severity of Illness Index ,Perioperative Care ,UNILATERAL PRIMARY ALDOSTERONISM ,Cohort Studies ,EVENTS ,Primary aldosteronism ,Outcome Assessment, Health Care ,Severity of illness ,HYPERALDOSTERONISM ,medicine ,MANAGEMENT ,Humans ,Aldosterone ,Netherlands ,Retrospective Studies ,primary aldosteronism ,business.industry ,Australia ,Blood Pressure Determination ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Hyperaldosteronism ,United States ,PREVALENCE ,Europe ,Treatment Outcome ,Defined daily dose ,Blood pressure ,CARDIOVASCULAR-DISEASE ,Cohort ,Female ,Surgery ,business ,Cohort study - Abstract
Background: In a first step toward standardization, the Primary Aldosteronism Surgical Outcomes investigators introduced consensus criteria defining the clinical outcomes after adrenalectomy for primary aldosteronism. Within this retrospective cohort study, we evaluated the use of these consensus criteria in daily clinical practice in 16 centers in Europe, Canada, Australia, and the United States.Methods: Patients who underwent unilateral adrenalectomy for primary aldosteronism between 2010 and 2016 were included. Patients with missing data regarding preoperative or postoperative blood pressure or their defined daily dose were excluded. According to the Primary Aldosteronism Surgical Outcomes criteria, patients were classified as complete, partial, or absent clinical success.Results: A total of 380 patients were eligible for analysis. Complete, partial, and absent clinical success was achieved in 30%, 48%, and 22%, respectively. Evaluation of the Primary Aldosteronism Surgical Outcomes criteria showed that in 11% and 47% of patients with partial and absent clinical success, this classification was incorrect or debatable (16% of the total cohort). This concept of a "debatable classification of success" was due mainly to the cutoff of >= 20 mmHg used to indicate a clinically relevant change in systolic blood pressure and the use of percentages instead of absolute values to indicate a change in defined daily dose.Conclusion: Although introduction of the Primary Aldosteronism Surgical Outcomes consensus criteria induced substantial advancement in the standardization of postoperative outcomes, our study suggests that there is room for improvement in the concept for success given the observed limitations when the criteria were tested within our international cohort. In line, determining clinical success remains challenging, especially in patients with opposing change in blood pressure and defined daily dose. (C) 2019 Elsevier Inc. All rights reserved. more...
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- 2019
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13. Defining and Predicting Early Recurrence in 957 Patients With Resected Pancreatic Ductal Adenocarcinoma
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John L. Cameron, Roberto J. Rivero-Soto, Vincent P. Groot, Jun Yu, Alex B. Blair, Jin He, Matthew J. Weiss, Georgios Gemenetzis, Inne H.M. Borel Rinkes, Ammar A. Javed, Christopher L. Wolfgang, I. Quintus Molenaar, and Richard A. Burkhart more...
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Pancreatic ductal adenocarcinoma ,Early Recurrence ,medicine.medical_treatment ,Research Support ,Disease-Free Survival ,Resection ,Cohort Studies ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Risk Factors ,Late Recurrence ,Journal Article ,Carcinoma ,Humans ,Pancreatic Neoplasms/mortality ,Medicine ,Non-U.S. Gov't ,Survival rate ,Neoplasm Recurrence, Local/epidemiology ,Pancreatic Ductal/mortality ,Local/epidemiology ,business.industry ,Research Support, Non-U.S. Gov't ,Background data ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Pancreatic Neoplasms ,Survival Rate ,Neoplasm Recurrence ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,Neoplasm Recurrence, Local ,Carcinoma, Pancreatic Ductal/mortality ,business ,Carcinoma, Pancreatic Ductal - Abstract
OBJECTIVES: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. SUMMARY BACKGROUND DATA: A clear definition of "early recurrence" after pancreatic ductal adenocarcinoma resection is currently lacking. METHODS: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models. RESULTS: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. CONCLUSION: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis. more...
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- 2019
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14. Reliability and agreement of radiological and pathological tumor size in patients with multiple endocrine neoplasia type 1-related pancreatic neuroendocrine tumors: results from a population-based cohort
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Geert Kazemier, Sjoerd Nell, Menno R. Vriens, Helena M. Verkooijen, Cornelis H. C. Dejong, Frederik J. H. Hoogwater, Inne H.M. Borel Rinkes, Harry van Goor, Lodewijk A.A. Brosens, Casper H.J. van Eijck, Dirk-Jan van Beek, Bert A. Bonsing, Gerlof D. Valk, Elisabeth J. M. Nieveen van Dijkum, Frank J. Wessels, CCA - Cancer Treatment and quality of life, Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Pathology, MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health more...
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Male ,Intraclass correlation ,SURGERY ,Endocrinology, Diabetes and Metabolism ,Neuroendocrine tumors ,GUIDELINES ,Endosonography ,Cohort Studies ,Endocrinology ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Multiple endocrine neoplasia ,Computed tomography ,EUS ,education.field_of_study ,medicine.diagnostic_test ,DEATH ,Middle Aged ,Reliability ,CANCER ,MEN1 ,Radiological weapon ,Cohort ,Multiple endocrine neoplasia type 1 ,Female ,Radiology ,Research Article ,Adult ,Diagnostic Imaging ,medicine.medical_specialty ,Population ,FORMALIN FIXATION ,LIVER METASTASES ,Agreement ,Cellular and Molecular Neuroscience ,All institutes and research themes of the Radboud University Medical Center ,Magnetic resonance imaging ,SDG 3 - Good Health and Well-being ,Pancreatic neuroendocrine tumor ,Internal medicine ,medicine ,MANAGEMENT ,Humans ,education ,Pathological ,Endocrine and Autonomic Systems ,business.industry ,Endoscopic ultrasonography ,Reproducibility of Results ,medicine.disease ,Pancreatic Neoplasms ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Tomography, X-Ray Computed ,business - Abstract
Background: Pancreatic neuroendocrine tumors (pNETs) have a high prevalence in patients with multiple endocrine neoplasia type 1 (MEN1) and are the leading cause of death. Tumor size is still regarded as the main prognostic factor and therefore used for surgical decision-making. We assessed reliability and agreement of radiological and pathological tumor size in a population-based cohort of patients with MEN1-related pNETs. Methods: Patients were selected from the Dutch MEN1 database if they had undergone a resection for a pNET between 2003 and 2018. Radiological (MRI, CT, and endoscopic ultrasonography [EUS]) and pathological tumor size were collected from patient records. Measures of agreement (Bland-Altman plots with limits of agreement [LoA] and absolute agreement) and reliability (intraclass correlation coefficients [ICC] and unweighted kappa) were calculated for continuous and categorized (< or ≥2 cm) pNET size. Results: In 73 included patients, the median radiological and pathological tumor sizes measured were 22 (3–160) and 21 (4–200) mm, respectively. Mean bias between radiological and pathological tumor size was −0.2 mm and LoA ranged from −12.9 to 12.6 mm. For the subgroups of MRI, CT, and EUS, LoA of radiological and pathological tumor size ranged from −9.6 to 10.9, −15.9 to 15.8, and −13.9 to 11.0, respectively. ICCs for the overall cohort, MRI, CT, and EUS were 0.80, 0.86, 0.75, and 0.76, respectively. Based on the 2 cm criterion, agreement was 81.5%; hence, 12 patients (18.5%) were classified differently between imaging and pathology. Absolute agreement and kappa values of MRI, CT, and EUS were 88.6, 85.7, and 75.0%, and 0.77, 0.71, and 0.50, respectively. Conclusion: Within a population-based cohort, MEN1-related pNET size was not systematically over- or underestimated on preoperative imaging. Based on agreement and reliability measures, MRI is the preferred imaging modality. more...
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- 2021
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15. A simplified primary aldosteronism surgical outcome score is a useful prediction model when target organ damage is unknown – Retrospective cohort study
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Q.Y. Duh, Dirk-Jan van Beek, Wilko Spiering, Els J. M. Nieveen van Dijkum, Inne H.M. Borel Rinkes, Cord Sturgeon, Raymon H. Grogan, Elliot J. Mitmaker, Schelto Kruijff, Nicole D. Bouvy, Catherine McManus, Nancy D. Perrier, Wen T. Shen, Minerva A. Romero Arenas, Tanya Castelino, Diederik P. D. Suurd, James A. Lee, H. Jaap Bonjer, Gerardo D'Amato, Valerie Schuermans, Rasa Zarnegar, Anton F. Engelsman, Scott B. Grant, Gerlof D. Valk, Frederick Thurston Drake, Thomas J. Fahey, Michiel N. Kerstens, Hasan H. Eker, David N. Parente, Mark Sywak, Jesse D. Pasternak, Wouter P. Visscher, David McAneny, Stan B. Sidhu, Marco Raffaelli, Menno R. Vriens, Wessel M.C.M. Vorselaars, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Surgery, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism more...
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Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Left ventricular hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Primary aldosteronism ,medicine ,Cohort Study ,business.industry ,Area under the curve ,Retrospective cohort study ,Adrenalectomy ,General Medicine ,medicine.disease ,Confidence interval ,Endocrine surgery ,PASO score ,030220 oncology & carcinogenesis ,Cohort ,Hypertension ,Blood pressure ,Surgery ,Microalbuminuria ,business - Abstract
Background Cure of hypertension after adrenalectomy for primary aldosteronism is no certainty and therefore preoperative patient counseling is essential. The Primary Aldosteronism Surgical Outcome (PASO) Score is a useful prediction model with an area under the curve (AUC) of 0.839. The PASO Score includes ‘Target Organ Damage’ (TOD) (i.e., left ventricular hypertrophy and/or microalbuminuria), which is often unavailable during preoperative counseling and might therefore limit its use in clinical practice. We hypothesized that the PASO score would still be useful if TOD is unknown at time of counseling. Therefore, we aimed to examine the predictive performance of the simplified PASO Score, without taking TOD into account. Materials and methods In this retrospective cohort study, patients who underwent unilateral adrenalectomy between 2010 and 2016 in 16 medical centers from North America, Europe and Australia were included. TOD was unknown in our database and therefore assigned as absent. Patients were classified as complete, partial or absent clinical success using the PASO consensus criteria. Results A total of 380 (73.9%) patients were eligible for analysis. Complete, partial and absent clinical success were observed in 29.5%, 55.8% and 14.7% of patients, respectively. The simplified PASO Score had an AUC of 0.730 (95% confidence interval 0.674–0.785) in our total cohort. Conclusion Without taking TOD into account, the simplified PASO Score had a lower predictive value as compared to the original derivation cohort. Ideally, the complete PASO Score should be used, but when data on TOD are not readily available, the simplified PASO Score is a useful and reasonable alternative., Highlights • We aimed to examine the predictive performance of the PASO Score, without taking ‘target organ damage’ (TOD) into account. • This simplified PASO Score had a lower predictive value as compared to the PASO Score in the original derivation cohort. • The simplified PASO Score increases the applicability of the model and is reasonable for clinicians to use in daily practice. • Ideally, the complete PASO Score should be used, but the simplified PASO Score is a useful and reasonable alternative. more...
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- 2021
16. Prognosis after surgery for multiple endocrine neoplasia type 1-related pancreatic neuroendocrine tumors: Functionality matters
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Elfi B. Conemans, Francesca Giusti, Helena M. Verkooijen, Pierre Goudet, Jerena Manoharan, Bert A. Bonsing, Cornelis H. C. Dejong, Naris Nilubol, Nancy D. Perrier, Sjoerd Nell, Elisabeth J. M. Nieveen van Dijkum, Harry van Goor, Geert Kazemier, Inne H.M. Borel Rinkes, Casper H.J. van Eijck, Jesse D. Pasternak, Cord Sturgeon, Menno R. Vriens, Detlef K. Bartsch, Sneha Giri, Maria Luisa Brandi, Nicolas Santucci, Laurent Brunaud, Jonathan Zagzag, Lodewijk A.A. Brosens, Ralph Hsiao, Ruben H J de Kleine, Gerlof D. Valk, Dirk Jan van Beek, Internal medicine, CCA - Cancer Treatment and quality of life, Surgery, and Amsterdam Gastroenterology Endocrinology Metabolism more...
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Adult ,Diagnostic Imaging ,Male ,medicine.medical_specialty ,Adolescent ,Biopsy ,030230 surgery ,Neuroendocrine tumors ,Gastroenterology ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Multiple Endocrine Neoplasia Type 1 ,medicine ,Humans ,MEN1 ,Neoplasm Metastasis ,Child ,Multiple endocrine neoplasia ,Lymph node ,Insulinoma ,Aged ,Neoplasm Staging ,Cause of death ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Hazard ratio ,Disease Management ,Middle Aged ,Prognosis ,medicine.disease ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Pancreatic Neoplasms ,Patient Outcome Assessment ,Neuroendocrine Tumors ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Surgery ,Disease Susceptibility ,Neoplasm Grading ,business ,Biomarkers - Abstract
Contains fulltext : 245221.pdf (Publisher’s version ) (Open Access) BACKGROUND: Metastasized pancreatic neuroendocrine tumors are the leading cause of death in patients with multiple endocrine neoplasia type 1. Aside from tumor size, prognostic factors of pancreatic neuroendocrine tumors are largely unknown. The present study aimed to assess whether the prognosis of patients with resected multiple endocrine neoplasia type 1-related nonfunctioning pancreatic neuroendocrine tumors differs from those with resected multiple endocrine neoplasia type 1-related insulinomas and assessed factors associated with prognosis. METHODS: Patients who underwent resection of a multiple endocrine neoplasia type 1-related pancreatic neuroendocrine tumors between 1990 and 2016 were identified in 2 databases: the DutchMEN Study Group and the International MEN1 Insulinoma Study Group databases. Cox regression was performed to compare liver metastases-free survival of patients with a nonfunctioning pancreatic neuroendocrine tumors versus those with an insulinoma and to identify factors associated with liver metastases-free survival. RESULTS: Out of 153 patients with multiple endocrine neoplasia type 1, 61 underwent resection for a nonfunctioning pancreatic neuroendocrine tumor and 92 for an insulinoma. Of the patients with resected lymph nodes, 56% (18/32) of nonfunctioning pancreatic neuroendocrine tumors had lymph node metastases compared to 10% (4/41) of insulinomas (P = .001). Estimated 10-year liver metastases-free survival was 63% (95% confidence interval 42%-76%) for nonfunctioning pancreatic neuroendocrine tumors and 87% (72%-91%) for insulinomas. After adjustment for size, World Health Organization tumor grade, and age, nonfunctioning pancreatic neuroendocrine tumors had an increased risk for liver metastases or death (hazard ratio 3.04 [1.47-6.30]). In pancreatic neuroendocrine tumors ≥2 cm, nonfunctioning pancreatic neuroendocrine tumors (2.99 [1.22-7.33]) and World Health Organization grade 2 (2.95 [1.02-8.50]) were associated with liver metastases-free survival. CONCLUSION: Patients with resected multiple endocrine neoplasia type 1-related nonfunctioning pancreatic neuroendocrine tumors had a significantly lower liver metastases-free survival than patients with insulinomas. Postoperative counseling and follow-up regimens should be tumor type specific and at least consider size and World Health Organization grade. more...
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- 2021
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17. Parenchymal transection in robotic liver resection: results of 70 resections using the Vessel Sealer
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J. Hagendoorn, Inne H.M. Borel Rinkes, I. Quintus Molenaar, Hjalmar C. van Santvoort, Carolijn L.M.A. Nota, and Wouter W. te Riele
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medicine.medical_specialty ,business.industry ,Parenchyma ,Medicine ,Robotic surgery ,business ,Resection ,Surgery - Published
- 2020
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18. Robotic Versus Open Minor Liver Resections of the Posterosuperior Segments: A Multinational, Propensity Score-Matched Study
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Yuman Fong, Carolijn L.M.A. Nota, Gi Hong Choi, Inne H.M. Borel Rinkes, T. Peter Kingham, Yanghee Woo, Karen Latorre, Thomas Boerner, Jeroen Hagendoorn, I. Quintus Molenaar, and Mustafa Raoof
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Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Carcinoma, Hepatocellular/pathology ,Liver resections ,Article ,03 medical and health sciences ,Hepatocellular/pathology ,Postoperative Complications ,0302 clinical medicine ,Robotic Surgical Procedures ,Interquartile range ,Journal Article ,medicine ,Hepatectomy ,Humans ,Comparative Study ,Laparoscopy/mortality ,Propensity Score ,Survival rate ,Aged ,Retrospective Studies ,business.industry ,Carcinoma ,Liver Neoplasms ,technology, industry, and agriculture ,Follow up studies ,Retrospective cohort study ,Liver Neoplasms/pathology ,Length of Stay ,Middle Aged ,Surgery ,Multicenter Study ,Survival Rate ,body regions ,Open group ,Hepatectomy/mortality ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Propensity score matching ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,Robotic Surgical Procedures/mortality ,business ,Hospital stay ,Follow-Up Studies - Abstract
BACKGROUND: Minor liver resections of posterosuperior segments (1, 4A, 7, 8) are challenging to perform laparoscopically and are mainly performed using an open approach. We determined the feasibility of robotic resections of posterosuperior segments and compared short-term outcomes with the open approach. METHODS: Data on open and robotic minor (≤ 3 segments) liver resections including the posterosuperior segments, performed between 2009 and 2016, were collected retrospectively from four hospitals. Robotic and open liver resections were compared, before and after propensity score matching. RESULTS: In total, 51 robotic and 145 open resections were included. After matching, 31 robotic resections were compared with 31 open resections. Median hospital stay was 4 days (interquartile range [IQR] 3-7) for the robotic group, versus 8 days (IQR 6-10) for the open group (p 0.99). There was no mortality in either group. CONCLUSION: Minor robotic liver resections of the posterosuperior segments are safe and feasible and display a shorter length of stay than open resections in selected patients at expert centers. more...
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- 2018
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19. Implications of the Pattern of Disease Recurrence on Survival Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma
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Ralph H. Hruban, Vincent P. Groot, Richard A. Burkhart, Alex B. Blair, Matthew J. Weiss, Jun Yu, Ammar A. Javed, Christopher L. Wolfgang, John L. Cameron, Inne H.M. Borel Rinkes, Ding Ding, I. Quintus Molenaar, Georgios Gemenetzis, Elliot K. Fishman, and Jin He more...
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Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Disease ,030230 surgery ,Cohort Studies ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Text mining ,Surgical oncology ,Internal medicine ,Carcinoma ,Humans ,Medicine ,Survival rate ,Neoadjuvant therapy ,Aged ,business.industry ,Prognosis ,medicine.disease ,Pancreatic Neoplasms ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,Surgery ,Neoplasm Recurrence, Local ,business ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies ,Cohort study - Abstract
After radical resection of pancreatic ductal adenocarcinoma (PDAC), approximately 80% of patients will develop disease recurrence. It remains unclear to what extent the location of recurrence carries prognostic significance. Additionally, stratifying the pattern of recurrence may lead to a deeper understanding of the heterogeneous biological behavior of PDAC. The aim of this study was to characterize the relationship of recurrence patterns with survival in patients with resected PDAC. This single-center cohort study included patients undergoing pancreatectomy at the Johns Hopkins Hospital between 2000 and 2013. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. Sites of first recurrence were stratified into five groups and survival outcomes were estimated using Kaplan–Meier curves. The association of specific recurrence locations with overall survival (OS) was analyzed using Cox proportional-hazards models with and without landmark analysis. Accurate follow-up data were available for 877 patients, 662 (75.5%) of whom had documented recurrence at last follow-up. Patients with multiple-site (n = 227, 4.7 months) or liver-only recurrence (n = 166, 7.2 months) had significantly worse median survival after recurrence when compared with lung- (n = 93) or local-only (n = 158) recurrence (15.4 and 9.7 months, respectively). On multivariable analysis, the unique recurrence patterns had variable predictive values for OS. Landmark analyses, with landmarks set at 12, 18, and 24 months, confirmed these findings. This study demonstrates that specific patterns of PDAC recurrence result in different survival outcomes. Furthermore, distinct first recurrence locations have unique independent predictive values for OS, which could help with prognostic stratification and decisions regarding treatment after the diagnosis of recurrence. more...
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- 2018
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20. Management of MEN1 Related Nonfunctioning Pancreatic NETs
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Helena M. Verkooijen, Olaf M. Dekkers, Inne H.M. Borel Rinkes, Sjoerd Nell, Peter H. Bisschop, Anouk N A van der Horst-Schrivers, Bas Havekes, Menno R. Vriens, Ad R. M. M. Hermus, Wouter W. de Herder, Madeleine L. Drent, Carolina R. C. Pieterman, Gerlof D. Valk, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Endocrinology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Internal Medicine, Clinical Neuropsychology, IBBA, RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, MUMC+: MA Endocrinologie (9), Interne Geneeskunde, Internal medicine, and AGEM - Endocrinology, metabolism and nutrition more...
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Male ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Neuroendocrine tumors ,GUIDELINES ,multiple endocrine neoplasia type 1 ,surgery ,0302 clinical medicine ,Non-U.S. Gov't ,Multiple endocrine neoplasia ,ENDOCRINE NEOPLASIA TYPE-1 ,education.field_of_study ,Research Support, Non-U.S. Gov't ,Hazard ratio ,Liver Neoplasms ,DEATH ,Pancreatic Neoplasms/complications ,PROPENSITY SCORE ,030220 oncology & carcinogenesis ,Multiple endocrine neoplasia type 1 ,oncology ,Female ,Adult ,medicine.medical_specialty ,Population ,030209 endocrinology & metabolism ,Research Support ,Lower risk ,Liver Neoplasms/prevention & control ,survival ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,medicine ,Journal Article ,Humans ,education ,Watchful Waiting ,Pancreatic neuroendocrine tumors ,Proportional Hazards Models ,pancreatic neuroendocrine tumors ,Proportional hazards model ,business.industry ,GTE ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Multiple Endocrine Neoplasia Type 1/complications ,Propensity score matching ,business ,Watchful waiting ,NEUROENDOCRINE TUMORS - Abstract
OBJECTIVE: To assess if surgery for Multiple Endocrine Neoplasia type 1 (MEN1) related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs) is effective for improving overall survival and preventing liver metastasis.BACKGROUND: MEN1 leads to multiple early-onset NF-pNETs. The evidence base for guiding the difficult decision who and when to operate is meager.METHODS: MEN1 patients diagnosed with NF-pNETs between 1990 and 2014 were selected from the DutchMEN1 Study Group database, including > 90% of the Dutch MEN1 population. The effect of surgery was estimated using time-dependent Cox analysis with propensity score restriction and adjustment.RESULTS: Of the 152 patients, 53 underwent surgery and 99 were managed by watchful waiting. In the surgery group, tumors were larger and faster-growing, patients were younger, more often male, and were more often treated in centers that operated more frequently. Surgery for NF-pNETs was not associated with a significantly lower risk of liver metastases or death, [adjusted hazard ratio (HR) = 0.73 (0.25-2.11)]. Adjusted HR's after stratification by tumor size were: NF-pNETs 3 cm managed by watchful waiting developed liver metastases or died compared with 6 out of the 16 patients who underwent surgery.CONCLUSIONS: MEN1 patients with NF-pNETs 3 cm, watchful waiting seems not advisable. more...
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- 2018
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21. ASO Author Reflections: Severe Morbidity After Major Surgery in Patients with MEN1
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Inne H.M. Borel Rinkes, Wessel M.C.M. Vorselaars, Dirk-Jan van Beek, and Menno R. Vriens
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medicine.medical_specialty ,business.industry ,General surgery ,ASO Author Reflections ,Oncology ,Surgical oncology ,Medicine ,Severe morbidity ,Humans ,Surgery ,MEN1 ,In patient ,Morbidity ,business - Published
- 2021
22. Lymphangiogenic Gene Expression Is Associated With Lymph Node Recurrence and Poor Prognosis After Partial Hepatectomy for Colorectal Liver Metastasis
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Klaas M. Govaert, Nicola Frenkel, Inne H.M. Borel Rinkes, Thomas T. Vellinga, Jeroen Hagendoorn, Onno Kranenburg, Susanne J. van Schelven, Inge Ubink, and Dieuwke Marvin
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0301 basic medicine ,Oncology ,medicine.medical_specialty ,Lymphovascular invasion ,Colorectal cancer ,Real-Time Polymerase Chain Reaction ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Cell Line, Tumor ,Internal medicine ,Biomarkers, Tumor ,medicine ,Hepatectomy ,Humans ,Lymphangiogenesis ,PDPN ,Lymph node ,Regulation of gene expression ,business.industry ,Liver Neoplasms ,Prognosis ,medicine.disease ,Gene Expression Regulation, Neoplastic ,030104 developmental biology ,medicine.anatomical_structure ,Lymphatic system ,Vascular endothelial growth factor C ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Surgery ,Lymph Nodes ,Colorectal Neoplasms ,business ,Follow-Up Studies - Abstract
Objectives To investigate the relevance of lymphangiogenic gene expression in primary and liver metastasis of colorectal cancer (CRC) and identify determinants of lymphatic invasion. Background Lymphatic development promoting vascular endothelial growth factor C (VEGFC) is associated with poor outcome in primary CRC. For colorectal liver metastasis (CRLM), intrahepatic lymph invasion and lymph node metastasis are poor prognostic factors. Exact biological factors promoting lymphatic involvement remain elusive, just as the association with molecular subtypes of CRC. Methods We designed a lymphangiogenic gene set (VEGFC, Nrp-2, PDPN, LYVE-1, MRC1, CCL-21) and applied it to large datasets of CRC. Gene expression of the lymphangiogenic signature was assessed in resected CRLM specimens by Rt-QPCR. In vitro experiments were performed with colon cancer cell line Colo320 (high Nrp-2 expression) and human dermal microvascular lymphatic endothelial cells (LECs). Results Lymphangiogenic gene expression was associated with poor prognosis in both primary and liver metastasis of CRC. CRLM with high expression of consensus molecular subtype-4 identifier genes also exhibited high lymphangiogenic gene expression. Lymph node recurrence following CRLM resection was associated with high expression of VEGFC and Nrp-2. Blocking Nrp-2 significantly reduced invasion of Colo320 cells through an LEC monolayer. Conclusions Lymphangiogenic gene expression is correlated with worse prognosis and consensus molecular subtype-4 in both primary and liver metastatic CRC. VEGFC and Nrp-2 expression may be predictive of lymph node involvement in recurrence after resection of CRLM. Nrp-2, expressed on both tumor and LECs, may have a mechanistic role in lymphatic invasion and is a potential novel target in CRC. more...
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- 2017
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23. Robotic liver resection of segment 7: A step-by-step description of the technique
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Inne H.M. Borel Rinkes, Carolijn L.M.A. Nota, Iq Quintus Molenaar, and Jeroen Hagendoorn
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Male ,medicine.medical_specialty ,Operative Time ,Forceps ,Video Recording ,Resection ,Robotic Surgical Procedures ,medicine ,Hepatectomy ,Humans ,Robotic surgery ,CLIPS ,Aged ,computer.programming_language ,Past medical history ,business.industry ,Liver Neoplasms ,Pringle manoeuvre ,TachoSil ,Prognosis ,Surgery ,Oncology ,Laparoscopy ,Laparoscopic Port ,Colorectal Neoplasms ,business ,computer - Abstract
Background Robotic surgery is increasingly employed in complex procedures such as liver resection. Minor resections of the posterosuperior segments might benefit in particular from a robotic approach, since the size of the incision dominates the postoperative recovery rather than the extent of the resection [ 1 ]. We aimed to provide a standardized, step-wise guide to robotic liver resection of segment 7. Methods This video illustrates, step-by-step, robotic segment 7 resection. Patients are placed in left lateral position, slight anti-Trendelenburg. Three robotic ports are used and one conventional laparoscopic port is placed for bedside assistance. Next, segment 7 is mobilized. Intraoperative ultrasound is used to delineate the tumor and ensure a safe oncologic margin. The EndoWrist ® One™ Vessel Sealer (Extend) (Intuitive Surgical Inc., Sunnyvale, CA, USA) is used for transection of the hepatic parenchyma, combined with a bipolar Maryland Forceps (Intuitive Surgical, Sunnyvale, California, USA). Hem-o-lok clips (Teleflex Inc., Morrisville, NC, USA) or laparoscopic staplers (Medtronic, Minneapolis, MN, USA) are used to control the hepatic pedicle. A pringle manoeuvre is applied when deemed appropriate. To ensure hemostasis and biliostasis, TachoSil (Takeda Nederland b.v. Takeda, Zurich, Switzerland) is applied to the resection surface. The specimen is extracted through an enlarged trocar incision. Results This video illustrates robotic liver resection of segment 7 in a 72-year-old male with a past medical history of colorectal cancer. New, resectable liver metastases were detected during follow-up. The procedure was completed fully robotically. No postoperative complications occurred and the patient was discharged on postoperative day one. Conclusion This video provides a step-by-step guide to robotic liver resection of segment 7. more...
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- 2020
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24. Choledochal malformations in adults in the Netherlands: Results from a nationwide retrospective cohort study
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Robert J. Porte, Philip R. de Reuver, Geert Kazemier, A.M. Schreuder, Cornelis H. C. Dejong, Thomas M. van Gulik, Annette S. H. Gouw, Jeroen de Jonge, Jan B F Hulscher, Joris I. Erdmann, Ruben H J de Kleine, Anneke Ten Hove, Inne H.M. Borel Rinkes, Surgery, Center for Liver, Digestive and Metabolic Diseases (CLDM), Groningen Institute for Organ Transplantation (GIOT), AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health more...
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Adult ,Male ,choledochal cyst ,medicine.medical_specialty ,Adolescent ,MULTICENTER ,Bile Duct Carcinoma ,Malignancy ,CLASSIFICATION ,DISEASE ,surgery ,Young Adult ,03 medical and health sciences ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,medicine ,Humans ,Cyst ,Choledochal cysts ,Genetics and Rare Liver Diseases ,Aged ,Netherlands ,Retrospective Studies ,Hepatology ,Bile duct ,business.industry ,Incidence (epidemiology) ,DILATATION ,BILE-DUCT CYSTS ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Bile Ducts, Intrahepatic ,medicine.anatomical_structure ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Severe morbidity ,Female ,Original Article ,030211 gastroenterology & hepatology ,bile duct carcinoma ,business ,choledochal malformation - Abstract
Contains fulltext : 229851.pdf (Publisher’s version ) (Open Access) BACKGROUND AND AIMS: Patients with a choledochal malformation, formerly described as cysts, are at increased risk of developing a cholangiocarcinoma and resection is recommended. Given the low incidence of choledochal malformation (CM) in Western countries, the incidence in these countries is unclear. Our aim was to assess the incidence of malignancy in CM patients and to assess postoperative outcome. METHODS: In a nationwide, retrospective study, all adult patients who underwent surgery for CM between 1990 and 2016 were included. Patients were identified through the Dutch Pathology Registry and local patient records and were analysed to determine the incidence of malignancy, as well as postoperative mortality and morbidity. RESULTS: A total of 123 patients with a CM were included in the study (Todani Type I, n = 71; Type II, n = 10; Type III, n = 3; Type IV, n = 27; unknown, n = 12). Median age was 40 years (range 18-70) and 81% were female. The majority of patients (99/123) underwent extrahepatic bile duct resection, with additional liver parenchyma resections in eight patients, only exploration in two, and a local cyst resection in eight patients. Postoperative 30-day mortality was 2% (2/123) and limited to patients who underwent liver resection. Severe morbidity occurred in 24%. In 14 of the 123 patients (11%), a malignancy was found in the resected specimen. One patient developed a periampullary malignancy 7 years later. CONCLUSIONS: In a large Western series of CM patients, 11% were found to have a malignancy. This justifies resection in these patients, despite the risk of morbidity (24%) and mortality (2%). more...
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- 2020
25. Prognostic factors and survival in MEN1 patients with gastrinomas: Results from the DutchMEN study group (DMSG)
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Sjoerd Nell, Peter H. Bisschop, Inne H.M. Borel Rinkes, Bas Havekes, Dirk-Jan van Beek, Anouk N A van der Horst-Schrivers, Wouter W. de Herder, Olaf M. Dekkers, Carolina R. C. Pieterman, Madeleine L. Drent, Annenienke C van de Ven, Gerlof D. Valk, Menno R. Vriens, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Internal medicine, AGEM - Endocrinology, metabolism and nutrition, Amsterdam Neuroscience - Mood, Anxiety, Psychosis, Stress & Sleep, Endocrinology, AMS - Ageing & Morbidty, Interne Geneeskunde, MUMC+: MA Endocrinologie (9), RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, and Internal Medicine more...
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Male ,SURGERY ,030230 surgery ,Neuroendocrine tumors ,GUIDELINES ,Gastroenterology ,Stomach Neoplasms/metabolism ,multiple endocrine neoplasia type 1 ,Cohort Studies ,0302 clinical medicine ,Research Articles ,Netherlands ,ENDOCRINE NEOPLASIA TYPE-1 ,Pancreatic Neoplasms/metabolism ,education.field_of_study ,Liver Neoplasms ,Hazard ratio ,General Medicine ,Middle Aged ,Prognosis ,Zollinger-Ellison syndrome ,Survival Rate ,Neuroendocrine Tumors ,Oncology ,030220 oncology & carcinogenesis ,oncology ,Female ,neuroendocrine tumor ,Research Article ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] ,Cohort study ,medicine.medical_specialty ,Population ,Neuroendocrine Tumors/metabolism ,ZOLLINGER-ELLISON-SYNDROME ,DIAGNOSIS ,Intestinal Neoplasms/metabolism ,03 medical and health sciences ,Liver Neoplasms/metabolism ,Zollinger‐Ellison syndrome ,Stomach Neoplasms ,Proto-Oncogene Proteins ,Internal medicine ,Intestinal Neoplasms ,medicine ,Journal Article ,MANAGEMENT ,Humans ,education ,Survival rate ,Gastrinoma ,business.industry ,Proportional hazards model ,NATURAL-HISTORY ,medicine.disease ,Proto-Oncogene Proteins/metabolism ,Pancreatic Neoplasms ,Gastrinoma/metabolism ,Surgery ,PANCREATIC NEUROENDOCRINE TUMORS ,business ,Follow-Up Studies - Abstract
Contains fulltext : 215696.pdf (Publisher’s version ) (Open Access) BACKGROUND AND OBJECTIVES: Gastrinomas are the most prevalent functioning neuroendocrine tumors (NET) in multiple endocrine neoplasia type 1 (MEN1). Guidelines suggest medical therapy in most patients, but surgery may be considered in a subgroup. Currently, factors to guide management are necessary. This population-based cohort study assessed prognostic factors of survival in patients with MEN1-related gastrinomas. METHODS: Patients with MEN1 having gastrinomas were identified in the Dutch MEN1 database from 1990 to 2014 based on fasting serum gastrin (FSG) levels and/or pathology. Predictors of overall survival were assessed using Cox regression. RESULTS: Sixty-three patients with gastrinoma (16% of the MEN1 population) were identified. Five- and 10-year overall survival rates were 83% and 65%, respectively. Prognostic factors associated with overall survival were initial FSG levels >/=20x upper limit of normal (ULN) (hazard ratio [HR], 6.2 [95% confidence interval, 1.7-23.0]), pancreatic NET >/=2 cm (HR 4.5; [1.5-13.1]), synchronous liver metastases (HR 8.9; [2.1-36.7]), gastroduodenoscopy suspicious for gastric NETs (HR 12.7; [1.4-115.6]), and multiple concurrent NETs (HR 5.9; [1.2-27.7]). CONCLUSION: Life expectancy of patients with MEN1 gastrinoma is reduced. FSG levels and pancreatic NETs >/=2 cm are prognostic factors. FSG levels might guide surveillance intensity, step-up to additional diagnostics, or provide arguments in selecting patients who might benefit from surgery. more...
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- 2019
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26. Robotic right hepatectomy for a central liver tumor- A video of the surgical technique
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Carolijn L.M.A. Nota, I. Quintus Molenaar, Inne H.M. Borel Rinkes, and Jeroen Hagendoorn
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Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Liver tumor ,Supine position ,medicine.medical_treatment ,Video Recording ,Robotic Surgical Procedures ,Minimally invasive surgery ,medicine ,Journal Article ,Hepatectomy ,Humans ,Robotic surgery ,Centrally located liver ,Mri scan ,Intrahepatic Cholangiocarcinoma ,Aged ,Liver resection ,business.industry ,Liver Neoplasms ,Prognosis ,medicine.disease ,Robotic liver surgery ,Surgery ,Robotic systems ,Oncology ,business - Abstract
Background Robotic surgery is gaining momentum in liver resection. Instrumentation of the surgical robot is articulated, movements are scaled and the view of the operative field is 3-dimensional and magnified[ 1 , 2 ]. Thus, these technical enhancements allow for a more precise dissection and curved work axes, as needed in liver resection. Aim of this video was to demonstrate the feasibility of fully robotic right hepatectomy with dissection of the variant right hepatic pedicles for a centrally located liver tumor. Methods This video illustrates robotic right hepatectomy in a 77-year-old male. A liver tumor in segment 5/8 with concurrent biliary dilation was detected on a CT-scan made in the course of his cardiac history. An additional MRI scan suggested the diagnosis of hepatocellular carcinoma or intrahepatic cholangiocarcinoma for which a right hepatectomy was indicated. Results After anesthesia, the patient was placed supine on a split-leg table in anti-Trendelenburg and left lateral tilt position. Four robotic trocars were placed and the da Vinci Xi robotic system was docked. Two laparoscopic ports were placed for tableside assistance. Right hepatectomy was performed including separate dissection of the posterior and anterior pedicles. The robotic Vessel Sealer was employed as main parenchymal transection device. Postoperative hospital stay was unremarkable. The patient was discharged on postoperative day 6. Conclusion This video illustrates the feasibility of a robotic approach to right hepatectomy. The increased surgical dexterity, as provided by the articulating robotic instrumentation, allows for precise dissection of the liver hilum, as needed in resection of centrally located tumors. more...
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- 2019
27. Safety of radiofrequency ablation in patients with locally advanced, unresectable pancreatic cancer: A phase II study
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Marieke S. Walma, Richard van Hillegersberg, Marc G. Besselink, Maarten S. van Leeuwen, Samira Fegrachi, Rutger C G Bruijnen, Ignace H. J. T. de Hingh, Inne H.M. Borel Rinkes, Joost M. Klaase, Erik G. von Asmuth, I. Quintus Molenaar, Jan J. J. de Vries, Hjalmar C. van Santvoort, Anesthesiology, Surgery, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Groningen Institute for Organ Transplantation (GIOT), Value, Affordability and Sustainability (VALUE), Radiology and nuclear medicine, and CCA - Cancer Treatment and quality of life more...
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Male ,Radiofrequency ablation ,Locally advanced pancreatic cancer ,Phases of clinical research ,Anastomotic Leak ,030230 surgery ,law.invention ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Digestive System Surgical Procedures ,Anastomosis, Surgical ,General Medicine ,Middle Aged ,medicine.anatomical_structure ,Jejunum ,Treatment Outcome ,surgical procedures, operative ,Oncology ,Liver ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Female ,therapeutics ,Phase II safety study ,medicine.medical_specialty ,Duodenum ,Gastric Bypass ,03 medical and health sciences ,Pancreatic Fistula ,medicine ,Humans ,Feeding tube ,Aged ,Radiofrequency Ablation ,Gastric emptying ,business.industry ,Carcinoma ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Gastric Emptying ,Pancreatitis ,Intestinal Perforation ,business - Abstract
INTRODUCTION: Radiofrequency ablation (RFA) has been proposed as a new treatment option for locally advanced, unresectable pancreatic cancer (LAPC). In preparation of a randomized controlled trial (RCT), the aim of this phase II study was to assess the safety of RFA for patients with LAPC.MATERIALS AND METHODS: Patients diagnosed with LAPC confirmed during surgical exploration between November 2012 and April 2014 were eligible for inclusion. RFA probes were placed under ultrasound guidance with a safety margin of at least 10 mm from the duodenum and 15 mm from the portomesenteric vessels. During RFA, the duodenum was continuously perfused with cold saline to reduce risk for thermal damage. Primary outcome was defined as the amount of major complications (Clavien-Dindo grade ≥III). RFA-related complications were predefined as: pancreatic fistula, pancreatitis, thermal damage to the portomesenteric vessels and duodenal perforation.RESULTS: In total, 17 patients underwent RFA. Delayed gastric emptying (DGE) requiring endoscopic feeding tube placement occurred in 4 patients (24%) as only major complication. Five patients (29%) had a major complication other than DGE. One (6%) RFA-related major complications occurred. One patient (6%) died due to complications from a biliary leak following hepaticojejunostomy. After evaluation of the first 5 patients, gastrojejunostomy was no longer performed routinely. Since then severe DGE seemed to occur less (3/5 vs. 3/12 grade C DGE).CONCLUSION: RFA is a major, but safe procedure for patients with LAPC if performed with strict predefined safety criteria. A RCT is currently investigating the true effectiveness of RFA in patients with LAPC. more...
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- 2019
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28. Clinical Outcomes After Unilateral Adrenalectomy for Primary Aldosteronism
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Emily L. Postma, Marco Raffaelli, Quan-Yang Duh, Rasa Zarnegar, Gerardo D'Amato, Menno R. Vriens, N. M. Vaarzon Morel, Benjamin J. Peipert, Gerlof D. Valk, Nicole D. Bouvy, F. Thurston Drake, Anton F. Engelsman, Sjoerd Nell, Tanya Castelino, Nancy D. Perrier, David N. Parente, Catherine McManus, Jesse D. Pasternak, Schelto Kruijff, Raymon H. Grogan, Michael N. Mongelli, Els J. M. Nieveen van Dijkum, H. Jaap Bonjer, Inne H.M. Borel Rinkes, Mark Sywak, Minerva A. Romero Arenas, Hasan H. Eker, Elliot J. Mitmaker, Wilko Spiering, Otis M. Vrielink, Valerie Schuermans, Stephanie D. Talutis, David McAneny, James A. Lee, Scott B. Grant, Wessel M.C.M. Vorselaars, Surgery, APH - Quality of Care, APH - Global Health, ACS - Microcirculation, Guided Treatment in Optimal Selected Cancer Patients (GUTS), MUMC+: MA AIOS Neurochirurgie (9), MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, and AGEM - Digestive immunity more...
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Adult ,Male ,medicine.medical_specialty ,Systole ,medicine.medical_treatment ,RESOLUTION SCORE ,Blood Pressure ,030230 surgery ,HYPERTENSION CURE ,Preoperative care ,EVENTS ,03 medical and health sciences ,0302 clinical medicine ,Primary aldosteronism ,Diastole ,Internal medicine ,HYPERALDOSTERONISM ,REGRESSION ,Journal Article ,MANAGEMENT ,Humans ,Medicine ,Adverse effect ,Antihypertensive Agents ,Aged ,CURE ,business.industry ,Adrenalectomy ,Middle Aged ,medicine.disease ,PREVALENCE ,Treatment Outcome ,Blood pressure ,030220 oncology & carcinogenesis ,Hypertension ,Cohort ,ARTERIAL-HYPERTENSION ,Female ,Surgery ,business ,Postoperative Hypertension ,Cohort study - Abstract
IMPORTANCE In addition to biochemical cure, clinical benefits after surgery for primary aldosteronism depend on the magnitude of decrease in blood pressure (BP) and use of antihypertensive medications with a subsequent decreased risk of cardiovascular and/or cerebrovascular morbidity and drug-induced adverse effects.OBJECTIVE To evaluate the change in BP and use of antihypertensive medications within an international cohort of patients who recently underwent surgery for primary aldosteronism.DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted across 16 referral medical centers in Europe, the United States, Canada, and Australia. Patients who underwent unilateral adrenalectomy for primary aldosteronism between January 2010 and December 2016 were included. Data analysis was performed from August 2017 to June 2018. Unilateral disease was confirmed using computed tomography, magnetic resonance imaging, and/or adrenal venous sampling. Patients with missing or incomplete preoperative or follow-up data regarding BP or corresponding number of antihypertensive medications were excluded.MAIN OUTCOMES AND MEASURES Clinical success was defined based on postoperative BP and number of antihypertensive medications. Cure was defined as normotension without antihypertensive medications, and clear improvement as normotension with lower or equal use of antihypertensive medications. In patients with preoperative normotensivity, improvement was defined as postoperative normotension with lower antihypertensive use. All other patients were stratified as no clear success because the benefits of surgery were less obvious, mainly owing to postoperative, persistent hypertension. Clinical outcomes were assessed at follow-up closest to 6 months after surgery.RESULTS On the basis of inclusion and exclusion criteria, a total of 435 patients (84.6%) from a cohort of 514 patients who underwent unilateral adrenalectomy were eligible. Of these patients, 186 (42.3%) were women; mean (SD) age at the time of surgery was 50.7 (11.4) years. Cure was achieved in 118 patients (27.1%), clear improvement in 135 (31.0%), and no clear success in 182 (41.8%). In the subgroup classified as no clear success, 166 patients (91.2%) had postoperative hypertension. However, within this subgroup, the mean (SD) systolic and diastolic BP decreased significantly by 9 (22) mm Hg (P CONCLUSIONS AND RELEVANCE In this study, for most patients, adrenalectomy was associated with a postoperative normotensive state and reduction of antihypertensive medications. Furthermore, a significant proportion of patients with postoperative, persistent hypertension may benefit from adrenalectomy given the observed clinically relevant and significant reduction of BP and antihypertensive medications. more...
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- 2019
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29. Randomized Phase III Study to Assess Efficacy and Safety of Adjuvant CAPOX with or without Bevacizumab in Patients after Resection of Colorectal Liver Metastases
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Joost R. M. van der Sijp, Otilia Dalesio, Erikv van Werkhoven, Sander B. Schouten, Inne H.M. Borel Rinkes, Nikol Snoeren, Andre M. Bergman, Richard van Hillegersberg, Rob A. E. M. Tollenaar, Emile E. Voest, Henk M.W. Verheul, CCA - Cancer Treatment and quality of life, and Medical oncology more...
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0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Bevacizumab ,medicine.medical_treatment ,Gastroenterology ,lcsh:RC254-282 ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Quality of life ,law ,Internal medicine ,medicine ,Clinical endpoint ,Chemotherapy ,business.industry ,CAPOX Regimen ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Oxaliplatin ,Surgery ,Regimen ,030104 developmental biology ,030220 oncology & carcinogenesis ,business ,medicine.drug - Abstract
Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF). Recurrence after resection of colorectal liver metastases (CRLMs), presumably caused by VEGF-mediated outgrowth of micrometastases, might decrease when VEGF is inhibited. This study examines the efficacy and safety of adding bevacizumab to an adjuvant regimen of CAPOX in patients undergoing radical resection for their CRLMs. Patients with resected CRLMs were randomized after surgery to receive CAPOX and bevacizumab (arm A) or CAPOX alone (arm B) as adjuvant treatment. CAPOX was given in both arms for a total of eight cycles. Bevacizumab was administered for 16 cycles. The primary end point was disease-free survival (DFS). Secondary outcomes were overall survival (OS), toxicity, and quality of life (QoL). In total, 79 patients were randomized. At the time of analysis, 23 events were encountered in arm A and 20 in arm B. One-year DFS rate was 79% [95% confidence interval (CI): 68%-93%] and 68% (95% CI: 55%-85%) for arm A and B, respectively ( P =.89). Toxicity was evaluated for 75 patients. No significant differences in toxicity between the two arms were found. QoL scores were higher in arm A, of which emotional functioning and global QoL scores were significant. Adding bevacizumab to a CAPOX regimen in patients undergoing a resection for their CLM is safe and showed higher QoL scores compared with CAPOX alone. Because of premature closure of the study, conclusions about the effect on DFS of additional VEGF inhibition in this setting could not yet be made. more...
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- 2017
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30. Robot-assisted spleen preserving pancreatic surgery in MEN1 patients
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Bert A. Bonsing, Els J. M. Nieveen van Dijkum, Inne H.M. Borel Rinkes, Ahmet Ayav, Geert Kazemier, Bas Groot Koerkamp, Gerlof D. Valk, Laurent Brunaud, Sjoerd Nell, Ruben H J de Kleine, Menno R. Vriens, I. Quintus Molenaar, and Jeroen Hagendoorn more...
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Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,General Medicine ,Perioperative ,030230 surgery ,Neuroendocrine tumors ,medicine.disease ,Pancreaticoduodenectomy ,Primary tumor ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,medicine ,Pancreas ,Multiple endocrine neoplasia ,business - Abstract
Background: Multiple Endocrine Neoplasia type 1 (MEN1) patients often undergo multiple pancreatic operations at a young age. Objective: To describe robot-assisted and laparoscopic spleen-preserving pancreatic surgery in MEN1 patients, and to compare both techniques. Methods: Robot-assisted pancreatectomies of the DutchMEN1 study group and the Universite de Lorraine, Nancy, France were compared to a historical cohort of laparoscopic treated MEN1 patients. Perioperative outcomes were compared. Results: A total of 21 MEN1 patients underwent minimally invasive pancreatic surgery for pancreatic neuroendocrine tumors, seven patients were subjected to robot-assisted surgery, and 14 patients underwent laparoscopic surgery. Demographics and clinical characteristics did not differ between the cohorts and no significant differences in operative outcomes were found. A high number of ISGPS grade B/C pancreatic fistulas were observed in both cohorts (38%), and no conversions were seen in the robot-assisted cohort (respectively 0% vs. 43%, P = 0.06). In one laparoscopic and one robot-assisted case the primary tumor was not resected. Conclusions: Minimally invasive spleen-preserving surgery in MEN1 patients is safe and feasible. Patients who underwent robot-assisted surgery did not require conversion to open surgery. more...
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- 2016
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31. A Validated Prognostic Multigene Expression Assay for Overall Survival in Resected Colorectal Cancer Liver Metastases
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Simon Turcotte, Vinod P. Balachandran, Hiromichi Ito, Jinru Shia, T. Peter Kingham, René Adam, Inne H.M. Borel Rinkes, Nikol Snoeren, Ronald P. DeMatteo, William R. Jarnagin, Agnes Viale, Arshi Arora, Michael I. D’Angelica, Mithat Gonen, Peter J. Allen, and Sander R. van Hooff more...
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Adult ,Male ,0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,Disease-Free Survival ,Article ,03 medical and health sciences ,Multigene expression ,0302 clinical medicine ,Internal medicine ,Biomarkers, Tumor ,Humans ,Medicine ,Prospective Studies ,RNA, Messenger ,Prospective cohort study ,Aged ,Retrospective Studies ,Aged, 80 and over ,Framingham Risk Score ,business.industry ,Liver Neoplasms ,Cancer ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,030104 developmental biology ,Multigene Family ,030220 oncology & carcinogenesis ,Cohort ,Female ,Metastasectomy ,Colorectal Neoplasms ,business - Abstract
Purpose: Risk stratification after surgery for colorectal cancer liver metastases (CRLM) is achieved using clinicopathologic variables, however, is of limited accuracy. We sought to derive and externally validate a multigene expression assay prognostic of overall survival (OS) that is superior to clinicopathologic variables in patients with surgically resected CRLM. Experimental Design: We measured mRNA expression in prospectively collected frozen tumor from 96 patients with surgically resected CRLM at Memorial Sloan Kettering Cancer Center (MSKCC, New York, NY). We retrospectively generated a 20-gene molecular risk score (MRS) and compared its prognostic utility for OS and recurrence-free survival (RFS) with three common clinical risk scores (CRS). We then tested the prognostic ability of the MRS in an external validation cohort (European) of 119 patients with surgically resected CRLM at the University Medical Center Utrecht (Utrecht, the Netherlands) and Paul Brousse Hospital (Villejuif, France). Results: For OS in the MSKCC cohort, MRS was the strongest independent prognosticator (HR, 3.7–4.9; P < 0.001) followed by adjuvant chemotherapy (HR, 0.3; P ≤ 0.001). For OS in the European cohort, MRS was the only independent prognosticator (HR, 3.5; P = 0.007). For RFS, MRS was also independently prognostic in the MSKCC cohort (HR, 2.4–2.6; P ≤ 0.001) and the European cohort (HR, 1.6–2.5; P ≤ 0.05). Conclusions: Compared with CRSs, the MRS is more accurate, broadly applicable, and an independent prognostic biomarker of OS in resected CRLM. This MRS is the first externally validated prognostic multigene expression assay after metastasectomy for CRLM and warrants prospective validation. Clin Cancer Res; 22(10); 2575–82. ©2016 AACR. more...
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- 2016
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32. Same-Day Fine-Needle Aspiration Cytology Diagnosis for Thyroid Nodules Achieves Rapid Anxiety Decrease and High Diagnostic Accuracy
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Jakob W. Kist, Wessel M.C.M. Vorselaars, Helena M. Verkooijen, Inne H.M. Borel Rinkes, Gerlof D. Valk, Maarten W. Barentsz, Menno R. Vriens, Nick T.M. van der Meij, and Lutske Lodewijk
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Adult ,Male ,Thyroid nodules ,medicine.medical_specialty ,Time Factors ,Adolescent ,Referral ,Cytodiagnosis ,Endocrinology, Diabetes and Metabolism ,Biopsy, Fine-Needle ,030209 endocrinology & metabolism ,Diagnostic accuracy ,Anxiety ,medicine.disease_cause ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Fine needle aspiration cytology ,Biopsy ,medicine ,Humans ,Psychological stress ,Thyroid Nodule ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,fungi ,Reproducibility of Results ,food and beverages ,General Medicine ,Biopsy fine needle ,Middle Aged ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,Radiology ,medicine.symptom ,business ,Stress, Psychological - Abstract
The time between the moment of referral for the diagnostic workup for thyroid nodules and the outcome can be worrisome for patients. In general, patients experience high levels of anxiety during the evaluation of a lesion suspicious for cancer. Therefore, the implementation of same-day fine-needle aspiration cytology (FNAC) diagnosis is becoming standard-of-care for many solid tumors. Our aim was to assess the feasibility of same-day FNAC diagnosis for thyroid nodules and to assess patient anxiety during the diagnostic process.For feasibility of same-day FNAC diagnosis, we assessed the proportion of patients receiving a diagnosis at the end of the visit. Accuracy was measured by comparing histology with the FNAC result. Patient anxiety was measured by the State Trait Anxiety Inventory at 6 moments during the diagnostic workup.Of the 131 included patients, 112 (86%) were female, and the mean age was 53 years. All patients, except those with a nondiagnostic FNAC result (n = 26; 20%), had a diagnosis at the end of the day. There were only two discordant results. Anxiety levels at the beginning of the day were high throughout the group, State Trait Anxiety Inventory (STAI) score 43.1 (SD 2.0) and decreased significantly more in patients with a benign FNAC result (STAI score 30.2), compared to patients with a malignant or indeterminate result (STAI score 39.6).Distress of patients with a thyroid nodule undergoing same-day FNAC diagnostics was high. Same-day FNAC diagnosis is feasible and accurate for the evaluation of thyroid nodules. Therefore, same-day FNAC diagnosis seems a safer, more patient-friendly approach to diagnose thyroid nodules. more...
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- 2016
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33. Procedural Surgical RCTs in Daily Practice: Do Surgeons Adopt or Is It Just a Waste of Time?
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Christian E. Oberkofler, Pierre-Alain Clavien, Sebastiano Biondo, Dink A. Legemate, Mario Morino, John V. Reynolds, Hugo Pinto-Marques, Philippe Brosi, Roxane D Staiger, Ricardo Robles Campos, Olivier Farges, Jacob F Hamming, Antonio D Pinna, Inne H.M. Borel Rinkes, Milo A. Puhan, Xavier Rogiers, Kjetil Søreide, and University of Zurich more...
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medicine.medical_specialty ,adoption of recommendations ,citation index ,clinical impact ,impact factor ,randomized controlled trial ,surgery ,Attitude of Health Personnel ,MEDLINE ,610 Medicine & health ,Outcome assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Daily practice ,Adaptation, Psychological ,Outcome Assessment, Health Care ,Health care ,Humans ,Medicine ,Practice Patterns, Physicians' ,Randomized Controlled Trials as Topic ,10217 Clinic for Visceral and Transplantation Surgery ,Evidence-Based Medicine ,business.industry ,Practice patterns ,Evidence-based medicine ,Surgical procedures ,United States ,2746 Surgery ,Surgical Procedures, Operative ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Physical therapy ,030211 gastroenterology & hepatology ,business ,human activities ,Forecasting - Abstract
Objective: To assess the adoption of recommendation from randomized clinical trials (RCTs) and investigate factors favoring or preventing adoption.Background: RCT are considered to be the cornerstone of evidence-based medicine by representing the highest level of evidence. As such, we expect RCT's recommendations to be followed rigorously in daily surgical practice.Methods: We performed a structured search for RCTs published in the medical and surgical literature from 2009 to 2013, allowing a minimum of 5-year follow-up to convincingly test implementation. We focused on comparative technical or procedural RCTs trials addressing the domains of general, colorectal, hepatobiliary, upper gastrointestinal and vascular surgery. In a second step we composed a survey of 29 questions among ESA members as well as collaborators from their institutions to investigate the adoption of surgical RCTs recommendation.Results: The survey based on 36 RCTs (median 5-yr citation index 85 (24-474), from 21 different countries, published in 15 high-ranked journals with a median impact factor of 3.3 (1.23- 7.9) at the time of publication. Overall, less than half of the respondents (47%) appeared to adhere to the recommendations of a specific RCT within their field of expertise, even when included in formal guidelines. Adoption of a new surgical practice was favored by watching videos (46%) as well as assisting live operations (18%), while skepticism regarding the methodology of a surgical RCT (40%) appears to be the major reason to resist adoption.Conclusion: In conclusion, surgical RCTs appear to have moderate impact on daily surgical practice. While RCTs are still accepted to provide the highest level of evidence, alternative methods of evaluating surgical innovations should also be explored. more...
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- 2019
34. Predicting Successful Catheter Drainage in Patients with Pancreatic Fistula after Pancreatoduodenectomy
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Casper H.J. van Eijck, Djamila Boerma, F. Jasmijn Smits, Sebastiaan Festen, Ignace H. J. T. de Hingh, Olivier R. Busch, Ronald M. van Dam, Koert P. de Jong, I. Quintus Molenaar, Inne H.M. Borel Rinkes, Marc G. Besselink, Erwin van der Harst, Hjalmar C. van Santvoort, Surgery, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, AGEM - Endocrinology, metabolism and nutrition, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Heelkunde (9), Guided Treatment in Optimal Selected Cancer Patients (GUTS), and Groningen Institute for Organ Transplantation (GIOT) more...
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Male ,PROGNOSIS ,Endocrinology, Diabetes and Metabolism ,multicenter ,Logistic regression ,Postoperative Complications ,ADJUVANT CHEMOTHERAPY ,0302 clinical medicine ,Endocrinology ,Risk Factors ,RISK ,Age Factors ,Area under the curve ,Middle Aged ,CANCER ,Diabetes and Metabolism ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Drainage ,Female ,030211 gastroenterology & hepatology ,INTERVENTIONS ,medicine.medical_specialty ,amylase ,Catheters ,INTENSIVE-CARE ,Pancreaticoduodenectomy ,Pancreatic Fistula ,03 medical and health sciences ,Sex Factors ,Intensive care ,Internal medicine ,MANAGEMENT ,medicine ,Internal Medicine ,Journal Article ,Humans ,pancreatic leakage ,Aged ,pancreatic carcinoma ,Hepatology ,business.industry ,Odds ratio ,Length of Stay ,medicine.disease ,Confidence interval ,Surgery ,MODEL ,Nomograms ,Logistic Models ,GEMCITABINE ,Respiratory failure ,GRADE C ,business ,complication management - Abstract
OBJECTIVES: The objective of this study was to identify predictors for successful minimally invasive catheter drainage (ie, survival without relaparotomy) for pancreatic fistula after pancreatoduodenectomy.METHODS: Included were consecutive patients undergoing catheter drainage as first intervention for pancreatic fistula after pancreatoduodenectomy (2005-2013) in 9 Dutch centers. Possible prognostic factors for successful catheter drainage (ie, survival without relaparotomy) were selected using Akaike information criterion.RESULTS: Included were 227 patients after 2196 pancreatoduodenectomies. Primary catheter drainage was successful in 175 (77%) of 227 patients. Multivariable logistic regression revealed the following negative prognostic factors for success: male sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.00; P = 0.049), higher age (for every 5 years over 50; OR, 0.69; 95% CI, 0.57-0.84; P < 0.001), and respiratory failure at time of catheter drainage (OR, 0.10; 95% CI, 0.03-0.33; P < 0.001). A prognostic model incorporating these factors yielded an area under the curve of 0.76 and demonstrated a success range of 98% to 14%.CONCLUSIONS: Male sex, higher age, and respiratory failure are associated with a low success rate of catheter drainage in patients with pancreatic fistula after pancreatoduodenectomy. These patients might benefit from an intensified postoperative monitoring for early detection and management of pancreatic fistula to prevent respiratory failure. more...
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- 2019
35. Robotic Developments in Cancer Surgery
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Yuman Fong, Carolijn L.M.A. Nota, Francina Jasmijn Smits, I. Q. Molenaar, Jeroen Hagendoorn, Inne H.M. Borel Rinkes, and Yanghee Woo
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medicine.medical_specialty ,Minimally Invasive Surgical Procedures/methods ,Review ,Oncologic surgery ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Minimally invasive surgery ,Neoplasms ,medicine ,Journal Article ,Minimally Invasive Surgical Procedures ,Humans ,Robotic surgery ,Laparoscopy ,medicine.diagnostic_test ,business.industry ,General surgery ,Robotic Surgical Procedures/methods ,technology, industry, and agriculture ,Neoplasms/surgery ,Robotics ,Neoplasms surgery ,body regions ,Robotic systems ,surgical procedures, operative ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Abdominal cancers ,business ,human activities ,Cancer surgery - Abstract
Indications for robotic surgery have been rapidly expanding since the first introduction of the robotic surgical system in the US market in 2000. As the robotic systems have become more sophisticated over the past decades, there has been an expansion in indications. Many new tools have been added with the aim of optimizing outcomes after oncologic surgery. Complex abdominal cancers are increasingly operated on using robot-assisted laparoscopy and with acceptable outcomes. In this article, the authors discuss robotic developments, from the past and the future, with an emphasis on cancer surgery. more...
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- 2019
36. Reply to: Assessing outcomes after adrenalectomy for unliateral primary aldosteronism
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Wilko Spiering, Wessel M.C.M. Vorselaars, Gerlof D. Valk, Dirk-Jan van Beek, Menno R. Vriens, Inne H.M. Borel Rinkes, and Emily L. Postma
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medicine.medical_specialty ,Letter ,Consensus ,Aldosterone ,business.industry ,Adrenalectomy ,medicine.medical_treatment ,MEDLINE ,medicine.disease ,Cohort Studies ,chemistry.chemical_compound ,Primary aldosteronism ,chemistry ,Internal medicine ,Hyperaldosteronism ,medicine ,Humans ,Surgery ,business ,Cohort study - Published
- 2019
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37. Systematic review on the use of matrix bound sealants in pancreatic resection
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Marc G. Besselink, F. Jasmijn Smits, Hjalmar C. van Santvoort, Inne H.M. Borel Rinkes, and I. Quintus Molenaar
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medicine.medical_specialty ,medicine.medical_treatment ,Matrix bound ,Gastroenterology ,Intraoperative Period ,Pancreatic Fistula ,Pancreatectomy ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Post operative ,Pancreatic resection ,Review Articles ,Hepatology ,business.industry ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Pancreatic fistula ,Tissue Adhesives ,Distal pancreatectomy ,Complication ,business ,Systematic search - Abstract
Background Pancreatic fistula is a potentially life threatening complication after a pancreatic resection. The aim of this systematic review was to evaluate the role of matrix bound sealants after a pancreatic resection in terms of preventing or ameliorating the course of a post operative pancreatic fistula. Methods A systematic search was performed in the literature from May 2005 to April 2015. Included were clinical studies using matrix bound sealants after a pancreatic resection, reporting a post operative pancreatic fistula (POPF) according to the International Study Group on Pancreatic Fistula classification, in which grade B and C fistulae were considered clinically relevant. Results Two were studies on patients undergoing pancreatoduodenectomy (sealants n = 67, controls n = 27) and four studies on a distal pancreatectomy (sealants n = 258, controls n = 178). After a pancreatoduodenectomy, 13% of patients treated with sealants versus 11% of patients without sealants developed a POPF ( P = 0.76), of which 4% versus 4% were clinically relevant ( P = 0.87). After a distal pancreatectomy, 42% of patients treated with sealants versus 52% of patients without sealants developed a POPF ( P = 0.03). Of these, 9% versus 12% were clinically relevant ( P = 0.19). Conclusions The present data do not support the routine use of matrix bound sealants after a pancreatic resection, as there was no effect on clinically relevant POPF. Larger, well designed studies are needed to determine the efficacy of sealants in preventing POPF after a pancreatoduodenectomy. more...
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- 2015
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38. Multipolar radiofrequency ablation for colorectal liver metastases close to major hepatic vessels
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Charlotte S. van Kessel, M.W. Nijkamp, Nikol Snoeren, Tim Berendsen, Klaas M. Govaert, Richard van Hillegersberg, and Inne H.M. Borel Rinkes
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Colorectal cancer ,Radiofrequency ablation ,Hepatic Veins ,Research Support ,Resection ,law.invention ,Liver metastases ,Hepatic Artery ,law ,Recurrence free survival ,Journal Article ,medicine ,Humans ,Risk factor ,Non-U.S. Gov't ,Aged ,Retrospective Studies ,Aged, 80 and over ,Portal Vein ,business.industry ,Research Support, Non-U.S. Gov't ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Colon cancer ,Liver ,Tumour size ,Catheter Ablation ,Female ,Surgery ,Vascular thrombosis ,Colorectal Neoplasms ,business - Abstract
Background: Resection of colorectal liver metastases (CRLM) is often hindered by their location close to the major hepatic vessels. So far, radiofrequency ablation for perivascular tumours was thought to be ineffective and unsafe due to either the heat sink effect or vascular thrombosis. The aim of this study was to examine whether RFA using multipolar probes could be a safe and effective option for CRLM adjacent to major hepatic vessels. Methods: Patients were treated with multipolar RFA during an open procedure using 3 simultaneously placed electrodes. In 52 consecutive patients with CRLM, 144 tumours were ablated with RFA. In 16 out of 52 (31%) patients, metastases were abutting major hepatic vessels. We examined whether perivascular location was a risk factor for local tumour progression. The relation between perivascular location and time to local tumour progression and recurrence free survival was assessed using cox-regression analysis. Results: All patients were followed for at least 3 years after RFA unless they deceased before this time. Local tumour progression following RFA occurred in 17 out of 144 tumours (12%), of which 4 out of 21 were perivascular tumours. Tumour size was the only risk factor for local tumour progression in this study. Proximity to large vessels was neither a risk factor for local local tumour progression, nor for time to local tumour progression or recurrence free survival. Discussion: This study indicates that patients with CRLM abutting any of the large hepatic vessels can be safe and effectively treated with RFA when using a multipolar system. more...
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- 2015
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39. Surgery-induced tumor growth in (metastatic) colorectal cancer
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Klaas M. Govaert, Onno Kranenburg, Inne H.M. Borel Rinkes, and Jennifer M.J. Jongen
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medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Inflammation ,Disease ,03 medical and health sciences ,Clinical ,0302 clinical medicine ,Circulating tumor cell ,medicine ,Hepatectomy ,Humans ,Clinical significance ,Tumor growth ,business.industry ,Liver Neoplasms ,Perioperative ,Hypoxia (medical) ,medicine.disease ,Prognosis ,Preclinical ,Surgery ,liver metastasis ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Colorectal Neoplasms ,Adjuvant - Abstract
Metastatic colorectal cancer (mCRC) is a devastating disease causing 700.000 deaths annually worldwide. Metastases most frequently develop in the liver. Partial hepatectomy has dramatically improved clinical outcome and is the only curative treatment option for eligible patients with mCRC. Pre-clinical studies have shown that surgical procedures can have tumor-promoting local 'side-effects’ such as hypoxia and inflammation, thereby altering the behaviour of residual tumor cells. In addition, systemically released factors following (colon or liver) surgery can act as a wakeup-call for dormant tumor cells in distant organs and/or help establish a pre-metastatic niche. Tumor handling during resection may also increase the number of circulating tumor cells. Despite the overwhelming amount of pre-clinical data demonstrating the pro-tumorigenic side effects of surgery, clinical evidence is scarce. Indications for hepatic surgery are rapidly increasing due to a rise in the incidence of mCRC and a trend towards more aggressive surgical treatment. Therefore, it is increasingly important to understand the principles of surgery-induced tumor growth, in order to devise perioperative or adjuvant strategies to further enhance long-term tumor control. In the current study we review the evidence for surgery-stimulated tumor growth and suggest strategies to assess the clinical relevance of such findings. more...
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- 2017
40. Use of imaging during symptomatic follow-up after resection of pancreatic ductal adenocarcinoma
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I. Quintus Molenaar, Hjalmar C. van Santvoort, Jeroen Hagendoorn, Vincent P. Groot, Inne H.M. Borel Rinkes, and Lois A. Daamen
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Oncology ,Diagnostic Imaging ,Male ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,Pancreatic neoplasms ,Survival ,medicine.medical_treatment ,Follow-up studies ,Disease ,Resection ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Recurrence ,Internal medicine ,Post-hoc analysis ,medicine ,Medical imaging ,Humans ,Prospective cohort study ,Aged ,Netherlands ,Proportional hazards model ,business.industry ,Middle Aged ,Pancreatic Neoplasms ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Carcinoma, Pancreatic Ductal - Abstract
Background Controversy exists whether follow-up after resection of pancreatic ductal adenocarcinoma (PDAC) should include standardized imaging for the detection of disease recurrence. The purpose of this study was to evaluate how often patients undergo imaging in a setting where routine imaging is not performed. Secondly, the pattern, timing, and treatment of recurrent PDAC were assessed. Materials and methods This was a post hoc analysis of a prospective database of all consecutive patients undergoing pancreatic resection of PDAC between January 2011 and January 2015. Data on imaging procedures during follow-up, recurrence location, and treatment for recurrence were extracted and analyzed. Associations between clinical characteristics and post-recurrence survival were assessed with the log-rank test and Cox univariable and multivariable proportional hazards models. Results A total of 85 patients were included. Seventy-four patients (87%) underwent imaging procedures during follow-up at least once, with a mean amount of 3.1 ± 1.9 imaging procedures during the entire follow-up period. Sixty-eight patients (80%) were diagnosed with recurrence, 58 (85%) of whom after the manifestation of clinical symptoms. Additional tumor-specific treatment was administered in 17 of 68 patients (25%) with recurrence. Patients with isolated local recurrence, treatment after recurrence, and a recurrence-free survival >10 mo had longer post-recurrence survival. Conclusions Even though a symptomatic follow-up strategy does not include routine imaging, the majority of patients with resected PDAC underwent additional imaging procedures during their follow-up period. Further prospective studies are needed to determine the actual clinical value, psychosocial implications, and cost-effectiveness of different forms of follow-up after resection of PDAC. more...
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- 2017
41. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT
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Inne H.M. Borel Rinkes, Steffi J.E. Rombouts, Hjalmar C. van Santvoort, Vincent P. Groot, Marc G. Besselink, Christopher L. Wolfgang, Joseph M. Herman, Marco van Vulpen, Jeroen Hagendoorn, and I. Quintus Molenaar more...
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Reoperation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,MEDLINE ,Disease ,Review ,030230 surgery ,Cochrane Library ,Radiosurgery ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Risk Factors ,Pancreatic cancer ,Internal medicine ,medicine ,Journal Article ,Humans ,Hepatology ,business.industry ,Gastroenterology ,Chemoradiotherapy ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Treatment Outcome ,030220 oncology & carcinogenesis ,Neoplasm Recurrence, Local ,business ,Tomography, X-Ray Computed - Abstract
Background The majority of patients who have undergone a pancreatic resection for pancreatic cancer develop disease recurrence within two years. In around 30% of these patients, isolated local recurrence (ILR) is found. The aim of this study was to systematically review treatment options for this subgroup of patients. Methods A systematic search was performed in PubMed, Embase and the Cochrane Library. Studies reporting on the treatment of ILR after initial curative-intent resection of primary pancreatic cancer were included. Primary endpoints were morbidity, mortality and survival after ILR treatment. Results After screening 1152 studies, 18 studies reporting on 313 patients undergoing treatment for ILR were included. Treatment options for ILR included surgical re-resection (8 studies, 100 patients), chemoradiotherapy (7 studies, 153 patients) and stereotactic body radiation therapy (SBRT) (4 studies, 60 patients). Morbidity and mortality were reported for re-resection (29% and 1%, respectively), chemoradiotherapy (54% and 0%) and SBRT (3% and 1%). Most patients had a prolonged disease-free interval before recurrence. Median survival after treatment of ILR of up to 32, 19 and 16 months was reported for re-resection, chemoradiotherapy and SBRT, respectively. Conclusion In selected patients, treatment of ILR following pancreatic resection for pancreatic cancer seems safe, feasible and associated with relatively good survival. more...
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- 2017
42. Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience
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Laleh G. Melstrom, Flavio G. Rocha, David J. Bentrem, Shimul A. Shah, Mustafa Raoof, Gagandeep Singh, Sharon M. Weber, Sean Ronnekleiv-Kelly, Jeroen Hagendoorn, Shishir K. Maithel, Alexander V. Fisher, Gi Hong Choi, Daniel E. Abbott, Adnan Alseidi, Emily R. Winslow, Robert J. Lewandowski, George A. Poultsides, Aarti Sekhar, Karen Latorre, Seetharam Chadalavada, Vikrom K. Dhar, Eleftherios Makris, Inne H.M. Borel Rinkes, Darren D. Kies, Yuman Fong, Oliver S. Eng, Riad Salem, and Aileen C. Johnson more...
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Adult ,Male ,medicine.medical_specialty ,Yttrium 90 therapy ,Colorectal cancer ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Yttrium Radioisotopes ,Single institution ,Aged ,Retrospective Studies ,Hepatology ,business.industry ,Liver Neoplasms ,Gastroenterology ,Retrospective cohort study ,Perioperative ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Surgery ,030220 oncology & carcinogenesis ,Operative time ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Background Single institution reports demonstrate variable safety profiles when liver-directed therapy with Yttrium-90 (Y-90) is followed by hepatectomy. We hypothesized that in well-selected patients, hepatectomy after Y90 is feasible and safe. Methods Nine institutions contributed data for patients undergoing Y90 followed by hepatectomy (2008–2017). Clinicopathologic and perioperative data were analyzed, with 90-day morbidity and mortality as primary endpoints. Results Forty-seven patients were included. Median age was 59 (20–75) and 62% were male. Malignancies treated included hepatocellular cancer (n = 14; 30%), colorectal cancer (n = 11; 23%), cholangiocarcinoma (n = 8; 17%), neuroendocrine (n = 8; 17%) and other tumors (n = 6). The distribution of Y-90 treatment was: right (n = 30; 64%), bilobar (n = 14; 30%), and left (n = 3; 6%). Median future liver remnant (FLR) following Y90 was 44% (30–78). Resections were primarily right (n = 16; 34%) and extended right (n = 14; 30%) hepatectomies. The median time to resection from Y90 was 196 days (13–947). The 90-day complication rate was 43% and mortality was 2%. Risk factors for Clavien-Dindo Grade>3 complications included: number of Y-90-treated lobes (OR 4.5; 95% CI1.14–17.7; p = 0.03), extent of surgery (p = 0.04) and operative time (p = 0.009). Conclusions These data demonstrate that hepatectomy following Y-90 is safe in well-selected populations. This multi-disciplinary treatment paradigm should be more widely studied, and potentially adopted, for patients with inadequate FLR. more...
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- 2019
43. Correction to: Validation of the Aldosteronoma Resolution Score Within Current Clinical Practice
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Wilko Spiering, Emily L. Postma, Gerlof D. Valk, Menno R. Vriens, Inne H.M. Borel Rinkes, Dirk-Jan van Beek, and Wessel M.C.M. Vorselaars
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Clinical Practice ,business.industry ,Medicine ,Surgery ,Artificial intelligence ,Resolution (logic) ,computer.software_genre ,business ,computer ,Natural language processing - Abstract
In the original article, two of the International CONNsortium Study Group collaborator’s names are spelled wrong: Anton F. Engelsman and Els J.M. Nieveen van Dijkum. The spellings are correct as reflected here. more...
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- 2019
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44. Robot-assisted Minimally Invasive Thoracolaparoscopic Esophagectomy Versus Open Transthoracic Esophagectomy for Resectable Esophageal Cancer : A Randomized Controlled Trial
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Sylvia van der Horst, Jelle P. Ruurda, Pieter C. van der Sluis, Lodewijk A.A. Brosens, Inne H.M. Borel Rinkes, Hans C. A. Joore, Anne M. May, Nadia Haj Mohammad, Stella Mook, Christiaan C. Kroese, Frank P. Vleggaar, Carlo Schippers, and Richard van Hillegersberg more...
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Male ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Transthoracic esophagectomy ,law.invention ,03 medical and health sciences ,esophageal carcinoma ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,Robotic Surgical Procedures ,law ,medicine ,Thoracoscopy ,Humans ,robot assisted ,Prospective Studies ,esophageal cancer ,Laparoscopy ,Prospective cohort study ,Minimally invasive esophagectomy ,Aged ,Preoperative chemoradiotherapy ,medicine.diagnostic_test ,business.industry ,Esophageal cancer ,Middle Aged ,medicine.disease ,robot-assisted minimally invasive thoracolaparoscopic esophagectomy ,Surgery ,Esophagectomy ,030220 oncology & carcinogenesis ,minimally invasive ,030211 gastroenterology & hepatology ,Female ,business - Abstract
BACKGROUND: The standard curative treatment for patients with esophageal cancer is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE). Robot-assisted minimally invasive thoracolaparoscopic esophagectomy (RAMIE) may reduce complications. METHODS: A single-center randomized controlled trial was conducted, assigning 112 patients with resectable intrathoracic esophageal cancer to either RAMIE or OTE. The primary endpoint was the occurrence of overall surgery-related postoperative complications (modified Clavien-Dindo classification grade 2-5). RESULTS: Overall surgery-related postoperative complications occurred less frequently after RAMIE (59%) compared to OTE (80%) [risk ratio with RAMIE (RR) 0.74; 95% confidence interval (CI), 0.57-0.96; P = 0.02]. RAMIE resulted in less median blood loss (400 vs 568 mL, P more...
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- 2019
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45. Robot-assisted Laparoscopic Fenestration of Giant Hepatic Cysts
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Carolijn L.M.A. Nota, Jeroen Hagendoorn, I. Quintus Molenaar, and Inne H.M. Borel Rinkes
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Severity of Illness Index ,Robotic Surgical Procedures ,Laparotomy ,medicine ,Humans ,Cyst ,Laparoscopy ,medicine.diagnostic_test ,Cysts ,business.industry ,Liver Diseases ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Robotic systems ,Female ,Hepatic Cyst ,Limited mobility ,business ,Fenestration ,Follow-Up Studies - Abstract
Traditionally, nonparasitic hepatic cysts are marsupialized using laparotomy. In the last 2 decades, laparoscopic fenestration has become the preferred treatment for hepatic cysts. However, this technique is limited by 2-dimensional view and the limited mobility of straight laparoscopic instruments. These limitations may be overcome by the use of a robotic system. We describe laparoscopic fenestration of giant hepatic cysts using the da Vinci Si robotic system with the use of the Endowrist One Vessel Sealer.Our first patient is a 32-year-old female with a solitary hepatic cyst. The second patient is a 51-year-old female with polycystic liver disease.We performed robot-assisted laparoscopic cyst fenestration with good clinical outcome. No intraoperative complications occurred and patients recovered rapidly.These data show that the da Vinci Si robotic system is eminently suited for the laparoscopic fenestration of large hepatic cysts and that this procedure is associated with rapid recovery. more...
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- 2015
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46. Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer: a systematic review and meta-analysis
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Hjalmar C. van Santvoort, Dorine S.J. Tseng, Nicolaas P.A. Zuithoff, Maarten S. van Leeuwen, Marc G. Besselink, Samira Fegrachi, I. Quintus Molenaar, and Inne H.M. Borel Rinkes
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Ampulla of Vater ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Cancer ,Diagnostic accuracy ,Computed tomography ,medicine.disease ,Pancreaticoduodenectomy ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Oncology ,Predictive Value of Tests ,Lymphatic Metastasis ,Meta-analysis ,Pancreatic cancer ,medicine ,Humans ,Surgery ,Lymph ,Radiology ,Tomography, X-Ray Computed ,business ,Lymph node ,Cohort study - Abstract
Objectives Computed tomography (CT) is the most widely used method to assess resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is the presence of extra-regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Methods We systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra-regional lymph nodes in patients undergoing pancreatoduodenectomy were included. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data. Results After screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80–100% and 67–90% respectively. However, PPV and sensitivity ranged from 0 to 100% and 0–38%. Pooled sensitivity, specificity, PPV and NPV were 25%, 86%, 28% and 84% respectively. Conclusions CT has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Therefore, suspicion of extra-regional lymph node metastases on CT alone should not be considered a contra-indication for exploration. more...
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- 2014
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47. A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery
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I. Q. Molenaar, Nicola Frenkel, Jeroen Hagendoorn, Inne H.M. Borel Rinkes, and Miangela M. Lacle
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medicine.medical_specialty ,Gastrointestinal bleeding ,Adenoma ,lcsh:Surgery ,Malignancy ,Asymptomatic ,digestive system ,Whipple Procedure ,03 medical and health sciences ,0302 clinical medicine ,Melena ,Case report ,medicine ,Journal Article ,Hamartoma ,Pharmacology (medical) ,business.industry ,lcsh:RD1-811 ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Duodenum ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Brunner’s gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner’s glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner’s glands without signs of malignancy. more...
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- 2017
48. Management of Severe Pancreatic Fistula After Pancreatoduodenectomy
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Olivier R. Busch, Ronald M. van Dam, Sebastiaan Festen, David P J van Dijk, Marilot C. T. Batenburg, Johanna A. M. G. Tol, Robbert A. E. Slooff, Erwin van der Harst, Koert P. de Jong, Marc G. Besselink, Ignace H. J. T. de Hingh, I. Quintus Molenaar, F. Jasmijn Smits, Inne H.M. Borel Rinkes, Peter Paul L. O. Coene, Hjalmar C. van Santvoort, Casper H.J. van Eijck, Djamila Boerma, MUMC+: MA Heelkunde (9), Surgery, RS: NUTRIM - R2 - Liver and digestive health, RS: NUTRIM - R3 - Respiratory & Age-related Health, Promovendi NTM, RS: NUTRIM - R2 - Gut-liver homeostasis, Groningen Institute for Organ Transplantation (GIOT), Guided Treatment in Optimal Selected Cancer Patients (GUTS), AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, and APH - Methodology more...
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medicine.medical_specialty ,SURGERY ,medicine.medical_treatment ,INTERNATIONAL STUDY-GROUP ,macromolecular substances ,030230 surgery ,SURGICAL COMPLICATIONS ,GUIDELINES ,Pancreaticoduodenectomy ,CONFIDENCE-INTERVALS ,DEFINITIONS ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Pancreatectomy ,Postoperative Complications ,COMPLETION PANCREATECTOMY ,Medicine ,Humans ,Pancreas ,Original Investigation ,RISK ,business.industry ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Surgery ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Relative risk ,Propensity score matching ,Cohort ,business ,GRADE C ,Cohort study - Abstract
IMPORTANCE Postoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking.OBJECTIVE To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula after pancreatoduodenectomy.DESIGN, SETTING, AND PARTICIPANTS A multicenter, retrospective, propensity-matched cohort study was conducted in 9 centers of the Dutch Pancreatic Cancer Group from January 1, 2005, to September 30, 2013. From a cohort of 2196 consecutive patients who underwent pancreatoduodenectomy, 309 patients with severe pancreatic fistula were included. Propensity score matching (based on sex, age, comorbidity, disease severity, and previous reinterventions) was used to minimize selection bias. Data analysis was performed from January to July 2016.EXPOSURES First intervention for pancreatic fistula: catheter drainage or relaparotomy.MAIN OUTCOMES AND MEASURES Primary end point was in-hospital mortality; secondary end points included new-onset organ failure.RESULTS Of the 309 patients included in the analysis, 209 (67.6%) were men, and mean (SD) age was 64.6 (10.1) years. Overall in-hospital mortality was 17.8%(55 patients): 227 patients (73.5%) underwent primary catheter drainage and 82 patients (26.5%) underwent primary relaparotomy. Primary catheter drainage was successful (ie, survival without relaparotomy) in 175 patients (77.1%). With propensity score matching, 64 patients undergoing primary relaparotomy were matched to 64 patients undergoing primary catheter drainage. Mortality was lower after catheter drainage (14.1% vs 35.9%; P = .007; risk ratio, 0.39; 95% CI, 0.20-0.76). The rate of new-onset single-organ failure (4.7% vs 20.3%; P = .007; risk ratio, 0.15; 95% CI, 0.03-0.60) and new-onset multiple-organ failure (15.6% vs 39.1%; P = .008; risk ratio, 0.40; 95% CI, 0.20-0.77) were also lower after primary catheter drainage.CONCLUSIONS AND RELEVANCE In this propensity-matched cohort, catheter drainage as first intervention for severe pancreatic fistula after pancreatoduodenectomy was associated with a better clinical outcome, including lower mortality, compared with primary relaparotomy. more...
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- 2017
49. Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm
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Wen T. Shen, Wouter P. Kluijfhout, Rasa Zarnegar, Nicole D. Bouvy, Wayne S. Lee, Anna Aronova, Ahmad Aniss, Raymon H. Grogan, Johannes H. W. de Wilt, Els J. M. Nieveen van Dijkum, Inne H.M. Borel Rinkes, Benjamin C. James, Cassandre E. Benay, Menno R. Vriens, Jakob W. Kist, Gavin Ho, Abbey Schepers, Jos A. van der Hage, Romana T. Netea-Maier, Guillaume Hoch, Schelto Kruijff, Inge Stegeman, John T. M. Plukker, Laurent Brunaud, Michael Jones, Elliot J. Mitmaker, Daniel T. Ruan, Gerlof D. Valk, Lutske Lodewijk, Jacobus W. A. Burger, Mark Sywak, H. Jaap Bonjer, Chiara Pandolfi, Marlon A. Guerrero, University Medical Center [Utrecht], University Medical Center Groningen [Groningen] (UMCG), Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), VU University Medical Center [Amsterdam], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Leiden University Medical Center (LUMC), Radboud University Medical Center [Nijmegen], Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Medical Center [San Francisco] (UCSF Medical Center), University of California [San Francisco] (UCSF), University of California-University of California, Weill Medical College of Cornell University [New York], McGill University Health Center [Montreal] (MUHC), The University of Sydney, Rush University Medical Center [Chicago], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Hépato-gastro-entérologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Brigham and Women's Hospital [Boston], The University of Arizona Medical Center, University of Arizona, Surgery, Radiology and nuclear medicine, CCA - Disease profiling, CCA - Innovative therapy, ICaR - Ischemia and repair, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Epidemiology and Data Science, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Other Research, RS: NUTRIM - R1 - Metabolic Syndrome, and MUMC+: MA Heelkunde (9) more...
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Male ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,LOBECTOMY ,Neoplasms, Multiple Primary ,Papillary microcarcinoma ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,QUALITY-OF-LIFE ,Stage (cooking) ,Thyroid cancer ,SURVIVORS ,Surgical strategy ,Incidence ,Contralateral carcinoma ,COMPLETION THYROIDECTOMY ,Middle Aged ,PAPILLARY ,Primary tumor ,3. Good health ,Tumor Burden ,Multicenter Study ,030220 oncology & carcinogenesis ,Differentiated thyroid carcinoma ,Thyroidectomy ,Original Article ,Female ,Adult ,medicine.medical_specialty ,Urology ,030209 endocrinology & metabolism ,Rare cancers Radboud Institute for Molecular Life Sciences [Radboudumc 9] ,Malignancy ,Thyroid carcinoma ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,medicine ,Carcinoma ,Journal Article ,Humans ,Neoplasm Invasiveness ,Thyroid Neoplasms ,Aged ,Retrospective Studies ,Completion thyroidectomy ,MALIGNANCY ,business.industry ,PROFILES ,medicine.disease ,Surgery ,Cross-Sectional Studies ,MICROCARCINOMA ,business ,LOW-RISK - Abstract
Contains fulltext : 172109.pdf (Publisher’s version ) (Open Access) PURPOSE: Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm. METHODS: A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma. RESULTS: A total of 1313 patients were included, of whom 426 (32 %) had a contralateral carcinoma. The contralateral carcinomas consisted of 288 (67 %) papillary thyroid carcinomas (PTC), 124 (30 %) follicular variant of a papillary thyroid carcinoma (FvPTC), 5 (1 %) follicular thyroid carcinomas (FTC), and 3 (1 %) Hurthle cell carcinomas (HTC). Ipsilateral multifocality was strongly associated with the presence of contralateral carcinomas (OR 2.62). Of all contralateral carcinomas, 82 % were more...
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- 2016
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50. Robotic liver resection including the posterosuperior segments: initial experience
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Richard van Hillegersberg, Inne H.M. Borel Rinkes, Jeroen Hagendoorn, Carolijn L.M.A. Nota, and I. Quintus Molenaar
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Adult ,Male ,medicine.medical_specialty ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,Robotic Surgical Procedures ,Minimally invasive surgery ,Outcome Assessment, Health Care ,medicine ,Journal Article ,Hepatectomy ,Humans ,Robotic surgery ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,Aged ,medicine.diagnostic_test ,Liver resection ,business.industry ,Length of Stay ,Middle Aged ,Clinical Trial ,Surgery ,Dissection ,Robotic systems ,030220 oncology & carcinogenesis ,Female ,business ,Complication - Abstract
Background Robot-assisted laparoscopy has been introduced to overcome the limitations of conventional laparoscopy. This technique has potential advantages over laparoscopy, such as increased dexterity, three-dimensional view, and a magnified view of the operative field. Therefore, improved dexterity may make a robotic system particularly suited for liver resections, which require nonlinear manipulation, such as curved parenchymal transection, hilar dissection, and resection of posterosuperior segments. Methods Between August 2014 and March 2016, 16 patients underwent robot-assisted laparoscopic liver resection at University Medical Center Utrecht. Results Fifteen robot-assisted laparoscopic liver resections were performed in a minimally invasive manner. One procedure was converted. In eight patients, we performed a resection of a posterosuperior segment (segment 7 or 8). Median operating time was 146 (60-265) min, and median blood loss was 150 (5-600) mL. Four patients had a Clavien–Dindo grade III complication. Median length of stay was 4 (1-8) days. There was no mortality. Conclusions This prospective study reporting on our initial experience with robot-assisted laparoscopic liver resection demonstrates that this technique is easily adopted, safe, and feasible for minor hepatectomies in selected patients. Moreover, it shows that the robotic platform also enables fully laparoscopic resections of the posterior segments. more...
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- 2016
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