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3. Hybrid FDG-PET/MRI for Diagnosis and Clinical Management of Patients with Suspected Perihilar Cholangiocarcinoma:A Feasibility Pilot Study

Author

de Jong, D. M., Chehin, K., Meijering, T. L. N., Segbers, M., van Driel, L. M. J. W., Bruno, M. J., Koerkamp, B. Groot, Ijzermans, J. N. M., Verburg, F. A., de la Sabloniere, Q. G. de Lussanet, Dwarkasing, R. S., de Jong, D. M., Chehin, K., Meijering, T. L. N., Segbers, M., van Driel, L. M. J. W., Bruno, M. J., Koerkamp, B. Groot, Ijzermans, J. N. M., Verburg, F. A., de la Sabloniere, Q. G. de Lussanet, and Dwarkasing, R. S.

Abstract

PurposeRecently introduced hybrid 2-[18 F]-fluoro-2-deoxy-D-glucose (18 F-FDG) Positron Emission Tomography (PET) combined with Magnetic Resonance Imaging (MRI) may aid in proper diagnosis and staging of perihilar cholangiocarcinoma (pCCA). The aim of this study is to assess the effect of 18 F-FDG PET/MRI on diagnosis and clinical decision making in the pre-operative work up of pCCA.MethodsIn this single-centre pilot study patients with presumed resectable pCCA underwent state-of-the-art 18 F-FDG hybrid PET/MRI using digital silicone photomultiplier detectors integrated within a 3-Tesla bore. Data were collected on several baseline and imaging characteristics. The primary outcome measure was the added diagnostic information and the effect on clinical decision making. Secondary aim was to correlate quantitative PET signal intensity to patient- and tumour characteristics. High and low SUVmax subgroups related to the mean value were made. Significance of lesion- and patient characteristics with the high and low SUVmax subgroups, as well as TLR and TBR, was evaluated with Fisher's exact test or Mann-Whitney-U test.ResultsIn total 14 patients were included (mean age 62.4 years, 64% male). Final diagnosis was pCCA in 10 patients (71.4%), follicular lymphoma in one patient (7.1%) and benign disease in the remaining three patients. FDG-PET/MRI added valuable diagnostic information in six (43%) patients and affected clinical decision making in two of these patients (14%) by increasing confidence for malignancy which lead to the decision for surgery on short term. High SUVmax values were seen in half of cases with pCCA and half of cases with non-cancerous lesions. In addition, high SUVmax values were directly associated with primary sclerosing cholangitis when present (p = 0.03).ConclusionSimultaneous 18 F-FDG-PET/MRI added diagnostic information in six of fourteen patients and influenced clinical decision making in two patients (14%) with presumed resectable pCCA.

Published
2024

9. T and B Cell Composition and Cytokine Producing Capacity Before and After Bariatric Surgery

Author

Wijngaarden, L. H., Taselaar, A. E., Nuijten, F., Harst, E. van der, Klaassen, R. A., Kuijper, T. M., Jongbloed, F., Ambagtsheer, G., Klepper, M., IJzermans, J. N. M., de Bruin, R. W. F., Litjens, N. H. R., Surgery, and Internal Medicine

Subjects
B-Lymphocytes, SDG 3 - Good Health and Well-being, Immunology, Bariatric Surgery, Cytokines, Humans, Interleukin-2, Immunology and Allergy, CD8-Positive T-Lymphocytes, Obesity, Morbid
Abstract

Morbid obesity is associated with a chronic state of low-grade inflammation, which may lead to accelerated differentiation of T and B cells. These differentiated immune cells are strongly cytotoxic and have an increased pro-inflammatory cytokine producing capacity. Furthermore, the anti-inflammatory function of the T and B cells decreases. The aim of this study was to evaluate the effect of morbid obesity on the subset profile and cytokine producing capacity of T and B cells. Subsequently, we assessed whether bariatric surgery affected the subset profile and cytokine producing capacity of these cells. We determined the proportion of T and B cell subsets and their cytokine producing capacity in peripheral blood collected from 23 morbidly obese patients before and three months after bariatric surgery using flow-cytometry. We compared this with the results of 25 lean controls. Both CD4+ and CD8+ T cells showed a more differentiated subset profile in morbidly obese patients as compared to lean controls, which was not recovered three months after bariatric surgery. The B cell composition of morbidly obese patients after bariatric surgery adjusted towards the profile of lean controls. However, the IL-2 and IFN-γ producing capacity of CD8+ T cells and the IL-2, IFN-γ, TNF-α and IL-10 producing capacity of B cells was not restored three months after bariatric surgery. In conclusion, the data suggest that the immune system has the capacity to recover from the detrimental effects of morbid obesity within three months after bariatric surgery in terms of cell composition; however, this was not seen in terms of cytokine producing capacity. The full restoration of the immune system after bariatric surgery may thus take longer.

Published
2022

11. 28.3 Incidentalomen

Author

IJzermans, J. N. M., Bonjer, H. J., editor, Aronson, D. C., editor, Blankensteijn, J. D., editor, Gooszen, H. G., editor, Gouma, D. J., editor, Kroon, B. B. R., editor, and van Vugt, A. B., editor

Published
2005
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14. Additional file 1 of Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial

Author

Oudmaijer, C. A. J., Minnee, R. C., Pol, R. A., van den Boogaard, W. M. C., Komninos, D. S. J., van de Wetering, J., van Heugten, M. H., Hoorn, E. J., Sanders, J. S. F., Hoeijmakers, J. H. J., Vermeij, W. P., and IJzermans, J. N. M.

Abstract

Additional file 1:. Figures and biological specimens.

Published
2022
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15. Additional file 2 of Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial

Author

Oudmaijer, C. A. J., Minnee, R. C., Pol, R. A., van den Boogaard, W. M. C., Komninos, D. S. J., van de Wetering, J., van Heugten, M. H., Hoorn, E. J., Sanders, J. S. F., Hoeijmakers, J. H. J., Vermeij, W. P., and IJzermans, J. N. M.

Abstract

Additional file 2:. Informed consent forms.

Published
2022
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17. Correction to: Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma (Annals of Surgical Oncology, (2020), 10.1245/s10434-020-08258-3)

Author

Olthof P. B., Aldrighetti L., Alikhanov R., Cescon M., Groot Koerkamp B., Jarnagin W. R., Nadalin S., Pratschke J., Schmelzle M., Sparrelid E., Lang H., Guglielmi A., van Gulik T. M., Andreou A., Bartsch F., Benzing C., Buettner S., Capobianco I., de Reuver P., de Savornin Lohman E., Dejong C. H. C., Efanov M., Erdmann J. I., Franken L. C., Frascaroli G., Giglio M. C., Gomez-Gavara C., Heid F., IJzermans J. N. M., Jansson H., Ligthart M. A. P., Maithel S. K., Malago M., Malik H. Z., Muiesan P., Olde Damink S. W. M., Pando E., Quinn L. M., Ratti F., Roberts K. J., Rolinger J., Ruzzenente A., Schadde E., Serenari M., Sultana A., Troisi R., van Laarhoven S., van Vugt J. L. A., Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., and van Vugt, J. L. A.

Abstract

In the original article Moritz Schmelzle’s last name is spelled wrong. It is correct as reflected here.

Published
2020

18. Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

Author

Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelze, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., IJzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., van Vugt, J. L. A., Surgery, Academic Medical Center, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelze, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., and van Vugt, J. L. A.

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, education, 030230 surgery, Preoperative care, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Preoperative Care, medicine, Hepatectomy, Humans, Embolization, Abscess, Bile Duct Neoplasm, Aged, Retrospective Studies, portal vein embolization, portal vein embolisation, Perihilar cholangiocarcinoma, Portal Vein, business.industry, Incidence (epidemiology), Liver Neoplasms, Correction, Retrospective cohort study, Middle Aged, Jaundice, medicine.disease, Embolization, Therapeutic, Surgery, Bile Duct Neoplasms, Oncology, Liver Neoplasm, Hepatobiliary Tumors, 030220 oncology & carcinogenesis, Propensity score matching, Cohort, medicine.symptom, business, Liver Failure, Human, Klatskin Tumor
Abstract

Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p p p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

Published
2020

23. Daily practice in guideline adherence to adjuvant chemotherapy in stage III colon cancer and predictors of outcome: Adjuvant chemotherapy in stage III colon cancer patients

Author

MS Medische Oncologie, Cancer, van den Berg, I, van de Weerd, S, van Klaveren, D, Coebergh van den Braak, R R J, van Krieken, J H J M, Koopman, M, Roodhart, J M L, Medema, J P, IJzermans, J N M, MS Medische Oncologie, Cancer, van den Berg, I, van de Weerd, S, van Klaveren, D, Coebergh van den Braak, R R J, van Krieken, J H J M, Koopman, M, Roodhart, J M L, Medema, J P, and IJzermans, J N M

Published
2021

26. Volume-outcome relationship of liver surgery:a nationwide analysis

Author

Olthof, P B, Elfrink, A K E, Marra, E, Belt, E J T, van den Boezem, P B, Bosscha, K, Consten, E C J, den Dulk, M, Gobardhan, P D, Hagendoorn, J, van Heek, T N T, IJzermans, J N M, Klaase, J M, Kuhlmann, K F D, Leclercq, W K G, Liem, M S L, Manusama, E R, Marsman, H A, Mieog, J S D, Oosterling, S J, Patijn, G A, Te Riele, W, Swijnenburg, R-J, Torrenga, H, van Duijvendijk, P, Vermaas, M, Kok, N F M, Grünhagen, D J, Olthof, P B, Elfrink, A K E, Marra, E, Belt, E J T, van den Boezem, P B, Bosscha, K, Consten, E C J, den Dulk, M, Gobardhan, P D, Hagendoorn, J, van Heek, T N T, IJzermans, J N M, Klaase, J M, Kuhlmann, K F D, Leclercq, W K G, Liem, M S L, Manusama, E R, Marsman, H A, Mieog, J S D, Oosterling, S J, Patijn, G A, Te Riele, W, Swijnenburg, R-J, Torrenga, H, van Duijvendijk, P, Vermaas, M, Kok, N F M, and Grünhagen, D J

Abstract

BACKGROUND: Evidence for an association between hospital volume and outcomes for liver surgery is abundant. The current Dutch guideline requires a minimum volume of 20 annual procedures per centre. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit.METHODS: This was a nationwide study in the Netherlands. All liver resections reported in the Dutch Hepato Biliary Audit between 2014 and 2017 were included. Annual centre volume was calculated and classified in categories of 20 procedures per year. Main outcomes were major morbidity (Clavien-Dindo grade IIIA or higher) and 30-day or in-hospital mortality.RESULTS: A total of 5590 liver resections were done across 34 centres with a median annual centre volume of 35 (i.q.r. 20-69) procedures. Overall major morbidity and mortality rates were 11·2 and 2·0 per cent respectively. The mortality rate was 1·9 per cent after resection for colorectal liver metastases (CRLMs), 1·2 per cent for non-CRLMs, 0·4 per cent for benign tumours, 4·9 per cent for hepatocellular carcinoma and 10·3 per cent for biliary tumours. Higher-volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer. There was no association between hospital volume and either major morbidity or mortality in multivariable analysis, after adjustment for known risk factors for adverse events.CONCLUSION: Hospital volume and postoperative outcomes were not associated.

Published
2020

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