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Pancreatic Neoplasms: HELP
Articles by Thomas M. van Gulik
Based on 30 articles published since 2010
(Why 30 articles?)
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Between 2010 and 2020, T. van Gulik wrote the following 30 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Systematic review of outcomes after distal pancreatectomy with coeliac axis resection for locally advanced pancreatic cancer. 2016

Klompmaker, S / de Rooij, T / Korteweg, J J / van Dieren, S / van Lienden, K P / van Gulik, T M / Busch, O R / Besselink, M G. ·Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. · Departments of Interventional Radiology, Academic Medical Centre, Amsterdam, The Netherlands. ·Br J Surg · Pubmed #27304847.

ABSTRACT: BACKGROUND: Pancreatic cancer involving the coeliac axis is considered unresectable by most guidelines, with a median survival of 6-11 months. A subgroup of these patients can undergo distal pancreatectomy with coeliac axis resection, but consensus on the value of this procedure is lacking. The evidence for this procedure, including the impact of preoperative hepatic artery embolization and (neo)adjuvant therapy, was evaluated. METHODS: A systematic review was performed according to the PRISMA guidelines until 27 May 2015. The primary endpoint was overall survival; secondary endpoints included morbidity and radical resection rates. RESULTS: A total of 19 retrospective studies, involving 240 patients, were included. The methodological quality of the studies ranged from poor to moderate. A radical resection was reported in 74·5 per cent (152 of 204), major morbidity in 27 per cent (26 of 96), ischaemic morbidity in 9·0 per cent (21 of 223) and 90-day mortality in 3·5 per cent (4 of 113). Overall, 35·5 per cent of patients (55 of 155) underwent preoperative hepatic artery embolization without an apparent beneficial impact on ischaemic morbidity. Overall, 15·7 per cent (29 of 185) had neoadjuvant and 51·0 per cent (75 of 147) had adjuvant therapy. There was a difference in survival between patient series where less than half of patients had (neo)adjuvant chemotherapy and series where more than half were receiving this treatment: case-weighted median overall survival was 16 (range 9-48) versus 18 (10-26) months respectively (P = 0·002). Overall median survival for the whole study population was 14·4 (range 9-48) months. CONCLUSION: Distal pancreatectomy with coeliac axis resection seems a valuable option for selected patients with pancreatic cancer involving the coeliac axis with acceptable morbidity and mortality, and a median survival of 18 months when combined with (neo)adjuvant therapy.

2 Review Non-radical resection versus bypass procedure for pancreatic cancer - a consecutive series and systematic review. 2015

Tol, J A M G / Eshuis, W J / Besselink, M G H / van Gulik, T M / Busch, O R C / Gouma, D J. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.tol@amc.uva.nl. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. ·Eur J Surg Oncol · Pubmed #25511567.

ABSTRACT: BACKGROUND: Most survival studies comparing non-radical resections to bypass surgery in patients with pancreatic cancer often do not differentiate between an R1 and R2 resection. The aim of this study was to evaluate whether non-radical R1 and R2 resections have better postoperative outcomes and survival compared to a palliative bypass. METHODS: A single center cohort study was performed analyzing mortality, morbidity and 1-year survival after R1 (tumor cells within 1 mm from the circumferential margin), R2 and bypass surgery in patients with pancreatic cancer. For the systematic review, studies were identified comparing R1 or R2 resections with bypass, in patients with pancreatic cancer. Postoperative outcomes were compared including the cohort study. RESULTS: The cohort study (n=405) showed higher morbidity rates after R1 (n=191) and R2 (n=11) resections compared to bypass (52% and 73% vs. 34%, p < 0.01). In-hospital mortality did not differ (overall 1.7%). 1-year survival rates were 71%, 46% and 32% after R1, R2 resection and bypass (p=0.6 between R2 and bypass). The systematic review identified 8 studies, after including the cohort study 1535 patients were analyzed. Increased morbidity after R1-R2 resection (48%) compared to bypass (30-34%) was found. Median survival was 14-18 months after R1 resection vs. 9-13 months after bypass and 8.5-11.5 months after R2 resection vs. 7.5-10.7 months after bypass. CONCLUSION: An R2 resection should be avoided in patients with pancreatic cancer due to its poor prognosis. Survival benefit after an R1 resection, as compared to bypass surgery, justifies a resection despite the increased morbidity rate.

3 Review Standard pre- and postoperative determination of chromogranin a in resectable non-functioning pancreatic neuroendocrine tumors--diagnostic accuracy: NF-pNET and low tumor burden. 2014

Jilesen, Anneke P J / Busch, Olivier R C / van Gulik, Thomas M / Gouma, Dirk J / Nieveen van Dijkum, Els J M. ·Academic Medical Center, Amsterdam, The Netherlands. ·Dig Surg · Pubmed #25572908.

ABSTRACT: BACKGROUND: Chromogranin A (CgA) is often used in metastatic patients with nonfunctioning pancreatic neuroendocrine tumors (NF-pNET). The aim of this study is to assess the diagnostic accuracy of CgA in patients with low tumor burden. METHODS: Resectable patients with NF-pNET without metastases at time of diagnosis were included between 2002 and 2013 in the Academic Medical Center of Amsterdam. CgA was determined at time of diagnosis and during follow-up according to a standardized method. The upper reference range was 94 µg/l. RESULTS: Overall, 47 patients were included in this study. CgA was elevated preoperatively in only 10 patients (27%). In the detection of metastases during follow-up, the positive predictive value for CgA was 50% and negative predictive value was 81%. In 50% of the patients with an elevated CgA during follow-up, this test result was false-positive. CONCLUSIONS: The diagnostic accuracy of CgA was low preoperatively in patients with resectable NF-pNET and low tumor burden. In the detection of recurrent disease after curative resection of NF-pNET, the diagnostic accuracy of CgA was moderate (50%). We conclude that the routine measurement of CgA at time of diagnosis or during follow-up after curative resection had limited value in patients with resectable NF-pNET.

4 Review Preoperative biliary drainage for pancreatic cancer. 2014

Van Heek, N T / Busch, O R / Van Gulik, T M / Gouma, D J. ·Department of Surgery, Academic Medical Center University of Amsterdam Amsterdam, The Netherlands - D.J.Gouma@amc.nl. ·Minerva Med · Pubmed #24727874.

ABSTRACT: This review is to summarize the current knowledge about preoperative biliary drainage (PBD) in patients with biliary obstruction caused by pancreatic cancer. Most patients with pancreatic carcinoma (85%) will present with obstructive jaundice. The presence of toxic substances as bilirubin and bile salts, impaired liver function and altered nutritional status due to obstructive jaundice have been characterized as factors for development of complications after surgery. Whereas PBD was to yield beneficial effects in the experimental setting, conflicting results have been observed in clinical studies. The meta-analysis from relative older studies as well as more importantly a recent clinical trial showed that PBD should not be performed routinely. PBD for patients with a distal biliary obstruction is leading to more serious complications compared with early surgery. Arguments for PBD have shifted from a potential therapeutic benefit towards a logistic problem such as patients suffering from cholangitis and severe jaundice at admission or patients who need extra diagnostic tests, or delay in surgery due to a referral pattern or waiting list for surgery as well as candidates for neoadjuvant chemo(radio)therapy. If drainage is indicated in these patients it should be performed with a metal stent to reduce complications after the drainage procedure such as stent occlusion and cholangitis. Considering a change towards more neoadjuvant therapy regimes improvement of the quality of the biliary drainage concept is still important.

5 Review The quandary of preresection biliary drainage for pancreatic cancer. 2012

Tol, Johanna A M G / Busch, Olivier R C / van der Gaag, Niels A / van Gulik, Thomas M / Gouma, Dirk J. ·Department of Surgery, Academic Medical Center at the University of Amsterdam, The Netherlands. ·Cancer J · Pubmed #23187841.

ABSTRACT: Surgery in patients with obstructive jaundice caused by a tumor in the pancreatic head area is associated with a higher risk of postoperative complications. Preoperative biliary drainage was introduced in an attempt to improve the general condition and reduce morbidity and mortality. Extensive experimental studies have been performed to analyze the beneficial effect of biliary drainage and showed improvement in liver function, nutritional status, and cell-mediated immune function as well as reduction in mortality. However, despite the results seen in the experimental studies, clinical studies reported both beneficial and adverse effects, and most studies advised against routinely performing preoperative biliary drainage. To add clarity to the ongoing controversy, a recent randomized controlled trial was performed and reported more overall complications in patients with jaundice who underwent preoperative biliary drainage followed by surgery compared to those who underwent surgery alone. Many of these complications were stent related. Like most clinical studies, a plastic stent was used to initiate biliary drainage. Patients with jaundice because of a tumor in the pancreatic head area without locoregional irresectability or metastases should be candidates for early surgery. Preoperative biliary drainage should not be performed routinely. However, some selected patients might benefit from preoperative biliary drainage, in cases of severe jaundice, neoadjuvant therapy, or postponed surgery due to logistics. In these cases, the use of metal biliary stents is indicated.

6 Clinical Trial Predicting distant metastasis in patients with suspected pancreatic and periampullary tumors for selective use of staging laparoscopy. 2011

Slaar, Annelie / Eshuis, Wietse J / van der Gaag, Niels A / Nio, C Yung / Busch, Olivier R C / van Gulik, Thomas M / Reitsma, Johannes B / Gouma, Dirk J. ·Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. ·World J Surg · Pubmed #21882032.

ABSTRACT: BACKGROUND: In patients with pancreatic or periampullary tumor, staging laparoscopy (SL) can detect metastases that are occult on computed tomography (CT), thereby precluding nontherapeutic laparotomy. Routine SL is not advocated, but some studies suggest its selective use. The aim of this study was to identify patients at risk for metastasis in whom SL could be beneficial. METHODS: A consecutive series of patients who underwent laparotomy for a suspected pancreatic or periampullary tumor were analyzed. We included patients with a suspected resectable solid lesion and a recent high-quality CT scan. Patients with and without an intraoperatively encountered metastasis were compared. Regression analysis was performed to examine the association between various predictors and metastasis. RESULTS: Data from 385 patients (mean age 63, 41% women) were analyzed. Distant metastasis was encountered in 79 patients (21%). Logistic regression analysis revealed the following key predictors for metastasis: tumor size on CT scan [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.16-1.76 per millimeter increase], weight loss (OR 1.28, 95% CI 1.01-1.63 per doubling the kilograms), and history of jaundice (OR 2.36, 95% CI 0.79-7.06). In patients with a tumor ≥3 cm and severe weight loss (≥10 kg) and in patients with a tumor ≥4 cm and moderate weight loss (≥5 kg), the proportion of patients with metastasis was >40%. CONCLUSIONS: In patients with a suspected pancreatic or periampullary tumor, the tumor size, weight loss, and jaundice are key predictors of metastasis at exploration. SL might be beneficial in patients with a tumor ≥3 cm and severe weight loss and in those with a tumor ≥4 cm and moderate weight loss.

7 Article Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis. 2019

Klompmaker, Sjors / Peters, Niek A / van Hilst, Jony / Bassi, Claudio / Boggi, Ugo / Busch, Olivier R / Niesen, Willem / Van Gulik, Thomas M / Javed, Ammar A / Kleeff, Jorg / Kawai, Manabu / Lesurtel, Mickael / Lombardo, Carlo / Moser, A James / Okada, Ken-Ichi / Popescu, Irinel / Prasad, Raj / Salvia, Roberto / Sauvanet, Alain / Sturesson, Christian / Weiss, Matthew J / Zeh, Herbert J / Zureikat, Amer H / Yamaue, Hiroki / Wolfgang, Christopher L / Hogg, Melissa E / Besselink, Marc G / Anonymous4750974. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. · Department of Surgery, University of Utrecht Medical Center, Utrecht, The Netherlands. · Department of Surgery, Pancreas Institute University of Verona, Verona, Italy. · Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. · Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany. · Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany. · Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France. · The Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania. · Department of HPB and Transplant Services, National Health Service, Leeds, UK. · Department of HPB Surgery, Hôpital Beaujon, APHP, University Paris VII, Clichy, France. · Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden. · Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. · Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. · Department of Surgery, Northshore University HealthSystem, Chicago, IL, USA. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. m.g.besselink@amc.nl. ·Ann Surg Oncol · Pubmed #30610560.

ABSTRACT: BACKGROUND: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. METHODS: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. RESULTS: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15-25 months). CONCLUSIONS: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.

8 Article Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies. 2019

van Roessel, Stijn / Mackay, Tara M / Tol, Johanna A M G / van Delden, Otto M / van Lienden, Krijn P / Nio, Chung Y / Phoa, Saffire S K S / Fockens, Paul / van Hooft, Jeanin E / Verheij, Joanne / Wilmink, Johanna W / van Gulik, Thomas M / Gouma, Dirk J / Busch, Olivier R / Besselink, Marc G. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. ·HPB (Oxford) · Pubmed #30606684.

ABSTRACT: BACKGROUND: Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome. METHODS: All consecutive PDs performed between 1992-2017 in a single pancreatic center were identified from a prospectively maintained database and analyzed according to three time periods. RESULTS: In total, 1434 patients underwent PD. Over time, more elderly patients underwent PD (P < 0.001) with increased use of vascular resection (10.4 to 16.0%, P < 0.001). In patients with cancer (n = 1049, 74.8%), the proportion pT3/T4 tumors increased from 54.3% to 70.6% over time (P < 0.001). The postoperative pancreatic fistula (16.0%), postpancreatectomy hemorrhage (8.0%) and delayed gastric emptying (31.0%) rate did not reduce over time, whereas median length of stay decreased from 16 to 12 days (P < 0.001). The overall failure-to-rescue rate (6.9%) and in-hospital mortality (2.2%) remained stable (P = 0.89 and P = 0.45). In 523 patients with pancreatic cancer (36.5%), the use of both adjuvant and neoadjuvant chemotherapy increased over time (both p<0.001), and the five-year overall survival improved from 11.0% to 17.4% (P < 0.001). CONCLUSIONS: In a period where indications for PD expanded, with more elderly patients, more advanced cancers and increased use of vascular resections, surgical outcome remained favorable and five-year survival for pancreatic cancer improved.

9 Article Tuberculosis presenting as a pancreatic cystic neoplasm. 2018

van der Naald, Niels / Engelsman, Anton F / Engelbrecht, Marc R W / Verheij, Joanne / Besselink, Marc G / Busch, Olivier R / van Gulik, Thomas. ·Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Radiology, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Pathology, Amsterdam UMC, University of Amsterdam, The Netherlands. ·BMJ Case Rep · Pubmed #30567214.

ABSTRACT: A 33-year-old Thai born woman was referred to our tertiary referral hospital with back and epigastric pain. Investigations included abdominal ultrasound and CT scan of the abdomen which demonstrated a 3 cm cystic lesion in the head of the pancreas, most likely a mucinous cystadenoma. Because of its malignant potential resection was advised. During surgical exploration, the tumour appeared unresectable, due to involvement of the common hepatic artery. PCR on biopsy revealed

10 Article Pancreatoduodenectomy with colon resection for pancreatic cancer: a systematic review. 2018

Solaini, Leonardo / de Rooij, Thijs / Marsman, E Madelief / Te Riele, Wouter W / Tanis, Pieter J / van Gulik, Thomas M / Gouma, Dirk J / Bhayani, Neal H / Hackert, Thilo / Busch, Olivier R / Besselink, Marc G. ·Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Dept of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy. · Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. · Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Dept of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands. · Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, USA. · Dept of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. · Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. ·HPB (Oxford) · Pubmed #29705346.

ABSTRACT: BACKGROUND: Radical resection of advanced pancreatic cancer may occasionally require a simultaneous colon resection. The risks and benefits of this combined procedure are largely unknown. This systematic review aimed to assess short and long term outcome after pancreatoduodenectomy with colon resection (PD-colon) for pancreatic ductal adenocarcinoma (PDAC). METHODS: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1994 and 2017 concerning PD-colon for PDAC. RESULTS: After screening 2038 articles, 5 articles with a total of 181 patients undergoing PD-colon were eligible for inclusion. Included studies showed a relatively low risk of bias. The pooled complication rate was 73% (95% CI 61-84) including a pooled colonic anastomotic leak rate of 5.5%. Pooled mortality was 10% (95% CI 6-15). Pooled mean survival (data from 86 patients) was 18 months (95% CI 13-23) with pooled 3- and 5-year survival of 31% (95% CI 20-72) and 19% (95% CI 6-38). CONCLUSION: Based on the available data, PD-colon for PDAC seems to be associated with an increased morbidity and mortality but with survival comparable with standard PD in selected patients. Future large series are needed to allow for better patient selection for PD-colon.

11 Article Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center. 2018

van Roessel, Stijn / Kasumova, Gyulnara G / Tabatabaie, Omidreza / Ng, Sing Chau / van Rijssen, L Bengt / Verheij, Joanne / Najarian, Robert M / van Gulik, Thomas M / Besselink, Marc G / Busch, Olivier R / Tseng, Jennifer F. ·Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Department of Surgery, Cancer Center Amsterdam, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. · Department of Pathology, Cancer Center Amsterdam, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. · Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. · Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Jennifer.Tseng@bmc.org. · Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Jennifer.Tseng@bmc.org. ·Ann Surg Oncol · Pubmed #29651577.

ABSTRACT: BACKGROUND: The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival. METHODS: Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan-Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved. RESULTS: Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, < 1, and ≥1 mm, respectively (all log-rank p < 0.001). On multivariate analysis, patients with a margin clearance of ≥1 mm demonstrated a survival advantage relative to those with 0 mm clearance [hazard ratio (HR) 0.71, p < 0.01], whereas survival was comparable for patients with a margin clearance of < 1 mm versus 0 mm (HR: 0.93, p = 0.60). Patients with involvement (0 or < 1 mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7 months) relative to those with SMA involvement (17.5 months). CONCLUSIONS: In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of ≥1 mm correlates with improved survival relative to < 1 mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival.

12 Article Induction Chemotherapy Followed by Resection or Irreversible Electroporation in Locally Advanced Pancreatic Cancer (IMPALA): A Prospective Cohort Study. 2017

Vogel, Jantien A / Rombouts, Steffi J / de Rooij, Thijs / van Delden, Otto M / Dijkgraaf, Marcel G / van Gulik, Thomas M / van Hooft, Jeanin E / van Laarhoven, Hanneke W / Martin, Robert C / Schoorlemmer, Annuska / Wilmink, Johanna W / van Lienden, Krijn P / Busch, Olivier R / Besselink, Marc G. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, University of Louisville, Louisville, KY, USA. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.g.besselink@amc.nl. ·Ann Surg Oncol · Pubmed #28560601.

ABSTRACT: BACKGROUND: Following induction chemotherapy, both resection or irreversible electroporation (IRE) may further improve survival in patients with locally advanced pancreatic cancer (LAPC). However, prospective studies combining these strategies are currently lacking, and available studies only report on subgroups that completed treatment. This study aimed to determine the applicability and outcomes of resection and IRE in patients with nonprogressive LAPC after induction chemotherapy. METHODS: This was a prospective, single-center cohort study in consecutive patients with LAPC (September 2013 to March 2015). All patients were offered 3 months of induction chemotherapy (FOLFIRINOX or gemcitabine depending on performance status), followed by exploratory laparotomy for resection or IRE in patients with Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 nonprogressive, IRE-eligible tumors. RESULTS: Of 132 patients with LAPC, 70% (n = 93) started with chemotherapy (46% [n = 61] FOLFIRINOX). After 3 months, 59 patients (64%) had nonprogressive disease, of whom 36 (27% of the entire cohort) underwent explorative laparotomy, resulting in 14 resections (11% of the entire cohort, 39% of the explored patients) and 15 IREs (11% of the entire cohort, 42% of the explored patients). After laparotomy, 44% (n = 16) of patients had Clavien-Dindo grade 3 or higher complications, and 90-day all-cause mortality was 11% (n = 4). With a median follow-up of 24 months, median overall survival after resection, IRE, and for all patients with nonprogressive disease without resection/IRE (n = 30) was 34, 16, and 15 months, respectively. The resection rate in 61 patients receiving FOLFIRINOX treatment was 20%. CONCLUSION: Induction chemotherapy followed by IRE or resection in nonprogressive LAPC led to resection or IRE in 22% of all-comers, with promising survival rates after resection but no apparent benefit of IRE, despite considerable morbidity. Registered at Netherlands Trial Register (NTR4230).

13 Article Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis. 2016

Lekkerkerker, Selma J / Nio, Chung Y / Issa, Yama / Fockens, Paul / Verheij, Joanne / Busch, Olivier R / van Gulik, Thomas M / Rauws, Erik A / Boermeester, Marja A / van Hooft, Jeanin E / Besselink, Marc G. ·Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·J Gastroenterol Hepatol · Pubmed #26997497.

ABSTRACT: BACKGROUND AND AIM: Data on non-surgical treatment of groove pancreatitis (GP) and the risk of cancer are lacking. We aimed to determine the prevalence and predictors of cancer in patients in whom the diagnosis GP was considered, and to evaluate symptom improvement after treatment. STUDY: Patients referred with possible GP (2001-2014) were retrospectively included. An experienced radiologist reassessed imaging. GP patients received questionnaires evaluating their symptoms. RESULTS: From the 38 possible GP patients, 10 had cancer (26%) and 28 GP (74%). Compared with cancer patients, GP patients more frequently had cysts (2/10 vs. 18/28, P = 0.03), less often jaundice (6/10 vs 3/27, P < 0.01), an abrupt caliber change of the CBD (5/10 vs. 2/28, P < 0.01) or suspicious cytology (5/9 vs 2/20, P = 0.02). Of the 28 GP patients, 14 patients were treated conservatively of whom 12 reported symptom improvement after a median follow-up of 45 months (range 7-127 months). All 6 patients treated endoscopically and 7/8 patients treated surgically reported symptom improvement. Surgery, performed because of treatment failure (3/8) or inability to exclude malignancy (5/8), caused mortality in 1/8 patients. CONCLUSIONS: Suspicion of pancreatic cancer should be high in patients presenting with possible GP. Conservative, endoscopic and surgical treatment can all lead to symptom improvement, suggesting a 'step-up approach' to GP once cancer is excluded.

14 Article Postoperative Outcomes of Enucleation and Standard Resections in Patients with a Pancreatic Neuroendocrine Tumor. 2016

Jilesen, Anneke P J / van Eijck, Casper H J / Busch, Olivier R C / van Gulik, Thomas M / Gouma, Dirk J / van Dijkum, Els J M Nieveen. ·Department of Surgery, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands. a.p.jilesen@amc.uva.nl. · Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1105 AZ, Amsterdam, The Netherlands. ·World J Surg · Pubmed #26608956.

ABSTRACT: BACKGROUND: Either enucleation or more extended resection is performed to treat patients with pancreatic neuroendocrine tumor (pNET). Aim was to analyze the postoperative complications for each operation separately. Furthermore, independent risk factors for complications and incidence of pancreatic insufficiency were analyzed. METHODS: Retrospective all resected patients from two academic hospitals in The Netherlands between 1992 and 2013 were included. Postoperative complications were scored by both ISGPS and Clavien-Dindo criteria. Based on tumor location, operations were compared. Independent risk factors for overall complications were identified. During long-term follow-up, pancreatic insufficiency and recurrent disease were analyzed. RESULTS: Tumor enucleation was performed in 60/205 patients (29%), pancreatoduodenectomy in 65/205 (31%), distal pancreatectomy in 72/205 (35%) and central pancreatectomy in 8/205 (4%) patients. Overall complications after tumor enucleation of the pancreatic head and pancreatoduodenectomy were comparable, 24/35 (69%) versus 52/65 (80%). The same was found after tumor enucleation and resection of the pancreatic tail (36 vs.58%). Number of re-interventions and readmissions were comparable between all operations. After pancreatoduodenectomy, 33/65 patients had lymph node metastasis and in patients with tumor size ≤2 cm, 55% had lymph node metastasis. Tumor in the head and BMI ≥25 kg/m(2) were independent risk factors for complications after enucleation. During follow-up, incidence of exocrine and endocrine insufficiency was significant higher after pancreatoduodenectomy (resp. 55 and 19%) compared to the tumor enucleation and distal pancreatectomy (resp. 5 and 7% vs. 8 and 13%). After tumor enucleation 19% developed recurrent disease. CONCLUSION: Since the complication rate, need for re-interventions and readmissions were comparable for all resections, tumor enucleation may be regarded as high risk. Appropriate operation should be based on tumor size, location, and functional status of the pNET.

15 Article Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. 2016

Tol, J A M G / van Hooft, J E / Timmer, R / Kubben, F J G M / van der Harst, E / de Hingh, I H J T / Vleggaar, F P / Molenaar, I Q / Keulemans, Y C A / Boerma, D / Bruno, M J / Schoon, E J / van der Gaag, N A / Besselink, M G H / Fockens, P / van Gulik, T M / Rauws, E A J / Busch, O R C / Gouma, D J. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. · Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands. ·Gut · Pubmed #26306760.

ABSTRACT: INTRODUCTION: In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. METHODS: A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. RESULTS: 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. CONCLUSIONS: For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. TRIAL REGISTRATION NUMBER: Dutch Trial Registry (NTR3142).

16 Article Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. 2015

Tol, J A M G / Brosens, L A A / van Dieren, S / van Gulik, T M / Busch, O R C / Besselink, M G H / Gouma, D J. ·Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. ·Br J Surg · Pubmed #25529117.

ABSTRACT: BACKGROUND: According to some studies, the number of lymph nodes with metastases in relation to the total number of removed lymph nodes, the lymph node ratio (LNR), is one of the most powerful predictors of survival after resection in patients with pancreatic cancer. However, contradictory results have been reported, and small sample sizes of the cohorts and different definitions of a microscopic positive resection margin (R1) hamper the interpretation of data. METHODS: The predictive value of LNR for 3-year survival was assessed using a Cox proportional hazards model. From 1992 to 2012, all patients with pancreatic and periampullary cancer operated on with pancreatoduodenectomy were selected from a database. Clinicopathological characteristics were analysed. Microscopic positive resection margin was defined as the microscopic presence of tumour cells within 1 mm of the margins. A nomogram was created. RESULTS: Some 760 patients were included. Predictive factors for death in 350 patients with pancreatic ductal adenocarcinoma included in the nomogram were: R1 resection (hazard ratio (HR) 1·55, 95 per cent c.i. 1·07 to 2·25), poor tumour differentiation (HR 2·78, 1·40 to 5·52), LNR above 0·18 (HR 1·75, 1·13 to 2·70) and no adjuvant therapy (HR 1·54, 1·01 to 2·34). The C statistic was 0·658 (0·632 to 0·698), and calibration was good (Hosmer-Lemeshow χ(2)  = 5·67, P =0·773). LNR and poor tumour differentiation (HR 4·51 and 3·30 respectively) were also predictive in patients with distal common bile duct (CBD) cancer. LNR, R1 resection and jaundice were predictors of death in patients with ampullary cancer (HR 7·82, 2·68 and 1·93 respectively). CONCLUSION: LNR is a common predictor of poor survival in pancreatic, distal CBD and ampullary cancer.

17 Article Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions. 2015

Atema, Jasper Jan / Jilesen, Anneke P J / Busch, Olivier R C / van Gulik, Thomas M / Gouma, Dirk J / Nieveen van Dijkum, Els J M. ·Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. ·HPB (Oxford) · Pubmed #25041879.

ABSTRACT: BACKGROUND: Resection for pancreatic neuroendocrine tumours (PNET) is suggested to be associated with an increased risk of a post-operative pancreatic fistula (POPF). The aim of this study was to describe morbidity after resections for PNET, focusing on POPF. Outcomes were compared with resections for other lesions. METHODS: Patients undergoing an elective pancreatic resection during a 12-year period were retrospectively analysed. Morbidity was defined according to the International Study Group of Pancreatic Surgery (ISGPS) definitions. RESULTS: Eighty-eight out of 832 patients (10.6%) underwent a resection for PNET. Atypical pancreatic resections (enucleation and central pancreatectomy) and distal pancreatectomies were more frequently performed for PNET. The POPF rate was 22.7% in patients operated for PNET compared with 17.2% in other patients (P = 0.200). In univariate analysis, body mass index (BMI), pancreatic duct diameter, somatostatin analogue administration, type of resection and type of pathology were associated with a POPF. In multivariate analysis, BMI, a pancreatic duct diameter <3 mm and central pancreatectomy remained independent risk factors [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.22-3.07 and OR 3.04, 95% CI 1.05-8.82, respectively]. CONCLUSIONS: High rates of POPF were found in patients operated for PNET. However, this was mainly owing to the fact that atypical resections, known to be associated with a higher fistula rate, were performed more frequently in these patients.

18 Article Shifting role of operative and nonoperative interventions in managing complications after pancreatoduodenectomy: what is the preferred intervention? 2014

Tol, Johanna A M G / Busch, Olivier R C / van Delden, Otto M / van Lienden, Krijn P / van Gulik, Thomas M / Gouma, Dirk J. ·Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. · Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: D.J.Gouma@amc.nl. ·Surgery · Pubmed #25017138.

ABSTRACT: INTRODUCTION: Operative complications after pancreatoduodenectomy can be managed by nonoperative or operative interventions. The aim of this study was to analyze the shift in management of five major complications and their success rates. An algorithm was developed according to predictors for type of intervention and failure of management. METHODS: From 1992-2012, patients with pancreaticojejunostomy, hepaticojejunostomy or gastroenterostomy leakage, postpancreatectomy hemorrhage, or primary abscess after pancreatoduodenectomy were selected from a prospectively maintained database. Complications were treated by nonoperative or operative intervention Two cohorts were created according to period of index operation. Pre- and postoperative characteristics were analyzed. RESULTS: Of 1,037 patients, 263 (25%) experienced operative complications. The incidence of pancreatic fistula increased from 11 to 18%, accompanied by a shift from operative toward nonoperative management. This was also seen in the management of late hemorrhage. Success rates of interventions remained similar for all complications. The incidence of primary abscesses decreased. Early sepsis (odds ratio [OR] 17.8, 95% confidence interval [CI] 4.9-64.4) was associated with failure of nonoperative interventions in patients with pancreatic fistula. Hemodynamic instability (OR 17.2, 95% CI 1.8-160.1) and sepsis (OR 6.7, 95% CI 2.7-16.3) were predictive for operative intervention. Failure of nonoperative intervention (HR 3.95% CI 1.3-7.1) and operative intervention (HR 6.4 95% CI 3.2-12.8) were predictors for poor survival. CONCLUSION: The shift towards nonoperative interventions was notable in patients suffering from pancreaticojejunostomy leakage and late hemorrhage. Anastomotic leakage, late hemorrhage, and primary abscesses can be managed nonoperatively however; hemodynamic instability and early sepsis are strong arguments to perform surgery.

19 Article Quality of life and functional outcome after resection of pancreatic cystic neoplasm. 2014

van der Gaag, Niels A / Berkhemer, Olvert A / Sprangers, Mirjam A / Busch, Olivier R C / Bruno, Marco J / de Castro, Steve M / van Gulik, Thomas M / Gouma, Dirk J. ·From the Departments of *Surgery, †Medical Psychology, and ‡Gastroenterology, Academic Medical Center, Amsterdam; and §Department of Gastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands. ·Pancreas · Pubmed #24743379.

ABSTRACT: OBJECTIVES: The objectives of this study were to assess the long-term quality of life (QOL) after the resection of a primary pancreatic cyst and to determine predictors of outcome. Secondary outcomes were pancreatic function and survival. METHODS: One hundred eight consecutive patients, who underwent resection between 1992 and 2007 and had nearly 60 months follow-up, were reviewed. Questionnaires and function tests were collected during scheduled outpatient clinic visits. RESULTS: At follow-up, 20 patients had died. Five-year overall survival was 94% for benign and 62% for malignant neoplasia. Of 88 living patients, 65 (74%) returned questionnaires. Generic physical and mental QOL scores were equal or better compared with healthy references. None of the disease-specific symptom scales were above mean 50, implicating none to mild complaints. Independent predictors for good generic QOL were young age (P < 0.05) and resected malignancy (P < 0.05); predictors for good gastrointestinal QOL were male sex (P < 0.1), limited resection (P < 0.05), endocrine insufficiency (P < 0.05), and employment (P < 0.05). Endocrine insufficiency prevalence was 40%, and 59% for exocrine insufficiency. CONCLUSIONS: After cyst resection, long-term QOL is equal to healthy references, pancreatic insufficiency is prevalent but does not impair QOL, and survival relates positive compared with solid pancreatic adenocarcinoma. The excellent long-term outcome justifies proceeding with surgery once a medical indication for resection has been established.

20 Article Pancreatoduodenectomy associated complications influence cancer recurrence and time interval to death. 2014

van der Gaag, N A / Harmsen, K / Eshuis, W J / Busch, O R C / van Gulik, T M / Gouma, D J. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: navandergaag@gmail.com. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: d.j.gouma@amc.uva.nl. ·Eur J Surg Oncol · Pubmed #24388408.

ABSTRACT: BACKGROUND: Resection is the only life-prolonging option for pancreatic or periampullary cancer. Cell-mediated immunity might reduce progression of metastasis or local recurrence likelihood, but surgery associated morbidity can suppress this immunity. The aim of this study was to examine the influence of complications on cancer specific survival after pancreatoduodenectomy (PD) for pancreatic and periampullary cancer. METHOD: 517 consecutive patients who underwent PD for pancreatic or periampullary adenocarcinoma were analysed. RESULTS: After median follow-up of 24 (14-44) months, 377 (73%) patients had died from progressive disease, 140 (27%) were alive. Median survival for pancreatic adenocarcinoma was 22 (18-25) months following an uncomplicated postoperative course versus 16 (13-19) months for patients with major surgical complications (p = 0.021). Multivariable Cox regression analysis demonstrated that microscopically residual disease (R1), complications, and adjuvant therapy were independent factors for recurrence. Within the R1 group, survival for patients with complications was even more limited, 9.7 (8.3-11.0) versus 18.7 (15.0-22.5) for those without (p < 0.001). For patients with R1 resection complications was the only independent predictor for a shorter time interval to death (hazard ratio 1.96; 95% CI 1.16-3.30). Complications did not influence survival of patients with periampullary adenocarcinoma. CONCLUSION: Complications after resection are independently related to an impaired survival following PD for pancreatic, but not periampullary cancer. The effect is even more dramatic in patients who had an R1 resection. Although the relation is not causal per se, the findings support the hypothesis of a complication-induced, compromised immunity rendering patients more susceptible for recurrent disease.

21 Article Association of preoperative symptoms of gastric outlet obstruction with delayed gastric emptying after pancreatoduodenectomy. 2013

Atema, Jasper J / Eshuis, Wietse J / Busch, Olivier R C / van Gulik, Thomas M / Gouma, Dirk J. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. ·Surgery · Pubmed #23972659.

ABSTRACT: BACKGROUND: Delayed gastric emptying (DGE) is among the most common complications after pancreatoduodenectomy (PD) and might demand postoperative nutritional support. The aim of this study was to investigate the association between preoperative symptoms of gastric outlet obstruction and DGE after PD in an attempt to identify patients in whom placement of a feeding tube at time of operation might be beneficial. METHODS: We analyzed a consecutive series of 401 patients undergoing PD from a prospective database. Preoperative symptoms of nausea, vomiting, loss of appetite, weight loss, postprandial complaints, and dysphagia were retrospectively determined. Primary outcome was clinically relevant DGE according to the International Study Group of Pancreatic Surgery classification and the necessity of postoperative insertion of a nasojejunal feeding tube. RESULTS: The incidence of clinically relevant DGE was 33.2% (133/401 patients). A nasojejunal feeding tube was inserted in 119 patients (29.7%). Patients having ≥2 symptoms of gastric outlet obstruction except weight loss (50 patients; 12.5%), were at a greater risk of developing both DGE (21.1% vs 8.2%; P < .001) and the need for insertion of a feeding tube (21.8% vs 8.5%; P < .001). In multivariable logistic regression analysis, the presence of ≥2 symptoms of gastric outlet obstruction other than weight loss remained a significant predictor of DGE (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.8) and the need for insertion of a nasojejunal feeding tube (OR, 3.1; 95% CI, 1.7-5.7). CONCLUSION: The preoperative presence of ≥2 symptoms of gastric outlet obstruction is a significant predictor of postoperative DGE after PD. By applying this risk factor, patients in whom placement of a feeding tube during surgery should be considered can be identified.

22 Article [Reliability of the registration of data on complex patients: effects on the hospital standardised mortality ratio (HSMR) in the Netherlands]. 2012

Tol, Johanna A M G / Broekman, Mariëtte C / Brauers, Marcel A L / van Gulik, Thomas M / Busch, Olivier R C / Gouma, Dirk J. ·Academisch Medisch Centrum, Afd. Chirurgie, Amsterdam, the Netherlands. j.tol@amc.uva.nl ·Ned Tijdschr Geneeskd · Pubmed #23218029.

ABSTRACT: OBJECTIVE: To evaluate the reliability of data registration in calculating the hospital standardised mortality ratio (HSMR). DESIGN: Retrospective, descriptive. METHOD: Data were collected from a research database on all patients who had undergone a partial pancreatoduodenectomy for pancreatic cancer in 2009 and 2010 at our hospital. These data were compared with information about these same patients recorded in the Dutch National Medical Registry (LMR), obtained from the medical administration department of our hospital. The differences between these 2 databases were evaluated on the basis of 3 variables: mortality, main diagnosis and secondary diagnoses (differentiated into complications and co-morbidities). Using the Charlson index, the co-morbidity score from both registries was calculated per patient. RESULTS: A total of 118 patients had been registered in the research database. Of these patients, 103 appeared in the LMR data; 15 had not been registered in this database. There were no differences in patient characteristics or mortality (2.5%) between the registries. In the LMR, the main diagnosis of 5 patients had been incorrectly recorded. This database contained information on 136 complications and 51 co-morbidities, of which 35 comorbities had been correctly recorded. The research database contained information on 188 complications and 99 comorbidities on these same patients. In the research database, comorbidity comprised 34% of all secondary diagnoses; in the LMR, 19% (p < 0.001). The median score on the Charlson index was 0 for all patients in the LMR and 3 in the research database (p < 0.001). CONCLUSION: Comorbidities in patients with pancreatic carcinoma who undergo a resection are being inadequately recorded in the LMR. This results in insufficient correction in the case mix and a low score on the Charlson index, which could result in an incorrect HSMR.

23 Article Evaluation of a selective management strategy of patients with primary cystic neoplasms of the pancreas. 2011

de Castro, S M M / Houwert, J T / van der Gaag, N A / Busch, O R C / van Gulik, T M / Gouma, D J. ·The Department of Surgery,Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. ·Int J Surg · Pubmed #21925294.

ABSTRACT: BACKGROUND: Recent studies have shown that a selective group of patients with primary cystic neoplasms of the pancreas can be managed conservatively by radiological follow-up. The aim of this study was to analyze if such a strategy is efficient and safe. PATIENTS AND METHODS: A retrospective analyses was performed of patients who underwent resection between January 1992 and January 2006 for primary cystic neoplasms of the pancreas in an era of aggressive management (i.e. all patients underwent resection) in order to analyze if the selective algorithm as proposed by the Memorial Sloan-Kettering Cancer Center is efficient and safe. RESULTS: One hundred patients underwent a resection for pancreatic cysts. Thirty-five percent of the patients with symptomatic cysts had a (pre)malignant lesion compared with 15% of the patients with an incidental cysts. In hospital mortality occurred in 1% of the patients and a postoperative complications in 39%. The Memorial Sloan-Kettering Cancer Center nomogram was able to correctly identify all patients with a benign incidental cyst. CONCLUSION: A selective management strategy can be implemented and algorithm proposed by the Memorial Sloan-Kettering Cancer Center nomogram is safe and efficient.

24 Article [Jaundice and a pancreatic tumour caused by auto-immune pancreatitis]. 2011

Coenen, Sandra / Welling, Lieke / de Schryver, Anneke M P / Laméris, Johan S / Schipper, D Lucette / van Gulik, Thomas M. ·Jeroen Bosch Ziekenhuis, Afd. Maag-, Darm- en Leverziekten, Den Bosch, the Netherlands. s.coenen@jbz.nl ·Ned Tijdschr Geneeskd · Pubmed #21902846.

ABSTRACT: Three male patients aged between 50 and 70 years were referred with jaundice and weight loss. Imaging showed a pancreatic mass and changes in the calibre of the choledochal or pancreatic duct, suggestive of malignancy. Two patients were operated on. One patient was considered to have an unresectable carcinoma but showed remarkable clinical improvement after steroids were given for his poor condition. In the other patient a resection was performed. Histology showed IgG4-positive plasma cell infiltration without signs of malignancy. Eventually these patients were diagnosed with auto-immune pancreatitis (AIP). In the third patient AIP was considered beforehand and this patient was treated with steroids. He responded quickly both clinically and radiologically. CT imaging showed complete remission of the mass. AIP is a benign inflammatory process which can mimic pancreatic carcinoma. In doubtful cases, a short trial of steroids might be considered.

25 Article Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. 2011

Eshuis, Wietse J / Hermanides, Jeroen / van Dalen, Jan W / van Samkar, Gan / Busch, Olivier R C / van Gulik, Thomas M / DeVries, J Hans / Hoekstra, Joost B L / Gouma, Dirk J. ·Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. ·Ann Surg · Pubmed #21475014.

ABSTRACT: OBJECTIVE: To investigate the relation between perioperative hyperglycemia and complications after pancreatoduodenectomy. BACKGROUND: Perioperative hyperglycemia is associated with complications after various types of surgery. This relation was never investigated for pancreatoduodenectomy. METHODS: In a consecutive series of 330 patients undergoing pancreatoduodenectomy, glucose values were collected from the hospital information system during 3 periods: pre-, intra-, and early postoperative. The average glucose value per period was calculated for each patient and divided in duals according to the median group value. Odds ratios for complications were calculated for the upper versus lower dual, adjusted for age, sex, American Society of Anesthesiologists Classification, body mass index, diabetes mellitus, intraoperative blood transfusion, duration of surgery, intraoperative insulin administration, and octreotide use. The same procedures were carried out to assess the consequences of increased glucose variability, expressed by the standard deviation. RESULTS: Average glucose values were 135 (preoperative), 133 (intraoperative) and 142 mg/dL (early postoperative). Pre- and intraoperative glucose values were not associated with postoperative complications. Early postoperative hyperglycemia (≥140 mg/dL) was significantly associated with complications [odds ratio (OR) 2.9, 95% confidence interval (CI), 1.7-4.9]. Overall, high glucose variability was not significantly associated with postoperative complications, but early postoperative patients who had both high glucose values and high variability had an OR for complications of 3.6 (95% CI, 1.9-6.8) compared to the lower glucose dual. CONCLUSIONS: Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. High glucose variability may enhance this risk. Future research must demonstrate whether strict glucose control in the early postoperative period prevents complications after pancreatoduodenectomy.

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