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Pancreatic Neoplasms: HELP
Articles by Hjalmar C. van Santvoort
Based on 31 articles published since 2010
(Why 31 articles?)
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Between 2010 and 2020, H. van Santvoort wrote the following 31 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies. 2019

van Veldhuisen, Eran / van den Oord, Claudia / Brada, Lilly J / Walma, Marieke S / Vogel, Jantien A / Wilmink, Johanna W / Del Chiaro, Marco / van Lienden, Krijn P / Meijerink, Martijn R / van Tienhoven, Geertjan / Hackert, Thilo / Wolfgang, Christopher L / van Santvoort, Hjalmar / Groot Koerkamp, Bas / Busch, Olivier R / Molenaar, I Quintus / van Eijck, Casper H / Besselink, Marc G / Anonymous4290998. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. · Department of Surgery, Regional Academic Cancer Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands. · Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. · Department of Surgery, University of Colorado, Denver, CO 80045, USA. · Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. · Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, VU University, 1081 HV Amsterdam, The Netherlands. · Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. · Department of Surgery, Universitätsklinikum Heidelberg, 69120 Heidelberg, Germany. · Department of Surgery, John's Hopkins Hospital, Baltimore, MD 21287, USA. · Departments of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands. · Department of Surgery, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. m.g.besselink@amsterdamumc.nl. ·Cancers (Basel) · Pubmed #31336859.

ABSTRACT: Locally advanced pancreatic cancer (LAPC) has several definitions but essentially is a nonmetastasized pancreatic cancer, in which upfront resection is considered not beneficial due to extensive vascular involvement and consequent high chance of a nonradical resection. The introduction of FOLFIRINOX chemotherapy and gemcitabine-nab-paclitaxel (gem-nab) has had major implications for the management and outcome of patients with LAPC. After 4-6 months induction chemotherapy, the majority of patients have stable disease or even tumor-regression. Of these, 12 to 35% are successfully downstaged to resectable disease. Several studies have reported a 30-35 months overall survival after resection; although it currently remains unclear if this is a result of the resection or the good response to chemotherapy. Following chemotherapy, selection of patients for resection is difficult, as contrast-enhanced computed-tomography (CT) scan is unreliable in differentiating between viable tumor and fibrosis. In case a resection is not considered possible but stable disease is observed, local ablative techniques are being studied, such as irreversible electroporation, radiofrequency ablation, and stereotactic body radiation therapy. Pragmatic, multicenter, randomized studies will ultimately have to confirm the exact role of both surgical exploration and ablation in these patients. Since evidence-based guidelines for the management of LAPC are lacking, this review proposes a standardized approach for the treatment of LAPC based on the best available evidence.

2 Review Postoperative surveillance of pancreatic cancer patients. 2019

Daamen, L A / Groot, V P / Intven, M P W / Besselink, M G / Busch, O R / Koerkamp, B Groot / Mohammad, N Haj / Hermans, J J / van Laarhoven, H W M / Nuyttens, J J / Wilmink, J W / van Santvoort, H C / Molenaar, I Q / Stommel, M W J / Anonymous1300994. ·Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, the Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands. Electronic address: L.A.Daamen-3@umcutrecht.nl. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, the Netherlands. · Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands. · Dept. of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Dept. of Surgery, Erasmus MC, Rotterdam, the Netherlands. · Dept. of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands. · Dept. of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. · Dept. of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Dept. of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands. · Dept. of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands. · Dept. of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: Martijn.Stommel@RadboudUMC.nl. ·Eur J Surg Oncol · Pubmed #31204168.

ABSTRACT: BACKGROUND: The aim of this study is to collect the best available evidence for diagnostic modalities, frequency, and duration of surveillance after resection for pancreatic ductal adenocarcinoma (PDAC). METHODS: PDAC guidelines published after 2015 were collected. Furthermore, a systematic search of the literature on postoperative surveillance was performed in PubMed and Embase from 2000 to 2019. Articles comparing different diagnostic modalities and frequencies of postoperative surveillance in PDAC patients with regard to survival, quality of life, morbidity and cost-effectiveness were selected. RESULTS: The literature search resulted in 570 articles. A total of seven guidelines and twelve original clinical studies were eventually evaluated. PDAC guidelines increasingly recommend a combination of tumor marker testing and computed tomography (CT) imaging every three to six months during the first two years after resection. These guidelines are, however, based on expert opinion and other low-level evidence. Prospective studies comparing different surveillance strategies are lacking. According to recent studies, surveillance with tumor markers and imaging at regular intervals results in the detection of PDAC recurrence before the onset of symptoms and more frequent administration of further therapy, such as chemotherapy or radiotherapy. CONCLUSION: Current evidence for recurrence-focused surveillance after PDAC resection is limited and contradictory. Consequently, recommendations on surveillance are conflicting. To define the clinical merit of recurrence-focused surveillance, patients who are most likely to benefit from early detection and treatment of PDAC recurrence need to be identified. To this purpose, well-designed prospective studies are needed, accounting for both economical and psychosocial implications of surveillance.

3 Review The diagnostic performance of CT versus FDG PET-CT for the detection of recurrent pancreatic cancer: a systematic review and meta-analysis. 2018

Daamen, Lois A / Groot, Vincent P / Goense, Lucas / Wessels, Frank J / Borel Rinkes, Inne H / Intven, Martijn P W / van Santvoort, Hjalmar C / Molenaar, I Quintus. ·Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands. Electronic address: L.A.Daamen-3@umcutrecht.nl. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands. · Dept. of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands. · Dept. of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands. · Dept. of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein. Electronic address: I.Q.Molenaar@umcutrecht.nl. ·Eur J Radiol · Pubmed #30150034.

ABSTRACT: OBJECTIVES: Radiologic surveillance after resection of pancreatic ductal adenocarcinoma (PDAC) can provide information on the extent and location of disease recurrence. This systematic review and meta-analysis aims to give an overview of the literature on the diagnostic performance of different imaging modalities for the detection of recurrent disease after surgery for PDAC. METHODS: A systematic search was performed in PubMed, EMBASE and Cochrane Library up to 20 December 2017. All studies reporting on the diagnostic value of imaging modalities for the detection of local and/or distant disease recurrence during follow-up after resection of PDAC were eligible. Both histologic confirmation of recurrent PDAC and clinical confirmation by disease progression on follow-up imaging were considered as suitable reference standard. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used for critical appraisal of methodological quality. Diagnostic accuracy data were extracted or calculated and presented in forest plots. A bivariate random-effects model was used to calculate pooled estimates of sensitivity and specificity. RESULTS: A total of seven retrospective studies with 333 relevant patients were ultimately eligible for data extraction. Overall, the methodological quality of the included studies was acceptable. All seven articles described test results of contrast-enhanced CT, whilst five and three articles reported outcomes on diagnostic accuracy of FDG PET-CT and FDG PET-CT combined with contrast-enhanced CT, respectively. For CT, pooled estimates for sensitivity were 0.70 (95% CI 0.61-0.78) and for specificity 0.80 (95% CI 0.69-0.88). For FDG PET-CT, pooled estimates for sensitivity and specificity were 0.88 (95% CI 0.81-0.93) and 0.89 (95% CI 0.80-0.94), respectively. For FDG PET-CT in combination with contrast-enhanced CT, pooled estimates for sensitivity were 0.95 (95% CI 0.88-0.98) and for specificity 0.81 (95% CI 0.63-0.92). CONCLUSIONS: According to the current literature, post-operative CT has a moderate diagnostic accuracy in the detection of recurrent disease. FDG PET-CT imaging could be of additional value when disease recurrence is suspected despite negative or equivocal CT findings. Nevertheless, evidence supporting radiologic surveillance after resection of PDAC is limited. Future prospective studies are needed to optimize surveillance strategies after resection of pancreatic cancer.

4 Review Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. 2017

Groot, Vincent P / van Santvoort, Hjalmar C / Rombouts, Steffi J E / Hagendoorn, Jeroen / Borel Rinkes, Inne H M / van Vulpen, Marco / Herman, Joseph M / Wolfgang, Christopher L / Besselink, Marc G / Molenaar, I Quintus. ·Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands; Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands; Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands. · Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands. · Dept. of Radiation Oncology, University Medical Center Utrecht Cancer Center, The Netherlands. · Dept. of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands. · Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl. ·HPB (Oxford) · Pubmed #28065427.

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.

5 Review Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer. 2016

Rombouts, Steffi J / Walma, Marieke S / Vogel, Jantien A / van Rijssen, Lennart B / Wilmink, Johanna W / Mohammad, Nadia Haj / van Santvoort, Hjalmar C / Molenaar, I Quintus / Besselink, Marc G. ·Department of Surgery, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands. · Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands. · Department of Medical Oncology, Academic Medical Centre, Amsterdam, The Netherlands. · Department of Medical Oncology, University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands. · Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. · Department of Surgery, G4-196, Academic Medical Centre, Amsterdam, The Netherlands. m.g.besselink@amc.uva.nl. ·Ann Surg Oncol · Pubmed #27370653.

ABSTRACT: BACKGROUND: FOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC. METHODS: The PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate. RESULTS: Fourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3-4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3-4 toxicity. CONCLUSIONS: Outcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.

6 Review Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis. 2016

van Rijssen, Lennart B / Narwade, Poorvi / van Huijgevoort, Nadine C M / Tseng, Dorine S J / van Santvoort, Hjalmar C / Molenaar, Isaac Q / van Laarhoven, Hanneke W M / van Eijck, Casper H J / Busch, Olivier R C / Besselink, Marc G H / Anonymous6500872. ·Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. · Department of Surgery, Utrecht Medical Center, Utrecht, Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands. · Department of Medical Oncology, Academic Medical Center, Amsterdam, Netherlands. · Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Electronic address: m.g.besselink@amc.nl. ·HPB (Oxford) · Pubmed #27346135.

ABSTRACT: BACKGROUND: Hepatic-artery and para-aortic lymph node metastases (LNM) may be detected during surgical exploration for pancreatic (PDAC) or periampullary cancer. Some surgeons will continue the resection while others abort the exploration. METHODS: A systematic search was performed in PubMed, EMBASE and Cochrane Library for studies investigating survival in patients with intra-operatively detected hepatic-artery or para-aortic LNM. Survival was stratified for node positive (N1) disease. RESULTS: After screening 3088 studies, 13 studies with 2045 patients undergoing pancreatoduodenectomy were included. No study reported survival data after detection of LNM and aborted surgical exploration. In 110 patients with hepatic-artery LNM, median survival ranged between 7 and 17 months. Estimated pooled mean survival in 84 patients with hepatic-artery LNM was 15 [95%CI 12-18] months (13 months in PDAC), compared to 19 [16-22] months in 270 patients with N1-disease without hepatic-artery LNM (p = 0.020). In 192 patients with para-aortic LNM, median survival ranged between 5 and 32 months. Estimated pooled mean survival in 169 patients with para-aortic LNM was 13 [8-17] months (11 months in PDAC), compared to 17 (6-27) months in 506 patients with N1-disease without para-aortic LNM (p < 0.001). Data on the impact of (neo)adjuvant therapy on survival were lacking. CONCLUSION: Survival after pancreatoduodenectomy in patients with intra-operatively detected hepatic-artery and especially para-aortic LNM is inferior to patients undergoing pancreatoduodenectomy with other N1 disease. It remains unclear what the consequence of this should be since data on (neo-)adjuvant therapy and survival after aborted exploration are lacking.

7 Review Pancreatic Exocrine Insufficiency in Patients With Pancreatic or Periampullary Cancer: A Systematic Review. 2016

Tseng, Dorine S J / Molenaar, I Quintus / Besselink, Marc G / van Eijck, Casper H / Borel Rinkes, Inne H / van Santvoort, Hjalmar C. ·From the *Department of Surgery, University Medical Center Utrecht, Utrecht; †Department of Surgery, Academic Medical Center, Amsterdam; and ‡Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. ·Pancreas · Pubmed #26495777.

ABSTRACT: OBJECTIVES: The aim of this study was to determine the prevalence of pancreatic exocrine insufficiency in patients with pancreatic or periampullary cancer, both before and after resection. METHODS: Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines). We included studies reporting on pancreatic exocrine insufficiency in patients with pancreatic or periampullary cancer. Data on patient demographics, type of pancreatic resection, diagnostic test, and occurrence of pancreatic exocrine insufficiency were extracted. Prevalence of pancreatic exocrine insufficiency was calculated before and after pancreatic resections and in patients with locally advanced pancreatic cancer. RESULTS: Nine observational cohort studies with 693 patients were included. Median preoperative prevalence of pancreatic exocrine insufficiency was 44% (range, 42%-47%) before pancreatoduodenectomy, 20% (range, 16%-67%) before distal pancreatectomy, 63% before total pancreatectomy, and 25% to 50% in patients with locally advanced pancreatic cancer. The median prevalence of pancreatic exocrine insufficiency at least 6 months after pancreatoduodenectomy was 74% (range, 36%-100%) and 67% to 80% after distal pancreatectomy. CONCLUSION: Pancreatic exocrine insufficiency is diagnosed in approximately half of all patients scheduled to undergo resection for pancreatic or periampullary cancer. The prevalence increases markedly after resection. These data highlight the need of pancreatic enzyme suppletion in these patients.

8 Review Systematic review on the use of matrix-bound sealants in pancreatic resection. 2015

Smits, F Jasmijn / van Santvoort, Hjalmar C / Besselink, Marc G H / Borel Rinkes, Inne H M / Molenaar, I Quintus. ·Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. ·HPB (Oxford) · Pubmed #26292846.

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.

9 Review Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. 2015

Rombouts, S J E / Vogel, J A / van Santvoort, H C / van Lienden, K P / van Hillegersberg, R / Busch, O R C / Besselink, M G H / Molenaar, I Q. ·Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. ·Br J Surg · Pubmed #25524417.

ABSTRACT: BACKGROUND: Locally advanced pancreatic cancer (LAPC) is associated with a very poor prognosis. Current palliative (radio)chemotherapy provides only a marginal survival benefit of 2-3 months. Several innovative local ablative therapies have been explored as new treatment options. This systematic review aims to provide an overview of the clinical outcomes of these ablative therapies. METHODS: A systematic search in PubMed, Embase and the Cochrane Library was performed to identify clinical studies, published before 1 June 2014, involving ablative therapies in LAPC. Outcomes of interest were safety, survival, quality of life and pain. RESULTS: After screening 1037 articles, 38 clinical studies involving 1164 patients with LAPC, treated with ablative therapies, were included. These studies concerned radiofrequency ablation (RFA) (7 studies), irreversible electroporation (IRE) (4), stereotactic body radiation therapy (SBRT) (16), high-intensity focused ultrasound (HIFU) (5), iodine-125 (2), iodine-125-cryosurgery (2), photodynamic therapy (1) and microwave ablation (1). All strategies appeared to be feasible and safe. Outcomes for postoperative, procedure-related morbidity and mortality were reported only for RFA (4-22 and 0-11 per cent respectively), IRE (9-15 and 0-4 per cent) and SBRT (0-25 and 0 per cent). Median survival of up to 25·6, 20·2, 24·0 and 12·6 months was reported for RFA, IRE, SBRT and HIFU respectively. Pain relief was demonstrated for RFA, IRE, SBRT and HIFU. Quality-of-life outcomes were reported only for SBRT, and showed promising results. CONCLUSION: Ablative therapies in patients with LAPC appear to be feasible and safe.

10 Review Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer: a systematic review and meta-analysis. 2014

Tseng, Dorine S J / van Santvoort, Hjalmar C / Fegrachi, Samira / Besselink, Marc G / Zuithoff, Nicolaas P A / Borel Rinkes, Inne H / van Leeuwen, Maarten S / Molenaar, I Quintus. ·Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. Electronic address: D.S.J.Tseng@umcutrecht.nl. · Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. · Department of Surgery, Academic Medical Center Amsterdam, HG G4-196, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HG STR6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. · Department of Radiology, University Medical Center Utrecht, HG E01.132, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. · Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. Electronic address: I.Q.Molenaar@umcutrecht.nl. ·Surg Oncol · Pubmed #25466853.

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.

11 Review Radiofrequency ablation for unresectable locally advanced pancreatic cancer: a systematic review. 2014

Fegrachi, Samira / Besselink, Marc G / van Santvoort, Hjalmar C / van Hillegersberg, Richard / Molenaar, Izaak Quintus. ·Department of Surgery, University Medical Centre Utrecht, Utrecht. ·HPB (Oxford) · Pubmed #23600801.

ABSTRACT: BACKGROUND: Median survival in patients with unresectable locally advanced pancreatic cancer lies in the range of 9-15 months. Radiofrequency ablation (RFA) may prolong survival, but data on its safety and efficacy are scarce. METHODS: A systematic literature search was performed in PubMed, EMBASE and the Cochrane Library with the syntax '(radiofrequency OR RFA) AND (pancreas OR pancreatic)' for studies published until 1 January 2012. In addition, a search of the proceedings of conferences on pancreatic disease that took place during 2009-2011 was performed. Studies with fewer than five patients were excluded as they were considered to be case reports. The primary endpoint was survival. Secondary endpoints included morbidity and mortality. RESULTS: Five studies involving a total of 158 patients with pancreatic cancer treated with RFA fulfilled the eligibility criteria. These studies reported median survival after RFA of 3-33 months, morbidity related to RFA of 4-37%, mortality of 0-19% and overall morbidity of 10-43%. Pooling of data was not appropriate as the study populations and reported outcomes were heterogeneous. Crucial safety aspects included ensuring a maximum RFA tip temperature of < 90 °C and ensuring minimum distances between the RFA probe and surrounding structures. CONCLUSIONS: Radiofrequency ablation seems to be feasible and safe when it is used with the correct temperature and at an appropriate distance from vital structures. It appears to have a positive impact on survival. Multicentre randomized trials are necessary to determine the true effect size of RFA and to minimize the impacts of selection and publication biases.

12 Review Robot-assisted pancreatic surgery: a systematic review of the literature. 2013

Strijker, Marin / van Santvoort, Hjalmar C / Besselink, Marc G / van Hillegersberg, Richard / Borel Rinkes, Inne H M / Vriens, Menno R / Molenaar, I Quintus. ·Department of Surgery, University Medical Centre, Utrecht, the Netherlands. ·HPB (Oxford) · Pubmed #23216773.

ABSTRACT: BACKGROUND: To potentially improve outcomes in pancreatic resection, robot-assisted pancreatic surgery has been introduced. This technique has possible advantages over laparoscopic surgery, such as its affordance of three-dimensional vision and increased freedom of movement of instruments. A systematic review was performed to assess the safety and feasibility of robot-assisted pancreatic surgery. METHODS: The literature published up to 30 September 2011 was systematically reviewed, with no restrictions on publication date. Studies reporting on over five patients were included. Animal studies, studies not reporting morbidity and mortality, review articles and conference abstracts were excluded. Data were extracted and weighted means were calculated. RESULTS: A total of 499 studies were screened, after which eight cohort studies reporting on a total of 251 patients undergoing robot-assisted pancreatic surgery were retained for analysis. Weighted mean operation time was 404 ± 102 min (510 ± 107 min for pancreatoduodenectomy only). The rate of conversion was 11.0% (16.4% for pancreatoduodenectomy only). Overall morbidity was 30.7% (n = 77), most frequently involving pancreatic fistulae (n = 46). Mortality was 1.6%. Negative surgical margins were obtained in 92.9% of patients. The rate of spleen preservation in distal pancreatectomy was 87.1%. CONCLUSIONS: Robot-assisted pancreatic surgery seems to be safe and feasible in selected patients and, in left-sided resections, may increase the rate of spleen preservation. Randomized studies should compare the respective outcomes of robot-assisted, laparoscopic and open pancreatic surgery.

13 Article Nationwide trends in incidence, treatment and survival of pancreatic ductal adenocarcinoma. 2020

Latenstein, Anouk E J / van der Geest, Lydia G M / Bonsing, Bert A / Groot Koerkamp, Bas / Haj Mohammad, Nadia / de Hingh, Ignace H J T / de Meijer, Vincent E / Molenaar, Izaak Q / van Santvoort, Hjalmar C / van Tienhoven, Geertjan / Verheij, Joanne / Vissers, Pauline A J / de Vos-Geelen, Judith / Busch, Olivier R / van Eijck, Casper H J / van Laarhoven, Hanneke W M / Besselink, Marc G / Wilmink, Johanna W / Anonymous1821040. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: a.e.latenstein@amsterdamumc.nl. · Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, Erasmus MC, Rotterdam, the Netherlands. · Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. · Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. · Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein and University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands. · Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. · Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. · Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. · Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. · Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: j.w.wilmink@amsterdamumc.nl. ·Eur J Cancer · Pubmed #31841792.

ABSTRACT: BACKGROUND: In recent years, new treatment options have become available for pancreatic ductal adenocarcinoma (PDAC) including 5-fluorouracil, leucovorin, irinotecan and oxaliplatin. The impact hereof has not been assessed in nationwide cohort studies. This population-based study aimed to investigate nationwide trends in incidence, treatment and survival of PDAC. MATERIALS AND METHODS: Patients with PDAC (1997-2016) were included from the Netherlands Cancer Registry. Results were categorised by treatment and by period of diagnosis (1997-2000, 2001-2004, 2005-2008, 2009-2012 and 2013-2016). Kaplan-Meier survival analysis was used to calculate overall survival. RESULTS: In a national cohort of 36,453 patients with PDAC, the incidence increased from 12.1 (1997-2000) to 15.3 (2013-2016) per 100,000 (p < 0.001), whereas median overall survival increased from 3.1 to 3.8 months (p < 0.001). Over time, the resection rate doubled (8.3%-16.6%, p-trend<0.001), more patients received adjuvant chemotherapy (3.0%-56.2%, p-trend<0.001) and 3-year overall survival following resection increased (16.9%-25.4%, p < 0.001). Over time, the proportion of patients with metastatic disease who received palliative chemotherapy increased from 5.3% to 16.1% (p-trend<0.001), whereas 1-year survival improved from 13.3% to 21.2% (p < 0.001). The proportion of patients who only received supportive care decreased from 84% to 61% (p-trend<0.001). CONCLUSION: The incidence of PDAC increased in the past two decades. Resection rates and use of adjuvant or palliative chemotherapy increased with improved survival in these patients. In all patients with PDAC, however, the survival benefit of 3 weeks is negligible because the majority of patients only received supportive care.

14 Article Safety of radiofrequency ablation in patients with locally advanced, unresectable pancreatic cancer: A phase II study. 2019

Fegrachi, Samira / Walma, Marieke S / de Vries, Jan J J / van Santvoort, Hjalmar C / Besselink, Marc G / von Asmuth, Erik G / van Leeuwen, Maarten S / Borel Rinkes, Inne H / Bruijnen, Rutger C / de Hingh, Ignace H / Klaase, Joost M / Molenaar, I Quintus / van Hillegersberg, Richard. ·Departments of Surgery, University Medical Center Utrecht Cancer Center, St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. · Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands. · Department of Radiology, University Medical Center Utrecht Cancer Center, University of Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. · Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands. · Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. · Departments of Surgery, University Medical Center Utrecht Cancer Center, St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. Electronic address: r.vanhillegersberg@umcutrecht.nl. ·Eur J Surg Oncol · Pubmed #31227340.

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.

15 Article Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial. 2019

de Rooij, Thijs / van Hilst, Jony / van Santvoort, Hjalmar / Boerma, Djamila / van den Boezem, Peter / Daams, Freek / van Dam, Ronald / Dejong, Cees / van Duyn, Eino / Dijkgraaf, Marcel / van Eijck, Casper / Festen, Sebastiaan / Gerhards, Michael / Groot Koerkamp, Bas / de Hingh, Ignace / Kazemier, Geert / Klaase, Joost / de Kleine, Ruben / van Laarhoven, Cornelis / Luyer, Misha / Patijn, Gijs / Steenvoorde, Pascal / Suker, Mustafa / Abu Hilal, Moh'd / Busch, Olivier / Besselink, Marc / Anonymous2620957. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht, the Netherlands. · Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. · Department of Surgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands. · Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands, and Universitätsklinikum Aachen, Aachen, Germany. · Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. · Clinical Research Unit, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Surgery, OLVG, Amsterdam, the Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. · Department of Surgery, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. · Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. · Department of Surgery, Isala Clinics, Zwolle, the Netherlands. · Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK. ·Ann Surg · Pubmed #30080726.

ABSTRACT: OBJECTIVE: This trial followed a structured nationwide training program in minimally invasive distal pancreatectomy (MIDP), according to the IDEAL framework for surgical innovation, and aimed to compare time to functional recovery after minimally invasive and open distal pancreatectomy (ODP). BACKGROUND: MIDP is increasingly used and may enhance postoperative recovery as compared with ODP, but randomized studies are lacking. METHODS: A multicenter patient-blinded randomized controlled superiority trial was performed in 14 centers between April 2015 and March 2017. Adult patients with left-sided pancreatic tumors confined to the pancreas without vascular involvement were randomly assigned (1:1) to undergo MIDP or ODP. Patients were blinded for type of surgery using a large abdominal dressing. The primary endpoint was time to functional recovery. Analysis was by intention to treat. This trial was registered with the Netherlands Trial Register (NTR5689). RESULTS: Time to functional recovery was 4 days [interquartile range (IQR) 3-6) in 51 patients after MIDP versus 6 days (IQR 5-8) in 57 patients after ODP (P < 0.001). The conversion rate of MIDP was 8%. Operative blood loss was less after MIDP (150 vs 400 mL; P < 0.001), whereas operative time was longer (217 vs 179 minutes; P = 0.005). The Clavien-Dindo grade ≥III complication rate was 25% versus 38% (P = 0.21). Delayed gastric emptying grade B/C was seen less often after MIDP (6% vs 20%; P = 0.04). Postoperative pancreatic fistulas grade B/C were seen in 39% after MIDP versus 23% after ODP (P = 0.07), without difference in percutaneous catheter drainage (22% vs 20%; P = 0.77). Quality of life (day 3-30) was better after MIDP as compared with ODP, and overall costs were non-significantly less after MIDP. No 90-day mortality was seen after MIDP versus 2% (n = 1) after ODP. CONCLUSIONS: In patients with left-sided pancreatic tumors confined to the pancreas, MIDP reduces time to functional recovery compared with ODP. Although the overall rate of complications was not reduced, MIDP was associated with less delayed gastric emptying and better quality of life without increasing costs.

16 Article Association of the location of pancreatic ductal adenocarcinoma (head, body, tail) with tumor stage, treatment, and survival: a population-based analysis. 2018

van Erning, Felice N / Mackay, Tara M / van der Geest, Lydia G M / Groot Koerkamp, B / van Laarhoven, Hanneke W M / Bonsing, Bert A / Wilmink, Johanna W / van Santvoort, Hjalmar C / de Vos-Geelen, Judith / van Eijck, Casper H J / Busch, Olivier R / Lemmens, Valery E / Besselink, Marc G / Anonymous3190963. ·a Department of Research , Netherlands Comprehensive Cancer Organisation (IKNL) , Utrecht , Netherlands. · b Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC , University of Amsterdam , Amsterdam , Netherlands. · c Department of Surgery , Erasmus Medical Center , Rotterdam , the Netherlands. · d Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC , University of Amsterdam , Amsterdam , the Netherlands. · e Department of Surgery , Leiden University Medical Center , Leiden , the Netherlands. · f Department of Surgery, Regional Academic Cancer Center Utrecht , University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein , Nieuwegein , the Netherlands. · g Department of Internal Medicine, Division of Medical Oncology , GROW - School for Oncology and Developmental Biology, Maastricht UMC+ , Maastricht , the Netherlands. · h Department of Public Health , Erasmus Medical Center , Rotterdam , the Netherlands. ·Acta Oncol · Pubmed #30264642.

ABSTRACT: BACKGROUND: The association between pancreatic ductal adenocarcinoma (PDAC) location (head, body, tail) and tumor stage, treatment and overall survival (OS) is unclear. METHODS: Patients with PDAC diagnosed between 2005 and 2015 were included from the population-based Netherlands Cancer Registry. Patient, tumor and treatment characteristics were compared with the tumor locations. Multivariable logistic and Cox regression analyses were used. RESULTS: Overall, 19,023 patients were included. PDAC locations were 13,451 (71%) head, 2429 (13%) body and 3143 (16%) tail. Differences were found regarding metastasized disease (head 42%, body 69%, tail 84%, p < .001), size (>4 cm: 21%, 40%, 51%, p < .001) and resection rate (17%, 4%, 7%, p < .001). For patients without metastases, median OS did not differ between head, body, tail (after resection: 16.8, 15.0, 17.3 months, without resection: 5.2, 6.1, 4.6 months, respectively). For patients with metastases, median OS differed slightly (2.6, 2.4, 1.9 months, respectively, adjusted HR body versus head 1.17 (95%CI 1.10-1.23), tail versus head 1.35 (95%CI 1.29-1.41)). CONCLUSIONS: PDAC locations in body and tail are larger, more often metastasized and less often resectable than in the pancreatic head. Whereas survival is similar after resection, survival in metastasized disease is somewhat less for PDAC in the pancreatic body and tail.

17 Article The Dutch Pancreas Biobank Within the Parelsnoer Institute: A Nationwide Biobank of Pancreatic and Periampullary Diseases. 2018

Strijker, Marin / Gerritsen, Arja / van Hilst, Jony / Bijlsma, Maarten F / Bonsing, Bert A / Brosens, Lodewijk A / Bruno, Marco J / van Dam, Ronald M / Dijk, Frederike / van Eijck, Casper H / Farina Sarasqueta, Arantza / Fockens, Paul / Gerhards, Michael F / Groot Koerkamp, Bas / van der Harst, Erwin / de Hingh, Ignace H / van Hooft, Jeanin E / Huysentruyt, Clément J / Kazemier, Geert / Klaase, Joost M / van Laarhoven, Cornelis J / van Laarhoven, Hanneke W / Liem, Mike S / de Meijer, Vincent E / van Rijssen, L Bengt / van Santvoort, Hjalmar C / Suker, Mustafa / Verhagen, Judith H / Verheij, Joanne / Verspaget, Hein W / Wennink, Roos A / Wilmink, Johanna W / Molenaar, I Quintus / Boermeester, Marja A / Busch, Olivier R / Besselink, Marc G / Anonymous3030939. · ·Pancreas · Pubmed #29521943.

ABSTRACT: OBJECTIVES: Large biobanks with uniform collection of biomaterials and associated clinical data are essential for translational research. The Netherlands has traditionally been well organized in multicenter clinical research on pancreatic diseases, including the nationwide multidisciplinary Dutch Pancreatic Cancer Group and Dutch Pancreatitis Study Group. To enable high-quality translational research on pancreatic and periampullary diseases, these groups established the Dutch Pancreas Biobank. METHODS: The Dutch Pancreas Biobank is part of the Parelsnoer Institute and involves all 8 Dutch university medical centers and 5 nonacademic hospitals. Adult patients undergoing pancreatic surgery (all indications) are eligible for inclusion. Preoperative blood samples, tumor tissue from resected specimens, pancreatic cyst fluid, and follow-up blood samples are collected. Clinical parameters are collected in conjunction with the mandatory Dutch Pancreatic Cancer Audit. RESULTS: Between January 2015 and May 2017, 488 patients were included in the first 5 participating centers: 4 university medical centers and 1 nonacademic hospital. Over 2500 samples were collected: 1308 preoperative blood samples, 864 tissue samples, and 366 follow-up blood samples. CONCLUSIONS: Prospective collection of biomaterials and associated clinical data has started in the Dutch Pancreas Biobank. Subsequent translational research will aim to improve treatment decisions based on disease characteristics.

18 Article Computed tomography findings after radiofrequency ablation in locally advanced pancreatic cancer. 2018

Rombouts, Steffi J E / Derksen, Tyche C / Nio, Chung Y / van Hillegersberg, Richard / van Santvoort, Hjalmar C / Walma, Marieke S / Molenaar, Izaak Q / van Leeuwen, Maarten S. ·Department of Surgery, University Medical Center Utrecht Cancer Center, 3508 GA, Utrecht, PO Box 85500, The Netherlands. · Department of Surgery, University Medical Center Utrecht Cancer Center, 3508 GA, Utrecht, PO Box 85500, The Netherlands. tychederksen@gmail.com. · Department of Radiology, Academic Medical Center Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. · Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands. · Department of Radiology, University Medical Center Utrecht Cancer Center, 3508 GA, Utrecht, PO Box 85500, The Netherlands. m.s.vanleeuwen@umcutrecht.nl. ·Abdom Radiol (NY) · Pubmed #29492602.

ABSTRACT: PURPOSE: The purpose of the study was to provide a systematic evaluation of the computed tomography(CT) findings after radiofrequency ablation (RFA) in locally advanced pancreatic cancer(LAPC). METHODS: Eighteen patients with intra-operative RFA-treated LAPC were included in a prospective case series. All CT-scans performed prior to RFA and 1 week and 3 months of post-RFA, according to standard regimen, were assessed by two radiologists in consensus, using standardized radiological scoring lists. RESULTS: 51 CT-scans were assessed. One week after RFA, the ablation zone was visible in all patients as a (partially) sharply defined (83%), heterogeneous area (94%). At 3 months of follow-up, the ablation zone was completely invaded by tumor in 67% of patients and still present, but decreased in 33%. In two patients (11%), local thrombosis and/or occlusion of the superior mesenteric vein occurred. The occlusions persisted without clinical consequences and the thrombosis disappeared. A peripancreatic fluid collection was visible 1 week after RFA in 3 patients, wherein the ablation zone extended ventrally outside of the pancreas. CONCLUSIONS: Directly after RFA for LAPC, a well-defined ablation zone is visible on CT-imaging. This ablation zone is usually replaced by tumor ingrowth after 3 months. Moreover, the ablation zone regularly included vascular structures, with rare asymptomatic venous occlusion or thrombosis and without adverse effects on arteries.

19 Article Systematic review on the role of serum tumor markers in the detection of recurrent pancreatic cancer. 2018

Daamen, Lois A / Groot, Vincent P / Heerkens, Hanne D / Intven, Martijn P W / van Santvoort, Hjalmar C / Molenaar, I Quintus. ·Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Radiation Oncology, UMC Utrecht Cancer Center, The Netherlands. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Surgery, The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Radiation Oncology, UMC Utrecht Cancer Center, The Netherlands. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands; Dept. of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. · Dept. of Surgery, UMC Utrecht Cancer Center, Utrecht, The Netherlands. Electronic address: I.Q.Molenaar@umcutrecht.nl. ·HPB (Oxford) · Pubmed #29366815.

ABSTRACT: BACKGROUND: Biomarker testing can be helpful to monitor disease progression after resection of pancreatic cancer. This systematic review aims to give an overview of the literature on the diagnostic value of serum tumor markers for the detection of recurrent pancreatic cancer during follow-up. METHODS: A systematic search was performed to 2 October 2017. All studies reporting on the diagnostic value of postoperatively measured serum biomarkers for the detection of pancreatic cancer recurrence were included. Data on diagnostic accuracy of tumor markers were extracted. Forest plots and pooled values of sensitivity and specificity were calculated. RESULTS: Four articles described test results of CA 19-9. A pooled sensitivity and specificity of respectively 0.73 (95% CI 0.66-0.80) and 0.83 (95% CI 0.73-0.91) were calculated. One article reported on CEA, showing a sensitivity of 50% and specificity of 65%. No other serum tumor markers were discussed for surveillance purposes in the current literature. CONCLUSION: Although testing of serum CA 19-9 has considerable limitations, CA 19-9 remains the most used serum tumor marker for surveillance after surgical resection of pancreatic cancer. Further studies are needed to assess the role of serum tumor marker testing in the detection of recurrent pancreatic cancer and to optimize surveillance strategies.

20 Article Systematic review on the impact of pancreatoduodenectomy on quality of life in patients with pancreatic cancer. 2018

van Dijk, Sven M / Heerkens, Hanne D / Tseng, Dorine S J / Intven, Martijn / Molenaar, I Quintus / van Santvoort, Hjalmar C. ·Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands. · Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands. · Department of Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Surgery, University Medical Center, Utrecht, The Netherlands. · Department of Surgery, University Medical Center, Utrecht, The Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: h.c.vansantvoort@umcutrecht.nl. ·HPB (Oxford) · Pubmed #29249649.

ABSTRACT: BACKGROUND: Patients undergoing pancreatoduodenectomy for pancreatic cancer have a high risk of major postoperative complications and a low survival rate. Insight in the impact of pancreatoduodenectomy on quality of life (QoL) is therefore of great importance. The aim of this systematic review was to assess QoL after pancreatoduodenectomy for pancreatic cancer. METHODS: A systematic review of the literature was performed according to the PRISMA guidelines. A systematic search of all the English literature available in PubMed and Medline was performed. All studies assessing QoL with validated questionnaires in pancreatic cancer patients undergoing pancreatoduodenectomy were included. RESULTS: After screening a total of 788 articles, the full texts of 36 articles were assessed, and 17 articles were included. QoL of physical and social functioning domains decreased in the first 3 months after surgery. Recovery of physical and social functioning towards baseline values took place after 3-6 months. Pain, fatigue and diarrhoea scores deteriorated postoperatively, but eventually resolved after 3-6 months. CONCLUSION: Pancreatoduodenectomy for malignant disease negatively influences QoL in the physical and social domains at short term. It will eventually recover to baseline values after 3-6 months. This information is valuable for counselling and expectation management of patients undergoing pancreatoduodenectomy.

21 Article Use of imaging during symptomatic follow-up after resection of pancreatic ductal adenocarcinoma. 2018

Groot, Vincent P / Daamen, Lois A / Hagendoorn, Jeroen / Borel Rinkes, Inne H M / van Santvoort, Hjalmar C / Molenaar, I Quintus. ·Department of Surgery, UMC Utrecht Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, UMC Utrecht Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands. · Department of Surgery, UMC Utrecht Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl. ·J Surg Res · Pubmed #29229122.

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.

22 Article Long-term health-related quality of life after pancreatic resection for malignancy in patients with and without severe postoperative complications. 2018

Heerkens, Hanne D / van Berkel, Lisanne / Tseng, Dorine S J / Monninkhof, Evelyn M / van Santvoort, Hjalmar C / Hagendoorn, Jeroen / Borel Rinkes, Inne H M / Lips, Irene M / Intven, Martijn / Molenaar, I Quintus. ·Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl. ·HPB (Oxford) · Pubmed #29092792.

ABSTRACT: BACKGROUND: Surgery for pancreatic cancer yields significant morbidity and mortality risks and survival is limited. Therefore, the influence of complications on quality of life (QoL) after pancreatic surgery is important. This study compares QoL in patients with and without severe complications after surgery for pancreatic (pre-)malignancy. METHODS: This prospective cohort study scored complications after pancreatic surgery according to the Clavien-Dindo system and the definitions of the International Study Group of Pancreatic Surgery. QoL was measured by the RAND36 questionnaire, the European Organization for Research and Treatment of Cancer core questionnaire (QLQ-C30) and the pancreas specific QLQ-PAN26. QoL in patients with severe complications was compared with QoL in patients with no or mild complications over a period of 12 months. Analysis was performed with linear mixed models for repeated measurements. RESULTS: Between March 2012 and July 2016, 137 patients were included. Sixty-eight patients (50%) had at least 1 severe complication. There were no statistically significant and clinically relevant differences between both groups in QoL up to 12 months after surgery. CONCLUSION: In this study, no differences in QoL between patients with and without severe postoperative complications were encountered during the first 12 months after surgery for pancreatic (pre-)malignancy. TRIAL REGISTRATION: http://www.clinicaltrials.gov Identifier: NCT02175992.

23 Article Risk of Pancreatic Cancer After a Primary Episode of Acute Pancreatitis. 2017

Rijkers, Anton P / Bakker, Olaf J / Ahmed Ali, Usama / Hagenaars, Julia C J P / van Santvoort, Hjalmar C / Besselink, Marc G / Bollen, Thomas L / van Eijck, Casper H / Anonymous5040915. ·From the *Department of Surgery, Erasmus MC, University Medical Center, Rotterdam; †Department of Surgery, University Medical Center, Utrecht; ‡Department of Surgery, Maasstad Hospital, Rotterdam; §Department of Surgery, Academic Medical Center, Amsterdam; and ∥Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands. ·Pancreas · Pubmed #28797012.

ABSTRACT: OBJECTIVE: Acute pancreatitis may be the first manifestation of pancreatic cancer. The aim of this study was to assess the risk of pancreatic cancer after a first episode of acute pancreatitis. METHODS: Between March 2004 and March 2007, all consecutive patients with a first episode of acute pancreatitis were prospectively registered. Follow-up was based on hospital records audit, radiological imaging, and patient questionnaires. Outcome was stratified based on the development of chronic pancreatitis. RESULTS: We included 731 patients. The median follow-up time was 55 months. Progression to chronic pancreatitis was diagnosed in 51 patients (7.0%). In this group, the incidence rate per 1000 person-years for developing pancreatic cancer was 9.0 (95% confidence interval, 2.3-35.7). In the group of 680 patients who did not develop chronic pancreatitis, the incidence rate per 1000 person-years for developing pancreatic cancer in this group was 1.1 (95% confidence interval, 0.3-3.3). Hence, the rate ratio of pancreatic cancer was almost 9 times higher in patients who developed chronic pancreatitis compared with those who did not (P = 0.049). CONCLUSIONS: Although a first episode of acute pancreatitis may be related to pancreatic cancer, this risk is mainly present in patients who progress to chronic pancreatitis.

24 Article Minimally invasive versus open distal pancreatectomy (LEOPARD): study protocol for a randomized controlled trial. 2017

de Rooij, Thijs / van Hilst, Jony / Vogel, Jantien A / van Santvoort, Hjalmar C / de Boer, Marieke T / Boerma, Djamila / van den Boezem, Peter B / Bonsing, Bert A / Bosscha, Koop / Coene, Peter-Paul / Daams, Freek / van Dam, Ronald M / Dijkgraaf, Marcel G / van Eijck, Casper H / Festen, Sebastiaan / Gerhards, Michael F / Groot Koerkamp, Bas / Hagendoorn, Jeroen / van der Harst, Erwin / de Hingh, Ignace H / Dejong, Cees H / Kazemier, Geert / Klaase, Joost / de Kleine, Ruben H / van Laarhoven, Cornelis J / Lips, Daan J / Luyer, Misha D / Molenaar, I Quintus / Nieuwenhuijs, Vincent B / Patijn, Gijs A / Roos, Daphne / Scheepers, Joris J / van der Schelling, George P / Steenvoorde, Pascal / Swijnenburg, Rutger-Jan / Wijsman, Jan H / Abu Hilal, Moh'd / Busch, Olivier R / Besselink, Marc G / Anonymous5090902. ·Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, AZ 1105, The Netherlands. · Department of Surgery, St Antonius Hospital, PO Box 2500, Nieuwegein, EM 3430, The Netherlands. · Department of Surgery, University Medical Center Groningen, PO Box 30 001, Groningen, RB 9700, The Netherlands. · Department of Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, HB 6500, The Netherlands. · Department of Surgery, Leiden University Medical Center, PO Box 9600, Leiden, ZA 2333, The Netherlands. · Department of Surgery, Jeroen Bosch Hospital, PO Box 90153, Den Bosch, ME 5200, The Netherlands. · Department of Surgery, Maasstad Hospital, PO Box 9100, Rotterdam, AC 3007, The Netherlands. · Department of Surgery, VU University Medical Center, PO Box 7057, Amsterdam, HV 1081, The Netherlands. · Department of Surgery, Maastricht University Medical Center, PO Box 5800, Maastricht, AZ 6202, The Netherlands. · Clinical Research Unit, Academic Medical Center, PO Box 22660, Amsterdam, DD 1100, The Netherlands. · Department of Surgery, Erasmus University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands. · Department of Surgery, Onze Lieve Vrouwe Gasthuis, PO Box 95500, Amsterdam, HM 1090, The Netherlands. · Department of Surgery, University Medical Center Utrecht, PO Box 85 500, Utrecht, GA 3508, The Netherlands. · Department of Surgery, Catharina Hospital, PO Box 1350, Eindhoven, ZA 5602, The Netherlands. · NUTRIM School for Nutrition and Translational Research in Metabolism, PO Box 5800, Maastricht, AZ 6202, The Netherlands. · Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, Enschede, KA 7500, The Netherlands. · Department of Surgery, Isala Clinics, PO Box 10 400, Zwolle, AB 8025, The Netherlands. · Department of Surgery, Reinier de Graag Gasthuis, PO Box 5011, Delft, GA 2600, The Netherlands. · Department of Surgery, Amphia Hospital, PO Box 90 158, Breda, RK 4800, The Netherlands. · Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, SO166YD, UK. · Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, DD 1100, The Netherlands. · Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, DD 1100, The Netherlands. m.g.besselink@amc.nl. ·Trials · Pubmed #28388963.

ABSTRACT: BACKGROUND: Observational cohort studies have suggested that minimally invasive distal pancreatectomy (MIDP) is associated with better short-term outcomes compared with open distal pancreatectomy (ODP), such as less intraoperative blood loss, lower morbidity, shorter length of hospital stay, and reduced total costs. Confounding by indication has probably influenced these findings, given that case-matched studies failed to confirm the superiority of MIDP. This accentuates the need for multicenter randomized controlled trials, which are currently lacking. We hypothesize that time to functional recovery is shorter after MIDP compared with ODP even in an enhanced recovery setting. METHODS: LEOPARD is a randomized controlled, parallel-group, patient-blinded, multicenter, superiority trial in all 17 centers of the Dutch Pancreatic Cancer Group. A total of 102 patients with symptomatic benign, premalignant or malignant disease will be randomly allocated to undergo MIDP or ODP in an enhanced recovery setting. The primary outcome is time (days) to functional recovery, defined as all of the following: independently mobile at the preoperative level, sufficient pain control with oral medication alone, ability to maintain sufficient (i.e. >50%) daily required caloric intake, no intravenous fluid administration and no signs of infection. Secondary outcomes are operative and postoperative outcomes, including clinically relevant complications, mortality, quality of life and costs. DISCUSSION: The LEOPARD trial is designed to investigate whether MIDP reduces the time to functional recovery compared with ODP in an enhanced recovery setting. TRIAL REGISTRATION: Dutch Trial Register, NTR5188 . Registered on 9 April 2015.

25 Article Health-related quality of life after pancreatic resection for malignancy. 2016

Heerkens, H D / Tseng, D S J / Lips, I M / van Santvoort, H C / Vriens, M R / Hagendoorn, J / Meijer, G J / Borel Rinkes, I H M / van Vulpen, M / Molenaar, I Q. ·Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. ·Br J Surg · Pubmed #26785646.

ABSTRACT: BACKGROUND: Health-related quality of life (QoL) is of major importance in pancreatic cancer, owing to the limited life expectation. The aim of this prospective longitudinal study was to describe QoL in patients undergoing resection for pancreatic or periampullary malignancy. METHODS: QoL was measured on a scale of 0-100 in patients who underwent pancreatic resection for malignancy or premalignancy at the University Medical Centre Utrecht before resection, and 1, 3, 6 and 12 months after surgery. Measures consisted of the RAND-36, the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and the EORTC pancreatic cancer-specific module (QLQ-PAN26). RESULTS: Between March 2012 and November 2013, 68 consecutive patients with a malignancy (59 patients) or premalignancy (9) were included. Physical role restriction, social and emotional domains showed a significant and clinically relevant deterioration directly after operation in 53 per cent (RAND-36, P < 0.001), 63 and 78 per cent (QLQ-C30 and RAND-36 respectively, P < 0.001) and 37 per cent (RAND-36, P < 0.001) of patients respectively. Most domains demonstrated recovery to preoperative values or better at 3 months, except for physical functioning. Emotional functioning at 3, 6 and 12 months was better than at baseline (P < 0.001). Symptom scores revealed a deterioration in vitality, pain (P = 0.002), fatigue (P < 0.001), appetite loss (P < 0.001), altered bowel habit (P = 0.001) and side-effects (P < 0.001) after 1 month. After 3 months, only side-effects were worse than preoperative values (P < 0.001). CONCLUSION: QoL after pancreatic resection for malignant and premalignant tumours decreased considerably in the early postoperative phase. Full recovery of QoL took up to 6 months after the operation.

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