J. J. B. van Lanschot

Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types†

Various definitions are used to calculate postoperative mortality. As variation hampers comparability between reports, a study was performed to evaluate the impact of using different definitions for several types of cancer surgery.

Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer.

IntroductionCachexia and obesity have been suggested to be risk factors for postoperative complications. However, high body mass index (BMI) might result in a higher R0-resection rate because of the presence of more fatty tissue surrounding the tumor. The purpose of this study was to investigate whether BMI is of prognostic value with regard to short-term and long-term outcome in patients who undergo esophagectomy for cancer.MethodsIn 556 patients who underwent esophagectomy (1991–2007), clinical and pathological outcome were compared between different BMI classes (underweight, normal weight, overweight, obesity).ResultsOverall morbidity, mortality, and reoperation rate did not differ in underweight and obese patients. However, severe complications seemed to occur more often in obese patients (pxa0=xa00.06), and the risk for anastomotic leakage increased with higher BMI (12.5% in underweight patients compared with 27.6% in obese patients, pxa0=xa00.04). Histopathological assessment showed comparable pTNM stages, although an advanced pT stage was seen more often in patients with low/normal BMI (pxa0=xa00.02). A linear association between BMI and R0-resection rate was detected (pxa0=xa00.02): 60% in underweight patients compared with 81% in obese patients. However, unlike pT-stage (pxa0<xa00.001), BMI was not an independent predictor for R0 resection (pxa0=xa00.12). There was no significant difference in overall or disease-free 5-year survival between the BMI classes (pxa0=xa00.25 and pxa0=xa00.6, respectively).ConclusionsBMI is not of prognostic value with regard to short-term and long-term outcome in patients who undergo esophagectomy for cancer and is not an independent predictor for radical R0 resection. Patients oncologically eligible for esophagectomy should not be denied surgery on the basis of their BMI class.

Recurrence pattern in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

Little is known about recurrence patterns in patients with a pathologically complete response (pCR) or an incomplete response after neoadjuvant chemoradiotherapy (CRT) followed by resection for oesophageal cancer. This study was performed to determine the pattern of recurrence in patients with a pCR after neoadjuvant CRT followed by surgery.

Radiological evaluation of colorectal anastomoses

Background and aimsThe purpose of this study was to determine the accuracy, interobserver variability, timing and discordance with relaparotomy of postoperative radiological examination of colorectal anastomoses.Patient/methodsFrom 2000 to 2005, 429 patients underwent an ileocolonic, colo-colonic, or colorectal anastomosis. Radiological examination of the anastomosis was not performed routinely, but only when there were clinically signs of leakage. Radiological imaging was reviewed by an independent radiologist and medical records were retrospectively analyzed. Clinical anastomotic leakage was the standard of reference and defined as leakage confirmed during relaparotomy, drainage of pus per anum or as an anastomotic defect identified at digital examination.ResultsRadiological evaluation of the anastomosis was performed in 91 patients (21%): CT in 27 patients, contrast radiography in 40, and both imaging modalities in 24 patients. The interobserver variability of CT and contrast radiography was 10% and 14%, respectively. The sensitivity and negative predictive value of imaging of the anastomosis was 65% and 73%, respectively. Anastomotic leakage was found in 11 of 21 patients (52%) who underwent relaparotomy despite negative imaging. Three of 36 patients (8%) with a diagnosis of anastomotic leakage based on radiological examination had an intact anastomosis at relaparotomy.ConclusionRadiological imaging of the anastomosis after colorectal surgery should be restrictively applied and interpreted with caution because of the high false-negative rate and the substantial interobserver variability.

Intrathoracic manifestations of cervical anastomotic leaks after transhiatal and transthoracic oesophagectomy.

A possible advantage of cervical oesophagogastrostomy over intrathoracic anastomosis after oesophagectomy is the presumed mild clinical course of cervical anastomotic leakage. The incidence and consequences of intrathoracic manifestations after cervical anastomotic leakage remain unclear, and were investigated in this study.

Analysis of gene expression identifies differentially expressed genes and pathways associated with lymphatic dissemination in patients with adenocarcinoma of the esophagus.

IntroductionThe presence of lymphatic dissemination is an important predictor of survival in esophageal adenocarcinoma (EA). The aim of this study was to discover a prognostic gene expression profile for lymphatic dissemination in EA and to identify genes and pathways that provide oncological insight in lymphatic dissemination.MethodsPatients who had lymphatic dissemination (Nxa0=xa055) were compared with patients without lymphatic dissemination (Nxa0=xa022). Whole-genome oligonucleotide microarrays were used to evaluate the genetic signature of 77 esophageal cancers. Multiple random validation was used to analyze the stability of the molecular signature and predictive power. Gene set enrichment analysis (GSEA) was applied to elucidate oncogenetic pathways.ResultsLymphatic dissemination was correctly predicted in 75xa0±xa014% of lymph node positive patients. The absence of lymphatic dissemination was correctly predicted in 41xa0±xa023% of lymph-node-negative patients. Argininosuccinate synthetase (ASS) was selected for validation on the protein level because it was present in most prognostic signatures as well as the list of differentially expressed genes. ASS expression was lower (Pxa0=xa00.048) in patients with lymphatic dissemination than in patients without. GSEA identified that arginine metabolism pathways and lipid metabolism pathways are related to less chance of developing lymphatic dissemination.DiscussionThe predictive profile does not outperform current clinical practice to predict the presence of lymphatic dissemination in patients with EA. Several genes, including ASS, and genetic pathways which are important in the development of lymphatic dissemination in EA, were identified.The presence of lymphatic dissemination is an important predictor of survival in esophageal adenocarcinoma (EA). The aim of this study was to discover a prognostic gene expression profile for lymphatic dissemination in EA and to identify genes and pathways that provide oncological insight in lymphatic dissemination. Patients who had lymphatic dissemination (Nxa0=xa055) were compared with patients without lymphatic dissemination (Nxa0=xa022). Whole-genome oligonucleotide microarrays were used to evaluate the genetic signature of 77 esophageal cancers. Multiple random validation was used to analyze the stability of the molecular signature and predictive power. Gene set enrichment analysis (GSEA) was applied to elucidate oncogenetic pathways. Lymphatic dissemination was correctly predicted in 75xa0±xa014% of lymph node positive patients. The absence of lymphatic dissemination was correctly predicted in 41xa0±xa023% of lymph-node-negative patients. Argininosuccinate synthetase (ASS) was selected for validation on the protein level because it was present in most prognostic signatures as well as the list of differentially expressed genes. ASS expression was lower (Pxa0=xa00.048) in patients with lymphatic dissemination than in patients without. GSEA identified that arginine metabolism pathways and lipid metabolism pathways are related to less chance of developing lymphatic dissemination. The predictive profile does not outperform current clinical practice to predict the presence of lymphatic dissemination in patients with EA. Several genes, including ASS, and genetic pathways which are important in the development of lymphatic dissemination in EA, were identified.

Accuracy and reproducibility of 3D-CT measurements for early response assessment of chemoradiotherapy in patients with oesophageal cancer.

BACKGROUNDnChemoradiotherapy is increasingly applied in patients with oesophageal cancer. The aim of the present study was to determine whether 3D-CT volumetry is able to differentiate between responding and non-responding oesophageal tumours early in the course of neoadjuvant chemoradiotherapy.nnnPATIENTS AND METHODSnSerial CT before and after two weeks of neoadjuvant chemoradiotherapy was performed in the multimodality treatment arm of a randomised trial including patients with oesophageal carcinoma. CT response was measured with the change in tumour volume between baseline and after 14 days of neoadjuvant therapy. Receiver Operating Characteristic (ROC) analysis was used to evaluate the ability of 3D-CT as an early imaging marker of response.nnnRESULTSnCT response analysis was performed in 39 patients, of whom 26 patients were histopathological responders. Median tumour volume increased between baseline and after 14 days of chemoradiotherapy in histopathological responders as well as in non-responders, though changes were not statistically significant. The area under the ROC curve was 0.71.nnnCONCLUSIONnTumour volume changes after 14 days of neoadjuvant chemoradiotherapy as measured by 3D-CT were not associated with histopathological tumour response. CT volumetry should not be used for early response assessment in patients with potentially curable oesophageal cancer treated with neoadjuvant chemoradiotherapy.

Cancer stem cells and their potential implications for the treatment of solid tumors

There is increasing evidence that a variety of human cancers is maintained by a subset of cells, cancer stem cells (CSCs), which sustain tumor growth, underlie its malignant behavior, and possibly initiate distant metastases. The aim of this review is to evaluate the current evidence for the existence of CSCs and the implications on the present management and treatment of solid tumors.

Design and validation of an automatic metabolic monitor

A self-calibrating fully automatic instrument for the measurement of oxygen consumption, carbon dioxide production and the respiratory quotient of mechanically ventilated patients has been developed. The instrument is based on commercially available conventional oxygen and carbon dioxide gas analysers and a domestic natural gas volumetric flow meter. The distribution of the different gas flows, i.e. calibration gases, the inspiratory mixture sample and the expiratory mixture sample, are controlled by in inexpensive microprocessor, which also performs the necessary calculations. The accuracy of the instrument has been validated by bench tests. The present prototype has been in use for over 3000 h without major failures.

Outcome prediction in critically ill patients by means of oxygen consumption index and simplified acute physiology score

AbstractBoth oxygen consumption index (n