Eelco J R de Graaf

Publications (17)48.2 Total impact

• Article: Colorectal surgeons' learning curve of transanal endoscopic microsurgery.

  Renée M Barendse, Marcel G Dijkgraaf, Ursula R Rolf, Arnold B Bijnen, Esther C J Consten, Christiaan Hoff, Evelien Dekker, Paul Fockens, Willem A Bemelman, Eelco J R de Graaf
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  ABSTRACT: BACKGROUND: Transanal endoscopic microsurgery (TEM) is a technically demanding key technique in minimally invasive rectal surgery. We investigated the learning curve of colorectal surgeons commencing with TEM. METHODS: All TEM procedures of four colorectal surgeons were analyzed. Procedures were ranked chronologically per surgeon. Outcomes included conversion, postoperative complications, procedure time, and recurrence. Backward multivariable regression analysis identified learning curve effects and other predictors. RESULTS: Four surgeons resected 693 rectal lesions [69.9 % adenoma/25.5 % carcinoma; median size 20 cm(2); interquartile range (IQR) 11-35; 7 ± 4 cm ab ano]. A total of 555 resections (80.1 %) were histopathologically radical (R0). Conversion (4.3 %) was influenced by a learning curve [odds ratio (OR) 0.991 per additional procedure; 95 % confidence interval (CI) 0.984-0.998] and by lesion size. Postoperative complications depended only on the individual surgeon and lesion size in benign lesions (10.4 % complications). A learning curve (OR 0.99; 95 % CI 0.988-0.998) and peritoneal entrance affected complications in malignant lesions (13.3 %). Procedure time [median 55 min (IQR 30-90)] was influenced by a learning curve [B -0.11 (95 % CI -0.14 to -0.09)], individual surgeon, single-piece resection, peritoneal entrance, lesion size, and rectal quadrant. Recurrence of benign lesions (4.5 %) depended on lesion size, R0 resection, and prior resection attempts. Recurrence of malignant lesions (8.9 %) depended on 3D stereoscopic view, lesion size, full-thickness resection, and length of follow-up. Recurrence-free survival of patients operated during the 36th through 80th procedure per surgeon was significantly shorter than in patients operated during procedures 1-35 and 81 onwards. CONCLUSIONS: A surgical learning curve affected conversion rate, procedure time, and complication rate. It did not influence recurrence rates, possibly due to evolving patient populations. This first insight into the learning curve of TEM stresses the importance of quality monitoring and centralisation of care.
  Surgical Endoscopy 04/2013; · 4.01 Impact Factor
• Article: Transanal Employment of Single Access Ports Is Feasible for Rectal Surgery.

  Renée M Barendse, Pascal G Doornebosch, Willem A Bemelman, Paul Fockens, Evelien Dekker, Eelco J R de Graaf
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  ABSTRACT: OBJECTIVE:: To evaluate the feasibility of transanal single port surgery in 15 consecutive patients. BACKGROUND:: The current method of choice for local resection of rectal tumors is transanal endoscopic microsurgery (TEM), a complex and expensive technique. Single access surgery is easy, relatively cheap, and more broadly applied in laparoscopy. Evidence regarding transanal use of single access ports is scarce. METHODS:: Consecutive patients with a rectal lesion otherwise eligible for TEM were operated using the Single Site Laparoscopic Access System (SSL) and standard laparoscopic instrumentation. Patient, lesion and procedure characteristics, hospitalization length, and peroperative and postoperative complications were recorded. RESULTS:: Fifteen patients were planned for single port transanal surgery. In 2 patients (13.3%), intrarectal retractor expansion failed, and conversion to conventional TEM was necessary. The remaining 13 patients were successfully operated. Rectal lesions (mean diameter 36 mm, standard deviation ±25 mm, mean distance from the dentate line 6 cm [±4.5]) included adenoma in 7 patients, T1 adenocarcinoma in 1, T2 adenocarcinoma in 3, carcinoid in 1, and fibrosis only in 1 (after prior polypectomy). All patients were operated in lithotomy position. Resections were en bloc, full thickness, and had complete margins. Resection specimens measured 65 (±35) × 52 (±24) mm. Twelve rectal defects were sutured. One peroperative pneumoscrotum occurred. Mean operating time was 57 (±39) minutes. One patient presented with postoperative hemorrhage, treated conservatively (postoperative morbidity rate 7.7%). Mean hospitalization lasted 2.5 days (±2.7). CONCLUSIONS:: Transanal single port surgery via the SSL is feasible and safe and may become a promising alternative to TEM.
  Annals of surgery 04/2012; · 7.90 Impact Factor
• Article: Transanal endoscopic microsurgery for T1 rectal cancer: size matters!

  Pascal G Doornebosch, Eliane Zeestraten, Eelco J R de Graaf, Pleun Hermsen, Imro Dawson, Rob A E M Tollenaar, Hans Morreau
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  ABSTRACT: Transanal endoscopic microsurgery (TEM) is considered a curative option for selected T1 rectal cancer. Although TEM is safe, local recurrence (LR) rates after TEM are unacceptably high. Evidence on selection criteria, however, is not abundant. To expand evidence on low- versus high-risk T1 rectal cancer with respect to LR, this study aimed to identify predictive histopathologic factors in a selected group of T1 rectal cancers treated with TEM only. The study enrolled 62 patients for whom specimens of the primary tumor containing an invasive T1 carcinoma could be reevaluated. Tumors were scored according to predefined criteria, and analysis of predictive factors for locoregional failure was performed. Local recurrence rates at 3 years for tumors 3 cm in size or smaller were significantly lower than for tumors larger than 3 cm (16 vs. 39%; P < 0.03). Combining smaller tumors with submucosal invasion depth and budding led to identifying tumors that likely will not recur (3-year LR rates, 7 and 10%, respectively). The findings showed that low- and high-risk criteria are too robust for identifying tumors at risk for LR. Tumor size alone or in combination with submucosal invasion depth or tumor budding appeared to be a significant predictive factor for locoregional failure after TEM for T1 rectal cancer.
  Surgical Endoscopy 02/2012; 26(2):551-7. · 4.01 Impact Factor
• Source

  Available from: Jeroen Leijtens

  Article: The CARTS study: Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery.

  Guus M J Bökkerink, Eelco J R de Graaf, Cornelis J A Punt, Iris D Nagtegaal, Heidi Rütten, Joost J M E Nuyttens, Esther van Meerten, Pascal G Doornebosch, Pieter J Tanis, Eric J Derksen, [......], Jeroen W A Leijtens, Guido Lammering, Geerard L Beets, Theo J Aufenacker, Apollo Pronk, Eric R Manusama, Christiaan Hoff, Andreas J A Bremers, Cornelelis Verhoef, Johannes H W de Wilt
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  ABSTRACT: The CARTS study is a multicenter feasibility study, investigating the role of rectum saving surgery for distal rectal cancer. Patients with a clinical T1-3 N0 M0 rectal adenocarcinoma below 10 cm from the anal verge will receive neoadjuvant chemoradiation therapy (25 fractions of 2 Gy with concurrent capecitabine). Transanal Endoscopic Microsurgery (TEM) will be performed 8 - 10 weeks after the end of the preoperative treatment depending on the clinical response.Primary objective is to determine the number of patients with a (near) complete pathological response after chemoradiation therapy and TEM. Secondary objectives are the local recurrence rate and quality of life after this combined therapeutic modality. A three-step analysis will be performed after 20, 33 and 55 patients to ensure the feasibility of this treatment protocol. The CARTS-study is one of the first prospective multicentre trials to investigate the role of a rectum saving treatment modality using chemoradiation therapy and local excision. The CARTS study is registered at clinicaltrials.gov (NCT01273051).
  BMC Surgery 12/2011; 11:34. · 1.33 Impact Factor
• Article: Transanal single port surgery: selecting a suitable access port in a porcine model.

  Renée M Barendse, Tessa Verlaan, Willem A Bemelman, Paul Fockens, Evelien Dekker, Joost Nonner, Eelco J R de Graaf
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  ABSTRACT: Single port surgery of rectal tumors may be associated with a shorter learning curve and fewer costs than transanal endoscopic microsurgery. The authors aimed to select the most optimal single access port for transanal employment. Four single access ports (GelPOINT, TriPort, SSL Access System, and SILS) were tested in 2 pigs. Insertion feasibility and intraoperative features of each port were assessed. A rectal excision was attempted using the most suitable port. Insertion of GelPOINT was impossible. SILS and TriPort were easily inserted; however, insufficient stability demanded manual fixation. CO(2) leaked through the TriPort trocar ports. Insertion of the 2-cm SSL Access System retractor was difficult, but pneumorectum and surgical circumstances were favorable. Single port transanal surgery may be a promising alternative for transanal endoscopic microsurgery. The SSL Access System was found the most suitable for this indication in a porcine model.
  Surgical Innovation 11/2011; 19(3):323-6. · 2.13 Impact Factor
• Article: Laparoscopic-monitored colonoscopic polypectomy: a multimodality method to avoid segmental colon resection.

  D J Grünhagen, M-C P van Ierland, P G Doornebosch, M M M Bruijninckx, R Winograd, E J R de Graaf
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  ABSTRACT: In some patients with adenoma, snare polypectomy may be technically impossible owing to angulation of the colon or after previous surgery. This may result in a segmental colonic resection, if malignant invasion is thought to be likely. Laparoscopic mobilization of the colon to enable a simultaneous colonoscopy can avoid this difficulty. A feasibility study was performed in 11 patients for whom endoscopic removal was technically impossible due to fibrosis after previous surgery or to anatomical difficulty. In 10, adenoma (histologically benign) had been diagnosed during diagnostic colonoscopy and in the remaining patient the indication was rectal bleeding. It was possible to perform a full colonoscopy after laparoscopic mobilization in all cases. In nine of the 10 patients with adenoma 11 tubulovillous adenomas were removed endoscopically, and in one the tumour was too large for endoscopic resection even after full mobilization. A laparoscopic segmental resection was performed in this case. In the patient with rectal bleeding, colonoscopy revealed an angiodysplasia of the caecum, also treated by resection. Apart from the two patients having resection, all patients were discharged within 24 h of the procedure. During endoscopic follow up (4-27 months) there were no recurrences. Combined laparoscopy and endoscopy enabled removal of adenomas otherwise inaccessible for endoscopic techniques. Thus, segmental colon resections can be avoided in most of these patients.
  Colorectal Disease 11/2010; 13(11):1280-4. · 2.93 Impact Factor
• Article: Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer.

  Pascal G Doornebosch, Floris T J Ferenschild, Johannes H W de Wilt, Imro Dawson, Geert W M Tetteroo, Eelco J R de Graaf
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  ABSTRACT: The aim of this study was to evaluate the management and outcome of local recurrences after transanal endoscopic microsurgery for T1 rectal cancer. Consecutive patients who underwent transanal endoscopic microsurgery for pT1 rectal cancer at a Dutch referral center (IJsselland Hospital) were registered in a prospective database. Follow-up was according to Dutch guidelines on rectal cancer, with additional rigid rectoscopy and endorectal ultrasound examinations every 3 months for the first 2 years, and every 6 months thereafter. Annual MRI of the lesser pelvis was added during the last 2 years of the study. Patients with local recurrence during follow-up were selected for individual analysis of outcome. Of a total of 88 patients who underwent transanal endoscopic microsurgery for pT1 rectal cancer, 18 patients (20.5%) had a local recurrence. Median time to local recurrence was 10 (range, 4-50) months. Median age at diagnosis of recurrence was 74 (range, 56-84) years. Of the 18 patients, 2 did not undergo further surgery because of concomitant metastatic disease, and 16 underwent salvage surgery, without need for multivisceral resections. No postoperative mortality was observed. In 15 patients (94%), a microscopically negative excision margin was obtained; in 1 patient, the excision margin was microscopically positive. Median follow-up after salvage surgery was 20 (range, 2-112) months. One patient had a local renewal of recurrence, and 7 patients (39%) had distant metastases. At 3 years, overall survival was 31%; cancer-related survival was 58%. Recurrent disease after transanal endoscopic microsurgery for T1 rectal cancer is a major problem. Although salvage surgery for achieving local control is feasible in most patients, survival is limited, mainly because of distant metastases. Tailoring selection of T1 rectal cancers and exploring possible adjuvant treatment strategies following salvage procedures should be the next steps toward improving survival.
  Diseases of the Colon & Rectum 09/2010; 53(9):1234-9. · 3.13 Impact Factor
• Article: [Two new treatments for haemorrhoids. Doppler-guided haemorrhoidal artery ligation and stapled anopexy].

  J W A Pim Burger, Erik Hans Eddes, Michael F Gerhards, Pascal G Doornebosch, Eelco J R de Graaf
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  ABSTRACT: Haemorrhoids occur in approximately 30% of the population. Commonly occurring complaints include blood loss, pruritus, hygiene problems and soiling. A high-fibre diet, with dietary-fiber supplementation if required, often resolves the symptoms. When symptoms are not resolved, the next step is rubber band ligation: a safe and easy procedure. In the long term, the result of rubber band ligation is often unsatisfactory. Haemorrhoidectomy was formerly the only alternative. Haemorrhoidectomy can be accompanied by serious complications, such as disabling pain and incontinence. Haemorrhoidectomy was therefore considered obsolete by the Dutch Institute for Healthcare Improvement (CBO) guideline of 1994. Today new operative procedures are available: Doppler-guided haemorrhoidal artery ligation (DG-HAL) and stapled anopexy. Both techniques are safe and yield good results. Moreover, these techniques cause little postoperative pain. DG-HAL and stapled anopexy offer an alternative for patients whose symptoms are not resolved by dietary-fiber supplementation and rubber band ligation.
  Nederlands tijdschrift voor geneeskunde 01/2010; 154:A787.
• Source

  Available from: PubMed Central

  Article: Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center.

  Floris T J Ferenschild, Imro Dawson, Johannes H W de Wilt, Eelco J R de Graaf, Richard P R Groenendijk, Geert W M Tetteroo
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  ABSTRACT: The aim of this study was to review the results and long-term outcome after total mesorectal excision (TME) for adenocarcinoma of the rectum in an unselected population in a community teaching hospital. Between 1996 and 2003, 210 patients with rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathological reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed. The mean age at diagnosis was 69 years (range 40-91 years). A total of 145 patients were treated by anterior rectal resection; 65 patients had to undergo an abdominoperineal resection (APR). Anastomotic leakage rate was 5%. Postoperative mortality was 3%. After a median follow-up of 3.6 years, the local recurrence-free rate in patients with microscopically complete resections was 91%. The 5-year overall survival rate was 58%. An increased serum carcinoembryonic antigen, an APR, positive lymph nodes, and an incomplete resection all significantly influenced the 5-year overall survival and local recurrence rate. In a multivariate analysis, age was the most important prognostic factor for overall survival. Patients with rectal cancer can safely be treated with TME in a community teaching hospital and leads to a good overall survival and an excellent local control. In patients aged above 80, treatment-related mortality is an important competitive risk factor, which obscures the positive effect of modern rectal cancer treatment.
  International Journal of Colorectal Disease 09/2009; 24(8):923-9. · 2.38 Impact Factor
• Article: Preoperative radiotherapy has no value for patients with T2-3, N0 adenocarcinomas of the rectum.

  Floris T J Ferenschild, Imro Dawson, Eelco J R de Graaf, Johannes H W de Wilt, Geert W M Tetteroo
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  ABSTRACT: Treatment of rectal cancer with preoperative radiotherapy followed by total mesorectal excision is nowadays the standard treatment. It reduces local recurrences and improves overall survival. However, in patients with T2-3, N0 rectal cancer, the role of preoperative radiotherapy remains controversial. The aim of this study was to review the benefit of radiotherapy in T2 and T3, N0 rectal cancer patients. Between 1996 and 2003, 103 patients with T2-3, N0 rectal cancer were identified in our prospective database. This study evaluated time to local recurrence, distant metastases and overall survival. Median follow-up was 4.3 years. The 5-year local control rate was 94%. The 5-year overall survival was 65%. The 5-year disease-free survival rate was 82%. Preoperative radiotherapy did not show any statistical differences. Abdominal perineal resection and T3 tumors negatively influenced overall survival (p = 0.02). Advanced age was of significant importance in overall survival. Preoperative radiotherapy does not seem to be of significant importance in patients with T2-3, N0 rectal cancer regarding local recurrence and survival. Since preoperative radiotherapy is associated with short- and long-term morbidity, patients with T2-3, N0 tumors should be identified and treated with surgery alone.
  Digestive surgery 08/2009; 26(4):291-6. · 1.37 Impact Factor
• Article: Transanal endoscopic microsurgery is feasible for adenomas throughout the entire rectum: a prospective study.

  Eelco J R de Graaf, Pascal G Doornebosch, Geert W M Tetteroo, Han Geldof, Wim C J Hop
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  ABSTRACT: Transanal endoscopic microsurgery for rectal adenomas is safe and has low recurrence rates. However, the feasibility of the procedure for all rectal adenomas is unclear. This issue was investigated prospectively. From 1996 to 2007, 353 consecutive rectal adenomas were evaluated according to a standard protocol. Transanal endoscopic microsurgery was intended in all rectal adenomas. The median diameter was 3 cm and median distance was 8 cm. The peritoneum was opened peroperatively without any adverse effects in 8.7 percent. The conversion rate was 9.6 percent, with an alternative local procedure performed in 4.2 percent and a transabdominal procedure performed in 5.4 percent. Conversion rate correlated with the distance of the tumor (P = 0.007) and the operating surgeon's level of experience (P = 0.004). The median operation time was 45 minutes. Operation time correlated with specimen area, experience, and operating surgeon (all P < 0.001). All rectal adenomas were excised in one piece. Complete margins were observed in 85 percent. Rectal adenomas with incomplete margins were larger (P < 0.001) and were located more proximally (P < 0.001). Morbidity was 7.8 percent and mortality 0.6 percent. The median hospital stay was four days. The median follow-up was 27 months. The recurrence rate at three years was 9.1 percent. The median time from operation to recurrence was 12 (range, 4-54) months. Resection margin status was a predictor of recurrence, with 6.1 percent recurrence in cases of complete margins and 25.2 percent in cases of incomplete margins (P < 0.001). For nearly all rectal adenomas, transanal endoscopic microsurgery is safe, feasible, and has excellent results.
  Diseases of the Colon & Rectum 07/2009; 52(6):1107-13. · 3.13 Impact Factor
• Source

  Available from: Eric J Derksen

  Article: Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study).

  Frank J C van den Broek, Eelco J R de Graaf, Marcel G W Dijkgraaf, Johannes B Reitsma, Jelle Haringsma, Robin Timmer, Bas L A M Weusten, Michael F Gerhards, Esther C J Consten, Matthijs P Schwartz, [......], James C H Hardwick, Pascal G Doornebosch, Annekatrien C T M Depla, Miranda F Ernst, Ivo P van Munster, Ignace H J T de Hingh, Erik J Schoon, Willem A Bemelman, Paul Fockens, Evelien Dekker
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  ABSTRACT: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications.The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma > or = 3 cm, located between 1-15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2) number of days not spent in hospital from initial treatment until 2 years afterwards; 3) major and minor morbidity; 4) disease specific and general quality of life; 5) anorectal function; 6) health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR of 3.3% and considering an upper-limit of 10% for EMR to be non-inferior (beta-error 0.2 and one-sided alpha-error 0.05), 89 patients are needed per group. The TREND study is the first randomized trial evaluating whether TEM or EMR is more cost-effective for the treatment of large rectal adenomas. (trialregister.nl) NTR1422.
  BMC Surgery 02/2009; 9:4. · 1.33 Impact Factor
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  Available from: Rob A E M Tollenaar

  Article: Integrating chromosomal aberrations and gene expression profiles to dissect rectal tumorigenesis.

  Esther H Lips, Ronald van Eijk, Eelco J R de Graaf, Jan Oosting, Noel F C C de Miranda, Tom Karsten, Cornelis J van de Velde, Paul H C Eilers, Rob A E M Tollenaar, Tom van Wezel, Hans Morreau
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  ABSTRACT: Accurate staging of rectal tumors is essential for making the correct treatment choice. In a previous study, we found that loss of 17p, 18q and gain of 8q, 13q and 20q could distinguish adenoma from carcinoma tissue and that gain of 1q was related to lymph node metastasis. In order to find markers for tumor staging, we searched for candidate genes on these specific chromosomes. We performed gene expression microarray analysis on 79 rectal tumors and integrated these data with genomic data from the same sample series. We performed supervised analysis to find candidate genes on affected chromosomes and validated the results with qRT-PCR and immunohistochemistry. Integration of gene expression and chromosomal instability data revealed similarity between these two data types. Supervised analysis identified up-regulation of EFNA1 in cases with 1q gain, and EFNA1 expression was correlated with the expression of a target gene (VEGF). The BOP1 gene, involved in ribosome biogenesis and related to chromosomal instability, was over-expressed in cases with 8q gain. SMAD2 was the most down-regulated gene on 18q, and on 20q, STMN3 and TGIF2 were highly up-regulated. Immunohistochemistry for SMAD4 correlated with SMAD2 gene expression and 18q loss. On basis of integrative analysis this study identified one well known CRC gene (SMAD2) and several other genes (EFNA1, BOP1, TGIF2 and STMN3) that possibly could be used for rectal cancer characterization.
  BMC Cancer 02/2008; 8:314. · 3.01 Impact Factor
• Article: Progression and tumor heterogeneity analysis in early rectal cancer.

  Esther H Lips, Ronald van Eijk, Eelco J R de Graaf, Pascal G Doornebosch, Noel F C C de Miranda, Jan Oosting, Tom Karsten, Paul H C Eilers, Rob A E M Tollenaar, Tom van Wezel, Hans Morreau
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  ABSTRACT: Adequate preoperative staging of large sessile rectal tumors requires identifying adenomas that already contain an invasive focus, specifically those that are growing in or beyond the submucosa. We systematically compared chromosomal instability patterns in adenoma and carcinoma fractions of the same lesion to assess specific steps in rectal tumor progression. We analyzed 36 formalin-fixed, paraffin-embedded tumors. Both the adenoma and carcinoma fractions were typed with single nucleotide polymorphism arrays and compared with 21 previously described pure adenomas. Eighteen cases were included in an intratumor heterogeneity analysis. Five specific "malignant" events (gain of 8q, 13q, and 20q and loss of 17p and 18q) and aberrant staining for p53 and SMAD4 were all increased in the adenoma fractions of carcinoma cases compared with pure adenomas. Paired analysis revealed that 31% of the samples had an equal amount of malignant aberrations in their adenoma and carcinoma fractions, whereas 25% had one and 33% had two or more extra malignant events in the carcinoma fraction. Analysis of three core biopsies per patient showed a large degree of intratumor heterogeneity. However, the number of malignant aberrations in the biopsy with the most aberrations per tumor correlated with the corresponding adenoma or carcinoma fraction (r = 0.807; P < 0.001). Five specific chromosomal aberrations, combined with immunohistochemistry for p53 and SMAD4, can predict possible progression of sessile rectal adenomas to early rectal cancer and can, after validation studies, be added to preoperative staging. Preferably, three biopsies should be taken from each tumor to address intratumor heterogeneity.
  Clinical Cancer Research 02/2008; 14(3):772-81. · 7.74 Impact Factor
• Article: Malignant fibrous histiocytoma of the sigmoid: a case report and review of the literature.

  Bas Bosmans, Eelco J R de Graaf, Rolf Torenbeek, Geert W M Tetteroo
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  ABSTRACT: Malignant fibrous histiocytoma (MFH) in the large bowel, which is composed of spindle-shaped cells arranged in a pleiomorphic and storiform pattern, is an extremely rare tumor. We in this study report on a case of a 73-year-old man with a sarcoma arising from a diverticular sigmoid without any signs of involvement of regional lymph nodes or metastasis to liver or the abdomen. A sigmoid resection was performed with an uneventful postoperative course. Microscopically, the tumor consisted of bundles of spindle-shaped and pleiomorphic multinucleated cells without differentiation characteristics for other tumors than MFH. Since the late 1970s, only 22 case reports of colorectal MFH have been documented, and little is known about its histogenesis and optimal treatment. A review of the cases and the world literature on immunohistochemistry and treatment is given.
  International Journal of Colorectal Disease 06/2007; 22(5):549-52. · 2.38 Impact Factor
• Article: Curative resection of rectal carcinoid tumors with transanal endoscopic microsurgery.

  Joost C Peerbooms, Jaap L Simons, Geert W M Tetteroo, Eelco J R De Graaf
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  ABSTRACT: Transanal endoscopic microsurgery is a minimally invasive technique for local resection of rectal tumors. Its place needs to be defined for resection of carcinoid tumors of the rectum. From 1998 to 2004, rectal carcinoid tumors were diagnosed in 5 patients. The diagnosis was suggested at biopsy in all patients. All tumors were resected full thickness with transanal endoscopic microsurgery. Data were obtained retrospectively from a review of hospital charts. At the time of operation all tumors were small without clinical or biochemical signs of metastasis. All resected tumors were highly differentiated and had free margins without invasion into the submucosa. Operative times ranged from 15 to 35 minutes. Hospital stays ranged from 2 to 4 days. No morbidity or mortality was observed. Follow-up ranged from 3 to 75 months. No recurrences were observed. Transanal endoscopic microsurgery is an excellent technique for removal of carcinoid tumors of the rectum and even the distal part of the sigmoid, if the diameter is <1 cm without invasion of the rectal wall.
  Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2006; 16(5):435-8. · 1.40 Impact Factor
• Article: Iatrogenic Arterial Trauma Associated with Hip Fracture Treatment

  Remmert K. Storm, Aa K. Sing, Eelco J. R. de Graaf, Geert W. M. Tetteroo
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  ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
  The Journal of Trauma and Acute Care Surgery. 04/2000; 48(5):957-959.