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Updates in surgery. 10/2012;
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ABSTRACT: Esophagectomy in elderly esophageal carcinoma patients is correlated with a high morbidity and even mortality. Studies on neoadjuvant chemoradiotherapy (NT) in elderly patients are scarce. The aim of this study was to evaluate the effect of advanced age in combination with NT in esophageal carcinoma patients who underwent an esophagectomy. Patients who underwent NT prior to esophagectomy between 1993 and 2010 were divided into three groups: <70, 70-74, and ≥75 years. Toxicity of NT and postoperative morbidity were compared between groups. Primary endpoints were toxicity, complication rate, and survival. Two hundred thirteen patients underwent NT during the study period, 26 were aged 70-74 years, and 17 were ≥70 years. Toxicity of NT was comparable for younger and elderly patients (46% vs. 54% vs. 47%, P = 0.263). Overall complications occurred in 62% of younger patients versus 73% and 71% among patients aged 70-74 years and ≥75 years, respectively (P = 0.836). Cardiac complications occurred in 14% of younger patients versus 27% and 41% of elderly patients (P = 0.021). Three-year survival rates were 59% versus 44% versus 31% among patients aged <70, 70-74, and ≥75 years, respectively (P = 0.237). Higher age (odds ratio 1.750, P < 0.001) was an independent risk factor for development of cardiac complications. Toxicity of NT and postoperative complications are comparable for patients aged <70, 70-74, and ≥75 years, with the exception of cardiac complications. Therefore, we consider NT followed by esophagectomy in elderly patients a safe treatment modality in our center.
Diseases of the Esophagus 08/2012; · 1.81 Impact Factor
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P van Hagen,
M C C M Hulshof,
J J B van Lanschot,
E W Steyerberg,
M I van Berge Henegouwen,
B P L Wijnhoven,
D J Richel,
G A P Nieuwenhuijzen,
G A P Hospers,
J J Bonenkamp, [......],
H van Dekken,
M J C van der Sangen,
T Rozema,
K Biermann,
J C Beukema,
A H M Piet,
C M van Rij,
J G Reinders,
H W Tilanus,
A van der Gaast
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ABSTRACT: The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established. We compared chemoradiotherapy followed by surgery with surgery alone in this patient population.
We randomly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin (doses titrated to achieve an area under the curve of 2 mg per milliliter per minute) and paclitaxel (50 mg per square meter of body-surface area) for 5 weeks and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by surgery.
From March 2004 through December 2008, we enrolled 368 patients, 366 of whom were included in the analysis: 275 (75%) had adenocarcinoma, 84 (23%) had squamous-cell carcinoma, and 7 (2%) had large-cell undifferentiated carcinoma. Of the 366 patients, 178 were randomly assigned to chemoradiotherapy followed by surgery, and 188 to surgery alone. The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia (6%) and neutropenia (2%); the most common major nonhematologic toxic effects were anorexia (5%) and fatigue (3%). Complete resection with no tumor within 1 mm of the resection margins (R0) was achieved in 92% of patients in the chemoradiotherapy-surgery group versus 69% in the surgery group (P<0.001). A pathological complete response was achieved in 47 of 161 patients (29%) who underwent resection after chemoradiotherapy. Postoperative complications were similar in the two treatment groups, and in-hospital mortality was 4% in both. Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group. Overall survival was significantly better in the chemoradiotherapy-surgery group (hazard ratio, 0.657; 95% confidence interval, 0.495 to 0.871; P=0.003).
Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer. The regimen was associated with acceptable adverse-event rates. (Funded by the Dutch Cancer Foundation [KWF Kankerbestrijding]; Netherlands Trial Register number, NTR487.).
New England Journal of Medicine 05/2012; 366(22):2074-84. · 53.30 Impact Factor
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ABSTRACT: Background Tumor location of extrahepatic cholangiocarcinoma (CCA) might influence survival after resection. Methods A consecutive series of 175 patients who had undergone a potentially curative resection of extrahepatic CCA was analyzed. We calculated concordance indices of different constructed prognostic models for survival including TNM (tumour-node-metastasis) staging and developed a nomogram of the most sensitive model. Results Overall cancer-specific survival rates were 83%, 58%, and 26% at 1, 2, and 5 years, respectively. Cancer-specific survival according to location was 42% for proximal, 23% for mid, and 19% for distal CCA after 5 years. Tumor location was not an independent significant predictor (P = 0.06). A prognostic model using all potential prognostic variables predicted survival better compared with TNM staging (concordance index 0.65 versus 0.63). A reduced model containing only lymph node status, microscopically residual tumor status, and tumor differentiation grade, also outperformed TNM staging (concordance index 0.66). Conclusions Tumor location of extrahepatic CCA does not independently predict cancer-specific survival after resection. We developed a nomogram, based on a prognostic model with lymph node status, microscopically residual tumor status of resection margins, and tumor differentiation grade, that predicted survival better than TNM staging.
Annals of Oncology 04/2012; 23(10):2642-9. · 6.43 Impact Factor
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ABSTRACT: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009.
Nationwide data on International Classification of Diseases, ninth revision (ICD-9) code 5-526 (PD, including Whipple), patient age, sex and mortality were retrieved from the independent nationwide KiwaPrismant registry. Based on established cut-off points of annually performed PDs, hospitals were categorized as very low (fewer than 5), low (5-10), medium (11-19) or high (at least 20) volume. A subgroup analysis based on a cut-off age of 70 years was also performed.
Some 2155 PDs were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 (P = 0·011). In these specific years, the proportion of patients undergoing PD in a medium- or high-volume centre increased from 52·9 to 91·2 per cent (P < 0·001). Nationwide mortality rates after PD decreased from 9·8 to 5·1 per cent (P = 0·044). The mortality rate during the 6-year period was 14·7, 9·8, 6·3 and 3·3 per cent in very low-, low-, medium- and high-volume hospitals respectively (P < 0·001). The difference in mortality between medium- and high-volume centres was statistically significant (P = 0·004). The volume-outcome relationship was not influenced by age (P = 0·467). The mortality rate after PD in patients aged at least 70 years was 10·4 per cent compared with 4·4 per cent in younger patients (P < 0·001).
With nationwide centralization of PD, the in-hospital mortality rate after this procedure decreased. Further centralization of PD is likely to decrease mortality further, especially in the elderly.
British Journal of Surgery 03/2012; 99(3):404-10. · 4.61 Impact Factor
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ABSTRACT: The body mass index (BMI) in the general population has increased over the past decades. A high BMI is a known risk factor for the development of esophageal adenocarcinoma. Several studies on the influence of a high BMI on the postoperative course and survival after esophagectomy have shown contradictory results. The aim of the present study was to determine the influence of a high BMI on postoperative complications and survival among a large cohort of esophageal cancer patients.
Patients who underwent an esophagectomy between 1993 and 2010 were divided into three groups according to their BMI: normal weight (<25 kg/m(2)), overweight (25-30 kg/m(2)) or obese (≥ 30 kg/m(2)). Severity of complications was scored according to the Dindo classification, which was divided into three categories: no complications, minor to moderate complications, and severe complications. Long-term survival was determined according to the Kaplan-Meier method.
A total of 736 esophagectomy patients were divided into three groups: normal weight (n = 352), overweight (n = 308), and obese (n = 72). Complications rates were similar for all groups (65-72%, P = 0.241). The incidence of anastomotic leakage was higher among obese patients compared to the other groups (20% vs. 10-12% respectively, P = 0.019), but there was no significant difference between the three groups regarding the severity of complications according to the Dindo classification (P = 0.660) or in 5-year survival rates (P = 0.517).
A high BMI is not associated with an increased incidence or severity of complications after esophagectomy; however, anastomotic leakage occurred more frequently in obese patients. Five-year survival rates were not influenced by the preoperative BMI. A high BMI is therefore ought not be an exclusion criterion for esophagectomy.
Annals of Surgical Oncology 03/2012; 19(3):766-71. · 4.17 Impact Factor
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ABSTRACT: Introduction. Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Patient and tumor characteristics, operative variables, and postoperative outcomes were evaluated retrospectively. Results. The primary tumor was located in the colon in two patients and in the rectum in three patients. The SLM was solitary in four patients and multiple in the remaining patient. Surgical approach was total laparoscopic (2 patients) or hand-assisted laparoscopic (3 patients). The midline umbilical or transverse suprapubic incision created for the hand port and/or extraction of the specimen varied between 5 and 10 cm. Median operation time was 303 (range 151-384) minutes with a total blood loss of 700 (range 200-850) mL. Postoperative hospital stay was 5, 5, 9, 14, and 30 days. An R0 resection was achieved in all patients. Conclusions. From this initial single-center experience, simultaneous laparoscopic colorectal and liver resection appears to be feasible in selected patients with CRC and SLM, with satisfying short-term results.
HPB Surgery 01/2012; 2012:893956.
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ABSTRACT: The relationship between hospital volume and outcome of care after pancreatic surgery, particularly mortality, has been described extensively in the past. Today, this relationship is frequently being used by healthcare providers and/or insurance companies to select hospitals for various surgical procedures. This concept, however, has many limitations. The conceptual model concerning the relationship between how hospital facilities are arranged and the different aspects of the process of providing healthcare is discussed in three case histories describing complicated postoperative courses after pancreatic resections. The conclusion is that, besides hospital volume, the manner in which the various facilities in hospitals are arranged as well as the process of care giving, particularly the effectiveness of multidisciplinary meetings, are of crucial importance to the quality of care. Data per illness, with adequate correction for case mix, are of crucial importance for comparing the differences in quality of care between hospitals.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(32):A4887.
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ABSTRACT: To analyse the extent of centralisation of pancreaticoduodenectomy (Whipple procedure) and changes in in-hospital mortality rates in the Netherlands.
Retrospective analysis.
Data on patients who had undergone pancreaticoduodenectomy (PD) during the 2004-2009 period was acquired from the Kiwa Prismant registry. Based on the number of procedures performed annually, hospitals were divided into 4 volume-categories: very-low (<5), low (5-10), medium (11-19) and high (≥20). Changes in volume and in-hospital mortality were analysed per volume category. A subgroup analysis based on age was also performed.
2155 patients who had undergone PD were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 (p = 0.01). The proportion of patients who had undergone PD in a medium- or high-volume hospital increased from 52.9% to 91.2% (p < 0.001). Post-operative mortality rates decreased from 9.8% to 5.1% (p = 0.04). Average mortality was 14.7%, 9.8%, 6.3% and 3.3% in very low-, low-, medium-, and high-volume hospitals, respectively (p < 0.001). The difference in mortality between medium- and high-volume hospitals was statistically significant (p = 0.004). The mortality rate in patients ≥ 70 years was 10.4% compared with 4.4% in younger patients (p < 0.001). CONCLUSION : Nationwide centralisation of PD is occurring in Netherlands, and this is associated with a decrease in in-hospital mortality. Further centralisation is likely to further decrease in-hospital mortality, especially in the elderly.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(32):A4791.
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ABSTRACT: OBJECTIVE: To evaluate the reliability of data registration in calculating the hospital standardised mortality ratio (HSMR). DESIGN: Retrospective, descriptive. METHOD: Data were collected from a research database on all patients who had undergone a partial pancreatoduodenectomy for pancreatic cancer in 2009 and 2010 at our hospital. These data were compared with information about these same patients recorded in the Dutch National Medical Registry (LMR), obtained from the medical administration department of our hospital. The differences between these 2 databases were evaluated on the basis of 3 variables: mortality, main diagnosis and secondary diagnoses (differentiated into complications and co-morbidities). Using the Charlson index, the co-morbidity score from both registries was calculated per patient. RESULTS: A total of 118 patients had been registered in the research database. Of these patients, 103 appeared in the LMR data; 15 had not been registered in this database. There were no differences in patient characteristics or mortality (2.5%) between the registries. In the LMR, the main diagnosis of 5 patients had been incorrectly recorded. This database contained information on 136 complications and 51 co-morbidities, of which 35 comorbities had been correctly recorded. The research database contained information on 188 complications and 99 comorbidities on these same patients. In the research database, comorbidity comprised 34% of all secondary diagnoses; in the LMR, 19% (p < 0.001). The median score on the Charlson index was 0 for all patients in the LMR and 3 in the research database (p < 0.001). CONCLUSION: Comorbidities in patients with pancreatic carcinoma who undergo a resection are being inadequately recorded in the LMR. This results in insufficient correction in the case mix and a low score on the Charlson index, which could result in an incorrect HSMR.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(49):A4918.
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ABSTRACT: Recent studies have shown that a selective group of patients with primary cystic neoplasms of the pancreas can be managed conservatively by radiological follow-up. The aim of this study was to analyze if such a strategy is efficient and safe.
A retrospective analyses was performed of patients who underwent resection between January 1992 and January 2006 for primary cystic neoplasms of the pancreas in an era of aggressive management (i.e. all patients underwent resection) in order to analyze if the selective algorithm as proposed by the Memorial Sloan-Kettering Cancer Center is efficient and safe.
One hundred patients underwent a resection for pancreatic cysts. Thirty-five percent of the patients with symptomatic cysts had a (pre)malignant lesion compared with 15% of the patients with an incidental cysts. In hospital mortality occurred in 1% of the patients and a postoperative complications in 39%. The Memorial Sloan-Kettering Cancer Center nomogram was able to correctly identify all patients with a benign incidental cyst.
A selective management strategy can be implemented and algorithm proposed by the Memorial Sloan-Kettering Cancer Center nomogram is safe and efficient.
International journal of surgery (London, England) 09/2011; 9(8):655-8.
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ABSTRACT: Effective diagnosis and treatment of patients with hilar cholangiocarcinoma (HCCA) is based on the synergy of endoscopists, interventional radiologists, radiotherapists and surgeons. This report summarizes the multidisciplinary experience in management of HCCA over a period of two decades at the Academic Medical Center in Amsterdam, with emphasis on surgical outcome.
From 1988 until 2003, 117 consecutive patients underwent resection on the suspicion of HCCA. Preoperative work-up included staging laparoscopy, preoperative biliary drainage, assessment of volume/function of future remnant liver and radiation therapy to prevent seeding metastases. More aggressive surgical approach combining hilar resection with extended liver resection was applied as of 1998. Outcomes of resection including actuarial 5-year survival were assessed.
Eighteen patients (15.3%) appeared to have a benign lesion on microscopical examination of the specimen, leaving 99 patients with histologically proven HCCA. These 99 patients were analysed according to three 5-year time periods of resection, i.e. period 1 (1988-1993, n=45), 2 (1993-1998, n=25) and 3 (1998-2003, n=29). The rate of R0 resections increased and actuarial five-year survival significantly improved from 20±5% for the periods 1 and 2, to 33±9% in period 3 (p<0.05). Postoperative morbidity and mortality in the last period were 68% and 10%, respectively.
Extended surgical resection resulted in increased rate of R0 resections and significantly improved survival. Candidates for resection should be considered by a specialized, multidisciplinary team.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 01/2011; 37(1):65-71. · 2.56 Impact Factor
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ABSTRACT: Esophagectomy with gastric tube reconstruction results in a variety of postoperative nutrition-related symptoms that may influence the patient's nutritional status.
We developed a 15-item questionnaire, focusing on the nutrition-related complaints the first year after an esophagectomy. The questionnaire was filled out the first week after discharge and 3, 6, and 12 months after surgery. The use of enteral nutrition, meal size and frequency, social aspects related to eating, defecation pattern, and body weight were recorded at the same time points. We analyzed the relationship between the baseline characteristics and the number of nutrition-related symptoms, as well as the relationship between those symptoms and body weight with linear mixed models.
We found no significant within-patient change for the total number of nutrition-related symptoms (P = 0.67). None of the baseline factors were identified as predictors of the complaint scores. The most frequently experienced complaints were early satiety, postprandial dumping syndrome, inhibited passage due to high viscosity, reflux, and absence of hunger. One year after surgery, meal sizes were still smaller, the social aspects of eating were influenced negatively, and patients experienced an altered stool frequency. Directly after the surgical procedure 78% of the patients lost weight, and the entire postoperative year the mean body weight remained lower (P = 0.47). We observed no association between the complaint scores and body weight (P = 0.15).
After an esophagectomy, most patients struggle with nutrition-related symptoms, are confronted with nutrition-related adjustments and a reduced body weight.
World Journal of Surgery 12/2010; 34(12):2844-52. · 2.36 Impact Factor
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ABSTRACT: 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.
Consecutive patients undergoing potentially curative transhiatal oesophagectomy (THO) or transthoracic oesophagectomy (TTO) with cervical oesophagogastrostomy between 1993 and 2007 were included. Intrathoracic manifestations after cervical anastomotic leakage were compared following THO and TTO. Multivariable logistic regression analysis was used to identify potential risk factors for intrathoracic manifestations.
Seventy-nine (15.8 per cent) of 501 patients developed anastomotic leakage after THO compared with 50 (15.3 per cent) of 327 after TTO (P = 0.853). Intrathoracic manifestations developed in 21 (27 per cent) and 22 (44 per cent) patients respectively (P = 0.041). A transthoracic approach was the only independent predictor of the development of intrathoracic manifestations in patients with cervical leakage (odds ratio 2.60; P = 0.022). Total hospital stay (P < 0.001), intensive care unit stay (P < 0.001) and in-hospital mortality (P = 0.035) were greater in patients with intrathoracic manifestations than in those without.
Intrathoracic manifestations of cervical anastomotic leakage are associated with a prolonged hospital stay, carry a higher mortality and occur more frequently after TTO than THO.
British Journal of Surgery 03/2010; 97(5):726-31. · 4.61 Impact Factor
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N A van der Gaag,
E A J Rauws,
C H J van Eijck,
M J Bruno,
E van der Harst,
F J G M Kubben,
J J G M Gerritsen,
J W Greve,
M F Gerhards,
I H J T de Hingh,
J H Klinkenbijl,
C Yung Nio,
S M M de Castro, O R C Busch,
T M van Gulik,
P M M Bosssuyt,
D J Gouma
Nederlands tijdschrift voor geneeskunde 01/2010; 154(29):A1883.
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ABSTRACT: To determine (a) the feasibility of implementing a system for the evaluation of teaching qualities (SETQ) of faculty in an academic medical centre, (b) the psychometric qualities of the questionnaires that are used for the generation of feedback and (c) how residents evaluate the teaching qualities of faculty members and how faculty rated themselves.
Questionnaire study.
Residents evaluated the teaching qualities of faculty members and faculty also evaluated themselves. Specialty specific questionnaires were developed for both evaluations. The psychometric qualities of the questionnaires were determined by using exploratory factor analysis and by calculating the reliability coefficients of scale constructs and item-total correlation. Mean, median and range were calculated for all teaching aspects per training programme.
In the course of one year, 16 residency programmes in our academic medical centre implemented the SETQ system for the evaluation of teaching faculty. 398 faculty members and 314 residents were invited to (self-) evaluate; the response rates were 80.9% and 73.6% respectively. Residents conducted 2,520 evaluations in total. Factor analysis resulted in the definition of 5 teaching domains: 'learning climate', 'professional attitude towards residents', 'communication of learning goals', 'evaluation of residents' and 'feedback to residents'. Item-total correlation and reliability were high for both the residents' questionnaire and the self-evaluation questionnaire (Cronbach's alpha: > 0.70), except for the educational aspect 'learning climate' on the self-evaluation questionnaire (alpha: 0.67) Faculty members were rated positively, but the self-evaluation of faculty members was slightly less positive. For both groups 'professional attitude towards residents' was the highest scoring teaching domain and 'communication of learning goals' the lowest one.
Implementing a system for the evaluation of teaching qualities (SETQ) of faculty in an academic hospital was proven feasible. The psychometric qualities of the underlying instruments was sufficient to good. Teaching faculty were evaluated positively, although interdepartmental variations existed.
Nederlands tijdschrift voor geneeskunde 01/2010; 154:A1222.
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ABSTRACT: Mucinous cystadenomas of the liver are rare cystic neoplasms. The aim of this study was to assess management of a consecutive series of patients who underwent laparotomy for a suspected cystadenoma or cystadenocarcinoma. Secondly, the origin of ovarian stroma (OS) in mucinous liver cystadenomas was examined during early embryonic development.
Patients diagnosed with mucinous liver cystadenomas or cystadenocarcinoma between 1994 and 2009 were included. Pathology specimens of patients who had undergone resection were reviewed for OS. Furthermore, in human embryos, morphology of the peritoneal epithelium and the position of the gonads in relation to the embryonic liver, pancreas and spleen were examined.
15 surgically treated patients (13 female, 2 male) with hepatic tumors were eventually diagnosed with mucinous liver cystadenomas (12) or cystadenocarcinomas (3). OS was present in all female patients with mucinous cystadenoma or cystadenocarcinoma. The 2 male patients were rediagnosed as intraductal papillary mucinous neoplasm (IPMN) or cystadenocarcinoma with features of IPMN. In human embryos, preceding their 'descent', the gonads are situated directly under the diaphragm, dorsal to the liver, the tail of the pancreas and the spleen, but separated from these organs by the peritoneal cavity. In contrast to the peritoneal epithelium elsewhere, the cells covering the gonads show an activated morphology.
For the diagnosis of mucinous liver cystadenoma, the presence of OS is prerequisite. This may be explained by the common origin of cystadenoma and OS in epithelial cells that cover the embryonic gonads in early fetal life.
Digestive surgery 01/2010; 27(1):19-23. · 1.37 Impact Factor
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ABSTRACT: This study examined the clinical outcome of patients with pancreatic metastases from renal cell carcinoma (RCC).
A systematic literature search produced individual data for 311 surgically and 73 non-surgically treated patients with pancreatic RCC metastases. A further ten patients underwent resection at the authors' institution.
In the resected group, pancreatic metastases were solitary in 65.3 per cent, symptomatic in 57.4 per cent, and were preceded and/or accompanied by extrapancreatic disease in 22.3 per cent. Respective values in the unresected group were 59, 60 and 58 per cent. Disease-free survival rates were 76.0 and 57.0 per cent respectively at 2 and 5 years after resection, and overall survival rates were 80.6 and 72.6 per cent. The only significant risk factor for disease-free survival after pancreatic resection was extrapancreatic disease (P = 0.001), and that for overall survival was symptomatic RCC metastasis (P = 0.031). Two- and 5-year overall survival rates were 41 and 14 per cent respectively in unresected patients.
The actuarial 5-year overall survival rate following pancreatic surgery for RCC metastases was 72.6 per cent, as determined by pooled analysis from published series. Extrapancreatic disease was an independent risk factor for recurrence, but had no significant impact on overall survival.
British Journal of Surgery 07/2009; 96(6):579-92. · 4.61 Impact Factor
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ABSTRACT: Nomograms are statistical tools providing the overall probability of a specific outcome; they have shown better individual discrimination than the tumour node metastasis staging system in several cancers. The pancreatic nomogram, originally developed in the Memorial Sloan-Kettering Cancer Center (MSKCC) in the USA, combines clinicopathological and operative data to predict disease-specific survival at 1, 2 and 3 years from initial resection.
An external patient cohort from a retrospective pancreatic adenocarcinoma database at the Academic Medical Centre in Amsterdam was used to test the validity of the pancreatic adenocarcinoma nomogram. The cohort included 263 consecutive patients who had surgery between January 1985 and December 2004.
Data for all the necessary variables were available for 256 patients (97.3 per cent). At the last follow-up, 35 patients were alive, with a median follow-up of 27 (range 3-114) months. The 1-, 2- and 3-year disease-specific survival rates were 60.8, 30.4 and 16.0 per cent respectively. The nomogram concordance index was 0.61. The calibration analysis of the model showed that the predicted survival did not significantly deviate from the actual survival.
The MSKCC pancreatic cancer nomogram provided an accurate survival prediction. It may aid in counselling patients and in stratification of patients for clinical trials.
British Journal of Surgery 05/2009; 96(4):417-23. · 4.61 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) for patients with unresectable pancreatic cancer and to analyze whether POSSUM can predict the long-term outcome in these patients. Such a scoring system could be useful to aid in the decision between surgical and endoscopic palliation.
Between January 1993 and December 2004, 241 patients were found to have unresectable pancreatic cancer during exploratory laparotomy and underwent a double bypass procedure consisting of a gastrojejunostomy and a hepaticojejunostomy.
Overall, 64 of 240 patients (27%) had one or more complications after bypass surgery and 4 patients (2%) died. POSSUM predicted morbidity in 114 patients (47%). The observed:predicted (O:P) ratio for morbidity was 0.56 and the model had a significant lack of fit (p < 0.001) using a goodness-of-fit analysis. The overall median survival was 7 months. The POSSUM scoring system was, however, an independent predictor of survival in multivariate analysis.
Overall, POSSUM overpredicted morbidity but was an independent predictor of survival.
Digestive surgery 01/2009; 26(1):75-9. · 1.37 Impact Factor
