J J van Lanschot

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (312)1252.1 Total impact

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    ABSTRACT: To determine the relation between time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) and pathologically complete response (pCR), surgical outcome, and survival in patients with esophageal cancer.
    Annals of surgery. 11/2014; 260(5):807-814.
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    ABSTRACT: We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT.
    Annals of surgery. 11/2014; 260(5):786-793.
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    ABSTRACT: To describe causes of death in the first year after esophagectomy and determine the time frame that should be used for measurement of quality of surgery. A case-mix adjustment model was developed for the comparison between hospitals.
    Annals of Surgery 08/2014; 260(2):267-73. · 6.33 Impact Factor
  • M Mahajan, A van der Gaast, J J B van Lanschot
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    ABSTRACT: A 66-year-old man had a dry ulcerating swelling on the throat with progressive growth. In the previous year, he had had neoadjuvant chemoradiotherapy and an operative resection of oesophagus carcinoma. Biopsy revealed a metastasis of the oesophagus carcinoma. Skin metastases of oesophagus carcinoma are rare and respond well to chemotherapy.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7561.
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    ABSTRACT: Esophageal cancer is increasingly recognized in younger patients. We compared clinicopathological characteristics, treatment, and survival of patients aged ≤50 years with patients aged >50 years diagnosed with esophageal cancer in the Netherlands. From the nationwide Netherlands Cancer Registry we identified all patients diagnosed with esophageal cancer between January 2000 and January 2011. Proportions were compared using the χ(2) test for categorical variables. Overall and relative survival was calculated. Eleven percent of the patients (n = 1,466) were aged ≤50 years and adenocarcinoma was the most common tumor type (73.6%). Grade of tumor differentiation was comparable between both age groups (P = 0.460) as well as T-stage (P = 0.058). Younger patients presented more often with positive lymph nodes (70.1% vs. 66.4%, P = 0.010) and distant metastasis (50.5% vs. 44.7%, P < 0.001) but had surgery more often as compared to older patients: 40.6% versus 37.9%, P = 0.047. There was no significant difference in the 5-year relative survival between both age groups: 18.1% versus 17.2%, P > 0.05. A subgroup analysis among patients diagnosed with adenocarcinoma revealed similar results. Young patients with esophageal cancer present with more advanced disease stage and received more often treatment. However, they show comparable relative survival rates with their older counterparts. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 12/2013; · 2.64 Impact Factor
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    ABSTRACT: To gain insight into the exact location of residual esophageal cancer in the esophageal wall and regional lymph nodes after neoadjuvant chemoradiotherapy (nCRT) and to determine the pattern of regression. Data from the recently published chemoradiotherapy for oesophageal cancer followed by surgery study trial showed that 49% of squamous cell carcinomas and 23% of adenocarcinomas had a pathologically complete response (pCR) in the resection specimen after nCRT. These results impose the ethical imperative to reconsider the necessity of esophagectomy with its substantial morbidity and mortality in patients with pCR. However, it remains challenging to accurately identify these patients before resection. Between January 2003 and July 2011, all patients with esophageal cancer in a tertiary referral center, who underwent nCRT (5 weekly courses of carboplatin and paclitaxel plus 41.4 Gy concurrent radiotherapy) and surgical resection, were analyzed. The resection specimens were carefully re-evaluated by an experienced gastrointestinal pathologist. Tumor regression grade (TRG) was meticulously scored for each specific layer of the esophageal wall and for all removed lymph nodes. One hundred two consecutive patients were included. Seventy-one (70%) of 102 patients were noncomplete responders (≥TRG2) and in 63 of these patients (89%), residual tumor cells were seen in the mucosa and/or submucosa. Five of 8 patients without involvement of the mucosa and the submucosa had isolated remnants in the muscle layer (5/102 = 5%); the other 3 patients had tumor cells only in a single lymph node (3/102 = 3%). The surrounding stroma showed the highest percentage of TRG1 (= pCR: 47%). In patients with pretreatment lymph node positivity, the percentage of TRG1 in all lymph nodes was also favorable (52%). Overall regression showed a nonrandom mixed pattern of both concentric regression and regression toward the lumen. After nCRT for esophageal cancer, both the mucosa and the submucosa show frequent residual malignant involvement. The surrounding stroma and the regional lymph nodes show the highest percentage of pCR and the overall regression pattern is most frequently a mixed pattern of both concentric regression and regression toward the lumen. This overall regression pattern lends support to careful testing of a wait-and-see approach in a subgroup of patients with esophageal cancer after nCRT.
    Annals of surgery 10/2013; · 7.90 Impact Factor
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    Pieter J Tanis, Annemiek Doeksen, J Jan B van Lanschot
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    ABSTRACT: Background: There is a lack of outcome data beyond local recurrence rates after primary treatment in rectal cancer, despite more information being necessary for clinical decision-making. We sought to determine patient selection, therapeutic modalities and outcomes of locally recurrent rectal cancer treated with curative intent. Methods:We searched MEDLINE (1990-2010) using the medical subject headings "rectal neoplasms" and "neoplasm recurrence, local." Selection of cohort studies was based on the primary intention of treatment and availability of at least 1 outcome variable. Results:We included 55 cohort studies comprising 3767 patients; 8 studies provided data on the rate of intentionally curative treatment from an unselected consecutive cohort of patients (481 of 1188 patients; 40%). Patients were symptomatic with pain in 50% (796 of 1607) of cases. Overall, 3088 of 3767 patients underwent resection. The R0 resection rate was 56% (1484 of 2637 patients). The rate of external beam radiotherapy was 100% in 9 studies, 0% in 5 studies, and ranged from 12% to 97% in 37 studies. Overall postoperative mortality was 2.2% (57 of 2515 patients). Five-year survival was at least 25%, with an upper limit of 41% in 11 of 18 studies including at least 50 resections. We found a significant increase in reported survival rates over time (r2 = 0.214, p = 0.007). Conclusion: More uniformity in treatment protocols and reporting on outcomes for locally recurrent rectal cancer is warranted. The observed improvement of reported survival rates in time is probably related to better patient selection and optimized multimodality treatment in specialized centres.
    Canadian journal of surgery. Journal canadien de chirurgie 04/2013; 56(2):135-44. · 1.63 Impact Factor
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    ABSTRACT: To compare preoperative chemoradiotherapy followed by surgery with primary surgery in patients with potentially surgically curable cancer of the oesophagus or oesophagogastric junction. Multicentre randomized controlled phase 3 trial. Patients with potentially curable carcinoma were randomized for preoperative chemoradiotherapy (CRT) followed by surgery (n = 178) or primary surgery (n = 188). Patients in the CRT arm were treated preoperatively with 5 weekly courses of carboplatine and paclitaxel in combination with simultaneous external radiotherapy (41.4 Gy). Patients were followed up postoperatively; survival, relapse and complications were recorded during follow-up. The hazard ratio (HR) for the primary outcome measure (overall survival) was estimated using Cox-regression analysis. In the period March 2004 to December 2008, 366 patients were included and analysed. Three-quarters of patients suffered from adenocarcinoma. More than 90% of patients in the CRT arm received the full planned dose of chemotherapy and radiotherapy. There was no significant difference in postoperative complications or postoperative mortality between the two groups. A microscopically radical resection (R0) was performed in 92% of patients in the CRT arm versus 69% in the primary surgery group (p < 0.001). In the CRT arm 29% of patients had a pathologically complete response. The estimated 5-year overall survival was significantly better in the CRT arm than in the primary surgery arm (47% vs. 34% respectively; p = 0.003; HR 0.657). Preoperative chemoradiotherapy followed by surgery leads to a significant increase in survival in patients with cancer of the oesophagus or the oesophagogastric junction.
    Nederlands tijdschrift voor geneeskunde 01/2013; 157(6):A5682.
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    ABSTRACT: BACKGROUND: 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. METHODS: All patients who received neoadjuvant CRT followed by oesophagectomy between 1993 and 2009 were identified from a database, and categorized according to pathological tumour response. Recurrences were classified as locoregional or distant. RESULTS: One hundred and eighty-eight patients were included. Median potential follow-up was 71·6 months. A pCR was achieved in 62 (33·0 per cent) of 188 patients. Recurrence developed in 24 (39 per cent) of 62 patients with a pCR and 70 (55·6 per cent) of 126 without a pCR (P = 0·044). Locoregional recurrence with or without synchronous distant metastases occurred in eight patients (13 per cent) in the pCR group and 31 (24·6 per cent) in the non-pCR group (P = 0·095). Locoregional recurrences without synchronous distant metastases occurred four (6 per cent) and ten (7·9 per cent) patients respectively (P = 0·945). The overall 5-year survival rate was significantly higher in the pCR group than in the non-pCR group (52 versus 33·9 per cent respectively; P = 0·019). CONCLUSION: Of patients with a pCR, 13 per cent still developed a locoregional recurrence. Although pCR is more favourable for survival, it is not synonymous with cure or complete locoregional disease control. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
    British Journal of Surgery 11/2012; · 4.84 Impact Factor
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    ABSTRACT: BACKGROUND: In esophageal cancer patients preoperative staging will determine the type of surgical procedure and use of neoadjuvant therapy. Tumor location and lymph node status play a pivotal role in this tailored strategy. The aim of the present study was to prospectively evaluate the accuracy of preoperative assessment of tumor location according to the Siewert classification and lymph node status per station with endoscopy/endoscopic ultrasound (EUS) and computed tomography (CT). METHODS: In 50 esophagectomy patients with adenocarcinoma of the gastroesophageal junction (GEJ), tumor location according to Siewert and N-stage per nodal station as determined preoperatively by endoscopy/EUS and CT were compared with the histopathologic findings in the resection specimen. RESULTS: Overall accuracy in predicting tumor location according to the Siewert classification was 70 % for endoscopy/EUS and 72 % for CT. Preoperative data could not be compared with the pathologic assessment in 11 patients (22 %), as large tumors obscured the landmark of the gastric folds. The overall accuracy for predicting the N-stage in 250 lymph node stations was 66 % for EUS and 68 % for CT. The accuracy was good for those stations located high in the thorax, but poor for celiac trunk nodes. CONCLUSIONS: Given the frequent discrepancy between the endoscopic and pathologic location of the GEJ and the common problem of advanced tumors obscuring the landmarks used in the assessment of the Siewert classification, its usefulness is limited. The overall accuracy for EUS and CT in predicting the N-stage per station was moderate.
    World Journal of Surgery 09/2012; · 2.23 Impact Factor
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    ABSTRACT: The 1st St. Gallen EORTC Gastrointestinal Cancer Conference 2012 Expert Panel clearly differentiated treatment and staging recommendations for the various gastroesophageal cancers. For locally advanced gastric cancer (⩾T3N+), the preferred treatment modality was pre- and postoperative chemotherapy. The majority of panel members would also treat T2N+ or even T2N0 tumours with a similar approach mainly because pretherapeutic staging was considered highly unreliable. It was agreed that adenocarcinoma of the gastroesophageal junction (AEG) is classified best according to Siewert et al. Preoperative radiochemotherapy (RCT) is the preferred treatment for AEG type I and II tumours. For AEG type III, i.e. tumours which may be considered as gastric cancer, perioperative chemotherapy is the majority approach. For resectable squamous cell cancer of the oesophagus a clear majority recommended radiochemotherapy followed by surgery as optimal approach, irrespective of tumour size. In contrast, definitive RCT was judged appropriate for advanced tumours with extended lymph node involvement (N2) or for cancers of the upper oesophagus. Additional recommendations are presented on the use of endosonography, PET-CT scan and laparoscopy for staging and on the preferred approach to surgery.
    European journal of cancer (Oxford, England: 1990) 08/2012; 48(16):2941-53. · 4.12 Impact Factor
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    ABSTRACT: 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. Population-based data for the period 1997-2008 were retrieved from the Rotterdam Cancer Registry for resectional surgery of oesophageal, gastric, colonic, rectal, breast, lung, renal and bladder cancer. Postoperative deaths were tabulated as 30-day, in-hospital or 90-day mortality. Postdischarge deaths were defined as those occurring after discharge from hospital but within 30 days. This study included 40,474 patients. Thirty-day mortality rates were highest after gastric (8·8 per cent) and colonic (6·0 per cent) surgery, and lowest after breast (0·2 per cent) and renal (2·0 per cent) procedures. For most tumour types, the difference between 30-day and in-hospital rates was less than 1 per cent. For bladder and oesophageal cancer, however, the in-hospital mortality rate was considerably higher at 5·1 per cent (+1·3 per cent) and 7·3 per cent (+2·8 per cent) respectively. For gastric, colonic and lung cancer, 1·0 per cent of patients died after discharge. For gastric, lung and bladder cancer, more than 3 per cent of patients died between discharge and 90 days. The 30-day definition is recommended as an international standard because it includes the great majority of surgery-related deaths and is not subject to discharge procedures. The 90-day definition, however, captures mortality from multiple causes; although this may be of less interest to surgeons, the data may be valuable when providing information to patients before surgery.
    British Journal of Surgery 06/2012; 99(8):1149-54. · 4.84 Impact Factor
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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. · 54.42 Impact Factor
  • B A Grotenhuis, B P L Wijnhoven, J J B van Lanschot
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    ABSTRACT: 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. A retrospective review of the English-language literature (1997-2010) concerning CSCs and their therapeutic implications was performed. CSCs are characterized by two main properties of normal stem cells: Self-renewal and differentiation, which are best assayed by serial transplantation experiments in immunodeficient mice. Cell-surface antigens that mark cell populations enriched for CSCs have been identified in various solid tumors. As such, the very existence of CSCs has vast clinical implications with regard to cancer treatment. The development of tailor-made CSC-targeted therapies (including therapies directed at these CSC-specific surface markers, and reversal of the intrinsic resistance of CSCs to chemo- and radiotherapy) entails great promises. However, normal stem cell toxicity and treatment resistance have been recognized as serious problems. The growing evidence indicating that CSCs drive and maintain various types of solid human malignancies has important implications for the treatment of patients. However, over the years the development of CSC-targeted therapies has faced a number of potential hurdles, which must be considered carefully in order to maximize the chance that such therapies will be successful.
    Journal of Surgical Oncology 02/2012; 106(2):209-15. · 2.64 Impact Factor
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    ABSTRACT: OBJECTIVE: This study aims to explain bodily pain using the Sprangers and Schwartz theoretical model (1999) on quality of life (QL) and response shift in its entirety. Response shift refers to the phenomenon that the meaning of a person's self-evaluation changes over time. In this model, response shift mediates effects of changes in health status (catalysts), stable characteristics of the person (antecedents), and coping mechanisms (mechanisms) on QL. METHODS: Cancer patients (202) were assessed prior to and 3 months following surgery. Measures were for catalysts: type of operation and possibility of tumor resection; for antecedents: age, duration of pain, optimism, and rigidity; for mechanisms: post-traumatic growth, social comparisons, social support, denial, and acceptance; and for QL: bodily pain; for response shift: the pretest-minus-thentest bodily pain score, further referred to as recalibration response shift. Structural equation modeling and sequential regression analyses were used. RESULTS: The final model reached close fit (RMSEA = 0.03; 90% CI = 0.000-0.071; χ2 (18) = 21.13; p = 0.27). Significant effects were found for catalysts on mechanisms, antecedents on mechanisms, mechanisms on response shift, and response shift on bodily pain. Four extra model effects had to be permitted. Using sequential regression analysis, recalibration response shift added 4.4% to the total amount of 29.8% explained variance of bodily pain. CONCLUSIONS: Many effects as hypothesized by the model were found. Recalibration response shift had a unique albeit small contribution to the explanation of bodily pain. Copyright © 2012 John Wiley & Sons, Ltd.
    Psycho-Oncology 01/2012; · 3.51 Impact Factor
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    ABSTRACT: Background: Patients with oesophageal cancer are at risk for developing locoregional recurrence after surgery. Neoadjuvant chemoradiotherapy (CRT) is believed to facilitate a radical resection and to improve locoregional control. Approximately one third of the patients have no tumour left in the resection specimen (pathologically complete response = pCR). Little is known about the pattern and timing of recurrence in patients with a pathologically complete or a non-complete response after receiving neoadjuvant chemoradiotherapy followed by resection for oesophageal cancer. Methods: All patients who received neoadjuvant CRT followed by oesophagectomy in our institution between 1993 and 2009 were identifi ed from a prospective database and allocated according to pathological tumour response. Results: One hundred and eighty-eight patients were included. Median potential follow-up was 71.6 months. A pathologically complete response (pCR) was achieved in 62/188 (33%) patients. Recurrence occurred in 24/62 (39%) patients in the pCR group vs. 70/126 (56%) patients in the non-pCR group (p = 0.03). Locoregional recurrence with or without synchronous distant metastases occurred in 8/62 (13%) patients in the pCR group vs. 31/126 (25%) in the non-pCR group (p = 0.63). Locoregional recurrences without synchronous distant metastases occurred 4/62 (7%) patients in the pCR group vs. 10/126 (8%) patients in the non-pCR group (p = 0.72). Overall 5-year survival was signifi cantly higher in the pCR group (50%) than in the non-pCR group (36%). Discussion: Of the patients with a pCR, 13% still developed a locoregional recurrence. Although a pCR is more favourable for survival, it is not synonymous with complete locoregional disease control. Disclosure: All authors have declared no confl icts of interest
    Diseases of the Esophagus 01/2012; 25(Supplement S1):85A. · 1.64 Impact Factor
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    ABSTRACT: BACKGROUND/AIMS: The Dutch guidelines for diagnosis and treatment of upper-GI malignancies recommend review of patients by a multidisciplinary tumour board (MDT). The purpose of this study was to determine the effect on clinical decision making of an MDT for patients with upper-GI malignancies. METHODS: All physicians participating in the MDT completed an electronic standardised case form to delineate their proposed treatment plan for the patients they presented, including the intent of treatment and the modality of treatment. This therapeutic or diagnostic proposal was then compared with the plan on which consensus was reached by the MDT. RESULTS: A total of 252/280 (90.0%) forms were completed and suitable for analysis. In 87/252 (34.5%) of the case presentations, the MDT altered the proposed plan of management. In 29/87 (33.3%) cases, a more extensive diagnostic work-up was decided upon. In 8/87 (9.2%) cases the curative intent of the proposed treatment was altered to palliation only. In 2/75 (2.7%) cases, however, it was decided that a patient could be treated with curative intent instead of the proposed palliative intent. CONCLUSION: In over 1/3 of cases, the diagnostic work-up or treatment plan is altered after evaluation by a multidisciplinary tumour board. This study supports Dutch guidelines recommending discussion of patients with upper-GI malignancies by a multidisciplinary tumour board.
    International Journal of Clinical Oncology 12/2011; · 1.41 Impact Factor
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    ABSTRACT: Chemoradiotherapy 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. Serial 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. CT 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. Tumour 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.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 09/2011; 37(12):1064-71. · 2.56 Impact Factor
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    ABSTRACT: The purpose of this study was to prospectively compare rectal resection (RR) with colonic resection on sexual, urinary and bowel function and quality of life in both short-term and long-term. Eighty-three patients who underwent RR were compared to 53 patients who underwent a colonic resection leaving the rectum in situ (RIS). A questionnaire assessing sexual, urinary and bowel functioning with a quality of life questionnaire (SF-36) was sent to all participants preoperatively, 3 and 12 months postoperatively and approximately 8 years after the onset of the study. Short-term dysfunction included diminished sexual activity in female RR patients at 3 months and significantly more erectile dysfunction in RR patients 1 year postoperatively. Long-term dysfunction included more frequent and more severe erectile dysfunction in RR patients compared to RIS patients. These short-term and long-term outcomes did not influence overall quality of life. The incidence of urinary dysfunction was comparable between both groups. Bowel functioning was significantly better in the RIS group compared to the RR group 3 months and 1 year postoperatively. Patients who underwent RR experienced up to 1 year postoperatively more sexual and bowel function problems than RIS patients. However, short-term and long-term dysfunction did not influence overall quality of life. Erectile dysfunction in male RR patients persisted in time, whereas other aspects of sexual, urinary and bowel function after RR and colonic resection are similar after a median follow-up of 8.5 years.
    International Journal of Colorectal Disease 09/2011; 26(12):1549-57. · 2.24 Impact Factor
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    ABSTRACT: Comparison of functional and surgical outcome of the J-pouch with the side-to-end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision in rectal cancer patients. In a multicentre study, patients with a carcinoma of the lower two-thirds of the rectum were randomized to either a J-pouch or a side-to-end reconstruction. Primary outcome was function of the neorectum 1 year after surgery. A functional outcome [COloREctal Functional Outcome (COREFO)] questionnaire, and two quality of life questionnaires (EORTC-QLQ-CR38 and SF-36) were to be completed by all participants preoperatively, and 4 and 12 months postoperatively. Independent data managers recorded surgical outcome. A group size of 30 patients in each group was calculated based on a 15-point difference of the COREFO scale. In total, 107 patients were randomized, 55 in the J-pouch group and 52 in the side-to-end anastomosis group. The COREFO incontinence scale at 4 months and the total functional outcome at 4 and 12 months showed better results for the J-pouch group in comparison with the side-to-end anastomosis group. The remaining COREFO scales (frequency, social impact, stool-related aspects and bowel medication), surgical outcome (complications, reoperations, length of hospital stay, readmissions and mortality) and quality of life did not show significant differences between treatment groups. The overall results of a coloanal J-pouch and a side-to-end anastomosis are comparable, although functional results are slightly better with a J-pouch. The side-to-end anastomosis is technically less demanding and therefore a justified alternative in sphincter-saving surgery.
    Colorectal Disease 08/2011; 14(6):705-13. · 2.08 Impact Factor

Publication Stats

8k Citations
1,252.10 Total Impact Points

Institutions

  • 2008–2013
    • Erasmus MC
      • Department of Surgery
      Rotterdam, South Holland, Netherlands
  • 1994–2013
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Surgery
      • • Academic Medical Center
      • • Department of Gastroenterology and Hepatology
      • • Department of Medical Psychology
      Amsterdam, North Holland, Netherlands
  • 1985–2013
    • Erasmus Universiteit Rotterdam
      • • Department of Surgery
      • • Department of Anesthesiology
      Rotterdam, South Holland, Netherlands
  • 2012
    • Integraal Kankercentrum Nederland
      Amsterdamo, North Holland, Netherlands
  • 2006–2010
    • St. Lucas Andreas Hospital
      • Department of Surgery
      Amsterdamo, North Holland, Netherlands
    • University of Groningen
      • Department of Surgery
      Groningen, Province of Groningen, Netherlands
    • Dalhousie University
      Halifax, Nova Scotia, Canada
    • Universitair Medisch Centrum Groningen
      • Department of Surgery
      Groningen, Groningen, Netherlands
  • 1995–2009
    • University of Amsterdam
      • • Faculty of Medicine AMC
      • • Department of Surgery
      Amsterdam, North Holland, Netherlands
  • 2007
    • Universität Heidelberg
      • Department of Spine Surgery
      Heidelberg, Baden-Wuerttemberg, Germany
    • Netherlands Cancer Institute
      Amsterdamo, North Holland, Netherlands
  • 2005
    • Medical University of Lublin
      • Department of Clinical Pathomorphology
      Lublin, Lublin Voivodeship, Poland
  • 2004
    • University of Leuven
      Louvain, Flanders, Belgium
  • 2000
    • University Medical Center Utrecht
      • Department of Surgery
      Utrecht, Provincie Utrecht, Netherlands
    • Onze Lieve Vrouwe Gasthuis
      • Department of Pathology
      Amsterdamo, North Holland, Netherlands
  • 1996
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands