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M Vermaas,
M P Gosselink,
F T J Ferenschild,
E van den Aardweg, H E Lont,
H W P M Kemperman,
E van der Harst,
G W M Tetteroo,
R J Oostenbroek,
C M Dijkhuis,
A M M Eggermont,
J H W de Wilt
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ABSTRACT: After publication of the results of the Dutch TME-trial preoperative radiotherapy followed by TME-surgery was introduced in July 2001 in the region of the comprehensive cancer centre Rotterdam as standard treatment for rectal cancer. The aim of this study is to identify the compliance to a new standardized treatment protocol i.e. the introduction of preoperative radiotherapy and to analyze the results of rectal cancer treatment in the Cancer Centre Rotterdam Region.
A total of 521 patients with adenocarcinoma of the rectum were included in the period from 2001 to 2003. All patients were treated with curative intent.
There was a significant increase of preoperative radiotherapy for patients with a tumour in the lower two-third of the rectum (21% versus 69%, p<0.001). Peri-operative mortality rate was 2.7% and overall anastomotic leakage rate was 10.3%. There was a significant increase in the occurrence of anastomotic leakage in end-to-end anastomoses (p<0.0001). Most anastomotic leakages occurred when patients were operated in between 4 and 8 days after the end of radiotherapy. Several aspects such as continence for urine and faeces and sexual functions were poorly registered. The total number of lymph nodes registered in pathology reports was low. The rate of reported circumferential margins increased from 37% to 70% after feedback to the regional pathology working group.
The regional quality of rectal cancer surgery is conform preset quality-demands. There was a significant increase in the percentage preoperative radiotherapy, but still about 25% of patients who qualified for radiotherapy did not receive radiation. Pathology reports improved during registration, which illustrates the importance of registration to assess and improve quality of rectal cancer treatment.
European Journal of Surgical Oncology 09/2007; 33(7):862-7. · 2.50 Impact Factor
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ABSTRACT: Residual tumor in the remnant liver after partial hepatectomy (PH) for colorectal liver metastases is a serious clinical problem. This fact is reflected by the high number of recurrences after potentially curative liver resections. Liver regeneration, it appears, might influence the growth of remaining micrometastases in the liver. Using rats, we demonstrated enhancement of growth of a syngeneic colon carcinoma (CC 531) in the remnant liver after 70% PH. Fourteen days after PH, tumor weights in the liver were twice as high as those of sham-operated rats. This difference in tumor weight was not found in extrahepatic tumors. In vitro experiments did not show stimulation of cultured CC 531 cells by portal or systemic serum withdrawn 24 hours or 14 days after hepatectomy as compared with sera obtained after sham operation. Co-cultures of CC 531 cells and hepatocytes (in ratios of 1:10 or 1:1) demonstrated a higher 3H-thymidine incorporation than was the case in separately cultured cells. In co-cultures, bromodeoxyuridine (BrdU) incorporation in DNA was found primarily in CC 531 cells and rarely in hepatocytes. Cell density appeared to be of influence on 3H-thymidine incorporation in co-cultures. Hepatocytes were found to have a stimulating effect on CC 531 cells in low-density cultures, whereas high-density cultures exhibited an inhibiting effect after a culture time of 120 hours. These results show that, depending on cell density in co-cultures, a paracrine stimulating influence of hepatocytes on this type of colon carcinoma cells (CC 531) might be responsible for the increased tumor growth in vivo.
Hepatology 11/1995; 22(4 Pt 1):1263-72. · 11.66 Impact Factor
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ABSTRACT: With the aim of aiding the accurate diagnosis and treatment of patients with pancreatic injuries, we reviewed the medical records of all those patients, treated for traumatic pancreatic lesions at our hospital in the period between 1971 and 1987. For all twenty-four male patients the mechanism of the injury, the diagnostic methods employed, associated injuries, location of the pancreatic injury, the presence of pancreatic duct lesion, treatment, the final outcome, and complications are described. In our view, the high mortality rate of patients with pancreatic trauma is due not to the pancreatic injury per se, but to the severe concomitant injuries resulting from a high-energy trauma. On the basis of the literature and our own experience we designed a flow chart for the management of pancreatic injuries. If the history and physical examination indicate that intra-abdominal injury might be present, radiographic and ultrasound investigation are the diagnostic methods of choice. Patients without pancreatic duct injury can be treated with debridement and external suction drainage. If pancreatic duct lesion is presented and is located to the right of the superior mesenteric vessels, treatment should consist of partial pancreatic resection and pancreatico-jejunostomy or a Whipple procedure. If the pancreatic duct lesion is located to the left of the superior mesenteric vessels, distal pancreatectomy and splenectomy with pancreatico-jejunostomy, should be performed.
Hepato-gastroenterology 11/1992; 39(5):447-50. · 0.66 Impact Factor
