PhD Henri A. M. Marres MD

Publications (12)32.92 Total impact

• Article: Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple‐assisted diverticulostomy to treat Zenker's diverticulum

  Veronique J. O. Verhaegen MD, Ton Feuth MSc, PhD Frank J. A. van den Hoogen MD, PhD Henri A. M. Marres MD, PhD Robert P. Takes MD, Veronique J. O. Verhaegen, Ton Feuth, Frank J. A. van den Hoogen, Henri A. M. Marres, Robert P. Takes
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  ABSTRACT: Background The 2 most frequently used endoscopic methods to treat Zenker's diverticulum are staple-assisted and CO2 laser esophagodiverticulostomy.Methods The study centered around a retrospective evaluation of 107 patients with Zenker's diverticulum who were treated endoscopically by CO2 laser (n = 72) or staple-assisted diverticulostomy (n = 35).ResultsPatients in the staple-assisted group had a shorter duration of postoperative hospitalization, attributed to earlier oral intake, than patients in the CO2 laser group. There were no serious postoperative complications in either group. Postoperative fever and emphysema in the neck or mediastinum occurred more frequently in the CO2 laser group, but this did not lead to any complications. Most patients reported partial or complete relief of their symptoms and there was no significant difference in the number of reoperations between the 2 treatment groups.Conclusions Zenker's diverticulum was treated safely and effectively by the 2 endoscopic techniques, but the staple-assisted method seemed to be the most favorable. © 2010 Wiley Periodicals, Inc. Head Neck, 2011
  Head & Neck 01/2011; 33(2):154 - 159. · 2.40 Impact Factor
• Article: Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple‐assisted diverticulostomy to treat Zenker's diverticulum

  Veronique J. O. Verhaegen MD, Ton Feuth MSc, PhD Frank J. A. van den Hoogen MD, PhD Henri A. M. Marres MD, PhD Robert P. Takes MD
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  ABSTRACT: Background The 2 most frequently used endoscopic methods to treat Zenker's diverticulum are staple-assisted and CO2 laser esophagodiverticulostomy.Methods The study centered around a retrospective evaluation of 107 patients with Zenker's diverticulum who were treated endoscopically by CO2 laser (n = 72) or staple-assisted diverticulostomy (n = 35).ResultsPatients in the staple-assisted group had a shorter duration of postoperative hospitalization, attributed to earlier oral intake, than patients in the CO2 laser group. There were no serious postoperative complications in either group. Postoperative fever and emphysema in the neck or mediastinum occurred more frequently in the CO2 laser group, but this did not lead to any complications. Most patients reported partial or complete relief of their symptoms and there was no significant difference in the number of reoperations between the 2 treatment groups.Conclusions Zenker's diverticulum was treated safely and effectively by the 2 endoscopic techniques, but the staple-assisted method seemed to be the most favorable. © 2010 Wiley Periodicals, Inc. Head Neck, 2011
  Head & Neck 01/2011; 33(2):154 - 159. · 2.40 Impact Factor
• Article: Oral squamous cell carcinoma and a clinically negative neck: The value of follow‐up

  Bart M. Wensing MD, Matthias A. W. Merkx MD, DMD, PhD, Paul F. M. Krabbe PhD, PhD Henri A. M. Marres MD, PhD Frank J. A. Van den Hoogen MD
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  ABSTRACT: Background In squamous cell carcinoma of the oral cavity (SCCOC), regular follow-up comprises 5 years of prescheduled visits, irrespective of tumor stage/classification and/or treatment. We analyzed our standard treatment and follow-up protocol in patients with a preoperative clinically negative neck (cN0) in SCCOC.Methods This is a retrospective chart analysis. Inventarization of treatment, occult metastatic spread, and follow-up were performed.ResultsIn all, 197 patients were included. The occult metastatic rate was 24%. Eighty-three percent of recurrent disease presented within 2 years. Fifty-three percent of the patients with recurrent disease visited their physician outside prescheduled control visits.Conclusions Ultrasound-guided fine-needle aspiration cytology currently is 1 of the most reliable staging techniques in cN0 SCCOC. Regular follow-up could perhaps be limited from 5 to 2 years of prescheduled follow-up visits. © 2010 Wiley Periodicals, Inc. Head Neck, 2010
  Head & Neck 11/2010; 33(10):1400 - 1405. · 2.40 Impact Factor
• Source

  Available from: Matthias AW Merkx

  Article: Impact of an integrated care program for patients with head and neck cancer on the quality of care

  Mariëlle M. M. T. J. Ouwens PhD, Rosella R. P. M. G. Hermens PhD, Marlies M. E. J. L. Hulscher PhD, PhD Matthias A. W. Merkx MD, PhD Frank J. A. van den Hoogen MD, Richard P. Grol PhD, PhD Hub C. H. Wollersheim MD, PhD Henri A. M. Marres MD, Mariëlle M. M. T. J. Ouwens, Rosella R. P. M. G. Hermens, Marlies M. E. J. L. Hulscher, Matthias A. W. Merkx, Frank J. A. van den Hoogen, Richard P. Grol, Hub C. H. Wollersheim, Henri A. M. Marres
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  ABSTRACT: Background.The management of patients with head and neck cancer is complex, and implementation of an integrated care program might improve the quality of care.Methods.A prospective before–after study was performed in 1 clinic for head and neck oncology on 311 adults with head and neck cancer to evaluate an integrated care program.Results.Scores on the integrated care indicators showed that the implementation of the integrated care program led to relevant improvements, eg, waiting time for diagnostic procedures less than 10 days (improvement of 37%), support for stopping smoking (+37%), nutrition support (+44%), assessment of CT and MRI scans by a an expert radiologist (+23%), and number of patients in contact with the specialist nurses (+37%). The program had no relevant effects on the outcome indicators.Conclusion.An integrated care program can improve several aspects of the management of patients with head and neck cancer. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
  Head & Neck 06/2009; 31(7):902 - 910. · 2.40 Impact Factor
• Article: Quality of integrated care for patients with nonsmall cell lung cancer

  Mariëlle M. M. T. J. Ouwens MSc, Rosella R. P. M. G. Hermens PhD, René A. R. Termeer MD, Saskia Y. Vonk-Okhuijsen MSc, PhD Vivianne C. G. Tjan-Heijnen MD, Ad F. T. M. Verhagen MD, Marlies M. E. J. L. Hulscher PhD, PhD Henri A. M. Marres MD, PhD Hub C. H. Wollersheim MD, Richard P. T. M. Grol PhD
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  ABSTRACT: BACKGROUND.In the current study, the authors focused on determinants influencing the quality of care and variations in the actual quality of integrated care for patients with nonsmall cell lung cancer (NSCLC) to estimate whether there is room for improvement.METHODS.The authors tested the quality of integrated care for 276 NSCLC patients with 14 quality indicators of professional (4 indicators), organizational (3 indicators), and patient-oriented quality (7 indicators). Patient characteristics and actual care data were derived from medical record data, patient-oriented care was derived from patient questionnaires, and professional and hospital characteristics were derived from questionnaires for professionals. The performance measure was the proportion of patients to whom the indicator applied who had positive scores on the indicator. Multilevel logistic regression analysis determined the influence of patient, professional, and hospital characteristics on care.RESULTS.With regard to professional quality, the proportions of patients who underwent fluorodeoxyglucose–positron emission tomography or cervical mediastinoscopy according to the guideline criteria were 88% and 84%, respectively. Only 50% of the biopsies were adequately obtained during mediastinoscopy, and in 3% of the patients with clinical stage III disease (based on the TNM classification) there was a search for brain metastases before the initiation of combination therapy. With regard to organizational quality, the diagnostic route of 79% of the patients was completed within 21 days; 51% of patients began therapy within 35 days and 57% were discussed during multidisciplinary consultation. All but 1 patient-oriented quality indicator scored ≤58%. Hospitals varied by ≥20% with regard to 11 of the 14 indicators. The patient-related determinants “stage of disease,” “age,” and “comorbidity” were found to influence the indicator scores the most.CONCLUSIONS.The quality of integrated care (especially patient-oriented care) for NSCLC patients needs improvement. Patient characteristics appear to influence performance more than professional or hospital characteristics. Cancer 2007. © 2007 American Cancer Society.
  Cancer 10/2007; 110(8):1782 - 1790. · 4.77 Impact Factor
• Article: Tumor microenvironment in head and neck squamous cell carcinomas: Predictive value and clinical relevance of hypoxic markers. A review

  Ilse J. Hoogsteen MD, PhD Henri A. M. Marres MD, PhD Johan Bussink MD, Albert J. van der Kogel PhD, PhD Johannes H. A. M. Kaanders MD
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  ABSTRACT: Background.Hypoxia and tumor cell proliferation are important factors determining the treatment response of squamous cell carcinomas of the head and neck. Successful approaches have been developed to counteract these resistance mechanisms although usually at the cost of increased short- and long-term side effects. To provide the best attainable quality of life for individual patients and the head and neck cancer patient population as a whole, it is of increasing importance that tools be developed that allow a better selection of patients for these intensified treatments.Methods.A literature review was performed with special focus on the predictive value and clinical relevance of endogenous hypoxia-related markers.Results.New methods for qualitative and quantitative assessment of functional microenvironmental parameters such as hypoxia, proliferation, and vasculature have identified several candidate markers for future use in predictive assays. Hypoxia-related markers include hypoxia inducible factor (HIF)-1α, carbonic anhydrase IX, glucose transporters, erythropoietin receptor, osteopontin, and others. Although several of these markers and combinations of markers are associated with treatment outcome, their clinical value as predictive factors remains to be established.Conclusions:A number of markers and marker profiles have emerged that may have potential as a predictive assay. Validation of these candidate assays requires testing in prospective trials comparing standard treatment against experimental treatments targeting the related microregional constituent. © 2007 Wiley Periodicals, Inc. Head Neck, 2007
  Head & Neck 05/2007; 29(6):591 - 604. · 2.40 Impact Factor
• Source

  Available from: Paul F.M. Krabbe

  Article: Screening for local and regional cancer recurrence in patients curatively treated for laryngeal cancer: Definition of a high‐risk group and estimation of the lead time

  Savitri C. Ritoe MD, PhD André L. M. Verbeek MD, PhD Paul F. M. Krabbe MSc, PhD Johannes H. A. M. Kaanders MD, PhD Frank J. A. van den Hoogen MD, PhD Henri A. M. Marres MD, Savitri C. Ritoe, André L. M. Verbeek, Paul F. M. Krabbe, Johannes H. A. M. Kaanders, Frank J. A. van den Hoogen, Henri A. M. Marres
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  ABSTRACT: Background.All patients treated for laryngeal cancer are offered the same follow-up schedule to detect asymptomatic locoregional recurrences. In this study, we evaluated the prognostic profile of patients for cancer recurrence and estimated the lead time.Methods.A cohort study was performed between 1990 and 1995. Cox proportional hazards model was used to analyze the prognostic factors. The effect of altering the follow-up for asymptomatic recurrence detection was determined after estimating the lead time.Results.The variables cT classification, smoking, and histologic grade proved to be prognostic factors. The risk of locoregional failure was 15% in the low-risk group versus 29% in the high-risk group. The estimated lead time was 2 to 4 weeks.Conclusion.Risk profiles for locoregional relapse were defined. Intensifying the follow-up schedule is not advisable because the lead time is very short. An excessively high number of routine visits would have to be performed to increase the detection rate for asymptomatic recurrences. © 2006 Wiley Periodicals, Inc. Head Neck, 2007
  Head & Neck 04/2007; 29(5):431 - 438. · 2.40 Impact Factor
• Article: Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators

  Mariëlle M. M. T. J. Ouwens MSc, PhD Henri A. M. Marres MD, Rosella R. P. Hermens PhD, Marlies M. E. Hulscher PhD, PhD Frank J. A. van den Hoogen MD, Richard P. Grol PhD, PhD Hub C. H. Wollersheim MD
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  ABSTRACT: Background.To improve the quality of integrated care, we developed indicators for assessing current practice in a large reference center for head and neck oncology.Methods.We defined a set of indicators based on integrated care literature, national evidence-based guidelines for patients with head and neck cancer, and the opinions of professionals and patients. We tested this set regarding assessement of current practice and clinimetric characteristics.Results.The final set consisted of 8 integrated care indicators and 23 specific indicators for patients with head and neck cancer. Current practice assessment produced high scores for the integrated care indicators, but the specific indicators showed room for improvement. The practice test showed that 9 indicators had good applicability.Conclusions.The indicators, while based on evidence-based guidelines and the principles of integrated care, should incorporate patients' opinions and include a practice test. Our results show that the quality of integrated care for patients with head and neck cancer could be improved. © 2006 Wiley Periodicals, Inc. Head Neck, 2007
  Head & Neck 03/2007; 29(4):378 - 386. · 2.40 Impact Factor
• Article: Effect of routine follow‐up after treatment for laryngeal cancer on life expectancy and mortality

  Savitri C. Ritoe MD, PhD Femmie de Vegt MSc, Inger M. Scheike MSc, PhD Paul F. M. Krabbe MSc, PhD Johannes H. A. M. Kaanders MD, PhD Frank J. A. van den Hoogen MD, PhD André L. M. Verbeek MD, PhD Henri A. M. Marres MD
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  ABSTRACT: BACKGROUND.Routine follow-up is offered to all patients with laryngeal cancer who are treated with curative intent. Although time and resources are devoted to surveillance, the effect of asymptomatic recurrence detection is not well understood. For this study, the authors evaluated the effect that routine follow-up may have on life expectancy and disease-specific mortality rate for patients with laryngeal cancer.METHODS.Using a Markov model, a cohort simulation was performed on 4 hypothetical age groups of patients with laryngeal cancer. Three different follow-up strategies were compared—the current schedule, no follow-up, and the perfect follow-up—in which all recurrences were detected asymptomatically. Sensitivity analyses were performed to study the impact of variations in the transition rates on life expectancy.RESULTS.Compared with no follow-up, the current schedule showed a gain in life expectancy with a range from 0.3 years to 1.5 years that decreased with advancing age. Abolishing the current follow-up schedule raised the disease-specific mortality rate; the increase ranged from 2.8% to 5.9%. Variations of ±25% in the transition rates produced only a modest effect on life expectancy.CONCLUSIONS.A small reduction in life expectancy was observed when follow-up was withheld from the majority of patients. Disease-specific mortality rates rose when no follow-up was provided. These rates probably were overestimated. A simplified version of the current follow-up protocol may be implemented. Cancer 2007. © 2006 American Cancer Society.
  Cancer 01/2007; 109(2):239 - 247. · 4.77 Impact Factor
• Article: Experimental results of the tracheoesophageal tissue connector for improved fixation of shunt valves in laryngectomized patients

  E. J. O. Ten Hallers MD, PhD Henri A. M. Marres MD, Eduard B. van der Houwen MSc, PhD John A. Jansen DDS, PhD Gerhard Rakhorst DVM, PhD Harm K. Schutte MD, PhD Theo G. van Kooten MSc, PhD Jan-Paul van Loon MSc, PhD Gijsbertus J. Verkerke MSc
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  ABSTRACT: Background.After total laryngectomy and voice rehabilitation using a tracheoesophageal shunt valve, patients often have valve-related complications such as leakage. To solve these problems, a tracheoesophageal tissue connector (TE-TC) was devised to serve as an interface between the patient's tissue (trachea and esophagus) and the shunt valve.Methods.The TE-TC is a permucosal connection constructed from a titanium ring (filled with a silicon rubber plug) combined with polypropylene or titanium mesh. After implantation in adult goats for 12 weeks the implants were submitted to histologic investigation.Results.Firm implant fixation was achieved. In nearly all (18/19), no signs of infection of the implant were seen; 11 of 19 animals died before the end of the experiment owing to complications not related to the implant.Conclusions.The TE-TC is a new device with potential in the solution for fixation-related problems in tracheoesophageal voice rehabilitation. © 2006 Wiley Periodicals, Inc. Head Neck, 2006
  Head & Neck 10/2006; 28(11):982 - 989. · 2.40 Impact Factor
• Article: Cancer recurrence after total laryngectomy: Treatment options, survival, and complications

  Savitri C. Ritoe MD, Heidi Bergman MD, Paul F. M. Krabbe PhD, PhD Johannes H. A. M. Kaanders MD, PhD Frank J. A. van den Hoogen MD, PhD André L. M. Verbeek MD, PhD Henri A. M. Marres MD
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  ABSTRACT: Background.A follow-up schedule to detect asymptomatic cancer recurrence is offered to all patients with laryngeal cancer. In this study, the therapeutic options, prognosis, and morbidity of patients with total laryngectomy, who were found to have cancer recurrence during this follow-up schedule were determined.Methods.Patients who had undergone a total laryngectomy between January 1, 1990, and January 1, 2000, and had cancer recurrence were included. Data from this group were analyzed retrospectively.Results.The prognosis was poor after the development of cancer recurrence. Curative therapy could only be offered to 27.5% of these patients. Only 5% of the patients were disease free at the end of the study period. Many patients with cancer recurrence needed interventions. A large proportion of them had complications.Conclusions.The follow-up schedule offered to patients after total laryngectomy should put greater emphasis on care than on early detection of cancer recurrence. © 2005 Wiley Periodicals, Inc. Head Neck27: 383–388, 2006
  Head & Neck 04/2006; 28(5):383 - 388. · 2.40 Impact Factor
• Article: FDG‐PET in the Clinically Negative Neck in Oral Squamous Cell Carcinoma

  Bart M. Wensing MD, Wouter V. Vogel MD, PhD Henri A. M. Marres MD, PhD Matthias A. W. Merkx MD, PhD Ernst J. Postema MD, PhD Wim J. G. Oyen MD, PhD Frank J. A. van den Hoogen MD
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  ABSTRACT: Objective: With improved diagnostic imaging techniques, it remains difficult to reduce occult metastatic disease in oral squamous cell carcinoma (SCC) to less than 20%. Therefore, supraomohyoid neck dissection (SOHND) still is a valuable staging procedure in these patients.Methods: Patients with clinically and ultrasonographically staged cN0 SCC of the oral cavity underwent FDG-PET before SOHND. Histologic examination of neck dissection specimens was used as a “gold standard.”Results: Twenty-eight consecutive patients were included, representing 30 necks. Occult metastatic disease was found in 30% of SOHND specimens. Average diameter of metastatic deposits was 4.3 mm. Sensitivity, specificity, and accuracy of FDG-PET was 33%, 76%, and 63%, respectively.Conclusions: In patients with cN0 SCC of the oral cavity, FDG-PET does not contribute to the preoperative workup. FDG-PET does not replace SOHND as a staging procedure.
  The Laryngoscope 04/2006; 116(5):809 - 813. · 1.75 Impact Factor