Johnny Moons

Universitair Ziekenhuis Leuven | UZ Leuven · Department of Thoracic surgery

Anastomotic leakage after esophagectomy is one of the most feared complications, which results in increased morbidity and mortality. Our aim was to evaluate the impact of a powered circular stapler on complications after esophagectomy with intrathoracic anastomosis for esophageal cancer. Between May 2019 and July 2021, all consecutive oesophagectom...

Studies have shown minimally invasive esophagectomy (MIE) to be a feasible surgical technique in treating esophageal carcinoma, with equal oncological results as open surgery. The number of MIEs in Europe are increasing. Postoperative complications have been recently reviewed by a multicenter study that benchmarked MIE outcomes. There are no studie...

Lung metastasectomy (LM) with curative intent has become a widely accepted treatment for selected patients with stage IV colorectal cancer (CRC), but its oncological benefits have yet to be demonstrated by substantial evidence. The aim of this study was to assess the current practice of LM for CRC metastases in high-volume referral centres, focusin...

To investigate factors associated with the ability to receive adjuvant chemotherapy in patients with pathological N1 and N2 stage after anatomic lung resections for non-small cell lung cancer (NSCLC). Multicenter retrospective analysis on 707 consecutive patients found pathologic N1 (pN1) or N2 (pN2) disease following anatomic lung resections for N...

Introduction The COVID-19 pandemic has resulted in unparalleled changes to patient care, including the suspension of cancer surgery. Concerns regarding COVID-19-related risks to patients and healthcare workers with the re-introduction of major complex minimally invasive and open surgery have been raised. This study examines the COVID-19 related ris...

Introduction The Covid-19 pandemic has resulted in unprecedented and challenging changes to surgical practice, especially with the suspension of cancer surgery. There have been concerns regarding Covid-19 risk and infection to patients and healthcare workers, during major complex open surgical intervention, especially with minimally invasive surger...

Background Many hospitals postponed elective surgical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Some centers continued elective surgery, including esophageal cancer surgery, with the use of preoperative screening methods; however, there is no evidence supporting the safety of this strategy as postoperative outc...

Enhanced recovery pathways (ERP) have the potential to improve clinical outcomes. Aim of this study was to determine the impact of ERP on perioperative results as compared with traditional care (TC) after esophagectomy. In this study, two cohorts were compared. Cohort 1 represented 296 patients to whom TC was provided. Cohort 2 consisted of 200 uns...

OBJECTIVES Mediastinal neurogenic tumours are uncommon and often benign neoplasms mostly located in the posterior mediastinum and usually diagnosed incidentally. We reviewed our results after surgical resection. We compared patient characteristics and tumour nature between children and adults. Differences between thoracoscopic and open approach wer...

BACKGROUND Tumor response and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiation (nCRT). We hypothesise that lymph node response (LNR) is also a valuable prognosticator in these patients, potentially revealing the added effect of nCRT. METHODS Hematoxyl...

The optimal perioperative fluid management during esophagectomy is still not clear. Liberal regimens have been associated with higher morbidity and respiratory complications. Restrictive regimens might raise concerns for kidney function and increase the need to associate vasopressors. The aim of this study was to investigate retrospectively the per...

The optimal perioperative fluid management during esophagectomy is still not clear. Liberal regimens have been associated with higher morbidity and respiratory complications. Restrictive regimens might raise concerns for kidney function and increase the need to associate vasopressors. Recently, perioperative care is changing towards goal-directed f...

Background: Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. Objective: Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. Thi...

Background Total minimally-invasive transthoracic esophagectomy (ttMIE) faces increasing application in surgical treatment of esophageal cancer. For esophago-gastric reconstruction, different anastomotic techniques are currently used, but their impact on postoperative anastomotic leakage and morbidity has not been investigated. The aim of this retr...

Objectives Success of an enhanced recovery program (ERP) is not easily measured/quantified. Can a newly developed measuring instrument help to determine compliance and thus success of an ERP? Methods From the introduction of our ERP (May 2017), 200 consecutive potential curative esophagectomies for cancer were reviewed. A newly developed instrumen...

Purpose/objectives: To develop normal tissue complication probability (NTCP) models for postoperative pulmonary and cardiac complications and one-year mortality after preoperative chemoradiotherapy and surgery in oesophageal cancer patients. Methods: 691 patients from two institutions (2002-2017) were included; 134 treated with protons. Multivar...

Objective: The aim of this study was to describe anastomotic techniques used for total minimally invasive transthoracic esophagectomy (ttMIE) and to analyze the associated morbidity. Background: ttMIE faces increasing application in surgical treatment of esophageal cancer. For esophagogastric reconstruction, different anastomotic techniques are...

Purpose: To explore whether a higher neoadjuvant radiation dose increases the probability of a pathological complete response (pCR) or pathological major response (pMR) response in oesophageal cancer patients. Material and methods: Between 2000 and 2017, 1048 patients from four institutions were stratified according to prescribed neoadjuvant radiat...

Objectives: Patients are at high risk of malnutrition following esophagectomy. In our enhanced recovery program (ERP), that started in 2017, patients are routinely given prolonged enteral nutrition through a feeding-jejunostomy, next to free oral feeding, in order to adapt to the new feeding regimen and counteract the risk of substantial weight-los...

Enchanced recovery in esophagectomy for cancer

Background Neoadjuvant treatment followed by esophagectomy is standard practice in locally advanced esophageal cancer. However, not all patients who started neoadjuvant treatment will undergo esophageal resection. The purpose of our study was to investigate the group of patients, scheduled for neoadjuvant treatment followed by esophagectomy, who ne...

Objectives: Combined modality treatment (CMT) for malignant pleural mesothelioma (MPM) remains a matter of debate regarding the choice of surgical procedure: extrapleural pneumonectomy (EPP) or pleurectomy/decortication. Methods: We performed a prospective interventional cohort study between 2003 and 2014. All consecutive patients with any histo...

https://kuleuvencongres.be/CARE4-2019/media/care42019-abstract-book-def-online.pdf

Background Despite integrated positron emission tomography and computed tomography screening before and after neoadjuvant treatment in patients with locally advanced esophageal cancer, unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted or is there a place for palliative resection? Met...

Background: Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esop...

Background Screening is an important tool in staging esophageal cancer as only patients without suspicion of metastases are considered for surgery-based treatment. Nevertheless unexpected metastatic disease is still found in some patients during surgery. In these cases should esophagectomy be aborted, or is there a place for palliative resection?...

Background Response of the primary tumor and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiation. Response on the primary tumor is well established using T(umor) R(egression) G(rading). However, little is known about the prognostic value of lymph node res...

Background: Little is known about the prognostic significance of residual nodal disease in otherwise complete pathologic responders (ypT0N+) after neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). The purpose is to analyze the long-term outcomes of EC patients with ypT0N+ following nCRT and esophagectomy. Methods: From a single insti...

Objectives: Current guidelines recommend preoperative invasive mediastinal staging in centrally located tumours with negative mediastinum on positron emission tomography-computed tomography, based on a 20-30% prevalence of occult mediastinal disease (pN2-3). However, a uniform definition of central tumour location is lacking. Our objective was to...

Objectives: The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality. Methods: This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 a...

A quarter of patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) based on positron emission tomography–computed tomography (PET-CT) imaging have occult mediastinal nodal involvement (N2 disease). In a prospective study, endosonography alone had an unsatisfactory sensitivity (38%) in detecting N2 disease. The current prospective multi...

The accepted importance of a positive circumferential resection margin (CRM) (defined as R1 in the TNM classification) is based on histopathology of the resection specimen obtained after primary surgery in esophageal cancer patients. The aim of this study is to look for the prognostic value of CRM after neoadjuvant chemoradiotherapy and to compare...

Objectives: Large retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed lower rate of N1 upstaging after VATS disappears af...

Objective: To define "best possible" outcomes in total minimally invasive transthoracic esophagectomy (ttMIE). Background: TtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy. Patients and methods: From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume center...

Objectives: The current study aims to examine the impact of extracapsular lymph node involvement (EC-LNI) on survival for both esophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) treated with neoadjuvant chemoradiation therapy (nCRT) followed by surgery. Background: Studies have demonstrated the negative prognostic value of EC-LNI i...

Objectives: We hypothesized that incomplete lymph node resection or fragmentation during videomediastinoscopy (VAM) could lead to incomplete resection after induction therapy in patients with baseline single level N2 NSCLC (pN2a). Our objective was to evaluate the occurrence of incomplete resection, the reason of incomplete resection and its impact...

Objective: Enhanced recovery after surgery (ERAS) is a patient-centered model combining surgery, anesthesia, nursing, nutrition, physiotherapy and psychology. It aims to minimize surgical stress and maintain physiological function in early perioperative care, thereby expediting recovery. Methods: Nurses, physiotherapists and other paramedic cowork...

Background: Maintenance of bronchopulmonary hygiene is mandatory for preventing respiratory complications in patients who had transthoracic esophagectomy. Removal of secretions from the tracheobronchial tree is crucial. Conventional therapy, designed to assist in dislodging airway secretions, includes chest physical therapy, early mobilisation, tra...

Objectives: Little is known about the prognostic significance of residual nodal disease in complete pathologic responders (ypT0N+) after neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). The purpose is to analyze the long-term outcomes of EC patients with ypT0N+ following nCRT and esophagectomy. Methods: From a single institution databa...

Objectives: Tissue confirmation prior to Stereotactic Body Radiation Therapy (SBRT) is recommended in current guidelines, but is incomplete in many studies. Survival is often compared with surgery in Non-Small Cell Lung Cancer (NSCLC) confirmed surgical series. Our objective is to evaluate the difference in overall survival (OS) if patients with ot...

Objectives: Several retrospective series showed lower pN1 nodal upstaging after VATS compared to open resections. Central tumor location was not included in their analysis. As open surgery is more often performed for central tumors, this could create a selection bias in case central location is associated with more frequent pN1-upstaging. Our objec...

Objective: Little is known about prognostic significance of residual nodal disease in complete primary tumor responders (ypT0N+) after neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). The purpose is to analyze the long-term outcomes of EC patients with ypT0N+ following nCRT and esophagectomy. Methods: From a single institution data...

Objectives: Esophagectomy is the cornerstone of curative treatment in esophageal adenocarcinoma and squamous cell carcinoma. Even for resectable esophageal sarcomas, surgical resection is the treatment of choice. However, few data are available about results of surgical treatment of rare non sarcomatous esophageal tumors. The objective of this stu...

Objectives: To compare the performance of three thoracic surgery centers using the Eurolung risk models for morbidity and mortality. Methods: Retrospective analysis on prospective databases from 3 academic centers (2014-2016). 2,011 patients (721 patients from center 1, 857 from center 2 and 433 from center 3) undergoing anatomic lung resections (1...

AIM: Enhanced recovery pathways (ERP) report decreased morbidity and length of stay (LOS), even after complex procedures, such as esophagectomy. Our first step in introducing a new ERP was focused on early mobilization. Purpose of this study was to determine the impact of early mobilization on LOS, complications and 30day-readmissions after esopha...

Objective: To compare the incidence of major adverse cardiac events (MACE) and mortality following video-assisted thoracoscopic surgery (VATS) lobectomy in patients with and without coronary artery disease (CAD). Methods: Multicentre retrospective analysis of 1699 patients undergoing VATS lobectomy (January 2012-March 2015). CAD definition: prev...

Recurrent disease after esophagectomy bears an infaust prognosis, especially when multiple recurrences are present. But little is known about survival in patients with limited recurrence (solitary locoregional recurrence or solid organ metastasis). Herein, we report our experience with these subgroups. We analyzed 1754 consecutive patients surgical...

Objective: Tumor regression grading (TRG) systems categorize residual tumor volume on the primary tumor after neoadjuvant treatment. Aim was to evaluate the impact of Mandard TRG, residual tumor depth (ypT) and residual lymph node status (ypN) and extent (ELNI) i.e. intracapsular versus extracapsular involvement on overall (OS) and disease-free su...

OBJECTIVES: Nodal upstaging is a quality indicator for oncological thoracic surgery and is found in up to 25% of patients with clinical stage I (cStage-I) non-small-cell lung cancer (NSCLC). In large retrospective series, lower N1 upstaging was reported after video-assisted thoracic surgery (VATS) resections. We studied the impact of central primar...

The current pathological lymph node (pN) staging is based on the number of positive lymph nodes but does not take into consideration characteristics of the involved lymph nodes itself. The current study aims to examine the prognostic value of extracapsular lymph node involvement (EC-LNI) and intracapsular lymph node involvement (IC-LNI) for esophag...

Objectives: A multicentre evaluation of the frequency and nature of major intraoperative complications during video-assisted thoracoscopic (VATS) anatomical resections. Methods: Six European centres submitted their series of consecutive anatomical lung resections with the intention to treat by VATS. Conversions to thoracotomy, vascular injuries...

Abstract OBJECTIVES: A multicentre evaluation of the frequency and nature of major intraoperative complications during video-assisted thoracoscopic (VATS) anatomical resections. METHODS: Six European centres submitted their series of consecutive anatomical lung resections with the intention to treat by VATS. Conversions to thoracotomy, vascular inj...

OBJECTIVES Nodal upstaging is a quality indicator for oncological thoracic surgery and is found in up to 25% of patients with clinical stage I (cStage-I) non-small-cell lung cancer (NSCLC). In large retrospective series, lower N1 upstaging was reported after video-assisted thoracic surgery (VATS) resections. We studied the impact of central primary...

INTRODUCTION Recurrent disease after esophagectomy bears an infaust prognosis, especially when multiple recurrences are present. But little is known about survival in patients with limited recurrence (solitary locoregional or solid organ metastasis). Herein we report our experience with these subgroups. METHODS We analyzed 1754 consecutive patie...

AGE- AND GENDER-CORRECTED BODY MASS INDEX: A NEW APPROACH IN SCREENING FOR UNDERWEIGHT IN ESOPHAGECTOMY FOR CANCER. presented at the 23rd European Conference on General Thoracic Surgery - Nurse Symposium; winner of the 2015 ESTS COVIDIEN NURSE SYMPOSIUM AWARD

Esophagectomy for cancer is often accompanied with severe preoperative weight loss. To measure the magnitude of this weight loss there are several tools at our disposal: Body Mass Index (BMI) Weight-loss percentage (WL%) Screening tools, e.g. NRS2002. However, due to enormous divergent findings from these tools, they are little helpful in daily pra...

To minimize air leak after anatomical lung resections, many video-assisted thoracic surgery (VATS) surgeons use a 'fissureless' technique, using staplers to divide the hilar bronchovascular structures first and the main part of the fissure last. We describe a cohort of 198 consecutive patients operated with an alternative fissureless technique, ope...