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Article ; Online: Completion Total Mesorectal Excision: A Case-Matched Comparison With Primary Resection.

Burghgraef, Thijs A / Rutgers, Marieke L / Leijtens, Jeroen W A / Tuyman, Jurriaan B / Consten, Esther C J / Hompes, Roel

Annals of surgery open : perspectives of surgical history, education, and clinical approaches

2023 Volume 4, Issue 3, Page(s) e327

Abstract: Objectives: The aim of this study was to compare the perioperative and oncological results of completion total mesorectal excision (cTME) : Background: Early-stage rectal cancer can be treated by local excision alone, which is associated with less ... ...

Abstract	Objectives: The aim of this study was to compare the perioperative and oncological results of completion total mesorectal excision (cTME) Background: Early-stage rectal cancer can be treated by local excision alone, which is associated with less surgical morbidity and improved functional outcomes compared with radical surgery. When high-risk histological features are present, cTME is indicated, with possible worse clinical and oncological outcomes compared to pTME. Methods: This retrospective cohort study included all patients that underwent TME surgery for rectal cancer performed in 11 centers in the Netherlands between 2015 and 2017. After case-matching, we compared cTME with pTME. The primary outcome was major postoperative morbidity. Secondary outcomes included the rate of restorative procedures and 3-year oncological outcomes. Results: In total 1069 patients were included, of which 35 underwent cTME. After matching (1:2 ratio), 29 cTME and 58 pTME were analyzed. No differences were found for major morbidity (27.6% Conclusions: cTME is not associated with higher major morbidity, whereas the abdominoperineal excision rate and 3-year oncological outcomes are similar compared to pTME. Local excision as a diagnostic tool followed by completion surgery for early rectal cancer does not compromise outcomes and should still be considered as the treatment of early-stage rectal cancer.
Language	English
Publishing date	2023-08-23
Publishing country	United States
Document type	Journal Article
ISSN	2691-3593
ISSN (online)	2691-3593
DOI	10.1097/AS9.0000000000000327
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Article ; Online: Quality of Life and Bowel Dysfunction after Transanal Endoscopic Microsurgery for Rectal Cancer: One Third of Patients Experience Major Low Anterior Resection Syndrome.

van Heinsbergen, Maarten / Leijtens, Jeroen W / Slooter, Gerrit D / Janssen-Heijnen, Maryska L / Konsten, Joop L

Digestive surgery

2019 Volume 37, Issue 1, Page(s) 39–46

Abstract: Background/aims: The low anterior resection syndrome (LARS) severely affects quality of life (QoL) after rectal cancer surgery. Studies investigating LARS and the effect on QoL after transanal endoscopic microsurgery (TEM) for rectal cancer are scarce. ... ...

Abstract	Background/aims: The low anterior resection syndrome (LARS) severely affects quality of life (QoL) after rectal cancer surgery. Studies investigating LARS and the effect on QoL after transanal endoscopic microsurgery (TEM) for rectal cancer are scarce. The aim of our study was to assess bowel dysfunction and QoL after TEM. Methods: Seventy-three -patients who underwent TEM for stage I rectal cancer were included in this single-centre, cross-sectional study Bowel dysfunction was assessed by the LARS-Score, QoL by the -European Organization for the Research and Treatment of Cancer QLQ-C30 and -CR29 questionnaires. Results: Fifty-five respondents (75.3%) could be included for the analyses. The median interval since treatment was 4.3 years, and the median age at the follow-up point was 72 years. "Major LARS" was observed in 29% of patients and "minor LARS" in 26%. Female gender (OR 4.00; 95% CI 1.20-13.36), neo-adjuvant chemoradiotherapy (OR 3.63; 95% CI 1.08-12.17) and specimen thickness in millimetres (OR 1.10 for each mm increase in thickness; 95% CI 1.01-1.20) were associated with the development of major LARS. Patients with major LARS fared worse in most QoL domains. Conclusion: This is the first study demonstrating major LARS after TEM treatment for rectal cancer, with a negative effect on QoL, even years after treatment. Our data provides an adequate counselling before TEM in terms of postoperative bowel dysfunction and its effect on QoL.
MeSH term(s)	Aged ; Aged, 80 and over ; Colectomy/adverse effects ; Cross-Sectional Studies ; Female ; Humans ; Intestinal Diseases/etiology ; Intestinal Diseases/physiopathology ; Male ; Middle Aged ; Proctectomy/adverse effects ; Quality of Life ; Rectal Neoplasms/physiopathology ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy ; Rectum/physiopathology ; Rectum/surgery ; Syndrome ; Transanal Endoscopic Microsurgery/adverse effects
Language	English
Publishing date	2019-06-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000496434
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Article ; Online: The Patient Navigator: Can a systematically developed online health information tool improve patient participation and outcomes related to the consultation in older patients newly diagnosed with colorectal cancer?

de Looper, Melanie / Smets, Ellen M A / Schouten, Barbara C / Bolle, Sifra / Belgers, Eric H J / Eddes, Eric H / Leijtens, Jeroen W A / van Weert, Julia C M

BMC cancer

2022 Volume 22, Issue 1, Page(s) 109

Abstract: Background: Older cancer patients may search for health information online to prepare for their consultations. However, seeking information online can have negative effects, for instance increased anxiety due to finding incorrect or unclear information. ...

Abstract	Background: Older cancer patients may search for health information online to prepare for their consultations. However, seeking information online can have negative effects, for instance increased anxiety due to finding incorrect or unclear information. In addition, existing online cancer information is not necessarily adapted to the needs of older patients, even though cancer is a disease often found in older individuals. Objective: The aim of this study was to systematically develop, implement and evaluate an online health information tool for older cancer patients, the Patient Navigator, providing information that complements the consultation with healthcare providers. Method: For the development and evaluation of the Patient Navigator, the four phases of the MRC framework were used. In the first and second phase the Patient Navigator was developed and pilot tested based on previous research and sub-studies. During the third phase the Patient Navigator was implemented in four Dutch hospitals. In the last phase, a pilot RCT was conducted to evaluate the Patient Navigator in terms of usage (observational tracking data), user experience (self-reported satisfaction, involvement, cognitive load, active control, perceived relevance of the tool), patient participation (observational data during consultation), and patient outcomes related to the consultation (questionnaire data regarding anxiety, satisfaction, and information recall). Recently diagnosed colorectal cancer patients (N = 45) were randomly assigned to the control condition (usual care) or the experimental condition (usual care + Patient Navigator). Results: The Patient Navigator was well used and evaluated positively. Patients who received the Patient Navigator contributed less during the consultation by using less words than patients in the control condition and experienced less anxiety two days after the consultation than patients in the control condition. Conclusion: Since the Patient Navigator was evaluated positively and decreased anxiety after the consultation, this tool is potentially a valuable addition to the consultation for patients. Usage of the Patient Navigator resulted in patients using less words during consultations, without impairing patients' satisfaction, possibly because information needs might be fulfilled by usage of the Patient Navigator. This could create the possibility to personalize communication during consultations and respond to other patient needs.
MeSH term(s)	Aged ; Colorectal Neoplasms ; Consumer Health Information/methods ; Female ; Humans ; Male ; Online Systems ; Patient Navigation/methods ; Patient Participation/psychology ; Patient Participation/statistics & numerical data ; Patient Satisfaction/statistics & numerical data ; Referral and Consultation/statistics & numerical data
Language	English
Publishing date	2022-01-25
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-021-09096-6
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Article: Is there a difference in laparoscopic cholecystectomy performed in a teaching hospital or a general hospital in The Netherlands?

Corten, Bartholomeus J G A / Leijtens, Jeroen W A / Janssen, Loes / Konsten, Joop L M

Acta chirurgica Belgica

2018 Volume 119, Issue 4, Page(s) 236–242

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Cholecystectomy, Laparoscopic ; Cohort Studies ; Female ; Hospitals, General ; Hospitals, Teaching ; Humans ; Male ; Middle Aged ; Netherlands ; Postoperative Complications/epidemiology ; Prospective Studies
Language	English
Publishing date	2018-09-26
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	210274-2
ISSN	0001-5458
ISSN	0001-5458
DOI	10.1080/00015458.2018.1502928
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Article ; Online: Robot-Assisted Total Mesorectal Excision Versus Laparoscopic Total Mesorectal Excision: A Retrospective Propensity Score-Matched Cohort Analysis in Experienced Centers.

Burghgraef, Thijs Adriaan / Crolla, Rogier M P H / Verheijen, Paul M / Fahim, Milad / van Geloven, Anna / Leijtens, Jeroen W A / Pronk, Apollo / Smits, Anke B / Verdaasdonk, Emiel G G / Consten, Esther C J

Diseases of the colon and rectum

2021 Volume 65, Issue 2, Page(s) 218–227

Abstract: Background: The superiority of robot-assisted over laparoscopic total mesorectal excision has not been proven. Most studies do not consider the learning curve while comparing the surgical technique.: Objective: This study aims to compare laparoscopic ...

Abstract	Background: The superiority of robot-assisted over laparoscopic total mesorectal excision has not been proven. Most studies do not consider the learning curve while comparing the surgical technique. Objective: This study aims to compare laparoscopic with robot-assisted total mesorectal excision performed by surgeons who completed the learning curve of the technique. Design: This is a multicenter retrospective propensity score-matched analysis. Settings: The study was performed in 2 large, dedicated robot-assisted hospitals and 5 large, dedicated laparoscopic hospitals. Patients: Patients were included if they underwent a robot-assisted or laparoscopic total mesorectal excision for rectal cancer with curative intent at a dedicated center for the minimally invasive technique between January 1, 2015, and December 31, 2017. Interventions: We compared robot-assisted with laparoscopic total mesorectal excision. Main outcome measures: The main outcome was conversion to laparotomy during surgery. Secondary outcomes were postoperative morbidity and positive circumferential resection margin. Results: A total of 884 patients were included and, after matching, 315 patients per treatment group remained. Conversion was similar between laparoscopic and robot-assisted total mesorectal excision (4.4% vs 2.5% (p = 0.20)). Positive circumferential resection margin was equal (3.2% vs 4.4% (p = 0.41)). Overall morbidity was comparable as well, although a lower rate of wound infections was observed in the robot-assisted group (5.7% vs 1.9% (p = 0.01)). More primary anastomoses were constructed in the robot-assisted group (50.8% vs 68.3% (p < 0.001)). Finally, more open procedures were performed in dedicated laparoscopic centers, with an overrepresentation of cT4N+ tumors in this group. Limitations: This is a retrospective multicenter cohort; however, propensity score matching was applied to control for confounding by indication. Conclusions: Robot-assisted and laparoscopic total mesorectal excision are equally safe in terms of short-term outcomes. However, with the robot-assisted approach, more primary anastomoses were constructed, and a lower wound infection rate was observed. See Video Abstract at http://links.lww.com/DCR/B677.ESCISIÓN MESORRECTAL TOTAL ASISTIDA POR ROBOT VERSUS ESCISIÓN MESORRECTAL TOTAL LAPAROSCÓPICA: UNA PUNTUACIÓN DE PROPENSIÓN RETROSPECTIVA ANÁLISIS DE COHORTES EMPAREJADAS EN CENTROS EXPERIMENTADOS. Antecedentes: No se ha demostrado la superioridad de la escisión mesorrectal total asistida por robot sobre la laparoscópica. La mayoría de los estudios no tienen en cuenta la curva de aprendizaje al comparar la técnica quirúrgica. Objetivo: Este estudio tiene como objetivo comparar la escisión mesorrectal total laparoscópica con la asistida por robot realizada por cirujanos que completaron la curva de aprendizaje de la técnica. Diseo: Este es un análisis multicéntrico retrospectivo emparejado por puntuación de propensión. Ajustes: El estudio se realizó en dos grandes hospitales dedicados asistidos por robots y cinco grandes hospitales laparoscópicos dedicados. Pacientes: Se incluyeron pacientes que se sometieron a escisión mesorrectal total asistida por robot o laparoscópica para cáncer de recto con intención curativa, en un centro dedicado a la técnica mínimamente invasiva entre el 1 de enero de 2015 y el 31 de diciembre de 2017. Intervenciones: Comparamos la escisión mesorrectal total asistida por robot con la laparoscópica. Principales medidas de resultado: El principal resultado fue la conversión a laparotomía durante la cirugía. Los resultados secundarios fueron la morbilidad posoperatoria y el margen circunferencial positivo. Resultados: Se incluyó a un total de 884 pacientes y, después de emparejar, quedaron 315 pacientes por grupo de tratamiento. La conversión fue similar entre la escisión mesorrectal total laparoscópica y asistida por robot (4,4% frente a 2,5% [p = 0,20]). El margen de resección circunferencial positivo fue igual (3,2% vs 4,4% [p = 0,41]). La morbilidad general también fue comparable, aunque se observó una menor tasa de infecciones de heridas en el grupo asistido por robot (5,7% frente a 1,9% [p = 0,01]). Se construyeron más anastomosis primarias en el grupo asistido por robot (50,8% frente a 68,3% [p < 0,001]). Finalmente, se realizaron procedimientos más abiertos en centros laparoscópicos dedicados, con una sobrerrepresentación de tumores cT4N + en este grupo. Limitaciones: Ésta es una cohorte multicéntrica retrospectiva; sin embargo, se aplicó el emparejamiento por puntuación de propensión para controlar los factores de confusión por indicación. Conclusiones: La escisión mesorrectal total asistida por robot y laparoscópica son igualmente seguras en términos de resultados a corto plazo. Sin embargo, con el abordaje asistido por robot, se construyeron más anastomosis primarias y se observó una menor tasa de infección de la herida. Consulte Video Resumen en http://links.lww.com/DCR/B677. (Traducción-Dr. Gonzalo Hagerman).
MeSH term(s)	Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Aged ; Clinical Competence ; Female ; Humans ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Proctectomy/adverse effects ; Propensity Score ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects
Language	English
Publishing date	2021-07-01
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002031
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Article ; Online: Impact of a diverting ileostomy in total mesorectal excision with primary anastomosis for rectal cancer.

Hol, Jeroen C / Burghgraef, Thijs A / Rutgers, Marieke L W / Crolla, Rogier M P H / van Geloven, Anna A W / de Jong, Gabie M / Hompes, Roel / Leijtens, Jeroen W A / Polat, Fatih / Pronk, Apollo / Smits, Anke B / Tuynman, Jurriaan B / Verdaasdonk, Emiel G G / Consten, Esther C J / Sietses, Colin

Surgical endoscopy

2022 Volume 37, Issue 3, Page(s) 1916–1932

Abstract: Background: The role of diverting ileostomy in total mesorectal excision (TME) for rectal cancer with primary anastomosis is debated. The aim of this study is to gain insight in the clinical consequences of a diverting ileostomy, with respect to stoma ... ...

Abstract	Background: The role of diverting ileostomy in total mesorectal excision (TME) for rectal cancer with primary anastomosis is debated. The aim of this study is to gain insight in the clinical consequences of a diverting ileostomy, with respect to stoma rate at one year and stoma-related morbidity. Methods: Patients undergoing TME with primary anastomosis for rectal cancer between 2015 and 2017 in eleven participating hospitals were included. Retrospectively, two groups were compared: patients with or without diverting ileostomy construction during primary surgery. Primary endpoint was stoma rate at one year. Secondary endpoints were severity and rate of anastomotic leakage, overall morbidity rate within thirty days and stoma (reversal) related morbidity. Results: In 353 out of 595 patients (59.3%) a diverting ileostomy was constructed during primary surgery. Stoma rate at one year was 9.9% in the non-ileostomy group and 18.7% in the ileostomy group (p = 0.003). After correction for confounders, multivariate analysis showed that the construction of a diverting ileostomy during primary surgery was an independent risk factor for stoma at one year (OR 2.563 (95%CI 1.424-4.611), p = 0.002). Anastomotic leakage rate was 17.8% in the non-ileostomy group and 17.2% in the ileostomy group (p = 0.913). Overall 30-days morbidity rate was 37.6% in the non-ileostomy group and 56.1% in the ileostomy group (p < 0.001). Stoma reversal related morbidity rate was 17.9%. Conclusions: The stoma rate at one year was higher in patients with ileostomy construction during primary surgery. The incidence and severity of anastomotic leakage were not reduced by construction of an ileostomy. The morbidity related to the presence and reversal of a diverting ileostomy was substantial.
MeSH term(s)	Humans ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Retrospective Studies ; Rectal Neoplasms/surgery ; Rectal Neoplasms/complications ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Ileostomy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery
Language	English
Publishing date	2022-10-18
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-022-09669-x
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Article ; Online: Comparison of three-year oncological results after restorative low anterior resection, non-restorative low anterior resection and abdominoperineal resection for rectal cancer.

Hol, Jeroen C / Burghgraef, Thijs A / Rutgers, Marieke L W / Crolla, Rogier M P H / van Geloven, Nanette A W / Leijtens, Jeroen W A / Polat, Fatih / Pronk, Apollo / Smits, Anke B / Tuynman, Jurriaan B / Verdaasdonk, Emiel G G / Consten, Esther C J / Hompes, Roel / Sietses, Colin

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2022 Volume 49, Issue 4, Page(s) 730–737

Abstract: Introduction: Oncological outcome might be influenced by the type of resection in total mesorectal excision (TME) for rectal cancer. The aim was to see if non-restorative LAR would have worse oncological outcome. A comparison was made between non- ... ...

Abstract	Introduction: Oncological outcome might be influenced by the type of resection in total mesorectal excision (TME) for rectal cancer. The aim was to see if non-restorative LAR would have worse oncological outcome. A comparison was made between non-restorative low anterior resection (NRLAR), restorative low anterior resection (RLAR) and abdominoperineal resection (APR). Materials and methods: This retrospective cohort included data from patients undergoing TME for rectal cancer between 2015 and 2017 in eleven Dutch hospitals. A comparison was made for each different type of procedure (APR, NRLAR or RLAR). Primary outcome was 3-year overall survival (OS). Secondary outcomes included 3-year disease-free survival (DFS) and 3-year local recurrence (LR) rate. Results: Of 998 patients 363 underwent APR, 132 NRLAR and 503 RLAR. Three-year OS was worse after NRLAR (78.2%) compared to APR (86.3%) and RLAR (92.2%, p < 0.001). This was confirmed in a multivariable Cox regression analysis (HR 1.85 (1.07, 3.19), p = 0.03). The 3-year DFS was also worse after NRLAR (60.3%), compared to APR (70.5%) and RLAR (80.1%, p < 0.001), HR 2.05 (1.42, 2.97), p < 0.001. The LR rate was 14.6% after NRLAR, 5.2% after APR and 4.8% after RLAR (p = 0.005), HR 3.22 (1.61, 6.47), p < 0.001. Conclusion: NRLAR might be associated with worse 3-year OS, DFS and LR rate compared to RLAR and APR.
MeSH term(s)	Humans ; Treatment Outcome ; Retrospective Studies ; Digestive System Surgical Procedures/methods ; Rectal Neoplasms/surgery ; Proctectomy ; Neoplasm Recurrence, Local/surgery
Language	English
Publishing date	2022-11-24
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2022.11.100
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Article ; Online: Een vrouw met een zeldzame tractus-digestivusbloeding.

Geerards, Daan / Raat, Frank H P J / Leijtens, Jeroen W A

Nederlands tijdschrift voor geneeskunde

2014 Volume 158, Page(s) A7846

Abstract: A 70-year old woman came to the emergency department with dyspnea and syncope. Hemoglobin level was 2,9 mmol/l (reference: 7,6-9,9 mmol/l). Gastroscopy was negative, CT-abdomen showed a hypervascular jejunal tumour. Laparoscopic jejunal segment resection ...

Title translation	A woman with a rare gastrointestinal bleeding.
Abstract	A 70-year old woman came to the emergency department with dyspnea and syncope. Hemoglobin level was 2,9 mmol/l (reference: 7,6-9,9 mmol/l). Gastroscopy was negative, CT-abdomen showed a hypervascular jejunal tumour. Laparoscopic jejunal segment resection was performed with resection of the tumour, after which the hemoglobin level improved. Pathological examination showed a gastrointestinal stromal tumour.
MeSH term(s)	Aged ; Female ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Stromal Tumors/complications ; Gastrointestinal Stromal Tumors/diagnosis ; Gastrointestinal Stromal Tumors/surgery ; Hemoglobins/metabolism ; Humans ; Jejunal Neoplasms/complications ; Jejunal Neoplasms/diagnosis ; Jejunal Neoplasms/surgery ; Laparoscopy
Chemical Substances	Hemoglobins
Language	Dutch
Publishing date	2014
Publishing country	Netherlands
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Abandonment of Routine Radiotherapy for Nonlocally Advanced Rectal Cancer and Oncological Outcomes.

Hazen, Sanne-Marije J A / Sluckin, Tania C / Intven, Martijn P W / Beets, Geerard L / Beets-Tan, Regina G H / Borstlap, Wernard A A / Buffart, Tineke E / Buijsen, Jeroen / Burger, Jacobus W A / van Dieren, Susan / Furnée, Edgar J B / Geijsen, E Debby / Hompes, Roel / Horsthuis, Karin / Leijtens, Jeroen W A / Maas, Monique / Melenhorst, Jarno / Nederend, Joost / Peeters, Koen C M J /

Rozema, Tom / Tuynman, Jurriaan B / Verhoef, Cornelis / de Vries, Marianne / van Westreenen, Henderik L / de Wilt, Johannes H W / Zimmerman, David D E / Marijnen, Corrie A M / Tanis, Pieter J / Kusters, Miranda

JAMA oncology

2023 Volume 10, Issue 2, Page(s) 202–211

Abstract: Importance: Neoadjuvant short-course radiotherapy was routinely applied for nonlocally advanced rectal cancer (cT1-3N0-1M0 with >1 mm distance to the mesorectal fascia) in the Netherlands following the Dutch total mesorectal excision trial. This policy ... ...

Abstract	Importance: Neoadjuvant short-course radiotherapy was routinely applied for nonlocally advanced rectal cancer (cT1-3N0-1M0 with >1 mm distance to the mesorectal fascia) in the Netherlands following the Dutch total mesorectal excision trial. This policy has shifted toward selective application after guideline revision in 2014. Objective: To determine the association of decreased use of neoadjuvant radiotherapy with cancer-related outcomes and overall survival at a national level. Design, setting, and participants: This multicenter, population-based, nationwide cross-sectional cohort study analyzed Dutch patients with rectal cancer who were treated in 2011 with a 4-year follow-up. A similar study was performed in 2021, analyzing all patients that were surgically treated in 2016. From these cohorts, all patients with cT1-3N0-1M0 rectal cancer and radiologically unthreatened mesorectal fascia were included in the current study. The data of the 2011 cohort were collected between May and October 2015, and the data of the 2016 cohort were collected between October 2020 and November 2021. The data were analyzed between May and October 2022. Main outcomes and measures: The main outcomes were 4-year local recurrence and overall survival rates. Results: Among the 2011 and 2016 cohorts, 1199 (mean [SD] age, 68 [11] years; 430 women [36%]) of 2095 patients (57.2%) and 1576 (mean [SD] age, 68 [10] years; 547 women [35%]) of 3057 patients (51.6%) had cT1-3N0-1M0 rectal cancer and were included, with proportions of neoadjuvant radiotherapy of 87% (2011) and 37% (2016). Four-year local recurrence rates were 5.8% and 5.5%, respectively (P = .99). Compared with the 2011 cohort, 4-year overall survival was significantly higher in the 2016 cohort (79.6% vs 86.4%; P < .001), with lower non-cancer-related mortality (13.8% vs 6.3%; P < .001). Conclusions and relevance: The results of this cross-sectional study suggest that an absolute 50% reduction in radiotherapy use for nonlocally advanced rectal cancer did not compromise cancer-related outcomes at a national level. Optimizing clinical staging and surgery following the Dutch total mesorectal excision trial has potentially enabled safe deintensification of treatment.
MeSH term(s)	Humans ; Female ; Aged ; Cross-Sectional Studies ; Neoadjuvant Therapy ; Rectal Neoplasms/pathology ; Netherlands/epidemiology ; Neoplasm Staging ; Neoplasm Recurrence, Local/surgery
Language	English
Publishing date	2023-12-21
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ISSN	2374-2445
ISSN (online)	2374-2445
DOI	10.1001/jamaoncol.2023.5444
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Article ; Online: MRI surveillance for the detection of local recurrence in rectal cancer after transanal endoscopic microsurgery.

Hupkens, Britt J P / Maas, Monique / Martens, Milou H / Deserno, Willem M L L G / Leijtens, Jeroen W A / Nelemans, Patty J / Bakers, Frans C H / Lambregts, Doenja M J / Beets, Geerard L / Beets-Tan, Regina G H

European radiology

2017 Volume 27, Issue 12, Page(s) 4960–4969

Abstract: Objectives: To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM).: Methods: Between January 2006 and February 2014, 81 patients who underwent TEM were ... ...

Abstract	Objectives: To evaluate diagnostic performance of follow-up MRI for detection of local recurrence of rectal cancer after transanal endoscopic microsurgery (TEM). Methods: Between January 2006 and February 2014, 81 patients who underwent TEM were included. Two expert readers (R1 and R2), independently evaluated T2-weighted (T2W) MRI and diffusion-weighted (DWI) MRI for the detection of local recurrence, retrospectively, and recorded confidence on a five-point scale. Diagnostic performance of follow-up MRI was assessed using ROC-curve analysis and kappa statistics for the reproducibility between readers. Results: 293 MRIs were performed, 203 included DWI. 18 (22%) patients developed a local recurrence: luminal 11, nodal two and both five. Areas under the curve (AUCs) for local recurrence detection were 0.72 (R1) and 0.80 (R2) for T2W-MRI. For DWI, AUCs were 0.70 (R1) and 0.89 (R2). For nodal recurrence AUCs were 0.72 (R1) and 0.80 (R2) for T2W-MRI. Reproducibility was good for T2W-MRI (κ0.68 for luminal and κ0.71 for nodal recurrence) and moderate for DWI (κ0.57). AUCs and reproducibility for recurrence detection increased during follow-up. Conclusions: Follow-up with MRI after TEM for rectal cancer is feasible. Postoperative changes can be confusing at the first postoperative MRI, but during follow-up diagnostic performance and reproducibility increase. Key points: • Follow-up with MRI is feasible for follow-up after TEM for rectal cancer. • DWI-MRI is a useful addition to detect recurrences after TEM. • Postoperative changes can be confusing and can lead to underestimation of recurrence. • Appearance of intermediate signal at T2W-MRI is suspicious for recurrence. • Nodal staging remains challenging.
MeSH term(s)	Adult ; Aged ; Area Under Curve ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Microsurgery ; Middle Aged ; Neoplasm Recurrence, Local/diagnostic imaging ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; ROC Curve ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Reproducibility of Results ; Retrospective Studies ; Transanal Endoscopic Microsurgery
Language	English
Publishing date	2017-06-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-017-4853-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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