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Article: Laparoscopic and Open Subtotal Colectomies Compared in a High-Volume Laparoscopic Center

Wijsmuller, A.R. / Oosterling, S.J.

2013 Volume 30, Issue 4-6, Page(s) 270–271

Institution	Erasmus University Medical Center, Department of General Surgery, Rotterdam, Netherlands
Language	English
Publishing date	2013-08-20
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Invited Commentary
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000354143
Database	Karger publisher's database

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Article ; Online: AbcApp: incidence of intra-abdominal ABsCesses following laparoscopic vs. open APPendectomy in complicated appendicitis.

Zamaray, Bobby / de Boer, M F J / Popal, Z / Rijbroek, A / Bloemers, F W / Oosterling, S J

Surgical endoscopy

2022 Volume 37, Issue 3, Page(s) 1694–1699

Abstract: Background: Patients with complicated appendicitis are more at risk for the occurrence of postoperative intra-abdominal abscesses than patients with uncomplicated appendicitis. Studies comparing laparoscopic and open appendectomy showed limitations and ... ...

Abstract	Background: Patients with complicated appendicitis are more at risk for the occurrence of postoperative intra-abdominal abscesses than patients with uncomplicated appendicitis. Studies comparing laparoscopic and open appendectomy showed limitations and contradictory findings on the incidence of intra-abdominal abscesses after appendicitis, as most of these studies analysed both uncomplicated and complicated appendicitis as one group. The aim of the present study is to investigate the incidence of intra-abdominal abscesses after laparoscopic versus open appendectomy for complicated appendicitis. Methods: A retrospective cohort study was performed over the period January 2009 till May 2020. All patients who had an intra-operative diagnosis of complicated appendicitis (e.g. perforation, necrosis) were included. The outcome measure was the occurrence of intra-abdominal abscesses with a postoperative follow-up of 30 days. Multivariate logistic regression analysis was performed including adjustments for significant confounders. Results: A total of 900 patients had undergone appendectomy for complicated appendicitis. The majority was operated laparoscopically (78%, n = 705). The incidence of postoperative intra-abdominal abscess was 12.3% in both laparoscopic and open appendectomy groups. On univariable analysis, the postoperative rates of intra-abdominal abscesses between laparoscopic and open appendectomy were not significantly different (odds ratio 1.11, 95% CI [0.67-1.84], p = 0.681). Conclusion: The present study provides evidence that, in current daily practice, intra-abdominal abscess formation remains a common postoperative complication for complicated appendicitis. Nonetheless, no significant difference was found with regard to intra-abdominal abscess formation when comparing laparoscopy with open surgery.
MeSH term(s)	Humans ; Incidence ; Retrospective Studies ; Appendectomy/adverse effects ; Appendicitis/surgery ; Appendicitis/etiology ; Abdominal Abscess/epidemiology ; Abdominal Abscess/etiology ; Abdominal Abscess/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Laparoscopy/adverse effects ; Length of Stay
Language	English
Publishing date	2022-10-06
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/s00464-022-09670-4
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Article ; Online: Cost-effectiveness of selective decontamination of the digestive tract to decrease infectious complications in colorectal cancer surgery: An analysis of the SELECT trial.

Reuvers, J R D / Gaikhorst, E / Ben, Â Jornada / Scholten, J / van Egmond, M / Bosmans, J E / Stockmann, H B A C / Kazemier, G / Tuynman, J B / Abis, G S A / Oosterling, S J

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

2023 Volume 49, Issue 12, Page(s) 107116

Abstract: Introduction: Selective decontamination of the digestive tract (SDD) is effective in reducing infectious complications in elective colorectal cancer (CRC) surgery. However, it is unclear whether SDD is cost-effective compared to standard antibiotic ... ...

Abstract	Introduction: Selective decontamination of the digestive tract (SDD) is effective in reducing infectious complications in elective colorectal cancer (CRC) surgery. However, it is unclear whether SDD is cost-effective compared to standard antibiotic prophylaxis. Material & methods: Economic evaluation alongside multicenter randomized controlled trial, the SELECT-trial, from a healthcare perspective. Patients included underwent elective surgery for non-metastatic CRC. The intervention group received oral non-absorbable colistin, tobramycin and amphotericin B (SDD) next to standard antibiotic prophylaxis. Both groups received a single shot intravenous cefazolin and metronidazole preoperatively as standard prophylaxis. Occurrence of postoperative infectious complication in the first 30 postoperative days was extracted from medical records, Quality-Adjusted Life-Years (QALYs) based on the ED-5D-3L, and healthcare costs collected from the hospital's financial administration. Results: Of the 455 patients, 228 were randomly assigned to intervention group and 227 patients to the control group. SDD significantly reduced the number of infectious complications compared to control (difference = -0.13, 95 % CI -0.05 to -0.20). No difference was found for QALYs (difference = 0.002, 95 % CI -0.002 to 0.005). Healthcare costs were statistically significantly lower in the intervention group (difference = -€1258, 95 % CI -2751 to -166). The ICER was -9872 €/infectious complication prevented and -820,380 €/QALY gained. For all willingness-to-pay thresholds, the probability that prophylactic SDD was cost-effective compared to standard prophylactic practice alone was 1.0. Conclusion: The addition of SDD to the standard preoperative intravenous antibiotic prophylaxis is cost-effective compared to standard prophylactic practice from a healthcare perspective and should be considered as the standard of care.
MeSH term(s)	Humans ; Anti-Bacterial Agents/therapeutic use ; Cost-Benefit Analysis ; Decontamination ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-10-27
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2023.107116
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Selective Decontamination with Oral Antibiotics in Colorectal Surgery: 90-day Reintervention Rates and Long-term Oncological Follow-up.

Scholten, J / Reuvers, J R D / Stockmann, H B A C / van Stralen, K J / van Egmond, M / Bonjer, H J / Kazemier, G / Abis, G S A / Oosterling, S J

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2023 Volume 27, Issue 8, Page(s) 1685–1693

Abstract: Background: Oral antibiotics (OAB) in colorectal surgery have been shown to reduce surgical site infections (SSIs) and possibly anastomotic leakage. However, evidence on long-term follow-up, reintervention rates and 5-year oncological follow-up is ... ...

Abstract	Background: Oral antibiotics (OAB) in colorectal surgery have been shown to reduce surgical site infections (SSIs) and possibly anastomotic leakage. However, evidence on long-term follow-up, reintervention rates and 5-year oncological follow-up is lacking. The current study aims at elucidating this knowledge gap. Methods: This study evaluated the long-term effectiveness of perioperative 'Selective decontamination of the digestive tract' (SDD) in colorectal cancer surgery. The primary outcome was anastomotic leakage within 90 days, secondary outcomes included infectious complications, reinterventions, readmission, hospital stay, and 5-year overall and disease-free-survival. Statistical analysis including univariate and multivariate analysis was performed to identify predictors of 90-day outcomes, and Kaplan-Meier survival analysis was used for the 5-year survival outcomes. Results: In total 455 patients were analyzed, 228 participants in the SDD group and 227 in the control group. Anastomotic leakage rate was not statistically different between the SDD and control group (6.6% versus 9.7%). One or more infectious complications occurred in 15.4% of patients in the SDD group and in 28.2% in the control group (OR 0.46, 95% C.I. 0.29 - 0.73). In the SDD group 8,8% of patients required a reintervention compared to 16,3% of patients in the control group (OR 0.47, 95% C.I. 0.26 - 0.84). After multivariable analysis SDD remained significant in reducing both infectious complications and reinterventions after 90-days follow-up. There was no difference between SDD and control group in 5-year overall survival and disease-free-survival. Conclusion: SDD as OAB is effective in reducing 90-days postoperative infectious complications and reinterventions. As such, SDD as standard OAB in elective colorectal surgery is highly recommended.
MeSH term(s)	Humans ; Anti-Bacterial Agents/therapeutic use ; Anastomotic Leak/epidemiology ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Follow-Up Studies ; Decontamination ; Colorectal Surgery
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-07-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-023-05746-1
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 354: Show issues

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Article ; Online: Laparoscopic and open subtotal colectomies compared in a high-volume laparoscopic center.

Wijsmuller, A R / Oosterling, S J

Digestive surgery

2013 Volume 30, Issue 4-6, Page(s) 270–271

MeSH term(s)	Colectomy/statistics & numerical data ; Female ; Humans ; Inflammatory Bowel Diseases/surgery ; Laparoscopy/statistics & numerical data ; Male
Language	English
Publishing date	2013
Publishing country	Switzerland
Document type	Comment ; Journal Article
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000354143
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Article ; Online: The effect of selective decontamination on the intestinal microbiota as measured with IS-pro: a taxonomic classification tool applicable for direct evaluation of intestinal microbiota in clinical routine.

van Doorn-Schepens, M L M / Abis, G S A / Oosterling, S J / van Egmond, M / Poort, L / Stockmann, H B A C / Bonjer, H J / Savelkoul, P H M / Budding, A E

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology

2022 Volume 41, Issue 11, Page(s) 1337–1345

Abstract: Selective decontamination of the digestive tract (SDD) is aimed at elimination of potential pathogenic microorganisms. In this study, the effect of SDD on gut microbiota was evaluated in a large homogenous group of elective colorectal cancer surgery ... ...

Abstract	Selective decontamination of the digestive tract (SDD) is aimed at elimination of potential pathogenic microorganisms. In this study, the effect of SDD on gut microbiota was evaluated in a large homogenous group of elective colorectal cancer surgery patients. Rectal swabs were taken from 118 patients undergoing colorectal surgery. These patients were randomly assigned to receive perioperative SDD or to the control group (no SDD). Rectal swabs were taken prior to surgery, 3 days after commencing administration of SDD. Gut microbial profiles were obtained with the IS-pro technique, a standardized microbiota profiling assay applicable in clinical routine. Differences in abundance for different taxonomical groups and diversity between the groups were assessed. Unsupervised and supervised classification techniques were used to assess microbial signatures, differentiating between the SDD group and the control group. Patients in the SDD group had different gut microbial signatures than in the control group, also in phyla that are not a target for SDD. Escherichia coli, Sutterella spp., Faecalibacterium prausnitzii, and Streptococcus spp. were the species that differed the most between the two groups. The SDD group showed clustering into two subgroups. In one subgroup, a decrease in Proteobacteria was observed, whereas the other subgroup showed a shift in Proteobacteria species. This study shows that SDD not only decreases colonization of the gastrointestinal tract with potential pathogenic Gram-negative microorganisms, but also reduces the abundance of normal colonizers of our gastrointestinal system and leads to a shift in total microbiota composition.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Decontamination/methods ; Elective Surgical Procedures/methods ; Gastrointestinal Microbiome ; Gastrointestinal Tract/microbiology ; Humans ; Intensive Care Units
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-10-01
Publishing country	Germany
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	603155-9
ISSN	1435-4373 ; 0934-9723 ; 0722-2211
ISSN (online)	1435-4373
ISSN	0934-9723 ; 0722-2211
DOI	10.1007/s10096-022-04483-8
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Article ; Online: Laparoscopic and Open Subtotal Colectomies Compared in a High-Volume Laparoscopic Center

Wijsmuller, A. R. / Oosterling, S. J.

Digestive Surgery

2013 Volume 30, Issue 4-6, Page(s) 270–271

Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ZDB-ID	605888-7
ISSN	1421-9883 ; 0253-4886 ; 0253-4886
ISSN (online)	1421-9883
ISSN	0253-4886
DOI	10.1159/000354143
Database	Karger publisher's database

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Article ; Online: Training residents in laparoscopic colorectal surgery: is supervised surgery safe?

Nijhof, H W / Silvis, R / Vuylsteke, R C L M / Oosterling, S J / Rijna, H / Stockmann, H B A C

Surgical endoscopy

2017 Volume 31, Issue 6, Page(s) 2602–2606

Abstract: Background: Colorectal resections are increasingly performed laparoscopically, and training in laparoscopic resections in the Netherlands has shifted from a post-residency fellowship to training in residency. The question remains if this supervised ... ...

Abstract	Background: Colorectal resections are increasingly performed laparoscopically, and training in laparoscopic resections in the Netherlands has shifted from a post-residency fellowship to training in residency. The question remains if this supervised surgery affects short-term patient outcome. Methods: Between January 2010 and July 2014, 523 consecutive patients, who underwent laparoscopic colorectal resection, were selected from a prospective single-center database. All data were obtained from the maintained database and retrospectively analyzed. We compared the short-term outcome of patients who underwent laparoscopic colorectal surgery by a supervised fifth- or sixth-year resident compared to patients who underwent laparoscopic colorectal surgery performed by a dedicated colorectal surgeon. Statistical analysis was performed using the Chi-square test for categorical variables and the t test for continuous variables. Results: Almost 40 % of operations were performed by a resident with an even distribution in type of resection, except for the abdominal-perineal resection (residents vs. surgeon 3.57 vs. 8.26 %, p = 0.04) and the total number of patients who underwent preoperative chemoradiation (resident vs. surgeon 6.66 vs. 20.65 %, p = 0.04). No difference was found in operative time or per-operative blood loss. A higher conversion rate was found when surgery was performed by a supervised resident (residents vs. surgeon 17.34 vs. 9.17 %, p = 0.01), which could be attributed to case selection and one single year. No differences in major complications, oncological outcome and construction of a stoma were found. In the case of minor complications, a significantly increased percentage of bladder retention was found in the surgeon group (residents vs. surgeon 1 vs. 4.6 %, p = 0.03). Conclusions: In this study, we found that patient safety and short-term outcome are not adversely affected when laparoscopic colorectal surgery is performed by a supervised fifth- or sixth-year resident.
Language	English
Publishing date	2017-06
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/s00464-016-5268-0
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Article ; Online: Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial).

Abis, G S A / Stockmann, H B A C / Bonjer, H J / van Veenendaal, N / van Doorn-Schepens, M L M / Budding, A E / Wilschut, J A / van Egmond, M / Oosterling, S J

The British journal of surgery

2019 Volume 106, Issue 4, Page(s) 355–363

Abstract: Background: Infectious complications and anastomotic leakage affect approximately 30 per cent of patients after colorectal cancer surgery. The aim of this multicentre randomized trial was to investigate whether selective decontamination of the digestive ...

Abstract	Background: Infectious complications and anastomotic leakage affect approximately 30 per cent of patients after colorectal cancer surgery. The aim of this multicentre randomized trial was to investigate whether selective decontamination of the digestive tract (SDD) reduces these complications of elective colorectal cancer surgery. Methods: The effectiveness of SDD was evaluated in a multicentre, open-label RCT in six centres in the Netherlands. Patients with colorectal cancer scheduled for elective curative surgery with a primary anastomosis were eligible. Oral colistin, tobramycin and amphotericin B were administered to patients in the SDD group to decontaminate the digestive tract. Both treatment and control group received intravenous cefazolin and metronidazole for perioperative prophylaxis. Mechanical bowel preparation was given for left-sided colectomies, sigmoid and anterior resections. Anastomotic leakage was the primary outcome; infectious complications and mortality were secondary outcomes. Results: The outcomes for 228 patients randomized to the SDD group and 227 randomized to the control group were analysed. The trial was stopped after interim analysis demonstrated that superiority was no longer attainable. Effective SDD was confirmed by interspace DNA profiling analysis of rectal swabs. Anastomotic leakage was observed in 14 patients (6·1 per cent) in the SDD group and in 22 patients (9·7 per cent) in the control group (odds ratio (OR) 0·61, 95 per cent c.i. 0·30 to 1·22). Fewer patients in the SDD group had one or more infectious complications than patients in the control group (14·9 versus 26·9 per cent respectively; OR 0·48, 0·30 to 0·76). Multivariable analysis indicated that SDD reduced the rate of infectious complications (OR 0·47, 0·29 to 0·76). Conclusion: SDD reduces infectious complications after colorectal cancer resection but did not significantly reduce anastomotic leakage in this trial. Registration number: NCT01740947 ( https://www.clinicaltrials.gov).
MeSH term(s)	Academic Medical Centers ; Aged ; Analysis of Variance ; Anastomosis, Surgical/methods ; Antibiotic Prophylaxis ; Colectomy/adverse effects ; Colectomy/methods ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Decontamination/methods ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/methods ; Female ; Follow-Up Studies ; Hospitals, University ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Netherlands ; Preoperative Care/methods ; Reference Values ; Risk Assessment ; Surgical Wound Infection/prevention & control ; Tobramycin/administration & dosage ; Treatment Outcome
Chemical Substances	Tobramycin (VZ8RRZ51VK)
Language	English
Publishing date	2019-02-25
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.11117
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Article ; Online: Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands.

Veltcamp Helbach, M / van Oostendorp, S E / Koedam, T W A / Knol, J J / Stockmann, H B A C / Oosterling, S J / Vuylsteke, R C L M / de Graaf, E J R / Doornebosch, P G / Hompes, R / Bonjer, H J / Sietses, C / Tuynman, J B

Surgical endoscopy

2019 Volume 34, Issue 1, Page(s) 192–201

Abstract: Background: Transanal total mesorectal excision (TaTME) is a new complex technique with potential to improve the quality of surgical mesorectal excision for patients with mid and low rectal cancer. The procedure is technically challenging and has shown ... ...

Abstract	Background: Transanal total mesorectal excision (TaTME) is a new complex technique with potential to improve the quality of surgical mesorectal excision for patients with mid and low rectal cancer. The procedure is technically challenging and has shown to be associated with a relative long learning curve which might hamper widespread adoption. Therefore, a national structured training pathway for TaTME has been set up in the Netherlands to allow safe implementation. The aim of this study was to monitor safety and efficacy of the training program with 12 centers. Methods: Short-term outcomes of the first ten TaTME procedures were evaluated in 12 participating centers in the Netherlands within the national structured training pathway. Consecutive patients operated during and after the proctoring program for rectal carcinoma with curative intent were included. Primary outcome was the incidence of intraoperative complications, secondary outcomes included postoperative complications and pathological outcomes. Results: In October 2018, 12 hospitals completed the training program and from each center the first 10 patients were included for evaluation. Intraoperative complications occurred in 4.9% of the cases. The clinicopathological outcome reported 100% for complete or nearly complete specimen, 100% negative distal resection margin, and the circumferential resection margin was positive in 5.0% of patients. Overall postoperative complication rate was 45.0%, with 19.2% Clavien-Dindo ≥ III and an anastomotic leak rate of 17.3%. Conclusions: This study shows that the nationwide structured training program for TaTME delivers safe implementation of TaTME in terms of intraoperative and pathology outcomes within the first ten consecutive cases in each center. However, postoperative morbidity is substantial even within a structured training pathway and surgeons should be aware of the learning curve of this new technique.
MeSH term(s)	Adult ; Aged ; Clinical Competence ; Colorectal Surgery/education ; Critical Pathways ; Education, Medical, Graduate/methods ; Female ; Humans ; Intraoperative Complications/epidemiology ; Learning Curve ; Male ; Margins of Excision ; Middle Aged ; Netherlands ; Postoperative Complications/epidemiology ; Proctectomy/education ; Proctectomy/methods ; Rectal Neoplasms/surgery ; Transanal Endoscopic Surgery/education ; Transanal Endoscopic Surgery/methods ; Treatment Outcome
Language	English
Publishing date	2019-03-19
Publishing country	Germany
Document type	Journal Article ; Multicenter Study
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-019-06750-w
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