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Article ; Online: The Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial.

Triemstra, Lianne / de Jongh, Cas / Tedone, Fabrizio / Brosens, Lodewijk A A / Luyer, Misha D P / Stoot, Jan H M B / Lagarde, Sjoerd M / van Hillegersberg, Richard / Ruurda, Jelle P

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) 107095

Abstract: Background: Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional ... ...

Abstract	Background: Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery. Methods: The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications and cardiovascular, gastrointestinal, infectious, pulmonary, and other complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman's rho-test and compared with standard Fisher's z-transformation. Results: Between 2015 and 2018, 211 patients underwent laparoscopic (n = 106) or open (n = 105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p = 0.755) and subgroups of complications (p > 0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (r Conclusions: The CCI is a composite scoring system based on the CDC and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, following abdominal surgery other than gastrectomy. Implementing CCI showed no clinically relevant benefit and caused additional workload compared to CDC for assessing complication burden. Therefore, using the CCI alongside the CDC after gastric cancer surgery is not recommended.
MeSH term(s)	Humans ; Gastrectomy/adverse effects ; Laparoscopy/adverse effects ; Postoperative Complications/etiology ; Reoperation ; Retrospective Studies ; Stomach Neoplasms/surgery
Language	English
Publishing date	2023-10-02
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2023.107095
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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: Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial.

de Jongh, Cas / Triemstra, Lianne / van der Veen, Arjen / Brosens, Lodewijk Aa / Nieuwenhuijzen, Grard Ap / Stoot, Jan Hmb / de Steur, Wobbe O / Ruurda, Jelle P / van Hillegersberg, Richard

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 10, Page(s) 107018

Abstract: Background: Quality of gastric cancer surgery is crucial for favorable prognosis. Generally, prospective trials lack quality control measures. This study assessed surgical quality and a novel D2-lymphadenectomy photo-scoring in the LOGICA-trial.: ... ...

Abstract	Background: Quality of gastric cancer surgery is crucial for favorable prognosis. Generally, prospective trials lack quality control measures. This study assessed surgical quality and a novel D2-lymphadenectomy photo-scoring in the LOGICA-trial. Methods: The multicenter LOGICA-trial randomized laparoscopic versus open total/distal D2-gastrectomy for resectable gastric cancer (cT1-4aN0-3M0) in 10 Dutch hospitals. During the trial, two reviewers prospectively analyzed intraoperative photographs of dissected nodal stations for quality control, and provided centers weekly feedback on their D2-lymphadenectomy, as continuous quality-enhancing incentive. After the trial, these photographs were reanalyzed to develop a photo-scoring for future trials, rating the D2-lymphadenectomy dissection quality (optimal-good-suboptimal-unevaluable). Interobserver variability was calculated (weighted kappa). Regression analyses related the photo-scoring to nodal yield, recurrence and 5-years survival. Results: Between 2015 and 2018, 212 patients underwent total/distal D2-gastrectomy (n = 122/n = 90), and 158 (75%) received neoadjuvant chemotherapy. R0-resection rate was 95%. Rate of ≥15 retrieved lymph nodes was 95%. Moderate agreement was obtained in stations 8 + 9 (κ = 0.522), 11p/11d (κ = 0.446) and 12a (κ = 0.441). Consensus was reached for discordant cases (30%). Stations 8 + 9, 11p/11d and 12a were rated 'optimal' in 76%, 63% and 68%. Laparoscopic photographs could be rated better than open (2% versus 12% 'unevaluable'; 73% versus 50% 'optimal'; p = 0.042). The photo-scoring did not show associations with nodal yield (p = 0.214), recurrence (p = 0.406) and survival (p = 0.988). Conclusions: High radicality and nodal yield demonstrated good quality of D2-gastrectomy. The prospective quality control probably contributed to this. The photo-scoring did not show good performance, but can be refined. Laparoscopic D2-gastrectomy was better suited for standardized surgical photo-evaluation than open surgery.
MeSH term(s)	Humans ; Stomach Neoplasms/surgery ; Stomach Neoplasms/pathology ; Prospective Studies ; Lymph Node Excision ; Quality Control ; Gastrectomy ; Laparoscopy
Language	English
Publishing date	2023-08-12
Publishing country	England
Document type	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.2023.107018
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Article ; Online: Distal Versus Total D2-Gastrectomy for Gastric Cancer: a Secondary Analysis of Surgical and Oncological Outcomes Including Quality of Life in the Multicenter Randomized LOGICA-Trial.

de Jongh, Cas / van der Veen, Arjen / Brosens, Lodewijk A A / Nieuwenhuijzen, Grard A P / Stoot, Jan H M B / Ruurda, Jelle P / van Hillegersberg, Richard

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

2023 Volume 27, Issue 9, Page(s) 1812–1824

Abstract: Background: Distal gastrectomy (DG) for gastric cancer can cause less morbidity than total gastrectomy (TG), but may compromise radicality. No prospective studies administered neoadjuvant chemotherapy, and few assessed quality of life (QoL).: Methods!# ...

Abstract	Background: Distal gastrectomy (DG) for gastric cancer can cause less morbidity than total gastrectomy (TG), but may compromise radicality. No prospective studies administered neoadjuvant chemotherapy, and few assessed quality of life (QoL). Methods: The multicenter LOGICA-trial randomized laparoscopic versus open D2-gastrectomy for resectable gastric adenocarcinoma (cT1-4aN0-3bM0) in 10 Dutch hospitals. This secondary LOGICA-analysis compared surgical and oncological outcomes after DG versus TG. DG was performed for non-proximal tumors if R0-resection was deemed achievable, TG for other tumors. Postoperative complications, mortality, hospitalization, radicality, nodal yield, 1-year survival, and EORTC-QoL-questionnaires were analyzed using Χ Results: Between 2015 and 2018, 211 patients underwent DG (n = 122) or TG (n = 89), and 75% of patients underwent neoadjuvant chemotherapy. DG-patients were older, had more comorbidities, less diffuse type tumors, and lower cT-stage than TG-patients (p < 0.05). DG-patients experienced fewer overall complications (34% versus 57%; p < 0.001), also after correcting for baseline differences, lower anastomotic leakage (3% versus 19%), pneumonia (4% versus 22%), atrial fibrillation (3% versus 14%), and Clavien-Dindo grading compared to TG-patients (p < 0.05), and demonstrated shorter median hospital stay (6 versus 8 days; p < 0.001). QoL was better after DG (statistically significant and clinically relevant) in most 1-year postoperative time points. DG-patients showed 98% R0-resections, and similar 30-/90-day mortality, nodal yield (28 versus 30 nodes; p = 0.490), and 1-year survival after correcting for baseline differences (p = 0.084) compared to TG-patients. Conclusions: If oncologically feasible, DG should be preferred over TG due to less complications, faster postoperative recovery, and better QoL while achieving equivalent oncological effectiveness. Distal D2-gastrectomy for gastric cancer resulted in less complications, shorter hospitalization, quicker recovery and better quality of life compared to total D2-gastrectomy, whereas radicality, nodal yield and survival were similar.
MeSH term(s)	Humans ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms/pathology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Gastrectomy/methods ; Laparoscopy/methods ; Treatment Outcome
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; 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/s11605-023-05683-z
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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)
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Article ; Online: Impact of the Surgical Approach for Neoadjuvantly Treated Gastroesophageal Junction Type II Tumors: A Multinational, High-volume Center Retrospective Cohort Analysis.

Wirsik, Naita M / Schmidt, Thomas / Nienhüser, Henrik / Donlon, Noel E / de Jongh, Cas / Uzun, Eren / Fuchs, Hans F / Brunner, Stefanie / Alakus, Hakan / Hölscher, Arnulf H / Grimminger, Peter / Schneider, Martin / Reynolds, John V / van Hillegersberg, Richard / Bruns, Christiane J

Annals of surgery

2023 Volume 278, Issue 5, Page(s) 683–691

Abstract: Objective: The aim of this study was to explore oncologic outcomes of transhiatal gastrectomy (THG) or transthoracic esophagectomy (TTE) for neoadjuvantly treated gastroesophageal junction (GEJ) Siewert type II adenocarcinomas, a multinational, high- ... ...

Abstract	Objective: The aim of this study was to explore oncologic outcomes of transhiatal gastrectomy (THG) or transthoracic esophagectomy (TTE) for neoadjuvantly treated gastroesophageal junction (GEJ) Siewert type II adenocarcinomas, a multinational, high-volume center cohort analysis was undertaken. Background: Neoadjuvant radiochemotherapy or perioperative chemotherapy (CTx) followed by surgery is the standard therapy for locally advanced GEJ. However, the optimal surgical approach for type II GEJ tumors remains unclear, as the decision is mainly based on individual experience and assessment of operative risk. Methods: A retrospective analysis of 5 prospectively maintained databases was conducted. Between 2012 and 2021, 800 patients fulfilled inclusion criteria for type II GEJ tumors and neoadjuvant radiochemotherapy or CTx. The primary endpoint was median overall survival (mOS). Propensity score matching was performed to minimize selection bias. Results: Patients undergoing THG (n=163, 20.4%) had higher American Society of Anesthesiologists (ASA) classification and cT stage ( P <0.001) than patients undergoing TTE (n=637, 79.6%). Neoadjuvant therapy was different as the THG group were mainly undergoing CTx (87.1%, P <0.001). The TTE group showed higher tumor regression ( P =0.009), lower ypT/ypM categories (both P <0.001), higher nodal yield ( P =0.009) and higher R0 resection rate ( P =0.001). The mOS after TTE was longer (78.0 vs 40.0 months, P =0.013). After propensity score matching a higher R0 resection rate ( P =0.004) and mOS benefit after TTE remained ( P =0.04). Subgroup analyses of patients without distant metastasis ( P =0.037) and patients only after neoadjuvant chemotherapy ( P =0.021) confirmed the survival benefit of TTE. TTE was an independent predictor of longer survival. Conclusion: Awaiting results of the randomized CARDIA trial, TTE should in high-volume centers be considered the preferred approach due to favorable oncologic outcomes.
MeSH term(s)	Humans ; Retrospective Studies ; Cohort Studies ; Esophagogastric Junction/surgery ; Esophagogastric Junction/pathology ; Adenocarcinoma/surgery ; Adenocarcinoma/drug therapy ; Esophageal Neoplasms/surgery ; Esophagectomy/methods ; Gastrectomy/methods ; Stomach Neoplasms/surgery ; Neoadjuvant Therapy
Language	English
Publishing date	2023-07-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006011
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Article ; Online: Pattern of lymph node metastases in gastric cancer: a side-study of the multicenter LOGICA-trial.

de Jongh, Cas / Triemstra, Lianne / van der Veen, Arjen / Brosens, Lodewijk A A / Luyer, Misha D P / Stoot, Jan H M B / Ruurda, Jelle P / van Hillegersberg, Richard

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association

2022 Volume 25, Issue 6, Page(s) 1060–1072

Abstract: Background: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns.: Methods: Individual LN ... ...

Abstract	Background: The relation between gastric cancer characteristics and lymph node (LN) metastatic patterns is not fully clear, especially following neoadjuvant chemotherapy (NAC). This study analyzed nodal metastatic patterns. Methods: Individual LN stations were analyzed for all patients from the LOGICA-trial, a Dutch multicenter randomized trial comparing laparoscopic versus open D2-gastrectomy for gastric cancer. The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC. Results: Between 2015-2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 120 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; p < 0.05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR > 1, p > 0.05). However, distal tumors also metastasized to proximal LN stations, and vice versa. Despite NAC, each LN station (no. 1-9, 11 and 12a) showed metastases, regardless of tumor location, cT-stage, histological subtype and NAC treatment, including station 12a for cT1N0-tumors. LN metastases were present more frequently in diffuse versus intestinal tumors (66% versus 52%; p = 0,048), but not for cT3-4- versus cT1-2-stage (59% versus 51%; p = 0.259). However, the pattern of LN metastases was similar for these subgroups. Conclusions: The extent of lymphadenectomy cannot be reduced after NAC for gastric cancer. Although the pattern of LN metastases is related to tumor location, all LN stations contained metastases regardless of tumor location, cT-stage (including cT1N0-tumors), histological subtype, or NAC treatment. Therefore, D2-lymphadenectomy should be routinely performed during gastrectomy in Western patients.
MeSH term(s)	Humans ; Stomach Neoplasms/surgery ; Stomach Neoplasms/pathology ; Lymphatic Metastasis/pathology ; Gastrectomy ; Lymph Node Excision ; Lymph Nodes/surgery ; Lymph Nodes/pathology
Language	English
Publishing date	2022-09-14
Publishing country	Japan
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	1463526-4
ISSN	1436-3305 ; 1436-3291
ISSN (online)	1436-3305
ISSN	1436-3291
DOI	10.1007/s10120-022-01329-2
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Article: Prognostic Value of [

Pullen, Lieke C E / Noortman, Wyanne A / Triemstra, Lianne / de Jongh, Cas / Rademaker, Fenna J / Spijkerman, Romy / Kalisvaart, Gijsbert M / Gertsen, Emma C / de Geus-Oei, Lioe-Fee / Tolboom, Nelleke / de Steur, Wobbe O / Dantuma, Maura / Slart, Riemer H J A / van Hillegersberg, Richard / Siersema, Peter D / Ruurda, Jelle P / van Velden, Floris H P / Vegt, Erik / On Behalf Of The Plastic Study Group

Cancers

2023 Volume 15, Issue 11

Abstract: Aim: To improve identification of peritoneal and distant metastases in locally advanced gastric cancer using [: Methods: [: Results: None of the models could identify metastases with low AUCs of 0.59, 0.51, and 0.56, for the clinical, radiomic, ... ...

Abstract	Aim: To improve identification of peritoneal and distant metastases in locally advanced gastric cancer using [ Methods: [ Results: None of the models could identify metastases with low AUCs of 0.59, 0.51, and 0.56, for the clinical, radiomic, and clinicoradiomic model, respectively. Subgroup analysis of intestinal and mixed-type tumours resulted in low AUCs of 0.67 and 0.60 for the clinical and radiomic models, and a moderate AUC of 0.71 in the clinicoradiomic model. Subgroup analysis of diffuse-type tumours did not improve the classification performance. Conclusion: Overall, [
Language	English
Publishing date	2023-05-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15112874
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Article ; Online: Surgical Techniques and Related Perioperative Outcomes After Robot-assisted Minimally Invasive Gastrectomy (RAMIG): Results From the Prospective Multicenter International Ugira Gastric Registry.

de Jongh, Cas / Cianchi, Fabio / Kinoshita, Takahiro / Kingma, Feike / Piccoli, Micaela / Dubecz, Attila / Kouwenhoven, Ewout / van Det, Marc / Mala, Tom / Coratti, Andrea / Ubiali, Paolo / Turner, Paul / Kish, Pursnani / Borghi, Felice / Immanuel, Arul / Nilsson, Magnus / Rouvelas, Ioannis / Hӧlzen, Jens Peter / Rouanet, Philippe /

Saint-Marc, Olivier / Dussart, David / Patriti, Alberto / Bazzocchi, Francesca / van Etten, Boudewijn / Haveman, Jan Willem / DePrizio, Marco / Sabino, Flávio / Viola, Massimo / Berlth, Felix / Grimminger, Peter Philip / Roviello, Franco / van Hillegersberg, Richard / Ruurda, Jelle

Annals of surgery

2023

Abstract: Objective: To gain insight in global practice of RAMIG and evaluated perioperative outcomes using an international registry.: Background: The techniques and perioperative outcomes of robot-assisted minimally invasive gastrectomy (RAMIG) for gastric ... ...

Abstract	Objective: To gain insight in global practice of RAMIG and evaluated perioperative outcomes using an international registry. Background: The techniques and perioperative outcomes of robot-assisted minimally invasive gastrectomy (RAMIG) for gastric cancer vary substantially in literature. Methods: Prospectively registered RAMIG-cases for gastric cancer (≥10 per center) were extracted from 25 centers in Europe, Asia and South-America. Techniques for the resection, reconstruction, anastomosis and lymphadenectomy were analyzed, and related to perioperative surgical and oncological outcomes. Complications were uniformly defined by the Gastrectomy Complications Consensus Group. Results: Between 2020-2023, 759 patients underwent total (n=272), distal (n=465) or proximal (n=22) gastrectomy (RAMIG). After total gastrectomy with Roux-en-Y-reconstruction, anastomotic leakage rates were 8% with hand-sewn (n=9/111) and 6% with linear stapled anastomoses (n=6/100). After distal gastrectomy with Roux-en-Y (67%) or Billroth-II-reconstruction (31%), anastomotic leakage rates were 3% with linear stapled (n=11/433) and 0% with hand-sewn anastomoses (n=0/26). Extent of lymphadenectomy consisted of D1+ (28%), D2 (59%) or D2+ (12%). Median nodal harvest yielded 31 nodes [IQR 21-47] after total and 34 nodes [IQR 24-47] after distal gastrectomy. R0-resection rates were 93% after total and 96% distal gastrectomy. Hospital stay was 9 days after total and distal gastrectomy, and was 3 days shorter without perianastomotic drains versus routine drain placement. Postoperative 30-day mortality was 1%. Conclusions: This large multicenter study provided a worldwide overview of current RAMIG-techniques with their respective perioperative outcomes. These outcomes demonstrated high surgical quality, set a quality standard for RAMIG and can be considered an international reference for surgical standardization.
Language	English
Publishing date	2023-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006147
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Article ; Online: Impact of

de Jongh, Cas / van der Meulen, Miriam P / Gertsen, Emma C / Brenkman, Hylke J F / van Sandick, Johanna W / van Berge Henegouwen, Mark I / Gisbertz, Suzanne S / Luyer, Misha D P / Nieuwenhuijzen, Grard A P / van Lanschot, Jan J B / Lagarde, Sjoerd M / Wijnhoven, Bas P L / de Steur, Wobbe O / Hartgrink, Henk H / Stoot, Jan H M B / Hulsewe, Karel W E / Spillenaar Bilgen, Ernst Jan / van Det, Marc J / Kouwenhoven, Ewout A /

Annals of surgical oncology

2024 Volume 31, Issue 6, Page(s) 4005–4017

Abstract: Background: Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of : Materials and methods: In this ... ...

Abstract	Background: Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of Materials and methods: In this cost analysis, four staging strategies were modeled in a decision tree: (1) Results: 18F Conclusions: For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine Trial registration: NCT03208621. This trial was registered prospectively on 30-06-2017.
MeSH term(s)	Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Stomach Neoplasms/diagnostic imaging ; Stomach Neoplasms/economics ; Humans ; Laparoscopy/economics ; Laparoscopy/methods ; Positron Emission Tomography Computed Tomography/economics ; Positron Emission Tomography Computed Tomography/methods ; Prospective Studies ; Neoplasm Staging ; Gastrectomy/economics ; Fluorodeoxyglucose F18/economics ; Radiopharmaceuticals/economics ; Cost-Benefit Analysis ; Follow-Up Studies ; Prognosis ; Costs and Cost Analysis ; Male ; Female
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D) ; Radiopharmaceuticals
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-024-15103-4
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