Abstractboek 2021

ABSTRACT BOEK 2021

Wetenschappelijke publicaties van az groeninge

1

CENTRA 02 ABDOMINALE CHIRURGIE

38 NEUROLOGIE

21 ANESTHESIE

43 NEUS-, KEEL- EN OORZIEKTEN

22 ENDOCRINOLOGIE

44 NUCELAIRE GENEESKUNDE

24 GYNAECOLOGIE

46 PATHOLOGISCHE ANATOMIE

25 INWENDIGE ZIEKTEN

47 ONCOLOGIE

27 KINDERGENEESKUNDE

49 ORTHOPEDIE

28 KLINISCH LABORATORIUM

53 PSYCHIATRIE

33 LONGZIEKTEN

55 UROLOGIE

34 MEDISCHE BEELDVORMING

58 VASCULAIRE EN THORACALE CHIRURGIE

37

NEFROLOGIE

VU Inge Buyse, Pres. Kennedylaan 4 | 8500 Kortrijk Uitgegeven in opdracht van het wetenschappelijk comité van az groeninge

2

ABSTRACTBOEK | 2021

Dit abstractboek is ook te raadplegen via azg.site/abstractboek

VOORWOORD

Geachte lezer

Intussen hebben we een tweede jaar achter de rug waarin onze normale werking in wisselende mate gecompromitteerd werd door de COVID-pandemie.

Anders dan tijdens de eerste golf werd alles in het werk gezet om zo veel mogelijk reguliere, niet-COVID-zorg te combineren met zorg voor COVID- patiënten. Door de combinatie van het grotere werkvolume, de arbeidsintensievere zorg in quarantaineafdelingen én personeelsuitval, door ziekte of quarantaine, was het een zeer intense, beproevende tijd.

Desondanks stelden artsen, verpleegkundigen, paramedici en alle ondersteunende medewerkers alles in het werk om ook in deze moeilijke tijden blijvend warme, kwalitatieve en veilige zorg aan te bieden. Dit werd heel recent voor de vierde maal op rij vastgesteld en bevestigd door een internationaal team van experten van Joint Commission International (JCI), die een week lang onze processen aan een grondige audit onderwierpen.

Misschien nog verrassender is het feit dat heel wat teams onverminderd schaarse vrije tijd wijdden aan wetenschappelijk werk; een aantal artsen werkten zelfs verder aan een doctoraat.

In dit abstractboek vindt u een overzicht van het wetenschappelijk werk van het voorbije kalenderjaar. Mijn groot respect gaat uit naar alle artsen en medewerkers, die de motivatie bleven vinden om hun bijdrage te leveren tot de verdere expansie van de medische wetenschap en om hun kennis en expertise te delen met hun peers.

DR. SERGE VANDERSCHUEREN MEDISCH DIRECTEUR MEI 2022

1

CENTRUM

ABDOMINALE CHIRURGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Updated alternative fistula risk score (ua-frs) to include minimally invasive pancreatoduodenectomy: paneuropean validation.

Impact of resection margins for colorectal liver metastases in laparoscopic and open liver resection: a propensity score analysis.

Mungroop T, Klompmaker S, Wellner U, D'Hondt M, et al.

Annals of surgery, 2021, 273(2), 334-340

Martínez-Cecilia D, Wicherts D, Cipriani F, D'Hondt M, et al .

Surgical endoscopy, 2021, 35(2), 809-818

ABSTRACT There is no clear consensus over the optimal width of resection margin for colorectal liver metastases (CRLM), with evolving definitions alongside the advances on the management of the disease. In addition, data on the impact of resection margin after laparoscopic liver resection are still scarce.

Prospectively maintained databases of patients undergoing open or laparoscopic CRLM resection in 7 European tertiary hepatobiliary referral centres were reviewed. After propensity score matching (PSM), the influence of 1 mm and wider margins on OS and DFS were evaluated in open and laparoscopic cohorts.

After PSM, 648 patients were comparable in each group.

The incidence of positive margins (< 1 mm) was similar in open and laparoscopic groups (17% vs 13%, p = 0,142).

Margins < 1 mm were associated with shorter RFS in open (12 vs 26 months, p = 0.042) and in laparoscopic group (13 vs 23, p = 0,002). Margins < 1 mm were associated with shorter OS in open (36 vs 57 months, p = 0.027), but not in laparoscopic group (49 vs 60, p = 0,177). Subgroups with margins ≥ 1 mm (1-4 mm, 5-9 mm, ≥ 10 mm) presented similar RFS in open (p = 0,251) or laparoscopic cohorts (p = 0.117), as well as similar OS in open (p = 0.295) or laparoscopic cohorts (p = 0.908). In the presence of liver recurrence, repeat liver resection was performed in 70 (30%) patients in the open group and 88 (48%) in the laparoscopic group (p < 0.001).

Our study suggests that a positive resection margin (less than 1 mm) width does not impact OS after laparoscopic resection of CRLMs as it does in open liver resection.

However, a positive margin continues to affect RFS in open and laparoscopic resection. Wider margins than 1 mm do not seem to improve oncological results in open or laparoscopic surgery.

2

ABSTRACTBOEK | 2021

ABSTRACT MIPD may be associated with an increased risk of postoperative pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD. The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort.

A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance.

Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk.

Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy.

The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged.

ABSTRACT 3 Hybrid minimally invasive esophagectomy to the rescue: a valid alternative for phased dissemination of tmie?

Nuytens F, Voron T, Piessen G Journal of Clinical Oncology, 2021, 39(1), 91-92

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 4 Five-year survival outcomes of hybrid minimally invasive esophagectomy in esophageal cancer: results of the miro randomized clinical trial.

Nuytens F, Dabakuyo-Yonli TS, Meunier B, et al.

JAMA Surgery, 2021, 156(4), 323-332

Main outcomes and measures: The primary end points of this follow-up study were 5-year OS and DFS. The secondary end points were the site of disease recurrence and potential risk factors associated with DFS and OS. A total of 207 patients were randomized, of whom 175 were men (85%), and the median (range) age was 61 (23-78) years. The median follow-up duration was 58.2 (95% CI, 56.5-63.8) months. The 5-year OS was 59% (95% CI, 48%-68%) in the HMIE group and 47% (95% CI, 37%-57%) in the open esophagectomy group (hazard ratio [HR], 0.71; 95% CI, 0.48-1.06). The 5-year DFS was 52% (95% CI, 42%-61%) in the HMIE group vs 44% (95% CI, 34%-53%) in the open esophagectomy group (HR, 0.81; 95% CI, 0.55-1.17). No statistically significant difference in recurrence rate or location was found between groups.

In a multivariable analysis, major intraoperative and postoperative complications (HR, 2.21; 95% CI, 1.41-3.45; P < .001) and major pulmonary complications (HR, 1.94; 95% CI, 1.21-3.10; P = .005) were identified as risk factors associated with decreased OS. Similarly, multivariable analysis of DFS identified overall intraoperative and postoperative complications (HR, 1.93; 95% CI, 1.28-2.90; P = .002) and major pulmonary complications (HR, 1.85; 95% CI, 1.192.86; P = .006) as risk factors.

ABSTRACT Available data comparing the long-term results of hybrid minimally invasive esophagectomy (HMIE) with that of open esophagectomy are conflicting, with similar or even better results reported for the minimally invasive esophagectomy group.

To evaluate the long-term, 5-year outcomes of HMIE vs open esophagectomy, including overall survival (OS), disease-free survival (DFS), and pattern of disease recurrence, and the potential risk factors associated with these outcomes.

This study found no difference in long-term survival between the HMIE and open esophagectomy groups.

Major postoperative overall complications and pulmonary complications appeared to be independent risk factors in decreased OS and DFS, providing additional evidence that HMIE may be associated with improved oncological results compared with open esophagectomy primarily because of a reduction in postoperative complications.

This randomized clinical trial is a post hoc follow-up study that analyzes the results of the open-label Multicentre Randomized Controlled Phase III Trial, which enrolled patients from 13 different centers in France and was conducted from October 26, 2009, to April 4, 2012. Eligible patients were 18 to 75 years of age and were diagnosed with resectable cancer of the middle or lower third of the esophagus. After exclusions, patients were randomized to either the HMIE group or the open esophagectomy group.

Data analysis was performed on an intention-to-treat basis from November 19, 2019, to December 4, 2020.

Interventions: Hybrid minimally invasive esophagectomy (laparoscopic gastric mobilization with open right thoracotomy) was compared with open esophagectomy.

International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy.

ABSTRACT 5

van der Poel M, Fichtinger R, Gorgec B, D'Hondt M, et al.

Hepato-pancreato-biliary (HPB) surgery - Oxford Medicine, 2021, 23(5), 707-714

ABSTRACT Despite a lack of high-level evidence, current guidelines recommend laparoscopic left lateral sectionectomy (LLLS) as the routine approach over openLLS (OLLS). Randomized studies and propensity score matched studies on LLLS vs OLLS for all indications, including malignancy, are lacking.

ABDOMINALE CHIRURGIE

3

This international multicenter propensity score matched retrospective cohort study included consecutive patients undergoing LLLS or OLLS in six centers from three European countries (January 2000-December 2016). Propensity scores were calculated based on nine preoperative variables and LLLS and OLLS were matched in a 1:1 ratio. Short-term operative outcomes were compared using paired tests.

A total of 560 patients were included. Out of 200 LLLS, 139 could be matched to 139 OLLS. After matching, baseline characteristics were well balanced. LLLS was associated with shorter operative time (144 (110-200) vs 199 (138283) minutes, P < 0.001), less blood loss (100 (50-300) vs 350 (100-750) mL, P = 0.005) and a 3-day shorter postoperative hospital stay (4 (3-7) vs 7 (5-9) days, P < 0.001).

This international multicenter propensity score matched study confirms the superiority of LLLS over OLLS based on shorter postoperative hospital stay, operative time and less blood loss thus validating current guideline advice.

ABSTRACT 6 Risk of conversion to open surgery during robotic and laparoscopic pancreatoduodenectomy and effect on outcomes: international propensity score-matched comparison study.

Lof S, Vissers F, Klompmaker S, Berti S, D'Hondt M British Journal of Surgery, 2021, 108(1), 80-87

and the overall 30-day mortality rate was 3.8 per cent.

Risk factors for conversion were tumour size larger than 40 mm (OR 2.7, 95 per cent c.i.1.0 to 6.8; P = 0.041), pancreatobiliary tumours (OR 2.2, 1.0 to 4.8; P = 0.039), age at least 75 years (OR 2.0, 1.0 to 4.1; P = 0.043), and laparoscopic pancreatoduodenectomy (OR 5.2, 2.5 to 10.7; P < 0.001).

Medium-volume centres had a higher risk of conversion than high-volume centres (15.2 versus 4.1 per cent, P < 0.001; OR 4.1, 2.3 to 7.4, P < 0.001). After propensity score matching (56 converted MIPDs and 56 completed MIPDs) including risk factors, rates of complications with a Clavien-Dindo grade of III or higher (32 versus 34 per cent; P = 0.841) and 30-day mortality (12 versus 6 per cent; P = 0.274) did not differ between converted and non-converted MIPDs. Risk factors for conversion during MIPD include age, large tumour size, tumour location, laparoscopic approach, and surgery in medium-volume centres. Although conversion during MIPD itself was not associated with worse outcomes, the outcome in these patients was poor in general which should be taken into account during patient selection for MIPD.

ABSTRACT 7 Robotic versus laparoscopic distal pancreatectomy: multicentre analysis.

Lof S, van der Heijde N, Abuawwad M, D'Hondt M, et al.

British Journal of Surgery,2021, 108(2), 188-195

ABSTRACT Minimally invasive pancreatoduodenectomy (MIPD) is increasingly being performed because of perceived patient benefits. Whether conversion of MIPD to open pancreatoduodenectomy worsens outcome, and which risk factors are associated with conversion, is unclear.

This was a post hoc analysis of a European multicentre retrospective cohort study of patients undergoing MIPD (2012-2017) in ten medium-volume (10-19 MIPDs annually) and four high-volume (at least 20 MIPDs annually) centres. Propensity score matching (1 : 1) was used to compare outcomes of converted and non-converted MIPD procedures. Multivariable logistic regression analysis was performed to identify risk factors for conversion, with results presented as odds ratios (ORs) with 95 per cent confidence intervals (c.i).

Overall, 65 of 709 MIPDs were converted (9.2 per cent)

4

ABSTRACTBOEK | 2021

ABSTRACT The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP. A multicentre international propensity score-matched study includedpatients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (ClavienDindo grade IIIa or above).

A total of 1551 patients (407 RDP and 1144 LDP) were included in thestudy. Some 402 patients who had RDP were

matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r.

225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004).

The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.

ABSTRACT 8 An unexpected cause of persistent bacteraemia and portomesenteric venous gas.

This case report summarises the diagnostic pathway and aims for higher awareness of non-ischemic PMVG causes.

ABSTRACT 9 An unexpected liver lesion?

De Somer T, D'Hondt M, Carels K Acta Gastro-Enterologica Belgica, 2021, 84(2), 385-386

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 10 Radiofrequency ablation and chemotherapy versus chemotherapy alone for locally advanced pancreatic cancer (PELICAN): study protocol for a randomized controlled trial.

Walma MS, Rombouts SJ, Brada LJH, D'Hondt M, et al.

Trials, 2021, 22(1), 313

ABSTRACT Loobuyck A, Vermeersch G, D'Hondt M Acta Gastro-Enterologica Belgica, 84(2), 2021, 375-377

ABSTRACT We report the case of a 59-year old man with portomesenteric venous gas (PMVG) due to inferior mesenteric vein fistulization caused by sigmoid diverticulitis with an unusual evolution.

The patient initially presented with classic symptoms of lower abdominal pain and fever. Diagnosis of uncomplicated sigmoid diverticulitis was confirmed on computed tomography (CT) for which intravenous antibiotics were initiated. Hemocultures were positive for omnisensitive Escherichia Coli, but despite adequate intravenous antibiotic therapy, episodes of bacteraemia persisted and hemocultures remained positive. Repeat CT scan demonstrated regression of inflammation without signs of abcedation or perforation consistent with clinical findings.

Endocarditis was excluded with a normal transoesophageal echocardiography.

Finally, positron emission tomography-computed tomography (PET-CT) suspected a colovenous fistula and the presence of PMVG. The patient was successfully treated with laparoscopic sigmoidectomy.

Approximately 80% of patients with locally advanced pancreatic cancer (LAPC) are treated with chemotherapy, of whom approximately 10% undergo a resection. Cohort studies investigating local tumor ablation with radiofrequency ablation (RFA) have reported a promising overall survival of 26-34 months when given in a multimodal setting. However, randomized controlled trials (RCTs) investigating the effect of RFA in combination with chemotherapy in patients with LAPC are lacking.

The "Pancreatic Locally Advanced Unresectable Cancer Ablation" (PELICAN) trial is an international multicenter superiority RCT, initiated by the Dutch Pancreatic Cancer Group (DPCG). All patients with LAPC according to DPCG criteria, who start with FOLFIRINOX or (nab-paclitaxel/) gemcitabine, are screened for eligibility. Restaging is performed after completion of four cycles of FOLFIRINOX or two cycles of (nab-paclitaxel/)gemcitabine (i.e., 2 months oftreatment), and the results are assessed within a nationwide online expert panel. Eligible patients with RECIST stable disease or objective response, in whom resection is not feasible, are randomized to RFA followed by chemotherapy or chemotherapy alone. In total, 228 patients will be included in 16 centers in The Netherlands and four other European centers.

The primary endpoint is overall survival. Secondary

ABDOMINALE CHIRURGIE

5

endpoints include progression-free survival, RECIST response, CA 19.9 and CEA response, toxicity, quality of life, pain, costs, and immunomodulatory effects of RFA. The PELICAN RCT aims to assess whether the combination of chemotherapy and RFA improves the overall survival when compared to chemotherapy alone, in patients with LAPC with no progression of disease following 2 months of systemic treatment.

Further analyses of long-term outcomes are needed.

ABSTRACT 11

ABSTRACT 12

Short-term outcomes after spleen-preserving minimally invasive distal pancreatectomy with or without preservation of splenic vessels: a pan-european retrospective study in high-volume centers.

Laparoscopic liver resection for colorectal liver metastases - short- and long-term outcomes: A systematic review.

Korrel M, Lof S, Sarireh BA, D'Hondt M, et al.

Annals of Surgery, 2021, doi: 10.1097/ SLA.0000000000004963

Taillieu E,De Meyere C, Nuytens F, Verslype C, D'Hondt M, et al.

World Journal of Gastrointestinal Oncology, 2021, 13(7), 732-757

ABSTRACT

ABSTRACT

Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce.

To compare short-term clinical outcomes after Kimura and Warshaw minimally invasive distal pancreatectomy (MIDP).

For well-selected patients and procedures, laparoscopic liver resection (LLR) has become the gold standard for the treatment of colorectal liver metastases (CRLM) when performed in specialized centers. However, little is currently known concerning patient-related and peri-operative factors that could play a role in survival outcomes associated with LLR for CRLM.AIM: To provide an extensive summary of reported outcomes and prognostic factors associated with LLR for CRLM.

Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in eight European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ('rescue') Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP. Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs. 1.6%, p = 0.127) and major complications (11.5% vs 14.4%, p = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs. 1.2%, p = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, p = 0.052). Kimura MIDP was associated with longer operative time (202 vs

6

184 min, p = 0.033) and less blood loss (100 vs 150 ml, p < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, p < 0.001).

Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity.

ABSTRACTBOEK | 2021

A systematic search was performed in PubMed, EMBASE, Web of Science and the Cochrane Library using the keywords "colorectal liver metastases", "laparoscopy", "liver resection", "prognostic factors", "outcomes" and "survival".

Only publications written in English and published until December 2019 were included. Furthermore, abstracts of which no accompanying full text was published, reviews, case reports, letters, protocols, comments, surveys and animal studies were excluded. All search results were saved to Endnote Online and imported in Rayyan for systematic selection. Data of interest were extracted from the included publications and tabulated for qualitative analysis.

Out of 1064 articles retrieved by means of a systematic and grey literature search, 77 were included for qualitative analysis. Seventy-two research papers provided data concerning outcomes of LLR for CRLM. Fourteen papers were eligible for extraction of data concerning prognostic factors affecting survival outcomes. Qualitative analysis

of the collected data showed that LLR for CRLM is safe, feasible and provides oncological efficiency. Multiple research groups have reported on the short-term advantages of LLR compared to open procedures.

The obtained results accounted for minor LLR, aswell as major LLR, simultaneous laparoscopic colorectal and liver resection, LLR of posterosuperior segments, two-stage hepatectomy and repeat LLR for CRLM. Few research groups so far have studied prognostic factors affecting long-term outcomes of LLR for CRLM. In experienced hands, LLR for CRLM provides good shortand long-term outcomes, independent of the complexity of the procedure.

ABSTRACT 13 Assessment of textbook outcome in laparoscopic and open liver surgery.

Görgec B, Benedetti, Cacciaguerra A, D'Hondt M, et al.

JAMA surgery, 2021 , 156(8), doi: 10.1001/jamasurg.2021.2064

ABSTRACT Textbook outcome (TO) is a composite measure that captures the mostdesirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR).

To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a largeinternational multicenter database using a propensity-score matched analysis. DESIGN, SETTING, AND PARTICIPANTS: Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African HepatoPancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated.

Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications,

readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin.

A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P < .001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P = .02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P = .002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P = .001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P < .001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P < .001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P = .01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P = .02; >10 cm = OR, 0.550 [95% CI, 0.3660.826]; P = .004) were associated with a worse TOLS rate.

In this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.

ABSTRACT 14 Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation. van der Heijde N, Ratti F, Aldrighetti L, D'Hondt M, et al.

Surgical Endoscopy, 2021, 5(11), 6139-6149

ABSTRACT Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS).

An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007-December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio.

Primary endpoint was major complication rate defined as

ABDOMINALE CHIRURGIE

7

Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve.

Additionally, possible risk factors were explored for operative time, blood loss and LOS. Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195-285) vs. 247 min (195-315) p = 0.004], less blood loss [260 (188-400) vs. 400 mL (280-550) p = 0.009] and a shorter LOS [5 (4-7) vs. 8 days (6-10), p = 0.002]. Major complication rate [n = 8 (5.3%) vs. n = 9 (6.0%) p = 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p = 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy.

This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate.

R-RPS and L-RPS can be performed in expert centres with goodoutcomes in well selected patients. R-RPS was associated with reduced blood loss and lower open conversion rates than L-RPS.

ABSTRACT 16

ABSTRACT 15

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses.

International multicentre propensity score-matched analysis comparing robotic versus laparoscopic right posterior sectionectomy.

Cheung TT, Wang X, Efanov M, D'Hondt M, et al.

Hepatobiliary Surgery and Nutrition, 2021, 10(5), 587-597

Chiow AKH, Fuks D, Choi GH, D'Hondt M, et al.

British Journal of Surgery, 2021, 108(12), 1513-1520

ABSTRACT Minimally invasive right posterior sectionectomy (RPS) is a technically challenging procedure. This study was designed to determine outcomes following robotic RPS (R-RPS) and laparoscopic RPS (L-RPS).

An international multicentre retrospective analysis of patients undergoing R-RPS versus those who had purely L-RPS at 21 centres from 2010 to 2019 was performed.

Patient demographics, perioperative parameters, and postoperative outcomes were analysed retrospectively from a central database.

8

Propensity score matching (PSM) was performed, with analysis of 1 : 2 and 1 : 1 matched cohorts.

Three-hundred and forty patients, including 96 who underwent R-RPS and 244 who had L-RPS, met the study criteria and were included. The median operating time was 295 minutes and there were 25 (7.4 per cent) open conversions. Ninety-seven (28.5 per cent) patients had cirrhosis and 56 (16.5 per cent) patients required blood transfusion.

Overall postoperative morbidity rate was 22.1 per cent and major morbidity rate was 6.8 per cent. The median postoperative stay was 6 days. After 1 : 1 matching of 88 R-RPS and L-RPS patients, median (i.q.r.) blood loss (200 (100-400) versus 450 (200-900) ml, respectively; P < 0.001), major blood loss (> 500 ml; P = 0.001), need for intraoperative blood transfusion (10.2 versus 23.9 per cent, respectively; P = 0.014), and open conversion rate (2.3 versus 11.4 per cent, respectively;P = 0.016) were lower in the R-RPS group.

Similar results were found in the 1 : 2 matched groups (66 R-RPS versus 132 L-RPS patients).

ABSTRACTBOEK | 2021

ABSTRACT The application and feasibility of minimally invasive liver resection (MILR) for huge liver tumours (≥10 cm) has not been well documented.

Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019. Huge tumors and large tumors were defined as tumors with a size ≥10.0 cm and 3.0-9.9 cm based on histology, respectively. 1:1 coarsened exact-matching (CEM) and 1:2 Mahalanobis distance-matching (MDM) was performed according to clinically-selected variables. Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff.

Of 2,890 patients with tumours ≥3 cm, there were 205 huge tumors. After 1:1 CEM, 174 huge tumors were matched to 174 large tumors; and after 1:2 MDM, 190 huge tumours were matched to 380 large tumours.

There was significantly and consistently increased intraoperative blood loss, frequency in the application of Pringle maneuver, major morbidity and postoperative stay in the huge tumourgroup compared to the large tumour group after both 1:1 CEM and 1:2 MDM. These findings were reinforced in RD analyses. Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM. MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement, with worse perioperative outcomes compared to MILR for large tumors, therefore judicious patient selection is pivotal.

ABSTRACT 17 Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): study protocol for an international multicentre prospective diagnostic accuracy study.

Görgec B, Hansen I, Lutin B, D'Hondt M, et al.

BMC Cancer, 2021, 21(1), 1116

diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in ≥10% of patients which is considered the minimal clinically important difference.

Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI. The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy.

This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy.

ABSTRACT 18 ASO author reflections: proposed algorithm for surgical treatment of localized duodenal gist.

ABSTRACT Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI.

Nuytens F, Honoré C, Dubois C Annals of Surgical Oncology, 2021, 28(11), 6307-6308

In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and

The current incidence of DHEC is discussed with conflicting data regarding its treatment and natural course.

To evaluate the incidence and risk factors of diaphragmatic herniation following esophagectomy for cancer (DHEC), and assess the results ofsurgical repair.

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 19 Incidence and Risk Factors for Diaphragmatic Herniation Following Esophagectomy for Cancer.

Hertault H, Gandon A, Behal H, Nuytens F, et al.

Annals of Surgery, 274(5), 2021, 758-765

ABSTRACT

ABDOMINALE CHIRURGIE

9

Monocentric retrospective cohort study (2009-2018).

From 902 patients, 719 patients with a complete follow-up of CT scans after transthoracic esophagectomy for cancer were reexamined to identify the occurrence of a DHEC. The incidence of DHEC was estimated using Kalbfleisch and Prentice method and risk factors of DHEC were studied using the Fine and Gray competitive risk regression model by treating death as a competing event. Survival was analyzed.

Five-year DHEC incidence was 10.3% [95% CI, 7.8%-13.2%] (n = 59), asymptomatic in 54.2% of cases. In the multivariable analysis, the risk factors for DHEC were: presence of hiatal hernia on preoperative CT scan (HR = 1.72 [1.01-2.94], P = 0.046), previous hiatus surgery (HR = 3.68 [1.61-8.45], P = 0.002), gastroesophageal junction tumor location (HR = 3.51 [1.91-6.45], P < 0.001), neoadjuvant chemoradiotherapy (HR = 4.27 [1.70-10.76], P < 0.001), and minimally invasive abdominal phase (HR = 2.98 [1.60-5.55], P < 0.001).

A cure for DHEC was achieved in 55.9%. The postoperative mortality rate was nil, the overall morbidity rate was 12.1%, and the DHEC recurrence rate was 30.3%. Occurrence of DHEC was significantly associated with a lower hazard rate of death in a time-varying Cox's regression analysis (HR = 0.43[0.23-0.81], P = 0.010).

The 5-year incidence of DHEC is 10.3% and is associated with a favorable prognosis. Surgical repair of symptomatic or progressive DHEC is associated with an acceptable morbidity. However, the optimal surgical repair technique remains to be determined in view of the large number of recurrences.

ABSTRACT 20 Risk prediction model of 90-Day mortality after esophagectomy for cancer.

D'Journo XB, Boulate D, Fourdrain A, Nuytens F, et al.

JAMA Surgery, 2021, 156(9), 836-845

In this diagnostic/prognostic study, we performed a retrospective analysis of patients from 39 institutions in 19 countries between January 1, 2015, and December 31, 2019. Patients with esophageal cancer were randomly assigned to development and validation cohorts. A scoring system that predicted death within 90 days based on logistic regression β-coefficients was conducted. A final prognostic score was determined and categorized into homogeneous risk groups that predicted death within 90 days. Calibration and discrimination tests were assessed between cohorts.

A total of 8403 patients (mean [SD] age, 63.6 [9.0] years; 6641 [79.0%] male) were included. The 30-day mortality rate was 2.0% (n = 164), and the 90-day mortality rate was 4.2% (n = 353). Development (n = 4172) and validation (n = 4231) cohorts were randomly assigned. The multiple logistic regression model identified 10 weighted point variables factored into the prognostic score:age, sex, body mass index, performance status, myocardial infarction, connective tissue disease, peripheral vascular disease, liver disease, neoadjuvant treatment, and hospital volume. The prognostic scores were categorized into 5 risk groups: very low risk (score, ≥1; 90-day mortality, 1.8%), low risk (score, 0; 90-day mortality, 3.0%), medium risk (score, -1 to -2; 90-day mortality, 5.8%), high risk (score, -3 to -4: 90-day mortality, 8.9%), and very high risk (score, ≤-5; 90-day mortality, 18.2%). The model was supported by nonsignificance in the Hosmer-Lemeshow test. The discrimination (area under the receiver operating characteristic curve) was 0.68 (95% CI, 0.64-0.72) in the development cohort and 0.64 (95% CI, 0.60-0.69) in the validation cohort.

In this study, on the basis of preoperative variables, the IESG risk prediction model allowed stratification of an individual patient's risk of death within 90 days after esophagectomy.

These data suggest that this model can help in the decision-making process when esophageal cancer surgery is being considered and in informed consent.

ABSTRACT Ninety-day mortality rates after esophagectomy are an indicator of the quality of surgical oncologic management.

Accurate risk prediction based on large data sets may aid patients and surgeons in making informed decisions.

To develop and validate a risk prediction model of death within 90 days after esophagectomy for cancer using the International Esodata Study Group (IESG) database, the largest existing prospective, multicenter cohort reporting standardized postoperative outcomes.

10

ABSTRACTBOEK | 2021

ABSTRACT 21 Limited resection versus pancreaticoduodenectomy for duodenal gastrointestinal stromal tumors? Enucleation interferes in the debate: a European multicenter retrospective cohort study.

Dubois C, Nuytens F, Behal H Annals of Surgical Oncology, 2021, 28, 6294-6306

ABSTRACT

ABSTRACT 22

The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined.

Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate.

The aim of this study was to compare the short- and longterm outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN).

European society of coloproctology guidance on the use of mesh in the pelvis incolorectal surgery.

In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared betweenPD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated.

Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016).

Postoperative morbidity was higher after PD (68.4% vs.

23.5%;p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences.

Maeda Y, Espin-Basany E, Gorissen K, van Geluwe B, et al.

Colorectal Disease, 23(9), 2021, 2228-2285

ABSTRACT This is a comprehensive and rigorous review of currently available data on the use of mesh in the pelvis in colorectal surgery. This guideline outlines the limitations of available data and the challenges of interpretation, followed by best possible recommendations.

For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes.

Based on these results, a surgical treatment algorithm is proposed.

ABDOMINALE CHIRURGIE

11

ABSTRACT 23 Randomised controlled trial to assess efficacy of pelvic floor muscle training on bowel symptoms after low anterior resection for rectal cancer: study protocol.

Asnong A, D'Hoore A, Van Kampen M, Van Geluwe B, et al.

BMJ Open, 2021, 11(1):e041797

ABSTRACT Radical surgery after a total mesorectal excision (TME) for rectal cancer often results in a significant decrease in the patient's quality of life, due to functional problems such as bowel, urinary and sexual dysfunction. The effect of pelvic floor muscle training (PFMT) on these symptoms has been scarcely investigated. We hypothesise that the proportion of successful patients will be significantly higher in the intervention group, receiving 12 weeks of PFMT, compared with the control group without treatment.

The primary outcome of this trial is the severity of bowel symptoms, measured through the Low Anterior Resection Syndrome questionnaire, 4 months after TME or stoma closure. Secondary outcomes are related to other bowel and urinary symptoms, sexual function, physical activity and quality of life.

This research protocol describes a multicentre single blind prospective, randomised controlled trial. Since January 2017, patients treated for rectal cancer (n=120) are recruited after TME in three Belgiancentres. One month following surgery or, in case of a temporary ileostomy, 1 month after stoma closure, patients are randomly assigned to the intervention group (n=60) or to the control group (n=60). The assessments concern the preoperative period and 1, 4, 6, 12 and 24 months postoperatively.

ABSTRACT 24 Chapter springer “pelvic floor disorders: a Laparoscopic versus open hemihepatectomy: The ORANGE II PLUS multicenter randomized controlled trial Fichtinger RS, Aldrighetti L, Troisi R, D'Hondt M, et al.

Annals of Oncology, 2021, 32(S5), S531

ABSTRACT Surgical resection forms the mainstay of curative treatment for cancers involving the liver. The laparoscopic approach to major liver resections is increasingly being performed.

Randomized evidence to show superiority of laparoscopic

12

ABSTRACTBOEK | 2021

(LH) compared to open hemihepatectomy (OH) for perioperative and oncological outcomes is lacking.

Patients undergoing hemihepatectomy for accepted indications (principally known or suspected cancer) were randomized 1:1 to either LH or OH in 16 European centers. Patients and ward personnel were blinded until postoperative day 4. The primary endpoint was time to functional recovery (TFR). The definition included being independently mobile with adequate oral intake and normalizing liver function. Secondary outcomes included length of hospital stay (LOS), postoperative 90-day morbidity, 90-day mortality, resection margin status and 3-year survival. All analyses were by intention to treat (ITT).

179 eligible patients were randomly assigned to LH and 173 to OH between October 2013 and January 2019. 135 (75%) of 179 patients in the LH group and 142 (82%) of 173 patients in the OH group had cancer: 162 colorectal liver metastases (CRLM), 47 hepatoma, 47 cholangiocarcinoma, 21 other metastases.

Primary ITT analysis included 327 patients (LH 164 vs OH 163) and demonstrated a significant reduction in TFR: LH 4 days (IQR 2-6) vs OH 5 days (IQR 3-7), P< 0.001. LOS was similarly different: LH 5 days (IQR 2-8) vs OH 6 days (IQR 4-8), P¼ 0.002. In the LH group 15% (24/164) of patients experienced complications > Clavien-Dindo IIIa within 90 days of surgery vs 18% (30/163) in the OH group, P¼ 0.36. There were 5 deaths (3.0%) within 90 days of surgery in the LH group vs 5 (3.1%) in the OH group, P¼ 0.99. For all cancers, resection margins 1 mm were attained for 107/133 (81%) patients in the LH group vs 121/138 (88%) patients in the OH group (OR 1.73, 99% CI 0.72-4.14, P¼ 0.11). At a median follow-up of 37 months (IQR 24-50 months) 3-year survival rate was 58% for LH vs 65% for OH (HR 1.16, 99% CI 0.68-1.98, P¼0.49).

LH is superior to OH in terms of TFR and LOS. No significant differences in oncological outcomes were observed but follow-up continues to permit a mature survival analysis.

ABSTRACT 25

ABSTRACT 26

Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis

Boerhaave's syndrome: successful conservative treatment in two patients.

Benedetti A, Görgec B, Lanari J, D'Hondt M, et al.

Journal Hepatobiliary Pancreatic Sciences, 2021, doi: 10.1002/jhbp.1087

ABSTRACT Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influence the outcome of cirrhotic patient.

Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009-2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed.

Van Geluwe B, Van Moerkercke W, Vergauwe P, et al.

Acta Gastro-Enterologica Belgica, 2021, 83(4), 654-656

ABSTRACT The Boerhaave syndrome is a spontaneous, post-emetic rupture of the esophagusand a rare but potentially fatal cause of upper gastrointestinal bleeding. There are currently no guidelines on the optimal treatment of these patients, although there is a strong tendency towards a surgical approach. We present 2 cases of male patients, 66- and 77-year old respectively, both admitted to the emergency department with hematemesis. Unexpectedly, these turned out to be caused by the Boerhaave syndrome.

Based on the severity of presentation, either a conservative or endoscopic treatment was adopted, both with good outcome.

PRESENTATIES/CONGRESSEN ABSTRACT 1

Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (p=0.042), lower overall and severe complication (p<0.001, 0.020), such as surgical site infection, acute kidney injury and liver failure were observed, parallel to a shorter length of hospital stay.

Minimal invasive liver resection Implementation: High Complexity procedures

Stratifying patients based on the type of resection, less severe complications was observed only after laparoscopic left hepatectomy (p=0.044), while the advantages of laparoscopy tend to decrease during right hepatectomy.

Subgroup analysis of long term survivals following liver resection for hepatocellular carcinoma showed no difference between mjLLR and mjOLR.

Er is geen abstract beschikbaar.

D’Hondt M, Cillo U, Aldrighetti L, Ciria R, Abu Hilal M January 2021, Webcast: Implementation of Minimally Invasive Liver Surgery, Online

ABSTRACT

This multicenter experience suggests potential short-term benefits of mjLLR in cirrhotic patients compared to mjOLR, without compromising long-term outcome. These findings might have interesting clinical implications for the management of patients with chronic liver disease.

ABSTRACT 2 The oncological efficiency of laparoscopic liver surgery for colorectal liver me-tastases D’Hondt M May, 2021, Webinar International Laparoscopic Liver Society: Minimally Invasive Management of Colorectal Liver Metastasis, Online

ABSTRACT Er is geen abstract beschikbaar.

ABDOMINALE CHIRURGIE

13

ABSTRACT 3 Surgical techniques and instrumentation for minimally invasive pancreatectomy D'Hondt, M May, 2021, Webcast: European Consortion on Minimally Invansive Pancreatic Surgery (E-MIPS) : Online Mastercourse,Online

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 4 A comparative study of an integrated ultrasonic/ bipolar sealing device versus an articulating bipolar sealing device for laparoscopic liver surgery.

D'Hondt M, Provoost A, De Meyere C, Parmentier I, Pottel H, Verslype C June 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS), Live Virtual Meeting online

loss was significantly higher with TB (50 mL (IQR: [20-120]) compared to ES (100 mL (IQR: [50-250]) (p<0.0001). The amount of blood loss was highest for anatomical major and lowest for minor resections, and increased proportionally with surgical difficulty scores. Use of CUSA was associated with an increase in blood loss in both TB and ES (100 mL (IQR: [50-300]) vs. 175 mL (IQR: [100-400]); p<0.0001). Median operative time was considerably shorter in TB (115 min (IQR: [45-300])) compared to ES (140 min (IQR: [40-370])) (p=0.0008). The Pringle maneuver was more often applied in TB (27.6%) compared to ES (13.8%) (p=0.0036). However, by adjusting for variables influencing blood loss in a generalized linear model, the type of hemostatic device remained a significant contributing factor in blood loss (p=0.0164). The postoperative complication rate was similar for bleeding (TB 0% vs. ES 1.2%; p=0.5574) and biliary leak (TB 1.0% vs. ES 1.6%; p=1.0000), and there was no significant difference in 90-day mortality (TB 0% vs. ES 0.8%; p=1.0000). Median hospital stay was significantly shorter for TB compared to ES (2 days (IQR: [1-4]) vs. 4 days (IQR: [3-6]); p<0.0001) although this might be explained by the introduction of an enhanced recovery after surgery (ERAS) clinical pathway in June 2015.

ABSTRACT Hemostatic devices are able to seal and cut tissue with the application of different energy modalities, and are routinely used in open and laparoscopic liver surgery. The aim of this study is to compare the outcome of Thunderbeat (TB) (Olympus Europa Se & Co, Hamburg, Germany), an integrated ultrasonic/bipolar sealing device, versus Enseal (ES) (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA), an articulating bipolar sealing device, in laparoscopic liver surgery.

A retrospective analysis of a prospectively maintained database was conducted in a single supra-regional Belgian center from September 2011 to September 2020. The primary endpoint was evaluation of difference in blood loss between the two hemostatic devices. Secondary endpoints consisted of complications, transfusion rate, operative time, hospital stay, and mortality. Influence of multiple variables was assessed including extension of resection (minor, anatomical major and technical major), laparoscopic liver resection difficulty scores (IWATE and Southampton score), use of cavitron ultrasonic surgical aspirator (CUSA), and application of Pringle maneuver and hemostatic agents.

352 patients were identified who underwent laparoscopic liver surgery, either by using TB (n=105) or ES (n=247). The TB and ES group were comparable in terms of sex, comorbities, extension of resection, and difficulty scores. Median blood

14

ABSTRACTBOEK | 2021

The integrated ultrasonic/bipolar sealing device is superior compared to the articulating bipolar sealing device in laparoscopic liver surgery in terms of perioperative blood loss without an increase in complications.

ABSTRACT 5 Is there a rapid adaptation in robotic liver surgery for a liver surgeon with a large experience in laparoscopic liver surgery?

D’Hondt M, Devooght A, De Meyere C, Parmentier I, Vandeputte M June 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS), Live Virtual Meeting online

ABSTRACT Robotic liver surgery (RLS) is currently limited to few highvolume centers. Its reproducibility is still debated. The aim of the present study was to evaluate the results of the first year of robotic liver surgery, performed by an early adopter in laparoscopic liver surgery (LLS) with experience in over 400 laparoscopic cases.

Over a one-year period, 53 patients underwent a robotic hepatectomy. The outcomes of the robotic cases (RG)

were compared to the ‘Initial Experience’-group (IE) of 120 laparoscopic cases, performed by the same surgeon.

Subsequently, the robotic series were compared to his last 120 laparoscopic cases or ‘Mastery Phase’-group (MP).

The 3 groups were similar with regards to age, gender, tumor type and Iwate or Southampton difficulty score.

Median skin-to-skin operative time of the RG was 140 min versus 130 min in the IE (p=0.026), and 108 min in the MP (p<0.001). Median intraoperative blood loss in the RG was less (40 ml (20-90)) compared to the IE (100 ml (50-250);p<0.001) and the MP (65ml (30-143;p=0.004).

Median hospital stay was 3 days in both the RG and MP, versus 5 days in the IE (p<0.001).

There was no significant difference in postoperative complications, conversion or readmission rate.

Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. Blood loss was significantly lower in RLS.

associated with shorter operative time, less blood loss, and shorter hospital stay. Compared to laparoscopy, robotic liver surgery has the advantage of 3D visualization and a larger range of motion thanks to endowrist technology. This video aims to demonstrate the first experience of a hepatopancreaticobiliary surgeon with robotic redo hepatectomy.

The Pringle maneuver was performed for 18 minutes.

Operative time was 170 minutes, and blood loss was 30 cc.

Pathology confirmed a R0 resection of the colorectal liver metastasis. There were no intraoperative complications encountered. The postoperative course was uneventful, and the patient was discharged on day 2 post-operatively.

Robotic redo hepatectomy is feasible after previous open extensive liver surgery for repeat metastatic liver disease in selected patients.

ABSTRACT 8 Robotic left hemihepatectomy with lymph node dissection for a large intrahepatic cholangiocarcinoma Willems E, D’Hondt M June 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS), Live Virtual Meeting online

ABSTRACT 6 Establishing minimally invasive liver surgery program D'Hondt M June 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS) , Live Virtual Meeting online

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 7 Robotic redo hepatectomy: Resection Sg 4B seven years after open right hemihepatectomy – video presentation D’Hondt M , Provoost A June, 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS), Live Virtual Meeting online

ABSTRACT Evidence shows that repeat liver resection is often the best treatment option for recurrent colorectal liver metastases.

Although repeat resections can be complex due to adhesion and altered liver anatomy, laparoscopic liver resection has been shown to be feasible in selected patients, and has been

ABSTRACT Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor following HCC. The incidence of ICC is low in most parts of the world. However, incidence has been rising. The only curative treatment option involves surgical resection as part of a multidisciplinary treatment.

The goal of surgery is to obtain negative section margins while leaving an adequate future liver remnant. The role of regional lymphadenectomy is still debated, as it might add to a higher postoperative morbidity. An expert consensus statement states that regional lymphadenectomy should be considered a standard part of surgical therapy for patients undergoing resection of ICC. Another question remains about the role of minimal invasive surgery for ICC. A laparoscopic approach may lead to lower morbidity without compromising oncological adequacy. However, some doubts remain about the extent of lymph node dissection in laparoscopic approach. This video aims to demonstrate the advantages of a robotic approach using the Da Vinci© XI for left hemihepatectomy with lymph node dissection for a large intrahepatic cholangiocarcinoma.

After screening for hepatic of peritoneal metastases, an extensive lymph node dissection of lymph node groups one and two is performed. Hilar structures are divided selectively. Next, a left hemihepatectomy is performed

ABDOMINALE CHIRURGIE

15

using the robotic vessel sealer. Finally, the left hepatic vein is divided using a vascular stapler and resection is finished.

Operative time was 270 min and blood loss was 20ml. The postoperative course was uneventful and the patient was discharged on postoperative day 3. Pathologic investigation showed an intrahepatic cholangiocarcinoma of 5cm, with tumorfree margins of 17mm. 0/10 lymph nodes were positive.

The robotic approach to major hepatectomy with lymph node dissection for intrahepatic cholangiocarcinoma is safe and feasible with an acceptable number of lymph nodes prelevated.

(49% LLS, 51% OLS), 29% primary liver tumors (57% LLS, 43% OLS) and 16% benign diseases (73%LLS, 27% OLS).

Hepatectomy was performed in 1413 cases and local thermal ablation (LA) in 118 procedures. Excluding LA from analysis, rate of major hepatectomies was 18,2% (n=258) (71 LLS, 187 OLS) and median Ghent difficulty score was 5,6 (4,8 LLS; 6,5 OLS). LLS were converted to OLS in 3,3% of cases.

Overall morbidity was 27% for LLS and 53% for OLS (p<0,001). 90-days mortality following LLS was 0,6% (5/841) and 2,9% (20/690) after OLS (p<0,001). LLS was associated with a shorter length of hospital stay (Median 4 vs 7 days p<0,001).

ABSTRACT 9 Belgian prospective registry on laparoscopic liver surgery (brells) compared to open procedures: 3 year snapshot of multicentric activity of open and laparoscopic hepatectomies

LLS are wide spreading in Belgium accounting globally to 55% of all liver surgeries. In selected patients, LLS are safe, advantageous and reproducible in major HPB centers. A low morbidity has been prospectively confirmed.

Lucidi V, Riva P, D’Hondt M, Vanlander A et al.

June 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS), Live Virtual Meeting online

Establishing a robotic liver surgery program

ABSTRACT Since the International “Louisville Statement” regarding laparoscopic liver surgery in 2009 and further international consensus conferences as the “Morioka recommendations” in 2015 as well as the ‘Southampton consensus guidelines” in 2018 the importance to hold prospective national registries was clearly established. The BReLLS (Belgian Registry on Laparoscopic Liver Surgery) is a prospective, non-compulsory, online registry of laparoscopic (LLS) and open (OLS) liver procedures, endorsed in 2016 by the Belgian Section of Hepato-Biliary and Pancreatic Surgery and approved by ethical committee of all participating centers.

The primary aim is to assess the evolution of laparoscopic liver surgery compared to the standard approach in Belgium. Participating centers included, through a secured SSL server (www.brells.org), all consecutive liver surgeries from 2017 to 2019. Demographic, pre-operative, intra-operative and postoperative (90-day morbidity and follow-up) data of all consecutive LLS and OLS were recorded. In total 13 centers participated to the study, of which 4 Academic hospitals. 1531 procedures were recorded (841 LLS and 690 OLS) in 1408 patients. Demographics of patients were similar between LLS and OLS with a median age of 65 years, gender 60% male, median BMI=26,2 and median ASA score of 2. Indication for surgery were 57% liver metastases

16

ABSTRACTBOEK | 2021

ABSTRACT 10

D'Hondt M June 2021, 14th Congress of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA),Bilbao – Virtual Webcast

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 11 Robotic management of mirizzi syndrome type IV with cholecystocolic fistula: a rare case report D'Hondt M, Provoost AL June 2021, 14th Congress of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), Bilbao – Virtual Webcast

ABSTRACT Mirizzi syndrome (MS) is a rare complication of prolonged cholelithiasis, with presence of a large gallstone impacted in Hartman’s pouch, causing chronic extrinsic compression of the common bile duct (CBD), and potentially leading to fistula formation between the gallbladder and the CBD and/ or bowel. Laparoscopic management is widely accepted for MS type I/II, whereas open surgery is the preferred

approach for MS type III/IV and presence of a cholecystoenteric fistula. Robotic surgery has the advantage of 3D visualization and endowrist technology, helping to operate more accurately compared to laparoscopy, and could provide an appropriate alternative surgical approach. This video demonstrates the robotic management of a MS type IV with cholecystocolic fistula.

ABSTRACT 14 Robotic redo hepatectomy: resection SG 4B seven years after open right hemihepatectomy D'Hondt M, Provoost AL June 2021, Bilbao – Virtual Webcast

ABSTRACT ABSTRACT 12 Robotic hepaticojejunostomy after open hepaticoduodenostomy D'Hondt M, Provoost AL June 2021, 14th Congress of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), Bilbao – Virtual Webcast

ABSTRACT Roux-en-Y hepaticojejunostomy (HJ) is the gold standard to repair iatrogenic bile duct injury. Robotic surgery seems a viable surgical approach, as it permits the sophisticated movements required for anastomotic technique, through 3D visualization, endowrist manipulation and tremor filtration. This video aims to demonstrate a robotic HJ after open hepaticoduodenostomy (HD).

Evidence shows that repeat liver resection is often the best treatment option for recurrent colorectal liver metastases.

Although repeat resections can be complex due to adhesion and altered liver anatomy, laparoscopic liver resection has been shown to be feasible in selected patients, and has been associated with shorter operative time, less blood loss, and shorter hospital stay. Compared to laparoscopy, robotic liver surgery has the advantage of 3D visualization and a larger range of motion thanks to endowrist technology.

This video aims to demonstrate the experience of a hepatopancreaticobiliary surgeon with robotic redo hepatectomy.

ABSTRACT 15 Robotic pancreas sparing resections for premalignant and neuroendocrine tumors of the pancreas D'Hondt M, Baekelandt L June 2021, Bilbao – Virtual Webcast

ABSTRACT 13

ABSTRACT

Robotic central hepatectomy: technical tips and tricks

Our video describes the use of the Da Vinci Surgical System Xi (Intuitive Surgical, Sunnyvale, CA) and application of fluorescence-guided intraoperative ultrasound for minimal invasive tissue sparing pancreas surgery.

D'Hondt M, Provoost AL June 2021, 14th Congress of the European-African HepatoPancreato-Biliary Association (E-AHPBA), Bilbao – Virtual Webcast

ABSTRACT 16 ABSTRACT Minimal invasive (MI) central hepatectomy is considered a technical complex procedure. The robotic approach could provide benefits over traditional laparoscopy, thanks to 3D visualization, endowrist technology and tremor filtration. Based on three different cases, this video aims to demonstrate technical tips and tricks for robotic central hepatectomy.

Assessing the impact of minimally invasive liver surgery in the overweight and obese: an international multicenter propensity score matched analysis Zimmitti G, Sijberden J, Ferrero A, D'hondt M et al.

June 2021, Bilbao – Virtual Webcast

ABSTRACT Despite the worldwide increase of obesity prevalence and widespread expansion of minimally invasive liver surgery (MILS), the safety and efficacy of MILS in obese patients is still a matter of debate. The aim of this study is to investigate possible advantages of MILS over open liver surgery (OLS) among patients with different classes of bodyweight.

ABDOMINALE CHIRURGIE

17

ABSTRACT 17

ABSTRACT 19

Robotic left hemihepatectomy with lymph node dissection for a large intrahepatic cholangiocarcinoma

Benefits of laparoscopy for major liver resection in cirrhotic patients: time for pushing indications beyond the limits? A propensity score matched analysis

Willems E, D'Hondt M June 2021, Bilbao – Virtual Webcast

ABSTRACT Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor following HCC. The incidence of ICC is low in most parts of the world. However, incidence has been rising. The only curative treatment option involves surgical resection as part of a multidisciplinary treatment.

The goal of surgery is to obtain negative section margins while leaving an adequate future liver remnant. The role of regional lymphadenectomy is still debated, as it might add to a higher postoperative morbidity. An expert consensus statement states that regional lymphadenectomy should be considered a standard part of surgical therapy for patients undergoing resection of ICC. Another question remains about the role of minimal invasive surgery for ICC. A laparoscopic approach may lead to lower morbidity without compromising oncological adequacy. However, some doubts remain about the extent of lymph node dissection in laparoscopic approach. This video aims to demonstrate the advantages of a robotic approach using the Da Vinci© XI for left hemihepatectomy with lymph node dissection for a large intrahepatic cholangiocarcinoma.

ABSTRACT 18 Robotic biliary surgery for benign and malignant bile duct obstruction

Benedetti Cacciaguerra A, Görgec B, Lanari J, D'Hondt M, et al.

June 2021, Bilbao – Virtual Webcast

ABSTRACT Despite an increasing use of laparoscopy for liver resection in cirrhotic patients, clear evidence of its advantage over the open approach in major liver resection is still lacking.

The aim of this study is to compare the outcomes of major laparoscopic liver resection (mjLLR) and major open liver resection (mjOLR) in cirrhotic patients.

ABSTRACT 20 First year of the european registry for minimally invasive pancreatic surgery (E-MIPS) van der Heijde N, Vissers F, Manzoni A, D'Hondt M, et al.

June 2021, Bilbao – Virtual Webcast

ABSTRACT The European registry for minimally invasive pancreatic surgery (E-MIPS) collects data on laparoscopic and robotic MIPS procedures in all low- and high-volume centers across Europe. The aim is to monitor and report on safety and quality outcomes of MIPS in daily clinical practice. Pancreatic surgery is known for high postoperative morbidity rates. The minority of these procedures is done through a minimally invasive approach.

D'Hondt M, Wicherts D June 2021, Bilbao – Virtual Webcast

ABSTRACT 21 ABSTRACT The majority of patients with benign or malignant biliary obstruction require surgical treatment with a bilio-enteric anastomosis. This requires fine dissection and advanced suturing. Robotic surgery may overcome some major limitations of conventional laparoscopic surgery. The precise role of robotic biliary surgery is however still to be defined.

Bile leakage after laparoscopic and open liver tesection; incidence and clinical impact: an international multicenter propensity score-matched study of 13,379 patients Görgec B, Benedetti Cacciaguerra A, Cipriani F, D'Hondt M, et al.

June 2021, Bilbao – Virtual Webcast

ABSTRACT Despite many developments, postoperative bile leakage (POBL) remains a relatively common postoperative complication after laparoscopic liver resection (LLR) and open liver

18

ABSTRACTBOEK | 2021

resection (OLR). Previous studies regarding the incidence and clinical impact of POBL have mainly focused on patients undergoing OLR. The aim of this study is to compare the incidence and clinical impact of POBL between patients undergoing LLR and OLR in a large international multicenter cohort using a propensity score matched analysis.

ABSTRACT 25 Minor liver resections are still major surgical procedures: Left lateral secionectomy, the golden standard D'Hondt M June 2021, Online

ABSTRACT 22

ABSTRACT

Robotic two-stage hepatectomy: tight hemihepatectomy after segment 4B resection and right portal vein embolisation

Er is geen abstract beschikbaar.

Heazntjes L, D'Hondt M June 2021, Bilbao – Virtual Webcast

Complications in Laparoscopic liver surgery : Prevention of complication in Laparoscopic liver surgery

ABSTRACT 26

ABSTRACT Two-stage liver surgery is a valid option for the treatment of bilobar colorectal liver metastasis (CRLMs) and offers a chance of cure. This video demonstrates technical aspects of a two-stage robotic hepatectomy for bilateral CRLMs.To our knowledge, this is the first video of a two-stage robotic liver resection.

D'Hondt M July 2021, Online

ABSTRACT 23

Parenchyma sparing laparoscopic liver resections : parenchyma sparing liver resection in the posterior segments

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 27 The basics in laparoscopic liver surgery are also essentials: Patients selection and preoperative investigations D'Hondt M April 2021, Online

D'Hondt M September 2021, Online

ABSTRACT ABSTRACT

Er is geen abstract beschikbaar.

Er is geen abstract beschikbaar.

ABSTRACT 28 ABSTRACT 24 Technology in laparoscopic liver surgery: the best use of intraoperative ultrasound in laparoscopic liver surgery D'Hondt M May, 2021, Online

Robotic liver surgery: video session D'Hondt M October 2021, Online

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT Er is geen abstract beschikbaar

ABDOMINALE CHIRURGIE

19

ABSTRACT 29 Major laparoscopic liver resections: central liver resections D'Hondt M November 2021, Online

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 30 Pushing boundaries in laparoscopic liver surgery.

Complex laparoscopic parenchymal sparing resections for bilobar colorectal liver metastases D'Hondt M December 2021, Online

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 31 How to start and implement a robotic program D'Hondt M December, 2021, Online

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 32 Minimal invasive liver resection Implementation: high complexity procedures Aldrighetti L, Abu Hilai M, D’Hondt M, et al.

Januari 2021, webinar : project of training and implementation in minimally invasive liver surgery : complex settings, Milan, Italy

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 33 Is there a rapid adaptation in robotic liver surgery for a liver surgeon with a large experience in laparoscopic liver surgery?

20 ABSTRACTBOEK | 2021

D’Hondt M, Devooght A, De Meyere C, Parmentier I, Vandeputte M June 2021, 3rd World Congress of International Laparoscopic Liver Society (ILLS), Live Virtual Meeting online

ABSTRACT Robotic liver surgery (RLS) is currently limited to few highvolume centers. Its reproducibility is still debated. The aim of the present study was to evaluate the results of the first year of robotic liver surgery, performed by an early adopter in laparoscopic liver surgery (LLS) with experience in over 400 laparoscopic cases.

Over a one-year period, 53 patients underwent a robotic hepatectomy. The outcomes of the robotic cases (RG) were compared to the ‘Initial Experience’-group (IE) of 120 laparoscopic cases, performed by the same surgeon.

Subsequently, the robotic series were compared to his last 120 laparoscopic cases or ‘Mastery Phase’-group (MP).

The 3 groups were similar with regards to age, gender, tumor type and Iwate or Southampton difficulty score.

Median skin-to-skin operative time of the RG was 140 min versus 130 min in the IE (p=0.026), and 108 min in the MP (p<0.001). Median intraoperative blood loss in the RG was less (40 ml (20-90)) compared to the IE (100 ml (50-250);p<0.001) and the MP (65ml (30-143;p=0.004).

Median hospital stay was 3 days in both the RG and MP, versus 5 days in the IE (p<0.001). There was no significant difference in postoperative complications, conversion or readmission rate.

Surgeons with sufficient experience in LLS can rapidly overcome the learning curve for RLS. In our experience, the short-term outcomes of the implementation phase of RLS are similar to the mastery phase of LLS. Blood loss was significantly lower in RLS.

CENTRUM

ANESTHESIE PRESENTATIES / CONGRESSEN ABSTRACT 1 Incidence and temporal distribution of death after major thoracic trauma. A retrospective analysis from the TraumaRegister DGU®.

Helsloot D, Verelst S, Fitzgerald M, Lefering R, et al.

October 2021, Lisbon, Portugal

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 2 Altered ionized calcium levels on admission are associated with increased mortality and coagulopathy after major trauma. A retrospective analysis from the TraumaRegister DGU. Helsloot D, Verelst S, Fitzgerald M, Lefering R, et al.

December 2021, Munich, Germany

ABSTRACT Er is geen abstract beschikbaar.

ANESTHESIE

21

CENTRUM

ENDOCRINOLOGIE/ DIABETOLOGIE

ARTIKELS ABSTRACT 1 Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial

insertion was more frequently reported by rtCGM users.

In an unselected adult type 1 diabetes population, switching from isCGM to rtCGM significantly improved time in range after 6 months of treatment, implying that clinicians should consider rtCGM instead of isCGM to improve the health and quality of life of people with type 1 diabetes.

ABSTRACT 2 Visser M, Charleer S, Fieuws S, Myngheer N, Vanhaverbeke G, et al.

The Lancet, 2021, 397( 10291), 2275-2283

Lipohypertrophy monitoring study (LIMO): effect of single use of 4 mm pen needles combined with education on injection site rotation on glycaemic control: Confirmation of an unpleasant truth

ABSTRACT People with type 1 diabetes can continuously monitor their glucose levels on demand (intermittently scanned continuous glucose monitoring [isCGM]), or in real time (real-time continuous glucose monitoring [rtCGM]). However, it is unclear whether switching from isCGM to rtCGM with alert functionality offers additional benefits.

Therefore, we did a trial comparing rtCGM and isCGM in adults with type 1 diabetes (ALERTT1).

We did a prospective, double-arm, parallel-group, multicentre, randomised controlled trial in six hospitals in Belgium. Adults with type 1 diabetes who previously used isCGM were randomly assigned (1:1) to rtCGM (intervention) or isCGM (control). Randomisation was done centrally using minimisation dependent on study centre, age, gender, glycated haemoglobin (HbA1c), time in range (sensor glucose 3·9–10·0 mmol/L), insulin administration method, and hypoglycaemia awareness. Participants, investigators, and study teams were not masked to group allocation. Primary endpoint was mean between-group difference in time in range after 6 months assessed in the intention-to-treat sample. This trial is registered with ClinicalTrials.gov, NCT03772600.

Between Jan 29 and Jul 30, 2019, 269 participants were recruited, of whom 254 were randomly assigned to rtCGM (n=127) or isCGM (n=127); 124 and 122 participants completed the study, respectively. After 6 months, time in range was higher with rtCGM than with isCGM (59·6% vs 51·9%; mean difference 6·85 percentage points [95% CI 4·36–9·34]; p<0·0001). After 6 months HbA1c was lower (7·1% vs 7·4%; p<0·0001), as was time <3·0 mmol/L (0·47% vs 0·84%; p=0·0070), and Hypoglycaemia Fear Survey version II worry subscale score (15·4 vs 18·0; p=0·0071).

Fewer participants on rtCGM experienced severe hypoglycaemia (n=3 vs n=13; p=0·0082). Skin reaction was more frequently observed with isCGM and bleeding after sensor

22

ABSTRACTBOEK | 2021

Bochanen N, Decochez K, Heleu E, Vanhaverbeke G Diabetic medicine, 2021, 39(1), e14672

ABSTRACT To investigate whether single use of 4 mm needles combined with education about injection technique and lipohypertrophy affects HbA1c, hypoglycaemia and glucose variability.

Insulin-injecting people with diabetes recruited from nine Belgian diabetes centres were prospectively followed for 6 months. They were provided 4 mm pen needles and education concerning injection technique using an online platform (BD and Me™) based on the international Forum for Injection Technique & Therapy Recommendations focused on avoidance of lipohypertrophy zones and reduction of needle reuse.

A total of 171 people with diabetes were included of which 146 completed the study.

At baseline, lipohypertrophy was present in 63.0% of those who completed the study, with 51.4% injecting in zones of lipohypertrophy, 37.0% incorrectly rotating and 95.9% reusing needles. After the intervention, 7.5% still injected in a lipohypertrophy zone, 4.1% rotated incorrectly and needle reuse decreased to 21.2%. The number of participants with severe hypoglycaemias (from 15.8% to 4.1%, p < 0.001), unexplained hypoglycaemias (from 46.6% to 16.4%, p < 0.001) and high glucose variability (from 64.4% to 29.5%, p < 0.001) was significantly reduced.

HbA1c and total daily insulin dose remained stable.

The combination of 4 mm pen needles and online education on injection techniques significantly reduced the number of people with severe hypoglycaemic episodes, unexplained hypoglycaemia and high glucose variability but did not improve HbA1c control nor lower insulin needs.

ABSTRACT 3 Characterisation of testicular function and spermatogenesis in transgender women Vereecke G, Defreyne J, Van Saen D Human reproduction,2021, 36(1), 5–15

ABSTRACT Gender-affirming treatment in transgender individuals may involve gender-affirming HT. The effects on spermatogenesis in TW remain unclear. In order to add information from a referral centre for transgender care, we wish to compare results of earlier studies with our population of TW who received a standard hormone treatment.

Study question: Does gender-affirming treatment prevent full spermatogenesis in transgender women (TW)? This was a prospective cohort study part of the European Network for the Investigation of Gender Incongruence (ENIGI), conducted between 15 February 2010 and 30 September 2015. There were 162 TW were included in the ENIGI study at the Ghent University Hospital in Belgium. Participants are included in ENIGI when they first start HT, and follow-up visits occur over the next 3 years.

The study included 97 TW who initiated HT with cyproterone acetate (CPA) plus oestrogens and proceeded with gonadectomy at the Ghent University Hospital. Testicular tissue retrieved during gonadectomy was processed and stained for four different germ cell markers by the Biology of the Testis lab at the Vrije Universiteit Brussel. Subsequent immunohistochemical staining was performed for melanoma-associated antigen A4 (MAGE-A4, marker for spermatogonia and early spermatocytes), boule homologue, RNA-binding protein (BOLL, marker for secondary spermatocytes and round spermatids), cAMP-responsive element modulator (CREM, marker for round spermatids) and acrosin (marker for acrosome visualization). Serum levels of sex steroids were measured prior to surgery. Suppressed testosterone levels (<50 ng/dl) were found in 92% of the participants prior to surgery. The mean time between initiation of HT and surgery was 685 days. In 88% (85/97) of the sections, MAGE-A4 staining was positive. Further staining could not reveal complete spermatogenesis in any participant.

HT leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained.

Serum testosterone levels are associated with the sperm maturation rate. It is important to discuss sperm preservation before the start of hormone therapy. If serum testosterone levels remain higher, spermatogenesis may still occur.

ENDOCRINOLOGIE/ DIABETOLOGIE

23

CENTRUM

GYNAECOLOGIE

ARTIKELS ABSTRACT 1 Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature Verhulst E, Bafort C, Tomassetti C, Platteeuw L, et al.

ACTA Chirurgica Belgica, 2021, 1-6

ABSTRACT We report a rare case of an endometriotic lung cyst in a 47-year woman with recurrent catamenial hemoptysis.

Chest computed tomography (CT) obtained outside the menstruation in October 2019 revealed a cystic lesion (2.5 cm) located in the right inferior lobe near the distal esophagus and the inferior pulmonary vein.

Compared to CT abdomen in May 2019, this lesion had increased with a larger volume and a thicker wall. An endometrial lung cyst was suspected as episodes of hemoptysis no longer occurred after initiating hormonal treatment with nomegestrol acetate. Exploratory video-assisted thoracoscopic surgery with wedge resection of the cyst was performed.

Histopathologic examination confirmed the diagnosis of an endometriotic cystic lesion. Postoperative course was uneventful with no further symptoms since then.

ABSTRACT 2 Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - two case reports and a literature review Vandenameele A, Alaerts H, Platteeuw L Facts, views and vision in ObGyn, 2021, 13(3), 261-266

ABSTRACT We report 2 cases of haemoperitoneum due to a bleeding of the uterine artery caused by infiltrating endometriosis. We have also conducted a literature review on endometriosis-related intra-abdominal haemorrhage and wrote a practical guideline on how this entity can be recognized and handled.

Case 1: A 49-year-old multiparous woman presented with intense stabbing pain in the lower abdomen during her menstruation. CT angiography showed a bleeding from a side branch of the internal iliac artery. Laparoscopy was

24

ABSTRACTBOEK | 2021

performed and an active bleeding from the right uterine artery was confirmed, clearly caused by infiltrating endometriosis lesions. Haemostasis was achieved by bipolar coagulation.

Case 2: A 29-year-old nulliparous woman was admitted for observation because of heavy stabbing pain in the right lower quadrant and presence of free fluid on CT abdomen. The day after the admission, laparoscopy was performed because of a decreasing haemoglobin level.

An arterial bleeding from the right parametrium was observed, probably originating from the right uterine artery. Histopathological examination of a biopsy of the right parametrium proved the presence of endometriosis. Haemostasis was achieved by bipolar coagulation.

Although endometriosis-related haemoperitoneum is a rare entity, this diagnosis should be considered when a patient presents with an intra-abdominal haemorrhage during menstruation or withdrawal bleeding - especially in case of a history or suspicion of endometriosis. Laparoscopy is the cornerstone of the treatment.

CENTRUM

INWENDIGE ZIEKTEN/ GASTROENTEROLOGIE ABSTRACT 4

ARTIKELS

Belangrijk gewichtsverlies bij een patiënt met een hardnekkige huideruptie

ABSTRACT 1

Vanbelleghem E, Werbrouck J, Libbrecht L, D'heygere F Tijdschrift voor Geneeskunde en gezondheidszorg, 2021, 8-15

Aanhoudende koorts zonder focus met lymfadenopathiëen:infectie, inflammatie of maligniteit?

ABSTRACT Desmedt S, Desmedt V, Billiet T, D'heygere F Tijdschrift voor geneeskunde en gezondheidszorg, 2021, 16-24

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 2 Mimicry of an acute pseudocyst by a gastrointestinal duplication cyst in a 14-year old boy Biliet T, Elewaut A, D'heygere F, et al.

Endoscopy, 2021, 1508-1510

Persistent skin eruption in a 52-year-old man losing weight.

This case report describes a 52-year-old male patient with important weight loss, fatigue, diarrhea and a skin eruption since 1 year. An olmesartan-induced enteropathy and skin vasculitis were diagnosed. There was a total resolution of the symptoms after the interruption of olmesartan.

Although sprue-like enteropathy and cutaneous vasculitis are very rare, clinicians should be aware of those potential adverse events, even years after the initiation of an angiotensin II receptor blocker.

ABSTRACT 5

Er is geen abstract beschikbaar.

Evaluating the accuracy of three international guidelines in identifying the risk of malignancy in pancreatic cysts: a retrospective analysis of a surgical treated population

ABSTRACT 3

Vanden Bulcke A, Jaekers J, Topal H Acta Gastro-enterology Belgica, 2021, 84(3), 443-450

ABSTRACT

Hypercalcemia induced pancreatitis as a rare presentation of primary hyperparathyroidism D'Heygere E, Vereecke G, Van Moerkercke W, et al.

Acta Gastroenterologie België, 84(2), 2021, 367-370

ABSTRACT Acute pancreatitis (AP) is an inflammatory process of the pancreas. It is a relatively common cause of acute upper abdominal pain and is potentially associated with high morbidity and mortality. Underlying hypercalcemia as a cause of AP is very rare. We present a case of a hypercalcemia-induced acute pancreatitis with an underlying parathyroid adenoma in an 81-year-old woman with no previous symptoms of hypercalcemia. The parathyroid adenoma was semi-urgently surgically resected with normalization of calcium-levels. This case report summarizes the causes of acute pancreatitis and hypercalcemia and its management.

ABSTRACT The international consensus Fukuoka guideline (Fukuoka ICG), The European evidence-based guideline on pancreatic cystic neoplasms (European EBG) and the American Gastroenterological Association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts (AGA IG) are 3 frequently cited guidelines for the risk stratification of neoplastic pancreatic cysts. The aim of this study was to assess the accuracy of detecting malignant cysts by strictly applying these guidelines retrospectively to a cohort of surgically resected pancreatic cysts.

72 resected cysts were included in the analysis. Invasive carcinoma, high grade dysplasia and neuro-endocrine tumour were considered as "malignant cysts" for the purpose of the study.

32% of the resected cysts were malignant. The analysis showed that the Fukuoka ICG, European EBG and AGA IG had a sensitivity of 66,8%, 95,5%, 80%; a specificity of

INWENDIGE ZIEKTEN

25

26,8%, 11,3%, 43,8%; a positive predictive value of 31,8%, 35%, 47,1% and a negative predicted value of 61,1%, 83,3%, 77,8% respectively. The missed malignancy rate was respectively 11,3%, 1,5%, 7,7% and surgical overtreatment was respectively 48,4%, 59,1%, 34,6%.

In this retrospective analysis, the European EBG had the lowest rate of missed malignancy at the expense of a high number of "unnecessary" resections. The Fukuoka ICG had the highest number of missed malignancy. The AGA IG showed the lowest rate of unnecessary surgery at the cost of a high number of missed malignancy. There is need to develop better biomarkers to predict the risk of malignancy.

ABSTRACT 6 Boerhaave's syndrome: succesful conservative treatment in 2 patients.

Van Geluwe B, Van Moerkercke W, Vergauwe P, et al.

Acta Gastro-Enterology Belgica, 2021, 83(4), 654-656

ABSTRACT Abstract is na te lezen op p. 13

26

ABSTRACTBOEK | 2021

PRESENTATIES /CONGRESSEN ABSTRACT 1 Investigating fatigue in vedolizumab-treated patients with ulcerative colitis or Crohn's Disease from a Belgian Registry Louis E, Muls V, Bossuyt P, D'heygere F, et al. july 2021, virtual

ABSTRACT Er is geen abstract beschikbaar.

CENTRUM

KINDERGENEESKUNDE

ARTIKELS ABSTRACT 1 Harlequin syndrome in a pediatric population: a case series Beullen N, Tourlamain G, Vallaeys L, et al.

Acta Neurologica Belgica, 2021, 121(3), 625-631

STRADA deletion of exon 9-13. Five additional PMSE patients have been reported since, each of them with loss-of-function variants. We report a female patient with the typical clinical features of PMSE, homozygous for a novel STRADA missense mutation c.792T>A (p.Ser264Arg) in exon 10. This finding contributes to the further delineation of the phenotype of PMSE.

ABSTRACT Harlequin syndrome is a rare condition, presenting with unilateral facial flushing and hyperhidrosis in response to physical exercise, heat or emotional stressors and has scarcely been reported in pediatric patients. It is caused by a dysfunction of vasomotor and sudomotor sympathetic fiber activity inhibiting the ability to flush on the affected side, causing the neurologically intact side to appear red.

We present three pediatric cases of this uncommon syndrome, each of them of different origin and displaying distinct associated (neurological) symptoms, and review medical literature.

Insight into the anatomical structure of the thoracocervical and facial sympathetic nervous system is pivotal as it dictates symptomatology. About half of Harlequin syndrome cases are complicated with ocular symptoms and a minority may be part of more extensive partial dysautonomias affecting facial sudomotor, vasomotor and pupillary responses, such as Holmes-Adie syndrome and Ross syndrome. Etiology is generally idiopathic, however cases secondary to surgery, trauma or infection have been described. Considering its predominantly self-limiting nature, treatment is usually unnecessary and should be restricted to incapacitating cases.

ABSTRACT 2 Homozygous missense STRADA mutation in a patient with polyhydramnios, megalencephaly and symptomatic epilepsy syndrome Aerden M, Vallaeys L, Holvoet M Clinical Dysmorphology, 2021, 30(3), 121-124

ABSTRACT Homozygous or compound heterozygous mutations in STRADA cause polyhydramnios, megalencephaly and symptomatic epilepsy syndrome (PMSE), with additional features of distinctive facial traits and severe developmental delay or intellectual disability. This syndrome was first defined in 16 Old Order Mennonite patients, carrying a homozygous

KINDERGENEESKUNDE

27

CENTRUM

KLINISCH LABORATORIUM

ARTIKELS ABSTRACT 1 Combined oropharyngeal/nasal swab is equivalent to nasopharyngeal sampling for SARS-CoV-2 diagnostic PCR Desmet T, De Paepe P, Boelens J, Coorevits L, et al.

BMC Microbiology, 2021, 21(1), 31

ABSTRACT Early 2020, a COVID-19 epidemic became a public health emergency of international concern. To address this pandemic broad testing with an easy, comfortable and reliable testing method is of utmost concern. Nasopharyngeal (NP) swab sampling is the reference method though hampered by international supply shortages. A new oropharyngeal/nasal (OP/N) sampling method was investigated using the more readily available throat swab.

35 patients were diagnosed with SARS-CoV-2 by means of either NP or OP/N sampling. The paired swabs were both positive in 31 patients. The one patient who tested negative on both NP and OP/N swab on admission, was ultimately diagnosed on bronchoalveolar lavage fluid. A strong correlation was found between the viral RNA loads of the paired swabs (r = 0.76; P < 0.05). The sensitivity of NP and OP/N analysis in hospitalized patients (n = 28) was 89.3% and 92.7% respectively.

This study demonstrates equivalence of NP and OP/N sampling for detection of SARS-CoV-2 by means of rRT-PCR. Sensitivity of both NP and OP/N sampling is very high in hospitalized patients.

liver and kidney dysfunction. The patient was transferred to the medium care unit of our hospital where she was observed for possible organ failure. During the next days, the kidney function improved and liver function started to recover. Four days after admission, the patient was transferred to the psychiatric ward. Urine, serum, plasma and whole-blood samples were analyzed for ricinine using a quantitative LC–MS-MS method. Initial values on admission (serum and urine) were very high in comparison with previously reported cases. Based on these values, the patient was monitored closely in the following days.

The patient made a full recovery, and during the course of hospitalization, concentrations of ricinine in plasma/serum, blood and urine gradually declined. The presence of ricinine in a patient’s blood or plasma is a proof of castor bean and, hence, ricin exposure.

However, based on this case and previously reported cases in literature, we can conclude that no clear correlation can be established between ricinine blood, plasma or urine levels and the severity of the intoxication. Clinicians should be aware of the potential danger of a ricin intoxication, and patients should be monitored closely for several days due to the unpredictable outcome of the intoxication.

ABTSTRACT 3 A G316A polymorphism in the ornithine decarboxylase gene promoter modulates MYCN-driven childhood neuroblastoma Gamble LD, Purgato S, Van Maerken T, et al.

Cancers, 2021, 13(8), 1807

ABSTRACT ABSTRACT 2 Non-lethal intoxication by ingestion of 50 castor beans: serial measurement of ricinine in blood, plasma and urine Lefever S, Geerts I, Vermeulen E, Croes K, et al.

Journal of Analytical Toxicology, 2021, 45(5), e8-e12, doi:10.1093/jat/bkaa139

ABSTRACT A 30-year-old woman presented to the emergency department 2 days after ingestion of 50 castor beans. Her symptoms on admission were vomiting, diarrhea, abdominal cramps, agitation and anxiety. Initial laboratory tests showed a slightly elevated C-reactive protein and mild

28

ABSTRACTBOEK | 2021

Ornithine decarboxylase (ODC1), a critical regulatory enzyme in polyamine biosynthesis, is a direct transcriptional target of MYCN, amplification of which is a powerful marker of aggressive neuroblastoma. A single nucleotide polymorphism (SNP), G316A, within the first intron of ODC1, results in genotypes wildtype GG, and variants AG/AA. CRISPR-cas9 technology was used to investigate the effects of AG clones from wildtype MYCN-amplified SK-N-BE(2)-C cells and the effect of the SNP on MYCN binding, and promoter activity was investigated using EMSA and luciferase assays.

AG clones exhibited decreased ODC1 expression, growth rates, and histone acetylation and increased sensitivity to ODC1 inhibition. MYCN was a stronger transcriptional regulator of the ODC1 promoter containing the G allele, and

preferentially bound the G allele over the A. Two neuroblastoma cohorts were used to investigate the clinical impact of the SNP. In the study cohort, the minor AA genotype was associated with improved survival, while poor prognosis was associated with the GG genotype and AG/GG genotypes in MYCN-amplified and non-amplified patients, respectively. These effects were lost in the GWAS cohort.

We have demonstrated that the ODC1 G316A polymorphism has functional significance in neuroblastoma and is subject to allele-specific regulation by the MYCN oncoprotein.

ABSTRACT 4 Predictors and Dynamics of the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccines in Hemodialysis Patients: A Multicenter Observational Study Van Praet J, Reynders M, De Bacquer D, De Bel A, et al.

Journal of the American Society of Nephrology, 32 (12), 2021, 3208-3220

ABSTRACT Preliminary evidence suggests patients on hemodialysis have a blunted early serological response to SARS-CoV-2 vaccination. Optimizing the vaccination strategy in this population requires a thorough understanding of predictors and dynamics of humoral and cellular immune responses to different SARS-CoV-2 vaccines.

This prospective multicenter study of 543 patients on hemodialysis and 75 healthy volunteers evaluated the immune responses at 4 or 5 weeks and 8 or 9 weeks after administration of the BNT162b2 or mRNA-1273 vaccine, respectively. We assessed anti-SARS-CoV-2 spike antibodies and T cell responses by IFN-γ secretion of peripheral blood lymphocytes upon SARS-CoV-2 glycoprotein stimulation (QuantiFERON assay) and evaluated potential predictors of the responses. Compared with healthy volunteers, patients on hemodialysis had an incomplete, delayed humoral immune response and a blunted cellular immune response. Geometric mean antibody titers at both time points were significantly greater in patients vaccinated with mRNA-1273 versus BNT162b2, and a larger proportion of them achieved the threshold of 4160 AU/ml, corresponding with high neutralizing antibody titers in vitro (53.6% versus 31.8% at 8 or 9 weeks, P<0.0001). Patients vaccinated with mRNA-1273 versus BNT162b2 exhibited significantly greater median QuantiFERON responses at both time points, and a larger proportion achieved the threshold of

0.15 IU/ml (64.4% versus 46.9% at 8 or 9 weeks, P<0.0001).

Multivariate analysis identified COVID-19 experience, vaccine type, use of immunosuppressive drugs, serum albumin, lymphocyte count, hepatitis B vaccine nonresponder status, and dialysis vintage as independent predictors of the humoral and cellular responses. The mRNA-1273 vaccine's greater immunogenicity may be related to its higher mRNA dose. This suggests a high-dose vaccine might improve the impaired immune response to SARS-CoV-2 vaccination in patients on hemodialysis.

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Whole transcriptome profiling of liquid biopsies from tumor xenografted mouse models enables specific monitoring of tumor-derived RNA

Deleu J, Vermeirssen V, Morlion A, Van Maerken T, et al. april 2021, Gent, België januari 2021, Amsterdam, Nederland

ABSTRACT Liquid biopsies enable disease diagnosis and treatment response monitoring. As compared to cell-free DNA, extracellular RNA is relatively unexplored. We aim to assess to which extent tumor RNA ends up in different blood fractions using mice engrafted with human tumor cells. This may unveil which compartment is best suited to probe tumor-derived extracellular transcriptomes.

We examined the circulating transcriptome in mice xenografted with SK-N-BE(2C) human neuroblastoma cells or a patient-derived breast cancer, also including non-tumor bearing control mice. Blood was collected from 5 mice per group via cardiac puncture, followed by preparation of platelets, platelet-rich, platelet-poor and platelet-free plasma. Using 60 µl input volumes, an established total RNA sequencing workflow to profile extracellular mRNA with synthetic spike-in RNA for calibration purposes, and a dedicated data processing pipeline to unambiguously distinguish human (tumor) from murine (host) mRNA, we charted the extracellular transcriptomes.

Despite the high RNA concentration variability among individual mice, we were able to detect human RNA in

KLINISCH LABORATORIUM

29

all plasma fractions in a ratio that was on average ten to hundred times lower than murine RNA. The murine RNA concentration in plasma increased with increasing platelet concentration. In contrast, human RNA concentrations were relatively constant and did not support the recently proposed concept of preferential loading of tumor RNA in platelets. We detected around 2000 human tumor-derived protein-coding genes. Functional exploration of the resulting transcriptomes revealed various enriched gene sets and pathways, indicative of biological signal. In conclusion, we demonstrate that mice xenograft models can be used to specifically study tumor-derived extracellular RNA in liquid biopsies.

Among others, we note a 50-fold difference in mRNA yield and a 5-fold difference in the number of detected mRNAs. Our results are summarized in 11 performance metrics that enable an informed selection of the most optimal sample processing workflow. In conclusion, we put forward robust quality control metrics for exRNA quantification methods with validated processing SOPs, representing paramount groundwork for future exRNA-based precision medicine applications.

ABSTRACT 3 Quantification and kinetic profiling of anti-RBD antibodies in COVID-19 patient serum and whole blood using a fiber optic SPR biosensor

ABSTRACT 2 Substantial performance differences among RNA purification kits and blood collection tubes in the Extracellular RNA Quality Control (exRNAQC) study

Qu J-H, Leirs K, Maes W, Callewaert N, et al.

2021, Palm Springs, United States

Van Maerken T, Van Paemel R, Verniers K, Yigit N, et al. maart 2021, Online meeting (VIB, België)

During the ongoing COVID-19 pandemic, serological tests have been proven useful in many different aspects, including evaluation of individual/community seroprevalence by measuring antibody responses. While the majority of serological tests have been used only for antibody quantification, SPR technology demonstrates clear advantages because of its capacity to reveal real-time binding kinetics of patient antibodies.

ABSTRACT

ABSTRACT The use of blood-based extracellular RNA (exRNA) as clinical biomarker requires the implementation of a validated procedure for sample collection, processing and profiling. So far, no study has systematically addressed the pre-analytical variables affecting transcriptome analysis of exRNAs. In the exRNAQC study, we evaluated 10 blood collection tubes, 3 time points between blood draw and downstream processing, and 8 RNA purification methods using the supplierspecified minimum and maximum biofluid input volumes.

The impact of these pre-analytics is assessed by deep transcriptome profiling of both small and messenger RNA from healthy donors' plasma or serum. Experiments are conducted in triplicate (for a total of 276 transcriptomes) using 189 synthetic spike-in RNAs as processing controls.

When comparing blood tubes, serum mRNA is remarkably very similar to EDTA plasma mRNA, in contrast to serum-derived small RNAs that are markedly different in biotype composition compared to their plasma counterparts. Furthermore, so-called blood preservation tubes do not stabilize RNA very well, as is reflected by increasing RNA concentration and number of detected genes over time, and by compromised reproducibility. We also document large differences in RNA purification kit performance in terms of sensitivity, reproducibility, and observed transcriptome complexity.

30 ABSTRACTBOEK | 2021

Here, we present LF FO-SPR serological bioassays for both quantification and kinetic profiling of all antibody isotypes against SARS-CoV-2 RBD in COVID-19 patient serum and whole blood samples. We immobilized His6-tagged RBD on the FO probe using cobalt (III)-nitrilotriacetic acid (Co(III)-NTA) chemistry, for a stable bioreceptor patterning, essential to detect target in complex sample matrices. The LF and sandwich bioassays were developed with 10 and 500-fold sample dilution, respectively. For the latter, we used 2 types of detection antibodies (i.e. goat anti-human (GAH) IgG and GAH polyvalent antibody targeting IgG, IgM and IgA) conjugated with gold nanoparticles (AuNPs) for sensitivity enhancement.

We tested 22 COVID-19 patient serum samples by sandwich bioassay and benchmarked it with ELISA, using the same bioassay components for each. The same patient serum samples were tested by FO-SPR LF bioassay. A commercial normal human serum (NHS) obtained before COVID-19 served as the negative control (NC).

Finally, we applied the established FO-SPRLF and sandwich bioassays in testing the level of anti-RBD antibodies in COVID-19 patient whole blood samples. Here, a mixture of 5 negative blood samples served as the NC. The SPR shift obtained after 30 min and SPR slope obtained within 30-120 s were calculated and used as the detection signals. The cutoff-1 and cutoff-2 values were calculated by summing the average and 3 or 10 times standard deviation (SD) of the NC, respectively. One-way analysis of variance (ANOVA) and Bonferroni multiple comparison test were performed in Matlab to identify statistical differences between the mean values, with ‘ns’ indicating non-significant difference. For correlation, the SPR shift was normalized by dividing the value with the mean of all the values for all samples. Pearson correlation coefficient (PCC) and intraclass correlation coefficient (ICC) were calculated in Matlab. First, we tested the level of anti-RBD IgG antibodies in 22 COVID-19 patient serum samples by an FO-SPR sandwich bioassay and ELISA, with the former capable of distinguishing more samples from the NC based on both ANOVA and cutoff values. Next, the same serum samples were assessed by FO-SPR LF bioassay, which is a rapid alternative (30 min) to sandwich bioassay (67 min) with a similar performance .

Moreover, this allowed direct insight into the level of all antibody isotypes, including kinetic profiling (i.e. antibody binding speed) revealed by SPR slope, the latter having a different profile compared to SPR shift. The robustness of LF bioassay was also verified by its excellent correlation with the sandwich bioassay.

Finally, we tested whole blood samples from 14 COVID-19 convalescent patients by FO-SPR LF and sandwich bioassays. They were similar in distinguishing the positive samples from the NC, which was further improved by testing undiluted blood samples directly

by LF bioassay. Rapid FO-SPR LF bioassays are capable of inspecting COVID-19 patient serum and whole blood samples for both quantification and kinetic profiling of antibodies, putting this technology at the forefront of other serological tests.

ABSTRACT 4 Combined flowcytometric phenotyping and interferon release assay of sars-cov-2 reactive T cells in whole blood Calcoen B, Callebaut K, Vandenbulcke A, Callewaert N, et al.

2021, Brussels, Belgium

ABSTRACT Our aim was to include flowcytometric assessment of SARS-CoV-2 specific T cell activation to a commercially available cytokine release assay on whole blood samples.

The EUROIMMUN SARS-CoV-2 interferon gamma release assay (IGRA) was performed according to the manufacturer’s instructions on whole blood samples from donors vaccinated against SARS-CoV-2 (n=6). In addition, the remaining pellet after centrifugation was resuspended in physiological buffer. Reconstituted samples were stained with a panel of fluorescently labeled monoclonal antibodies including anti-CD3, anti-CD4, anti-CD8 and anti-CD69.

Following lysis of red blood cells, flowcytometric sample acquisition was performed. Specific interferon gamma release (mean = 1368 ± 937.8 mIU/mL) was found in whole blood from vaccinated donors upon stimulation with SARS-CoV-2 antigens. Furthermore, using our protocol, it was possible to reliably differentiate both CD4+ and CD8+ T cells in the reconstituted whole blood samples following IGRA. In addition, expression of the early T cell activation marker CD69 was significantly upregulated in both CD4+ and CD8+ T cells from vaccinated donors upon stimulation with SARS-CoV-2 antigens.

This study showed that flowcytometric profiling of T cell activation can be successfully implemented as additional read-out to a commercially available SARS-CoV-2 specific interferon gamma release assay.

The feasibility of directly testing (undiluted) blood samples could also greatly simplify sample preparation and shed light towards developing FO-SPR technology into true POC biosensors.

KLINISCH LABORATORIUM

31

ABSTRACT 5 Real-world monitoring of bnt162b2 vaccine-induced SARS-CoV-2 specific functional antibody response and RBD specific B cells in healthcare workers .

Calcoen B, Callebaut K, Vandenbulcke A, Callewaert N, et al.

2021, Ghent, Belgium

ABSTRACT SARS-CoV-2 is the causative virus of an unseen and still ongoing pandemic. Today, multiple vaccines are available within the armamentarium to reduce overall SARS-CoV-2 related mortality and infection rate. Vaccine efficacy studies often rely solely on quantification of serologic responses.

Besides conventional serology, in this study we also considered the frequency of circulating vaccine-induced B cells specific for the receptor binding domain (RBD) of SARS-CoV-2. In addition, we address the neutralization efficacy of the vaccine-induced antibodies. Our aim was to describe in detail the vaccine-induced B-cell response in healthcare workers three months after receiving COVID-19 vaccine bnt162b2. In a cohort of 30 healthcare workers from a supraregional hospital in Belgium, blood was taken before and three months after bnt162b2 vaccination against SARS-CoV-2. Serum was used to determine both anti-S IgG and anti-RBD IgG titers and to quantify the neutralization efficacy (in vitro inhibition of RBD binding to human ACE2).

In addition, peripheral blood mononuclear cells were fluorescently labeled with anti-CD19 and RBD-biotin combined with streptavidin-PE to allow detection of circulating RBD specific B-cells. Local EC approval was obtained.

Three months post-vaccination, all subjects showed detectable vaccine-induced anti-S IgG (mean index: 26.06 ± 7.002) and anti-RBD IgG titers (mean: 941.3 ± 514 IU/mL) except for one that had low anti-S IgG (index: 2.72) and no detectable anti-RBD IgG. Vaccine-induced neutralization was high for all (mean inhibition: 89.68 ± 13.97 %) except for the same subject with low anti-S IgG. RBD specific B-cells were detected in nine participants at a precursor frequency of 0.08 ± 0.07 %. The level of circulating RBD specific B-cells showed moderate correlation with anti-S and anti-RBD IgG (R² = 0.4371, Spearman r = 0.9121 and R² = 0.6353, Spearman r = 0.8619 respectively) and neutralization efficacy (R² = 0.3351, Spearman r = 0.8619). Upon bnt162b2 vaccination, virtually all subjects in this study display induction of functionally neutralizing antibodies. However, only one in three subjects have circulating RBD-specific B cells, the latter only showing moderate correlation with serology and functionality.

32

ABSTRACTBOEK | 2021

CENTRUM

LONGZIEKTEN

ARTIKELS ABSTRACT 1 Incremental experience in in vitro primary culture of human pulmonary arterial endothelial cells harvested from swan-ganz pulmonary arterial catheters Thielemans B, Belge C, Delcroix M, Leys M, et al.

Cells, 2021, 10(11), 3229

ABSTRACT Pulmonary arterial hypertension (PAH) is a devastating condition affecting the pulmonary microvascular wall and endothelium, resulting in their partial or total obstruction.

Despite a combination of expensive vasodilatory therapies, mortality remains high. Personalized therapeutic approaches, based on access to patient material to unravel patient specificities, could move the field forward.

An innovative technique involving harvesting pulmonary arterial endothelial cells (PAECs) at the time of diagnosis was recently described. The aim of the present study was to fine-tune the initial technique and to phenotype the evolution of PAECs in vitro subcultures. PAECs were harvested from Swan-Ganz pulmonary arterial catheters during routine diagnostic or follow up right heart catheterization.

Collected PAECs were phenotyped by flow cytometry and immunofluorescence focusing on endothelial-specific markers. We highlight the ability to harvest patients' PAECs and to maintain them for up to 7-12 subcultures. By tracking the endothelial phenotype, we observed that PAECs could maintain an endothelial phenotype for several weeks in culture.

The present study highlights the unique opportunity to obtain homogeneous subcultures of primary PAECs from patients at diagnosis and follow-up. In addition, it opens promising perspectives regarding tailored precision medicine for patients suffering from rare pulmonary vascular diseases. .

LONGZIEKTEN

33

CENTRUM

MEDISCHE BEELDVORMING

ARTIKELS ABSTRACT 1 Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): study protocol for an international multicentre prospective diagnostic accuracy study Görgec B, Hansen I, Kemmerich G, Lutin B, et al.

BMC Cancer, 2021, 21(1), 1116

ABSTRACT

case of a nearly thrombectomy-resistant stroke thrombus, our study showed an atypical composition compared to the common structural features found in ischemic stroke thrombi. The core of the retrieved thrombus consisted of extracellular DNA that colocalized with von Willebrand factor and microcalcifications.

These results support the hypothesis that von Willebrand factor, neutrophil extracellular traps and microcalcifications contribute to mechanical thrombectomy resistance. Such information is important to identify novel targets in order to optimize technical treatment protocols and techniques to increase first pass success rates.

Abstract is na te lezen op p. 9

ABSTRACT 3 ABSTRACT 2 Detailed histological analysis of a thrombectomyresistant ischemic stroke thrombus: a case report Staessens S, François O, Desender L, Andersson T, et al.

Thrombosis Journal, 2021, 19 (1), 11

Thrombectomy for primary distal posterior cerebral artery occlusion stroke: the topmost study Meyer L, Stracke CP, Jungi N, Andersson T, et al.

JAMA Neurology, 2021, 78 (4), 434-444

ABSTRACT ABSTRACT Mechanical removal of a thrombus by thrombectomy can be quite challenging. For reasons that are not fully understood, some thrombi require multiple passes to achieve successful recanalization, whereas other thrombi are efficiently removed in a single pass. Since first pass success is associated with better clinical outcome, it is important to better understand the nature of thrombectomy resistant thrombi. The aim of this study was therefore to characterize the cellular and molecular composition of a thrombus that was very hard to retrieve via mechanical thrombectomy.

In a patient that was admitted with a right middle cerebral artery M1-occlusion, 11 attempts using various thrombectomy devices and techniques were required for removal of the thrombus. This peculiar case provided a rare opportunity to perform an in-depth histopathological study of a difficult to retrieve thrombus. Thrombus material was histologically analyzed using hematoxylin and eosin, Martius Scarlet Blue stain (red blood cells and fibrin), Feulgen stain (DNA), von Kossa stain (calcifications) and immunohistochemical analysis of von Willebrand factor, platelets, leukocytes and neutrophil extracellular traps. Histological analysis revealed abnormally high amounts of extracellular DNA, leukocytes, von Willebrand factor and calcifications.

Extracellular DNA stained positive for markers of leukocytes and NETs, suggesting that a significant portion of DNA is derived from neutrophil extracellular traps. In this unique

34 ABSTRACTBOEK | 2021

Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse.

To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up.

Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P = .06). Significant treatment effects of mechanical

thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P = .04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.

ABSTRACT 4 Health economic impact of first pass success: an asia-pacific cost analysis of the ARISE II study Yeo L, Zaidat OO, Saver JL, Andersson T, et al Journal of Stroke, 2021, 23 (1), 139-143

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 5 How are manual skills to reach excellence in microsurgery and endovascular technique best acquired, maintained, and developed with relation to unruptured aneurysm treatment: hybrid neurosurgeons or team approach?

Andersson T Acta Neurochirurgica, 2021, 136(5), 1525-1526

funnel component designed to reduce clot fragmentation and facilitate retrieval in combination with stent-retrievers (SRs) in stroke patients by restricting flow and limiting clot shaving. In previous publications ANA presented excellent in vitro/in vivo efficacy data, especially with fibrin-rich hard clots. We aimed to determine the main physical property responsible for these results, namely suction force versus aspiration flow.

We evaluated in a bench model the suction force and flow generated by ANA and compared them to other neurovascular catheters combined with a SR (Solitaire). Aspiration flow was evaluated with a flow rate sensor while applying vacuum pressure with a pump. Suction force was determined using a tensile strength testing machine and a purposely designed tool that completely seals the device tip simulating complete occlusion by a hard clot. Suction force was defined as the force needed to separate the device from the clot under aspiration. All experiments were repeated five times, and mean values used for comparisons.

Aspiration flow increased with the inner diameter of the device: ANA 1.85±0.04 mL/s, ACE68 3.74±0.05 mL/s, and 8F-Flowgate2 5.96±0.30 mL/s (P<0.001). After introducing the SR, the flow was reduced by an average of 0.57±0.12 mL/s. Due to its larger distal surface, ANA suction force (1.69±0.40 N) was significantly higher than ACE68 (0.26±0.04 N) and 8F-Flowgate2 (0.42±0.06 N) (P<0.001).

After introducing the SR, suction force variation was not relevant except for ANA that increased to 2.64±0.41 N. Despite lower in vitro aspiration flow, the ANA design showed a substantially higher suction force than other thrombectomy devices.

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 7

ABSTRACT 6

High-resolution cone-beam computed tomography is a fast and promising technique to quantify bone microstructure and mechanics of the distal radius

Suction force rather than aspiration flow correlates with recanalization in hard clots: an in vitro study model

Mys K, Varga P, Stockmans F, Vanovermeire O Calcified Tissue International, 2021, 108 (3), 314-323

Fernandez-Sanchez D, Garcia-Sabido D, Jovin TG, Andersson T, et al.

Journal of Neurointerventional Surgery, 2021, 13(12), 1157-1161

ABSTRACT

ABSTRACT Obtaining high-resolution scans of bones and joints for clinical applications is challenging. HR-pQCT is considered the best technology to acquire high-resolution images of the peripheral skeleton in vivo, but a breakthrough for widespread clinical applications is still lacking.

ANA Advanced Neurovascular Access provides a novel

MEDISCHE BEELDVORMING

35

Recently, we showed on trapezia that CBCT is a promising alternative providing a larger FOV at a shorter scanning time. The goals of this study were to evaluate the accuracy of CBCT in quantifying trabecular bone microstructural and predicted mechanical parameters of the distal radius, the most often investigated skeletal site with HR-pQCT, and to compare it with HR-pQCT. Nineteen radii were scanned with four scanners: (1) HR-pQCT (XtremeCT, Scanco Medical AG, @ (voxel size) 82 μm), (2) HR-pQCT (XtremeCT-II, Scanco, @60.7 μm), (3) CBCT (NewTom 5G, Cefla, @75 2021, 2021, µm) reconstructed and segmented using in-house developed software and (4) microCT (VivaCT40, Scanco, @19 μm-gold standard).

The following parameters were evaluated: predicted stiffness, strength, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N).

The overall accuracy of CBCT with in-house optimized algorithms in quantifying bone microstructural parameters was comparable (R2 = 0.79) to XtremeCT (R2 = 0.76) and slightly worse than XtremeCT-II (R2 = 0.86) which were both processed with the standard manufacturer's technique.

CBCT had higher accuracy for BV/TV and Tb.Th but lower for Tb.Sp and Tb.N compared to XtremeCT. Regarding the mechanical parameters, all scanners had high accuracy (R2 [Formula: see text] 0.96).

While HR-pQCT is optimized for research, the fast scanning time and good accuracy renders CBCT a promising technique for high-resolution clinical scanning.

36

ABSTRACTBOEK | 2021

CENTRUM

NEFROLOGIE

ARTIKELS ABSTRACT 1 Static histomorphometry allows for a diagnosis of bone turnover in renal osteodystrophy in the absence of tetracycline labels Jorgensen H, Behets G, Viaene L, et al.

Bone, 2021, 152, 1-7

ABSTRACT 2 Predictors and dynamics of the humoral and cellular immune response to SARS-CoV-2 mRNA vaccines in hemodialysis patients: a multicenter observational study Van Praet J, Reynders M, De Bacquer D, Viaene L, Doubel P et al.

Journal of the American Society of Nephrology, 2021, 32, 2393-2683

ABSTRACT A bone biopsy with prior tetracycline labeling is the gold standard to diagnose renal osteodystrophy. In cases of missing tetracycline labels, it is still paramount to gain clinically relevant information from the extracted bone sample, by evaluating the static histomorphometry.

This study investigates the diagnostic performance of static histomorphometry for the evaluation of high and low bone turnover. Transiliac bone biopsies taken pre- or post- kidney transplantation, of sufficient quality for a full histomorphometric analysis were included (n = 205). The cohort was randomly split to provide separate exploration and validation subsets. Diagnostic performance was evaluated by area under the receiver operator characteristics curve (AUC). All histomorphometric parameters were significantly different across categories of low (24%), normal (60%), and high (16%) bone turnover, and all were significant predictors of both high and low bone turnover (AUC 0.71-0.84).

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 3 Longevity and correlation with disease severity of the humoral and cellular response to SARS-CoV-2 infection in haemodialysis patients De Vriese A, Van Praet J, Reynders M, Viaene L, et al.

Clinical Kidney Journal, 2021, 14(11), 2446-2448

ABSTRACT Er is geen abstract beschikbaar.

Diagnostic performance was very good for high turnover, as a combination of static parameters resulted in negative and positive predictive values (NPV and PPV) of 80% and 96%, respectively. For low turnover, the combined model resulted in PPV of 71% and NPV of 82%.

We conclude that in the absence of tetracycline labels, static histomorphometry provide an acceptable alternative for a diagnosis of bone turnover in renal osteodystrophy.

NEFROLOGIE

37

CENTRUM

NEUROLOGIE

ARTIKELS ABSTRACT 1 Be aware: COVID-19 the new stroke mimicker Zuurbier SM, Verschelde HL, Vantyghem S, Vanacker P, et al.

Acta Neurologica Belgica, 2021, 121(1), 309-310

ABSTRACT

respectively).

Despite a reduction in absolute volumes, there was no difference in the monthly proportion of thrombolysis or endovascular treatment provided to the overall stroke hospitalizations. Acute treatment time metrics did not change between COVID-19 pandemic and control time epochs. We found no difference in 90-day functional outcomes nor in mortality after stroke between patients admitted during the pandemic versus control periods.

Er is geen abstract beschikbaar.

ABSTRACT 2

We found a decline in the volume of stroke hospitalizations during the first wave of the COVID-19 pandemic in Belgium.

Stroke care quality parameters remained unchanged.

Detailed histological analysis of a thrombectomyresistant ischemic stroke thrombus: a case report

ABSTRACT 4 Staessens S, Francois O, Desender L, Vanacker P, et al.

Thrombosis Journal, 2021, 19(11)

The state of stroke services across the globe: report of world stroke organization-world health organization surveys

ABSTRACT Het abstract is na te lezen op p. 34

ABSTRACT 3

ABSTRACT

The impact of COVID-19 on acute stroke care in Belgium

Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata.

The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019.

Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ~60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol.

Raymaekers V, Demeestere J, Bellante F, Vanacker P, et al.

Acta neurologica Belgica, 121(5), 2021, 1251–1258

ABSTRACT A worldwide decline in stroke hospitalizations during the COVID-19 pandemic has been reported. Information on stroke care during the pandemic in Belgium is lacking. This study aims to analyze the impact of COVID-19 on acute stroke care in eight Belgian stroke centers.

This Belgian study is part of an international observational and retrospective study in 70 countries and 457 stroke centers. We compared volumes of COVID-19 and stroke hospitalizations, intravenous thrombolysis and endovascular treatment rates, acute treatment time intervals and functional outcome at 90 days during the first wave of the pandemic to two control intervals (March-May 2019 and December-February 2020). From March 2020 to May 2020, 860 stroke patients were hospitalized. In the same time period, 2850 COVID-19 patients were admitted, of which 37 (1.3%) were diagnosed with a stroke. Compared to the months prior to the pandemic and the same time epoch one year earlier, stroke hospitalizations were reduced (relative difference 15.9% [p = 0.03] and 14.5% [p = 0.05],

38

Owolabi MO, Thrift AG, Vanacker P, et al.

International Journal of Stroke, 2021, 16(8), 889-901

ABSTRACTBOEK | 2021

There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.

ABSTRACT 5 Global impact of COVID-19 on stroke care and IV thrombolysis Nogueira RG, Abdelkader M, Vanacker P, et al.

Neurology, 2021, 96(23), e2824-e2838

centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

ABSTRACT 6 Characteristics of patients with atrial fibrillation prescribed edoxaban in Belgium and the Netherlands: insights from the ETNA-AF-Europe study de Vries TAC, Hemels MEW, Cools F, Vanacker P, et al.

Netherlands Heart Journal, 2021, 29(3), 158-167

ABSTRACT Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban.

ABSTRACT To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.

We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissi.

With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15-50 ml/min, weight ≤60 kg, and/or use of strong p‑glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation.

The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and

NEUROLOGIE

39

ABSTRACT 7

ABSTRACT 8

Anticoagulant selection in relation to the SAMe-TT 2 R 2 score in patients with atrial fibrillation: The GLORIA-AF registry

Sustained improvements in motor and non-motor symptoms in advanced parkinson’s disease patients treated with carbidopa levodopa enteral suspension in a ‘realworld’study: interim results of the multinational duoglobe study with at least 24 months follow-up

Ntaios G, Huisman MV, Diener HC, Vanacker P, et al.

Hellenic Journal of Cardiology, 2021, 62(2), 152-157

ABSTRACT The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC).

We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMeTT2R2 scores >2 than to patients with lower scores. We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor.

We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2.

The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.

40 ABSTRACTBOEK | 2021

Aldred J, Standaert D, Kovacs N, Bourgeois P, et al.

Neurology, 2021, 96 (15), 4584

ABSTRACT CLES has established benefit in reducing both motor and non-motor symptoms, but prospective long-term data on the effect of CLES on dyskinesia symptoms and associated effects on QoL and caregiver burden in a real-world setting are limited. Evaluate the effect of carbidopa levodopa enteral suspension (CLES) on motor and nonmotor symptoms in a multi-country observational study in advanced Parkinson’s disease (PD) patients treated with LCIG in routine clinical practice.

Design/Methods: DUOGLOBE is a prospective multinational observational study (including US sites) of CLES naïve patients treated as part of routine clinical practice with 3-years follow-up planned (NCT02611713). Assessments included “Off” time, Unified Dyskinesia Rating Scale (UDysRS), Non-Motor Symptoms Scale (NMSS), sleep symptoms (PD Sleep Scale-2, PDSS-2), Quality of Life (8-item PD questionnaire, PDQ-8), and Serious Adverse Events (SAEs). Interim outcomes from baseline up to month (M) 24 are presented.In this interim analysis, 196 patients were included (62% male, 78% ≥65 years old; 51% ≥10 years’ PD duration). Mean (SD) LCIG treatment duration was 711 (368) days with a median daily CLES infusion of 16.0 h/d.

Significant improvements (mean change from baseline to M24) were observed in “Off” time (−3.7 h/d; 95% CI −4.3 to −3.1; p<.001), UDysRS total scores (−7.9; 95% CI −12.5 to −3.2; p=.001), NMSS total scores (−22.2; 95% CI −30.7 to −13.7; p<.001), PDSS-2 total score (−5.8; 95% CI −8.2 to −3.3; p<.001), and QoL (−5.8; 95% CI −10.0 to −1.5; p=.009).

Overall, 52% of patients experienced SAEs, 23% (n=45) of patients discontinued the study due to AEs as primary reason. This interim analysis shows sustained real-world long-term improvements with CLES in routine clinical practice on motor and non-motor symptoms in advanced PD patients. Safety was consistent with the established CLES.

ABSTRACT 9

ABSTRACT 10

Duoglobe: one-year outcomes in a real-world study of levodopa carbidopa intestinal gel for parkinson's disease

Efficacy and safety of ticagrelor and aspirin in patients with moderate ischemic stroke: an exploratory analysis of the thales randomized clinical trial

Standaert D, Aldred J, Anca-Herschkovitsch M, Bourgeois P, et al.

Movement Disorders, 2021, 8(7), 1061-1074

Wang Y, Pan Y, Li H, Vanacker P, et al.

JAMA Neurology, 2021, 78(9), 1091-1098

ABSTRACT

Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and efficacy in this subgroup. To evaluate the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 4 to 5). The THALES trial was a randomized trial conducted at 414 hospitals in 28 countries in January 2018 and December 2019.

ABSTRACT Levodopa-carbidopa intestinal gel (LCIG) is an established treatment for improving motor and some non-motor symptoms (NMS) in patients with advanced Parkinson's disease (PD). Prospective long-term data in routine clinical practice are limited. Assess LCIG effectiveness and safety in patients with advanced PD after 12months during real-world routine clinical practice.

Duodopa/Duopa in patients with advanced Parkinson's disease—a global observational study evaluating long-term effectiveness (DUOGLOBE) (NCT02611713) is an ongoing, prospective, multinational, observational study of LCIGnaïve patients treated as part of routine clinical practice; 3years of follow-up are planned. The primary outcome is the change in patient-reported off time.

Other assessments include the Unified Dyskinesia Rating Scale (UDysRS), Non-Motor Symptoms Scale (NMSS), Parkinson's Disease Sleep scale (PDSS-2), Epworth Sleepiness Scale (ESS), health-related quality of life (HR-QoL), caregiver burden, and serious adverse events (SAEs). Outcomes from baseline to month (M) 12 are presented. In this 12-month follow-up, patients (N = 195) had baseline characteristics similar to other LCIG studies.

Significant improvements (mean change to M12) were observed in off time (−3.9±3.6hr/day, P<0.001), dyskinesia assessed using the UDysRS (−9.6±22.5, P<0.001), NMSS (−23.1±41.4, P<0.001), sleep and sleepiness symptoms on the PDSS-2 (−6.5±12.2, P<0.001) and ESS (−1.0±5.7, P<0.05), HR-QoL (−9.0±21.6, P<0.001), and caregiver burden (−1.9±6.7, P = 0.008). Overall, 40.5% (n = 79) of patients experienced SAEs; fall (n = 6; 3.1%) and urinary tract infection (n = 6; 3.1%) were SAEs reported in ≥3% of patients.

These 12-month outcome data show sustained, long-term improvements and support the real-world effectiveness of LCIG in patients with advanced PD. Safety was consistent with previous studies.

This exploratory analysis compared patients with moderate stroke (baseline NIHSS score of 4 to 5) with patients with less severe stroke (NIHSS score of 0 to 3). A total of 9983 patients with stroke were included in the present analysis, after excluding 2 patients with NIHSS scores greater than 5 and 1031 patients with transient ischemic attack. Data were analyzed from March to April 2021. Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily on days 2 to 30) or placebo within 24 hours after symptom onset. All patients received aspirin, 300 to 325 mg, on day 1 followed by aspirin, 75 to 100 mg, daily on days 2 to 30.

Patients were observed for 30 additional days.

The primary outcome was time to stroke or death within 30 days. The primary safety outcome was time to severe bleeding.

In total, 3312 patients presented with moderate stroke and 6671 presented with less severe stroke. Of those in the moderate stroke group, 1293 (39.0%) were female, and the mean (SD) age was 64.5 (10.8) years; of those in the less severe stroke group, 2518 (37.7%) were female, and the mean (SD) age was 64.8 (11.2) years. The observed primary outcome event rate in patients with moderate stroke was 7.6% (129 of 1671) for those in the ticagrelor group and 9.1% (150 of 1641) for those in the placebo group (hazard ratio, 0.84; 95% CI, 0.66-1.06); the primary outcome event rate in patients with less severe stroke was 4.7% (158 of

NEUROLOGIE

41

3359) for those in the ticagrelor group and 5.7% (190 of 3312) for those in the placebo group (hazard ratio, 0.82; 95% CI, 0.66-1.01) (P for interaction = .88). Severe bleeding occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group in those with moderate stroke compared with 16 patients (0.5%) and 3 patients (0.1%), respectively, with less severe stroke (P for interaction = .26).

In this study, patients with a moderate ischemic stroke had consistent benefit from ticagrelor plus aspirin vs aspirin alone compared with patients with less severe ischemic stroke, with no further increase in the risk of intracranial bleeding or other severe bleeding event.

42

ABSTRACTBOEK | 2021

CENTRUM

NEUS-, KEEL- EN OORZIEKTEN

ARTIKELS ABSTRACT 1 Predicting the premorbid shape of a diseased mandible Wang E, Tran KL, D'heygere E, Prisman E The Laryngoscope, 2021, 131 (3), e781-e786

ABSTRACT Virtual surgical planning (VSP) for reconstructions of advanced mandibular neoplasms that have distorted the contour of the mandible is challenging, as the premorbid shape of the mandible is unknown.

We introduce a novel modeling technique, based on a statistical shape model (SSM), that has learned the shape of a normal mandible from a set of 84 mandibles, such that given a diseased mandible, the model can determine its premorbid shape. Eightyfour control mandibles were used to generate an SSM. Various mandibular defects were created, and the SSM was applied to predict the shape of the original mandible. The predicted and original shape of the defect were compared for accuracy using volumetric overlap and Hausdorff distance.

All mandibular VSP cases in the past 2 years were reviewed to identify those that required virtual due to significantly distorted mandibular contours. The SSM was compared to those cases requiring preprocessing and highlighted in one prospective VSP. The average volumetric overlap and Hausdorff distance between the defect replacement and the defect are 73.9%±13.3% and 4.51mm±2.65mm, respectively. The SSM is more accurate for smaller defects, and those not including the condyle. Ten out of 40 VSP cases required preprocessing using four different techniques.

Qualitatively, the SSM outperformed those preprocessing techniques applied in the retrospective cases. The SSM can accurately predict the premorbid shape of a distorted mandible and is superior to current preprocessing techniques. The SSM was successfully applied to a retrospective series and one prospective index case.

NEUS-, KEEL- EN OORZIEKTEN

43

CENTRUM

NUCLEAIRE GENEESKUNDE ARTIKELS ABSTRACT 1 Practical considerations when interpreting FDG PET/ CT imaging for staging and treatment response assessment in melanoma patients Van de Wiele C, Gebruers J, Vander Borght K, Maes A, et al.

Seminars in Nuclear Medicin, 2021, 51(6), 544-553

ABSTRACT While FDG PET/CT bears a high sensitivity and specificity for the staging of stage III and IV melanoma as well as for the purpose of melanoma recurrence detection, overall results tend to vary from one part of the body to another as well as for melanoma from cutaneous or choroidal origin.

In this paper, organ or site-related differences in sensitivity and specificity in melanoma patients, both from cutaneous and choroidal origin, as well as their impact on clinical decision making are discussed. Furthermore, with the advent of immunotherapy for the treatment of malignant melanoma, post-treatment related potential false positive findings have emerged, the knowledge of which is essential for accurate treatment response assessment.

These post-treatment related potential false positive findings are summarized in this paper so as to help the nuclear medicine physician in avoiding erroneous interpretation of acquired FDG PET/CT images in melanoma patients receiving immuntherapy.

however, to a significantly variable degree. This may, in part, relate to the tumour model used given the fact that different tumour cell lines bear a different sensitivity to a similar chemotherapeutic agent, to differences in the chemotherapeutic concentration and exposure time, as well as to the different timing of imaging performed post-treatment.

The best validated cell membrane acidification and caspase 3 targeting radioligands, respectively 18F-ML-10 from the Aposense family and the radiolabelled caspase 3 substrate 18F-CP18, have also been injected in healthy individuals and shown to bear favourable dosimetric and safety characteristics. However, in contrast to, for instance, the 99mTc-HYNIC-Annexin V, neither of both tracers was taken up to a significant degree by the bone marrow in the healthy individuals under study. Removal of white and red blood cells from the bone marrow through apoptosis plays a major role in the maintenance of hematopoietic cell homeostasis.

The major apoptotic population in normal bone marrow are immature erythroblasts.

While an accurate estimate of the number of immature erythroblasts undergoing apoptosis is not feasible due to their unknown clearance rate, their number is likely substantial given the ineffective quote of the erythropoietic process described in healthy subjects. Thus, the clinical value of both 18F-ML-10 and 18F-CP18 for apoptosis imaging in cancer patients, as suggested by a small number of subsequent clinical phase I/II trials in patients suffering from primary or secondary brain malignancies using 18F-ML-10 and in an ongoing trial in patients suffering from cancer of the ovaries using 18F-CP18, remains to be proven and warrants further investigation.

ABSTRACT 2 Apoptosis imaging in oncology by means of positron emission tomography: a review Van de Wiele C, Ustmert S, De Jonghe P, Maes A, et al International Journal of Molecular Sciences, 2021, 22(5), 2753

ABSTRACT To date, a wide variety of potential PET-apoptosis imaging radiopharmaceuticals targeting apoptosis-induced cell membrane asymmetry and acidification, as well as caspase 3 activation (substrates and inhibitors) have been developed with the purpose of rapidly assessing the response to treatment in cancer patients. Many of these probes were shown to specifically bind to their apoptotic target in vitro and their uptake to be enhanced in the in vivo-xenografted tumours in mice treated by means of chemotherapy,

44 ABSTRACTBOEK | 2021

ABSTRACT 3 68Ga-DOTA-TATE PET/CT imaging for differentiating a sarcoid-like reaction from progression following immunotherapy in a triple-negative breast carcinoma patient Deleu A, Hanssens M, Maes A, Van de Wiele C European Journal of Nuclear Medicine and Molecular Imaging, 2021, 48(3) 945-946

ABSTRACT Er is geen abstract beschikbaar.

ABSTRACT 4 The utility of metabolic parameters on baseline F-18 FDG PET/CT in predicting treatment response and survival in paediatric and adolescent Hodgkin Lymphoma Reed JD, Masenge A, Buchner A, Van de Wiele C Journal of Clinical Medicine, 2021, 10(24), 5979

ABSTRACT Lymphoma is the third most common paediatric cancer.

Early detection of high-risk patients is necessary to anticipate those who require intensive therapy and follow-up.

Current literature shows that residual tumor avidity on PET (Positron Emission Tomography) following chemotherapy corresponds with decreased survival.

However, the value of metabolic parameters has not been adequately investigated. In this retrospective study, we aimed to evaluate the prognostic value of metabolic and other parameters in paediatric and adolescent Hodgkin lymphoma. We recorded tMTV (total Metabolic Tumor Volume), TLG (Total Lesion Glycolysis), and SUVmax (maximum Standard Uptake Value) on baseline PET, as well the presence of bone marrow or visceral involvement.

HIV (human immunodeficiency virus) status and baseline biochemistry from clinical records were noted.

All patients received stage-specific standard of care therapy. Response assessment on end-of-treatment PET was evaluated according to the Deauville criteria. We found that bone marrow involvement (p = 0.028), effusion (p < 0.001), and treatment response (p < 0.001) on baseline PET, as well as HIV status (p = 0.036) and baseline haemoglobin (p = 0.039), were significantly related to progression-free survival (PFS), whereas only effusion (p = 0.017) and treatment response (p = 0.050) were predictive of overall survival (OS). Only baseline tMTV predicted treatment response (p = 0.017). This confirms the value of F-18 FDG PET/CT (Fluoro-deoxy-glucose Positron Emission Tomography/Computed Tomography) in prognostication in paediatric and adolescent Hodgkin lymphoma; however, further studies are required to define the significance of metabolic parameters.

NUCLEAIRE GENEESKUNDE

45

CENTRUM

PATHOLOGISCHE ANATOMIE

ABSTRACT 1 Belangrijk gewichtsverlies bij een patiënt met een hardnekkige huideruptie Vanbelleghem E, Werbrouck J, Libbrecht L, D'heygere F Tijdschrift voor Geneeskunde en gezondheidszorg, 2021, doi:10.47671/tvg.77.21.038

ABSTRACT Het abstract is na te lezen op p. 25

ABSTRACT 2 Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - two case reports and a literature review Vandenameele A, Alaerts H, Platteeuw L Facts, views and vision in ObGyn, 2021, 13(3), 261-266

ABSTRACT Het abstract is na te lezen op p. 24

46 ABSTRACTBOEK | 2021

CENTRUM

ONCOLOGIE

ARTIKELS ABSTRACT 1

V-STORM trial will explore the best treatment approach in this setting. Early results on the acute toxicity profile are projected to be published in quarter 3, 2021.

Effectiveness of adjunctive analgesics in head and neck cancer patients receiving curative (chemo-) radiotherapy: a systematic review

ABSTRACT 3

Lefebvre T, Tack L, Lycke M, Goethals L, et al.

Pain Medicine, 2021, 22(1), 152-164

C-reactive protein and neutrophil-lymphocyte ratio are prognostic in metastatic clear-cell renal cell carcinoma patients treated with nivolumab

ABSTRACT Objective: Our aim was to give an overview of the effectiveness of adjunctive analgesics in head and neck cancer (HNC) patients receiving (chemo-) radiotherapy.

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched for studies concerning "head neck cancer," "adjunctive analgesics," "pain," and "radiotherapy."

Pain outcome, adverse events, and toxicity and other reported outcomes, for example, mucositis, quality of life, depression, etc.

Nine studies were included in our synthesis. Most studies were of low quality and had a high risk of bias on several domains of the Cochrane Collaboration tool. Only two studies comprised high-quality randomized controlled trials in which pregabalin and a doxepin rinse showed their effectiveness for the treatment of neuropathic pain and pain from oral mucositis, respectively, in HNC patients receiving (chemo-) radiotherapy.

More high-quality trials are necessary to provide clear evidence on the effectiveness of adjunctive analgesics in the treatment of HNC (chemo-) radiation-induced pain.

ABSTRACT 2 The multicenter, randomized, phase 2 PEACE V-STORM trial: defining the best salvage treatment for oligorecurrent nodal prostate cancer metastases Zilli T, Dirix P, Liefhooghe N, Stellamans K, et al.

European Urology Focus, 2021, 7(2), 241-244

Roussel E, Kinget L, Verbiest A, Debruyne P, et al.

Urologic oncology, 2021, 39(4), 239.e17-239.e25

ABSTRACT To evaluate the impact of markers of systemic inflammation such as C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) on outcomes of metastatic clear-cell renal cell carcinoma (m-ccRCC) patients treated with nivolumab.

We retrospectively evaluated m-ccRCC patients treated with nivolumab and collected known prognostic factors and survival data.

We used Kaplan-Meier survival analysis and cox proportional hazards regression analysis to study prognostic factors for overall survival (OS) and progression-free survival (PFS) since start of nivolumab. Harrell's C-index was used to evaluate the models. We included 113 patients.

Median OS and PFS after initiation of nivolumab was 15 (interquartile range 7-28) and 4 months (interquartile range 3-11), respectively. Elevated baseline CRP was associated with worse OS (HR per 25 mg/l 1.35, 95% CI 1.16-1.52, P < 0.001) and PFS (HR per 25 mg/l 1.19, 95% CI 1.08-1.35, P = 0.001), independent from the international metastatic renal cell carcinoma database consortium (IMDC) prognostic criteria, increasing the model's C-index from 0.72 to 0.77 for OS and 0.59 to 0.62 for PFS. Elevated NLR was associated with worse OS (HR 1.10, 95% CI 1.04-1.17, P = 0.002) and PFS (HR 1.06, 95% CI 1.01-1.11, P = 0.03) independent from the other IMDC prognostic criteria. The model's C-index decreased from 0.72 to 0.70 for OS and increased from 0.59 to 0.60 for PFS. Elevated baseline CRP and NLR predict worse OS and PFS on nivolumab in m-ccRCC patients.

Including baseline CRP in the IMDC prognostic model improves its discriminatory power to predict OS and PFS since start of nivolumab.

ABSTRACT Optimal local treatment for nodal oligorecurrent prostate cancer is unknown. The randomized phase 2 PEACE

ONCOLOGIE

47

PRESENTATIES/ CONGRESSEN ABSTRACT 4 A randomised wait-list controlled trial to evaluate emotional freedom techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON)

ABSTRACT 1 Application of the ESTRO/EORTC oligometastatic disease classification system to current evidence

Tack L, Lefebvre T, Lycke M, Debruyne P, et al.

EClinicalMedicine by the Lancet Discovery, 2021, 39, 101081

Nevens D, Jongen A, Kindts I, et al.

ABSTRACT

There is increasing evidence for the integration of locally ablative therapy into multimodality treatment of oligometastatic disease (OMD); however, the non-standardized definition of OMD has hindered comparison of individual studies and their translation into clinical practice. To support standardised data collection, analysis, and reporting, a consensus for OMD classification has previously been established: this study aims to apply the OMD classification system to current evidence on stereotactic body radiotherapy (SBRT) as identified in a systematic review. A systematic literature review was performed in Medline, Embase,

2021, Madrid, Spanje

ABSTRACT Cancer-related cognitive impairment (CRCI) is a prevalent source of comprised quality of life in cancer survivors.

This study evaluated the efficacy of Emotional Freedom Techniques (EFT) on self-reported CRCI (sr-CRCI).

In this prospective multicentre randomised wait-list controlled study, eligible cancer survivors had completed curative treatment, were 18 years or older and screened positive for sr-CRCI with ≥ 43 on the Cognitive Failures Questionnaire (CFQ). Participants were randomised to the immediate treatment group (ITG) or wait-list control (WLC) group, based on age (< or ≥ 65 years), gender, treatment (chemotherapy or not), and centre. The ITG started to apply EFT after inclusion and performed this for 16 weeks. The WLC group could only start the application of EFT after 8 weeks of waiting. Evaluations took place at baseline (T0), 8 weeks (T1) and 16 weeks (T2).

The primary outcome was the proportion of patients with sr-CRCI according to the CFQ score. Between October 2016 and March 2020, 121 patients were recruited with CFQ ≥ 43 indicating sr-CRCI. At T1, the number of patients scoring positive on the CFQ was significantly reduced in the ITG compared to the WLC group (40.8% vs. 87.3% respectively; p<0.01). For the WLC group, a reduction in CFQ scores was observed at T2, comparable to the effect of the ITG at T1. Linear mixed model analyses indicated a statistically significant reduction in the CFQ score, distress, depressive symptoms, fatigue and also an improvement in quality of life.

This study provides evidence for the application of EFT for sr-CRCI in cancer survivors and suggests that EFT may be useful for other symptoms in cancer survivors.

Items for Sys, and Cochrane, searching for prospective and retrospective studies, where SBRT was a treatment component of OMD. Availability of the OMD characteristics as described in the EORTC/ESTRO consensus

48 ABSTRACTBOEK | 2021

CENTRUM

ORTHOPEDIE

ARTIKELS ABSTRACT 1 High-resolution cone-beam computed tomography is a fast and promising technique to quantify bone microstructure and mechanics of the distal radius Mys K, Varga P, Stockmans F, Vanovermeire O Calcified Tissue International, 108 (3), 2021, 314-323

ABSTRACT Het abstract is na te lezen op p.35

ABSTRACT 2 Avascular necrosis of the foot and ankle in a patient with systemic sclerosis: a case based review Wastyn H, Leys M, Deleu A, Michels F, et al.

Modern Rheumatology Journal, 2021, 15(1), 94-97

ABSTRACT This report describes a case of atraumatic avascular necrosis in the foot and ankle in a patient with systemic sclerosis who did not receive corticosteroid therapy.

Both avascular necrosis and systemic sclerosis are uncommon disease entities. This case depicts that the vasculitis and secondary vasoconstriction in the pathogenesis of systemic sclerosis are important risk factors for the development of avascular necrosis of the foot and ankle.

Therefore, if these patients develop chronic foot and ankle pain, avascular necrosis should be included in the differential diagnosis, even if they do not receive corticosteroids.

MRI remains the gold standard for avascular necrosis diagnosis and follow-up. It should be used to diagnose AVN in an early stage.

ABSTRACT Anatomical reconstruction of the calcaneofibular ligament (CFL) is a common technique to treat chronic lateral ankle instability. A bone tunnel is used to fix the graft in the calcaneus.

The purpose of this study is to provide some recommendations about tunnel entrance and tunnel direction based on anatomical landmarks. The study consisted of 2 parts. The first part assessed the lateral tunnel entrance for location and safety. The second part addressed the tunnel direction and safety upon exiting the calcaneum on the medial side. In the first part, 29 specimens were used to locate the anatomical insertion of the CFL based on the intersection of 2 lines related to the fibular axis and specific landmarks on the lateral malleolus. In the second part, 22 specimens were dissected to determine the position of the neurovascular structures at risk during tunnel drilling.

Therefore, a method based on four imaginary squares using external anatomical landmarks was developed. For the tunnel entrance on the lateral side, the mean distance to the centre of the CFL footprint was 2.8±3.0 mm (0-10.4 mm).

The mean distance between both observers was 4.2±3.2 mm (0-10.3 mm). The mean distance to the sural nerve was 1.4±2 mm (0-5.8 mm). The mean distance to the peroneal tendons was 7.3±3.1 mm (1.2-12.4 mm). For the tunnel exit on the medial side, the two anterior squares always contained the neurovascular bundle. A safe zone without important neurovascular structures was found and corresponded to the two posterior squares. Lateral landmarks enabled to locate the CFL footprint.

Precautions should be taken to protect the nearby sural nerve. A safe zone on the medial side could be determined to guide safe tunnel direction. A calcaneal tunnel should be directed to the posterior inferior medial edge of the calcaneal tuberosity.

ABSTRACT 3

ABSTRACT 4

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

The intrinsic subtalar ligaments have a consistent presence, location and morphology

Michels F, Matricali G, Wastyn H, et al.

Knee Surgery Sports Traumatology Arthroscopy, 2021, 29(4), 1325-1331

Michels F, Matricali G, Vereecke E, et al.

Foot Ankle Surgery, 2021, 27(1), 101-109

ABSTRACT Chronic subtalar instability is a disabling complication after acute ankle sprains. Currently, the literature describing

ORTHOPEDIE

49

the anatomy of the intrinsic subtalar ligaments is limited and equivocal which causes difficulties in diagnosis and . treatment of subtalar instability. The purpose of this study is to assess the anatomical characteristics of the subtalar ligaments and to clarify some points of confusion.

In 16 cadaveric feet, the dimensions and locations of the subtalar ankle ligaments were assessed and measured.

CT-scans before dissection and after indication of the footprints with radio-opaque paint allowed to generate 3D models and assess the footprint characteristics. The cervical ligament (CL) had similar dimensions as the lateral ligaments: anterior length 13.9±1.5 mm, posterior length 18.5±2.9 mm, talar width 13.6±2.2 mm, calcaneal width 15.8±3.7 mm. The anterior capsular ligament (ACaL) and interosseous talocalcaneal ligament (ITCL) were found to be smaller structures with consistent dimensions and locations.

This study identified consistent characteristics of the intrinsic subtalar ligaments and clarifies the local anatomical situation. The dimensions and footprints of the intrinsic ligaments of the subtalar joint suggest a more important role of the CL and ACaL in the stability of the subtalar joint.

The results of this study are relevant to improve diagnostic tools and offer some guidelines when reconstructing the injured ligaments.

PRESENTATIES/ CONGRESSEN

tendon graft. This is technically more demanding than a repair however, the major advantage is that we end up with a strong new ligament.

Repair versus reconstruction. In general the ligament repair is still the golden standard. However, in many cases you can consider to perform a ligament reconstruction instead of a repair. Especially in revision cases, patients with poor ligament quality and generalized hyperlaxity but also in patients with lesions of the calcaneofibular ligament, suspected subtalar instability, major instability. Besides in patients with lateral ankle instability, a similar technique is also used to perform reconstructions in patients with medial, subtalar and midfoot instability.

Reconstruction of the ankle ligaments using the gracilis graft is a safe and reliable technique. It allows to restore the local anatomy and to obtain a stable reconstruction.

The technique should be adapted according to the needs of each patient.

ABSTRACT 2 The importance of tunnels in lateral and medial ankle ligament reconstruction Michels F June 2021, Eurasion Orthopedic Forum, Moscow, Russia

ABSTRACT 1

ABSTRACT

Reconstruction of the ankle ligaments using the M. Gracilis Tendon

In the past we performed tenodesis and drilled curved bone tunnels. Today we aim for an anatomical reconstruction to restore the normal function of the ligaments. Bone tunnels (interference screws) offer a greater fixation strength than bone anchors. The most challenging part is the position of the bone tunnels. The entry point should be at the normal anatomical footprint insertion. The tunnels should be directed to maximize the surrounding bone and to avoid soft tissue damage. Fibular tunnel. Drill one single tunnel to fix ATFL and CFL. Look for the fibular obscure tubercle.

Hold the foot in inversion. Use a slightly more medially located entrance point to avoid the digital fossa and peroneal tendons. Drill an oblique tunnel (longer tunnel, more surrounding bone). Lateral talar tunnel. A blind ended tunnel measuring 5 mm in diameter and 22 mm in depth directed to the posterior point of medial malleolus is recommended.

Michels F June 2021, Eurasion Orthopedic Forum, Moscow, Russia

ABSTRACT In the past tenodesis was used to restore the stability of the lateral part of the ankle. Since 1960 the Brostrom technique became popular. It consists of a suture or reattachment of the injured ligaments. The extensor retinaculum can be added to reinforce the repair. More recently a ligament reconstruction was described. A reconstruction can be defined as a replacement of the injured ligaments by graft tissue. In this technique often a gracilis tendon is used. The reconstruction can be performed using an open technique or an endoscopic technique. The technique of ligament reconstruction using the gracilis tendon was first described

by M Takao in 2005! The technique allows to reconstruct the ATFL or both the ATFL and CFL with a strong gracilis

50 ABSTRACTBOEK | 2021

Alternatively, a transosseous tunnel measuring 5 mm in diameter directed to the inferior point of MM can be used. Lateral calcaneal tunnel. Use the lateral malleolus

as a landmark. A tunnel length of > 30 is easily obtained, larger diameters are possible, because of weaker bone oversizing the screw is allowed. Avoid screw protrusion. A transosseous tunnel is directed to the lower posterior edge of calcaneal tuberosity. Tibial tunnel. Start in intercollicular groove and aim in an anterolateral direction just lateral to the tibial crest. Medial talar tunnel. Aim in a an anterolateral direction to the triangular region of the talus. Medial calcaneal tunnel. Aim in a distal posterior direction to avoid the subtalar joint.

Conclusion. Interference screws in tunnels offer a good fixation. The tunnel entrance should correspond with the normal anatomical footprint to restore the normal anatomical function of the ligaments. The tunnel direction should: allow sufficient surrounding bone, allow a sufficient tunnel length, avoid neurovascular structures.

technique to the deformity. Cadaverlabtraining is mandatary before performing MIS in clinical situations. The postoperative care is as important as the surgical technique.

ABSTRACT 4 Toe corrections: postoperative care Michels F June 2021, International Basic and Advanced Course of Foot MIS and Percutaneous Surgery, Barcelona, Spain

ABSTRACT

Percutaneous treatment of hammertoes

The main goal is to maintain the toe in a corrected position during healing. Adhesive wound closure strips are often used. They are very powerful and allow correction adapted to the deformity. They provide a quite semirigid fixation. Early postoperative mobilisations of the toes is recommended. Physiotherapy should be focused on plantarflexion. The osteotomy site should be protected during the healing process.

Michels F June 2021, International Basic and Advanced Course of Foot MIS and Percutaneous Surgery, Barcelona, Spain

Surgical technique in percutaneous toe corrections

ABSTRACT 3

ABSTRACT The purpose of this surgical technique is to realignment of the toes and to restore the function. The percutaneous techniques should be seen as an additional toolbox to correct the different toe deformities. We distinguish 2 groups of procedures: the soft tissue procedures and the bony procedures. The different procedures are combined and adapted to correct the toe deformity.

A tenotomy of the both extensor tendons allows to correct a hyperextension of the metatarsophalangeal joint. In medial or lateral deviations the same approach can be used to do a release of the collateral ligaments. Especially in overlapping toes and subluxations this is quite useful. A tenotomy of both flexor tendons is performed by a plantar approach on the level of the proximal phalanx. An osteotomy of the proximal phalanx. Using a plantar proximal approach a burr is introduced. If needed a tenotomy of the flexor tendons is performed before. If not the tendons are pushed to the side. According to the needed correction we perform a wedge osteotomy, a complete osteotomy or a shortening osteotomy.

ABSTRACT 5

Michels F June 2021, International Basic and Advanced Course of Foot MIS and Percutaneous Surgery, Barcelona, Spain

ABSTRACT During this presentation the different technical aspects of percutaneous toe corrections are discussed: specific recommendations, technical tips, pitfalls and tricks.

ABSTRACT 6 Dressing techniques in percutaneous foot surgery: movie session Michels F, Malagelada F June 2021, International Basic and Advanced Course of Foot MIS and Percutaneous Surgery, Barcelona, Spain

ABSTRACT During this presentations different dressing techniques are discussed with use of movies.

The percutaneous techniques offers a new toolbox to correct the different toe deformities. Adapt your surgical

ORTHOPEDIE

51

ABSTRACT 7 Percutaneous foot surgery: kinesiotaping, orthoses and aftercare Michels F June 2021, International Basic and Advanced Course of Foot MIS and Percutaneous Surgery, Barcelona, Spain

ABSTRACT The use of elastic tapings (kinesiotape) is discussed in the postoperative care: indications, applications and results.

The use of silicone orthoses is discussed in the postoperative care: indications, applications and results. The other aspects in the aftercare are discussed: physiotherapy, shoes, patient counseling.

52

ABSTRACTBOEK | 2021

CENTRUM

PSYCHIATRIE

ARTIKELS

ABSTRACT 2

ABSTRACT 1

Euthanasia in adults with psychiatric conditions: a descriptive study of the experiences of Belgian psychiatrists

Discontinuation of continuation or maintenance electroconvulsive therapy caused by the COVID-19 pandemic: a naturalistic study investigating relapse in patients with major depressive disorder Van De Velde N, Geerts PJ, Tandt H, Titeca K, et al.

The Journal of ECT, 2021, 37(4), 230-237

ABSTRACT Continuation or maintenance electroconvulsive therapy (C/M-ECT) is recommended to reduce relapse rates of patients with major depressive disorder. During the ongoing COVID-19 pandemic, ECT services have come under pressure or needed to close because of redirected resources and safety reasons.

We investigated the impact of C/M-ECT discontinuation on relapse in patients with unipolar depressive disorder in Flanders, Belgium. Between March 30 and June 18, 2020, all patients receiving C/M-ECT in 2 ECT centers were included.

Continuation or maintenance electroconvulsive therapy was discontinued in 33 patients and continued in 4 patients.

Relapse was defined as the need to restart ECT or the need for hospitalization. Depressive symptoms were assessed every 3 weeks using the Patient Health Questionnaire, the Clinical Global Impression Scale, and 2 additional patientrated questions. Relapse in the discontinuation group was 60.6%. All 4 patients who continued ECT remained remitted.

Kaplan-Meier survival analysis showed significantly shorter relapse rates for patients receiving bitemporal and/or frequent C/M-ECT (1- to 2-week intervals). Patients older than 60 years showed longer survival rates.

Our results confirm earlier prospective and retrospective data regarding the efficacy and importance of C/M-ECT as relapse prevention. After treatment discontinuation, close monitoring of early warning signs for relapse is crucial, especially in the first few months. With the COVID-19 pandemic continuing, our data provide an indication of the necessity to ensure adequate care and access to ECT not only for the acutely ill but also for the vulnerable patients who are depending on C/M-ECT.

Verhofstadt M, Audenaert K, Van den Broeck K, Titeca K, et al.

Science progress, 2021, 104(3), 1–23

ABSTRACT To investigate the experience of psychiatrists who completed assessment procedures of euthanasia requests from adults with psychiatric conditions (APC) over the last 12 months. Between November 2018 and April 2019 a cross-sectional survey was sent to a sample of 753 psychiatrists affiliated with Belgian organisations of psychiatrists to gather detailed information on their latest experience with a completed euthanasia assessment procedure, irrespective of its outcome (i.e.euthanasia being performed or not).

Information on 46 unique cases revealed that most APC suffered from comorbid psychiatric and/or somatic disorders, and had received different kinds of treatment for many years prior to their euthanasia request. Existential suffering was the main reason for the request. The entire procedure spanned an average of 14months, and an average of 13.5months in the 23 cases that culminated in the performance of euthanasia. In all cases, the entire procedure entailed multidisciplinary consultations, including with family and friends.

Psychiatrists reported fewer difficulties in assessing due care criteria related to the APC’s self-contemplation – for example, unbearable suffering on top of the due care criteria related to their medical condition; incurability due to lack of reasonable treatment perspectives. In a few cases in which euthanasia was the outcome, not all legal criteria were fulfilled in the reporting physicians’ opinions.

Both positive and negative experiences of the assessment procedure were reported: for example, reduced suicide risk for the APC; an emotional burden and a feeling of being pressured for the psychiatrist.

This study confirms that euthanasia assessment in APC entails a lengthy process with diverse complexities, and psychiatrists require support in more than one respect if the assessments are to be handled adequately. Thorough evaluation of current guidelines is recommended: that is, to what extent the guidelines sufficiently address the complexities around (e.g.) assessing legal criteria

PSYCHIATRIE

53

or involving relatives. We formulate various avenues for further research to build on this study’s insights and to fill remaining knowledge gaps.

PRESENTATIES/ CONGRESSEN

van verschillende beoordelingscriteria alsook al eens tot tegengestelde conclusies kwamen inzake wilsbekwaamheid. We pluizen uit hoe Belgische psychiaters dit criterium beoordelen.

ABSTRACT 2 ABSTRACT 1 Euthanasie bij psychisch lijden ten gevolge van een psychiatrische aandoening – psychiaters de lat mag hoog: streven naar een deskundige aanpak.

Euthanasie bij psychisch lijden ten gevolge van een psychiatrische aandoeningGerichtheid op de doodswens en het leven.

Titeca K

Titeca K februari 2021, 10e Vlaams Geestelijke Gezondheidscongres, Antwerpen (online)

februari 2021, 10e Vlaamse Geestelijke Gezondheidscongres, Antwerpen (online)

ABSTRACT

ABSTRACT

In België kunnen patiënten hun leven beëindigen via euthanasie. Jaarlijks zien we een toename in het aantal uitgevoerde euthanasiecasussen. Ook het aantal uitgevoerde euthanasiecasussen op basis van een psychiatrische aandoening is gestegen: van 5 casussen tussen 2003-2007 over 72 casussen tussen 2008-2012 tot 181 casussen tussen 2013-2017. Al is er sinds 2017 een lichte daling te zien in het aantal uitgevoerde psychiatrische euthanasiecasussen, toch gaan er steeds meer stemmen op om de huidige euthanasiewet terug te schroeven of te verstrengen voor deze specifieke groep patiënten die hoofdzakelijk lijden aan een psychiatrische aandoening (anders dan dementie), temeer daar enkele psychiatrische euthanasiecasussen recent onderworpen werden aan juridische toetsing.

Sinds de euthanasiewet in werking trad, nam het aantal psychiatrische patiënten dat via euthanasie is overleden gestaag toe. Hoewel zij slechts een kleine minderheid van het totale aantal sterfgevallen via euthanasie vertegenwoordigen, beroeren zij de samenleving het meest. Tijdens de laatste jaren heeft dit namelijk geleid tot talrijke verhitte discussies geleid tussen voor-, midden- en tegenstanders van de euthanasiewet bij ‘ondraaglijk psychisch lijden door een psychiatrisch ziektebeeld.’

Nederlands onderzoek wees uit dat psychiaters een eerder terughoudende houding aannemen en zelden euthanasieverzoeken van deze patiëntengroep honoreren. Maar hoe staan Belgische psychiaters tegenover de euthanasiewet en -praktijk bij psychiatrische patiënten? Welke concrete ervaringen hebben zij reeds achter de kiezen? Zijn ze eventueel (nog) bereid om een concrete rol in dergelijke euthanasieprocedures te vervullen? Zo ja, voelen zij zich voldoende geruggesteund door de wettelijke bepalingen en/of recent gepubliceerde adviesteksten of is er nog ruimte voor verbetering?

Dit symposium maakt de eerste onderzoeksresultaten uit zowel Vlaams- als Franstalig België bekend over de houding en ervaringen van psychiaters rond dit topic. Ook zoomen we in op een belangrijk kerncriterium in euthanasie-assessment: de wilsbekwaamheid. Uit Nederlands onderzoek bleek namelijk dat artsen soms gebruik maken

54 ABSTRACTBOEK | 2021

Tijdens dit symposium zoomen we in op de patiënt die de vraag naar euthanasie stelt en diens naasten. Wat noopt een patiënt om de vraag naar euthanasie te stellen? Wat maakt hun lijden zo ondraaglijk dat zij de weg naar euthanasie willen bewandelen? Onderzoek leert ons dat de hele euthanasieprocedure soms als een vorm van extra lijden wordt gepercipieerd.

Anderzijds leert onderzoek ons ook dat het patiënten een vorm van geruststelling kan bieden, het gevoel van ernstig genomen te worden, en zelfs een hernieuwde kracht kan geven om therapie en dientengevolge het leven een nieuwe kans te geven. We zien in de praktijk dat patiënten hun euthanasieverzoek soms op eigen verzoek intrekken. Mede vanuit deze ervaringen heeft de Vlaamse Vereniging voor Psychiatrie het 2-sporenbeleid geïntroduceerd om met elke patiënt zowel het spoor richting de uitklaring van de euthanasievraag alsook het spoor van alternatieve levenspaden te bewandelen, liefst geflankeerd door de naasten van de patiënt. De laatste jaren heeft de krachtgerichte herstelbeweging het levenspad mee geplaveid.

Dit symposium zal tevens het eerste Inloophuis alsook een nieuw ontworpen informatiebrochure voor patiënten en naasten lanceren.

CENTRUM

UROLOGIE ARTIKELS

ABSTRACT 2 Multicentric prospective local treatment of metastatic prostate cancer (LoMP study)

ABSTRACT 1 Treatment of patients with newly diagnosed metastatic hormone sensitive prostate cancer (mHSPC) in Belgium: a real world data analysis Lambert E, Hollebosch S, Van Praet C, Van Bruwaene S, et al.

Acta Clinica Belgica, 2021, doi: 10.1080/17843286.2021.2001999

Buelens S, Poelaert F, Claeys T, Billiet I, et al.

BJU International, 2021, doi: 10.1111/bju.15553

ABSTRACT To investigate the role of cytoreductive radical prostatectomy in addition to standard of care for patients with newly diagnosed metastatic prostate cancer.

Abiraterone acetate + prednisone (AAP) and docetaxel have proven their efficacy in the treatment of patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) in clinical trials. However, real-world data are scarce.

This multicentre, prospective study included asymptomatic patients from 2014 to 2018 (NCT02138721). Cytoreductive radical prostatectomy was offered to all fit patients with resectable tumours, resulting in 40 patients. Standard of care was administered to 40 patients who were ineligible or unwilling to undergo surgery. The primary endpoint was castration resistant cancer-free survival at the time point of ≥50% events.

The goal of this study is to evaluate real-world data on the efficacy and safety of these therapies in mHSPC patients.

Records of 93 patients from 21 different centres were retrospectively reviewed. Primary and secondary endpoints were radiographic and PSA progression-free survival (RPFS – PSA-PFS) and cancer specific and overall survival (CSS – OS), respectively. Adverse events (AEs) were evaluated according to the Common Terminology Criteria for Adverse Events version 5.0. Differences in oncological outcome and AEs were evaluated between three treatment groups: ADT only (N=26) – ADT + AAP (N=48) – ADT + docetaxel (N=19).

Survival analysis was performed using Kaplan–Meier statistics. Median RPFS was 13 months (95% confidence interval [CI]: 9–17) for ADT only, 21 months (95% CI: 19–23) for ADT + AAP and 12 months (95% CI: 11–14) for ADT + docetaxel (p = 0.004). The 1-year PSA-PFS, CSS and OS were 73.5%, 90.7% and 88.7%, respectively, with no significant differences between the three groups. Adverse events of grade 3 or higher were not observed more frequently.

The secondary endpoint was local event-free survival.

Kaplan–Meier and Cox regression analyses with propensity-score analysis were applied. After a median (quartiles) follow-up of 35 (24–47) months, 42 patients became castration-resistant or died. The median castration resistant cancer-free survival was 53 (95% confidence interval [CI] 14–92) vs 21 (95% CI 15–27) months for cytoreductive radical prostatectomy compared to standard of care (P = 0.017). The 3-year estimates for local event-free survival were 83% (95% CI 71–95) vs 59% (95% CI 51–67) for cytoreductive radical prostatectomy compared to standard of care (P = 0.012). However, treatment group showed no significance in the multivariable models for castration resistant cancer-free survival (P = 0.5) or local event-free survival (P = 0.3), adjusted for propensity-score analysis.

Complications were similar to the non-metastatic setting.

Patients undergoing surgery were younger, with lower baseline prostate-specific antigen levels, alkaline phosphatase levels and metastatic burden.

Retrospective real-world data show a significantly longer RPFS for mHSPC patients treated with ADT + AAP compared to ADT only or ADT + docetaxel at short-term follow-up. This can aid in counselling of mHSPC patients in daily clinical practice.

The present LoMP study was unable to show a difference between the two inclusion groups regarding castration resistant cancer-free survival for asymptomatic patients with newly diagnosed metastatic prostate cancer. These results validate previous evidence that, in well-selected and informed patients, cytoreductive radical prostatectomy is feasible and safe, with corresponding continence rates compared to the non-metastatic, high-risk setting.

ABSTRACT

UROLOGIE

55

Whether cytoreductive radical prostatectomy could be a valuable option to achieve good local palliation needs to be further researched. Overall, the role of cytoreductive radical prostatectomy needs to be further explored in randomized studies to correct for potential bias.

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Hormone treatment–related adverse events with darolutamide in patients with nonmetastatic castration-resistant prostate cancer from the phase 3 ARAMIS study Fizazi K, Shore, N, Smith M, Werbrouck P July 2021, Virtual

ABSTRACT Darolutamide is a structurally distinct and highly potent androgen receptor inhibitor (ARI) that has been demonstrated to significantly prolong metastasis-free survival and overall survival in men with nonmetastatic castration-resistant prostate cancer (nmCRPC) in the phase 3 ARAMIS trial. Darolutamide improved MFS by almost 2 years and reduced the risk of death by 31% compared with placebo.

Men with nmCRPC are generally asymptomatic from their cancer, but they may experience cancer treatment-related adverse events (AEs) that can affect daily life. Darolutamide has a consistently favorable safety profile, with discontinuation rates due to AEs similar between darolutamide (8.9%) and placebo (8.7%) groups. Hormone treatment–related (HTR) AEs include fatigue, memory impairment, hypertension, falls, fractures, hot flush, gynecomastia, erectile dysfunction, anemia, diabetes, cardiac disorders, weight gain, and dyslipidemia.

Here, we present HTR AEs for darolutamide treatment and characterize their onset and occurrence over time versus placebo. ARAMIS was a global, multicenter, double-blind, randomized, phase 3 trial of darolutamide 600 mg twice daily (n=955) versus placebo (n=554) plus androgen deprivation therapy (ADT) in men with nmCRPC and prostate-specific antigen doubling time ≤10 months. HTR AE rates were determined by Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Cumulative incidences of HTR AEs were analyzed using Kaplan-Meier estimates. The observation period was truncated at 24 months to ensure ≥10% of the population was at risk of AEs in each cohort.

During the double-blind period, time interval–specific new

56

ABSTRACTBOEK | 2021

event rates of HTR AEs were determined for the time period between consecutive study visits.

Consistent with previous safety reports, darolutamide was well tolerated in patientswith nmCRPC. Most HTR AEs occurred at a low incidence with darolutamide and with similarincidence to that of placebo. Fatigue, hypertension, hot flush, falls, fractures, anemia, and coronary artery disorders showed minimal increase with continued darolutamide treatment.

ABSTRACT 2 Time course profile of adverse events of interest and serious adverse events with darolutamide in the ARAMIS Trial Gratzke C, Fizazi K, Shore N, Werbrouck P, et al.

September 2021, online

ABSTRACT Darolutamide is a structurally distinct and highly potent androgen-receptor inhibitor (ARI) that improved metastasis-free survival by almost 2 years and reduced the risk of death by 31% vs placebo in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) in the phase 3 ARAMIS trial. Adverse events (AEs) of interest commonly associated with ARIs that can impact patient daily life include fatigue, falls, fractures, hypertension, mental impairment, and rash2-4.

Darolutamide has a consistently favorable safety and tolerability profile, with most AEs of interest showing ≤2% difference vs placebo. Fatigue was the only AE with an incidence with >10% in the darolutamide arm (13.2% vs 8.3% for placebo). Discontinuation rates due to AEs were similar between darolutamide (8.9%) and placebo (8.7%) groups and remained constant after longer follow-up.

Patients with nmCRPC are generally asymptomatic from their cancer and may receive prolonged treatment with ARIs. Understanding the burden and time course of AEs commonly associated with ARIs that may impact patients’ daily lives will help inform optimal treatment selection for patients with nmCRPC. Using data from ARAMIS, we present analyses of AEs of interest, grade 3/4 AEs, and serious AEs, characterizing their onset and occurrence over time. ARAMIS was a global, multicenter, double-blind, randomized, phase 3 trial of darolutamide 600 mg twice daily (n=955) vs placebo (n=554) plus androgen deprivation therapy in

patients with nmCRPC and prostate-specific antigen doubling time ≤10 months1,2. Cumulative incidences of AEs were analyzed using Kaplan–Meier estimates for the first 24 months of the double-blind period to ensure >10% of the population was at risk for AEs in each cohort.

Time interval–specific analysis determined new event rates of AEs at each scheduled study visit. During the first 24 months of the double-blind period, the incidence of AEs of interest with darolutamide was low and ≤2% different from that in the placebo group, except for fatigue (Figure 1). During the first month of darolutamide and placebo treatment, new event rates were very low and similar in the darolutamide and placebo arms for falls (0.2% and 0.7%), fractures (0.4% and 0.5%), mental impairment (0% and 0.4%), hypertension (1.7% and 1.1%), and rash (0.7% and 0.2%), respectively. In patients who had fatigue during the first 24 months (darolutamide, 12.6%; placebo, 8.3%), almost one-half experienced fatigue onset during the first month in both arms (darolutamide, 5.9%; placebo, 4.0%; Figure 2).

Cumulative incidence of fatigue minimally increased over time (Figure 2). Falls and fractures occurred mostly after the first month of treatment and had similar cumulative incidences for darolutamide and placebo (Figures 3 and 4).

New-onset hypertension was not time interval–specific, and cumulative incidences of hypertension were similar between treatments (Figure 5). Mental impairment rarely occurred (<1% in each treatment group per time interval) and had similar cumulative incidences for darolutamide and placebo (Figure 6). Rash mostly occurred in the first 4 months of treatment and showed minimal increase over time (Figure 7). Rash was reported with worst grade of 1 or 2 in severity in almost all patients, except for 2 patients treated with darolutamide and 1 patient assigned to placebo who had rash of grade 3 severity Grade 3/4 AEs and Serious AEs. Rate of initial onset and cumulative incidence of grade 3/4 AEs and serious AEs were similar for darolutamide and placebo over 24 months (Figures 8 and 9). The time course profile of most AEs of interest, grade 3/4 AEs, and serious AEs confirms the safety profile of darolutamide, showing low incidence and a similar onset and cumulative incidence vs placebo.

UROLOGIE

57

CENTRUM

VASCULAIRE EN THORACALE CHIRURGIE ARTIKELS

ABSTRACT 1 Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARSCoV-2: the COVIDSurg mortality score Lerut P, De Smul G, Wallaert P, Janssen M, et al.

British Journal of Surgery, 2021, 108(11), 1274-1292

ABSTRACT To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2.

We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years.

Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods.

Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·911·32; p=0·21).

ABSTRACT 2 Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable.

Halliday A, Bulbulia R, Bonati LH, Lerut P, et al.

The Lancet, 2021, 398, 1065-1073

ABSTRACT 3 ABSTRACT Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks.

Quality Indicators in Vascular Surgery: Toward a National Consensus on 20 Quality Indicators in Belgium Peerboom D, De Coster J, Vanhaecht K, Lerut P, et al.

Annals of Vascular Surgery, 2021, 71, 237-248

ABSTRACT However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which

58

ABSTRACTBOEK | 2021

The aim of the present study is to develop relevant quality indicators (QI) to monitor and improve quality of care in vascular surgery. The Delphi method was used to incorporate expert opinion to reach consensus on a set of QI. A national expert panel consisting of 52 vascular surgeons was installed on a voluntary basis and endorsed by the Belgian Society of Vascular Surgery and the Flemish Hospital Network KU Leuven. A task force team consisting of 12 surgeons was created to serve as a delegation of the expert panel to discuss and filter the obtained data from the different Delphi rounds.

A total of 3 Delphi rounds were needed to reach consensus on a set of 20 QI. Each QI had a content validity index (using a 7-point Likert scale), a feasibility index, and a target level. Twelve outcome indicators and 8 process indicators on several vascular topics were selected: overall for all vascular treatments (n = 1), arterial occlusive disease in general (n = 3), arterial occlusive disease of the lower limbs (n = 4), arterial occlusive disease of the carotid arteries (n = 5), arterial aneurysm disease in general (n = 2), arterial aneurysm disease with endovascular treatment (n = 1), and venous disease (n = 4).

This resulted in the successful identification of 20 validated and relevant vascular QI, focusing on arterial occlusive disease, arterial aneurysm disease, and venous disease. The next step in this project will be the performance of an implementation study.

VASCULAIRE EN THORACALE CHIRURGIE

59

NOTITIES

60 ABSTRACTBOEK | 2021

Az groeninge is internationaal erkend door jci voor veilige zorg en kwaliteit. www.azgroeninge.be/kwaliteit

62

ABSTRACTBOEK | 2021