Abstractboek 2022 - az groeninge

ABSTRACT BOEK 2022

Wetenschappelijke publicaties van az groeninge

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

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

VOORWOORD Beste lezer,

Voor u ligt de laatste editie van ons abstractboek, dat intussen naar gewoonte een overzicht geeft van de wetenschappelijke output van onze medische diensten en medewerkers van het voorbije jaar.

Wetenschappelijke interesse in ons ziekenhuis is geen nieuw gegeven. Al sinds het ontstaan van het fusieziekenhuis, ruim 20 jaar geleden, nam het aantal en het niveau van de publicaties toe. Een deel van deze publicaties vond zijn oorsprong in klinische studies, aanvankelijk grotendeels op initiatief van farmaceutische bedrijven, maar door de jaren ook steeds vaker in huis opgezette klinische studies, al dan niet in samenwerking met een universiteit, vaak de nabij gelegen Kulak. Een toenemend aantal stafleden is houder van een doctoraat of is geëngageerd om er een te behalen. Het aantal artsen specialist in opleiding en stagiairs nam gaandeweg toe; in samenwerking met Kulak werd een groeiende rol opgenomen in het praktisch onderwijs voor bachelor-studenten geneeskunde. Ook de praktische opleiding voor verpleegkundigen, kinesisten, analisten en een hele reeks zorgprofessionals werd steeds beter uitgebouwd. Sommige van onze cursussen voor gevestigde professionals mikken intussen met succes op een internationaal publiek; ook onze traditionele symposia evolueren al eens tot een internationaal congres.

Op een organische manier ontpopte AZ Groeninge zich geleidelijk aan tot een centrum van (toegepaste) wetenschap en innovatie, een baken van expertise die genereus gedeeld wordt met externen. Om deze spontane evolutie verder te professionaliseren werd in het voorjaar van 2023 binnen de schoot van ons ziekenhuis een innovatie- en expertisehub gelanceerd. Deze kreeg de naam The Greenhouse. Die naam verwijst met een knipoog naar de naam van ons ziekenhuis, Groeninge, maar verwijst tegelijk metaforisch naar een broeikas, een plaats waar ideeën kunnen groeien en bloeien. Bij de aanvang kent The Greenhouse drie pijlers met een sterke onderlinge overlap: innovatie, klinische studies en data, en het expertisecentrum. Ons reeds jaren bestaand wetenschappelijk comité integreert zich in deze werking en zal waar relevant junior stafleden ondersteunen bij hun wetenschappelijke ambities. Bij het ter perse gaan van dit abstractboek zijn we nog volop bezig met aanwervingen en het verder structureren en uitbouwen van deze hub, die hoger aangehaalde spontane evolutie nog meer moet faciliteren en stimuleren. Uiteraard willen we deze ambities niet alléén waar maken, en mikken daarbij nadrukkelijk op samenwerking. We steken de hand uit naar de farma- en medtech industrie, de universiteiten en hogescholen, naar onze E17-netwerkpartners, en waar van toepassing ook naar ziekenhuizen buiten ons netwerk.

Voorliggend abstractbook illustreert perfect de expertise en het kunnen dat ons ziekenhuis in deze samenwerkingen te bieden heeft.

DR. SERGE VANDERSCHUEREN MEDISCH DIRECTEUR AZ GROENINGE

ABDOMINALE CHIRURGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Provoost AL, D'Hondt M, Willems E et al.

JOURNAL: World Journal of Surgery

TITEL: A Comparative Study of an Integrated Ultrasonic/Bipolar Sealing Device Versus an Articulating Bipolar Sealing Device for Laparoscopic Liver Surgery.

VOLUME: 46

ISSUE: 12

PAGINA’S: 2963-2972

JAAR: 2022

DOI: 10.1007/s00268-022-06734-3

ABSTRACT:

BACKGROUND:

Sealing devices (SD) seal and cut tissue through different energy modalities, and are routinely used in laparoscopic liver surgery (LLS). The aim of this study is to compare the outcome of Thunderbeat (TB), an integrated ultrasonic/bipolar SD, versus Enseal (ES), an articulating bipolar SD, in LLS.

METHODS:

A retrospective analysis was conducted in a single center from December 2013 to September 2020. The primary endpoint was difference in blood loss (BL) between ES and TB. Secondary endpoints were complications, operative time, hospital stay, and 90-day mortality.

RESULTS:

352 patients were identified: TB (n = 105) and ES (n = 247). Median BL was significantly lower with TB (50 mL [20-120]) compared to ES (100 mL [50-250]) (p < 0.0001). Significant differences were identified for median operative time (TB 115 min [45-300]) vs. ES 140 min [40-370]; p = 0.0008) and median hospital stay (TB 2 days [1-4] vs. ES 4 days [3-6]; p < 0.0001). No major differences were encountered for postoperative bleeding (TB 0% vs. ES 1%; p = 0.5574), biliary leak (TB 1% vs. ES 2%; p = 1.0000), and 90-day mortality (TB 0% vs. ES 1%; p = 1.0000).

CONCLUSION:

The integrated ultrasonic/bipolar SD is superior to the articulating bipolar SD in LLS for intraoperative BL without an increase in complications.

AUTEURS: Willems E, D'Hondt M, Kingham TP, Fuks D, Choi G, Syn NS, et al.

JOURNAL: Journal of the American College of Surgeons

TITEL: Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity-Score Matched and Coarsened-Exact Matched Analysis of 1100 Patients.

VOLUME: 1

ISSUE: 235

PAGINA’S: 859-868

JAAR: 2022

DOI: 10.1097/XCS.0000000000000394

ABSTRACT:

BACKGROUND:

The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy.

STUDY DESIGN:

This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure

laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact-matched analysis was performed.

RESULTS:

A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/ MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching.

CONCLUSIONS:

Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.

AUTEURS: Sucandy I, Rayman S, Lai E, Tang C, Chong Y, Efanov M, Fuks D, Choi G, Chong C, Chiow A, Marino M, Prieto M, Lee J, Kingham T, D’Hondt M, Troisi R, Choi S, Sutcliffe R, Cheung T, Rotellar F, Park J, Scatton O, Han H, Pratschke J, International Robotic and Laparoscopic Liver Resection Study Group Collaborators

JOURNAL: Annals of Surgical Oncology

TITEL: ASO Visual Abstract: Robotic Versus Laparoscopic Left and Extended Left Hepatectomy-An International Multicenter Study Propensity-Score-Matched Analysis.

VOLUME: 29

ISSUE:

PAGINA’S: 8410–8412

JAAR: 2022

DOI: 10.1245/s10434-022-12305-6

ABSTRACT:

AUTEURS: D’Silva M, Han H, Liu R, Kingham T, Choi G, Syn N, Prieto M, Choi S, Sucandy I, Chiow A, Marino MV, Efanov M, Lee JH, Sutcliffe RP, Chong C, Tang C, Cheung TT, Pratschke J, Wang X, Park J, Chan C, Scatton O, Rotellar F, Troisi R, D’Hondt M, Fuks D, Goh B

JOURNAL: British Journal of Surgery

TITEL: Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches

VOLUME: 109

ISSUE: 11

PAGINA’S: 1140–1149

JAAR: 2022

DOI: https://doi.org/10.1093/bjs/znac270

ABSTRACT:

BACKGROUND:

Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).

METHODS:

This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres

between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.

RESULTS:

Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40–200) versus 200 (100–500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20–46) versus 40 (25–58) min; P = 0.012), and median duration of operation (175 (130–255) versus 224 (155–300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.

CONCLUSION:

Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.

AUTEURS: Görgec B, Cacciaguerra AB, Pawlik TM, Aldrighetti LA, Alseidi AA, Cillo U, Kokudo N, Geller DA, Wakabayashi G, Asbun HJ, Besselink MG, Cherqui D, Cheung TT, Clavien HA, Conrad C, D'Hondt M, Dagher I, Dervenis C, Devar J , Dixon E, Edwin B, Efanov M, Ettore GM, Ferrero A, Fondevilla C, Fuks D, Giuliante F, Han H-S, Honda G, Imventarza O, Kooby D, Lodge P, Lopez-Ben S, Machado MA, Marques HP, O'Rourke N, Pekolj J, Pinna AD, Portolani N, Primrose J, Rotellar F, Ruzzenente A , Schadde E, Siriwardena AK, Smadi S , Soubrane O, Tanabe KK , Teh CSC, Torzilli G , Van Gulik TM, Vivarelli M, Wigmore SJ, Abu Hila M

JOURNAL: Annals of Surgery

TITEL: An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)

VOLUME: 277

ISSUE: 5

PAGINA’S: 821-828

JAAR: 2022

DOI: 10.1097/SLA.0000000000005668.

ABSTRACT:

OBJECTIVE:

To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method. Summary background data: Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite a recently developed international definition of Textbook Outcome in Liver Surgery (TOLS), a standardized and expert consensus-based definition is lacking.

METHODS:

This international, consensus-based, qualitative study used a Delphi process to achieve consensus on the definition of TOLS. The survey comprised 6 surgical domains with a total of 26 questions on individual surgical outcome variables. The process included 4 rounds of online questionnaires. Consensus was achieved when a threshold of at least 80% agreement was reached. Results from the Delphi rounds were used to establish an international definition of TOLS.

RESULTS:

In total, 44 expert liver surgeons from 22 countries and all three major international hepato-pancreato-biliary associations completed round 1. Forty-two (96%), 41 (98%) and 41 (98%) of the experts participated in round 2, 3 and 4, respectively. The TOLS definition derived from the consensus process included the absence of intraoperative grade ≥2 incidents, postoperative bile leakage grade B/C, postoperative liver failure grade B/C, 90-day major postoperative complications, 90-day readmission due to surgery-related major complications, 90-day/in-hospital mortality and the presence of R0 resection margin.

CONCLUSIONS:

This is the first study providing an international expert consensus-based definition of TOLS for minimally invasive and open liver resections by use of a formal Delphi consensus approach. TOLS may be useful in assessing patient-level hospital performance and carrying out international comparisons between centers with different clinical practices to further improve patient outcomes.

AUTEURS: Choi SH, Chen K-H, Syn NL, Cipriani F, Cheung TT, Chiow AKH, Choi G-H, Siow T-F, Sucandy I, Marino MV, Gastaca M, Chong CC, Lee JH, Ivanecz A, Mazzaferro V, Lopez-Ben S, Fondevila C, Rotellar F, Robles Campos R, Efanov M, Kingham TP, Sutcliffe RP, Troisi RI, Pratschke J, International robotic and laparoscopic liver resection study group investigators

JOURNAL: Surgical Endoscopy

TITEL: Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

VOLUME: 36

ISSUE:

PAGINA’S: 9204–9214

JAAR: 2022

DOI: 10.1007/s00464-022-09404-6

ABSTRACT:

INTRODUCTION:

The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated.

METHODS:

Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes.

RESULTS:

The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality.

CONCLUSION:

Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

AUTEURS: Efanov M, Salimgereeva D, Alikhanov R, Wu AGR, Geller D, Cipriani F, et al. D’hondt M. International Robotic and Laparoscopic Liver Resection Study Group Investigators

JOURNAL: Journal of Hepato-Biliary-Pancreatic Sciences

TITEL: Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8: An international multicenter propensity-score matched study

VOLUME: 30

ISSUE: 2

PAGINA’S: 177-191

JAAR: 2022

DOI: https://doi.org/10.1002/jhbp.1210

ABSTRACT:

BACKGROUND:

Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8.

METHODS:

A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed.

1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8.

RESULTS:

A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay.

CONCLUSION:

Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

AUTEURS: Wang HP, Yong CCY, Wu AGR, Cherqui D, Troisi RI, Cipriani F, et al., D'Hondt M, International Robotic and Laparoscopic Liver Resection Study Group Investigators

JOURNAL: Surgery

TITEL: Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study

VOLUME: 172

ISSUE: 2

PAGINA’S: 617-624

JAAR: 2022

DOI: https://doi.org/10.1016/j.surg.2022.03.037

ABSTRACT:

BACKGROUND:

Despite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes.

METHODS:

This is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases.

RESULTS:

The open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P = .011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P = .009), and larger tumor size (50 mm vs 32 mm, P < .001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach.

CONCLUSION:

Male sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases.

JOURNAL: Trials

TITEL: Laparoscopic versus open resections in the posterosuperior liver segments within an enhanced recovery programme

(ORANGE Segments): study protocol for a multicentre randomised controlled trial

VOLUME: 23

ISSUE: 1

PAGINA’S: 206

JAAR: 2022

DOI: 10.1186/s13063-022-06112-3

ABSTRACT:

BACKGROUND:

A shift towards parenchymal-sparing liver resections in open and laparoscopic surgery emerged in the last few years. Laparoscopic liver resection is technically feasible and safe, and consensus guidelines acknowledge the laparoscopic approach in the posterosuperior segments. Lesions situated in these segments are considered the most challenging for the laparoscopic approach. The aim of this trial is to compare the postoperative time to functional recovery, complications, oncological safety, quality of life, survival and costs after laparoscopic versus open parenchymal-sparing liver resections in the posterosuperior liver segments within an enhanced recovery setting.

METHODS:

The ORANGE Segments trial is an international multicentre randomised controlled superiority trial conducted in centres experienced in laparoscopic liver resection. Eligible patients for minor resections in the posterosuperior segments will be randomised in a 1:1 ratio to undergo laparoscopic or open resections in an enhanced recovery setting. Patients and ward personnel are blinded to the treatment allocation until postoperative day 4 using a large abdominal dressing. The primary endpoint is time to functional recovery. Secondary endpoints include intraoperative outcomes, length of stay, resection margin, postoperative complications, 90-day mortality, time to adjuvant chemotherapy initiation, quality of life and overall survival. Laparoscopic liver surgery of the posterosuperior segments is hypothesised to reduce time to functional recovery by 2 days in comparison with open surgery. With a power of 80% and alpha of 0.04 to adjust for interim analysis halfway the trial, a total of 250 patients are required to be randomised.

DISCUSSION:

The ORANGE Segments trial is the first multicentre international randomised controlled study to compare short- and long-term surgical and oncological outcomes of laparoscopic and open resections in the posterosuperior segments within an enhanced recovery programme.

AUTEURS: Cacciaguerra AB , Görgec B, Cipriani F, Aghayan D, Borelli G, Aljaiuossi A, D'Hondt M, et al.

JOURNAL: Ann Surg

TITEL: Risk Factors of Positive Resection Margin in Laparoscopic and Open Liver Surgery for Colorectal Liver Metastases: A New Perspective in the Perioperative Assessment: A European Multicenter Study

VOLUME: 275

ISSUE: 1

PAGINA’S: e213-e221

JAAR: 2022

DOI: 10.1097/SLA.0000000000004077

AUTEURS: Kuemmerli C, Fichtinger RS, Moekotte A, Aldrighetti LA, Aroori S, Besselink MGH, D'Hondt M, et al. ORANGE trials collaborative

ABSTRACT:

OBJECTIVE:

To assess the risk factors associated with R1 resection in patients undergoing OLS and LLS for CRLMs.

BACKGROUND:

The clinical impact of R1 resection in liver surgery for CRLMs has been continuously appraised, but R1 risk factors have not been clearly defined yet.

METHODS:

A cohort study of patients who underwent OLS and LLS for CRLMs in 9 European high-volume referral centers was performed. A multivariate analysis and the receiver operating characteristic curves were used to investigate the risk factors for R1 resection. A model predicting the likelihood of R1 resection was developed.

RESULTS:

Overall, 3387 consecutive liver resections for CRLMs were included. OLS was performed in 1792 cases whereas LLS in 1595; the R1 resection rate was 14% and 14.2%, respectively. The risk factors for R1 resection were: the type of resection (nonanatomic and anatomic/nonanatomic), the number of nodules and the size of tumor. In the LLS group only, blood loss was a risk factor, whereas the Pringle maneuver had a protective effect. The predictive size of tumor for R1 resection was >45 mm in OLS and >30 mm in LLS, > 2 lesions was significative in both groups and blood loss >350 cc in LLS. The model was able to predict R1 resection in OLS (area under curve 0.712; 95% confidence interval 0.665-0.739) and in LLS (area under curve 0.724; 95% confidence interval 0.671-0.745).

CONCLUSIONS:

The study describes the risk factors for R1 resection after liver surgery for CRLMs, which may be used to plan better the perioperative strategies to reduce the incidence of R1 resection during OLS and LLS.

AUTEURS: Kadam P, Sutcliffe RP, Scatton O, Sucandy I, Kingham P, Liu R, Choi GH, Syn NL, Gastaca M, Choi S, Chiow AKH, Marino MV, Efanov M, Lee J, Chong CC, Tang C, Cheung T, Pratschke J, Wang X, Campos RR, Ivanecz A, Park JO, Rotellar F, Fuks D, D'Hondt M, Han H, Troisi RI, Goh BKP, International Robotic and Laparoscopic Liver Resection Study Group Investigators

JOURNAL: Journal of Hepato-Biliary-Pancreatic Sciences

TITEL: An international multicenter propensity-score matched and coarsened-exact matched analysis comparing robotic versus laparoscopic partial liver resections of the anterolateral segments

VOLUME: 29

ISSUE: 8

PAGINA’S: 843-854

JAAR: 2022

DOI: https://doi.org/10.1002/jhbp.1149

ABSTRACT:

BACKGROUND:

Robotic liver resections (RLR) may have the ability to address some of the drawbacks of laparoscopic liver resections (LLR) but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques.

METHODS:

A retrospective study was conducted of 3202 patients who underwent minimally invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. Two thousand six hundred and six cases met study criteria of which there were 358 RLR and 1868 LLR cases. Perioperative outcomes were compared between the two groups using a 1:3 Propensity Score Matched (PSM) and 1:1 Coarsened Exact Matched (CEM) analysis.

RESULTS:

Patients matched after 1:3 PSM (261 RLR vs 783 LLR) and 1:1 CEM (296 RLR vs 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality, and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss (50 mL vs 100 ml, P < .001) and lower rates of open conversion on both PSM (1.5% vs 6.8%, P = .003) and CEM (1.4% vs 6.4%, P = .004) compared to LLR. Though PSM analysis showed RLR to

have a longer operating time than LLR (170 minutes vs 160 minutes, P = .036), this difference proved to be insignificant on CEM (167 minutes vs 163 minutes, P = .575).

CONCLUSION:

This multicentre international combined PSM and CEM study showed that both RLR and LLR have equivalent perioperative outcomes when performed in selected patients at high-volume centres. The robotic approach was associated with significantly lower blood loss and allowed more surgeries to be completed in a minimally invasive fashion.

AUTEURS: Zimmitti G, Sijberden JP, Osei-Bordom D, Russolillo N, Aghayan D, Lanari J, Cipriani F, López-Ben S, Rotellar F, Fuks D, D'Hondt M, Primrose JN, Görgec B, Cacciaguerra AB, Marudanayagam R, Langella S, Vivarelli M, Ruzzenente A, Besselink MG, Alseidi A, Efanov M, Giuliante F, Dagher I, Jovine E, di Benedetto F, Aldrighetti LA, Cillo U, Edwin B, Ferrero A, Sutcliffe RP, Abu Hilal M

Journal: Int J Surg

TITEL: Indications, trends, and perioperative outcomes of minimally invasive and open liver surgery in non-obese and obese patients: An international multicentre propensity score matched retrospective cohort study of 9963 patients

VOLUME: 107

ISSUE:

PAGINA’S: 106957

JAAR: 2022

DOI: 10.1016/j.ijsu.2022.106957.

ABSTRACT:

BACKGROUND:

Despite the worldwide increase of both obesity and the use of minimally invasive liver surgery (MILS), evidence regarding the safety and eventual benefits of MILS in obese patients is scarce. The aim of this study was therefore to compare the outcomes of non-obese and obese patients (BMI 18.5-29.9 and BMI≥30, respectively) undergoing MILS and OLS, and to assess trends in MILS use among obese patients.

METHODS:

In this retrospective cohort study, patients operated at 20 hospitals in eight countries (2009-2019) were included and the characteristics and outcomes of non-obese and obese patients were compared. Thereafter, the outcomes of MILS and OLS were compared in both groups after propensity-score matching (PSM). Changes in the adoption of MILS during the study period were investigated.

RESULTS:

Overall, 9963 patients were included (MILS: n = 4687; OLS: n = 5276). Compared to non-obese patients (n = 7986), obese patients(n = 1977) were more often comorbid, less often received preoperative chemotherapy or had a history of previous hepatectomy, had longer operation durations and more intraoperative blood loss (IOBL), paralleling significantly higher rates of wound- and respiratory-related complications. After PSM, MILS, compared to OLS, was associated, among both non-obese and obese patients, with less IOBL (200 ml vs 320 ml, 200 ml vs 400 ml, respectively), lower rates of transfusions (6.6% vs 12.8%, 4.7% vs 14.7%), complications (26.1% vs 35%, 24.9% vs 34%), bile leaks(4% vs 7%, 1.8% vs 4.9%), liver failure (0.7% vs 2.3%, 0.2% vs 2.1%), and a shorter length of stay(5 vs 7 and 4 vs 7 days). A cautious implementation of MILS over time in obese patients (42.1%-53%, p < .001) was paralleled by stable severe morbidity (p = .433) and mortality (p = .423) rates, despite an accompanying gradual increase in surgical complexity.

CONCLUSIONS:

MILS is increasingly adopted and associated with perioperative benefits in both non-obese and obese patients.

AUTEURS: Drubay V, Nuytens F, Renaud F, Adenis A, Eveno C, Piessen G.

JOURNAL: World J Gastrointest Oncol

TITEL: Poorly cohesive cells gastric carcinoma including signet-ring cell cancer: Updated review of definition, classification and therapeutic management

VOLUME: 14

ISSUE: 8

PAGINA’S: 1406-1428

JAAR: 2022

DOI: 10.4251/wjgo.v14.i8.1406.

ABSTRACT:

While the incidence of gastric cancer (GC) in general has decreased worldwide in recent decades, the incidence of diffuse cancer historically comprising poorly cohesive cells-GC (PCC-GC) and including signet ring cell cancer is rising. Literature concerning PCC-GC is scarce and unclear, mostly due to a large variety of historically used definitions and classifications. Compared to other histological subtypes of GC, PCC-GC is nevertheless characterized by a distinct set of epidemiological, histological and clinical features which require a specific diagnostic and therapeutic approach. The aim of this review was to provide an update on the definition, classification and therapeutic strategies of PCC-GC. We focus on the updated histological definition of PCC-GC, along with its implications on future treatment strategies and study design. Also, specific considerations in the diagnostic management are discussed. Finally, the impact of some recent developments in the therapeutic management of GC in general such as the recently validated taxane-based regimens (5-Fluorouracil, leucovorin, oxaliplatin and docetaxel), the use of hyperthermic intraperitoneal chemotherapy as well as pressurized intraperitoneal aerosol chemotherapy and targeted therapy have been reviewed in depth for their relative importance for PCC-GC in particular.

AUTEURS: Bres C, Voron T, Benhaim L, Bergeat D, Parc Y, Karoui M, Genser L, Péré G, Demma JA, Bacoeur-Ouzillou O, Lebreton G, Thereaux J, Gronnier C, Dartigues P, Svrcek M, Bouzillé G, Bardier A, Brunac AC, Roche B, Darcha C, Bazille C, Doucet L, Belleannee G, Lejeune S, Buisine MP, Renaud F, Nuytens F, Benusiglio PR, Veziant J, Eveno C, Piessen G.

JOURNAL: Ann Surg

TITEL: Management of Pathogenic CDH1 Variant Carriers Within the FREGAT Network: A Multicentric Retrospective Study

VOLUME: 276

ISSUE: 5

PAGINA’S: 830-837

JAAR: 2022

DOI: 10.1097/SLA.0000000000005626.

ABSTRACT:

OBJECTIVE:

To describe the management of pathogenic CDH1 variant carriers (pCDH1vc) within the FREGAT (FRench Eso-GAsTric tumor) network. Primary objective focused on clinical outcomes and pathological findings, Secondary objective was to identify risk factor predicting postoperative morbidity (POM).

BACKGROUND:

Prophylactic total gastrectomy (PTG) remains the recommended option for gastric cancer risk management in pCDH1vc with, however, endoscopic surveillance as an alternative.

METHODS:

A retrospective observational multicenter study was carried out between 2003 and 2021. Data were reported as median (interquartile range) or as counts (proportion). Usual tests were used for univariate analysis. Risk factors of overall and severe POM (ie, Clavien-Dindo grade 3 or more) were identified with a binary logistic regression.

RESULTS:

A total of 99 patients including 14 index cases were reported from 11 centers. Median survival among index cases was 12.0 (7.6-16.4) months with most of them having peritoneal carcinomatosis at diagnosis (71.4%). Among the remaining 85 patients, 77 underwent a PTG [median age=34.6 (23.7-46.2), American Society of Anesthesiologists score 1: 75%] mostly via a minimally invasive approach (51.9%). POM rate was 37.7% including 20.8% of severe POM, with age 40 years and above and low-volume centers as predictors ( P =0.030 and 0.038). After PTG, the cancer rate on specimen was 54.5% (n=42, all pT1a) of which 59.5% had no cancer detected on preoperative endoscopy (n=25).

CONCLUSIONS:

Among pCDH1vc, index cases carry a dismal prognosis. The risk of cancer among patients undergoing PTG remained high and unpredictable and has to be balanced with the morbidity and functional consequence of PTG.

AUTEURS: Taillieu E, De Meyere C, Nuytens F, Vanneste G, Libbrecht L, Alaerts H, Parmentier I, Verslype C, D'Hondt M

Journal: Langenbecks Arch Surg

TITEL: Laparoscopic liver resection for colorectal liver metastases: retrospective analysis of prognostic factors and oncological outcomes in a single-center cohort

VOLUME: 407

ISSUE: 6

PAGINA’S: 2399-2414

JAAR: 2022

DOI: doi: 10.1007/s00423-022-02534-4

ABSTRACT:

PURPOSE:

Laparoscopic liver resection (LLR) has gained acceptance as an effective treatment for colorectal liver metastases (CRLM) in selected patients, providing similar oncologic outcomes compared to open liver resection (OLR). The aim of this study was to determine prognostic factors for survival outcomes associated with LLR for CRLM.

METHODS:

A single-center retrospective analysis of a prospectively maintained database was performed. The inclusion period ranged from September 2011 until mid-March 2020.

RESULTS:

Two hundred consecutive LLRs were included. The 5-year overall survival (OS) and disease-free survival (DFS) rates equalled 54.8% and 49%, respectively. A pushing (HR = 5.42, 95% CI 1.56-18.88, p = 0.008), as well as a replacement (3.87, 1.05-14.2, p = 0.04) growth pattern of the CRLM, poor differentiation of the primary colorectal cancer (CRC) (3.72, 1.72-8.07, p < 0.001) and administration of neoadjuvant chemotherapy (NAC) (2.95, 1.28-6.8, p = 0.01) were identified as independent predictors of a worse OS. Requirement of more than 6 cycles of NAC (6.17, 2.37-16.03, p < 0.001), a replacement (4.96, 1.91-12.87, p < 0.001), as well as a pushing (4.3, 1.68-11, p = 0.002) growth pattern of the CRLM and poor differentiation of the primary CRC (2.61, 1.31-5.2, p = 0.006) were identified as independent predictors of a worse DFS.

CONCLUSION:

LLR for CRLM offers adequate long-term oncologic outcomes. OS and DFS rates are negatively affected by the administration of NAC and by pathological features, including the differentiation grade of the primary CRC and the histological growth pattern of the CRLM.

AUTEURS: Nuytens F, Lenne X, Clément G, Bruandet A, Eveno C, Piessen G.

JOURNAL: Ann Surg Oncol

TITEL: Effect of Phased Implementation of Totally Minimally Invasive Ivor Lewis Esophagectomy for Esophageal Cancer after Previous Adoption of the Hybrid Minimally Invasive Technique: Results from a French Nationwide Population-Based Cohort Study

VOLUME: 29

ISSUE: 5

PAGINA’S: 2791-2801

JAAR: 2022

DOI: 10.1245/s10434-021-11110-x

ABSTRACT:

ABSTRACT BACKGROUND:

Several randomized controlled trials (RCTs) have demonstrated improved short-term outcomes of totally minimally invasive esophagectomy (TMIE) compared with open esophagectomy (OE); however, to what extent these outcomes can be

extrapolated to a national level remains debatable.

OBJECTIVE:

The aim of this study was to evaluate, on a nationwide basis, the short-term outcomes of TMIE and to analyze these results within the context of previously implemented hybrid minimally invasive esophagectomy (HMIE).

METHODS:

All consecutive patients who underwent a curative Ivor Lewis esophagectomy in France between 2017 and 2019 were included in this retrospective cohort study. The primary endpoint was to compare 90-day postoperative mortality (POM) between OE, HMIE, and TMIE, while secondary endpoints were defined as the rate of postoperative complications. A matched and multivariate analysis was adjusted for confounding factors.

RESULTS:

Overall, 2675 patients were included (1003 OE vs. 1498 HMIE vs. 174 TMIE). In every center where TMIE was performed, HMIE had been previously adopted. The matched 90-day POM rate in the TMIE group was significantly lower compared with the OE group (2.3% vs. 6.3%, p = 0.046) but not compared with the HMIE group (2.3% vs. 4.9%, p = 0.156). There was no significant difference between TMIE and OE, or TMIE and HMIE, regarding the 30-day fistula rate (21.8% vs. 17%, p = 0.176; and 21.8% vs. 21.3%, p = 0.88, respectively). TMIE was associated with a reduced rate of pulmonary complications compared with OE (33.9% vs. 44%, p = 0.027) and HMIE (33.9% vs. 42.8%, p = 0.05). Low-volume centers were identified as a negative predictive factor for 90-day POM (odds ratio 1.89, 95% confidence interval 1.3-2.75, p = 0.001).

CONCLUSION:

TMIE is associated with a lower 90-day POM rate compared with OE and offers reduced rates of pulmonary complications compared with OE and HMIE. After previous adoption of the HMIE technique, TMIE can be safely implemented in high-volume centers nationwide.

AUTEURS: Ciers P., Vanderhaege D., Vansteenkiste F., Moubax K., Vanooteghem S., Van Moerkercke W., et al.

Journal: Acta Chir. Belg. 2022

TITEL: Lymphoepithelial cysts of the pancreas: case report and review of the literature

VOLUME: -

ISSUE: -

PAGINA’S: 1-5

JAAR: 2022

DOI: 10.1080/00015458.2022.2050032

ABSTRACT:

BACKGROUND:

Lymphoepithelial cysts (LECs) of the pancreas are a rare type of true pancreatic cysts and represent an estimated 0.5% of all pancreatic cystic lesions . They are benign lesions and have no malignant potential. However, they are hard to differentiate from malignant lesions because their imaging and clinical presentation vary greatly. Seeing as these are benign lesions which are increasingly found incidentally during imaging for other indications, correct diagnosis is important to prevent unnecessary intervention and morbidity.

CASE REPORT:

We report the case of a 41-year-old female who presented with abdominal discomfort, bloating and dyspepsia. An abdominal computed tomography (CT) showed a large mass in the left fossa. We describe the diagnostic and therapeutic measures taken in this case. Methods: We reviewed the literature for common features of the LEC. We grouped common imaging and histological features of the LEC of the pancreas to provide easily identifiable characteristics to facilitate diagnosis. For the review, we focused on papers, mostly case reports, presenting these common characteristics. We also reviewed the literature for key topics that should be taken into account when considering therapeutic interventions in a patient with a possible diagnosis of a LEC.

CONCLUSION:

Cysts of the pancreas are increasingly identified due to widespread use and improved resolution of cross-sectional imaging. To obtain the correct diagnosis, it is sometimes necessary to combine advanced imaging, i.e. CT and MRI-imaging, and endoscopic ultrasound with fine needle aspiration (EUS/FNA), while CA 19-9 also has diagnostic value.

We summarize all diagnostic characteristics in a table for ease of use. Furthermore we summarized possible therapeutic interventions.

AUTEURS: van der Wilk BJ, Hagens ERC, Eyck BM, Gisbertz SS, van Hillegersberg R, Nafteux P, Schröder W, Nilsson M, Wijnhoven BPL, Lagarde SM, van Berge Henegouwen MI; Nuytens F, International Esodata Study Group Collaborators.

JOURNAL: Br J Surg

TITEL: Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group

VOLUME: 109

ISSUE: 3

PAGINA’S: 283-290

JAAR: 2022

DOI: 10.1093/bjs/znab432.

ABSTRACT:

BACKGROUND:

Large studies comparing totally minimally invasive oesophagectomy (TMIE) with laparoscopically assisted (hybrid) oesophagectomy are lacking. Although randomized trials have compared TMIE invasive with open oesophagectomy, daily clinical practice does not always resemble the results reported in such trials. The aim of the present study was to compare complications after totally minimally invasive, hybrid and open Ivor Lewis oesophagectomy in patients with oesophageal cancer.

METHODS:

The study was performed using data from the International Esodata Study Group registered between February 2015 and December 2019. The primary outcome was pneumonia, and secondary outcomes included the incidence and severity of anastomotic leakage, (major) complications, duration of hospital stay, escalation of care, and 90-day mortality. Data were analysed using multivariable multilevel models.

RESULTS:

Some 8640 patients were included between 2015 and 2019. Patients undergoing TMIE had a lower incidence of pneumonia than those having hybrid (10.9 versus 16.3 per cent; odds ratio (OR) 0.56, 95 per cent c.i. 0.40 to 0.80) or open (10.9 versus 17.4 per cent; OR 0.60, 0.42 to 0.84) oesophagectomy, and had a shorter hospital stay (median 10 (i.q.r. 8-16) days versus 14 (11-19) days (P = 0.041) and 11 (9-16) days (P = 0.027) respectively). The rate of anastomotic leakage was higher after TMIE than hybrid (15.1 versus 10.7 per cent; OR 1.47, 1.01 to 2.13) or open (15.1 versus 7.3 per cent; OR 1.73, 1.26 to 2.38) procedures.

CONCLUSION:

Compared with hybrid and open Ivor Lewis oesophagectomy, TMIE resulted in a lower pneumonia rate, a shorter duration of hospital stay, but higher anastomotic leakage rates. Therefore, no clear advantage was seen for either TMIE, hybrid or open Ivor Lewis oesophagectomy when performed in daily clinical practice.

AUTEURS: Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C; TENTACLE—Esophagus Collaborative Group.

JOURNAL: Br J Surg

TITEL: Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

VOLUME: 109

ISSUE: 9

PAGINA’S: 864-871

JAAR: 2022

DOI: 10.1093/bjs/znac226

ABSTRACT:

BACKGROUND:

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

METHODS:

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

RESULTS:

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

CONCLUSION:

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

AUTEURS: Giani A, Ramshorst T, Mazzola M, Bassi C, Esposito A, Pastena M, Edwin B, Sahakyan M, Kleive D, Jah A, van Laarhoven S, Boggi U, Kauffman EF, Casadei R, Ricci C, Dokmak S, Ftériche FS., White SA, SKamarajah SK, Butturini G, Frigerio I, Zerbi A, Capretti G, Pando E, Sutcliffe RP, Marudanayagam R, Fusai GK, Fabre JM, Björnsson B, Timmermann L, Soonawalla Z, Burdio F, Keck T, Hackert T, Koerkamp BG, D’Hondt M, Coratti A, Pessaux P, Pietrabissa A, Al-Sarireh B, Marino MV, Molenaar Q, Yip V, Besselink M, Ferrari G, Hilal MA, for the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

JOURNAL: British Journal of Surgery

TITEL: Benchmarking of minimally invasive distal pancreatectomy with splenectomy: European multicentre study

VOLUME: 109

ISSUE: 11

PAGINA’S: 1124-1130

JAAR: 2022

DOI: 10.1093/bjs/znac204.

ABSTRACT:

BACKGROUND:

Benchmarking is the process to used assess the best achievable results and compare outcomes with that standard. This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy (MIDPS).

METHODS:

This retrospective study included consecutive patients undergoing MIDPS for any indication, between 2003 and 2019, in 31 European centres. Benchmarks of the main clinical outcomes were calculated according to the Achievable Benchmark of Care (ABC™) method. After identifying independent risk factors for severe morbidity and conversion, risk-adjusted ABCs were calculated for each subgroup of patients at risk.

RESULTS:

A total of 1595 patients were included. The ABC was 2.5 per cent for conversion and 8.4 per cent for severe morbidity. ABC values were 160 min for duration of operation time, 8.3 per cent for POPF, 1.8 per cent for reoperation, and 0 per cent for mortality. Multivariable analysis showed that conversion was associated with male sex (OR 1.48), BMI exceeding 30 kg/m2 (OR 2.42), multivisceral resection (OR 3.04), and laparoscopy (OR 2.24). Increased risk of severe morbidity was

associated with ASA fitness grade above II (OR 1.60), multivisceral resection (OR 1.88), and robotic approach (OR 1.87).

CONCLUSION:

The benchmark values obtained using the ABC method represent optimal outcomes from best achievable care, including low complication rates and zero mortality. These benchmarks should be used to set standards to improve patient outcomes.

AUTEURS: de’Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D’Hondt M, Di Saverio S, Diana M, Simone MD, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger W, Catena F

Journal: World Journal of Emergency Surgery

TITEL: Robotic surgery in emergency setting: 2021 WSES position paper

VOLUME: 17

ISSUE: 4

PAGINA’S:

JAAR: 2022

DOI: 10.1186/s13017-022-00410-6

ABSTRACT:

BACKGROUND:

Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery.

METHODS:

This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus.

RESULTS:

Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations.

CONCLUSIONS:

Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.

AUTEURS: Chong CC, Fuks D, Lee K-F, Zhao JJ, Hong Choi G, Sucandy I, Chiow AKH , Marino MV, Gastaca M, Wang X, Lee

JH, Efanov M, Kingham TP, D'Hondt M, Troisi R, Choi S-H, Sutcliffe RP, Chan C-Y, Lai ECH, Park JO , Di Benedetto F, Rotellar

F, Sugioka A, Coelho FF, Ferrero A, Long TCD, Lim C, Scatton O, Liu Q, Schmelzle M, Pratschke J, Cheung T-T, Liu R, Han

H-S, Tang CN, Goh BKP; International Robotic and Laparoscopic Liver Resection study group investigators

Journal: JAMA Surgery

TITEL: Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy

VOLUME: 157

ISSUE: 5

PAGINA’S: 436-444

JAAR: 2022

DOI: 10.1001/jamasurg.2022.0161

ABSTRACT:

IMPORTANCE:

Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH).

OBJECTIVE:

To compare the outcomes of robotic vs laparoscopic RH/ERH.

DESIGN, SETTING, AND PARTICIPANTS:

In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included.

INTERVENTIONS:

Robotic vs laparoscopic RH/ERH.

MAIN OUTCOMES AND MEASURES:

Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed.

RESULTS:

Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46).

CONCLUSION AND RELEVANCE:

Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.

AUTEURS: Yang HY, Choi GH, Chin K-M, Choi SH, Syn NL, Cheung T-T, Chiow AKH, Sucandy I, Marino MV, Prieto M, Chong

CC, Lee JH, Efanov M, Kingham P, Sutcliffe RP, Troisi R, Pratschke J, Wang X, D'Hondt M, Tang CN, Liu R, Park JO, Rotellar

F, Scatton O, Sugioka A, Long TCD, Chan C, Fuks D, Han H-S, Goh BKP; the International Robotic and Laparoscopic Liver Resection Study Group Investigators

JOURNAL: British Journal of Surgery

TITEL: Robotic and laparoscopic right anterior sectionectomy and central hepatectomy: multicentre propensity scorematched analysis

VOLUME: 109

ISSUE: 4

PAGINA’S: 311–314

JAAR: 2022

DOI: https://doi.org/10.1093/bjs/znab463

ABSTRACT:

AUTEURS: Taillieu E, Celine De Meyere C, D'Hondt M

JOURNAL: Surgical Endoscopy

TITEL: The role of the laparoscopic approach in two-stage hepatectomy for colorectal liver metastases: a single-center experience

VOLUME: 36

ISSUE: 1

PAGINA’S: 559-568

JAAR: 2022

DOI: 10.1007/s00464-021-08317-0

ABSTRACT:

BACKGROUND:

In selected patients, laparoscopic liver surgery for the treatment of colorectal liver metastases (CRLM) leads to better short-term outcomes and comparable oncologic outcomes in comparison with an open approach. However, its role in two-stage hepatectomy (TSH) remains poorly explored.

METHODS:

A single-center retrospective study was performed to evaluate the role of laparoscopic liver resection (LLR) in the first and second stage of TSH. Demographic data, comorbid factors, perioperative outcomes, and short-term outcomes were evaluated.

RESULTS:

Between September 2011 and May 2020, 23 patients were planned to undergo a TSH. The first stage hepatectomy (FSH) was performed laparoscopically in 22 patients (96%) without need for conversion. The median blood loss was 50 cc (IQR 30-100 cc) and postoperative length of hospital stay was 4 days (IQR 2.5-5 days). R0 resections were obtained in 18 FSHs (78%), while all others were R1 vascular (22%). Fourteen patients (61%) underwent a second stage hepatectomy (SSH). All SSHs were anatomically major hepatectomies. SSH was performed laparoscopically in 7 patients (50%), with need for conversion in 1 case (14%). The median blood loss was slightly lower in the open liver resection (OLR) group compared to the LLR group (200 cc (IQR 110-375 cc) vs. 240 cc (IQR 150-400 cc), respectively. The median postoperative length of hospital stay was 3 days shorter in the LLR group compared to the OLR group (4 days (IQR 3.5-4 days) vs. 7 days (IQR 4.5-8.5 days), respectively).

CONCLUSIONS:

The already proven advantages of LLR in the treatment of CRLM favor the role of a laparoscopic approach in TSH for CRLM. In first stage minor or technically major hepatectomy, LLR is progressively becoming the gold standard. Laparoscopic second stage anatomically major hepatectomy is feasible in experienced hands, but should be limited to selected cases and should be performed in expert centers.

AUTEURS: D'Hondt M, Pironet Z, Parmentier I, De Meyere C, Besselink M, Pottel H, Vansteenkiste F, Verslype C

JOURNAL: Surgical Endoscopy

TITEL: One-stage laparoscopic parenchymal sparing liver resection for bilobar colorectal liver metastases: safety, recurrence patterns and oncologic outcomes

VOLUME: 36

ISSUE: 2

PAGINA’S: 1018-1026

JAAR: 2022

DOI: 10.1007/s00464-021-08366-5

ABSTRACT:

BACKGROUND AND PURPOSE:

Laparoscopic liver resections (LLR) of bilobar colorectal liver metastases (CRLM) are challenging and the safety and longterm outcomes are unclear. In this study, the short- and long-term outcomes and recurrence patterns of one-stage LLR for bilobar CRLM were compared to single laparoscopic resection for CRLM.

METHODS:

This single-center study consisted of all patients who underwent a parenchymal sparing LLR for CRLM between October 2011 and December 2018. Demographics, perioperative outcomes, short-term outcomes, oncologic outcomes and recurrence patterns were compared. Data were retrieved from a prospectively maintained database.

RESULTS:

Thirty six patients underwent a LLR for bilobar CRLM and ninety patients underwent a single LLR. Demographics were similar among groups. More patients received neoadjuvant chemotherapy in the bilobar group (55.6% vs 34.4%, P = 0.03). There was no difference in conversion rate, R0 resection and transfusion rate. Blood loss and operative time were higher in the bilobar group (250 ml (IQR 150-450) vs 100 ml (IQR 50-250), P < 0.001 and 200 min (IQR 170-230) vs 130 min (IQR 100-165), P < 0.001) and hospital stay was longer (5 days (IQR 4-7) vs 4 days (IQR 3-6), P = 0.015). The bilobar group had more technically major resections (88.9% vs 56.7%, P < 0.001). Mortality was nil in both groups and major morbidity was similar (2.8% vs 3.3%, P = 1.0). There was no difference in recurrence pattern. Overall survival (OS) was similar (1 yr: 96% in both groups and 5 yr 76% vs 66%, P = 0.49), as was recurrence-free survival (RFS) (1 yr: 64% vs 73%, 3 yr: 38 vs 42%, 5 yr: 38% vs 28%, P = 0.62).

CONCLUSION:

In experienced hands, LLR for bilobar CRLM can be performed safely with similar oncologic outcomes as patients who underwent a single LLR for CRLM.

DOCTORAAT

AUTEUR: M. D’Hondt

TITEL: Improving outcomes in hepatobiliary surgery in the era of minimally invasive surgery

JAARTAL: 2022

UNIVERSITEIT: KU Leuven

ANESTHESIE - INTENSIEVE ZORGEN

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Nateghi Haredasht F, Viaene L, Vens C, Callewaert N, De Corte W, Pottel H.

JOURNAL: Journal of Clinical Medicine

TITEL: Comparison between Cystatin C- and creatinine-based estimated glomerular filtration rate in the follow-up of patients recovering from a stage-3 AKI in ICU

VOLUME: 11

ISSUE: 24

PAGINA’S: 7264

JAAR: 2022

DOI: https://doi.org/10.3390/jcm11247264

ABSTRACT:

BACKGROUND:

Acute kidney injury (AKI) in critically ill patients is associated with a significant increase in mortality as well as long-term renal dysfunction and chronic kidney disease (CKD). Serum creatinine (SCr), the most widely used biomarker to evaluate kidney function, does not always accurately predict the glomerular filtration rate (GFR), since it is affected by some non-GFR determinants such as muscle mass and recent meat ingestion. Researchers and clinicians have gained interest in cystatin C (CysC), another biomarker of kidney function. The study objective was to compare GFR estimation using SCr and CysC in detecting CKD over a 1-year follow-up after an AKI stage-3 event in the ICU, as well as to analyze the association between eGFR (using SCr and CysC) and mortality after the AKI event.

METHOD:

This prospective observational study used the medical records of ICU patients diagnosed with AKI stage 3. SCr and CysC were measured twice during the ICU stay and four times following diagnosis of AKI. The eGFR was calculated using the EKFC equation for SCr and FAS equation for CysC in order to check the prevalence of CKD (defined as eGFR < 60 mL/ min/1.73 m2).

RESULTS:

The study enrolled 101 patients, 36.6% of whom were female, with a median age of 74 years (30–92), and a median length of stay of 14.5 days in intensive care. A significant difference was observed in the estimation of GFR when comparing formulas based on SCrand CysC, resulting in large differences in the prediction of CKD. Three months after the AKI event, eGFRCysC < 25 mL/min/1.73 m2 was a predictive factor of mortality later on; however, this was not the case for eGFRSCr.

CONCLUSION:

The incidence of CKD was highly discrepant with eGFRCysC versus eGFRSCr during the follow-up period. CysC detects more CKD events compared to SCr in the follow-up phase and eGFRCysC is a predictor for mortality in follow-up but not eGFRSCr. Determining the proper marker to estimate GFR in the post-ICU period in AKI stage-3 populations needs further study to improve risk stratification. Keywords: acute kidney injury, intensive care unit, serum creatinine, serum cystatin C, eGFR, chronic kidney disease.

AUTEURS: The Pose study group incl Desmet M.

JOURNAL: European Journal of anesthesiology

TITEL: Peri-interventional outcome study in the elderly in Europe: A 30-day prospective cohort study

VOLUME: 39

ISSUE:

PAGINA’S: 198-209

JAAR: 2022

DOI: 10.1097/EJA.0000000000001639

ABSTRACT:

OBJECTIVES:

The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality. Design: A prospective cohort study.

SETTING:

European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period. Patients: Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia.

Main outcome measures:

The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan-Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect.

RESULTS:

Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days.

CONCLUSIONS:

The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population.

AUTEURS: Fitzgerald M, Allen T, Bai S, Mitra B, Chiu W, Helsloot D, et al.

JOURNAL: Emergency Medicine Australasia

TITEL: Pleural decompression procedural safety for traumatic pneumothorax and haemothorax: Kelly clamps versus fine artery foceps.

VOLUME: 35

ISSUE: 6

PAGINA’S: 954-958

JAAR: 2022

DOI: 10.1111/1742-6723.14019

ABSTRACT:

OBJECTIVES:

The present study aimed to determine the difference in force required to puncture simulated pleura comparing Kelly clamps to fine artery forceps. The treatment of symptomatic traumatic pneumothorax and haemothorax involves puncture of the parietal pleura to allow decompression. This is usually performed using Kelly clamps or fine artery forceps. Over-puncture pulmonary injury risk increases with the force used.

METHODS:

An experienced single operator performed puncturing of simulated parietal pleura on a thoracic mannequin while wearing a force sensor under gloves. The force imparted at the device tip onto the parietal pleura was estimated by subtracting the force required to hold the device from the total force. Outcome variables were the total maximum force and force imparted by the device.

RESULTS:

There were 11 simulated procedures completed, seven using Kelly clamps and four using fine artery forceps. After subtracting the force required to hold the chosen forceps, the median value of pleural puncture force using Kelly clamps was 52.91 N (IQR 36.68-63.56) and 10.70 N (IQR 7.64-26.56) using fine artery forceps (P = 0.006).

CONCLUSIONS:

A significantly increased force was required to puncture simulated parietal pleura using Kelly clamps compared to fine artery forceps. This higher puncture force will be associated with increased instrument acceleration at the time of pleural puncture, which may result in an increased risk of injury to the underlying lung. Based on these data, clinicians may reduce the risk of pulmonary injury by using fine artery forceps rather than Kelly clamps when performing pleural decompression.

CONGRES

POSTERS

NAAM CONGRES: Belgian Society of Intensive care medicine annual meeting 2022

DATUM: June 15th, 2022

PLAATS: Belgium, Brussels

TITEL POSTER 1: Impact on mental health for ICU COVID-19 survivors and their relatives.

AUTEUR POSTER 1: Menegatti F., MD(1); Lagast S., PhD(2); Boscart I(2); Geerts PJ, MD(3); De Corte W, MD, PhD(1); Lamote S, MD(1).

NAAM CONGRES: Belgian Society of Intensive care medicine annual meeting 2022

DATUM: June 15th, 2022

PLAATS: Belgium, Brussels

TITEL POSTER 1: Effect of COVID-19 on ICU standardised mortality ratio

AUTEUR POSTER 1: Van Overmeire H, De Corte W, Lamote S

PRESENTATIES

NAAM CONGRES: ESRA Webinar

DATUM: 24/02/2022

PLAATS: Online

TITEL PRESENTATIE: Adjuvants and regional anesthesia

SPREKER PRESENTATIE: Matthias Desmet

NAAM CONGRES: ESRA annual meeting

DATUM: 22-25 juni 2022

PLAATS: Thessaloniki

TITEL PRESENTATIE 1: Tips and tricks on getting the best out of your US images.

TITEL PRESENTATIE 2: Conflict management in the OR

TITEL PRESENTATIE 3: Getting the most of your additives.

TITEL PRESENTATIE 4: RA techniques for clavicular fractures

SPREKER PRESENTATIE: Matthias Desmet

CARDIOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: El Jattari H, Holvoet W, De Roeck F, Cottens D, Ungureanu C, Bennett J et al.

JOURNAL: Journal of Invasive Cardiology (JIC)

TITEL: Intracoronary Lithotripsy in Calcified Coronary Lesions: A Multicenter Observational Study

VOLUME: 34

ISSUE: 1

PAGINA’S: E24-E31

JAAR: 2022

ABSTRACT:

OBJECTIVES:

The aim of this study was to evaluate the feasibility, effectiveness, and safety of coronary intravascular lithotripsy (IVL; Shockwave Medical) in the treatment of severe coronary artery calcification (CAC) in a real-world setting.

BACKGROUND:

Severe CAC can be an arduous obstacle in interventional cardiology, often leading to suboptimal results of percutaneous coronary interventions (PCI). Coronary IVL is a novel technique that modulates severe CAC, thereby facilitating stent implantation.

METHODS AND RESULTS:

In this multicenter observational study, data from 134 IVL procedures in 5 Belgian hospitals were prospectively obtained. Successful delivery of the IVL catheter was achieved in all cases but 1 (99.3%). The primary endpoint was final overall procedural success, which was obtained in 88.1% of cases, an aggregate of 92.6% in de novo lesions and 77.5% in stent underexpansion or in-stent restenosis (ISR). IVL therapy effect was considered successful by the operators in 94% of cases, with 68.7% achieving optimal and 25.3% achieving suboptimal results. The 1-month major adverse cardiovascular event rate was 3%, including 2 cardiovascular deaths (1 in-stent thrombosis and 1 coronary artery perforation).

CONCLUSIONS:

This real-world experience suggests that Shockwave IVL is a feasible, effective, and safe technique for the treatment of heavily calcified coronary lesions.

Keywords: coronary artery calcification; intravascular lithotripsy; lesion modification; stent underexpansion.

AUTEURS: Holvoet W, van den Buijs D, Bogaerts E, Willems E, Ameloot K, Dens J.

JOURNAL: European Heart Journal – Case Reports

TITEL: Giant coronary artery aneurysm of the left main treated with a covered stent: a case report

VOLUME: 7

ISSUE: 7

PAGINA’S: 5

JAAR: 2022

DOI: 10.1093/ehjcr/ytac463

ABSTRACT:

BACKGROUND:

Coronary artery aneurysms (CAAs) of the left main represent a small subset of coronary artery disease and are associated with cardiovascular death. Because of its rare entity, large data are lacking and therefore treatment guidelines are missing.

CASE SUMMARY:

We describe a case of a 56-year-old female with a past medical history of spontaneous dissection of the distal descending left artery (LAD) 6 years before. She presented to our hospital with a non-ST elevation myocardial infarction and a coronary angiogram showed a giant saccular aneurysm of the shaft of the left main coronary artery (LMCA). Given the risk of rupture and distal embolization, the heart team decided to go for a percutaneous approach. Based on a pre-interventional 3D reconstructed CT scan and guided by intravascular ultrasound, the aneurysm was successfully excluded with a 5 mm papyrus-covered stent. At 3-month and 1-year follow-up, the patient is still asymptomatic and repeat angiographies showed full exclusion of the aneurysm and the absence of restenosis in the covered stent.

DISCUSSION:

We describe the successful percutaneous IVUS-guided treatment of a giant LMCA shaft coronary aneurysm with a papyrus-covered stent with an excellent 1-year angiographic follow-up showing no residual filling of the aneurysm and no stent restenosis.

KEYWORDS:

Case report; Coronary artery aneurysm; Covered stent; Left main coronary artery; Percutaneous coronary intervention.

ENDOCRINOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Visser MM, Charleer S, Fieuws S, De Block C, Hilbrands R, Van Huffel L, Maes T, Vanhaverbeke G, Dirinck E, Myngheer N, Vercammen C, Nobels F, Keymeulen B, Mathieu C, Gillard P.

JOURNAL: J Diabetes Sci Technol.

TITEL: The Impact of Baseline User Characteristics on the Benefits of Real-Time Versus Intermittently Scanned Continuous Glucose Monitoring in Adults With Type 1 Diabetes: Moderator Analyses of the ALERTT1 Trial

VOLUME: 0

ISSUE:

PAGINA’S: 0

JAAR: 2022

DOI: 10.1177/19322968221128315

ABSTRACT:

BACKGROUND:

ALERTT1 showed that switching from intermittently scanned continuous glucose monitoring (isCGM) without alerts to real-time CGM (rtCGM) with alert functionality improved time in range (TIR; 70-180 mg/dL), glycated hemoglobin (HbA1c), time <54 mg/dL, and Hypoglycemia Fear Survey version II worry subscale (HFS-worry) score after six months in adults with type 1 diabetes (T1D). Moderator analyses aimed to identify certain subgroups that would benefit more from switching to rtCGM than others.

METHODS:

Post hoc analyses of ALERTT1 evaluated the impact of 14 baseline characteristics on the difference (delta) in mean TIR, HbA1c, time <54 mg/dL, and HFS-worry score at six months between rtCGM and isCGM. Therefore, the delta was allowed to depend on each of these variables by including interactions in the moderator analysis model. Analyses were performed separately for each variable; variables with P < .10 in the univariable analysis were combined into a single model.

RESULTS:

Univariable analyses showed no dependency of delta TIR, HbA1c, or time <54 mg/dL on variables other than CGM type. Only delta HFS-worry score depended on baseline HbA1c (P = .0059), indicating less worries with rtCGM in people with baseline HbA1c <6.5% or ≥8%. Given P < .10 for dependency of delta TIR on insulin therapy type (favoring multiple daily injections), baseline HbA1c, and baseline TIR, these variables were combined into a multivariable analysis; interactions were not statistically significant.

CONCLUSIONS:

Except for HFS-worry score, no interactions between 14 baseline characteristics and the six-month intervention effect of rtCGM on TIR, HbA1c, or time <54 mg/dL were observed, supporting the conclusion of ALERTT1 that switching from isCGM without alerts to rtCGM with alert functionality is beneficial for a wide range of people with T1D.

AUTEURS: Bochanen N, Decochez K, Heleu E, Cuypers J, Vercammen C, Coremans P, Vanhaverbeke G, Shadid S, Keymeulen B, Bolsens N, De Block C.

JOURNAL: Diabet Med.

TITEL: 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.

VOLUME: 39

ISSUE: 1

PAGINA’S: 1-13

JAAR: 2022

DOI: 10.1111/dme.14672

ABSTRACT:

AIMS:

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

Methods: 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.

RESULTS:

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.

CONCLUSION:

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.

GASTRO-ENTEROLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Coppens T, Meersseman W, Suys E, D'heygere F

JOURNAL: Tijdschrift voor Geneeskunde

TITEL: Recidiverende furunculose bij een jonge patiënte

VOLUME: 1 volume 1

PAGINA’S: 22-24

JAAR: 2022

DOI: 10.47671/TVG.77.21.091

AUTEURS: Billiet T, Elewaut A, d’Heygere F, de Hertogh G, Aerts R, Verslype C, Laleman W.

JOURNAL: Endoscopy

TITEL: Mimicry of an acute pseudocyst by a gastrointestinal duplication cyst in a 14-year-old boy

VOLUME: 54

ISSUE: 6

PAGINA’S: E271-E272

JAAR: 2022

DOI: 10.1055/a-1508-5546

ABSTRACT: no abstract

AUTEURS: Vanbelleghem E, Werbrouck J, Verstraete S, Libbrecht L, D'heygere F

JOURNAL: Tijdschrift voor Geneeskunde

TITEL: Belangrijk gewichtsverlies bij een patiënte met een hardnekkige huideruptie

VOLUME: 7

PAGINA’S: 33-36

JAAR: 2022

DOI: 10.47671/TVG.77.21.038

AUTEURS: Billiet A., Moubax K., Libbrecht L., Van Moerkercke W.

JOURNAL: Acta Gastroenterol Belg. 2022

TITEL: A Yellow sign indicating danger ahead

PAGINA’S: 654-655

JAAR: 2022

DOI: 10.51821/85.3.10922

ABSTRACT: Free article. No abstract available.

AUTEURS: De Galan C, Gonzales GB, Van Welden S, Tavernier SJ, Lobaton T, Van Moerkercke W, et al.

JOURNAL: Clin. Trans. Med.

TITEL: Role of integrin expression in the prediction of response to vedolizumab: A prospective real-life multicentre cohort study.

VOLUME: -

ISSUE: -

PAGINA’S: -

JAAR: 2022

DOI: 10.1002/ctm2.769.PMID:35384344

ABSTRACT: No abstracts available

AUTEURS: Ciers P., Vanderhaege D., Vansteenkiste F., Moubax K., Vanooteghem S., Van Moerkercke W., et al.

TITEL: Lymphoepithelial cysts of the pancreas: case report and review of the literature

MEER INFO: Abdominale chirurgie

AUTEURS: Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, Debruyne P.

Journal: Acta Clin Belg

TITEL: Developing and evaluating a participatory arts programme for cancer patients and their caregivers

VOLUME: 77

ISSUE: 1

PAGINA’S: 18-24

JAAR: 2022

DOI: 10.1080/17843286.2020.1773653.

ABSTRACT:

OBJECTIVES:

Cancer patients, survivors and caregivers often encounter severe distress, having significant consequences to wellbeing, functionality and physical health. This study developed and evaluated a participatory arts programme to determine if such could help to improve the wellbeing of cancer patients and their caregivers.

METHODS:

To inform the development of a participatory arts programme, cancer patients and their caregivers at an Organisation of European Cancer Institute (OECI)-designated cancer centre were asked which activities they would wish to engage in (anonymous survey one). A programme was then developed and trialled for 1 year. Following participation, we explored the satisfaction and any benefits of taking part (anonymous survey two).

RESULTS:

Survey one had a participation rate of 70%. In this survey, participants indicated they preferred group-based activities (61%) over an individual approachto take place on a monthly basis (46%). The developed programme ran from December 2018 to December 2019, with 435 patients and caregivers taking part. Two hundred and eighteen completed survey two and revealed a positive response to both the structure and content of the programme and its impact on the wellbeing of patients and caregivers. The majority indicated they felt (much) betterfrom participating in the participatory arts programme.

CONCLUSION:

This study points out the interest and potential value of a participatory arts programme to the perceived wellbeing. This suggests such programmes could be incorporated into cancer care provision, to serve as psychosocial support. The latter is particularly relevant for improving the lives, wellbeing and health of cancer patients and those supporting them

AUTEURS: D.Alsoud ,D.Franchimont, F.D'heygere, et al.

JOURNAL: Gastroenterology

TITEL: Real-world effectiveness and safety of risankizumab for moderate-severe multi-refractory crohn’s disease: results from a belgian multi-centric cohort

VOLUME: 162

ISSUE: 7

PAGINA’S: S818 - S819

JAAR: 2022

DOI: 10.1016/S0016-5085(22)61930-9

ABSTRACT: /

CONGRES

POSTERS

NAAM CONGRES: 17th congress of ECCO (European Chron’s and Colitis Organisation)

DATUM: 16-19/02/2022

PLAATS: Online

TITEL POSTER 1: Real-world effectiveness and safety of risankizumab in patients with moderate-to-severe multi-refractory Crohn’s disease: a Belgian multi-centric cohort study

AUTEUR POSTER 1: Alsoud D, Franchimont D, D’Heygere F, Bossuyt P, Vijverman A, Van Hootegem P, Sabino J, Cremer A, Vermeire S, Ferrante M.

PRESENTATIES

NAAM CONGRES: DDW 2022

DATUM: 22 okt 2022-30 okt 2022

PLAATS: Eindhoven Nederland

TITEL PRESENTATIE: Gastric Non-Helicobacter Pylori Helicobacter species (HNPH) and disease: From animals to cllinical relevance in Humans

SPREKER PRESENTATIE: E. Taillieu, S. Rutten, S. Michiels, Y. Arnstz, S. De Bruyckere, K. Chiers, F. Van Aert, H. De Schepper, E. Callewaert, C. George, W. Van Moerkercke, G. Vanneste, N. Van Heddegems, E. Vanderstraeten, F. Haesebrouck, C. Van Steenkiste

NAAM CONGRES: UEGW 2022

DATUM: 08 nov 2022 - 11 nov 2022

PLAATS: Wenen

TITEL PRESENTATIE: Vedeolizumab is associated with steroid-free clinical remission and discontinuation-free survival in patients with moderate-to-severe ulcerative proctitis

SPREKER PRESENTATIE: G. D'Haens, P. Bossuyt, F. Baert, T. Molnar, P. Hindryck, W. Van Moerkerke, E. Clasquin, M. Lowenberg, N. Mostafavi, H. Peeters, G. Lambrecht, S. Vermeire

NAAM CONGRES: 14 th international Workshop on Pathogenetics and Host Response in Helicobacter infections

DATUM: 21 mei 2022 - 24 mei 2022

PLAATS: San Diego

TITEL PRESENTATIE: 14 th International Workshop on Pathogenetics and Host response in Helicobacter infections

SPREKER PRESENTATIE: Taillieu E., Rutten S., Michiels S., Arnst Y., De Bruyckere S., Chiers K., Van Aert F., De Schepper H., Callewaert E., George C., Van Moerkercke W., Vanneste G., Van heddegem N., Vanderstraeten E., Van Steenkiste C., Haesebrouck F.

BOEKEN

TITEL: E-book: Dermatologie 2021

AUTEURS: De Vos AS, Temmerman L, Desmet L, D'heygere F et al.

CHAPTER TITEL: Huideruptie bij sartanen

JAAR UITGAVE: 2022

ISBN: 10.47671/TVG.78.22.E003

GYNAECOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Verhulst E, Bafort C, Tomassetti C, Wolthuis A, Bielen D, Coolen J, Weynand B, Platteeuw L, Meuleman C, Van Raemdonck D.

JOURNAL: Acta Chir Belg.

TITEL: Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature

VOLUME: 122

ISSUE: 6

PAGINA’S: 432-437

JAAR: 2022

DOI: 10.1080/00015458.2021.1887556

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.

HEMATOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, Debruyne P

TITEL: Developing and evaluating a participatory arts programme for cancer patients and their caregivers

MEER INFO: Gastro-enterologie

KLINISCHE BIOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Monteyne T, Oyaert M, Van Dalem A, Godefroid M, Cuyckx M, Callewaert N

JOURNAL: Annals of Laboratory Medicine

TITEL: Impact of bicarbonate interference on routine ion-selective electrode chloride measurements

VOLUME: 42

ISSUE: 5

PAGINA’S: 566-574

JAAR: 2022

DOI: https://doi.org/10.3343/alm.2022.42.5.566

ABSTRACT:

BACKGROUND:

Chloride measurement is crucial for calculating the anion gap. Bicarbonate can interfere with chloride measurements; however, there is no information on the specific types of electrodes affected or the changes in bicarbonate non-selectivity over time. We evaluated the interference of bicarbonate on chloride measurements using different electrodes and the stability of this interference over time.

METHODS:

The effect of bicarbonate on chloride measured with electrodes of various manufacturers was assessed. When non-selectivity toward bicarbonate was observed, the stability of this interference during the electrode’s lifetime was explored. The impact of the bicarbonate concentration on the calibrator was also evaluated.

RESULTS:

Non-selectivity was observed for electrodes using quaternary ammonium salts (Beckman Coulter, Siemens, and Roche), with overestimated or underestimated chloride values observed at high or low bicarbonate concentrations, respectively. The degree of selectivity varied among electrodes. With the Roche electrode, interference became more pronounced over time, whereas the Siemens electrode appeared to gain selectivity during its lifetime. For the Roche system, adjusting the calibrator’s bicarbonate concentration from 30 mmol/L to 20–24 mmol/L reduced the number of samples with unacceptable bias (>3%) from 77.3% to 12.6%. Lot-to-lot variations in the calibrator bicarbonate concentration increased the uncertainty of chloride measurements.

CONCLUSIONS:

The extent of bicarbonate-induced error varied according to the type, manufacturer, and wear of the electrode; the bicarbonate concentration in the calibrators and the tested sample; and the chloride content. Laboratories should be aware of the impact of bicarbonate on routine chloride measurements to establish appropriate QC procedures.

AUTEURS: Qu JH, Leirs K, Maes W, Imbrechts M, Callewaert N, Lagrou K, et al.

JOURNAL: ACS Sensors

TITEL: Innovative FO-SPR label-free strategy for detecting anti-RBD antibodies in COVID-19 patient serum and whole blood

VOLUME: 7

ISSUE: 2

PAGINA’S: 477-487

JAAR: 2022

DOI: https://doi.org/10.1021/acssensors.1c02215

ABSTRACT:

The ongoing COVID-19 pandemic has emphasized the urgent need for rapid, accurate, and large-scale diagnostic tools. Next to this, the significance of serological tests (i.e., detection of SARS-CoV-2 antibodies) also became apparent for studying patients’ immune status and past viral infection. In this work, we present a novel approach for not only measuring antibody levels but also profiling of binding kinetics of the complete polyclonal antibody response against the receptor

binding domain (RBD) of SARS-CoV-2 spike protein, an aspect not possible to achieve with traditional serological tests. This fiber optic surface plasmon resonance (FO-SPR)-based label-free method was successfully accomplished in COVID19 patient serum and, for the first time, directly in undiluted whole blood, omitting the need for any sample preparation. Notably, this bioassay (1) was on par with FO-SPR sandwich bioassays (traditionally regarded as more sensitive) in distinguishing COVID-19 from control samples, irrespective of the type of sample matrix, and (2) had a significantly shorter time-to-result of only 30 min compared to >1 or 4 h for the FO-SPR sandwich bioassay and the conventional ELISA, respectively. Finally, the label-free approach revealed that no direct correlation was present between antibody levels and their kinetic profiling in different COVID-19 patients, as another evidence to support previous hypothesis that antibody-binding kinetics against the antigen in patient blood might play a role in the COVID-19 severity. Taking all this into account, the presented work positions the FO-SPR technology at the forefront of other COVID-19 serological tests, with a huge potential toward other applications in need for quantification and kinetic profiling of antibodies.

AUTEURS: Calcoen B, Callewaert N, Vandenbulcke A, Kerstens W, Imbrechts M, Vercruysse T, et al.

JOURNAL: Viruses

TITEL: High Incidence of SARS-CoV-2 Variant of Concern Breakthrough Infections Despite Residual Humoral and Cellular Immunity Induced by BNT162b2 Vaccination in Healthcare Workers: A Long-Term Follow-Up Study in Belgium

VOLUME: 14

ISSUE: 6

PAGINA’S: 1257

JAAR: 2022

DOI: https://doi.org/10.3390/v14061257

ABSTRACT:

To mitigate the massive COVID-19 burden caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several vaccination campaigns were initiated. We performed a single-center observational trial to monitor the mid(3 months) and long-term (10 months) adaptive immune response and to document breakthrough infections (BTI) in healthcare workers (n = 84) upon BNT162b2 vaccination in a real-world setting. Firstly, serology was determined through immunoassays. Secondly, antibody functionality was analyzed via in vitro binding inhibition and pseudovirus neutralization and circulating receptor-binding domain (RBD)-specific B cells were assessed. Moreover, the induction of SARS-CoV2-specific T cells was investigated by an interferon-y release assay combined with flowcytometric profiling of activated CD4+ and CD8+ T cells. Within individuals that did not experience BTI (n = 62), vaccine-induced humoral and cellular immune responses were not correlated. Interestingly, waning over time was more pronounced within humoral compared to cellular immunity. In particular, 45 of these 62 subjects no longer displayed functional neutralization against the delta variant of concern (VoC) at long-term follow-up. Noteworthily, we reported a high incidence of symptomatic BTI cases (17.11%) caused by alpha and delta VoCs, although vaccine-induced immunity was only slightly reduced compared to subjects without BTI at mid-term follow-up.

AUTEURS: Imbrechts M, Maes W, Callewaert N, Ampofo L, Van den Berghe N, Calcoen B, et al.

JOURNAL: iScience

TITEL: Potent neutralizing anti-SARS-CoV-2 human antibodies cure infection with SARS-CoV-2 variants in hamster model

VOLUME: 25

ISSUE: 8

PAGINA’S: 104705

JAAR: 2022

DOI: https://doi.org/10.1016/j.isci.2022.104705

ABSTRACT:

Treatment with neutralizing monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2

(SARS-CoV-2) contributes to COVID-19 management. Unfortunately, SARS-CoV-2 variants escape several of these recently approved mAbs, highlighting the need for additional discovery and development. In a convalescent patient with COVID19, we identified six mAbs, classified in four epitope groups, that potently neutralized SARS-CoV-2 D614G, beta, gamma, and delta infection in vitro, with three mAbs neutralizing omicron as well. In hamsters, mAbs 3E6 and 3B8 potently cured infection with SARS-CoV-2 Wuhan, beta, and delta when administered post-viral infection at 5 mg/kg. Even at 0.2 mg/kg, 3B8 still reduced viral titers. Intramuscular delivery of DNA-encoded 3B8 resulted in in vivo mAb production of median serum levels up to 90 ug/mL, and protected hamsters against delta infection. Overall, our data mark 3B8 as a promising candidate against COVID-19, and highlight advances in both the identification and gene-based delivery of potent human mAbs.

AUTEURS: Coucke W, Charlier C, Croes K, Mahieu B, Neels H, Stove C et al.

JOURNAL: CCLM

TITEL: Analytical performance of eight enzymatic assays for ethanol in serum evaluated by data from the Belgian external quality assessment scheme

VOLUME: 60

ISSUE: 8

PAGINA’S: 1211-1217

JAAR: 2022

DOI: https://doi.org/10.1515/cclm-2022-0285

ABSTRACT:

OBJECTIVES:

Fast and reliable ethanol assays analysis are used in a clinical context for patients suspected of ethanol intoxication. Mostly, automated systems using an enzymatic reaction based on ethanol dehydrogenase are used. The manuscript focusses on the evaluation of the performance of these assays.

METHODS:

Data included 30 serum samples used in the Belgian EQA scheme from 2019 to 2021 and concentrations ranged from 0.13 to 3.70 g/L. A regression line between target concentrations and reported values was calculated to evaluate outliers, bias, variability and measurement uncertainty.

RESULTS:

A total of 1,611 results were taken into account. Bias was the highest for Alinity c over the whole concentration range and the lowest for Vitros for low concentrations and Cobas 8000 using the c702 module for high concentrations. The Architect and Cobas c501/c502 systems showed the lowest variability over the whole concentration range. Highest variability was observed for Cobas 8000 using the 702 module, Thermo Scientific and Alinity c. Cobas 8000 using the c702 module showed the highest measurement uncertainty for lower concentrations. For higher concentrations, Alinity c, Thermo Scientific and Vitros were the methods with the highest measurement uncertainty.

CONCLUSIONS:

The bias of the enzymatic techniques is nearly negligible for all methods except Alinity c. Variability differs strongly between measurement procedures. This study shows that the Alinity c has a worse measurement uncertainty than other systems for concentrations above 0.5 g/L. Overall, we found the differences in measurement uncertainty to be mainly influenced by the differences in variability

AUTEURS: Nateghi Haredasht F, Viaene L, Vens C, Callewaert N, De Corte W, Pottel H.

TITEL: Comparison between Cystatin C- and creatinine-based estimated glomerular filtration rate in the follow-up of patients recovering from a stage-3 AKI in ICU

MEER INFO: Anesthesie – Intensieve zorgen

AUTEURS: Vermeirssen V, Deleu J, Morlion A, Everaert C, De Wilde J, Anckaert J, Durinck K, Nuytens J, Rishfi M, Speleman

F, Van Droogenbroeck H, Verniers K, Baietti MF, Albersen M, Leucci E, Post E, Best MG, Van Maerken T, De Wilde B, Vandesompele J, Decock A.

JOURNAL: NAR Cancer

TITEL: Whole transcriptome profiling of liquid biopsies from tumour xenografted mouse models enables specific monitoring of tumour-derived extracellular RNA

VOLUME: 4

ISSUE: 4

PAGINA’S: zcac037

JAAR: 2022

DOI: 10.1093/narcan/zcac037

ABSTRACT:

While cell-free DNA (cfDNA) is widely being investigated, free circulating RNA (extracellular RNA, exRNA) has the potential to improve cancer therapy response monitoring and detection due to its dynamic nature. However, it remains unclear in which blood subcompartment tumour-derived exRNAs primarily reside. We developed a host-xenograft deconvolution framework, exRNAxeno, with mapping strategies to either a combined human-mouse reference genome or both species genomes in parallel, applicable to exRNA sequencing data from liquid biopsies of human xenograft mouse models. The tool enables to distinguish (human) tumoural RNA from (murine) host RNA, to specifically analyse tumour-derived exRNA. We applied the combined pipeline to total exRNA sequencing data from 95 blood-derived liquid biopsy samples from 30 mice, xenografted with 11 different tumours. Tumoural exRNA concentrations are not determined by plasma platelet levels, while host exRNA concentrations increase with platelet content. Furthermore, a large variability in exRNA abundance and transcript content across individual mice is observed. The tumoural gene detectability in plasma is largely correlated with the RNA expression levels in the tumour tissue or cell line. These findings unravel new aspects of tumour-derived exRNA biology in xenograft models and open new avenues to further investigate the role of exRNA in cancer.

AUTEURS: Deleu J, Schoofs K, Decock A, Verniers K, Roelandt S, Denolf A, Verreth J, De Wilde B, Van Maerken T, De Preter K, Vandesompele J.

JOURNAL: Human Genomics

TITEL: Digital PCR-based evaluation of nucleic acid extraction kit performance for the co-purification of cell-free DNA and RNA

VOLUME: 16

ISSUE: 1

PAGINA’S: 73

JAAR: 2022

DOI: 10.1186/s40246-022-00446-4

ABSTRACT:

BACKGROUND:

Blood plasma, one of the most studied liquid biopsies, contains various molecules that have biomarker potential for cancer detection, including cell-free DNA (cfDNA) and cell-free RNA (cfRNA). As the vast majority of cell-free nucleic acids in circulation are non-cancerous, a laboratory workflow with a high detection sensitivity of tumor-derived nucleic acids is a prerequisite for precision oncology. One way to meet this requirement is by the combined analysis of cfDNA and cfRNA from the same liquid biopsy sample. So far, no study has systematically compared the performance of cfDNA and cfRNA co-purification to increase sensitivity.

RESULTS:

First, we set up a framework using digital PCR (dPCR) technology to quantify cfDNA and cfRNA from human blood plasma in order to compare cfDNA/cfRNA co-purification kit performance. To that end, we optimized two dPCR duplex assays, designed to quantify both cfDNA and cfRNA with the same assays, by ensuring that primers and probes are located

within a highly abundant exon. Next, we applied our optimized workflow to evaluate the co-purification performance of two manual and two semi-automated methods over a range of plasma input volumes (0.06-4 mL). Some kits result in higher nucleic acid concentrations in the eluate, while consuming only half of the plasma volume. The combined nucleic acid quantification systematically results in higher nucleic acid concentrations as compared to a parallel quantification of cfDNA and cfRNA in the eluate.

CONCLUSIONS:

We provide a framework to evaluate the performance of cfDNA/cfRNA co-purification kits and have tested two manual and two semi-automated co-purification kits in function of the available plasma input amount and the intended use of the nucleic acid eluate. We demonstrate that the combined quantification of cfDNA and cfRNA has a benefit compared to separate quantification. We foresee that the results of this study are instrumental for clinical applications to help increase mutation detection sensitivity, allowing improved disease detection and monitoring.

CONGRES

POSTERS

NAAM CONGRES: Symposium infectieziekten 2022

DATUM: 19 mei 2022

PLAATS: Brussel

TITEL POSTER 1: Polyclonal Burkholderia cepacia outbreak originating from contaminated wash gloves

AUTEUR POSTER 1: Peeters C, Echahidi F, De Bel A , Boudewijns M, Bruyneel H, De Canck E et al.

NAAM CONGRES: Royal Belgian Society for Laboratory Medicine (RBSLM)

DATUM: 18/11/2022

PLAATS: Brussel

TITEL POSTER 1: The added value of methylmalonic acid as indicator of vitamin B12 deficiency

AUTEUR POSTER 1: Dedeene L, Theunynck S, Heylen O, Callewaert N, Croes K

NAAM CONGRES: 27th Annual Meeting of the RNA Society

DATUM: 31 mei - 5 juni 2022

PLAATS: Boulder, USA

TITEL POSTER 1: Whole transcriptome profiling of liquid biopsies from tumour xenografted mouse models enables specific monitoring of tumour-derived extracellular RNA

AUTEUR POSTER 1: Deleu J, Vermeirssen V, Everaert C, Morlion A, Verniers K, Anckaert J, Vandesompele J, Van Maerken T, Decock A, De Wilde B.

NAAM CONGRES: Research Day of the UGent Faculties of Medicine and Health Sciences, Pharmaceutical Sciences and Veterinary Medicine

DATUM: 31 maart 2022

PLAATS: Gent

TITEL POSTER 1: Whole transcriptome profiling of liquid biopsies from tumor xenografted mouse models enables specific monitoring of tumor-derived extracellular RNA

AUTEUR POSTER 1: Deleu J, Vermeirssen V, Everaert C, Morlion A, Verniers K, Anckaert J, Vandesompele J, Van Maerken

T, Deock A, De Wilde B.

TITEL POSTER 2: Digital PCR based evaluation of extraction kit performance for the co-elution of cell-free DNA/RNA from blood plasma

AUTEUR POSTER 2: Schoofs KR, Deleu J, Verreth J, Denolf A, De Wilde B, Van Maerken T, et al.

TITEL POSTER 3: The RNA signature of model systems treated with the small kinase inhibitor repotrectinib

AUTEUR POSTER 3: Van Droogenbroeck H, Deleu J, Vandesompele J, Van Maerken T, De Wilde B.

PRESENTATIES

NAAM CONGRES: BSHAM - SFMM Joint Symposium 2022

DATUM: 31 maart 2022

PLAATS: Gent

TITEL PRESENTATIE: Value of bronchoalveolar lavage fluid aspergillus galactomannan lateral flow assay at two secondary care hospitals

SPREKER PRESENTATIE: De Muynck E, Tegenbosch C, Loof S, De Bel A, Steyaert S.

KLINISCHE FARMACIE

CONGRES

PRESENTATIES

NAAM CONGRES: ESCP (European Society of Clinical Pharmacy)

DATUM: 19-21 oktober 2022

PLAATS: Praag, Tsjechië

TITEL PRESENTATIE: Evaluation of a pharmaceutical transitional care program for orthopaedic patients: a before-after prospective study

SPREKER PRESENTATIE: Apr. Frauke Van Coile

LONGZIEKTEN

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Stefan Andreas, Marco Testa, Laurent Boyer, Guy Brusselle, Wim Janssens, Edward Kerwin, Alberto Papi, Bonavuth Pek, Luis Puente-Maestu, Dinesh Saralay, Henrik Watz, Tom M A Wilkinson, Daniela Casula, Gennaro Di Maro, Maria Lattanzi, Luca Moraschini, Sonia Schoonbroodt, Annaelisa Tasciotti, Ashwani K Arora, François Maltais; Guy Brusselle, Jean-Louis Corhay, Eduard Janssens, Wim Janssens, Mathias Leys, Murdo Ferguson, Mark Fitzgerald, François Maltais, Irvin Mayers, Shelly McNeil, Bonavuth Pek, Arnaud Bourdin, Laurent Boyer, Francis Couturaud, Luc Dussart, Stefan Andreas, Gabriele Illies, Andreas Eich, Andrea Ludwig-Sengpiel, Henrik Watz, Francesco Blasi, Stefano Centanni, Alberto Papi, Carlo Pomari, José Maria Echave-Sustaeta, Eleuterio Llorca Martínez, Silvia Narejos Pérez, Sergi PascualGuardia, Mercè Pérez Vera, Luis Puente-Maestu, Manuel Terns Riera, William Anderson, Gourab Choudhury, Anthony De-Soyza, Dinesh Saralaya, Tom Ma Wilkinson, Joseph Boscia Iii, Kenneth Chinsky, Leonard Dunn, David Erb, Charles Fogarty, Herman Jackson Downey, Edward Kerwin, Craig Kunz, Terry Poling, Richard Sellman, Barry Sigal, John Southard, Selwyn Spangenthal, Ziad Tannous, Marco Testa, Daniela Casula, Gennaro Di Maro, Maria Lattanzi, Luca Moraschini, Sonia Schoonbroodt, Annaelisa Tasciotti, Ashwani K Arora

JOURNAL: Lancet Respir Med.

TITEL: Non-typeable Haemophilus influenzae–Moraxella catarrhalis vaccine for the prevention of exacerbations in chronic obstructive pulmonary disease: a multicentre, randomised, placebo-controlled, observer-blinded, proof-of-concept, phase 2b trial

VOLUME: 10

ISSUE: 5

PAGINA’S: 435 - 446

JAAR: 2022

DOI: https://doi.org/10.1016/S2213-2600(21)00502-6

ABSTRACT:

BACKGROUND:

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with changes in the sputum microbiome, including an increased prevalence of pathogenic bacteria. Vaccination against the most frequent bacteria identified in AECOPD might reduce exacerbation frequency. We assessed the efficacy, safety, and immunogenicity of a candidate vaccine containing surface proteins from non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) in patients with COPD.

METHODS:

This multicentre, randomised, observer-blinded, placebo-controlled, proof-of-concept, phase 2b trial recruited patients with stable COPD, moderate-to-very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 2, 3, or 4), at 67 clinical sites in Belgium, Canada, France, Germany, Italy, Spain, UK, and USA. Eligible patients were aged 40–80 years and had a history of at least one moderate or severe exacerbation in the previous year. Patients were allocated (1:1) using a minimisation algorithm to receive two intramuscular injections of NTHi–Mcat vaccine or placebo 60 days apart, in addition to standard care. The allocation algorithm considered age category, number of previous exacerbations, COPD severity at study entry, and country as minimisation factors, to guarantee treatment balance within each factor. Vaccine recipients and those responsible for evaluating study endpoints were masked to group allocation.

In the analysis of efficacy, the primary outcome was the rate of any moderate or severe AECOPD occurring within a 1-year period, starting 1 month after the second dose in patients who received two vaccine doses (modified total vaccinated cohort). Safety was assessed in the total vaccinated cohort. The trial is registered with ClinicalTrials.gov, number NCT03281876, and is complete.

FINDINGS:

Between Nov 27, 2017, and Nov 30, 2018, 606 adults were enrolled and included in the total vaccinated cohort (304 in the NTHi–Mcat vaccine group, 302 in the placebo group); 571 received two doses and were included in the primary efficacy analysis (279 in the NTHi–Mcat vaccine group, 292 in the placebo group). 23 participants dropped-out in the NTHi–Mcat vaccine group and 39 in the placebo group; this included 4 patients in the NTHi–Mcat vaccine group and 15 in the placebo

group who withdrew from the study because of an adverse event. The primary analysis included 340 exacerbations (in follow-up time 102 123 days) in the NTHi–Mcat vaccine group and 333 (in 104 443 days) in the placebo group, with a yearly rate of moderate or severe AECOPD of 1·22 in the NTHi–Mcat vaccine group and 1·17 in the placebo group, with vaccine efficacy in reducing the yearly rate of moderate or severe AECOPD estimated to be zero (vaccine efficacy point estimate −2·26% [87% CI –18·27 to 11·58]; p=0·82). Solicited local adverse events were more frequent in the NTHi–Mcat vaccine group (216 [72%] of 301 patients) than with placebo (34 [11%] of 299 patients), and the frequency of solicited general adverse events was similar between groups (239 [79%] of 301 vs 235 [79%] of 299 patients). There was one death in the NTHi–Mcat vaccine group (acute respiratory failure, not related to vaccination) and ten in the placebo group (seven due in part to COPD or respiratory failure). There were 158 serious adverse events (89 [29%] of 304 patients) in the NTHi–Mcat vaccine group, not related to vaccination, and 214 (99 [33%] of 302 patients) in the placebo group.

INTERPRETATION

NTHi–Mcat vaccine administered to patients with COPD did not show efficacy in reducing the yearly rate of moderate or severe exacerbations. No safety concerns were identified.

AUTEURS: Didier Cataldo, Shane Hanon, Rudi V Peché, Daniel J Schuermans, Jean M Degryse, Isabelle A De Wulf, Karin Elinck, Mathias H Leys, Peter L Rummens, Eric Derom

JOURNAL: Adv Ther

TITEL: How to Choose the Right Inhaler Using a Patient-Centric Approach?

VOLUME: 39

ISSUE: 3

PAGINA’S: 1149-1163

JAAR: 2022

DOI: 10.1007/s12325-021-02034-9

ABSTRACT:

There are many different inhaler devices and medications on the market for the treatment of asthma and chronic obstructive pulmonary disease, with over 230 drug-delivery system combinations available. However, despite the abundance of effective treatment options, the achieved disease control in clinical practice often remains unsatisfactory. In this context, a key determining factor is the match or mismatch of an inhalation device with the characteristics or needs of an individual patient. Indeed, to date, no ideal device exists that fits all patients, and a personalized approach needs to be considered. Several useful choice-guiding algorithms have been developed in the recent years to improve inhaler-patient matching, but a comprehensive tool that translates the multifactorial complexity of inhalation therapy into a user-friendly algorithm is still lacking. To address this, a multidisciplinary expert panel has developed an evidence-based practical treatment tool that allows a straightforward way of choosing the right inhaler for each patient.

AUTEURS: Van kerckhove O, Renders F, Leys M

JOURNAL: Acta cardiologica

TITEL: A case of myocarditis following ChAdOx1 nCov-19 vaccination

VOLUME: 77

ISSUE: 9

PAGINA’S: 852-854

JAAR: 2022

DOI: 10.1080/00015385.2022.2040825

ABSTRACT:

INTRODUCTION:

Myocarditis is an inflammatory disease of the myocardium, that might lead to reduced cardiac function and in the most severe cases to mortality. Although uncommon, it is a known adverse event after vaccination with coronavirus disease

2019 (COVID-19) mRNA vaccines. Here, we report the case of myocarditis following vaccination with a viral vector vaccine, ChAdOX1 nCoV-19.

CASE PRESENTATION:

A 50-year-old male presented at the emergency department with shortness of breath, general malaise and fever, 5 days after receiving a second dose of the ChAdOx1 vaccine. Biochemical analysis revealed elevated serum CRP and troponin levels. Two weeks after initial presentation, a cardiac MRI showed belated contrast capitation in the left ventricle, confirming the diagnosis of myocarditis.

CONCLUSIONS:

To our knowledge, this is the first report of myocarditis following ChAdOx1 vaccination. Except for some case of myocarditis upon the Ad26COVS1 vaccine, no other cases were reported upon vaccination with the ChAdOX1 viral vector vaccines. With this report we would like to raise awareness about myocarditis as an adverse event following ChAdOx1 vaccination.

AUTEURS: Van De Sijpe G., Gilissen L, Vandebotermet M, Peetermans W, Spriet I, Schrijvers R

JOURNAL: Allergy

TITEL: Non-invasive delabeling and refining of beta-lactam allergy labels in inpatients to optimize antimicrobial stewardship

VOLUME: 77

ISSUE: 10

PAGINA’S: 3157-3159

JAAR: 2022

DOI: 10.1111/all.15453

ABSTRACT: Geen abstract

AUTEURS: Habran M, Vandebotermet M, Schrijvers R.

JOURNAL: J Investig Allergol Clin Immunol

TITEL: Polyethylene Glycol Allergy and Immediate-Type Hypersensitivity Reaction to COVID-19 Vaccination: Case Report.

VOLUME: 32

ISSUE: 3

PAGINA’S: 234-235

JAAR: 2022

DOI: 10.18176/jiaci.0740

ABSTRACT: no abstract available

AUTEURS: Ieven T, Vandebotermet M, Nuyttens L, Devolder D, Vandenberghe P, Bullens D, et al.

Journal: Vaccines (Basel)

TITEL: COVID-19 Vaccination Safety and Tolerability in Patients Allegedly at High Risk for Immediate Hypersensitivity Reactions.

VOLUME: 10

ISSUE: 2

PAGINA’S: 286

JAAR: 2022

DOI: 10.3390/vaccines10020286

ABSTRACT:

The reported incidence of immediate hypersensitivity reactions (IHR) including anaphylaxis after COVID-19 vaccination is 10-fold higher than for other vaccines. Several patient groups are theorized to be at particular risk. Since specific

vaccination guidelines for these patients are based on expert opinion, we performed a retrospective monocentric analysis of the tolerability of adenoviral vector and mRNA-based COVID-19 vaccines in a cohort of patients allegedly at high risk of IHR. Reactions were assessed immediately on-site by allergists during a monitored vaccination protocol and after 3-7 days through telephone interviews. The cohort included 196 patients (aged 12-84 years) with primary mast cell disease (pMCD, 50.5%), idiopathic anaphylaxis (IA, 19.9%), hereditary angioedema (HAE, 5.1%) or miscellaneous indications (24.5%). Twenty-five immediate reactions were observed in 221 vaccine doses (11.3%). Most occurred in IA or miscellaneous patients. None fulfilled anaphylaxis criteria and most were mild and self-limiting. Reaction occurrence was significantly associated with female sex. In total, 13.5% of pMCD patients reported mast cell activation-like symptoms within 72 h post-vaccination. All pediatric pMCD patients (n = 9, 12-18 years) tolerated both mRNA-based vaccine doses. In summary, adenoviral vector and mRNA-based COVID-19 vaccines were safe and well-tolerated in patients with pMCD, HAE, and IA. No anaphylaxis was observed. The mild and subjective nature of most reactions suggests a nocebo effect associated with vaccination in a medicalized setting. Patients with pMCD could experience mild flare-ups of mast cell activation-like symptoms, supporting antihistamine premedication.

AUTEURS: Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, Debruyne P

TITEL: Developing and evaluating a participatory arts programme for cancer patients and their caregivers

MEER INFO: Gastro-enterologie

MOND-, KAAK- EN AANGEZICHTSHEELKUNDE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Verstraeten J, Slootweg PJ, Cuijpers VM, Meijer GJ

JOURNAL: International Journal of Oral and Maxillofacial Surgery

TITEL: Do dental implants facilitate bone invasion in patients with oral squamous cell carcinoma? A case series

VOLUME: Volume 52

ISSUE: Issue 4

PAGINA’S: P413-416

JAAR: 2022

DOI: 10.1016/j.ijom.2022.08.004

ABSTRACT:

Osseointegrated dental implants in the vicinity of oral squamous cell carcinoma (OSCC) will become more common given the increasing popularity of dental implants. Reports and studies of OSCC around dental implants are rare, as is the topic of how to handle OSCC surgically when implants are in contact with the tumour. In view of this uncertainty, a histological study was performed to assess tumour behaviour around implants. The aim was to determine whether an implant facilitates inward growth of the tumour and how this should be taken into account during staging and treatment planning. A total of 20 specimens were collected. The implants were macroscopically in contact with OSCC in 13 of the 20 specimens. Histologically, tumour tissue near the implant was indeed confirmed in nine of these cases. In seven cases, tumour invasion had led to resorption of the underlying jaw bone; tumour between the bone–implant interface was identified in only two of these cases, but without downward growth along the implant. In conclusion, no proof was found to confirm that the bone–implant interface is a preferred route for invasion. Therefore, dental implants in the vicinity of OSCC should not influence staging and treatment planning in this regard.

NEFROLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Van Meerhaeghe T, Baurain JF, Bechter O, Orte Cano C, Del Marmol V, Devresse A, Doubel P, Hanssens M, Hellemans R, Lienard D, Rutten A, Sprangers B, Le Moine A, Aspeslagh S.

JOURNAL: Front. Nephrol

TITEL: Cemiplimab for advanced cutaneous squamous cell carcinoma in kidney transplant recipients

VOLUME: 2

JAAR: 2022

DOI: https://doi.org/10.3389/fneph.2022.1041819

ABSTRACT:

Malignancy is a significant adverse event in kidney transplant recipients (KTR). The most frequent NMSC (non-melanoma skin cancer) encountered in KTR is cutaneous squamous cell carcinoma (cSCC). Moreover, KTR patients tend to have a more aggressive behavior of the disease and an increased risk of metastasis and cancer related death. Cemiplimab, a human monoclonal IgG4 antibody against anti-PD-1 has shown favorable overall survival and progression free survival in immunocompetent patients suffering from advanced cSCC. However, these trials excluded patients with a history of solid organ transplantation owing to concerns about alloimmunity, organ rejection, and the use of concomitant immunosuppressive therapy possibly abolishing the efficacy of immunotherapy. Herein, we review the real-world experience with cemiplimab in KTR for advanced cSCC in Belgium. Cemiplimab might be a promising treatment for patients with advanced cSCC and could be considered as second-line treatment in KTR with difficult to treat cSCC.

AUTEURS: De Vriese A, Van Praet J, Reynders M, Heylen Line, Viaene L, Caluwé R, et al.

JOURNAL: Kidney International Reports

TITEL: Longevity and clinical effectiveness of the humoral and cellular responses to SARS-Cov-2 vaccination in hemodialysis patients

VOLUME: 7

ISSUE: 5

PAGINA’S: 1103-1107

JAAR: 2022

DOI: 10.1016/j.ekir.2022.02.007

ABSTRACT: No abstract available

AUTEURS: Nateghi Haredasht F, Viaene L, Vens C, Callewaert N, De Corte W, Pottel H.

TITEL: Comparison between Cystatin C- and creatinine-based estimated glomerular filtration rate in the follow-up of patients recovering from a stage-3 AKI in ICU

MEER INFO: Anesthesie - Intensieve zorgen

AUTEURS: Jorgensen H, Behets G, Viaene L, Bammens B, Claes K, Meijers B, et al.

JOURNAL: American journal of kidney diseases

TITEL: Diagnostic accuracy of nonivasive bone turnover markers in renal osteodystrophy

VOLUME: 79 (5)

ISSUE:

PAGINA’S: 667-676

JAAR: 2022

DOI: https://doi.org/10.1053/j.ajkd.2021.07.027

ABSTRACT:

RATIONALE & OBJECTIVE:

Bone biopsy remains the gold standard for diagnosing renal osteodystrophy as comparable noninvasive alternatives have yet to be established. This study investigated the diagnostic accuracy of biochemical markers of skeletal remodeling to predict bone turnover. Study design: Cross-sectional retrospective diagnostic test study.

Setting & participants:

Patients with chronic kidney disease glomerular filtration rate categories 4-5, including patients treated with dialysis (G4-G5D) and kidney transplant recipients with successful transiliac bone biopsies.

TESTS COMPARED:

Bone turnover as determined by bone histomorphometry was compared with the following biochemical markers: fulllength (amino acids 1-84) "biointact" parathyroid hormone (PTH), bone-specific alkaline phosphatase (BsAP), intact procollagen type I N-terminal propeptide (PINP), and tartrate-resistant acid phosphatase isoform 5b (TRAP5b).

OUTCOME:

Diagnostic performance was evaluated by area under the receiver operator characteristics curve (AUC), sensitivity, specificity, and negative and positive predictive values. Optimal diagnostic cutoffs were determined in an exploration cohort (n = 100) and validated in a separate cohort (n = 99).

RESULTS:

All biomarkers differed across categories of low 33 (17%), normal 109 (55%), and high 57 (29%) bone turnover. AUC values were in the range of 0.75-0.85. High negative predictive values (≥90%) were found for both high and low bone turnover, indicating the ability to rule out both conditions using the suggested biomarker cutoffs. The highest diagnostic performances were seen with combinations of biomarkers, with overall diagnostic accuracies of 90% for high turnover, and 78% for low turnover. Results were comparable for kidney transplant candidates and recipients in a sensitivity analysis.

Limitations: The single-center approach and heterogeneity of the study cohort are main limitations of this study.

CONCLUSIONS:

We conclude that the diagnostic performance of biochemical markers of bone turnover is acceptable, with clinical utility in ruling out both high and low turnover bone disease

CONGRES

PRESENTATIES

NAAM CONGRES: Annual congress of the european society of intensive care Medicine (ESICM)

DATUM: mei 2022

PLAATS: Madrid, Spain

TITEL PRESENTATIE: Serum creatinine-based versus cystatin C-based eGFR in AKI-stage3 critically ill patients

SPREKER PRESENTATIE: Nateghi Haredasht F.

NEUROLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Chaudhuri K, Kovacs N, Pontieri F, Aldred J, Bourgeois P, Davis T et al.

JOURNAL: Neurology

TITEL: Long-Term Motor and Non-Motor Symptom Benefits in Patients With Advanced Parkinson's Disease treated With Levodopa-Carbidopa Intestinal Gel: Final analysis of the 36-Month DUOGLOBE Real-world Multinational Observational Study (P1-1.Virtual)

VOLUME: 98

ISSUE: s18

PAGINA’S: 1457

JAAR: 2022

DOI: Online ISSN: 1526-632X

ABSTRACT:

RESULTS:

Of 188 patients with baseline H&Y scores, baseline characteristics in both groups were similar except mean (SD) UPDRS II (<3, 10.7 [6.7]; ≥3, 16.8 [7.6]) and III (<3, 19.3 [9.4]; ≥3, 31.7 [13.0]). Strong, significant improvements were observed in “Off” time through M36 in both groups (<3, P<.01; ≥3, P<.001). In <3, UDysRS total scores improved significantly until M12 (P<.05) and numerically through M36, and significantly improved through M36 (P<.05) in ≥3. Sustained improvements in NMSS were observed in both groups (both P<.05), with significant improvements in PDQ-8 until M18 (<3, P<.05; ≥3, P<.01). Both groups showed a significant increase in UPDRS II and III scores at M36 (UPDRS II <3, P<.001; ≥3, P<.05; UPDRS III <3, P<.01; ≥3, P<.05). Axial symptoms worsened in <3 (P<.001) but remained generally stable over time in ≥3. SAEs and discontinuation rates were generally similar in both groups. Conclusions: This first reported long-term analysis in patients who received LCIG in different H&Y stages suggests patients experience important benefits from LCIG treatment independent of H&Y stage. Safety was consistent with the established LCIG safety profile.

AUTEURS: Kovács N,Bergmann L, Anca-Herschkovitsch M, Cubo E, Davis TL, Iansek R, Siddiqui MS, Simu M, Standaert DG, Chaudhuri KR, Bourgeois P, Gao T, Kukreja P, Pontieri FE, Aldred J

Journal: Journal of Parkinson's Disease today

TITEL: Outcomes Impacting Quality of Life in Advanced Parkinson's Disease Patients Treated with Levodopa-Carbidopa

Intestinal Gel

VOLUME: 12

ISSUE: 3

PAGINA’S: 917-926.

JAAR: 2022

DOI: doi: 10.3233/JPD-212979.

ABSTRACT:

BACKGROUND:

It is believed that motor symptoms, including dyskinesia, and non-motor symptoms impact health-related quality of life (HRQoL) in patients with Parkinson's disease (PD), and that improvements in these metrics are correlated.

OBJECTIVE:

Investigate the relationship between HRQoL and measures of PD severity and treatment efficacy, including motor and non-motor symptoms.

METHODS:

This was a planned investigation of an international, prospective, single-arm, post-marketing observational study of the long-term effectiveness of levodopa-carbidopa intestinal gel (LCIG) in patients with advanced PD. Pearson correlation coefficients (PCC) were calculated for baseline and change from baseline at 12 months between HRQoL and motor and

non-motor symptoms.

RESULTS:

A total of 195 patients were included. At baseline, HRQoL was moderately positively correlated with Activities of Daily Living (UPDRS II, PCC = 0.44), non-motor symptoms (0.48), and measures of sleep (0.50 and 0.40); all p < 0.001. After 12 months of treatment with LCIG, improvements in HRQoL were moderately positively correlated with improvement from baseline in non-motor symptoms (PCC = 0.42), sleep (0.54), and daytime sleepiness (0.40; all p < 0.001), and weakly correlated with improvement in dyskinesia signs and symptoms (PCC = 0.23; p = 0.011). Improvement in HRQoL was not correlated with improvements in OFF time or dyskinesia time.

CONCLUSION:

Both at baseline and for change from baseline at 12 months, HRQoL was correlated with baseline and change from baseline in dyskinesia, Activities of Daily Living, and non-motor symptoms, including sleep; but not with baseline or change in OFF time.

AUTEURS: Nguyen TN, Qureshi MM, Klein P, …, Vanacker P, et al.

JOURNAL: J Stroke

TITEL: Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

VOLUME: 24

ISSUE: 2

PAGINA’S: 256-265

JAAR: 2022

DOI: 10.5853/jos.2022.00752

ABSTRACT:

BACKGROUND AND PURPOSE:

Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year.

METHODS:

We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020).

RESULTS:

There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths.

CONCLUSIONS:

During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

AUTEURS: Ordies S, Lesenne A, Bekelaar K, … Vanacker P, et al.

JOURNAL: Acta Neurol Belg.

TITEL: Multicentric validation of a reduced features case-mix set for predicting functional outcome after ischemic stroke in Belgium

VOLUME: 11

ISSUE:

PAGINA’S: 21

JAAR: 2022

DOI: 10.1007/s13760-022-02142-5.

ABSTRACT:

INTRODUCTION:

Ischemic stroke is the second cause of death and leading cause of severe disability worldwide. A reduced features set of CT-DRAGON (age, NIHSS on admission and pre-stroke mRS) predicts 90-day functional outcome after stroke in a single center. The current study was designed to validate this adapted CT-DRAGON score in three major Belgian hospitals, in the framework of future case-mix adjustment.

METHODS:

This retrospective study included stroke patients, treated by thrombolysis, thrombectomy, a combination of both or neither thrombolysis or thrombectomy (conservative treatment) in 2019. Patient characteristics and 90-day mRS were collected. Multivariable logistic regression analysis of 90-day mRS 0-2 vs. 3-6 and 0-5 vs. 6 with the reduced features set was performed. Discriminative performance was assessed by the area under the receiver operating characteristic curve (AUROC).

RESULTS:

Thirty-three percent of patients (413/1243) underwent treatment. Majority of strokes was treated conservatively (n = 830, 67%), 18% (n = 225) was treated by thrombolysis, 7% (n = 88) by thrombectomy and 8% (n = 100) by thrombolysis and thrombectomy. Age, NIHSS and pre-stroke mRS were independently associated with 90-day mRS 0-2 (all p ≤ 0.0001, AUROC 0.88). When treatment modality was added in the model, age, NIHSS, pre-stroke mRS and treatment modality were independently associated with 90-day mRS 0-2 (p < 0.0001, p < 0.0001, p < 0.0001 and p = 0.0001) AUROC 0.89). Age, NIHSS, pre-stroke mRS and treatment modality were independently associated with 90-day survival (p = 0.0001, p < 0.0001, p < 0.0001 and p = 0.008, AUROC 0.86).

DISCUSSION:

The reduced features set (age, NIHSS and pre-mRS) was independently associated with long-term functional outcome in a Belgian multicentric cohort, making it useful for case-mix adjustments in Belgian stroke centers. Treatment modality was associated with long-term outcome.

AUTEURS: De Moerloose S, Geerts PJ, Vanacker P, Lemmens GMD.

JOURNAL: Journal of ECT

TITEL: A Case Report of Acute Cervical Dystonia After Electroconvulsive Therapy

VOLUME: 38

ISSUE: 4

PAGINA’S: 260-261

JAAR: 2022

DOI: doi: 10.1097/YCT.0000000000000865

ABSTRACT: No abstract

AUTEURS: Paciaroni M, Caso V, Agnelli G, …, Vanacker P,.. et al.

JOURNAL: Stroke

TITEL: Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study.

VOLUME: 53

ISSUE: 8

PAGINA’S: 2620-2627

JAAR: 2022

DOI: doi: 10.1161/STROKEAHA.121.038239

ABSTRACT:

BACKGROUND:

In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain.

METHODS:

This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment.

RESULTS:

After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA2DS2-VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0-1.3] for each point increase; P=0.05) and hypertension (OR, 2.3 [95% CI, 1.0-5.1]; P=0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0-1.2] for each year increase; P=0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4-14.2]; P=0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4-5.5]; P=0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8-1.7]).

CONCLUSIONS:

Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.

AUTEURS: Lip GYH, Kotalczyk A, Teutsch C, ... Vanacker P, et al.; GLORIA-AF Investigators

JOURNAL: Clin Res Cardiol.

TITEL: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice:

GLORIA-AF Registry.

VOLUME: 111

ISSUE: 5

PAGINA’S: 560-573

JAAR: 2022

DOI: 10.1007/s00392-022-01996-2

ABSTRACT:

BACKGROUND AND PURPOSE:

Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed

atrial fibrillation (AF).

METHODS:

In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest.

RESULTS:

The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79-2.03), major bleeding 0.59 (0.40-0.88), myocardial infarction 0.68 (0.40-1.16), and all-cause death 0.86 (0.67-1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76-1.78), myocardial infarction 0.84 (0.48-1.46), major bleeding 0.98 (0.63-1.52) and all-cause death 1.01 (0.791.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52-1.19), myocardial infarction 0.96 (0.63-1.45), major bleeding 1.54 (1.14-2.08), and all-cause death 0.97 (0.80-1.19).

CONCLUSIONS:

Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death.

AUTEURS: Kimura S, Toyoda K, Yoshimura S, ... Vanacker P et al.;

SAMURAI, RELAXED, RAF, RAF-NOAC, CROMIS-2, NOACISP LONGTERM, Erlangen Registry and Verona Registry Investigator.

JOURNAL: Stroke.

TITEL: Practical "1-2-3-4-Day" Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study.

VOLUME: 53

ISSUE: 5

PAGINA’S: 1540-1549

JAAR: 2022

DOI: 10.1161/STROKEAHA.121.036695

ABSTRACT:

BACKGROUND:

The "1-3-6-12-day rule" for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severity.

METHODS:

The combined data of prospective registries in Japan, Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-nonvalvular atrial fibrillation (September 2011 to March 2014) and RELAXED (February 2014 to April 2016) were used. Patients were divided into transient ischemic attack and 3 stroke subgroups by the National Institutes of Health Stroke Scale score: mild (0-7), moderate (8-15), and severe (≥16). The early treatment group was defined as patients starting DOACs earlier than the median initiation day in each subgroup. Outcomes included a composite of recurrent stroke or systemic embolism, ischemic stroke, and severe bleeding within 90 days. Six European prospective registries were used for validation.

RESULTS:

In the 1797 derivation cohort patients, DOACs were started at median 2 days after transient ischemic attack and 3, 4, and 5 days after mild, moderate, and severe strokes, respectively. Stroke or systemic embolism was less common in Early Group (n=785)-initiating DOACS within 1, 2, 3, and 4 days, respectively-than Late Group (n=1012) (1.9% versus 3.9%; adjusted

hazard ratio, 0.50 [95% CI, 0.27-0.89]), as was ischemic stroke (1.7% versus 3.2%, 0.54 [0.27-0.999]). Major bleeding was similarly common in the 2 groups (0.8% versus 1.0%). On validation, both ischemic stroke (2.4% versus 2.2%) and intracranial hemorrhage (0.2% versus 0.6%) were similarly common in Early (n=547) and Late (n=1483) Groups defined using derivation data.

CONCLUSIONS:

In Japanese and European populations, early DOAC initiation within 1, 2, 3, or 4 days according to stroke severity seemed to be feasible to decrease the risk of recurrent stroke or systemic embolism and no increase in major bleeding. These findings support ongoing randomized trials to better establish the optimal timing of DOAC initiation.

AUTEURS: Owolabi M, Thrift A, Mahal A, ... Vanacker P, et al. ; Stroke Experts Collaboration Group

JOURNAL: Lancet Public Health

TITEL: Primary stroke prevention worldwide: translating evidence into action

VOLUME: 7

ISSUE: 1

PAGINA’S: 74-85

JAAR: 2022

DOI: 10.1016/S2468-2667(21)00230-9.

ABSTRACT:

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.

AUTEURS: Polymeris AA, Macha K, Paciaroni M, ... Vanacker P, et al.; NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF and Verona Registry Collaborators.

JOURNAL: Ann Neurol.

TITEL: Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation.

VOLUME: 91

ISSUE: 1

PAGINA’S: 78-88

JAAR: 2022

DOI: 10.1002/ana.26267

ABSTRACT:

OBJECTIVE:

To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years.

METHODS:

Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (<3 months) aged ≥85 versus <85 years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all-cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk.

RESULTS:

In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged ≥85 years and 3,688 (62%) received a DOAC. During 6,874 patient-years follow-up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged ≥85 (HR≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR<85y = 0.79, 95%-CI [0.66, 0.95]) in simple (pinteraction = 0.129), adjusted (pinteraction = 0.094) or weighted (pinteraction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patientyears for ICH-weights 1.5 to 3.1).

INTERPRETATION:

The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old.

CONGRES

POSTERS

NAAM CONGRES: 2022 International Association of Parkinsonism and related disorders 27th world Congress

DATUM: May 1-4 2022

PLAATS: virtual congress

TITEL POSTER 1: Long-Term Motor and Non-Motor symptom Benefits of Levodop-Carbidopa Intestinal Gel by Baseline Hoehn & Yahr Stage: Duoglobe post hoc analysis

AUTEUR POSTER 1: Pontieri F, Bourgeois P, Gao T, Davis T, Iansek R, Cubo E, et al.

NAAM CONGRES: AAN of Neurology

DATUM: April 2-7 2022

PLAATS: Seattle, Washington

TITEL POSTER 1: Long-term Motor and Non-Motor Symptom Benefits in Patients With Advanced Parkinson's Disease Treated With Levodopa-Carbidopa Intestinal Gel: Final Analysis of the 36-Month DUOGLOBE Real-World Multinational Observational Study

AUTEUR POSTER 1: Chaudhuri KR, Kovacs N, Pontieri FE, Aldred J, Bourgeois P, Davis TL et al.

NAAM CONGRES: EAN

DATUM: 25-28 june 2022

PLAATS: Vienna

TITEL POSTER 1: A-22-03200 Levodpa-Carbidopa Intestinal Gel Improves Long-Term Parkinson's Disease Symptoms: Final analysis of the DUOGLOBE Study

AUTEUR POSTER 1: Chaudhuri, Kovacs, Pontieri, Aldred, Bourgeois P, Davis T,et al.

NUCLEAIRE GENEESKUNDE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Soffers F, Helsen N, Van de Wyngaert T, Carp L, Hoekstra OS, Goethals L, Martens M, Deben K, Spaepen K, De Bree R, De Geeter F, Zwezerijnen GJC, Van Laer C, Maes A, Lenssen O, Stroobants S, ECLYPS Investigators.

JOURNAL: Eur J Nucl Med Mol Imaging Res.

TITEL: Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy

VOLUME: 12

ISSUE: 1

PAGINA’S: 34

JAAR: 2022

DOI: 10.1186/s13550-022-00905-y

ABSTRACT:

BACKGROUND:

FDG-PET/CT has a high negative predictive value to detect residual nodal disease in patients with locally advanced squamous cell head and neck cancer after completing concurrent chemoradiotherapy (CCRT). However, the positive predictive value remains suboptimal due to inflammation after radiotherapy, generating unnecessary further investigations and possibly even surgery. We report the results of a preplanned secondary end point of the ECLYPS study regarding the potential advantages of dual time point FDG-PET/CT imaging (DTPI) in this setting. Standardized dedicated head and neck FDG-PET/CT images were obtained 12 weeks after CCRT at 60 and 120 min after tracer administration. We performed a semiquantitative assessment of lymph nodes, and the retention index (RI) was explored to optimize diagnostic performance. The reference standard was histology, negative FDG-PET/CT at 1 year, or > 2 years of clinical follow-up. The time-dependent area under the receiver operator characteristics (AUROC) curves was calculated.

RESULTS:

In total, 102 subjects were eligible for analysis. SUV values increased in malignant nodes (median SUV1 = 2.6 vs. SUV2 = 2.7; P = 0.04) but not in benign nodes (median SUV1 = 1.8 vs. SUV2 = 1.7; P = 0.28). In benign nodes, RI was negative although highly variable (median RI = - 2.6; IQR 21.2), while in malignant nodes RI was positive (median RI = 12.3; IQR 37.2) and significantly higher (P = 0.018) compared to benign nodes. A combined threshold (SUV1 ≥ 2.2 + RI ≥ 3%) significantly reduced the amount of false-positive cases by 53% (P = 0.02) resulting in an increased specificity (90.8% vs. 80.5%) and PPV (52.9% vs. 37.0%), while sensitivity (60.0% vs. 66.7%) and NPV remained comparably high (92.9% vs. 93.3%). However, AUROC, as overall measure of benefit in diagnostic accuracy, did not significantly improve (P = 0.62). In HPV-related disease (n = 32), there was no significant difference between SUV1, SUV2, and RI in malignant and benign nodes, yet this subgroup was small.

CONCLUSIONS:

DTPI did not improve the overall diagnostic accuracy of FDG-PET/CT to detect residual disease 12 weeks after chemoradiation. Due to differences in tracer kinetics between malignant and benign nodes, DTPI improved the specificity, but at the expense of a loss in sensitivity, albeit minimal. Since false negatives at the 12 weeks PET/CT are mainly due to minimal residual disease, DTPI is not able to significantly improve sensitivity, but repeat scanning at a later time (e.g. after 12 months) could possibly solve this problem. Further study is required in HPV-associated disease.

AUTEURS: Maserumule LC, Mokoala KMG, Van de Wiele C, Popoola G, Hlongwa KN, Ndlovu H, Maes A, Vorster M, Sathekge

JOURNAL: Biomedicines

TITEL: 68Ga-PSMA-11 PET/CT Initial Staging in Black and White South African Males with ISUP Grade Group 1 and 2 Prostate Adenocarcinoma

VOLUME: 10

ISSUE: 4

PAGINA’S: 882

JAAR: 2022

DOI: 10.3390/biomedicines10040882

ABSTRACT:

Prostate adenocarcinoma (PCa) is a leading cause of mortality. Black males with high-risk PCa have a poorer prognosis compared to white males. Patients with International Society of Urological Pathology (ISUP) Grade Group (GG) 1 and 2 PCa have little potential for metastases post radical prostatectomy. 68Gallium prostate specific membrane antigen (68Ga-PSMA) PET/CT imaging for metastatic PCa is superior to conventional imaging in staging high-risk PCa. No strong evidence is available to support imaging low-risk patients. We aimed to evaluate the value of 68Ga-PSMA PET/CT in black and white South African (BSA and WSA) males with GG1 and 2 PCa at initial staging. We evaluated 25 WSA and 123 BSA males. The image findings were correlated with prostate specific antigen (PSA). PSA levels significantly correlated with both primary tumor and whole-body PSMA-tumor volume (PSMA-TV) and were higher in BSA males. No differences were noted in the occurrence of metastases; however, PSA, seminal vesicle invasion and black race predicted metastases. Our findings suggest higher PSMA expression and tumor burden in BSA with histologically low-risk PCa, and future research with immunohistochemistry evaluation will be essential to confirm these findings.

AUTEURS: Lengana T, Lawal I, Janse Van Rensburg C, Mokoala E, Mazibuko S, Van de Wiele C, Maes A, Vorster M, Sathekge MM

JOURNAL: Nuklearmedizin

TITEL: The Diagnostic Performance of 18F-PSMA-1007 PET/CT in Prostate Cancer Patients with Early Recurrence after Definitive Therapy with a PSA <10 ng/ml

VOLUME: 61

ISSUE: 2

PAGINA’S: 120-129

JAAR: 2022

DOI: 10.1055/a-1759-1603

ABSTRACT:

AIM:

The prostate bed is one of the common sites of early recurrence of prostate cancer. The currently used PSMA ligands (68Ga-PSMA-11 and 99mTc-PSMA) undergo early urinary clearance resulting in interfering physiological activity within and surrounding the prostate. This can result in sites of cancer recurrence being obscured. 18F-PSMA-1007 has an advantage of delayed urinary clearance thus the prostate region is reviewed without any interfering physiological activity. The aim of this study was to determine the diagnostic performance of 18F-PSMA-1007 PET/CT in patients with early biochemical recurrence after definitive therapy.

METHODS:

Forty-six Prostate cancer (mean age 66.7±7.5, range 48-87 years) presenting with biochemical recurrence (median PSA 1.6ng/ml, range 0.1-10.0) underwent non-contrast-enhanced 18F-PSMA-1007 PET/CT. PET/CT findings were evaluated qualitatively and semiquantitatively (SUVmax) and compared to the results of histology, Gleason grade, and conventional imaging.

RESULTS:

Twenty-four of the 46 (52.2%) patients demonstrated a site of recurrence on 18F-PSMA-1007 PET/CT. Oligometastatic disease was detected in 15 (32.6%) of these patients. Of these 10 (37.5%) demonstrated intra-prostatic recurrence, lymph node disease was noted in 11 (45.8%) whilst two patients demonstrated skeletal metastases. The detection rates for PSA levels 0-<0.5, 0.5-<1, 1-2, >2 were 31.3%, 33.3%, 55.6% and 72.2% respectively. 7 (29.2%) of the positive patients had been described as negative or equivocal on conventional imaging. An optimal PSA cut-off level of 1.3ng/ml was found.

CONCLUSION:

18F-PSMA-1007 demonstrated good diagnostic performance detecting sites of recurrence. Its ability to detect sites of recurrence in the setting of early biochemical recurrence will have a significant impact on patient management.

AUTEURS: Mokoala KMG, Lawal IO, Maserumule LC, Hlongwa KN, Ndlovu H, Reed J, Bida M, Maes A, Van de Wiele C, Mahapane J, Davis C, Jeong JM, Popoola G, Vorster M, Sathekge MM.

JOURNAL: J Clin Med

TITEL: A Prospective Investigation of Tumor Hypoxia Imaging with 68Ga-Nitroimidazole PET/CT in Patients with Carcinoma of the Cervix Uteri and Comparison with 18F-FDG PET/CT: Correlation with Immunohistochemistry

VOLUME: 11

ISSUE: 4

PAGINA’S: 962

JAAR: 2022

DOI: 10.3390/jcm11040962

ABSTRACT:

Hypoxia in cervical cancer has been associated with a poor prognosis. Over the years 68Ga labelled nitroimidazoles have been studied and have shown improved kinetics. We present our initial experience of hypoxia Positron Emission Tomography (PET) imaging in cervical cancer with 68Ga-Nitroimidazole derivative and the correlation with 18F-FDG PET/ CT and immunohistochemistry. Twenty women with cervical cancer underwent both 18F-FDG and 68Ga-Nitroimidazole PET/CT imaging. Dual-point imaging was performed for 68Ga-Nitroimidazole PET. Immunohistochemical analysis was performed with hypoxia inducible factor-1α (HIF-1α). We documented SUVmax, SUVmean of the primary lesions as well as tumor to muscle ratio (TMR), tumor to blood (TBR), metabolic tumor volume (MTV) and hypoxic tumor volume (HTV). There was no significant difference in the uptake of 68Ga-Nitroimidazole between early and delayed imaging. Twelve patients had uptake on 68Ga-Nitroimidazole PET. Ten patients demonstrated varying intensities of HIF-1α expression and six of these also had uptake on 68Ga-Nitroimidazole PET. We found a strong negative correlation between HTV and immunohistochemical staining (r = -0.660; p = 0.019). There was no correlation between uptake on PET imaging and immunohistochemical analysis with HIF-1α. Two-thirds of the patients demonstrated hypoxia on 68Ga-Nitroimidazole PET imaging.

AUTEURS: Sathekge M, Bruchertseifer F, Vorster M, Lawal IO, Knoesen O, Mahapane J, Davis C, Mdlophane A, Maes A, Mokoala K, Mathabe K, Van De Wiele C, Morgenstern A

JOURNAL: J Nucl Med

TITEL: mCRPC Patients Receiving 225Ac-PSMA-617 Therapy in the Post-Androgen Deprivation Therapy Setting: Response to Treatment and Survival Analysis

VOLUME: 63

ISSUE: 10

PAGINA’S: 1496 - 1502

JAAR: 2022

DOI: 10.2967/jnumed.121.263618

ABSTRACT:

Ac-PSMA-617, targeting the prostate-specific membrane antigen (PSMA), which is overexpressed on prostate cancer cells, has shown a remarkable therapeutic efficacy in heavily pretreated patients with metastatic castration-resistant prostate carcinoma (mCRPC). Here, we report on treatment outcome and survival using this novel treatment modality in a series of 53 patients with mCRPC directly after their androgen deprivation treatment (ADT). Methods: 225Ac-PSMA617 was administered to 53 such patients. 68Ga-PSMA PET/CT was obtained at baseline, before every treatment cycle, and on follow-up to select patients for treatment, determine the activity to be administered, and assess their response. Serial prostate-specific antigen (PSA) measurements were obtained for response assessment. Results: The median age of the patients was 63.4 y (range, 45-83 y). In total, 167 cycles were administered (median, 3; range, 1-7). Forty-eight patients (91%) had a PSA decline of at least 50%, and 51 patients (96%) had any decline in PSA. 68Ga-PSMA PET findings became negative in 30 patients. In the multivariate analysis, a PSA decline of at least 50% proved predictive of both progression-free survival (PFS) and overall survival (OS), and platelet count also proved predictive for PFS. The median

estimated OS was 9 mo for patients with a PSA decline of less than 50% but was not yet reached at the latest follow-up (55 mo) for patients with a PSA decline of 50% or more. The estimated median PFS was 22 mo for patients with a PSA decline of at least 50% and 4 mo for patients with a PSA decline of less than 50%. No severe hematotoxicity was noted, and only 3 patients had grade III-IV nephrotoxicity. The commonest toxicity seen was grade I-II xerostomia, observed in 81% of patients. Conclusion: In 91% of 53 patients with mCRPC, treatment with 225Ac-PSMA-617 immediately after ADT resulted in at least a 50% decrease in PSA level. Furthermore, a PSA decline of at least 50% proved the single most important factor predicting PFS and OS after 225Ac-PSMA-617 treatment. Of interest, median OS in patients with a PSA decline of at least 50% was not yet reached at the latest follow-up (55 mo). These favorable results suggest that it would be of major clinical relevance to perform a prospective randomized study comparing 225Ac-PSMA-617 with current standard-of-care treatment options such as enzalutamide, abiraterone acetate, and docetaxel after ADT.

AUTEURS: Deleu A, Sathekge MJ, Maes A, De Spiegeleer B, Beels L, Sathekge M, Pottel H, Van de Wiele C

JOURNAL: Eur J Nucl Med Mol Imaging Physics

TITEL: Principal component analysis of texture features derived from FDG PET images of melanoma lesions

VOLUME: 9

ISSUE: 1

PAGINA’S: 64

JAAR: 2022

DOI: 10.1186/s40658-022-00491-x

ABSTRACT:

BACKGROUND:

The clinical utility of radiomics is hampered by a high correlation between the large number of features analysed which may result in the "bouncing beta" phenomenon which could in part explain why in a similar patient population texture features identified and/or cut-off values of prognostic significance differ from one study to another. Principal component analysis (PCA) is a technique for reducing the dimensionality of large datasets containing highly correlated variables, such as texture feature datasets derived from FDG PET images, increasing data interpretability whilst at the same time minimizing information loss by creating new uncorrelated variables that successively maximize variance. Here, we report on PCA of a texture feature dataset derived from 123 malignant melanoma lesions with a significant range in lesion size using the freely available LIFEx software.

RESULTS:

Thirty-eight features were derived from all lesions. All features were standardized. The statistical assumptions for carrying out PCA analysis were met. Seven principal components with an eigenvalue > 1 were identified. Based on the "elbow sign" of the Scree plot, only the first five were retained. The contribution to the total variance of these components derived using Varimax rotation was, respectively, 30.6%, 23.6%, 16.1%, 7.4% and 4.1%. The components provided summarized information on the locoregional FDG distribution with an emphasis on high FDG uptake regions, contrast in FDG uptake values (steepness), tumour volume, locoregional FDG distribution with an emphasis on low FDG uptake regions and on the rapidity of changes in SUV intensity between different regions.

CONCLUSIONS:

PCA allowed to reduce the dataset of 38 features to a set of 5 uncorrelated new variables explaining approximately 82% of the total variance contained within the dataset. These principal components may prove more useful for multiple regression analysis considering the relatively low numbers of patients usually included in clinical trials on FDG PET texture analysis. Studies assessing the superior differential diagnostic, predictive or prognostic value of principal components derived using PCA as opposed to the initial texture features in clinical relevant settings are warranted.

AUTEURS: Wynendaele E, Debunne N, Janssens Y, De Spiegeleer A, Verbeke F, Tack L, Van Welden S, Goossens E, Knappe D, Hoffmann R, Van de Wiele C, Laukens D, Van Eenoo P, Vereecke L, Van Immerseel F, De Wever O, De Spiegeleer B

JOURNAL: BMC Biol.

TITEL: The quorum sensing peptide EntF* promotes colorectal cancer metastasis in mice: a new factor in the host-microbiome interaction

VOLUME: 20

ISSUE: 1

PAGINA’S: 151

JAAR: 2022

DOI: 10.1186/s12915-022-01317-z

ABSTRACT:

BACKGROUND:

Colorectal cancer, one of the most common malignancies worldwide, is associated with a high mortality rate, mainly caused by metastasis. Comparative metagenome-wide association analyses of healthy individuals and cancer patients suggest a role for the human intestinal microbiota in tumor progression. However, the microbial molecules involved in host-microbe communication are largely unknown, with current studies mainly focusing on short-chain fatty acids and amino acid metabolites as potential mediators. Quorum sensing peptides are not yet considered in this context since their presence in vivo and their ability to affect host cells have not been reported so far.

RESULTS:

Here, we show that EntF*, a metabolite of the quorum sensing peptide EntF produced by Enterococcus faecium, is naturally present in mice bloodstream. Moreover, by using an orthotopic mouse model, we show that EntF* promotes colorectal cancer metastasis in vivo, with metastatic lesions in liver and lung tissues. In vitro tests suggest that EntF* regulates E-cadherin expression and consequently the epithelial-mesenchymal transition, via the CXCR4 receptor. In addition, alanine-scanning analysis indicates that the first, second, sixth, and tenth amino acid of EntF* are critical for epithelial-mesenchymal transition and tumor metastasis.

CONCLUSION:

Our work identifies a new class of molecules, quorum sensing peptides, as potential regulators of host-microbe interactions. We prove, for the first time, the presence of a selected quorum sensing peptide metabolite in a mouse model, and we demonstrate its effects on colorectal cancer metastasis. We believe that our work represents a starting point for future investigations on the role of microbiome in colorectal cancer metastasis and for the development of novel bio-therapeutics in other disease areas.

ONCOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Van Meerhaeghe T, Baurain JF, Bechter O, Orte Cano C, Del Marmol V, Devresse A, Doubel P, Hanssens M, Hellemans R, Lienard D, Rutten A, Sprangers B, Le Moine A, Aspeslagh S.

TITEL: Cemiplimab for advanced cutaneous squamous cell carcinoma in kidney transplant recipients

MEER INFO: Nefrologie

AUTEURS: Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, Debruyne P

TITEL: Developing and evaluating a participatory arts programme for cancer patients and their caregivers

MEER INFO: Gastro-enterologie

AUTEURS: Tack L, Schofield P, Boterberg T, Chandler R, Parris CN, Debruyne PR

JOURNAl: Cancers (Basel)

TITEL: Psychosocial Care after Cancer Diagnosis: Recent Advances and Challenges

VOLUME: 14

ISSUE: 23

PAGINA’S: 5882

JAAR: 2022

DOI: https://doi.org/10.3390/cancers14235882

ABSTRACT:

Psychosocial oncology is coming of age. While the survival rates of cancer patients have increased, many patients suffer from treatment-related long-lasting effects that may adversely affect their mental health and health-related quality of life. Along with the changes in therapeutic strategies, physicians should pay more attention to the psychosocial problems secondary to cancer as it is well recognized that the diagnosis of cancer and its treatment can be extremely stressful and emotional for cancer patients. Psychosocial oncology refers to the multidisciplinary subdiscipline of cancer care that was created to improve patients’ mental well-being by offering strategies to help them cope with the demands of treatment and uncertainty of disease outcome in the best possible way. Psychosocial care should be available prior to diagnosis to beyond palliative care and survival. The International Psycho-Oncology Society (IPOS) is the multidisciplinary international body responsible for the psychological, social and behavioural issues in cancer care. They propose an international quality standard, which could have a synergistic effect, in addition to international and national efforts to improve psychosocial cancer care: 1. Psychosocial cancer care should be recognized as a universal human right. 2. Quality cancer care must integrate the psychosocial domain into routine care. 3. Distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate and pain. That brings us to the topic of this Special Issue: what are the recent advances in psychosocial oncology and what challenges are we facing?

AUTEURS: Vanneste L, Lefebvre T, Tack L, Van Eygen K, Cool L, Schofield P, Boterberg T, De Rijdt T, Verhaeghe A, Verhelle K, Debruyne PR

JOURNAL: Pain Medicine

TITEL: Pain Medication Adherence in Patients with Cancer: A Pragmatic Review

VOLUME: 23

ISSUE: 4

PAGINA’S: 782-798

JAAR: 2022

DOI: 10.1093/pm/pnab010

ABSTRACT:

OBJECTIVE:

Adherence to pain medication in patients with cancer is crucial for successful pain therapy. This review aimed to investigate the rate of adherence, which factors influence adherence, whether adherence differs in diverse patient populations, whether there are methods to improve adherence, and the relationship between adherence and pain relief.

METHODS:

This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE/PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov were searched. All types of studies investigating adherence of patients with cancer, factors influencing adherence, and methods to improve adherence to pain medication were included. They were first screened on title and abstract and thereafter on full text. Selected articles were subjected to a quality assessment according to the PRISMA checklist. From included articles, study characteristics and outcomes were extracted.

RESULTS:

Of 795 articles, 18 were included. Different methods were used to measure adherence, which led to adherence rates ranging from 8.9% to 82.0%. White Americans and men were found to be more adherent than African Americans and women. Because of various barriers, adherence is often suboptimal. Fear of addiction, physiological and harmful effects, tolerance, and disease progression are common concerns. Interventions, such as pain education booklets, pain consults, and specialized nurses, may be beneficial to increase the adherence. Lower adherence rates were associated with lower pain relief.

CONCLUSION:

Adherence of cancer patients to pain medication is suboptimal. Health care workers should focus on addressing barriers to increase adherence to obtain better pain relief.

AUTEURS: Meert G, Kenis C, Milisen K, Debruyne PR, De Groof I, Focan C, Cornélis F, et al.

JOURNAL: Journal of Geriatric Oncology

TITEL: Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study

VOLUME: 13

ISSUE: 8

PAGINA’S: 1162-1171

JAAR: 2022

DOI: 10.1016/j.jgo.2022.08.019.

ABSTRACT:

INTRODUCTION:

Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline.

MATERIAL AND METHODS:

This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL.

RESULTS:

Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were

dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2-4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression.

DISCUSSION:

Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.

AUTEURS: Kenis C, Decoster L, Flamaing J, Debruyne PR, De Groof, Focan C, et al.

JOURNAL: BMC Geriatrics

TITEL: Incidence of falls and fall-related injuries and their predictive factors in frail older persons with cancer: a multicenter study

VOLUME: 22

ISSUE: 1

PAGINA’S: 877

JAAR: 2022

DOI: 10.1186/s12877-022-03574-7.

ABSTRACT:

BACKGROUND:

Falls and fall-related injuries are a major public health problem. Data on falls in older persons with cancer is limited and robust data on falls within those with a frailty profile are missing. The aim of this study is to investigate the incidence and predictive factors for falls and fall-related injuries in frail older persons with cancer.

METHODS:

This study is a secondary data analysis from data previously collected in a large prospective multicenter observational cohort study in older persons with cancer in 22 Belgian hospitals (November 2012-February 2015). Patients ≥70 years with a malignant tumor and a frailty profile based on an abnormal G8 score were included upon treatment decision and evaluated with a Geriatric Assessment (GA). At follow-up, data on falls and fall-related injuries were documented.

RESULTS:

At baseline 2141 (37.2%) of 5759 included patients reported at least one fall in the past 12 months, 1427 patients (66.7%) sustained an injury. Fall-related data of 3681 patients were available at follow-up and at least one fall was reported by 769 patients (20.9%) at follow-up, of whom 289 (37.6%) fell more than once and a fall-related injury was reported by 484 patients (62.9%). Fear of falling was reported in 47.4% of the patients at baseline and in 55.6% of the patients at follow-up. In multivariable analysis, sex and falls history in the past 12 months were predictive factors for both falls and fall-related injuries at follow-up. Other predictive factors for falls, were risk for depression, cognitive impairment, dependency in activities of daily living, fear of falling, and use of professional home care.

CONCLUSION:

Given the high number of falls and fall-related injuries and high prevalence of fear of falling, multifactorial falls risk assessment and management programs should be integrated in the care of frail older persons with cancer. Further studies with long-term follow-up, subsequent impact on cancer treatment and interventions for fall prevention, and integration of other important topics like medication and circumstances of a fall, are warranted.

AUTEURS: Demasure S., Spriet I., Debruyne PR, Laenen A., Wynendaele W., Baldewijns M., et al.

JOURNAL: Acta Oncologica

TITEL: Overall survival improvement in patients with metastatic clear-cell renal cell carcinoma between 2000 and 2020: a retrospective cohort study

VOLUME: 61

ISSUE: 1

PAGINA’S: 22-29

JAAR: 2022

DOI: 10.1080/0284186X.2021.1989720.

ABSTRACT:

BACKGROUND:

Only a few recent phase III trials with targeted therapies or immune checkpoint inhibitors (ICIs) in metastatic clear-cell renal cell carcinoma (m-ccRCC) demonstrated an overall survival (OS) benefit compared to standard of care. We aimed to study the evolution of OS since the start of systemic therapy from 2000 to 2020.

PATIENTS AND METHODS:

Retrospective study on all consecutively treated m-ccRCC patients in three Belgian hospitals starting with systemic therapy. The study outcome was OS since the start of systemic therapy. We used a univariable Cox model for OS with year of the start of therapy as a predictor, and a multivariable analysis including known prognostic factors. Linear and non-linear trends of time were tested.

RESULTS:

Five hundred patients were included. In a linear model, the HR for OS depending on the year of the start of therapy was 0.95 (95%CI 0.93-0.97; p < 0.0001), estimated for an increase with 1 year in time. In a non-linear model, OS started to improve from 2006 on, when vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) replaced interferon alfa (IFNa) as a standard of care and continued to increase steadily during the following years. On multivariable analysis, the year of the start of therapy remained an independent prognostic factor for OS. Two-year OS after the start of systemic therapy was 23%, 34%, 50% and 59% for patients who started treatment in 2000-2005, 2006-2011, 20122017, and 2018-2020, respectively. The five-year OS of the first three groups was 7%, 14% and 24%. The mean number of administered lines of therapy increased over time, with an incidence rate ratio of 1.07 (95%CI 1.05-1.08; p < 0.0001) per year increase for the period 2000-2016.

CONCLUSION:

OS of m-ccRCC patients has been improving significantly over the last 15 years since the introduction of VEGFR-TKIs and ICIs.

CONGRES

POSTERS

NAAM CONGRES: Afternoon meeting "Nurse Led Clinics" van de Belgische Vereniging Verpleegkundig Specialisten (BVVS)

DATUM: 22 april 2022

PLAATS: Brussel

TITEL PRESENTATIE: Pilootproject nurse-led clinic (NLC) door verpleegkundig specialisten in de ambulante oncologische zorg

SPREKER PRESENTATIE: Decadt Ine

NAAM CONGRES: World Congress by the Canadian Association of Psychosocial Oncology (CAPO) and the International Psycho-Oncology Society (IPOS)

DATUM: 03/09/2022

PLAATS: Toronto, Canada

TITEL PRESENTATIE: A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON)

SPREKER PRESENTATIE: Laura Tack

NAAM CONGRES: Research Day Ghent University

DATUM: 31/03/2022

PLAATS: Gent

TITEL PRESENTATIE: A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON)

SPREKER PRESENTATIE: Laura Tack

NAAM CONGRES: Belgian Society of Medical Oncology (BSMO) Annual Meeting

DATUM: 04/02/2022

PLAATS: Mechelen

TITEL PRESENTATIE: A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON)

SPREKER PRESENTATIE: Laura Tack

NAAM CONGRES: Belgian Society of Medical Oncology (BSMO) Annual Meeting

DATUM: 05/02/2022

PLAATS: Mechelen

TITEL PRESENTATIE: The use of Emotional Freedom Techniques to reduce Fear of Cancer Recurrence

SPREKER PRESENTATIE: Philip Debruyne, Tack Laura

NAAM CONGRES: OECI Oncology Days 2022

DATUM: 15 juni 2022

PLAATS: Valencia

TITEL PRESENTATIE: Coordinating interdisciplinary care - The implementation of an interdisciplinary care meeting on the oncology ward

SPREKER PRESENTATIE: Annelies Courtens

ORTHOPEDIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Michels F, Stockmans F, Pottel H, Matricali G.

JOURNAL: Foot Ankle Surgery

TITEL: Reconstruction of the cervical ligament in patients with chronic subtalar instability

VOLUME: 28

ISSUE: 8

PAGINA’S: 1286-1292

JAAR: 2022

DOI: doi: 10.1016/j.fas.2022.06.006.

ABSTRACT:

PURPOSE:

Diagnosis and treatment of subtalar instability (STI) remains complicated and challenging. The purpose of this study was to investigate the outcome of an anatomical reconstruction of the cervical ligament in patients with suspected chronic STI.

METHODS:

This prospective study assessed the results of a surgical reconstruction of the cervical ligament using a gracilis tendon graft in a group of 14 patients (16 feet). Diagnosis of STI was performed using a predefined algorithm including clinical signs, MRI and peroperative evaluation. All patients had symptoms of chronic hindfoot instability despite prolonged non-surgical treatment. At final follow-up the outcome was assessed using the Karlsson score, the Foot and Ankle Outcome Score and the American Orthopaedic Foot and Ankle Society score.

RESULTS:

After an average follow up of 22.6 months (range, 15-36), all patients reported significant improvement compared to their preoperative symptoms. The mean preoperative Karlsson score improved from 36.4 ± 13.5 (median 37, range 10-55) to a mean postoperative Karlsson score was 89.6 ± 8.5 (median 90, range 72-100) (P < 0.0001). The cervical ligament reconstruction was combined with other procedures in 13 cases: calcaneofibular ligament (CFL) reconstruction (3), CFL and anterior talofibular ligament reconstruction (7), bifurcate ligament reconstruction (3).

CONCLUSION:

Anatomical reconstruction of the cervical ligament is a valid technique to treat patients with STI. It is a safe procedure and produces good clinical results with minimal complications. This technique can be considered in more complex cases and can be combined with other procedures according to the specific location of the instability. Level of evidence: Level III.

AUTEURS: Michels F, Taylan O, Stockmans F, Vereecke E, Scheys L, Matricali G.

JOURNAL: Foot Ankle Surgery

TITEL: The different subtalar ligaments show significant differences in their mechanical properties

VOLUME: 28

ISSUE: 7

PAGINA’S: 1014-1020

JAAR: 2022

DOI: 10.1016/j.fas.2022.02.008.

ABSTRACT:

BACKGROUND:

Today, the relative contribution of each ligamentous structure in the stability of the subtalar joint is still unclear. The purpose of this study is to assess the material properties of the different ligamentous structures of the subtalar joint.

METHODS:

Eighteen paired fresh-frozen cadaveric feet were used to obtain bone-ligament-bone complexes of the calcaneofibular ligament (CFL), the cervical ligament (CL) and the anterior capsular ligament-interosseous talocalcaneal ligament complex

(ACaL-ITCL). The samples were subjected to uniaxial testing to calculate their respective stiffness and failure load.

RESULTS:

The stiffness of ACaL-ITCL complex (mean: 150 ± 51 N/mm, 95% confidence interval (CI): 125.0-176.6 N/mm) was significantly higher than both CFL (mean: 55.8 ± 23.0 N/mm, CI: 43.8-67.7 N/mm) and CL (mean: 63.9 ± 38.0 N/mm, CI: 44.4-83.3 N/mm). The failure load of both the ACaL-ITCL complex (mean:382.5 ± 158 N, CI: 304.1-460.8 N) and the CFL (mean:320.4 ± 122.0 N, CI: 257.5-383.2 N) were significantly higher than that of the CL (mean:163.5 ± 58.0 N, CI: 131.3-195.7 N). The injury pattern demonstrated a partial rupture in all CFL and ACaL-ITCL specimens and in 60% of the CL specimens.

CONCLUSION:

The CFL, CL and ACaL-ITCL show significant differences in their intrinsic mechanical properties. Both the CFL and CL are more compliant ligaments and seem to be involved in the development of subtalar instability. Based on the material properties, a gracilis tendon graft seems more appropriate than a synthetic ligament to reconstruct a CL or CFL. A partial rupture was the most commonly seen injury pattern in all ligaments. A fibular avulsion of the CFL was only rarely seen. The injury patterns need further investigation as they are important to optimize diagnosis and treatment.

CONGRES

PRESENTATIES

NAAM CONGRES: BFAS: Residents ongoing research

DATUM: 12-03-2022

PLAATS: Antwerpen

TITEL PRESENTATIE: The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis

SPREKER PRESENTATIE: H Wastyn, F Michels, G Matricali

NAAM CONGRES: 14th International Basic Course of Foot & Ankle Minimally invasive Surgery

DATUM: 14-06-2022

PLAATS: Barcelona, Spanje

TITEL PRESENTATIE 1: Lesser toe deformities: soft tissues & bone, surgical tips

TITEL PRESENTATIE 2: Lesser toes: postoperative care and dressing techniques

TITEL PRESENTATIE 3: Dressing techniques in percutaneous surgery

SPREKER PRESENTATIE: Frederick Michels

NAAM CONGRES: OTC IV advanced course: Lower limb mal – and nonunions: Causes and optimal treatment

DATUM: 17-12-2022

PLAATS: Brussel

TITEL PRESENTATIE: My worst case in ankle trauma

SPREKER PRESENTATIE: Frederick Michels

NAAM CONGRES: 15th edition EFAS 2022

DATUM: 27-10-2022

PLAATS: Edinburgh, UK

TITEL PRESENTATIE: Reconstruction of the cervical ligament in patients with chronic subtalar instability

SPREKER PRESENTATIE: Frederick Michels

DOCTORAAT

AUTEUR: F. Michels

TITEL: How to improve the clinical approach to patients with subtalar instability

JAARTAL: 2022

UNIVERSITEIT: KU Leuven

PATHOLOGISCHE ANATOMIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Billiet A., Moubax K., Libbrecht L., Van Moerkercke W.

TITEL: A Yellow sign indicating danger ahead

MEER INFO: Gastro-enterologie

AUTEURS: Van Bockstal MR, Libbrecht L, Dubail A, Berlière M, Galant C

JOURNAL: Int J Surg Pathol.

TITEL: Breast-implant Related Silicone Lymphadenopathy: Asteroid Bodies do not Always Equal Sarcoidosis!

JAAR: 2022

DOI: https://doi.org/10.1177/10668969221129890

ABSTRACT:

Silicone breast implants are frequently used for breast augmentation for cosmetic purposes, as well as for breast reconstruction after prophylactic or therapeutic mastectomy. Silicone lymphadenopathy is a well-known complication of silicone breast implants. Silicone droplets are present in the breast tissue through ‘silicone bleeding’ of the implant or because of implant rupture. These silicone particles can migrate from the breast to the regional lymph nodes. Silicone lymphadenopathy is caused by a substantial foreign body reaction against these silicone particles, and is frequently associated with asteroid body-containing multinucleated giant cells. Similar multinucleated giant cells are often observed in the capsule surrounding the silicone breast implant, and the number of associated asteroid bodies is highly variable. Here, we discuss a series of twelve women with breast implant-related asteroid bodies in their lymph nodes and/or breast tissue. This pictorial essay illustrates that the presence of asteroid bodies in a lymph node does not necessarily suggests a diagnosis of sarcoidosis. Clinical information about the patient having (or having had) silicone breast implants is often lacking. The encounter of asteroid body-containing giant cells in lymph node cytology, biopsies or resections should therefore lead to reflex clinical-pathological correlation, before establishing a final diagnosis.

AUTEURS: Taillieu E, De Meyere C, Nuytens F, Vanneste G, Libbrecht L, Alaerts H, Parmentier I, Verslype C, D'Hondt M

TITEL: Laparoscopic liver resection for colorectal liver metastases: retrospective analysis of prognostic factors and oncological outcomes in a single-center cohort

MEER INFO: Abdominale chirurgie

PEDIATRIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Naesens L, Nemegeer J, Roelens F, Vallaeys L, Meuwissen M, Janssens K et al.

JOURNAL: Journal of Clinical Immunology

TITEL: Mutations in RNU7-1 Weaken Secondary RNA Structure, Induce MCP-1 and CXCL10 in CSF, and Result in Aicardi-Goutières Syndrome with Severe End-Organ Involvement

VOLUME: 42

ISSUE:

PAGINA’S: 962-974

JAAR: 2022

DOI: https://doi.org/10.1007/s10875-022-01209-5

ABSTRACT:

BACKGROUND:

Aicardi-Goutières syndrome (AGS) is a type I interferonopathy usually characterized by early-onset neurologic regression. Biallelic mutations in LSM11 and RNU7-1, components of the U7 small nuclear ribonucleoprotein (snRNP) complex, have been identified in a limited number of genetically unexplained AGS cases. Impairment of U7 snRNP function results in misprocessing of replication-dependent histone (RDH) pre-mRNA and disturbance of histone occupancy of nuclear DNA, ultimately driving cGAS-dependent type I interferon (IFN-I) release.

OBJECTIVE:

We performed a clinical, genetic, and immunological workup of 3 unrelated patients with uncharacterized AGS.

Methods

Whole exome sequencing (WES) and targeted Sanger sequencing of RNU7-1 were performed. Primary fibroblasts were used for mechanistic studies. IFN-I signature and STAT1/2 phosphorylation were assessed in peripheral blood. Cytokines were profiled on serum and cerebrospinal fluid (CSF). Histopathology was examined on brain and kidney tissue.

RESULTS:

Sequencing revealed compound heterozygous RNU7-1 mutations, resulting in impaired RDH pre-mRNA processing. The 3' stem-loop mutations reduced stability of the secondary U7 snRNA structure. A discrete IFN-I signature in peripheral blood was paralleled by MCP-1 (CCL2) and CXCL10 upregulation in CSF. Histopathological analysis of the kidney showed thrombotic microangiopathy. We observed dysregulated STAT phosphorylation upon cytokine stimulation. Clinical overview of all reported patients with RNU7-1-related disease revealed high mortality and high incidence of organ involvement compared to other AGS genotypes.

CONCLUSIONS:

Targeted RNU7-1 sequencing is recommended in genetically unexplained AGS cases. CSF cytokine profiling represents an additional diagnostic tool to identify aberrant IFN-I signaling. Clinical follow-up of RNU7-1-mutated patients should include screening for severe end-organ involvement including liver disease and nephropathy.

PSYCHIATRIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: De Moerloose S, Geerts PJ, Vanacker P, Lemmens GMD.

TITEL: A Case Report of Acute Cervical Dystonia After Electroconvulsive Therapy

MEER INFO: Neurologie

CONGRES

PRESENTATIES

NAAM CONGRES: SLP Summer school. Speech-Language Pathology International Network (SLP-IN)

DATUM: Augustus 2022

PLAATS: University of Turku, Findland

TITEL PRESENTATIE: Gender identity and dysphoria. What’s in the name and what’s the standard of care?

SPREKER PRESENTATIE: Geerts Pieter-Jan, Verstraete J.

NAAM CONGRES: 11e Vlaams Geestelijke Gezondheidscongres

DATUM: 20/09/2022

PLAATS: Antwerpen

TITEL PRESENTATIE: Wat werkt voor wie in de liaisonpsychiatrie?

SPREKER PRESENTATIE: Van Den Eede F., Geerts PJ

POSTERS

NAAM CONGRES: The European Association of Consultation-Liason Psychiatry annual conference 2022

DATUM: 10-06-2022

PLAATS: Wenen, Oostenrijk

TITEL POSTER 1: Routine alcohol screening, alcohol withdrawal protocol and brief behavioral interventions in a general HOSPITAL: description of a hospital-wide protocol and results from 3 years' experience.

AUTEUR POSTER 1: Kraus A., Geerts PJ

NAAM CONGRES: 11e Vlaamse Geestelijke Gezondheidscongres

DATUM: 20 en 21 september 2022

PLAATS: Antwerpen, Wilrijk – Campus Drie Eiken

TITEL POSTER 1: Wanneer twijfelen zorgt voor comfort(room)

AUTEUR POSTER 1: Abihi S., Lanssens K., Cool L., Titeca K.

TITEL POSTER 2: Wanneer ongehoorzaamheid leidt tot veiligheid: Suïcidepreventie in de praktijk

AUTEUR POSTER 2: Abihi S., Verhelst D., Lanssens K., Titeca K.

TITEL POSTER 3: Wanneer het onzichtbare tastbaar wordt

AUTEUR POSTER 3: Abihi S., Defreyne M., Cool L., Titeca K.

PSYCHOLOGIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, Debruyne P

TITEL: Developing and evaluating a participatory arts programme for cancer patients and their caregivers

MEER INFO: Gastro-enterologie

RADIOTHERAPIE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Nevens D, Jongen A, Kindts I, Billiet C, Deseyne P, Joye I, Lievens Y,

JOURNAL: Int J Radiat Oncol Biol Phys

Guckenberger M.

TITEL: Completeness of Reporting Oligometastatic Disease Characteristics in the Literature and Influence on Oligometastatic Disease Classification Using the ESTRO/EORTC Nomenclature

VOLUME: 114

ISSUE: 4

PAGINA’S: 587-595

JAAR: 2022

DOI: 10.1016/j.ijrobp.2022.06.067

ABSTRACT:

PURPOSE:

There is increasing evidence for the integration of locally ablative therapy into multimodality treatment of oligometastatic disease (OMD). To support standardised data collection, analysis, and comparison, a consensus OMD classification based on fundamental disease and treatment characteristics has previously been established. This study investigated the completeness of reporting the proposed OMD characteristics in literature and evaluated whether the proposed OMD classification system can be applied to the historical data.

METHODS AND MATERIALS:

A systematic literature review was performed in Medline, Embase, and Cochrane, searching for prospective and retrospective studies, where stereotactic body radiation therapy was a treatment component of OMD. Reporting of the OMD characteristics as described in the European Organisation for Research and Treatment of Cancer/European Society for Radiotherapy and Oncology classification was analyzed, feasibility to retrospectively classify the proposed OMD states was investigated, and the effect of the categorization on overall survival (OS) was evaluated.

RESULTS:

Our study shows incomplete reporting of the proposed OMD characteristics. The most fully reported characteristic was type of involved organs (88/95 studies); history of cancer progression was the least reported (not mentioned in 50/95 studies). Retrospective OMD classification of existing literature was only possible for 7 of the 95 studies. With respect to categorization as de novo, repeat, or induced OMD, homogeneous patient cohorts were observed in 21 of the 95 studies, most frequently de novo OMD in 20 studies. Differences in OS at 2, 3, or 5 years were not statistically significant between the different states. OS was significantly influenced by primary tumor histology, with superior OS observed for prostate cancer and worst OS observed for non-small cell lung cancer.

CONCLUSIONS:

The largely incomplete reporting of the proposed OMD characteristics hampers a retrospective classification of existing literature. To facilitate future comparison of individual studies, as well as validation of the OMD classification, comprehensive reporting of OMD characteristics using standardised terminology is recommended, as proposed by the European Organisation for Research and Treatment of Cancer/European Society for Radiotherapy and Oncology classification system and following the European Society for Radiotherapy and Oncology/American Society for Radiation Oncology consensus.

AUTEURS: Van der Vorst A, Kindts I, Laenen A, Neven P, Janssen H, Weltens C

JOURNAL: Breast

TITEL: Validation of a prognostic scoring system for postmastectomy locoregional recurrence in breast cancer

VOLUME: 64

ISSUE:

PAGINA’S: 29-34

JAAR: 2022

DOI: 10.1016/j.breast.2022.04.007

ABSTRACT:

BACKGROUND:

To date, it remains unclear which patients with breast cancer (BC) benefit from post-mastectomy radiotherapy (PMRT). Cheng et al. developed and validated a scoring system based on 4 prognostic factors for locoregional recurrence (LRR) to identify patients in need for PMRT. These factors include age, estrogen receptor status, lymphovascular status and number of affected axillary lymph nodes.

PURPOSE:

To validate the scoring system for LRR in BC developed by Cheng et al. by using an independent BC database.

Methods and materials:

We retrospectively identified 1989 BC cases, treated with mastectomy (ME) with or without PMRT at the University Hospitals Leuven between 2000 and 2007. The primary endpoint was 5-year locoregional control rate with and without PMRT, according to the LRR score.

RESULTS:

Median follow-up time was 11.4 years. After excluding patients with missing variables 1103 patients were classified using the LRR scoring system: 688 (62.38%) patients were at low risk of recurrence (LRR score 0-1), 335 (30.37%) patients were at intermediate risk of recurrence (LRR score 2-3) and 80 (7.25%) patients were at high risk of recurrence (LRR score ≥4).

5-year locoregional control rates with and without PMRT were 99.20% versus 99.21% (p = 0.43) in the low-risk group; 98.24% versus 85.74% (p < 0.0001) in the intermediate-risk group and 96.87% versus 85.71% (p = 0.10) in the high-risk group respectively.

CONCLUSION:

Our validation of the LRR scoring system suggests it can be used to point out patients that would benefit from PMRT. We recommend further validation of this scoring system by other independent institutions before application in clinical practice.

AUTEURS: Duma M, Offersen B, Bessermann Johansen M, Boye K, Kristensen B, Meattini I, Kindts I, et al.

JOURNAL: Radiother Oncol

TITEL: PO-1569 An international, multicenter planning study on regional nodal irradiation in breast cancer

VOLUME: 170

ISSUE:

PAGINA’S: S1350-S1351

JAAR: 2022

DOI: 10.1016/S0167-8140(22)03533-2

ABSTRACT: Digital poster

AUTEURS: Rans K, Berghen C, Ameye F, De Hertogh O, den Hartog J, Draulans C, Rumez H, Engels B, Goffin K, Laenen A, Liefhooghe N, Poels K, Selembier C, Slabbaert K, Vandendriessche H, Vanneste B, Jonieau S, De Meerleer G.

JOURNAL: BMC Cancer

TITEL: SPARKLE: a new spark in treating oligorecurrent prostate cancer: adding systemic treatment to stereotactic body radiotherapy or metastasectomy: key to long-lasting event-free survival

VOLUME: 22

ISSUE: 1

PAGINA’S: 1294

JAAR: 2022

DOI: 10.1186/s12885-022-10374-0

ABSTRACT:

BACKGROUND:

Metastasis-directed therapy (MDT) significantly delays the initiation of palliative androgen deprivation therapy (pADT) in patients with oligorecurrent prostate cancer (PCa) with a positive impact on patient's quality of life. However, it remains unclear whether the addition of ADT improves polymetastatic free survival (PMFS) and metastatic castration refractory PCa-free survival (mCRPC-FS) and how long concomitant hormone therapy should be given. A significant overall survival (OS) benefit was shown when an androgen receptor targeted agent (ARTA) was added to pADT in patients with metastatic hormone sensitive PCa (HSPC). However, whether the addition of and ARTA to MDT in the treatment of oligorecurrent PCa results in better PMFS and mCRPC-FS has not been proven yet.

METHODS & DESIGN:

Patients diagnosed with oligorecurrent HSPC (defined as a maximum of 5 extracranial metastases on PSMA PET-CT) will be randomized in a 1:1:1 allocation ratio between arm A: MDT alone, arm B: MDT with 1 month ADT, or arm C: MDT with 6 months ADT together with ARTA (enzalutamide 4 × 40 mg daily) for 6 months. Patients will be stratified by PSA doubling time (≤ 3 vs. > 3 months), number of metastases (1 vs. > 1) and initial localization of metastases (M1a vs. M1b and/or M1c). The primary endpoint is PMFS, and the secondary endpoints include mCRPC-FS, biochemical relapse-free survival (bRFS), clinical progression free survival (cPFS), cancer specific survival (CSS), overall survival (OS), quality of life (QOL) and toxicity.

DISCUSSION:

This is the first prospective multicentre randomized phase III trial that investigates whether the addition of short-term ADT during 1 month or short-term ADT during 6 months together with an ARTA to MDT significantly prolongs PMFS and/ or mCRPC-FS.

AUTEURS: Lefebvre T, Tack L, Meersman M, Vanneste H, Cool L, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, De Backer J, Chandler R, Lane P, Boterberg T, Debruyne P

TITEL: Developing and evaluating a participatory arts programme for cancer patients and their caregivers

MEER INFO: Gastro-enterologie

AUTEURS: Achard V, Jaccard M, Vanhoutte F, Siva S, Heikkilä R, Dirix P, Liefhooghe N, Otte FX, Gomez-Iturriaga A, Berghen C, Shelan M, Conde-Moreno A, Lopez Campos F, Papachristofilou A, Guckenberger M, Meersschout S, Putora PM, Zwahlen D, Couñago F, Scorsetti M, Eito C, Barrado M, Zapatero A, Muto P, Van De Voorde L, Lamanna G, Koutsouvelis N, Dipasquale G, Ost P, Zilli T.

JOURNAL: Radiother Oncol.

TITEL: Oligorecurrent nodal prostate cancer: Radiotherapy quality assurance of the randomized PEACE V-STORM phase II trial

VOLUME: 172

ISSUE:

PAGINA’S: 1-9

JAAR: 2022

DOI: 10.1016/j.radonc.2022.04.020

ABSTRACT:

PURPOSE:

Aim of this study is to report the results of the radiotherapy quality assurance program of the PEACE V-STORM randomized phase II trial for pelvic nodal oligorecurrent prostate cancer (PCa).

MATERIAL AND METHODS:

A benchmark case (BC) consisting of a postoperative case with 2 nodal recurrences was used for both stereotactic body radiotherapy (SBRT, 30 Gy/3 fx) and whole pelvic radiotherapy (WPRT, 45 Gy/25 fx + SIB boost to 65 Gy).

RESULTS:

BC of 24 centers were analyzed. The overall grading for delineation variation of the 1st BC was rated as 'UV' (Unacceptable Variation) or 'AV' (Acceptable Variation) for 1 and 7 centers for SBRT (33%), and 3 and 8 centers for WPRT (46%), respectively. An inadequate upper limit of the WPRT CTV (n = 2), a missing delineation of the prostate bed (n = 1), and a missing nodal target volume (n = 1 for SBRT and WPRT) constituted the observed 'UV'. With the 2nd BC (n = 11), the overall delineation review showed 2 and 8 'AV' for SBRT and WPRT, respectively, with no 'UV'. For the plan review of the 2nd BC, all treatment plans were per protocol for WPRT. SBRT plans showed variability in dose normalization (Median D90% = 30.1 Gy, range 22.9-33.2 Gy and 30.6 Gy, range 26.8-34.2 Gy for nodes 1 and 2 respectively).

CONCLUSIONS:

Up to 46% of protocol deviations were observed in delineation of WPRT for nodal oligorecurrent PCa, while dosimetric results of SBRT showed the greatest disparities between centers. Repeated BC resulted in an improved adherence to the protocol, translating in an overall acceptable contouring and planning compliance rate among participating centers.

AUTEURS: Adair Smith G, Dunlop A, Alexander SE, Barnes H, Casey F, Chick J, Gunapala R, Herbert T, Lawes R, Mason SA, Mitchell A, Mohajer J, Murray J, Nill S, Patel P, Pathmanathan A, Sritharan K, Sundahl N, Westley R, Tree AC, McNair HA.

JOURNAL: Tech Innov Patient Support Radiat Oncol

TITEL: Interobserver variation of clinical oncologists compared to therapeutic radiographers (RTT) prostate contours on T2 weighted MRI.

VOLUME: 25

ISSUE:

PAGINA’S: 100200

JAAR: 2022

DOI: 10.1016/j.tipsro.2022.12.007

ABSTRACT:

The implementation of MRI-guided online adaptive radiotherapy has enabled extension of therapeutic radiographers' roles to include contouring. An offline interobserver variability study compared five radiographers' and five clinicians' contours on 10 MRIs acquired on a MR-Linac from 10 patients. All contours were compared to a "gold standard" created from an average of clinicians' contours. The median (range) DSC of radiographers' and clinicians' contours compared to the "gold standard" was 0.91 (0.86-0.96), and 0.93 (0.88-0.97) respectively illustrating non-inferiority of the radiographers' contours to the clinicians. There was no significant difference in HD, MDA or volume size between the groups.

AUTEURS: Sritharan K, Dunlop A, Mohajer J, Adair-Smith G, Barnes H, Brand D, Greenlay E, Hijab A, Oelfke U, Pathmanathan A, Mitchell A, Murray J, Nill S, Parker C, Sundahl N, Tree AC

JOURNAL: Clin Transl Radiat Oncol

TITEL: Dosimetric comparison of automatically propagated prostate contours with manually drawn contours in MRI-guided

RADIOTHERAPY: A step towards a contouring free workflow?

VOLUME: 37

ISSUE:

PAGINA’S: 25-32

JAAR: 2022

DOI: 10.1016/j.ctro.2022.08.004

ABSTRACT:

BACKGROUND:

The prostate demonstrates inter- and intra- fractional changes and thus adaptive radiotherapy would be required to ensure optimal coverage. Daily adaptive radiotherapy for MRI-guided radiotherapy can be both time and resource intensive when structure delineation is completed manually. Contours can be auto-generated on the MR-Linac via a deformable image registration (DIR) based mapping process from the reference image. This study evaluates the performance of automatically generated target structure contours against manually delineated contours by radiation oncologists for prostate radiotherapy on the Elekta Unity MR-Linac.

METHODS:

Plans were generated from prostate contours propagated by DIR and rigid image registration (RIR) for forty fractions from ten patients. A two-dose level SIB (simultaneous integrated boost) IMRT plan is used to treat localised prostate cancer; 6000 cGy to the prostate and 4860 cGy to the seminal vesicles. The dose coverage of the PTV 6000 and PTV 4860 created from the manually drawn target structures was evaluated with each plan. If the dose objectives were met, the plan was considered successful in covering the gold standard (clinician-delineated) volume.

RESULTS:

The mandatory PTV 6000 dose objective (D98% > 5580 cGy) was met in 81 % of DIR plans and 45 % of RIR plans. The SV were mapped by DIR only and for all the plans, the PTV 4860 dose objective met the optimal target (D98% > 4617 cGy). The plans created by RIR led to under-coverage of the clinician-delineated prostate, predominantly at the apex or the bladder-prostate interface.

CONCLUSION:

Plans created from DIR propagation of prostate contours outperform those created from RIR propagation. In approximately 1 in 5 DIR plans, dosimetric coverage of the gold standard PTV was not clinically acceptable. Thus, at our institution, we use a combination of DIR propagation of contours alongside manual editing of contours where deemed necessary for online treatments.

AUTEURS: De Jaeghere EA, Kanervo H, Colman R, Schrauwen W, West P, Vandemaele N, De Pauw A, Jacobs C, Hilderson

I, Saerens M, Sundahl N, Vandecasteele K, Naert E, Lapeire L, Kruse V, Rottey S, Lemmens G, Denys HG

JOURNAL: Cancers

TITEL: Mental Health and Quality of Life among Patients with Cancer during the SARS-CoV-2 Pandemic: Results from the Longitudinal ONCOVID Survey Study

VOLUME: 14

ISSUE:

PAGINA’S: 1093

JAAR: 2022

DOI: 10.3390/cancers14041093

ABSTRACT:

PURPOSE:

This longitudinal survey study aimed to investigate the self-reported outcome measures of COVID-19 peritraumatic distress, depression, anxiety, stress, quality of life (QOL), and their associated factors in a cohort of cancer patients treated at a tertiary care hospital during the SARS-CoV-2 pandemic.

METHODS:

Surveys were administered at four time points between 1 April 2020 and 18 September 2020. The surveys included the CPDI, DASS-21, and WHOQOL-BREF questionnaires.

RESULTS:

Survey response rates were high (61.0% to 79.1%). Among the 355 participants, 71.3% were female, and the median age was 62.2 years (IQR, 53.9 to 69.1). The majority (78.6%) were treated with palliative intention. An important proportion of the participants reported symptoms of COVID-19 peritraumatic distress (34.2% to 39.6%), depression (27.6% to 33.5%), anxiety (24.9% to 32.7%), and stress (11.4% to 15.7%) at any time point during the study period. We did not find clinically meaningful mental health and QOL differences during the study period, with remarkably little change in between the pandemic's first and second wave. We found no consistent correlates of mental health or QOL scores, including cancer type, therapy intention, and sociodemographic information.

CONCLUSION:

This cohort of cancer patients showed considerable resilience against mental health and QOL deterioration during the SARS-CoV-2 pandemic.

AUTEURS: Spaas M, Sundahl N, Ost P

JOURNAL: Eur Urol

TITEL: Re: Nivolumab in Combination with Stereotactic Body Radiotherapy in Pretreated Patients with Metastatic Renal Cell Carcinoma. Results of the Phase II NIVES Study

VOLUME: 81

ISSUE:

PAGINA’S: 216

JAAR: 2022

DOI: 10.1016/j.eururo.2021.11.003

ABSTRACT: n/a

CONGRES

PRESENTATIES

NAAM CONGRES: ESTRO

DATUM: 2022

PLAATS: Copenhagen

TITEL PRESENTATIE: A comparison of doctor and therapeutic radiographer (RTT) prostate contours on T2 weighted MRI

SPREKER PRESENTATIE: Gillian Smith

UROLOGIE

WETENSCHAPPELIJKE ARTIKELS

JOURNAL: The Lancet Oncology

TITEL: Niraparib in patients with metastatic castration-resistant prostate cancer and DNA repair gene defects (GALAHAD): a multicentre, open-label, phase 2 trial

VOLUME: 23

ISSUE: 3

PAGINA’S: 362-373

JAAR: 2022

DOI: https://doi.org/10.1016/S1470-2045(21)00757-9

ABSTRACT:

BACKGROUND:

Metastatic castration-resistant prostate cancers are enriched for DNA repair gene defects (DRDs) that can be susceptible to synthetic lethality through inhibition of PARP proteins. We evaluated the anti-tumour activity and safety of the PARP inhibitor niraparib in patients with metastatic castration-resistant prostate cancers and DRDs who progressed on previous treatment with an androgen signalling inhibitor and a taxane.

METHODS:

In this multicentre, open-label, single-arm, phase 2 study, patients aged at least 18 years with histologically confirmed metastatic castration-resistant prostate cancer (mixed histology accepted, with the exception of the small cell pure phenotype) and DRDs (assessed in blood, tumour tissue, or saliva), with progression on a previous next-generation androgen signalling inhibitor and a taxane per Response Evaluation Criteria in Solid Tumors 1.1 or Prostate Cancer Working Group 3 criteria and an Eastern Cooperative Oncology Group performance status of 0–2, were eligible. Enrolled patients received niraparib 300 mg orally once daily until treatment discontinuation, death, or study termination. For the final study analysis, all patients who received at least one dose of study drug were included in the safety analysis population; patients with germline pathogenic or somatic biallelic pathogenic alterations in BRCA1 or BRCA2 (BRCA cohort) or biallelic alterations in other prespecified DRDs (non-BRCA cohort) were included in the efficacy analysis population. The primary endpoint was objective response rate in patients with BRCA alterations and measurable disease (measurable BRCA cohort). This study is registered with ClinicalTrials.gov, NCT02854436.

FINDINGS:

Between Sept 28, 2016, and June 26, 2020, 289 patients were enrolled, of whom 182 (63%) had received three or more systemic therapies for prostate cancer. 223 (77%) of 289 patients were included in the overall efficacy analysis population, which included BRCA (n=142) and non-BRCA (n=81) cohorts. At final analysis, with a median follow-up of 10·0 months (IQR 6·6–13·3), the objective response rate in the measurable BRCA cohort (n=76) was 34·2% (95% CI 23·7–46·0). In the safety analysis population, the most common treatment-emergent adverse events of any grade were nausea (169 [58%] of 289), anaemia (156 [54%]), and vomiting (111 [38%]); the most common grade 3 or worse events were haematological (anaemia in 95 [33%] of 289; thrombocytopenia in 47 [16%]; and neutropenia in 28 [10%]). Of 134 (46%) of 289 patients with at least one serious treatment-emergent adverse event, the most common were also haematological (thrombocytopenia in 17 [6%] and anaemia in 13 [4%]). Two adverse events with fatal outcome (one patient with urosepsis in the BRCA cohort and one patient with sepsis in the non-BRCA cohort) were deemed possibly related to niraparib treatment.

INTERPRETATION:

Niraparib is tolerable and shows anti-tumour activity in heavily pretreated patients with metastatic castration-resistant prostate cancer and DRDs, particularly in those with BRCA alterations.

AUTEURS: Smith M, Sher H, Sandhu S, Efstathiou E, Lara Jr P, Yu E, George D, Chi K, Saad F, Stahl O, Olmos D, Danila D, Mason G, Espina B, Zhao X, Urtishak K, Francis P, Lopez-Gitlitz A, Fizazi K. et al for GALAHAD investigators, Van Bruwaene S

AUTEURS: Meagher M, Mir M, Autorina R, Minervini A, Kriegmair M, Maurer T, Porpiglia F, Van Bruwaene S. et al

JOURNAL: Clinical Genitourinary Cancer

TITEL: Impact of Metastasectomy on Cancer Specific and Overall Survival in Metastatic Renal Cell Carcinoma: Analysis of the REMARCC Registry

VOLUME: 20

ISSUE: 4

PAGINA’S: 326-333

JAAR: 2022

DOI: https://doi.org/10.1016/j.clgc.2022.03.013

ABSTRACT:

BACKGROUND:

Treatment paradigms for management of metastatic renal cell carcinoma (mRCC) are evolving. We examined impact of surgical metastasectomy on survival across in mRCC stratified by risk-group.

METHODS:

Multicenter retrospective analysis from the Registry of Metastatic RCC database. The cohort was subdivided utilizing Motzer criteria (favorable-, intermediate-, high-risk). Primary outcome was all-cause mortality (ACM)/overall survival (OS); secondary outcome was cancer-specific mortality (CSM)/cancer-specific survival (CSS). Impact of metastasectomy was analyzed via Cox-Regression analysis adjusting for potential prognostic variables and Kaplan-Meier analysis (KMA) within each risk-group.

RESULTS:

Four hundred thirty-one patients (59 favorable-risk, 274 intermediate-risk, 98 high-risk; median follow-up 27.2 months) were analyzed. Metastasectomy was performed in 22 (37%), 66 (24%), and 32 (16%) of favorable-, intermediate- and high-risk groups (P = .012). Median number of metastases at diagnosis differed significantly (favorable-risk 2, intermediate-risk 3.4, high-risk 5.1, P < .001). On Cox-regression, high-risk (HR = 1.72, P = .002) was associated with worsened ACM, while metastasectomy was associated with improved ACM (HR = 0.56, P = .005). On KMA, median OS (months) was longer with metastasectomy in favorable- (92.7 vs. 25.8, P = .003) and intermediate-risk (26.3 vs. 20.1, P = .038), but not high-risk (P = .911) groups. Metastasectomy was associated with longer CSS in favorable- (76.1 vs. 32.8, P = .004) but not intermediate- (P = .06) and high-risk (P = .595) groups.

CONCLUSIONS:

Metastasectomy was independently associated with improved ACM and CSM, as well as improved CSS and OS in favorableand intermediate-risk mRCC patients. Metastasectomy may be considered as component of multimodal management strategy in favorable and intermediate-risk subgroups. In high-risk patients, metastasectomy should be deferred except in select circumstances.

AUTEURS: Lambert E, Hollebosch S, Van Praet C, Van Bruwaene S, Duck L, De Roock W. et al

JOURNAL: Acta Clinical Belgica

TITEL: Treatment of patients with newly diagnosed metastatic hormone sensitive prostate cancer (mHSPC) in Belgium: a real world data analysis

VOLUME: 77

ISSUE: 6

PAGINA’S: 897-905

JAAR: 2022

DOI: https://doi.org/10.1080/17843286.2021.2001999

ABSTRACT:

INTRODUCTION:

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

PATIENTS AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

AUTEURS: Develtere D, Mazzone E, Berquin C, Sinatti C, Veys R, Farinha R. et al

JOURNAL: Journal of endourology

TITEL: Transvesical Approach in Robot-Assisted Bladder Diverticulectomy: Surgical Technique and Outcome

VOLUME: 36

ISSUE: 3

PAGINA’S: 313-316

JAAR: 2022

DOI: https://doi.org/10.1089/end.2021.0366

ABSTRACT:

OBJECTIVE:

Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTIs). When bladder outlet obstruction is present, a simultaneous desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes.

PATIENTS AND SURGICAL PROCEDURE:

We retrospectively analyzed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is observed. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture.

RESULTS:

Median age was 66 years (interquartile range [IQR] 60-69). The number of diverticula removed ranged from 1 to 3. Ten patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 minutes (IQR 120-180), median estimated blood loss was 250 mL (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). One patient developed urinary leakage after catheter removal, one patient developed a UTI. Median follow-up was 9 months (IQR 3.5-14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 mL (IQR 0-111), with a median decline of 120 mL (IQR -402 to -33).

CONCLUSIONS:

Transvesical approach for RABD is a safe and reliable technique that gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterization time is short. No relapse has been observed.

AUTEURS: Del Favero L, Tasso G, Deruyver Y, Tutolo M, Beels E, Schillebeeckx C. et al

JOURNAL: Uropean urology focus

TITEL: Long-term Functional Outcomes and Patient Satisfaction After AdVance and AdVanceXP Male Sling Surgery

VOLUME: 8

ISSUE: 5

PAGINA’S: 1408-1414

JAAR: 2022

DOI: https://doi.org/10.1016/j.euf.2022.01.017

ABSTRACT:

BACKGROUND

Transobturator male sling has gained increasing acceptance for the treatment of male urinary incontinence. Several prospective trials have demonstrated the safety and efficacy of the AdVance and AdVanceXP slings.

OBJECTIVE

To evaluate long-term functional outcomes after AdVance or AdVanceXP sling implant for non-neurogenic male stress urinary incontinence and identify factors associated with a higher risk for incontinence or decreased satisfaction.

Design, setting, and participants

Patients who underwent AdVance or AdVanceXP implant surgery between June 2007 and April 2018 were retrospectively included in this single-institution, consecutive series. Outcome measurements and statistical analysis In April 2020, patients were recontacted to evaluate long-term functional outcomes and satisfaction by standardized, validated questionnaires.

RESULTS AND LIMITATIONS

A total of 216 patients were included in this study; 172 of them could be contacted for the assessment of long-term patient reported outcomes. The median follow-up period was 49 mo. Overall social continence (ie, needing no more than one pad per 24 h) at 5-yr follow-up was 66% (confidence interval [CI]: 58–73%). In an ideal population (ie, needing no more than four pads per 24 h and naïve for pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery), 5-yr social continence rates were markedly better and reached 79% (CI: 69–85%). Overall social continence rates tended to decrease at 10-yr follow-up to 42% (CI: 33–52%). Overall, totally dry rate at 5-yr follow-up was 53% (CI: 46–60%), which again was significantly better in the ideal population (62%, CI: 51–70%). According to the Patient Global Improvement Indices score, 71% (CI: 63–78%) of patients indicated to be satisfied after 5 yr, which improved to 77% (CI: 67–85%) in the ideal patient population. In a multivariate analysis, prior pelvic radiotherapy and previous incontinence or urethral stricture surgery were associated with decreased continence rates and patient satisfaction.

CONCLUSIONS

In general, long-term continence rates and patient satisfaction after AdVance and AdVance XP sling surgery are acceptable but deteriorate significantly as time from surgery progresses. Especially patients with a history of pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery should be counseled properly about their higher risk for sling failure.

PATIENT SUMMARY

In this report, we investigated long-term outcomes after Advance and AdvanceXP sling implant for male stress urinary incontinence. We found that, in general, continence and patient satisfaction are acceptable but deteriorate significantly as time from surgery progresses. Patients with previous pelvic radiotherapy, incontinence surgery, or urethral stricture surgery are at higher risk for sling failure.

AUTEURS: Deruyver Y, Schillebeeckx C, Beels E, De Ridder D, Van der Aa F.

JOURNAL: World Journal of Urology

TITEL: Long-term outcomes and patient satisfaction after artificial urinary sphincter implantation

VOLUME: 40

ISSUE:

PAGINA’S: 497-503

JAAR: 2022

DOI: 10.1007/s00345-021-03877-1

ABSTRACT:

PURPOSE

To evaluate long-term functional outcomes of artificial urinary sphincter implantation in men for the treatment of stress urinary incontinence.

MATERIALS AND METHODS

Patients who underwent artificial urinary sphincter implant for non-neurogenic stress urinary incontinence between June 1989 and January 2020 were included in this single-centre retrospective series. All patients with a functional artificial urinary sphincter in situ were contacted to evaluate long-term functional outcomes using validated questionnaires.

RESULTS

A total of 263 patients were included in this retrospective series with a mean follow-up of 61 months. Explant-free survival after 5 years was 75% with a median time to explant of 16.2 years. Revision-free implant survival was 62% after 5 years with a median revision-free implant survival rate of 10.8 years. Previous pelvic irradiation, history of stricture disease and previous artificial urinary sphincter implant were associated with decreased implant survival. Overall social continence rate after 5 years was 60%. Prior radiation therapy, anticoagulation therapy and previous anti-incontinence surgery were associated with a higher incontinence risk. On long-term evaluation of 158 patients with their artificial urinary sphincter currently in situ, 51% were socially continent and 29% reported they were totally dry. Of these patients, 92% indicated to be satisfied with their current continence status.

CONCLUSION

A significant proportion of patients undergoing artificial urinary sphincter implant incontinence needed revision or explant surgery. Long-term continence rates are acceptable but tend to decrease by time. Nonetheless, if patients can maintain a functional AUS in situ, long-term patient satisfaction rates remain high.

AUTEURS: Karamaria S, Ranguelov N, Hansen P, De Boe V, Verleyen P, Segers N. et al

JOURNAL: Frontiers in pediatrics

TITEL: Impact of New vs. Old International Children's Continence Society Standardization on the Classification of Treatment

Naïve Enuresis Children at Screening: The Value of Voiding Diaries and Questionnaires

VOLUME: 10

ISSUE:

PAGINA’S: Article 862248

JAAR: 2022

DOI: https://doi.org/10.3389/fped.2022.862248

ABSTRACT:

Expert consensus papers recommend differentiating enuresis using questionnaires and voiding diaries into non- (NMNE) and monosymptomatic enuresis (MNE) is crucial at intake to decide the most appropriate workout and treatment. This national, Belgian, prospective study investigates the correlation, consistency, and added value of the two methods, the new against the old International Children's Continence Society (ICCS) definitions, and documents the prevalence of the two enuresis subtypes in our population. Ninety treatment-naïve enuretic children were evaluated with the questionnaire, and the voiding diary and the two clinical management tools were compared. Almost 30% of the children had a different diagnosis with each method, and we observed inconsistencies between them in registering Lower Tract Symptoms (κ = -0.057-0.432 depending on the symptom). Both methods had a high correlation in identifying MNE (rs = 0.612, p = 0.001) but not for NMNE (rs = 0.127, p = 0.248). According to the latest ICCS definitions, the incidence of MNE was significantly lower (7 vs. 48%) with the old standardization.

CONCLUSION:

The voiding diary and the questionnaire, as recommended by the ICCS at the screening of treatment-naïve enuretic patients, are considerably inconsistent and have significantly different sensitivities in identifying LUTS and thus differentiating MNE from NMNE. However, the high incidence of LUTS and very low prevalence of MNE suggest that differentiating MNE from NMNE to the maximum might not always correlate with different therapy responses.

AUTEURS: Bjartell A, Costa L, Kramer G, Zurawski B, Galli L, Werbrouck P. et al

JOURNAL: European urology open science

TITEL: Real-world Treatment Sequencing in Patients with Metastatic Castration-resistant Prostate Cancer: Results from the Prospective, International, Observational Prostate Cancer Registry

VOLUME: 45

ISSUE:

PAGINA’S: 12-22

JAAR: 2022

DOI: https://doi.org/10.1016/j.euros.2022.08.018

ABSTRACT:

BACKGROUND:

Prostate cancer has a multifaceted treatment pattern. Evidence is lacking for optimal treatment sequences for metastatic castration-resistant prostate cancer (mCRPC).

OBJECTIVE:

To increase the understanding of real-world treatment pathways and outcomes in patients with mCRPC. Design, setting, and participants

A prospective, noninterventional, real-world analysis of 3003 patients with mCRPC in the Prostate Cancer Registry (PCR; NCT02236637) from June 14, 2013 to July 9, 2018 was conducted. Intervention Patients received first- and secondline hormonal treatment and chemotherapy as follows: abiraterone acetate plus prednisone (abiraterone)-docetaxel (ABI-DOCE), abiraterone-enzalutamide (ABI-ENZA), abiraterone–radium-223 (ABI-RAD), docetaxel-abiraterone (DOCEABI), docetaxel-cabazitaxel (DOCE-CABA), docetaxel-enzalutamide (DOCE-ENZA), and enzalutamide-docetaxel (ENZADOCE). Outcome measurements and statistical analysis Baseline patient characteristics, quality of life, mCRPC treatments, and efficacy outcomes (progression and survival) were presented descriptively.

RESULTS AND LIMITATIONS:

Data from 727 patients were eligible for the analysis (ABI-DOCE n = 178, ABI-ENZA n = 99, ABI-RAD n = 27, DOCE-ABI n = 191, DOCE-CABA n = 74, DOCE-ENZA n = 116, and ENZA-DOCE n = 42). Demographics and disease characteristics among patients between different sequences varied greatly. Most patients who started on abiraterone or enzalutamide stopped therapy because of disease progression. No randomisation to allow treatment/sequence comparisons limited this observational study.

CONCLUSIONS:

The real-world PCR data complement clinical trial data, reflecting more highly selected patient populations than seen in routine clinical practice. Baseline characteristics play a role in mCRPC first-line treatment selection, but other factors, such as treatment availability, have an impact. Efficacy observations are limited and should be interpreted with caution.

PATIENT SUMMARY:

Baseline characteristics appear to have a role in the first-line treatment selection of metastatic castration-resistant prostate cancer in the real-world setting. First-line abiraterone acetate plus prednisone seems to be the preferred treatment option for older patients and those with lower Gleason scores, first-line docetaxel for younger patients and those with more advanced disease, and first-line enzalutamide for patients with fewer metastases and more favourable performance status. The benefit to patients from these observations remains unknown.

CONGRES

POSTERS

NAAM CONGRES: BMUC

DATUM: 11/03/2022

PLAATS: Dolce La Hulpe

TITEL POSTER 1: Lutetium-177-PSMA in metastatic castrationresistant prostate carcinoma: a promising last line?

AUTEUR POSTER 1: Van Bos E, Lesage K, Maes A, Ustmert S, Lavent F, Beels L, Vossaert P, Delaere B, Van Bruwaene S.

NAAM CONGRES: American Urological Association (AUA) Annual Meeting

DATUM: 13-16/05/2022

PLAATS: New Orleans

TITEL POSTER 1: Niraparib with abiraterone acetate and prednisone for metastatic castration-resistant prostate cancer: results from the phase 2 QUEST study

AUTEUR POSTER 1: Chi K, Fleshner N, Chiuri V, Van Bruwaene S, Hafron J, McNeel D. et al

PRESENTATIES

NAAM CONGRES: Elautprijs

DATUM: 18/06/2022

PLAATS: Gent

TITEL PRESENTATIE: Lutetium-177-PSMA voor gemetastaseerd castratie-refractair prostaatcarcinoom: een heilzame laatste lijn?

SPREKER PRESENTATIE: Eva Van Bos

VAATHEELKUNDE

WETENSCHAPPELIJKE ARTIKELS

AUTEURS: Elkhouly A, Karamustafaoglu Y, Galvez C, Rao M, Lerut P, Grimonprez A, et al.

JOURNAL: Asian Cardiovascular and Thoracic Annals

TITEL: Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis

VOLUME: 30

ISSUE: 9

PAGINA’S: 1010-1016

JAAR: 2022

DOI: 10.1177/02184923221129239

ABSTRACT:

BACKGROUND:

We aimed at comparing in a multicenter propensity-matched analysis, results of nonintubated versus intubated video-assisted thoracic surgery (VATS) bullectomy/blebectomy for primary spontaneous pneumothorax (PSP).

METHODS:

Eleven Institutions participated in the study. A total of 208 patients underwent VATS bullectomy by intubated (IVATS) (N = 138) or nonintubated (NIVATS) (N = 70) anesthesia during 60 months. After propensity matching, 70 pairs of patients were compared. Anesthesia in NIVATS included intercostal (N = 61), paravertebral (N = 5) or thoracic epidural (N = 4) block and sedation with (N = 24) or without (N = 46) laryngeal mask under spontaneous ventilation. In the IVATS group, all patients underwent double-lumen-intubation and mechanical ventilation. Primary outcomes were morbidity and recurrence rates.

RESULTS:

There was no difference in age (26.7 ± 8 vs 27.4 ± 9 years), body mass index (19.7 ± 2.6 vs 20.6 ± 2.5), and American Society of Anesthesiology score (2 vs 2). Main results show no difference both in morbidity (11.4% vs 12.8%; p = 0.79) and recurrence free rates (92.3% vs 91.4%; p = 0.49) between NIVATS and IVATS, respectively, whereas a difference favoring the NIVATS group was found in anesthesia time (p < 0.0001) and operative time (p < 0.0001), drainage time (p = 0.001), and hospital stay (p < 0.0001). There was no conversion to thoracotomy and no hospital mortality. One patient in the NIVATS group needed reoperation due to chest wall bleeding.

CONCLUSION:

Results of this multicenter propensity-matched study have shown no intergroup difference in morbidity and recurrence rates whereas shorter operation room time and hospital stay favored the NIVATS group, suggesting a potential increase in the role of NIVATS in surgical management of PSP. Further prospective studies are warranted. Keywords: VATS; nonintubated anesthesia; primary spontaneous pneumothorax; spontaneous ventilation; thoracoscopy.

NOTITIES

NOTITIES

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