Publications by authors named "Luc Heijnen"
Objective: To compare costs for 2 days versus 5 days of postoperative antibiotics within the antibiotics after an aPPendectomy In Complex appendicitis trial.Background:Recent studies suggest that restrictive antibiotic use leads to a significant reduction in hospital stays without compromising patient safety. Its potential effect on societal costs remains underexplored.
View Article and Find Full Text PDFBackground: The appropriate duration of postoperative antibiotics for complex appendicitis is unclear. The increasing global threat of antimicrobial resistance warrants restrictive antibiotic use, which could also reduce side-effects, length of hospital stay, and costs.
Methods: In this pragmatic, open-label, non-inferiority trial in 15 hospitals in the Netherlands, patients with complex appendicitis (aged ≥8 years) were randomly assigned (1:1) to receive 2 days or 5 days of intravenous antibiotics after appendicectomy.
Background: Adrenal incidentalomas (AIs) are regularly discovered on staging computed tomography (CT) of patients with colorectal cancer (CRC). Although CRC is considered unlikely to metastasize to the adrenal gland, it is not known how often an AI appears to be a CRC metastasis. This causes a diagnostic dilemma for many patients with newly diagnosed CRC.
View Article and Find Full Text PDFBackground: Acute appendicitis is one of the most common indications for emergency surgery. In patients with a complex appendicitis, prolonged antibiotic prophylaxis is recommended after appendectomy. There is no consensus regarding the optimum duration of antibiotics.
View Article and Find Full Text PDFArticle Synopsis
- Patients with locally advanced rectal carcinoma show improved outcomes with preoperative chemoradiotherapy, but the reliability of MRI for restaging post-treatment is questioned.
- A retrospective study involving 48 patients was conducted in a Dutch rectal cancer center to evaluate MRI accuracy in assessing tumor stages after preoperative chemoradiation.
- The results revealed varying accuracy rates for T and N staging among three radiologists, with issues of overstaging being more common; additionally, the correlation between MRI tumor regression grades and histopathologic outcomes was weak, indicating limited effectiveness of MRI in this scenario.
Background: The aim of this study was to establish the oncological and functional results of organ preservation with a watch-and-wait approach (W&W) and selective transanal endoscopic microsurgery (TEM) in patients with a clinical complete or near-complete response (cCR) after neoadjuvant chemoradiation for rectal cancer.
Methods: Between 2004 and 2014, organ preservation was offered if response assessment with digital rectal examination, endoscopy, and MRI showed (near) cCR. Watch-and-wait was offered for cCR, and two options were offered for near cCR: TEM or reassessment after three months.
Background: Response Evaluation Criteria In Solid Tumors (RECIST) are known to have limitations in assessing the response of colorectal liver metastases (CRLMs) to chemotherapy.
Objective: The objective of this article is to compare CT texture analysis to RECIST-based size measurements and tumor volumetry for response assessment of CRLMs to chemotherapy.
Methods: Twenty-one patients with CRLMs underwent CT pre- and post-chemotherapy.
Purpose: This study aims to explore the influence of chemoradiation treatment (CRT) on rectal cancer nodes and to generate hypotheses why nodal restaging post-CRT is more accurate than at primary staging.
Methods: Thirty-nine patients with locally advanced rectal cancer underwent MRI pre- and post-CRT. All visible mesorectal nodes were measured on a 3D T1-weighted gradient echo (3D T1W GRE) sequence with 1-mm(3) voxels and matched between pre- and post-CRT-MRI and with histology by lesion-by-lesion matching.
Purpose: Aim of this study was to evaluate the distribution of persistent mesorectal lymph node metastases on restaging MRI in patients with a good or complete response of their primary tumor (ypT0-2) after CRT for locally advanced rectal cancer.
Methods: Two hundred and twenty eight locally advanced rectal cancer patients underwent CRT, which resulted in a good response (downstaging to yT0-2) in 144 patients. Forty-nine patients were excluded (no surgery/insufficient follow-up or lacking lesion-by-lesion histology results).
Objectives: To assess the value of MRI and diffusion-weighted imaging (DWI) for diagnosing local tumour regrowth during follow-up of organ preservation treatment after chemoradiotherapy for rectal cancer.
Methods: Seventy-two patients underwent organ preservation treatment (chemoradiotherapy + transanal endoscopic microsurgery or "wait-and-see") and were followed with MRI including DWI (1.5 T) every 3 -months during the first year and 6 months during following years.
Article Synopsis
- This study evaluated how well clinical exams (like DRE and endoscopy) and MRI techniques (T2W-MRI and DWI) detect complete responses (CR) in rectal cancer patients after chemoradiotherapy (CRT).
- It involved 50 patients and showed that clinical assessments were most accurate, with a 34% CR rate and very high posttest probability (98%) for predicting CR when combining exams and MRIs.
- The findings suggest that while clinical exams are key for identifying CR, adding MRI techniques can enhance diagnostic accuracy, making this combination the best approach for selecting patients for organ-preserving treatment.
Objectives: To explore whether whole-liver diffusion-weighted MRI analysis (of the apparently normal liver parenchyma) can help differentiate between patients with colorectal liver metastasis and controls without liver disease.
Materials And Methods: Ten patients with colorectal liver metastasis and 10 controls with no focal/diffuse liver disease underwent liver MRI at 1.5 T including diffusion-weighted imaging (DWI; b-values 0, 50, 100, 500, 750, 1000).
Background And Purpose: Dynamic contrast-enhanced MRI (DCE-MRI) provides information on perfusion and could identify good prognostic tumors. Aim of this study was to evaluate whether DCE-MRI using a novel blood pool contrast-agent can accurately predict the response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer.
Materials And Methods: Thirty patients underwent DCE-MRI before and 7-10weeks after chemoradiotherapy.
Background: Liver metastases limit survival in colorectal cancer. Earlier detection of (occult) metastatic disease may benefit treatment and survival.
Objective: The objective of this article is to evaluate the potential of whole-liver CT texture analysis of apparently disease-free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases.
Background: Retrospective single-center studies have shown that diffusion-weighted magnetic resonance imaging (DWI) is promising for identification of patients with rectal cancer with a complete tumor response after neoadjuvant chemoradiotherapy (CRT), using certain volumetric thresholds.
Objective: This study aims to validate the diagnostic value of these volume thresholds in a larger, independent, and bi-institutional patient cohort.
Methods: A total of 112 patients with locally advanced rectal cancer (2 centers) treated with a long course of CRT were enrolled.
Objectives: Our primary objective was to evaluate diagnostic performance of gadofosveset T1-weighted magnetic resonance imaging (T1W MRI) for discriminating between ypT0-2 and ypT3-4 tumours after chemoradiation therapy (CRT) for rectal cancer compared with T2W MRI for a general and expert reader. Second objectives included assessing the value of multiplanar reformatting (MPR) and interobserver agreement.
Methods: A general and expert reader evaluated 49 patients for likelihood of ypT0-2 tumour after CRT on T2W, gadofosveset T1W MRI, and gadofosveset T1W MRI + T2W MRI.
Objectives: A previous study showed promising results for gadofosveset-trisodium as a lymph node magnetic resonance imaging (MRI) contrast agent in rectal cancer. The aim of this study was to prospectively confirm the diagnostic performance of gadofosveset MRI for nodal (re)staging in rectal cancer in a second patient cohort.
Methods: Seventy-one rectal cancer patients were prospectively included, of whom 13 (group I) underwent a primary staging gadofosveset MRI (1.
Objectives: Magnetization transfer-magnetic resonance imaging (MT-MRI) uses differences in the magnetization interaction of the free "unbound" water protons and the macromolecular-bound protons. The aim of this study was to evaluate whether the magnetization transfer ratio (MTR) may be used to identify fibrosis in patients with rectal cancer treated with chemoradiotherapy.
Materials And Methods: This study was part of a rectal cancer imaging study, which was approved by the local institutional review board.
Objectives: To evaluate the performance of diffusion-weighted MRI (DWI) for the detection of lymph nodes and for differentiating between benign and metastatic nodes during primary rectal cancer staging.
Methods: Twenty-one patients underwent 1.5-T MRI followed by surgery (± preoperative 5 × 5 Gy).
Article Synopsis
- The study aimed to determine the effectiveness of nodal signal intensity (SI) and chemical shift artefact in detecting lymph node metastases from rectal cancer using gadofosveset-enhanced MRI.
- Thirty-three patients underwent specialized MRI scans to measure both the SI of the lymph nodes and the characteristics of the surrounding chemical shift artefact.
- The results indicated that benign nodes exhibited significantly higher signal intensities than metastatic ones, and combining these indicators led to a strong diagnostic accuracy for identifying metastatic lymph nodes.