[Preventing ineffective laparoscopic cholecystectomies].

The number of laparoscopic cholecystectomies in the Netherlands has increased significantly in recent years. However, there is a large variation in practice. This is a sign of inefficient use of cholecystectomy.

[Outcomes of 16 years of oesophageal surgery: low postoperative mortality and improved long-term survival].

Objective: To assess trends in patient characteristics and treatment outcomes in a large cohort of patients who underwent oesophagectomy for oesophageal carcinoma in a tertiary referral centre over a period of 16 years.

Design: Retrospective cohort study.

Methods: We carried out a trend analysis on collected data on demographic and clinico-pathological characteristics, complications and survival of patients who underwent oesophagectomy between January 1993 and December 2008 at the Academic Medical Center in Amsterdam (AMC), the Netherlands.

Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trial.

Introduction: Results of the first randomized trial comparing on-demand versus planned-relaparotomy strategy in patients with severe peritonitis (RELAP trial) indicated no clear differences in primary outcomes. We now report the full economic evaluation for this trial, including detailed methods, nonmedical costs, further differentiated cost calculations, and robustness of different assumptions in sensitivity analyses.

Methods: An economic evaluation was conducted from a societal perspective alongside a randomized controlled trial in 229 patients with severe secondary peritonitis and an acute physiology and chronic health evaluation (APACHE)-II score >or=11 from two academic and five regional teaching hospitals in the Netherlands.

Evaluation of POSSUM for patients undergoing pancreatoduodenectomy.

Background: Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center.

Methods: Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease.

Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction.

Introduction: Even after potentially curative esophagectomy, the majority of patients with adenocarcinoma of the esophagus or gastroesophageal junction die due to cancer recurrence. To predict individual disease-specific survival, a nomogram has been developed in a high-volume center in the Netherlands. The validity of this nomogram was externally tested in patients treated in another country at a different high-volume institution.

Analysis of micrometastatic disease in histologically negative lymph nodes of patients with adenocarcinoma of the distal esophagus or gastric cardia.

Lymphatic dissemination is the most important prognostic factor in patients with esophageal carcinoma. However, the clinical significance of lymph node micrometastases is still debated due to contradictory results. The aim of the present study was to identify the incidence of potentially relevant micrometastatic disease in patients with histologically node-negative esophageal adenocarcinoma and to analyze the sensitivity and specificity of three different immunohistochemical assays.

[Evidence-based surgery].

Authority-based surgery is slowly being replaced by evidence-based surgery. New and existing interventions are increasingly being studied in randomised controlled trials (RCTs). RCTs allow not only for comparison of different types of surgical interventions but also for comparison with non-surgical interventions and adjuvant therapies.

Decision making for relaparotomy in secondary peritonitis.

Background/aims: To provide a qualitative ranking of clinical variables by surgeons that influence their decision for reoperation and to evaluate whether these variables are related to positive findings at relaparotomy.

Methods: Importance in decision making for relaparotomy was evaluated for 21 factors using a 10-point visual analogue scale (VAS). Variables with median VAS scores >5.

Preoperative prediction of the occurrence and severity of complications after esophagectomy for cancer with use of a nomogram.

Background: Predicting the severity of complications after esophagectomy may supply important information for both patient and surgeon. The aim of the present study was to develop a nomogram based on preoperative risk factors to predict the severity of complications in patients who undergo esophagectomy for cancer.

Methods: A consecutive series of 663 patients who underwent esophagectomy between January 1993 and August 2005 was used to develop a prognostic model.

The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma.

Background: The numbers of margin-negative resections and survival times have greatly improved because of a more aggressive surgical approach to resectable hilar cholangiocarcinoma (Klatskin tumour). It was shown initially by Japanese authors that complete resection of the caudate lobe together with partial hepatectomy leads to more margin-negative resections. However, this concept has not been unanimously taken up by Western authors.

Fracture of the pancreas in two patients after a go-kart accident.

Background: After blunt abdominal trauma, an isolated injury to the pancreatic duct is uncommon. Physical signs and laboratory parameters are often inaccurate, and missing this diagnosis can cause serious clinical problems.

Case Outlines: Two young women (aged 18 and 20 years) are reported who sustained isolated trauma to the pancreatic duct in go-kart accidents.

Original article: New surgical approaches to the Klatskin tumour.

Background: Surgical treatment of hilar cholangiocarcinoma (Klatskin tumours) is difficult because of its central location in the liver hilum. Recent developments in surgical techniques have improved the outcome after resection.

Aim: To describe the surgical approaches currently applied in our centre and the impact of these strategies on outcome and criteria for resection.

Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence.

Background: Esophagectomy is frequently accompanied by substantial complications with secondary disturbance of the immune system. After esophagectomy for adenocarcinoma of the distal esophagus and/or gastroesophageal junction, the majority of patients develops an early recurrence and dies within 2 years. The aim of this study was to determine the relevance of perioperative complications on the timing of death due to recurrence.

Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial.

Objective: To determine whether extended transthoracic esophagectomy for adenocarcinoma of the mid/distal esophagus improves long-term survival.

Background: A randomized trial was performed to compare surgical techniques. Complete 5-year survival data are now available.

Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer.

Background: The aims of the present study were to validate the Physiological and Operative Severity Score for the enUmeration of Mortality adjusted for oesophagogastric surgery (O-POSSUM).

Methods: Data on patients who underwent potentially curative oesophagectomy in a tertiary referral centre for adenocarcinoma or squamous cell carcinoma of the oesophagus were analysed. The in-hospital mortality predicted by O-POSSUM was compared with the actual value by linear analysis.

Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury.

Background: The aim of the present study was to assess the role of the referral pattern and the timing of the surgical procedure on outcome after reconstructive surgery for bile duct injury (BDI).

Summary Background Data: BDI after laparoscopic cholecystectomy remains a major problem in current surgical practice. Controversy exists about the influence of previous interventions before referral and the timing of repair on outcome.

Management of solid-pseudopapillary neoplasms of the pancreas: a comparison with standard pancreatic neoplasms.

Background: Solid-pseudopapillary neoplasms (SPNs) of the pancreas are increasingly diagnosed, but the exact surgical management in terms of extent of the resection is not well defined.

Materials And Methods: Patients operated on in our hospital between January 1993 and March 2005 formed the study groups.

Results: From 659 consecutive resections for pancreatic neoplasms, 12 female patients (1.

Predictive factors associated with prolonged chest drain production after esophagectomy.

After esophagectomy, pleural drainage is performed to ensure complete drainage of the pleural cavities. The aim of this study was to detect predisposing factors for prolonged drainage. Patients who underwent transhiatal or extended transthoracic esophagectomy for adenocarcinoma of the distal esophagus or gastroesophageal junction were included.

Initial and long-term outcome after palliative surgical drainage of 269 patients with malignant biliary obstruction.

Aims: This study aimed to analyse the current outcome after palliative surgical drainage of malignant biliary obstruction.

Method: From 1992 to 2003, perioperative parameters and the incidence and indications of readmissions were analysed in 269 patients who underwent a palliative biliary bypass for periampullary carcinoma.

Results: Hospital mortality occurred in seven patients and median postoperative stay was 10 days.

Delayed closure of complex duodenal injuries by a Foley balloon catheter duodenostomy.

Less than 5% of abdominal injuries comprise the duodenum. Treatment is complex with high mortality and morbidity rates. These injuries are usually treated surgically and complications frequently occur.

Results of the combination of open transthoracic esophagectomy with laparoscopic gastric tube formation for esophageal cancer.

Background: Postoperative complications after open transthoracic esophagectomy could possibly be reduced if the abdominal phase is performed laparoscopically. The aim of this study was to investigate the feasibility of laparoscopic mobilization of the stomach and gastric tube formation in patients undergoing an open transthoracic esophagectomy for cancer.

Methods: Thirteen patients underwent an open transthoracic esophagectomy with extended en bloc lymphadenectomy combined with laparoscopic gastric tube formation.

[Centralisation of pancreatic resection: a systematic review and evaluation in the Netherlands].

Objective: To analyse the volume-outcome effect of pancreatic surgery by means of a systematic review, and to determine the effect of the ongoing plea for centralisation of pylorus-preserving pancreaticoduodenectomy in the Netherlands.

Design: Systematic review and retrospective evaluation.

Method: A systematic search for studies comparing hospital mortality rates after pancreatic resection in high- and low-volume hospitals was conducted.

Microscopically incomplete resection offers acceptable palliation in pancreatic cancer.

Background: Because mortality and morbidity of pancreatic surgery have decreased to acceptable levels, the complex question arises whether pancreatic resection should be performed in patients with preoperatively doubtful resectable pancreatic cancer.

Methods: Perioperative parameters and outcome of 80 patients who underwent a microscopically incomplete (R1) resection were compared with those of 90 patients who underwent a bypass for locally advanced disease for pancreatic adenocarcinoma. All patients initially underwent exploratory laparotomy with the intention to perform a resection.