Aim A Snapshot study design eliminates changes in treatment and outcome over time. This population based Snapshot study aimed to determine current practice and outcome of rectal cancer treatment... Show moreAim A Snapshot study design eliminates changes in treatment and outcome over time. This population based Snapshot study aimed to determine current practice and outcome of rectal cancer treatment with published landmark randomized controlled trials as a benchmark.Method In this collaborative research project, the dataset of the Dutch Surgical Colorectal Audit was extended with additional treatment and long-term outcome data. All registered patients who underwent resection for rectal cancer in 2011 were eligible. Baseline characteristics and outcome were evaluated against the results of the Dutch TME trial and the COLOR II trial from which the original datasets were obtained.Results A total of 71 hospitals participated, and data were completed for 2102 out of the potential 2633 patients (79.8%). Median follow-up was 41 (interquartile range 25-47) months. Overall circumferential resection margin (CRM) involvement was 9.3% in the Snapshot cohort and 18.5% in the Dutch TME trial. CRM positivity after laparoscopic resection was 7.8% in the Snapshot and 9.5% in the COLOR II trial. Three-year overall local recurrence rate in the Snapshot was 5.9%, with a disease-free survival of 67.1% and overall survival of 79.5%. Benchmarking with the randomized controlled trials revealed an overall favourable long-term outcome of the Snapshot cohort.Conclusion This study showed that current rectal cancer care in a large unselected Dutch population is of high quality, with less positive CRM since the TME trial and oncologically safe implementation of minimally invasive surgery after the COLOR II trial. Show less
Wilson, M.J.; Haaren, M. van; Harlaar, J.J.; Park, H.C.; Bonjer, H.J.; Jeekel, J.; ... ; Schipperus, M. 2017
Aim Open knot-tying and suturing skills are fundamental surgical skills, founding many alternative knot-tying techniques. It is therefore mandatory for residents to possess adequate basic open knot... Show moreAim Open knot-tying and suturing skills are fundamental surgical skills, founding many alternative knot-tying techniques. It is therefore mandatory for residents to possess adequate basic open knot-tying skills. The aim of this study was to compare an objective assessment of open knot-tying skills by residents to a resident's own estimation of his or her knot-tying skills, before and after a knot-tying course. Material and Methods A prospective observational cohort study was performed. At baseline level, after 1 training day in the Advanced Suturing Course (ASC) in the Netherlands and Belgium and after 6 weeks of autonomous practice (i.e. self-practice), 99 residents' open knot-tying skills were objectively evaluated using the Objective Structured Assessment of Technical Skills (OSATS). The resident's own confidence in these skills was also evaluated. Results The ASC substantially and significantly improved residents' knot-tying skills according to the OSATS between baseline and post-measurement. The observed improvement after 1 training day decreased after 6 weeks of autonomous practice. Self-confidence increased directly after the training program and was maintained 6 weeks later. Residents having completed the first 3 years of residency displayed an overall greater self-confidence than residents not having completed the first 3 years of residency, although the increase in self-confidence was significantly larger in the latter after 6 weeks' autonomous training. Conclusion There is a divergence between residents' objectified open knot-tying skills and self-confidence in these skills. The ASC improved open knot-tying skills according to the OSATS, however this improvement decreased after a 6-week period of autonomous practice. Self-confidence, in contrast, was maintained or increased. Further research is needed to correlate validated training programs with clinical outcomes and to determine whether residents' open knot-tying skills and self-confidence are retained beyond 1 year. Show less
