Colorectal cancer is one of the most frequent cancers in the Western world. Forty-five percent of symptomatic patients have metastatic disease. The overall prevalence of adenoma in an asymptomatic... Show moreColorectal cancer is one of the most frequent cancers in the Western world. Forty-five percent of symptomatic patients have metastatic disease. The overall prevalence of adenoma in an asymptomatic population is 25-30% at the age of 50 years and approximately two-thirds of all colonic polyps are adenomatous. Around 95% of CRCs evolve from an adenomatous polyp or sessile serrated lesion (SSL). Only 5% of all adenomatous polyps progress to CRC. To reduce both the incidence and mortality rate of CRC, a national bowel screening program started in January 2014. This thesis focussed on improving clinical care for patients with colorectal neoplasms. From identifying high risk persons/families through the national screening program to modifying a surgical technique to a minimal invasive organ-preserving technique for removal of colorectal neoplasms to the treatment of metastatic colorectal cancer. All studies are based on clinical questions arise from the daily practice. And is therefore also applicable in daily practice. Show less
Background: The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new... Show moreBackground: The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new surgical techniques and the effect on postoperative outcomes are important for quality assurance, can show potential areas for country-specific improvement, and might be illustrative and supportive for similar implementation programs in other countries. Therefore, this study aimed to evaluate differences in patient selection, applied techniques, and results of minimal invasive surgery for colorectal cancer between the Netherlands and Sweden. Methods: Patients who underwent elective minimally invasive surgery for T1-3 colon or rectal cancer (2012-2018) registered in the Dutch ColoRectal Audit or Swedish ColoRectal Cancer Registry were included. Time trends in the application of MIS were determined. Outcomes were compared for time periods with a similar level of MIS implementation (Netherlands 2012-2013 versus Sweden 2017-2018). Multilevel analyses were performed to identify factors associated with adverse short-term outcomes.Results: A total of 46,095 Dutch and 8,819 Swedish patients undergoing MIS for colorectal cancer were included. In Sweden, MIS implementation was approximately 5 years later than in the Netherlands, with more robotic surgery and lower volumes per hospital. Although conversion rates were higher in Sweden, oncological and surgical outcomes were comparable. MIS in the Netherlands for the years 2012- 2013 resulted in a higher reoperation rate for colon cancer and a higher readmission rate but lower non- surgical complication rates for rectal cancer if compared with MIS in Sweden during 2017-2018.Conclusion: This study showed that the implementation of MIS for colorectal cancer occurred later in Sweden than the Netherlands, with comparable outcomes despite lower volumes. Our study demonstrates that new surgical techniques can be implemented at a national level in a controlled and safe way, with thorough quality assurance. Show less
Velde, C.J.H. van de; Aristei, C.; Boelens, P.G.; Beets-Tan, R.G.H.; Blomqvist, L.; Borras, J.M.; ... ; Valentini, V. 2013
Unilateral transflaval microdiscectomy is the golden standard for surgical treatment of lumbar disc related sciatica to which all new techniques should be compared. Minimally invasive tubular... Show moreUnilateral transflaval microdiscectomy is the golden standard for surgical treatment of lumbar disc related sciatica to which all new techniques should be compared. Minimally invasive tubular discectomy has been popularised aiming at reduced muscle trauma, less postoperative low-back pain, shorter hospitalisation and faster resumption of work and daily activities. This thesis outlines the results of a double-blind multicentre trial in which tubular discectomy (166 patients) was compared with unilateral transflaval microdiscectomy (159 patients). Use of tubular discectomy compared with conventional microdiscectomy did not result in a statistically significant functional improvement as measured by the Roland Disability Questionnaire for Sciatica. The median time until complete recovery was 2 weeks, irrespective of the allocated surgical treatment. Both groups reported relief of leg pain and low-back pain, although the differences favoured the conventional microsurgery group. However, these differences were small and not clinically relevant. At 2 years after surgery, 71% of patients who underwent tubular discectomy versus 77% of those treated with conventional surgery reported complete recovery. Cost-utility analysis showed no significant difference between tubular discectomy and conventional microdiscectomy. In conclusion, the data of this trial did not support a superior outcome of tubular discectomy compared with conventional microdiscectomy. Show less
