Quality Measurement in Oesophagogastric Cancer Surgery

Quality of oesophagogastric cancer surgery is measured with quality indicators. The reliability, validity and value of these indicators is tested in this thesis

Mid-infrared diagnostics of starburst galaxies: clumpy, dense structures in star-forming regions in the Antennae (NGC 4038/4039)

Recently, mid-infrared instruments have become available on several large ground-based telescopes, resulting in data sets with unprecedented spatial resolution at these long wavelengths. In this paper we examine 'ground-based-only' diagnostics, which can be used in the study of star-forming regions in starburst galaxies. By combining output from the stellar population synthesis code Starburst 99 with the photoionization code Mappings, we model stellar clusters and their surrounding interstellar medium, focusing on the evolution of emission lines in the N- and Q-band atmospheric windows (8-13 and 16.5-24.5 micron respectively) and those in the near-infrared. We address the detailed sensitivity of various emission line diagnostics to stellar population age, metallicity, nebular density, and ionization parameter. Using our model results, we analyze observations of two stellar clusters in the overlap region of the Antennae galaxies obtained with VLT Imager and Spectrometer for mid Infrared (VISIR). We find evidence for clumpy, high density, ionized gas. The two clusters are young (younger than 2.5 and 3 Myr respectively), the surrounding interstellar matter is dense (10^4 cm^-3 or larger) and can be characterized by a high ionization parameter (logU > -1.53). Detailed analysis of the mid-infrared spectral features shows that a (near-)homogeneous medium cannot account for the observations, and that complex structure on scales below the resolution limit, containing several young stellar clusters embedded in clumpy gas, is more likely.Comment: 24 pages, 16 figures (3 in color), accepted for publication in Ap

Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG)

OBJECTIVE: This nation-wide population-based study aimed to report postoperative morbidity and mortality after esophagectomy and gastrectomy in the Netherlands according to the definitions of the Esophagectomy Complications Consensus Group (ECCG). BACKGROUND: To standardize international outcome reporting in esophageal surgery, the ECCG developed a standardized outcomes set. METHODS: For this national cohort study, all patients undergoing esophagectomy or gastrectomy for cancer between 2016 and 2017 were selected from the Dutch Upper gastrointestinal Cancer Audit. In a random sample of hospitals, data completeness and accuracy were validated by reabstraction of the data. The investigated o

Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation:Results from the Dutch Upper Gastrointestinal Cancer Audit

Item does not contain fulltextINTRODUCTION: The value of routine intensive care unit (ICU) admission after minimally invasive esophagectomy (MIE) has been questioned. This study aimed to investigate Dutch hospital variation regarding length of direct postoperative ICU stay, and the impact of this hospital variation on short-term surgical outcomes. MATERIALS AND METHODS: Patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) undergoing curative MIE were included. Length of direct postoperative ICU stay was dichotomized around the national median into short ICU stay ( ≤ 1 day) and long ICU stay ( > 1 day). A case-mix corrected funnel plot based on multivariable logistic regression analyses investigated hospital variation. The impact of this hospital variation on short-term surgical outcomes was investigated using multilevel multivariable logistic regression analyses. RESULTS: Between 2017 and 2019, 2110 patients from 16 hospitals were included. Median length of postoperative ICU stay was 1 day [hospital variation: 0-4]. The percentage of short ICU stay ranged from 0 to 91% among hospitals. Corrected for case-mix, 7 hospitals had statistically significantly higher short ICU stay rates and 6 hospitals had lower rates. ICU readmission, in-hospital/30-day mortality, failure to rescue, postoperative pneumonia, cardiac complications and anastomotic leakage were not associated with hospital variation in length of ICU stay. Total length of hospital stay was significantly shorter in hospitals with relatively short ICU stay. CONCLUSION: This study showed significant hospital variation in postoperative length of ICU stay after MIE. Short ICU stay was associated with shorter overall hospital admission and did not negatively impact short-term surgical outcomes. More selected use of ICU resources could result in a national significant cost reduction