Surgery publications

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Browsing Surgery publications by Author "Aalbers, A.G.J."

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    Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II)
    (Oxford University Press, 2021) Voogt, E.L.K.; Nordkamp, S.; Aalbers, A.G.J.; Buffart, T.; Creemers, G.J.; Marijnen, C.A.M.; Verhoef, C.; Havenga, K.; Holman, F.A.; Kusters, M.; Marinelli, A.W.K.S.; Melenhorst, J.; Abdul Aziz, N.; Abecasis, N.; Abraham-Nordling, M.; Akiyoshi, T.; Alberda, W.; Albert, M.; Andric, M.; Angenete, E.; et al.
    Background: A resection with clear margins (R0 resection) is the most important prognostic factor in patients with locally recurrent rectal cancer (LRRC). However, this is achieved in only 60 per cent of patients. The aim of this study is to investigate whether the addition of induction chemotherapy to neoadjuvant chemo(re)irradiation improves the R0 resection rate in LRRC. Methods: This multicentre, international, open-label, phase III, parallel-arms study will enrol 364 patients with resectable LRRC after previous partial or total mesorectal resection without synchronous distant metastases or recent chemo- and/or radiotherapy treatment. Patients will be randomized to receive either induction chemotherapy (three 3-week cycles of CAPOX (capecitabine, oxaliplatin), four 2-week cycles of FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) or FOLFORI (5-fluorouracil, leucovorin, irinotecan)) followed by neoadjuvant chemoradiotherapy and surgery (experimental arm) or neoadjuvant chemoradiotherapy and surgery alone (control arm). Tumours will be restaged using MRI and, in the experimental arm, a further cycle of CAPOX or two cycles of FOLFOX/FOLFIRI will be administered before chemoradiotherapy in case of stable or responsive disease. The radiotherapy dose will be 25 × 2.0 Gy or 28 × 1.8 Gy in radiotherapy-naive patients, and 15 × 2.0 Gy in previously irradiated patients. The concomitant chemotherapy agent will be capecitabine administered twice daily at a dose of 825 mg/m2 on radiotherapy days. The primary endpoint of the study is the R0 resection rate. Secondary endpoints are long-term oncological outcomes, radiological and pathological response, toxicity, postoperative complications, costs, and quality of life. Discussion: This trial protocol describes the PelvEx II study. PelvEx II, designed as a multicentre, open-label, phase III, parallel-arms study, is the first randomized study to compare induction chemotherapy followed by neoadjuvant chemo(re)irradiation and surgery with neoadjuvant chemo(re)irradiation and surgery alone in patients with locally recurrent rectal cancer, with the aim of improving the number of R0 resections.
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    Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline
    (Wiley, 2022) Fahy, M.R.; Kelly, M.E.; Aalbers, A.G.J.; Abdul Aziz, N.; Abecasis, N.; Abraham-Nordling, M.; Akiyoshi, T.; Alberda, W.; Albert, M.; Andric, M.; Angeles, M.A.; Angenete, E.; Antoniou, A.; Auer, R.; Austin, K.K.; Aytac, E.; Aziz, O.; Bacalbasa, N.; Baker, R.P.; Bali, M.; et al.
    Abstract not available
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    Pelvic Exenteration for Advanced Nonrectal Pelvic Malignancy PelvExCollaborative
    (Wolters Kluwer Health, 2019) Kelly, M.E.; Ryan, E.J.; Aalbers, A.G.J.; Abdul, A.N.; Abraham-Nordling, M.; Alberda, W.; Antoniou, A.; Austin, K.K.; Baker, R.; Bali, M.; Baseckas, G.; Bednarski, B.K.; Beets, G.L.; Berg, P.L.; Beynon, J.; Biondo, S.; Bordeianou, L.; Bremers, A.B.; Brunner, M.; Buchwald, P.; et al.
    Objective: To determine factors associated with outcomes following pelvic exenteration for advanced nonrectal pelvic malignancy. Background: The PelvEx Collaborative provides large volume data from specialist centers to ascertain factors associated with improved outcomes. Methods: Consecutive patients who underwent pelvic exenteration for nonrectal pelvic malignancy between 2006 and 2017 were identified from 22 tertiary centers. Patient demographics, neoadjuvant therapy, histopathological assessment, length of stay, 30-day major complication/mortality rate were recorded. The primary endpoints were factors associated with survival. The secondary endpoints included the difference in margin rates across the cohorts, impact of neoadjuvant treatment on survival, associated morbidity, and mortality. Results: One thousand two hundred ninety-three patients were identified. 40.4% (n ¼ 523) had gynecological malignancies (endometrial, ovarian, cervical, and vaginal), 35.7% (n ¼ 462) urological (bladder), 18.1% (n ¼ 234) anal, and 5.7% had sarcoma (n ¼ 74). The median age across the cohort was 63 years (range, 23–85). The median 30-day mortality rate was 1.7%, with the highest rates occurring following exenteration for recurrent sarcoma or locally advanced cervical cancer (3.3% each). The median length of hospital stay was 17.5 days. 34.5% of patients experienced a major complication, with highest rate occurring in those having salvage surgery for anal cancer. Multivariable analysis showed R0 resection was the main factor associated with long-term survival. The 3-year overall-survival rate for R0 resection was 48% for endometrial malignancy, 40.6% for ovarian, 49.4% for cervical, 43.8% for vaginal, 59% for bladder, 48.3% for anal, and 48.1% for sarcoma. Conclusion: Pelvic exenteration remains an important treatment in selected patients with advanced or recurrent nonrectal pelvic malignancy. The range in 3-year overall survival following R0 resection (40%–59%) reflects the diversity of tumor types.