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J Jeekel

Publications and source records attributed to J Jeekel.

At least 55 records · Page 3Linked to original sources
PubMed1999

Palliative chemotherapy and radiotherapy for pancreatic cancer: is It worthwhile?

The role of palliative chemotherapy or radiotherapy (or both) in pancreatic cancer is discussed. In patients with disseminated pancreatic cancer chemoradiotherapy has so far not been effective in prolonging survival. Recent trials with gemcitabine has shown a modest improvement in clinical benefit and survival. Patients with locally advanced disease should be offered 5-fluorouracil and radiation therapy, as valid data have repeatedly shown better median survival compared to no therapy. The option of a second-look laparotomy to evaluate resectability after palliative chemoradiotherapy in patients with locally advanced disease should be applied liberally because currently available imaging techniques sometimes do not accurately reflect tumor size and tumor progression. New treatment strategies, such as regional perfusion, are being investigated.

Antimetabolites, Antineoplastic↗
PubMed1999

Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire, the QLQ-C30 in patients with pancreatic cancer. EORTC Study Group on Quality of Life.

There is overwhelming consensus that quality of life assessment is urgently required in pancreatic cancer, yet little research has been conducted. We report on the development of a disease specific questionnaire module to supplement the EORTC core cancer module, the QLQ-C30 in patients with pancreatic cancer, using EORTC quality of life study group guidelines for module development. Relevant QoL issues were generated from literature searches and interviews with health professionals and patients with pancreatic cancer. Issues were constructed into items and provisionally translated. The provisional module was pretested in patients in 8 European centres. The resulting module the QLQ-PAN26 includes 26 items related to disease symptoms, treatment side-effects and emotional issues specific to pancreatic cancer. This should ensure that the module will be sensitive to assess the small but important disease and treatment related QoL changes in pancreatic cancer. The use of the QLQ-C30 and QLQ-PAN26 will provide a comprehensive system of QoL assessment in international trials of pancreatic cancer.

Adult↗
PubMed1999

Red blood cells inhibit tumour cell adhesion to the peritoneum.

BACKGROUND: Perioperative blood transfusion has been associated with increased tumour recurrence and poor prognosis in colorectal cancer. Blood loss in the peritoneal cavity might be a tumour-promoting factor for local recurrence. The aim of this study was to investigate whether blood in the peritoneal cavity affects local tumour recurrence. METHODS: In an established in vivo rat model the effect of 1.5 ml syngeneic whole blood on tumour cell adhesion and tumour growth was investigated. In the same model the effect of 1.5 ml pure red blood cell (RBC) concentrate and 1.5 ml RBC-derived substances on tumour cell adhesion was studied. In an established in vitro model the effect of increasing numbers of RBCs (0-250 bx 10(6)) on tumour cell adhesion and tumour growth was assessed. RESULTS: Both the presence of blood and RBC concentrate in the peritoneal cavity prevented tumour cell adhesion in vivo (overall P </= 0.001 and P </= 0.05 respectively), rather than promoting adherence. RBC concentrate and RBC-derived substances had a comparable inhibitory effect on tumour cell adhesion. In in vitro studies RBCs inhibited tumour cell adhesion but not tumour growth. CONCLUSION: RBC-derived factors prevent tumour cell adhesion to the peritoneum, and consequently tumour recurrence.

Animals↗
PubMed1999

Hyaluronate-based coating solution for prevention of surgical adhesions has no major effect on adhesion and growth of intraperitoneal tumour cells.

OBJECTIVE: To find out whether the perioperative use of a solution containing hyaluronic acid (HA, Sepracoat) might affect the adhesion of tumour cells. DESIGN: Laboratory studies in vitro and in two experiments in rats. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 27 female inbred WAG rats. INTERVENTIONS: Mesothelial cells were cultured in monolayers and the adhesion of CC-531 colonic carcinoma cells was assessed with and without Sepracoat. Uterine horn experiment: after laparotomy Sepracoat 3 ml (n = 5) or phosphate buffered saline (PBS) (n = 4) were instilled in rats; the right uterine horn was abraided with gauze, and the left was left untouched; CC-531 cells were seeded intraperitoneally; and the tumour load at 8 different sites was scored after 3 weeks. Laparotomy model: after laparotomy Sepracoat and PBS were instilled (n = 9 rats in each group), CC-531 cells were seeded, and the wound was closed; the tumour load was scored after 3 weeks. RESULTS: Sepracoat had a small but significant inhibitory effect on the adhesion of CC-531 cells in vitro. However, we were unable to repeat this effect in either rat experiment. CONCLUSION: Sepracoat may inhibit adhesion of tumour cells to the mesothelium but it had no appreciable effect on intra-abdominal tumour growth in this dose in either experiment in rats.

Animals↗
PubMed1999

Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group.

OBJECTIVE: The survival benefit of adjuvant radiotherapy and 5-fluorouracil versus observation alone after surgery was investigated in patients with pancreatic head and periampullary cancers. SUMMARY BACKGROUND DATA: A previous study of adjuvant radiotherapy and chemotherapy in these cancers by the Gastrointestinal Tract Cancer Cooperative Group of EORTC has been followed by other studies with conflicting results. METHODS: Eligible patients with T1-2N0-1aM0 pancreatic head or T1-3N0-1aM0 periampullary cancer and histologically proven adenocarcinoma were randomized after resection. RESULTS: Between 1987 and 1995, 218 patients were randomized (108 patients in the observation group, 110 patients in the treatment group). Eleven patients were ineligible (five in the observation group and six in the treatment group). Baseline characteristics were comparable between the two groups. One hundred fourteen patients (55%) had pancreatic cancer (54 in the observation group and 60 in the treatment group). In the treatment arm, 21 patients (20%) received no treatment because of postoperative complications or patient refusal. In the treatment group, only minor toxicity was observed. The median duration of survival was 19.0 months for the observation group and 24.5 months in the treatment group (log-rank, p = 0.208). The 2-year survival estimates were 41% and 51 %, respectively. The results when stratifying for tumor location showed a 2-year survival rate of 26% in the observation group and 34% in the treatment group (log-rank, p = 0.099) in pancreatic head cancer; in periampullary cancer, the 2-year survival rate was 63% in the observation group and 67% in the treatment group (log-rank, p = 0.737). No reduction of locoregional recurrence rates was apparent in the groups. CONCLUSIONS: Adjuvant radiotherapy in combination with 5-fluorouracil is safe and well tolerated. However, the benefit in this study was small; routine use of adjuvant chemoradiotherapy is not warranted as standard treatment in cancer of the head of the pancreas or periampullary region.

Adenocarcinoma↗
PubMed1999

Perioperative lavage promotes intraperitoneal adhesion in the rat.

This study was designed to study the effect of peritoneal lavage solutions on postsurgical adhesion formation in rats undergoing laparotomy and standardized ischemic injury to the lateral peritoneum with sutures. This reproducible model enabled semiquantitative scoring of adhesion formation. Adhesions were induced in 33 adult female Wistar rats. The solutions RPMI medium, NaCl (0.9%), Viaspan(R) and both povidone-iodine (1%) and chlorhexidine (0.02%) in dilution were evaluated. In the control group that was operated upon (without peritoneal lavage), a mean adhesion percentage of 22.5% was scored. All solutions used for abdominal lavage in this rat model induced significantly (p = 0. 0001) more adhesions (40.6-70.8%). Not all solutions induced an equal effect. The results found in the present in vivo study correlate with observations in previous in vitro experiments i.e. exposure of peritoneal areas to lavage solutions enhances peritoneal activation and thus promotes intra-abdominal adhesion formation.

Animals↗
PubMed1997

[Abdominal wall metastasis following surgical removal of colorectal carcinomas].

Abdominal wall metastases after laparoscopic resection of colorectal cancer have been reported by various authors. It appeared that abdominal wall metastases occur more frequently after laparoscopic than after conventional, open resection of colorectal cancer. However, the frequency of abdominal wall metastases after laparoscopic surgery varies from only 0 to 1.9% in centres with sufficient relevant experience, whereas after conventional resections the frequency is 0.8-3.3%. A randomized clinical study comparing laparoscopic with conventional resection of colon cancer is necessary to assess the optimal surgical approach to colon cancer. Such a trial has been set up.

Abdominal Muscles↗
PubMed1997

[The 'Colon cancer laparoscopic or open resection' (COLOR) trial].

The value of laparoscopic surgery for colorectal malignancy as compared with open surgery will be determined in the COLOR-trial. The disease-free survival time is the primary end point. Twenty-one hospitals in the Netherlands and Scandinavia will participate in the trial. In the COLOR trial 1500 patients with colon carcinoma will be randomised for either a laparoscopic or open colon resection.

Colonic Neoplasms↗
PubMed1997

The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment.

OBJECTIVE: The authors determined the prevalence of incisional hernia and nerve entrapment in patients with a low transverse Pfannenstiel incision. SUMMARY BACKGROUND DATA: The literature on the Pfannenstiel incision suggests an incisional hernia rate of 0.0% to 0.5%. However, in these series, physical examination, which is essential in the authors' view, was not performed. To the authors' knowledge, the prevalence of nerve entrapment after the Pfannenstiel incision is not known or has never been published. METHODS: All adult women, operated on between 1986 and 1992 using a Pfannenstiel incision and not having had another lower abdominal incision other than for laparoscopy, were invited for follow-up at the outpatient department. All patients were interviewed and subjected to a physical examination, with special interest to the presence of incisional hernia or nerve entrapment. RESULTS: In patients having had a Pfannenstiel incision, no incisional hernias were found. In patients also having had a laparoscopy, the incisional hernia rate was 3.5%. Nerve entrapment was found in 3.7%. The length of the incision was identified as a risk factor (p = 0.02). CONCLUSIONS: Incisional hernia is a rare complication of the Pfannenstiel incision. Complications of nerve damage, however, are not uncommon and should be recognized. When possible, nerves should be identified and preserved, especially when extending the incision more laterally.

Abdomen↗
PubMed1997

Adjuvant or neoadjuvant therapy for pancreatic carcinoma?

Whipple's resection for pancreatic cancer is an inadequate procedure and should be regarded as a lumpectomy. Adjuvant treatment should be directed towards local regional and liver recurrences. In the USA, adjuvant treatment after curative Whipple resection is standard procedure, based upon results of the GITSG study in which postoperative radiotherapy and 5-FU treatment resulted in significantly better survival in 23 patients. Preliminary results of our study in Rotterdam, however, do not seem to confirm these data. In this study, 218 patients were randomly assigned to surgery only or for 40-Gy radiotherapy and 4 weeks 5-FU treatment. Another option is neoadjuvant treatment which has theoretic advantages. A number of nonrandomized studies seem to indicate that radiotherapy and 5-FU treatment may have benefit in pancreatic cancer in a neoadjuvant treatment form. It is not clear which direction to take. Randomized studies are necessary to study the effect of neoadjuvant treatment with radiotherapy and 5-FU or with regional perfusion of the pancreatic area.

Antineoplastic Agents↗
PubMed1997

Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study.

BACKGROUND: The role of laparoscopic surgery for malignant disease is controversial. To evaluate differences in tumour growth after conventional and laparoscopic surgery, an experimental study was performed in rats. METHODS: After intraperitoneal injection of CC-531 colonic cancer cells or subcapsular renal implantation of CC-531 cancer cells, rats underwent either laparoscopically assisted small bowel resection, open small bowel resection or anaesthesia only. Peritoneal tumour growth and subcapsular renal tumour growth were assessed after operation. RESULTS: Peritoneal tumour growth was the least after anaesthesia only (P < 0.05) and less after laparoscopic than open resection (P < 0.05). Subcapsular renal tumour growth after either laparoscopic resection or anaesthesia only was less than after open resection (P < 0.01). CONCLUSION: Laparoscopic surgery was associated with less tumour growth than conventional surgery in this experimental study.

Animals↗
PubMed1997

Reduction of intraperitoneal adhesion formation by use of non-abrasive gauze.

BACKGROUND: Adhesion formation is potentially harmful. Surgical swabs may contribute to adhesions by trauma to the peritoneum. The purpose of this study was to evaluate whether standard surgical gauze (Medipres) has an adhesion-promoting effect, and to determine whether a soft textile (Fastsorb), used in the electronics industry, might be less traumatic and therefore lead to less adhesion formation. METHODS: A reproducible rat model allowing semiquantitative scoring of adhesion formation was used. Three different adhesion models representing increasing degrees of peritoneal trauma (minimal, moderate and severe) were employed. The model inflicting minimal peritoneal trauma was combined with standardized rubbing of the peritoneum with surgical gauze or non-surgical textile. RESULTS: Minimal peritoneal trauma resulted in a significantly lower mean adhesion percentage (21 per cent) than moderate (44 per cent) or severe (60 per cent) peritoneal trauma (P < or = 0.005). Rubbing of the peritoneum with surgical gauze after minimal peritoneal trauma induced significantly more adhesion formation (58 versus 23 per cent, P < 0.0001). After minimal peritoneal trauma, rubbing with surgical gauze produced significantly more adhesions than rubbing with non-surgical textile (63 versus 19 per cent, P < 0.0001). Moreover, rubbing the peritoneum with non-surgical textile after minimal peritoneal trauma did not induce any additional adhesion formation (35 versus 24 per cent, P = 0.23). CONCLUSION: The extent of adhesion formation correlates significantly with the degree of peritoneal damage. Standard surgical gauze is traumatizing to the peritoneum and promotes adhesion formation whereas a less abrasive non-surgical textile does not.

Animals↗
PubMed1996

Laparoscopic surgery in the rat. Beneficial effect on body weight and tumor take.

BACKGROUND: The ability of laparoscopic techniques to treat malignant disease is controversial. We developed a rat model to assess metabolic and oncological effects of laparoscopic surgery. METHODS: Experiment I. The postoperative body weight in 10 rats having laparoscopic bowel resection (group I), 10 rats having open bowel resection (group II) and 5 rats having anesthesia only (group III) was determined. Experiment II. Tumor take was scored in 11 rats having laparoscopic bowel resection (group IV), 11 rats having open bowel resection (group V), 6 rats having CO2 pneumoperitoneum without bowel resection (group VI) and 6 rats having anesthesia only (group VII). All rats had CC531 cancer cells injected intraperitoneally postoperatively. RESULTS: Experiment I. Body weight loss in group I compared to group II (p<0.036). Rats of group III lost no weight postoperatively. Experiment II. Tumor take was less in the subcutis (p=0.005), parietal peritoneum (p<0.001) and bowel anastomosis (p=0.021) in group IV compared to group V. Tumor take was significantly greater at all sites except for subcutis in group VI compared to VII (all p<0.022). CONCLUSIONS: Laparoscopic surgery is associated with less postoperative weight loss and less tumor take compared to open surgery. CO2 insufflation appears to increase tumor take.

Adenocarcinoma↗
PubMed1996

Foreign material in postoperative adhesions.

OBJECTIVE: The authors determined the prevalence of foreign body granulomas in intra-abdominal adhesions in patients with a history of abdominal surgery. PATIENTS AND METHODS: In a cross-sectional, multicenter, multinational study, adult patients with a history of one or more previous abdominal operations and scheduled for laparotomy between 1991 and 1993 were examined during surgery. Patients in whom adhesions were present were selected for study. Quantity, distribution, and quality of adhesions were scored, and adhesion samples were taken for histologic examination. RESULTS: In 448 studied patients, the adhesions were most frequently attached to the omentum (68%) and the small bowel (67%). The amount of adhesions was significantly smaller in patients with a history of only one minor operation or one major operation, compared with those with multiple laparotomies (p < 0.001). Significantly more adhesions were found in patients with a history of adhesions at previous laparotomy (p < 0.001), with presence of abdominal abscess, hematoma, and intestinal leakage as complications after former surgery (p = 0.01, p = 0.002, and p < 0.001, respectively), and with a history of an unoperated inflammatory process (p = 0.04). Granulomas were found in 26% of all patients. Suture granulomas were found in 25% of the patients. Starch granulomas were present in 5% of the operated patients whose surgeons wore starch-containing gloves. When suture granulomas were present, the median interval between the present and the most recent previous laparotomy was 13 months. When suture granulomas were absent, this interval was significantly longer--i.e., 30 months (p = 0.002). The percentage of patients with suture granulomas decreased gradually from 37% if the previous laparotomy had occurred up to 6 months before the present operation, to 18% if the previous laparotomy had occurred more than 2 years ago (p < 0.001). CONCLUSIONS: The number of adhesions found at laparotomy was significantly larger in patients with a history of multiple laparotomies, unoperated intra-abdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized.

Adult↗
PubMed1996

Autologous blood donation and epoetin alfa in cancer surgery.

Patients undergoing cancer surgery frequently require blood, and the transfusion of allogeneic blood in these patients has been controversially linked to an increased risk of tumor recurrence. This patient population may therefore benefit from preoperative autologous blood donation (ABD) with or without epoetin alfa therapy, although the precise impact of autologous blood transfusion has not been fully explored. In some trials, preoperative ABD reduced allogeneic blood exposure by 50% in patients undergoing surgery for cancer resection, while, in another study, perioperative treatment with epoetin alfa significantly increased hematocrit (Hct) levels preoperatively and led to a reduction in postoperative allogeneic blood exposure. A combination of epoetin alfa and preoperative ABD seems a reasonable approach to reducing allogeneic blood exposure in patients undergoing cancer surgery.

Anemia↗