Her summary stays important because of the extensive literature review given . Traditionally it is believed that Jan van Doesborch originates from Doesburg near Arnhem, but this is not certain and actually not very probable.
Carcinoma of the oesophagus is a disease with a dismal prognosis.
The curative treatment consists of a surgical resection of the oesophagus including a regional lymph node dissection, aiming to remove all cancerous tissue. There are three main surgical approaches, transthoracal, transhiatal and minimally invasive oesophagectomy MIO.
MIO has a number of intraoperative benefits compared to transthoracal surgery, such as a reduced number of pulmonary complications. Successful epidural analgesia is expected to effectively reduce postoperative pain and consequently the number of pulmonary complications, making it as safe as MIO.
However, iatrogenous trauma of the mediastinum is supposed to be responsible for a large proportion postoperative pulmonary complications, independent of the factor pain. This research therefore aims to determine if there are differences between the three treatments with respect to these complications, and what the influence of the extent of mediastinal trauma and the role of epidural analgesia would be.
For the epidemiological characteristics and comparison of pulmonary complications, several publications are used. Data concerning pulmonary complications and the extent of mediastinal dissection is extracted from available patient resources treated with transthoracal surgery in our hospital between and ; the latter by counting the number of retrieved lymph nodes.
Confounding variables have been corrected for. The relationships between pulmonary complications and epidural analgesia, and the number of harvested lymph nodes have been statistically analysed. There is no statistically significant association between epidural analgesia and pulmonary complications within our population.
In addition, there is no correlation between the number of harvested lymph nodes and pulmonary complications. A crude comparison with literature data yields a lower rate of pulmonary complications and a higher number of harvested lymph nodes in MIO compared to the transthorically treated patients in our hospital, and with transhiatal and transthoracal esophagectomy combined in literature.
The non-significant effect of epidural analgesia could be rejected by choosing another end parameter within the same population. The lack of association between the number of harvested lymph nodes and pulmonary complications is probably caused by the effective epidural analgesia. MIO seems to be safe and effective and the pulmonary complication rate seems to be lower than in transthoracal esophagectomy.
However, these results should be considered flawed by some selection bias. The long term oncological effectivity of MIO and its probably lower pulmonary complication rate has yet to be proven by conducting a multi centered randomised controlled study.
Nederlandse samenvatting Oesofaguscarcinoom is een ziekte met een slechte langtermijn-prognose. De curatieve behandeling is meestal operatief, waarbij de slokdarm en drainerende lymfeklieren worden verwijderd in de hoop geen tumorresten achter te Iaten.
Er zijn drie operatieve hoofdbenaderingen: Transhiatale oesofagectomie resulteert in minder pulmonale complicaties maar lijkt een lagere oncologische effectiviteit te hebben. Bij MIO zouden minder pulmonale complicaties optreden ten opzichte van transthoracale chirurgie.The total number of people who shared the printenbind homepage on Delicious.
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Elke Van de Casteele with expertise in: Medical Physics and Radiology. Read 54 publications, and contact Elke Van de Casteele on ResearchGate, the professional network for scientists.
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Deze bijzonder heldere studie die (en dat zullen de auteurs mij, gelet op hun conclusie, wel vergeven) bijna leest als een detectiveroman, laat op toegankelijke wijze zien hoe psychopathologische symptomen de basisstructuren van het menselijk leven blootleggen die tevens de .