The risk of revision after total hip arthroplasty in young patients depends on surgical approach, femoral head size and bearing type; an analysis of 19,682 operations in the Dutch arthroplasty register.

BACKGROUND: Total hip arthroplasty (THA) is used increasingly in younger patients. There is little knowledge about the effect of THA characteristics on risk of revision, especially in young patients. Therefore, we studied the influence of both patient-related and surgical factors on the risk of revision using data from the Dutch Arthroplasty Registry (LROI). METHODS: All patients younger than 55 years with a primary THA implanted in the Netherlands between 2007 and 2017 were selected (n = 19,682). The covariates age, sex, primary diagnosis, ASA-classification, surgical approach, fixation method, bearing type, head size and year of surgery were entered into Cox proportional hazards models to calculate hazard ratios for the risk of revision. RESULTS: The overall 5-year survival of primary THA was 95.3% (95% CI, 94.9-95.6). Use of the anterior approach resulted in a lower risk of revision than the use of the posterolateral approach (HR: 0.66, 95% CI: 0.47-0.92). THAs with a head diameter ≥ 38 mm had a higher risk of revision (HR: 1.90, 95% CI: 1.33-2.72) than THAs with 32 mm heads. Use of MoM bearings resulted in an increased risk when compared to C-PE (HR: 1.76, 95% CI: 1.27-2.43). CONCLUSION: The risk of revision in patients younger than 55 years depends on surgical approach, head size and bearing type. The anterior approach resulted in a decreased risk of revision, whereas use of ≥38 mm heads and MoM bearings resulted in an increased risk of revision for any reason.

Small but significant excess mortality compared with the general population for long-term survivors of breast cancer in the Netherlands.

BACKGROUND: Coinciding with the relatively good and improving prognosis for patients with stage I-III breast cancer, late recurrences, new primary tumours and late side-effects of treatment may occur. We gained insight into prognosis for long-term breast cancer survivors. PATIENTS AND METHODS: Data on all 205 827 females aged 15-89 diagnosed with stage I-III breast cancer during 1989-2008 were derived from the Netherlands Cancer Registry. Conditional 5-year relative survival was calculated for every subsequent year from diagnosis up to 15 years. RESULTS: For stage I, conditional 5-year relative survival remained ~95% up to 15 years after diagnosis (a stable 5-year excess mortality rate of 5%). For stage II, excess mortality remained 10% for those aged 15-44 or 45-59 and 15% for those aged 60-74. For stage III, excess mortality decreased from 35% at diagnosis to 10% at 15 years for those aged 15-44 or 45-59, and from ~40% to 30% for those aged ≥60. CONCLUSIONS: Patients with stage I or II breast cancer had a (very) good long-term prognosis, albeit exhibiting a small but significant excess mortality at least up to 15 years after diagnosis. Improvements albeit from a lower level were mainly seen for patients who had been diagnosed with stage III disease. Caregivers can use this information to better inform (especially disease-free) cancer survivors about their actual prognosis.

Treatment and complications in elderly stage III colon cancer patients in the Netherlands.

BACKGROUND: We evaluated which patient factors were associated with treatment tolerance and outcome in elderly colon cancer patients. DESIGN: Population-based data from five regions included in the Netherlands Cancer Registry were used. Patients with resected stage III colon cancer aged ≥75 years diagnosed in 1997-2004 who received adjuvant chemotherapy (N = 216) were included as well as a random sample (N = 341) of patients who only underwent surgery. RESULTS: The most common motives for withholding adjuvant chemotherapy were a combination of high age, co-morbidity and poor performance status (PS, 43%) or refusal by the patient or family (17%). In 57% of patients receiving chemotherapy, adaptations were made in treatment regimens. Patients who received adjuvant chemotherapy developed more complications (52%) than those with surgery alone (41%). For the selection of patients who had survived the first year after surgery, receiving adjuvant chemotherapy resulted in better 5-year overall survival (52% versus 34%), even after adjustment for differences in age, co-morbidity and PS. CONCLUSION: Despite high toxicity rates and adjustments in treatment regimens, elderly patients who received chemotherapy seemed to have a better survival. Prospective studies are needed for evaluating which patient characteristics predict the risks and benefits of adjuvant chemotherapy in elderly colon cancer patients.

Diminishing differences in treatment between patients with colorectal cancer with and without diabetes: a population-based study.

AIMS: An increasing number of oncologists will be confronted with individuals having diabetes and cancer. We assessed changes in patient-, tumour- and treatment-related variables in patients with colorectal cancer with and without diabetes. METHODS: All 17 170 cases of primary colorectal cancer between 1995 and 2010 in the South-Eastern Netherlands were included. The Cochrane-Armitage test and logistic regression analysis were used to analyse trends. RESULTS: In total, 11 893 patients were diagnosed with colon cancer and 5277 with rectal cancer, of whom 1711 (14%) and 609 (12%), respectively, had diabetes at the time of cancer diagnosis. Patients with colorectal cancer with diabetes compared with those without were approximately 5 years older and more often diagnosed with proximal colon tumours (60 vs. 54%; P < 0.0001). Chemotherapy administration significantly increased in patients with stage III colon cancer with and without diabetes (from 17% in 1995-1998 to 50% in 2007-2010, 38% to 63%, respectively; P < 0.0001). However, in the most recent period, and after adjusting for the co-variables age, gender, year of diagnosis and specific co-morbidities, patients with stage III colon cancer with diabetes received adjuvant chemotherapy less frequently than those without [odds ratio 0.7 (95% CI 0.5-0.9); P = 0.002]. The proportion of patients with stage II/III rectal cancer with and without diabetes who underwent radiotherapy has been similar in recent years (91 vs. 87%). CONCLUSIONS: Although the administration of chemotherapy and radiotherapy increased between 1995 and 2010 in patients with colorectal cancer with and without diabetes, patients with colorectal cancer with diabetes continue to receive chemotherapy less frequently than those without diabetes.

Miss rate of colorectal cancer at CT colonography in average-risk symptomatic patients.

OBJECTIVES: Computed tomographic colonography (CTC) is a less burdensome alternative to colonoscopy in excluding colorectal cancer (CRC) in symptomatic patients. We evaluated the proportion of patients who underwent CTC in whom CRC was missed. METHODS: Patients who had undergone CTC in the period 1 January 2007 to 1 January 2011 were merged with all cases of CRC recorded in the Cancer Registry between 1 January 2007 and 1 July 2011 to identify all patients who had undergone CTC less than 2 years before CRC had been diagnosed. RESULTS: In 53 out of 1,855 patients who had undergone CTC, CRC was diagnosed. Of these, 40 patients had suspected CRC and 5 had large polyps at CTC. In five patients with an indeterminate mass, further investigation confirmed malignancy. One cancer in the caecum was missed because of poor distension. Two cancers were missed: one in the distal rectum and one in the ascending colon. Sensitivity of CTC for CRC was 94.3 % (95 % CI 88-100 %). The true miss rate, excluding the inadequate distended study, was 2 out of 53 (3.8 %). CONCLUSION: This study shows that the miss rate for CTC is low, which means that CTC is accurate in excluding CRC in symptomatic patients at a relatively low risk of CRC.

Large variation between hospitals in follow-up for colorectal cancer in southern Netherlands.

PURPOSE: The aims of the study were to describe the follow-up of colorectal cancer (CRC) patients in southern Netherlands and examine their overall and disease-free survival. METHODS: Patients newly diagnosed with CRC in 2003-2005 and 2008 with a survival of at least 1 year after diagnosis and recorded in the retrospective Eindhoven Cancer Registry were included (n = 579). Follow-up was defined as at least one liver imaging and at least two carcinoembryonic antigen (CEA) measurements. Logistic regression analyses were conducted to assess determinants of follow-up. Proportions of patients undergoing colonoscopy, CEA measurements and liver and chest imaging were calculated. Overall and disease-free survival were calculated. RESULTS: Patients ≥75 years (odds ratio (OR) 0.5 (95% confidence interval (CI) 0.3-0.7)) were less likely to receive follow-up, contrasting patients <50 years (OR 3.1 (95% CI 1.3-7.4)). In 2008, follow-up intensity increased (OR 2.3 (95% CI 1.2-4.3)), especially for liver imaging and CEA measurements. There were large differences in follow-up intensity and activities between hospitals, which were unaffected by comorbidity: ranges for colonoscopy 15-73 %, CEA measurement 46-91 % and imaging of the liver 22-70 % between hospitals. No effect of follow-up intensity was found on 5-year disease-free survival for patients aged <75 years (64 vs. 68 %; p = 0.6). Similarly, no effect of follow-up intensity on 5-year overall survival was found in these patients (77 vs. 82 %; p = 0.07). CONCLUSION: Large variation in follow-up was found for patients with CRC, mainly declining with age and hospital of follow-up. Over time, follow-up became more intensive, especially with respect to liver imaging and CEA measurements. However, follow-up consisting of at least one liver imaging and at least two CEA measurements did not improve overall and disease-free survival.

Increased adjuvant treatment and improved survival in elderly stage III colon cancer patients in The Netherlands.

BACKGROUND: We determined to what extent patients with colon cancer stage III ≥ 75 years received adjuvant chemotherapy and the impact on overall and disease-specific survival. PATIENTS AND METHODS: Data from The Netherlands Cancer Registry on all 8051 patients with colon cancer stage III ≥ 75 years diagnosed in 1997-2009 were included. Trends in adjuvant chemotherapy administration were analysed and multivariable overall and disease-specific survival analyses were performed. RESULTS: The proportion of stage III colon cancer patients ≥ 75 years who received adjuvant chemotherapy increased from 12%in 1997-2000 to 23% in 2007-2009 (P < 0.0001), with a marked age gradient and large geographic variation. Five-year overall survival increased over time from 28% in 1997-2000 to 35% in 2004-2006 (P < 0.0001). Sixty percent of patients died of colorectal cancer. Adjuvant chemotherapy was the strongest positive predictor of survival in this retrospective study (hazard ratio = 0.5; 95% confidence interval: 0.4-0.5). CONCLUSION: There has been an increase in administration of adjuvant chemotherapy to elderly patients with stage III colon cancer in The Netherlands since 1997. Survival of elderly patients with stage III colon cancer increased over time, at least partly due to stage migration. The large effect of adjuvant chemotherapy on survival in this study is likely to be associated with the selection of fitter patients for adjuvant treatment.

Large age and hospital-dependent variation in administration of adjuvant chemotherapy for stage III colon cancer in southern Netherlands.

BACKGROUND: The purpose was to assess factors associated with the administration of chemotherapy and their relation to survival at a population-based level. METHODS: All patients diagnosed with primary colon cancer stage III from 2001 to 2007 in the area of the Eindhoven Cancer Registry were included (N = 1637). We examined determinants of the administration of adjuvant chemotherapy and their relation to survival. RESULTS: The proportion of patients receiving adjuvant chemotherapy decreased with increasing age from 85% for patients <65 years to 68% for those 65-74 years and 17% for patients > or =75 years, with large interhospital variation. Elderly patients {odds ratio (OR) 0.1 [95% confidence interval (CI) 0.1-0.1]} and those with comorbidity [OR 0.6 (95% CI 0.5-0.8)] received adjuvant chemotherapy less often. Patients with an intermediate [OR 1.4 (95% CI 1.1-1.9)] or high socioeconomic status [OR 1.5 (95% CI 1.1-2.0)] or stage IIIC [OR 1.5 (95% CI 1.1-2.0)] received adjuvant chemotherapy more often. Adjuvant chemotherapy was the most important predictor of survival. In a multivariable analysis, older age was no longer a significant negative predictor of survival, in contrast to comorbidity, higher tumor stage, poor tumor grade, and male gender. The improvement in survival from 2001 to 2006 did not reach statistical significance. CONCLUSION: Adherence to guidelines for adjuvant chemotherapy was still suboptimal in 2007, especially for elderly patients, and differed widely between hospitals.

Improved survival of colon cancer due to improved treatment and detection: a nationwide population-based study in The Netherlands 1989-2006.

BACKGROUND: We described changes in treatment of colon cancer over time and the impact on survival in The Netherlands in the period 1989-2006. PATIENTS AND METHODS: All 103,744 patients with invasive colon cancer during 1989-2006 in The Netherlands were included. Data were extracted from The Netherlands Cancer Registry. Trends in treatment over time were analysed and multivariable relative survival analysis was carried out. RESULTS: The administration of adjuvant chemotherapy in stage III patients <75 years increased from 19% in 1989-1993 to 79% in 2004-2006 and from 1% to 19% in stage III patients ≥75 years. Among stage IV patients, resection rates of the primary tumour decreased from 72% to 63%, while chemotherapy administration increased from 23% to 64% in those <75 years. Survival increased from 52% to 58% in males and from 55% to 58% among females. Stage III patients with adjuvant chemotherapy exhibited a relative excess risk of 0.4 (95% confidence interval 0.4-0.4) compared with those without. Among stage IV patients, resection of primary tumour, palliative chemotherapy, and metastasectomy were important prognostic factors. CONCLUSIONS: There were substantial improvements in management and survival of colon cancer from 1989 to 2006. Stage III disease patients with colon cancer experienced the largest improvement in survival, most likely related to the increased administration of adjuvant chemotherapy.

Was there shortening of the interval between diagnosis and treatment of colorectal cancer in southern Netherlands between 2005 and 2008?

BACKGROUND: The Dutch Cancer Society proposed that the interval between diagnosis and start of treatment should be less than 15 working days. The purpose of this study was to determine whether the interval from diagnosis to treatment for patients with colorectal cancer (CRC) shortened between 2005 and 2008 in hospitals in southern Netherlands. METHODS: Patients with CRC diagnosed in six hospitals in southern Netherlands during January to December in 2005 (n = 445) and January to July in 2008 (n = 353) were included. The time between diagnosis and start of treatment was assessed, and the proportion of patients treated within the recommended time (<15 working days) was calculated. RESULTS: The time to treatment for colon cancer patients was 13 working days in 2005 and 17 working days in 2008. For rectal cancer patients, the median time to preoperative radiotherapy was 28 working days in 2005 and 30 working days in 2008, and the median time to surgical treatment for rectal cancer patients was 26 working days in 2005 and 18 working days in 2008. Time to treatment did not shorten between 2005 and 2008 for colon and rectal cancer patients, except for rectal cancer patients who underwent surgery as initial treatment in patients aged >70 years and those with stage I disease. Substantial variation was seen among hospitals. CONCLUSIONS: Time to treatment for patients with CRC in southern Netherlands did not shorten between 2005 and 2008. The time to treatment should be reduced to meet the advice of the Dutch Cancer Society.

Screening caused rising incidence rates of ductal carcinoma in situ of the breast.

The purpose of this study was to examine trends in incidence and detection of ductal carcinoma in situ (DCIS) of the breast in southern Netherlands in the period 1984-2006 and assess the effect of mass screening. All patients with primary DCIS registered between 1984 and 2006 in the population-based Eindhoven Cancer Registry were included (n = 1,767). These data were linked to data from the population-based screening programme. The incidence of DCIS of the breast increased from 3/100,000 to almost 34/100,000 person-years in women aged 50-69 years in southern Netherlands since 1984. Mass screening was responsible for this increase. A stable 60% of DCIS was screen-detected. Over 11% of breast cancer patients have DCIS. In conclusion, the incidence of DCIS increased markedly in southern Netherlands with a clear effect of mammography screening since 1992.

Fast Starters, Slow Starters, and Late Dippers: Trajectories of Patient-Reported Outcomes After Total Hip Arthroplasty: Results from a Dutch Nationwide Database.

BACKGROUND: The purpose of this study was to explore whether subgroups of patients with different functional recovery trajectories after total hip arthroplasty can be discerned, as well as their predictors, using data from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten [LROI]). METHODS: We retrospectively reviewed prospectively collected Oxford Hip Scores (OHS) up to 1 year postoperatively for patients who had undergone a primary total hip arthroplasty. Latent class growth modeling was used to classify subgroups of patients according to the trajectory of functional recovery represented by the patients' OHS. We used multivariable multinomial logistic regression analysis to explore factors associated with class membership. RESULTS: A total of 6,030 patients were analyzed. Latent class growth modeling identified fast starters (fast initial improvement, high 12-month scores; 87.7%), slow starters (no initial change and subsequent improvement; 4.6%), and late dippers (initial improvement and subsequent deterioration; 7.7%). Factors associated with slow starters were female sex (odds ratio [OR], 1.63 [95% confidence interval (CI), 1.14 to 2.33]) and smoking (OR, 1.95 [95% CI, 1.26 to 3.03]); an anterior approach (OR, 0.47 [95% CI, 0.29 to 0.78]) had a protective effect against a less favorable response. Factors associated with late dippers were age of >75 years (OR, 1.62 [95% CI, 1.22 to 2.15]), smoking (OR, 1.68 [95% CI, 1.17 to 2.42]), American Society of Anesthesiologists (ASA) grade of III or IV (OR, 1.41 [95% CI, 1.05 to 1.91]), obesity (OR, 1.96 [95% CI, 1.43 to 2.69]), poorer EuroQol-5 Dimensions (EQ-5D) Self-Care (OR, 1.41 [95% CI, 1.09 to 1.82] for "some problems" and OR, 2.90 [95% CI, 1.39 to 6.03] for "unable"), poorer EQ-5D Anxiety/Depression (OR, 1.31 [95% CI, 1.00 to 1.71] for "moderately" and OR, 1.86 [95% CI, 1.06 to 3.24] for "extremely"), poorer EQ-5D visual analog scale (OR, 0.91 [95% CI, 0.86 to 0.97] per 10 points), direct lateral approach (OR, 2.18 [95% CI, 1.58 to 3.02]), and hybrid fixation with a cemented acetabular implant (OR, 1.79 [95% CI, 1.00 to 3.21]). CONCLUSIONS: We discerned fast starters, slow starters, and late dippers after total hip arthroplasty. Female sex, older age, obesity, higher ASA grades, and worse EQ-5D scores were associated with a less favorable response to total hip arthroplasty, as well as hybrid fixation (cemented acetabular implant) and direct lateral approach. Anterior approach had a protective effect against a less favorable response. However, all subgroups experienced functional improvement following total hip arthroplasty. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Significant improvement in survival of patients presenting with metastatic colon cancer in the south of The Netherlands from 1990 to 2004.

BACKGROUND: In randomised controlled trials, the median overall survival (OS) for patients with metastatic colon cancer has improved. However, the results of randomised controlled trials should be interpreted with caution and cannot simply be extrapolated to the general practice. We retrospectively analysed population-based survival data of patients who presented with metastatic colon cancer at diagnosis. PATIENTS AND METHODS: All patients diagnosed with primary metastatic colon cancer from 1990 to 2004 in the registration area of the Eindhoven Cancer Registry were included. Date of diagnosis was divided into four periods (1990-1994, 1995-1999, 2000-2002, and 2003-2004) according to the availability of chemotherapy for metastatic colon cancer. We assessed OS according to chemotherapy use and period. RESULTS: Of the 1769 patients, 30.6% received chemotherapy. Chemotherapy use over time increased from 24% in 1990-1994 to 55% in 2000-2004 for patients aged <70 years and from 2% to 22% in patients aged 70 years and older. Median survival for patients diagnosed in 1990-1994 was 26 [95% confidence interval (CI) 22-32] weeks, while patients diagnosed in 2003-2004 had a median survival of 39 (95% CI 31-48) weeks. Patients who did not receive chemotherapy had a survival of 22 (95% CI 20-25) weeks, while the survival for patients who did receive chemotherapy was 57 (95% CI 51-65) weeks. OS decreased with increasing age (P < 0.0001). In the multivariate survival analysis, chemotherapy use, increasing age, having multiple comorbid conditions, and having more than one tumour site significantly affect survival, with the strongest effect of chemotherapy use. CONCLUSION: Palliative chemotherapy significantly improved OS in unselected patients with metastatic colon cancer.

Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands: a population-based study.

BACKGROUND: Preferred treatment for resectable oesophageal cancer is surgery with or without neoadjuvant treatment. However, oesophageal surgery has high morbidity and in vulnerable patients with co-morbidity other treatment modalities can be proposed. We examined determinants in decision making for surgery and factors affecting survival in patients with resectable oesophageal cancer in southern Netherlands. METHODS: All patients with resectable (T1-3, N0-1, M0-1A) oesophageal cancer (n=849) diagnosed between 2003 and 2010 were selected from the population-based data of the Eindhoven Cancer Registry. Logistic regression analysis and multivariable Cox survival analysis were conducted to examine determinants of surgery and survival. RESULTS: Forty-five percent of the patients underwent surgery. In multivariable survival analysis only surgery, chemoradiation alone and tumour stage influenced overall survival (OS). Patients aged ≥ 70 yrs, a low socioeconomic status (SES), one or more co-morbidities, cT1-tumours, cN1-tumours, a squamous-cell carcinoma, and those with a proximal tumour were significantly less often offered surgical resection. Older patients and patients with cT1 tumours were less likely to receive chemoradiation alone. Patients with clinically positive lymph nodes or a proximal tumour were more likely to receive chemoradiation alone. CONCLUSION: Treatment modalities including surgery and chemoradiation alone as well as stage of disease were independent predictors of a better OS in patients with potentially resectable oesophageal cancer. Therefore, the decision to perform potentially curative treatment is of crucial importance to improve OS for patients with potentially resectable oesophageal cancer. Although age and SES had no significant influence on overall survival, a higher age and low SES negatively influenced the probability to propose potentially curative treatment.

Time trends and inter-hospital variation in treatment and axillary staging of patients with ductal carcinoma in situ of the breast in the era of screening in Southern Netherlands.

BACKGROUND: To examine variation in time and place in axillary staging and treatment of patients with ductal carcinoma in situ (DCIS) of the breast. METHODS: Trends in patients with DCIS recorded in the Eindhoven Cancer Registry diagnosed in 1991-2010 (n = 2449) were examined. RESULTS: The use of breast conserving surgery (BCS) went from 17% to 67% in 1991-2010 and administration of radiotherapy after BCS increased to 89%. Axillary lymph node dissection decreased to almost 0%, while sentinel node biopsy was performed in 65% of patients in 2010. The proportion who underwent BCS varied between hospitals from 49% to 80%; the proportion without axillary staging ranged from 21% to 60%. Patients with screen-detected DCIS were more likely to receive BCS. CONCLUSION: There was considerable variation in the use of BCS, radiotherapy, and axillary staging of DCIS over time and between hospitals. Patients with DCIS were more likely to be treated with BCS if their disease was detected by screening.

Conditional survival for long-term colorectal cancer survivors in the Netherlands: who do best?

AIM: With the increase in the number of long-term colorectal cancer (CRC) survivors, there is a growing need for subgroup-specific analysis of conditional survival. METHODS: All 137,030 stage I-III CRC patients diagnosed in the Netherlands between 1989 and 2008 aged 15-89 years were selected from the Netherlands Cancer Registry. We determined conditional 5-year relative survival rates, according to age, subsite and tumour stage for each additional year survived up to 15 years after diagnosis as well as trends in absolute risks for and distribution of causes of death during follow-up. RESULTS: Minimal excess mortality (conditional 5-year relative survival >95%) was observed 1 year after diagnosis for stage I colon cancer patients, while for rectal cancer patients this was seen after 6 years. For stage II and III CRC, minimal excess mortality was seen 7 years after diagnosis for colon cancer, while for rectal cancer this was 12years. The differences in conditional 5-year relative survival between colon and rectal cancer diminished over time for all patients, except for stage III patients aged 60-89 years. The absolute risk to die from CRC diminished sharply over time and was below 5% after 5 years. The proportion of patients dying from CRC decreased over time after diagnosis while the proportions of patients dying from other cancers, cardiovascular disease and other causes increased. CONCLUSION: Prognosis for CRC survivors improved with each additional year survived, with the largest improvements in the first years after diagnosis. Quantitative insight into conditional relative survival estimates is useful for caregivers to inform and counsel patients with stage I-III colon and rectal cancer during follow-up.

Hospital of diagnosis and probability to receive a curative treatment for oesophageal cancer.

BACKGROUND: Surgical treatment of oesophageal cancer in the Netherland is performed in high volume centres. However, the decision to refer patients for curative surgery is made in the referring hospital of diagnosis. The objective of this study was to determine the influence of hospital of diagnosis on the probability of receiving a curative treatment and survival. MATERIAL AND METHOD: All patients with resectable oesophageal cancer (cT1-3, cN0-3, cM0-1A) diagnosed between 2003 and 2010 (n = 849) were selected from the population-based Eindhoven Cancer Registry, an area with ten non-academic hospitals. Multivariate logistic regression analysis was conducted to examine the independent influence of hospital of diagnosis on the probability to receive curative treatment. Furthermore, the effect of hospital of diagnosis on overall survival was examined using multivariate Cox regression analysis. RESULTS: 849 patients were included in the study. A difference in proportion of patients referred for surgery was observed ranging from 33% to 67% (p = 0.002) between hospitals of diagnosis. Multivariate logistic regression analysis confirmed the effect of hospital of diagnosis on the chance of undergo curative treatment (OR 0.1, 95% CI 0.1-0.4). Multivariate Cox regression analysis showed that hospital of diagnosis also had an effect on overall survival, up to hazard ratio (HR) 2.2 (95% CI 1.3-3.7). CONCLUSION: There is a strong relation between hospital of diagnosis and the chance of referring patients with oesophageal cancer for a curative treatment as well as overall survival. Patients diagnosed with oesophageal cancer should be discussed within a regional multidisciplinary expert panel.

No difference between lowest and highest volume hospitals in outcome after colorectal cancer surgery in the southern Netherlands.

AIM: To investigate the quality of surgical colorectal cancer (CRC) care in the southern Netherlands by evaluating differences between the five hospitals with the lowest volume and the five hospitals with the highest volume. METHODS: Patients who underwent resection for primary CRC diagnosed between 2008 and 2011 in southern Netherlands were included (n = 5655). The five hospitals performing <130 resections/year were classified 'low volume'; the five hospitals performing ≥ 130 resections/year 'high volume'. Differences in surgical approach, circumferential resection margins (CRM), anastomotic leakage and 30-day mortality between hospital volumes were analysed using Chi(2) tests. Expected proportions anastomotic leakage and 30-day mortality were calculated using multivariable logistic regression. Crude 3-year survival was calculated using Kaplan-Meier curves. Cox regression was used to discriminate independent risk factors for death. RESULTS: 23% of patients with locally advanced rectal cancer (LARC) diagnosed in a low volume centre was referred to a high volume centre. Patients with colon cancer underwent less laparoscopic surgery and less urgent surgery in low compared to high volume hospitals (10% versus 32%, p < 0.0001, and 8% versus 11%, p = 0.003, respectively). For rectal cancer, rates of abdominoperineal resections versus low anterior resections, and CRM were not associated with hospital volume. Anastomotic leakage, 30-day mortality, and survival did not differ between hospital volumes. CONCLUSION: In southern Netherlands, low volume hospitals deliver similar high quality surgical CRC care as high volume hospitals in terms of CRM, anastomotic leakage and survival, also after adjustment for casemix. However, this excludes LARC since a substantial proportion was referred to high volume hospitals.

Minimal excess mortality for long-term colon cancer survivors in the Netherlands 1989-2008.

We determined conditional 5-year relative survival rates for colon cancer patients, according to age, gender and tumour stage for each additional year of survival up to 15 years after diagnosis. All 89,451 patients diagnosed in the Netherlands with colon cancer stage I-III in 1989-2008 aged 15-89 years were selected from the Netherlands Cancer Registry. Conditional 5-year relative survival was computed for every additional year of survival up to 15 years. There was minimal excess mortality (conditional 5-year relative survival >95%) 1-4 years after diagnosis of stage I patients and 4-7 years after diagnosis of stage II patients, with patients aged 45-74 years reaching this point later compared to both younger and elderly patients. For stage III patients, minimal excess mortality was observed 5 years after diagnosis for those aged 75-89 years, but it remained elevated up to 13 years after diagnosis for those aged 15-44 years. Initial differences in relative survival at diagnosis between age and stage groups largely disappeared with increasing number of years survived. The prognosis for colon cancer survivors improved with each additional year survived. In the first years after diagnosis conditional survival improved largely for all colon cancer patients, especially for stage III patients. There was minimal excess mortality for colon cancer patients stage I-III at some point within 15 years of diagnosis, being later for more advanced stages. Quantitative insight into conditional survival for cancer patients is useful for caregivers to help plan optimal cancer surveillance and inform patients about their prognosis.

Improving lymph node detection in colon cancer in community hospitals and their pathology department in southern Netherlands.

AIM: The aim was to investigate whether a set of measures directed at increasing lymph node (LN) detection among colon cancer patients led to clinically relevant changes in LN detection rate. METHODS: Data of all patients with curative colon cancer (pT(any) N(any) M0) diagnosed in 1999-2007 whose resection specimens were evaluated by the Institute for Pathology and Medical Microbiology in Eindhoven (n=1501) were included. Feedback to specialists, increased fixation time, and ex-vivo injection of the specimen with Patent blue V dye were used to increase LN detection rate. Trends in the proportion of patients with insufficient LNs examined were investigated; moreover, the Patent blue-stained patients (n=86) were compared with a group of unstained patients (n=84). Based on the decrease in the proportion of high-risk node-negative patients, a calculation of chemotherapy-related costs saved was made. RESULTS: The proportion of patients with <12 LNs examined decreased from 87% in 1999 to 48% in 2007 (p(trend)<0.0001). In the stained group this was 37%, versus 56% for the unstained group (p=0.010). In 1999, 79% of stage II patients were high-risk compared to 55% in 2007, which translates to a saving of almost 1,000,000 euro based on 92 stage II patients diagnosed in 2007. CONCLUSION: A diverse set of measures increased the number of examined lymph nodes among patients with colon cancer. Large savings can be made due to the reduced proportion of high-risk node-negative patients who would otherwise have received adjuvant chemotherapy.