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Browsing by Author "van Hooft, Jeanin"
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Item A multimodality test to guide the management of patients with a pancreatic cyst(American Association for the Advancement of Science, 2019-07-17) Springer, Simeon; Masica, David L.; Dal Molin, Marco; Douville, Christopher; Thoburn, Christopher J.; Afsari, Bahman; Li, Lu; Cohen, Joshua D.; Thompson, Elizabeth; Allen, Peter J.; Klimstra, David S.; Schattner, Mark A.; Schmidt, C. Max; Yip-Schneider, Michele; Simpson, Rachel E.; Castillo, Carlos Fernandez-Del; Mino-Kenudson, Mari; Brugge, William; Brand, Randall E.; Singhi, Aatur D.; Scarpa, Aldo; Lawlor, Rita; Salvia, Roberto; Zamboni, Giuseppe; Hong, Seung-Mo; Hwang, Dae Wook; Jang, Jin-Young; Kwon, Wooil; Swan, Niall; Geoghegan, Justin; Falconi, Massimo; Crippa, Stefano; Doglioni, Claudio; Paulino, Jorge; Schulick, Richard D.; Edil, Barish H.; Park, Walter; Yachida, Shinichi; Hijioka, Susumu; van Hooft, Jeanin; He, Jin; Weiss, Matthew J.; Burkhart, Richard; Makary, Martin; Canto, Marcia I.; Goggins, Michael G.; Ptak, Janine; Dobbyn, Lisa; Schaefer, Joy; Sillman, Natalie; Popoli, Maria; Klein, Alison P.; Tomasetti, Cristian; Karchin, Rachel; Papadopoulos, Nickolas; Kinzler, Kenneth W.; Vogelstein, Bert; Wolfgang, Christopher L.; Hruban, Ralph H.; Lennon, Anne Marie; Surgery, School of MedicinePancreatic cysts are common and often pose a management dilemma, because some cysts are precancerous, whereas others have little risk of developing into invasive cancers. We used supervised machine learning techniques to develop a comprehensive test, CompCyst, to guide the management of patients with pancreatic cysts. The test is based on selected clinical features, imaging characteristics, and cyst fluid genetic and biochemical markers. Using data from 436 patients with pancreatic cysts, we trained CompCyst to classify patients as those who required surgery, those who should be routinely monitored, and those who did not require further surveillance. We then tested CompCyst in an independent cohort of 426 patients, with histopathology used as the gold standard. We found that clinical management informed by the CompCyst test was more accurate than the management dictated by conventional clinical and imaging criteria alone. Application of the CompCyst test would have spared surgery in more than half of the patients who underwent unnecessary resection of their cysts. CompCyst therefore has the potential to reduce the patient morbidity and economic costs associated with current standard-of-care pancreatic cyst management practices.Item New and Recurrent Colorectal Cancers After Resection: a Systematic Review and Meta-analysis of Endoscopic Surveillance Studies(Elsevier, 2019) Fuccio, Lorenzo; Rex, Douglas K.; Ponchon, Thierry; Frazzoni, Leonardo; Dinis-Ribeiro, Mário; Bhandari, Pradeep; Dekker, Evelien; Pellisè, Maria; Correale, Loredana; van Hooft, Jeanin; Jover, Rodrigo; Libanio, Diogo; Radaelli, Franco; Alfieri, Sergio; Bazzoli, Franco; Senore, Carlo; Regula, Jaroslaw; Seufferlein, Thomas; Rösch, Thomas; Sharma, Prateek; Repici, Alessandro; Hassan, Cesare; Medicine, School of MedicineBackground & Aims Outcomes of endoscopic surveillance following surgery for colorectal cancer (CRC) vary with the incidence and timing of CRC detection, at anastomoses or non- anastomoses in the colorectum. We performed a systematic review and meta-analysis to evaluate the incidence of CRCs identified during surveillance colonoscopies of patients who have already undergone surgery for this cancer. Methods We searched PubMed, EMBASE, SCOPUS, and the Cochrane Central Register of Clinical Trials through January 1, 2018 to identify studies investigating rates of CRCs at anastomoses or other locations in the colorectum after curative surgery for primary CRC. We collected data from published randomized controlled, prospective, and retrospective cohort studies. Data were analyzed by multivariate meta-analytic models. Results From 2373 citations, we selected 27 studies with data on 15,803 index CRCs for analysis (89% of patients with stage 1–3 CRC). Overall, 296 CRCs at non-anastomotic locations were reported over time periods of more than 16 years (cumulative incidence, 2.2% of CRCs; 95% CI, 1.8%–2.9%). The risk of CRC at a non-anastomotic location was significantly reduced more than 36 months after resection compared with before this timepoint (odds ratio for non-anastomotic CRCs at 36–48 months vs 6–12 months after surgery, 0.61; 95% CI, 0.37–0.98; P=.031); 53.7% of all non-anastomotic CRCs were detected within 36 months of surgery. One hundred fifty-eight CRCs were detected at anastomoses (cumulative incidence of 2.7%; 95% CI, 1.9%–3.9%). The risk of CRCs at anastomoses was significantly lower 24 months after resection than before (odds ratio for CRCs at anastomoses at 25–36 months after surgery vs 6–12 months, 0.56; 95% CI, 0.32–0.98; P=.036); 90.8% of all CRCs at anastomoses were detected within 36 months of surgery. Conclusions After surgery for CRC, the highest risk of CRCs at anastomoses and at other locations in the colorectum is highest during 36 months after surgery—risk decreases thereafter. Patients who have undergone CRC resection should be evaluated by colonoscopy more closely during this time period. Longer intervals may be considered thereafter.