Optimization and evaluation of advances in modern Upper GI surgery
Sander Mertens is a PhD student in the department Robotics and Mechatronics. (Co)Supervisors are prof.dr. I.A.M.J. Broeders from the faculty of Electrical Engineering, Mathematics and Computer Science, prof.dr. M.I. van Berge Henegouwen from Amsterdam UMC and dr. W.A. Draaisma from Joeroen Bosch Hospital.
The first part of this thesis describes several studies in gastroesophageal reflux disease due to diaphragmatic hiatal hernias, while the second part focuses on malignancies of the esophagus and stomach.
Part I
Gastroesophageal reflux disease (GERD) is a debilitating spectrum of diseases of the stomach and esophagus. It is estimated that up to 20% of the adult European population suffers from reflux at least weekly. Although GERD is a serious disease in and of itself, this thesis focusses on patients with a hiatal hernia as the suspected underlying cause.
The safety and risks of hiatal hernia surgery are described in chapter five. Chapter two discusses the adverse events that might be encountered during robot-assisted hiatal hernia surgery. Chapter three explains how to handle the recurrence of a hiatal hernia. Chapter six discusses the merits of an often-reported criticism of robotic assisted surgery: operating times and cost. Chapter four explores the incidence of damage to the spleen due to ligation of vasculature during the creation of a fundoplication. Chapter seven evaluates the accuracy of CT-imaging compared to intraoperative findings.
Part II
Gastric and esophageal cancer are both in the top 10 of cancer-related deaths worldwide, and surgery is still the cornerstone of treatment. In esophageal cancer there is consensus that the diseased esophagus should be removed, in addition to the gastroesophageal junction. In gastric cancer, however, it is often harder to discern exactly where the tumor is located. There is active discussion on the optimal type of resection for each location. [SM1] It gets especially complicated when the tumor in question is located at the gastro-esophageal junction, because in this situation there often is overlap between gastric, esophageal, and gastro-esophageal junction treatment options and guidelines.
Chapter eleven uses data from a national registry (Dutch Upper GI Cancer Audit) to compare short-term outcomes between gastric and esophageal resections for junction tumors. An esophageal resection can be performed using a transhiatal or transthoracic approach. Chapter ten compares these two approaches using a Dutch national cancer treatment audit registry. Chapter nine describes the results of a case series in patients with early postoperative delayed gastric tube emptying, in which an endoscopic pneumatic pyloric dilation procedure was performed. The chapter discusses the safety and gains in quality of life in this population. In chapter eight, the Dutch research database of the LOGICA Study Group for gastric cancer was used to determine the amount of risk a patient is exposed to after surgical resection, depending on their age.
