Ewout A. Kouwenhoven

Objective: To compare the quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE). Background: Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery. Methods: This randomized controlled superiority trial was conducted across 4 Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality. Results: From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference: 3.7, 95% CI: −2.3 to 9.7; P=0.268). Epidural patients had significantly higher QoR-40 scores on POD1 and 2 (mean difference: 7.7, 95% CI: 2.3–13.1; P=0.018 and mean difference: 7.3, 95% CI: 1.9–12.7; P=0.020) and lower pain scores (median 1 vs 2; PP=0.033). More epidural patients required vasopressor medication on POD1 (38.3% vs 13.3%; PP<0.001). No significant differences were found in postoperative complications or hospital/intensive care unit stay. Conclusions: This randomized controlled trial did not demonstrate the superiority of paravertebral over epidural analgesia regarding the quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.

Sensitivity analyses on the association between hematocrit levels and severity of CRF at the different timepoints among survivors that were fatigued or anemic at least once during the study period

Analyses on the association between hematocrit levels and prevalence and severity of CRF at the different timepoints stratified by tumor stage and location

Sensitivity analyses on the association between hematocrit levels and severity of CRF at the different timepoints among survivors that were fatigued or anemic at least once during the study period

Background:Cancer-related fatigue (CRF) is a frequent symptom in colorectal cancer survivors. It is unknown to what extent anemia may contribute to CRF in colorectal cancer survivors. This study aimed to investigate the association between hematocrit, as marker for anemia, and CRF among colorectal cancer survivors from diagnosis until two years thereafter.Methods:The study population included 1,506 newly diagnosed colorectal cancer survivors at any stage of disease from a prospective cohort study. Hematocrit and CRF (EORTC QLQ-C30) were assessed at diagnosis, six months, and two years after diagnosis. Multivariable logistic regression or multivariable linear mixed models were used to assess the associations of hematocrit with CRF prevalence, or CRF severity over time, respectively.Results:A low hematocrit (levels <40% men/<36% women) was present in a third of the survivors at diagnosis and six months thereafter, and among 16% two years after diagnosis. The prevalence of CRF was 15% at diagnosis, peaked at 27% at six months, and was 14% two years after diagnosis. Hematocrit was associated with the prevalence of CRF at diagnosis [OR, 0.92; confidence interval (CI), 0.88–0.95], 6 months (OR, 0.89; 95% CI, 0.86–0.92), and 2 years (OR, 0.91; CI, 0.87–0.96) after diagnosis. Lower hematocrit was associated with higher severity of CRF over time (beta-coefficient = 1.3; CI, 1.5–1.1).Conclusions:Lower hematocrit levels were longitudinally associated with a higher prevalence and severity of CRF in colorectal cancer.Impact:Our findings emphasize the importance of long-term anemia monitoring and a potential role of anemia in CRF among colorectal cancer survivors.

: Baseline characteristics of included CRC survivors (n=1,506) and excluded survivors (n=624)

: Baseline characteristics of included CRC survivors (n=1,506) and excluded survivors (n=624)

Background:Cancer-related fatigue (CRF) is a frequent symptom in colorectal cancer survivors. It is unknown to what extent anemia may contribute to CRF in colorectal cancer survivors. This study aimed to investigate the association between hematocrit, as marker for anemia, and CRF among colorectal cancer survivors from diagnosis until two years thereafter.Methods:The study population included 1,506 newly diagnosed colorectal cancer survivors at any stage of disease from a prospective cohort study. Hematocrit and CRF (EORTC QLQ-C30) were assessed at diagnosis, six months, and two years after diagnosis. Multivariable logistic regression or multivariable linear mixed models were used to assess the associations of hematocrit with CRF prevalence, or CRF severity over time, respectively.Results:A low hematocrit (levels <40% men/<36% women) was present in a third of the survivors at diagnosis and six months thereafter, and among 16% two years after diagnosis. The prevalence of CRF was 15% at diagnosis, peaked at 27% at six months, and was 14% two years after diagnosis. Hematocrit was associated with the prevalence of CRF at diagnosis [OR, 0.92; confidence interval (CI), 0.88–0.95], 6 months (OR, 0.89; 95% CI, 0.86–0.92), and 2 years (OR, 0.91; CI, 0.87–0.96) after diagnosis. Lower hematocrit was associated with higher severity of CRF over time (beta-coefficient = 1.3; CI, 1.5–1.1).Conclusions:Lower hematocrit levels were longitudinally associated with a higher prevalence and severity of CRF in colorectal cancer.Impact:Our findings emphasize the importance of long-term anemia monitoring and a potential role of anemia in CRF among colorectal cancer survivors.

Analyses on the association between hematocrit levels and prevalence and severity of CRF at the different timepoints stratified by tumor stage and location

Esophageal cancer can be treated effectively with esophagectomy; however, the postoperative complication rate is high. In this paper, we study to what extent machine learning methods can predict anastomotic leakage and pneumonia up to two days in advance. We use a dataset with 417 patients who underwent esophagectomy between 2011 and 2021. The dataset contains multimodal temporal information, specifically, laboratory results, vital signs, thorax images, and preoperative patient characteristics. The best models scored mean test set AUROCs of 0.87 and 0.82 for leakage 1 and 2 days ahead, respectively. For pneumonia, this was 0.74 and 0.61 for 1 and 2 days ahead, respectively. We conclude that machine learning models can effectively predict anastomotic leakage and pneumonia after esophagectomy.