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Radical surgery currently remains the most realistic chance of cure for cancer of the esophagus or gastro esophageal junction (GEJ). Nowadays experienced centers consistently perform such an aggressive surgery with perioperative mortality rates of 3 to 5% and obtain overall 5-years survival rates of at least 35 to 40%, even after neoadjuvant treatment. Although results have improved, the majority of patients will ultimately die from locoregional or systemic recurrent disease. Furthermore, despite considerable improvements in surgical technique and perioperative care over the last 2 decades, the morbidity and impact on quality of life of esophageal resection remains substantial.As a consequence, careful study of esophageal cancer to obtain new insights and to develop new pathways to improve the quality and the related outcome remain the principal goal of all involved health–care professionals.In this thesis, we have shown that a rigorous analysis of our database of more than 2500 patients, we could assess a number of selected and specific qualitative aspects related to pathological staging, surgical therapy and quality of life indices in esophageal cancer patients.By doing so, we have brought some interesting new insights in addressing the qualitative aspects of the treatment of esophageal cancer at several levels. They were already implemented or will serve to improve and guide ongoing esophageal cancer treatment.Quality of pathological evaluationThe 7th edition (2010) of the TNM staging system refining the previous versions, has introduced (as in other cancers) the notion of number of involved lymph nodes but did not take into account characteristics of the lymph node itself despite our group being the first to really highlight the importance of nodal capsular breakthrough on survival. In view of the eighth revision, the impact of the capsular status, being intracapsular or extracapsular involvement, was further examined as prognostic factor. In Chapter 3 (Eur J Cardiothorac Surg. 2014;28:1001-10) extracapsular lymph node invasion was confirmed as an independent negative prognostic factor in pN1 adenocarcinoma patients (i.e. 1 or 2 involved lymph nodes) treated by primary surgery and furthermore it was suggested that incorporating these results in the TNM classification systems could increase its prognostic performance. This paved the way for a large multicentric study described in Chapter 4, involving 6 high volume tertiary referral centers in Europe who underwent primary surgery. Our findings on the impact of extracapsular involvement in pN1 patients were confirmed on this large dataset and furthermore the results suggested that absence of extracapsular involvement in pN1 patients gave a 5-year survival comparable to stage IIB (i.e. pT3N0).These results are a plea to incorporate presence/absence of extracapsular lymph node involvement in the upcoming 8th edition of the UICC/AJJC TNM staging manual.In the current literature there is still no consensus on the definition of a microscopically incomplete resection (the so called R1 resection) as different definition are used and results from the literature are conflicting. Therefore in Chapter 5 (Submitted to Dis Esoph.) an analysis was performed on a homogeneous group of pT3 patients treated with primary surgery. Multivariate analysis showed that besides the number of involved lymph nodes, only a true R1-resection was statistically different from a complete (R0) resection.Chapter 6 (Ann Surg 2014;260: 1023-1029) explored the biological behavior and the prognosis of a specific subtype of esophageal adenocarcinoma: the Signet Ring Cell carcinoma (SRC). In the literature on stomach cancer, this subtype shows a worse prognosis but on the contrary, Literature data on esophageal SRC carcinoma are scarce. In this series on adenocarcinoma patients treated by primary surgery, SRC was shown to have a more aggressive behavior compared to classic adenocarcinoma with more involved lymph nodes, and hence a significant worse 5-year survival. However in lymph node positive patients, SRC <50% show a similar survival rate to ADC (both 30% 5-year survival) which is significantly better than the SCR >50% group (0% 5-year survival). The survival difference is mainly explained by the higher number of recurrences in the SRC >50% group. Our data also showed that it is impossible to discriminate between ADC and SCR >50% solely based on the preoperative biopsies.Quality of surgeryOverall and pulmonary complication rates after open esophagectomy (OO) have remained sufficiently high to encourage the search for alternative operative techniques. The main purposes of these techniques are to achieve similar cure rates with less morbidity/mortality, which may lead to a better postoperative quality of life whilst guaranteeing the same oncologic outcome. In chapter 7 (Eur J Cardiothorac Surg. 2011;40:1455-63), we have shown that minimally invasive esophagectomy compared to open transthoracic esophagectomy in early cancers of the esophagus and gastro-esophageal junction had decreased significantly pulmonary complications and subsequent admissions to ICU. Minimally invasive esophagectomy had improved the quality of life after 3 months but differences between both groups faded away at one year. From this experience we have been able to gradually expand the use of this technique in more advanced cancer without jeopardizing the oncologic aspects of the surgery.The Achilles heel of gastric pull up after any esophagectomy is anastomotic leak and the subsequent risk of stricture interfering with the patient’s ability to swallow. In Chapter 8 ( submitted to J Surg Oncol.) a promising new semi-mechanical anastomotic technique was compared to the classical surgical hand-sewn anastomosis. The need for dilatation and especially the need for repeated dilatations were significantly lower after semi-mechanical anastomosis with comparable anastomotic leakage rate. Furthermore an analysis of the QOL dysphagia (sub) scores showed a clinically relevant improved dysphagia score for semi-solids and saliva in the early postoperative phase in the SMA group. Our results confirmed that the semi-mechanical anastomosis can be used safely after gastric tubulation thus not compromising resection of the lesser curvature, an important oncologic principle for distal-half and gastro-esophageal tumors. This type of anastomosis has become our anastomosis of choice whenever possible.The main aims of neoadjuvant treatment are to enhance the number of R0-resections and thus lowering the number of recurrences in particular locoregional recurrence after surgery. From the literature it is well known that the best survival rates after neoadjuvant treatment followed by surgery are seen after pathological complete respons (pCR). However little is known about the recurrence pattern after neoadjuvant chemo-radiotherapy followed by surgery, especially in case of pathological complete response. This was examined in Chapter 8 (Br J Surg 2013;100:267-73). With a complete response achieved in one third of the patients, a statistically significant improved 3-year survival and decreased recurrence rate was shown for complete responders. Nevertheless, with distant metastasis in one third and loco-regional failure in one out of 7 patients, pathological complete response is not synonymous with ‘cure’ or perfect locoregional control. Even in case of pathological complete response, aggressive surgical approach is thus still warranted.Health related quality of lifeHealth-related quality of life has become increasingly important in treating cancer patients. This is especially true for esophageal cancer surgery which is known to have an important negative impact on patient’s HRQL. Several studies on this subject have already been published but due to small population samples, differences in surgical approaches and/or in the questionnaires used to evaluate HRQL, results have been inconsistent and difficult to analyse. Furthermore, little is known about the impact of preoperative HRQL on postoperative morbidity and likewise, the impact of postoperative complications on postoperative HRQL. Chapter 9 (Eur J Cardiothorac Surg ;44:525-33) is devoted to the relations between HRQOL and the postoperative course. In our study, independent prognosticators for a longer LOS (>10 days) were: medical and surgical complications, readmission to intensive care unit and poor physical functioning. Furthermore, our data suggested that early discharge correlates with improved postoperative HRQL outcomes.The different chapters/parts of this thesis project have highlighted the importance of the continuous quest of quality improvement as the key to improved results and survival in esophageal cancer treatment. So today cure is no longer an accident and surgery is now offering the patient a realistic perspective for a long-term survival combined with a good quality of life.

Academic collection --- Theses --- Neoplasms --- Surgical Procedures, Operative --- WI 250 Esophagus

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WI 250 Esophagus --- Academic Dissertations --- Gastroesophageal Reflux --- Duodenogastric Reflux --- Academic collection --- Theses

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Voor wie het begrip participatie vanuit verschillende wetenschappelijke invalshoeken wil bekijken, biedt deze uitgave een onmisbare eerste aanzet. Wat wordt precies bedoeld met het containerbegrip participatie? En wat niet? Wat moet die participatie precies opleveren: nieuwe inzichten en kennis voor beleid? Of meer sociaal kapitaal en vertrouwen? En is participatie middel of doel, vertrekpunt of aankomst? De verschillende academische brillen waarmee naar participatie gekeken wordt, maakt dit boek uniek. Een betere inzicht en begrip van elkaars brillen levert immers niet alleen vanuit academisch perspectief een meerwaarde op, maar is ook zinvol ten aanzien van de alledaagse interactie tussen burger en bestuur. Al te vaak blijkt dat de ene partij onvoldoende zicht heeft op het perspectief en de verwachtingen van de andere partij; met onbegrip en conflicten tot gevolg.Inhoudstafel1. Burgerparticipatie: een politicologisch perspectief 2. Juridische benadering van participatie 3. Participatie: een sociologische benadering 4. Participatie als concept binnen de revalidatiegeneeskunde 5. Het politiek-filosofische debat over participatie en representatie: van de historische bronnen naar het supranationale domein 6. Een beleidswetenschappelijk perspectief op maatschappelijke participatie 7. Een economische kijk op maatschappelijke participatie 8. Besluit - Een multidisciplinaire kijk op maatschappelijke participatie

participatie --- Community organization --- sociale participatie --- Policy --- Sociology --- Economics --- legislation and jurisprudence --- Consumer Participation --- JN 318 Political institutions and public administration (Europe) --- Academic collection --- #SBIB:35H501 --- #SBIB:324H50 --- #KVHB:Maatschappij --- Participatie --- Bestuur en samenleving: netwerken, inspraak, participatie, interactief beleid --- Politieke participatie en legitimiteit (referenda, directe democratie, publieke opinie...) --- Social participation --- Civil society --- Samenleving --- Beleid --- Participatiesamenleving --- Analyse --- Evaluatie --- Belgique

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Een goede inschatting van de kosteneffectiviteit van interventies in de welzijns- en de gezondheidszorg is zowel voor de praktijk als voor het beleid van belang. In de gezondheidszorg is onderzoek over de kosteneffectiviteit al enige tijd een vertrouwde invalshoek om preventie en behandelingen te beoordelen. Voor de welzijnssector is dit een relatief onontgonnen terrein. Dit boek is het resultaat van een onderzoek van het Steunpunt Welzijn Volksgezondheid en Gezin. Het biedt een status questionis van de methoden voor evaluatie van interventies en een toepassing van deze benadering in de bijzondere jeugdzorg. Het is geschreven voor al wie betrokken is bij of belangstelling heeft voor welzijnseconomische evaluatie. (Bron: covertekst)

Health Care --- Costs and Cost Analysis --- Mathematical models --- Economics --- Welfare economics --- W 74 Medical economics. Health care costs (General) --- Academic collection --- 660 Welzijn --- 670 Gezondheid --- gezondheidszorg --- welzijnszorg --- S20110039.jpg --- bijzondere jeugdbijstand --- evaluatie van de hulpverlening --- welzijnsplanning --- 362.74 --- 361.2 --- 361.01 --- projectmanagement --- Sociology of health --- kosten-baten analyse --- gezondheidseconomie --- Provincie West-Vlaanderen

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This Jubile Book is written by experienced clinicians and scientists in the field of sleep medicine in Belgium, and active members of the Belgian Association of Sleep Medicine and Sleep research (BASS). It provides an overview of the most pertinent activities and trends in sleep research and sleep medicine in Belgium in the past 25 years, since its founding. It focuses on the pioneers of sleep medicine in Belgium, the founders of the BASS, clinical and scientific activities, memorable meetings and activities, and finally the future of sleep medicine. The authors have tried to make a convenient whole, which reads easily and which contains anecdotes and inside information from the field. The book is written for those who are interested in sleep research and sleep medicine and for those who want to have some historical background in this field. In short, it is a must for each clinician and scientist involved in this area.

Neuropathology --- Pharmacology. Therapy --- Paediatrics --- WL 108 Physiology of sleep --- Sleep Disorders --- Sleep --- Belgium --- Academic collection --- Sleep. --- Sleep, Slow-Wave --- Sleep, Slow Wave --- Slow-Wave Sleep --- Belgium. --- Sleepiness --- Research --- Sleep Wake Disorders --- Sleep disorders --- Troubles du sommeil --- history --- History --- Histoire --- Belgian Association for the Study of Sleep --- Medical aspects --- Physiological aspects --- Belgian Association for Sleep Research and Sleep Medecine (Belgium) --- Festschriften --- Sleep Habits --- Sleeping Habit --- Sleeping Habits --- Habit, Sleep --- Habit, Sleeping --- Habits, Sleep --- Habits, Sleeping --- Sleep Habit --- Research - Belgium --- Sleep medicine specialty