Rudi Roumen

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Iancu Emil Plesea

UNIVERSITY OF MEDICINE AND PHARMACY CAROL DAVILA BUCHAREST

Raafat Hegazy

Zagazig University

Robert Platt

McGill University

Y. Coppieters

Université libre de Bruxelles

Xavier Ferrer-Francesch

University Autonoma of Barcelona

Dániel Bereczki

Semmelweis University

Masood Naseripour

Iran University of Medical Sciences

Mehdi Modarreszadeh

Iran University of Medical Sciences

Dragos Simandan

Brock University

Reda Eldemerdash

Mansoura University

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Papers by Rudi Roumen

Improving the Success Rate of Repeat Sentinel Node Biopsy in Recurrent Breast Cancer

Annals of Surgical Oncology, 2015

Repeat sentinel node biopsy (SNB) is an alternative to axillary lymph node dissection (ALND) for ... more Repeat sentinel node biopsy (SNB) is an alternative to axillary lymph node dissection (ALND) for axillary staging in recurrent breast cancer. This study was conducted to determine factors associated with technical success of repeat SNB. A total of 536 patients with locally recurrent nonmetastatic breast cancer underwent lymphatic mapping (LM) and repeat SNB in 29 Dutch hospitals. A total of 179 patients previously underwent breast-conserving surgery (BCS) with SNB, 262 patients BCS with ALND and 61 patients mastectomy, 35 with SNB and 26 with ALND. Another 34 patients underwent breast surgery without axillary interventions. A repeat sentinel node (SN) was identified in 333 patients (62.1 %) and was successfully removed in 235 (53.5 %). The overall repeat SN identification rate was 62.1 %, varying from 35 to 100 % in the participating hospitals. Previous radiotherapy of the breast [odds ratio (OR) 0.16; 95 % confidence interval (CI) 0.03-0.84], subareolar tracer injection (OR 0.34; 95 % CI 0.16-0.73), and a 2-day LM protocol (OR 0.57; 95 % CI 0.33-0.97) after previous BCS were independently associated with failure of SN identification. Injection of a larger amount of tracer (&gt;180 MBq) led to a higher identification rate (OR 4.40; 95 % CI 1.45-13.32). Repeat SNB is a technically feasible procedure for axillary staging in recurrent breast cancer patients. Previous radiotherapy appears to be associated with failure of SN identification. Injection with a larger amount of tracer (&gt;180 MBq) leads to a higher identification rate; subareolar injection and a 2-day LM protocol after previous BCS appear to be less adequate.

Inguinal vesical herniation: A case study

Nederlands Tijdschrift voor Urologie

ABSTRACT

Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair

by Rudi Roumen and Marc Scheltinga

World Journal of Surgery, 2015

Some patients develop chronic groin pain after a Lichtenstein hernia repair. Previous studies hav... more Some patients develop chronic groin pain after a Lichtenstein hernia repair. Previous studies have demonstrated beneficial effects of removal of entrapped inguinal nerves or a meshectomy in patients with chronic pain after open inguinal hernia mesh repair. Factors determining success following this remedial surgery are unknown. The aim of the study was to identify potential patient- or surgery-related factors predicting the surgical efficacy for inguinodynia following Lichtenstein repair. Consecutive adult patients with a history of persistent pain following Lichtenstein repair who underwent remedial surgery were analysed using univariate analysis. Significant confounders (p &lt; 0.05) were combined in a multivariate logistic regression model using a backward stepwise regression method. A total of 136 groin pain operations were available for analysis. Factors contributing to success were removal of a meshoma (OR 4.66) or a neuroma (OR 5.60) and the use of spinal anaesthesia (OR 4.38). In contrast, female gender (OR 0.30) and preoperative opioid use (OR 0.38) were significantly associated with a less favourable outcome. Using a multivariate analysis model, surgery under spinal anaesthesia (OR 4.04), preoperative use of opioids (OR 0.37), and meshoma removal (OR 5.31) greatly determined surgical outcome. Pain reduction after remedial surgery for chronic groin pain after Lichtenstein repair is more successful if surgery is performed under spinal anaesthesia compared to general anaesthesia. Removal of a meshoma must be considered as success rates are optimized following these measures. Patients using opioids preoperatively have less favourable outcomes.

[Diagnostic image (411) A man with chronic pain after surgery for inguinal hernia]

Nederlands tijdschrift voor geneeskunde

Differences in Response and Surgical Management with Neoadjuvant Chemotherapy in Invasive Lobular Versus Ductal Breast Cancer

Annals of Surgical Oncology, 2015

This study was conducted to determine the impact of neoadjuvant chemotherapy (NAC) on the likelih... more This study was conducted to determine the impact of neoadjuvant chemotherapy (NAC) on the likelihood of breast-conserving surgery (BCS) performed for patients with invasive lobular breast carcinoma (ILC) and invasive ductal carcinoma (IDC). Female patients with a diagnosis of ILC or IDC in The Netherlands between July 2008 and December 2012 were identified through the population-based Netherlands Cancer Registry. A total of 466 ILC patients received NAC compared with 3622 IDC patients. Downstaging by NAC was seen in 49.7 % of the patients with ILC and in 69.6 % of the patients with IDC, and a pathologic complete response (pCR) was observed in 4.9 and 20.2 % of these patients, respectively (P &lt; 0.0001). Breast-conserving surgery was performed for 24.4 % of the patients with ILC receiving NAC versus 39.4 % of the patients with IDC. In the ILC group, 8.2 % of the patients needed surgical reinterventions after BCS due to tumor-positive resection margins compared with 3.4 % of the patients with IDC (P &lt; 0.0001). Lobular histology was independently associated with a higher mastectomy rate (odds ratio 1.91; 95 % confidence interval 1.49-2.44). Among the patients with clinical T2 and T3 disease, BCS was achieved more often when NAC was administered in ILC as well as IDC. The patients with ILC receiving NAC were less likely to experience a pCR and less likely to undergo BCS than the patients with IDC. With regard to BCS, the impact of NAC for ILC patients was lower than for patients receiving surgery without NAC. However, despite the high number to treating in order to achieve BCS, a small subset of ILC patients, especially cT2 and cT3 patients, still may benefit from NAC.

Management of diverticulitis: results of a survey among gastroenterologists and surgeons

Colorectal Disease

The study aimed to investigate current management strategies for left-sided diverticulitis and co... more The study aimed to investigate current management strategies for left-sided diverticulitis and compare them with current international guidelines. Differences between surgeons and gastroenterologists and between gastrointestinal and nongastrointestinal surgeons were assessed. A web-based survey of treatment options for uncomplicated and complicated diverticulitis was carried out among surgeons and gastroenterologists in the Netherlands. Only surgeons were asked about surgical strategy. A total of 292 surgeons and 87 gastroenterologists responded, representing 92% of all surgical and 46% of all gastroenterology departments. Ninety per cent of respondents treated mild diverticulitis without antibiotics. About one-fifth (18% gastroenterologists; 19% surgeons) regarded a CT scan as mandatory in the initial assessment. Most surgeons and gastroenterologists used some form of bowel rest, would consider outpatient treatment and would perform a colonoscopy on follow up. For Hinchey Stage 3, ...

Chronic sequelae of common elective groin hernia repair

Hernia : the journal of hernias and abdominal wall surgery, 2007

The aim of this study was to assess long-term chronic pain, numbness and functional impairment af... more The aim of this study was to assess long-term chronic pain, numbness and functional impairment after open and laparoscopic groin hernia repair in a teaching hospital. We performed a cross-sectional study in which all adult patients with a groin hernia repair between January 2000 and August 2005 received a questionnaire by post. It contained questions concerning frequency and intensity of pain, presence of bulge, numbness, and functional impairment. One thousand seven hundred and sixty-six questionnaires were returned (81.6%) and after a median follow-up period of nearly 3 years 40.2% of patients reported some degree of pain. Thirty-three patients (1.9%) experienced severe pain. Almost one-fourth reported numbness which correlated significantly with pain (P < 0.001). Other variables, identified as risk factors for the development of pain were age (P < 0.001) and recurrent hernia repair (P = 0.003). One-fifth of the patients felt functionally impaired in their work or leisure ac...

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