Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
09 11 2023
09 11 2023
Historique:
received:
17
07
2023
revised:
01
09
2023
accepted:
09
09
2023
medline:
13
11
2023
pubmed:
11
10
2023
entrez:
11
10
2023
Statut:
ppublish
Résumé
The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1). Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
Sections du résumé
BACKGROUND
The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.
METHODS
Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).
RESULTS
Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).
CONCLUSION
Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
Identifiants
pubmed: 37819790
pii: 7306886
doi: 10.1093/bjs/znad311
pmc: PMC10638542
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1863-1876Subventions
Organisme : Medtronic External Research Program
Investigateurs
Andreas J A Bremers
(AJA)
Floris T Ferenschild
(FT)
Stefanie de Vriendt
(S)
André D'Hoore
(A)
Gabriele Bislenghi
(G)
Jordi Farguell
(J)
Antonio M Lacy
(AM)
Paula González Atienza
(PG)
Charlotte S van Kessel
(CS)
Yann Parc
(Y)
Thibault Voron
(T)
Maxime K Collard
(MK)
Jorge Sancho Muriel
(JS)
Hannia Cholewa
(H)
Laura A Mattioni
(LA)
Alice Frontali
(A)
Sebastiaan W Polle
(SW)
Fatih Polat
(F)
Ndidi J Obihara
(NJ)
Bruna B Vailati
(BB)
Miranda Kusters
(M)
Jurriaan B Tuynmann
(JB)
Sanne J A Hazen
(SJA)
Alexander A J Grüter
(AAJ)
Takahiro Amano
(T)
Hajime Fujiwara
(H)
Mario Salomon
(M)
Hernán Ruiz
(H)
Ricardo Gonzalez
(R)
Diego Estefanía
(D)
Nicolas Avellaneda
(N)
Augusto Carrie
(A)
Mateo Santillan
(M)
Diana A Pantoja Pachajoa
(DAP)
Matias Parodi
(M)
Manuel Gielis
(M)
Alf-Dorian Binder
(AD)
Thomas Gürtler
(T)
Peter Riedl
(P)
Sarit Badiani
(S)
Christophe Berney
(C)
Matthew Morgan
(M)
Paul Hollington
(P)
Nigel da Silva
(N)
Gavin Nair
(G)
Yiu M Ho
(YM)
Michael Lamparelli
(M)
Raj Kapadia
(R)
Hidde M Kroon
(HM)
Nagendra N Dudi-Venkata
(NN)
Jianliang Liu
(J)
Tarik Sammour
(T)
Nicolas Flamey
(N)
Paul Pattyn
(P)
Ahmed Chaoui
(A)
Louis Vansteenbrugge
(L)
Nathalie E J van den Broek
(NEJ)
Patrick Vanclooster
(P)
Charles de Gheldere
(C)
Pieter Pletinckx
(P)
Barbara Defoort
(B)
Maxime Dewulf
(M)
Mihail Slavchev
(M)
Nikolay Belev
(N)
Boyko Atanasov
(B)
Panche Krastev
(P)
Manol Sokolov
(M)
Svilen Maslyankov
(S)
Petar Gribnev
(P)
Vasil Pavlov
(V)
Tsvetomir Ivanov
(T)
Martin Karamanliev
(M)
Emil Filipov
(E)
Pencho Tonchev
(P)
Felix Aigner
(F)
Martin Mitteregger
(M)
Caterina Allmer
(C)
Gerald Seitinger
(G)
Nicola Colucci
(N)
Nicolas Buchs
(N)
Frédéric Ris
(F)
Christian Toso
(C)
Eleftherios Gialamas
(E)
Aurélie Vuagniaux
(A)
Roland Chautems
(R)
Marc-Olivier Sauvain
(MO)
Silvio Daester
(S)
Markus von Flüe
(M)
Marc-Olivier Guenin
(MO)
Stephanie Taha-Mehlitz
(S)
Gabriel F Hess
(GF)
Lubomír Martínek
(L)
Matej Skrovina
(M)
Maria Machackova
(M)
Vladimir Benčurik
(V)
Deniz Uluk
(D)
Johann Pratschke
(J)
Luca S Dittrich
(LS)
Safak Guel-Klein
(S)
Daniel Perez
(D)
Julia-Kristin Grass
(JK)
Nathaniel Melling
(N)
Simone Mueller
(S)
Lene H Iversen
(LH)
Jacob D Eriksen
(JD)
Gunnar Baatrup
(G)
Issam Al-Najami
(I)
Thomas Bjørsum-Meyer
(T)
Jüri Teras
(J)
Roland M Teras
(RM)
Fatma A Monib
(FA)
Nagm Eldin Abu Elnga Ahmed
(NEAE)
Eithar Alkady
(E)
Ahmed K Ali
(AK)
Gehan Abd Elatti Khedr
(GAE)
Ahmed Samir Abdelaal
(AS)
Fouad M Bassyouni Ashoush
(FMB)
Moataz Ewedah
(M)
Eslam M Elshennawy
(EM)
Mohamed Hussein
(M)
Daniel Fernández-Martínez
(D)
Luis J García-Flórez
(LJ)
María Fernández-Hevia
(M)
Aida Suárez-Sánchez
(A)
Izaskun Del Hoyo Aretxabala
(I)
Iria Losada Docampo
(IL)
Jesús Gómez Zabala
(JG)
Patricia Tejedor
(P)
Javier T Morales Bernaldo de Quirós
(JTMB)
Ignacio Bodega Quiroga
(IB)
Antonio Navarro-Sánchez
(A)
Iván Soto Darias
(IS)
Cristina López Fernández
(CL)
Cristina de La Cruz Cuadrado
(C)
Luis Sánchez-Guillén
(L)
Francisco López-Rodríguez-Arias
(F)
Álvaro Soler-Silva
(Á)
Antonio Arroyo
(A)
Juan C Bernal-Sprekelsen
(JC)
Segundo Á Gómez-Abril
(SÁ)
Paula Gonzálvez
(P)
María T Torres
(MT)
Teresa Rubio Sánchez
(TR)
Francisco Blanco Antona
(FB)
Juan E Sánchez Lara
(JES)
José A Alcázar Montero
(JAA)
Fernando Mendoza-Moreno
(F)
Manuel Díez-Alonso
(M)
Belén Matías-García
(B)
Ana Quiroga-Valcárcel
(A)
Enrique Colás-Ruiz
(E)
Marta M Tasende-Presedo
(MM)
Ignacio Fernández-Hurtado
(I)
José A Cifuentes-Ródenas
(JA)
Marta Castro Suárez
(MC)
Manuel Losada
(M)
Miguel Hernández
(M)
Alfredo Alonso
(A)
Beatriz Diéguez
(B)
Daniel Serralta
(D)
Rita E Medina Quintana
(REM)
Jose M Gil Lopez
(JMG)
Francisca Lima Pinto
(FL)
Elena Nieto-Moreno
(E)
Alba Correa Bonito
(AC)
Carlos Cerdán Santacruz
(CC)
Elena Bermejo Marcos
(EB)
Javier García Septiem
(JG)
Aránzazu Calero-Lillo
(A)
Javier Alanez-Saavedra
(J)
Salvador Muñoz-Collado
(S)
Manuel López-Lara
(M)
María Labalde Martínez
(ML)
Eduardo Ferrero Herrero
(EF)
Francisco Javier García Borda
(FJG)
Óscar García Villar
(ÓG)
Jorge Escartín
(J)
Juan L Blas
(JL)
Rocío Ferrer
(R)
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(JG)
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(A)
Germán Mínguez-Ruiz
(G)
Guillermo Carreño-Villarreal
(G)
Gerardo Pire-Abaitua
(G)
Jana Dziakova
(J)
Carlos Sáez-Cazallas Rodríguez
(CS)
María J Pizarro Aranda
(MJP)
José M Muguerza Huguet
(JMM)
Nerea Borda-Arrizabalaga
(N)
José M Enriquez-Navascués
(JM)
Garazi Elorza Echaniz
(GE)
Yolanda Saralegui Ansorena
(YS)
Mercedes Estaire-Gómez
(M)
Carlos Martínez-Pinedo
(C)
Alejandro Barbero-Valenzuela
(A)
Pablo Ruíz-García
(P)
Miquel Kraft
(M)
María J Gómez-Jurado
(MJ)
Gianluca Pellino
(G)
Eloy Espín-Basany
(E)
Eddy Cotte
(E)
Nathalie Panel
(N)
Claire-Angéline Goutard
(CA)
Nicola deÁngelis
(N)
Lelde Lauka
(L)
Shafaque Shaikh
(S)
Laura Osborne
(L)
George Ramsay
(G)
Vladimir-Ion Nichita
(VI)
Santosh Bhandari
(S)
Panchali Sarmah
(P)
Rob M Bethune
(RM)
Heather C M Pringle
(HCM)
Lisa Massey
(L)
George E Fowler
(GE)
Hytham K S Hamid
(HKS)
Belinda D de Simone
(BD)
James Kynaston
(J)
Nicholas Bradley
(N)
Roxane M Stienstra
(RM)
Shashank Gurjar
(S)
Tanmoy Mukherjee
(T)
Ashfaq Chandio
(A)
Safia Ahmed
(S)
Baljit Singh
(B)
Francois Runau
(F)
Sanjay Chaudhri
(S)
Oliver Siaw
(O)
Janahan Sarveswaran
(J)
Victor Miu
(V)
Daniel Ashmore
(D)
Haitham Darwich
(H)
Deepak Singh-Ranger
(D)
Nirbhaibir Singh
(N)
Mohamed Shaban
(M)
Fahed Gareb
(F)
Thalia Petropolou
(T)
Adreas Polydorou
(A)
Mit Dattani
(M)
Asma Afzal
(A)
Akshay Bavikatte
(A)
Boby Sebastian
(B)
Nicholas Ward
(N)
Amitabh Mishra
(A)
Dimitrios Manatakis
(D)
Christos Agalianos Nikolaos Tasis
(CAN)
Maria-Ioanna Antonopoulou
(MI)
Ioannis Karavokyros
(I)
Alexandros Charalabopoulos
(A)
Dimitrios Schizas
(D)
Efstratia Baili
(E)
Athanasios Syllaios
(A)
Lysandros Karydakis
(L)
Michail Vailas
(M)
Dimitrios Balalis
(D)
Dimitrios Korkolis
(D)
Aris Plastiras
(A)
Aliki Rompou
(A)
Sofia Xenaki
(S)
Evangelos Xynos
(E)
Emmanuel Chrysos
(E)
Maria Venianaki
(M)
Grigorios Christodoulidis
(G)
Konstantinos Perivoliotis
(K)
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(G)
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(I)
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(MF)
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(SS)
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(TW)
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(K)
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(G)
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(D)
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(J)
Goran Zukanović
(G)
Michael E Kelly
(ME)
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(JO)
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(PH)
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(BJ)
Tara M Connelly
(TM)
Peter Neary
(P)
Jessica Ryan
(J)
Peter McCullough
(P)
Maytham A Al-Juaifari
(MA)
Hayder Hammoodi
(H)
Ali Hashim Abbood
(AH)
Marcello Calabrò
(M)
Andrea Muratore
(A)
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(A)
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(F)
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(CV)
Nicolò Fabbri
(N)
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(A)
Marta Fazzin
(M)
Francesco Roscio
(F)
Federico Clerici
(F)
Andrea Lucchi
(A)
Laura Vittori
(L)
Laura Agostinelli
(L)
Maria Cristina Ripoli
(MC)
Daniele Sambucci
(D)
Andrea Porta
(A)
Giovanni Sinibaldi
(G)
Giacomo Crescentini
(G)
Antonella Larcinese
(A)
Emanuele Picone
(E)
Roberto Persiani
(R)
Alberto Biondi
(A)
Roberto Pezzuto
(R)
Laura Lorenzon
(L)
Gianluca Rizzo
(G)
Claudio Coco
(C)
Luca D'Agostino
(L)
Antonino Spinelli
(A)
Matteo M Sacchi
(MM)
Michele Carvello
(M)
Caterina Foppa
(C)
Antonino Spinelli
(A)
Matteo M Sacchi
(MM)
Michele Carvello
(M)
Caterina Foppa
(C)
Annalisa Maroli
(A)
Gian M Palini
(GM)
Gianluca Garulli
(G)
Nicola Zanini
(N)
Paolo Delrio
(P)
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(D)
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(F)
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(G)
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(A)
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(L)
Chiara Vignotto
(C)
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(C)
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(G)
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(I)
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(F)
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(M)
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(P)
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(FT)
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(M)
Omar Ghazouani
(O)
Raffaele Galleano
(R)
Nicolò Tamini
(N)
Massimo Oldani
(M)
Luca Nespoli
(L)
Arcangelo Picciariello
(A)
Donato F Altomare
(DF)
Giovanni Tomasicchio
(G)
Giuliano Lantone
(G)
Fausto Catena
(F)
Mario Giuffrida
(M)
Alfredo Annicchiarico
(A)
Gennaro Perrone
(G)
Ugo Grossi
(U)
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(GA)
Giacomo Zanus Alessandro Iacomino
(GZA)
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(S)
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(N)
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(M)
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(L)
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(M)
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Gaetano Gallo
(G)
Giuseppe Sammarco
(G)
Gilda de Paola
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Salvatore Pucciarelli
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Gianluca Buzzi
(G)
Salomone Di Saverio
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Paola Meroni
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Cristiano Parise
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Pierfrancesco Lapolla
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Gioia Brachini
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Bruno Cirillo
(B)
Andrea Mingoli
(A)
Giuseppe Sica
(G)
Leandro Siragusa
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Giovanni de Manzoni
(G)
Maria A di Cosmo
(MA)
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(BMH)
Mahmoud W M Qandeel
(MWM)
Mohammad Bani Hani
(MB)
Alexander Rabadi
(A)
Mohammad S El Muhtaseb
(MS)
Basel Abdeen
(B)
Fahed Karmi
(F)
Justas Žilinskas
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Algimantas Tamelis
(A)
Ingrida Pikūnienė
(I)
Vygintas Šlenfuktas
(V)
Tomas Poskus
(T)
Marius Kryzauskas
(M)
Matas Jakubauskas
(M)
Saulius Mikalauskas
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Lina Jakubauskiene
(L)
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(SY)
Amani Altrabulsi
(A)
Eman Abdulwahed
(E)
Reem Ghmagh
(R)
Abdulqudus Deeknah
(A)
Entisar Alshareea
(E)
Muhammed Elhadi
(M)
Saleh Abujamra
(S)
Ahmed A Msherghi
(AA)
Osama W E Tababa
(OWE)
Mohammed A Majbar
(MA)
Amine Souadka
(A)
Amine Benkabbou
(A)
Raouf Mohsine
(R)
Sabrillah Echiguer
(S)
Paulina Moctezuma-Velázquez
(P)
Noel Salgado-Nesme
(N)
Omar Vergara-Fernández
(O)
Juan C Sainz-Hernández
(JC)
Francisco E Alvarez-Bautista
(FE)
Andee D Zakaria
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Zaidi Zakaria
(Z)
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(MPK)
Razif Ismail
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Aini F Ibrahim
(AF)
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(NAN)
Rokayah Julaihi
(R)
Sameer Bhat
(S)
Greg O'Grady
(G)
Ian Bissett
(I)
Bas Lamme
(B)
Gijsbert D Musters
(GD)
Anne M Dinaux
(AM)
Brechtje A Grotenhuis
(BA)
Ernst J Steller Arend G J Aalbers
(EJSAGJ)
Marjolein M Leeuwenburgh
(MM)
Harm J T Rutten
(HJT)
Jacobus W A Burger
(JWA)
Johanne G Bloemen
(JG)
Stijn H J Ketelaers
(SHJ)
Usama Waqar
(U)
Tabish Chawla
(T)
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(H)
Pallavi Rani
(P)
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(AK)
Lieke Scheurink
(L)
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(J)
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(K)
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(M)
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(B)
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(A)
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(T)
Parisa Golshani
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(R)
Abudi Mohamed
(A)
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(M)
Andreas Marinelli
(A)
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(HL)
Marije Zwakman
(M)
Annette D van Dalsen
(AD)
Wouter J Vles
(WJ)
Joost Nonner
(J)
Boudewijn R Toorenvliet
(BR)
Paul T J Janssen
(PTJ)
Emiel G G Verdaasdonk
(EGG)
Femke J Amelung
(FJ)
Koen C M J Peeters Renu R Bahadoer
(KCMJPRR)
Fabian A Holman
(FA)
Jeroen Heemskerk
(J)
Noortje Vosbeek
(N)
Jeroen W A Leijtens
(JWA)
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(SBM)
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(BHM)
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(Y)
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(I)
Christiaan Hoff
(C)
Daniela Jou-Valencia
(D)
Esther C J Consten Thijs A Burghgraef
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Nicole D Bouvy
(ND)
Aurelia C L Wildeboer
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Sonja Verstappen
(S)
Alexander J Pennings
(AJ)
Berber van den Hengel
(B)
Allard G Wijma
(AG)
Jael de Haan
(J)
Lindsey C F de Nes
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Vera Heesink
(V)
Tom Karsten
(T)
Charlotte M Heidsma
(CM)
Willem J Koemans
(WJ)
Jan-Willem T Dekker
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Charlène J van der Zijden
(CJ)
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(D)
Ahmet Demirkiran
(A)
Sjirk van der Burg
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Steven J Oosterling
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Imraan Mia
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Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
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