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Background Pectus carinatum is a thoracic deformity of the sternum that can be treated in a non-invasive manner by compressive bracing. The treatment duration, which typically consists of three different phases, is extensive. As a consequence, therapeutic compliance can be a challenge, especially in adolescents for whom the bracing treatment can cause social discomfort and psychological distress. At the department of thoracic surgery at UZ Leuven, pectus carinatum patients are treated with a Wilmington brace. Methods All patients who started bracing therapy between 2019/01/01 and 2021/12/31 at the UZ Leuven Hospital, and who subsequently received follow-up by the same physician, were admitted. Data collection was twofold. Firstly, we retrospectively collected data from clinic reports. And secondly, we used the validated PCEQ (Pectus Carinatum Evaluation Questionnaire) and PeCBI-QOL (Pectus Carinatum Body Image-Quality of Life) questionnaires to investigate treatment compliance, complications, physical limitations and social and psychological well-being during and after brace use. Results 79 patients were included, with a median age at the start of treatment of 14 years old. 16 patients finished treatment and 52 patients are still under treatment. 14% (N=11) were lost to follow-up. Of the patients who finished treatment, 75% (N=12) finished treatment successfully and 25% (N=4) experienced treatment failure. Mean treatment duration for the group who successfully completed treatment was 16 months. In addition, successfully treated patients had a significantly higher number of follow-up clinics than other outcome groups (p< 0.001). Skin problems occurred in 11% (N=9) of patients. Pain during bracing treatment was present in 11% (N=9) of patients and was mainly manifested by chest pain (N=3) and back pain (N=4). Brace damage occurred in 7.6% (N=6) of patients. As asked in the PCEQ, patients responded to have been compliant ‘many times’ regarding the prescribed number of days per week and number of hours per day. The degree of chest pain, back pain, dyspnoea and limitation in activities during brace wearing was reported as low. Conclusions In this study, the Wilmington brace seems to be an effective and safe non-invasive treatment for pectus carinatum. Already 56 patients achieved a complete correction after a mean treatment duration of 7 months. As expected, regular follow-up consultations were associated with a greater treatment success. Complications were minor and included skin problems, pain during bracing treatment and minor brace damage. Since most patients are still under bracing treatment, we will have to repeat this study in a few years time, when more patients have ended the treatment.

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Introduction Esophagectomy is an important part of the treatment of esophageal cancer. This type of surgery is associated with a significant reduced quality of life and symptoms due to malnutrition. One way to improve the postoperative management is nutritional support (NS) in addition to a normal diet. The aim of this systematic review was to give a qualitative synthesis of the different post-operative nutritional support methods in this patient group, described in clinical trials over the past 20 years. Methods We searched systematically in three different databases: MEDLINE, Embase and CENTRAL. The screening and selection was done independently by two reviewers, data collection and risk of bias assessment by the first reviewer. Results We identified 516 records, finally we included 49 studies for qualitative synthesis. The described NS interventions could be divided into five different domains: (1) Enteral NS vs. parenteral NS (2) the optimal timing and route of enteral NS (3) Immunonutrition (4) Home enteral nutrition (HEN) and (5) Early oral feeding. We analysed the evidence and influence of these interventions on nutritional, prognosis and complication outcomes. Discussion The last 20 years, there was a noticeable evolution in the postoperative nutritional support (NS) after esophagectomy from parenteral to enteral NS to early oral feeding. It’s important that there is still attention to the important contribution of NS to reach the daily caloric intake. Especially long-term clinical trials to the impact of NS on QOL and functional recovery are needed in further research.

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Doelstellingen: Met deze studie willen we de institutionele ervaring met de Abramson procedure binnen het UZ Leuven nagaan. We onderzoeken welke complicaties er worden gezien na deze operatie. Alsook wat de levenskwaliteit van de patiënten is die deze procedure ondergingen en of deze verschilt van de levenskwaliteit van de algemene Belgische bevolking. Naderhand wordt de correlatie tussen beide onderzoeksvragen geanalyseerd en trachten we na te gaan of de patiënten met ernstige complicaties na de Abramson procedure een minder gunstig resultaat bekomen dan patiënten zonder of met milde complicaties. Patiënten en methoden: Voor het eerste onderdeel van deze studie werden de patiëntendossiers van alle 59 patiënten bij wie de Abramson procedure in UZ Leuven werd uitgevoerd van 2013 t.e.m. 2021 retrospectief onderzocht voor detectie van complicaties. Het tweede deel bestond uit een prospectief onderzoek waarbij er 3 vragenlijsten (EQ-5D-5L, SF-36v2, SSQ) die naar de levenskwaliteit van deze patiënten en de tevredenheid over het resultaat van de operatie peilen opgestuurd werden. 32 patiënten zijn op deze bevraging ingegaan. Resultaten: Er werden 216 complicaties geregistreerd bij de 59 patiënten, 84,72%hiervan kon geclassificeerd worden als een Clavien-Dindo graad I, 7,41% als een graad II en 7,87% als een graad IIIb. Er werd geen significant verschil geobserveerd in levenskwaliteit tussen de behandelde patiënten en een Belgische referentiepopulatie aan de hand van de EQ-5D-5L. Er werd eveneens geen significant verschil geobserveerd in levenskwaliteit en resultaat van de operatie tussen patiënten met geen of milde complicaties en deze met ernstige complicaties aan de hand van de SSQ. Conclusie: Patiënten dienen een doordachte afweging te maken tussen de complicaties die kunnen optreden en de winst in levenskwaliteit en zelfzekerheid door deze operatie. Deze beslissing is persoonsgebonden en kan verschillen naargelang de mate waarin de patiënt zich aan deze aangeboren afwijking stoort. Er dient opgemerkt te worden dat de studiepopulatie uit een klein aantal deelnemers bestaat en dat er verder onderzoek dient te gebeuren met grotere studiepopulaties om significante verschillen te kunnen opmerken.

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ABSTRACT Objectives The Abramson procedure is a relative new minimally invasive procedure for Pectus Carinatum (PC) repair. Half 2013 the Abramson procedure was introduced in our centre as alternative treatment for PC. The objective of this study was to evaluate the initial experience obtained three years after the implementation of the Abramson procedure in our institution and to assess postoperative quality of life (QoL). Methods In this single centre retrospective study we analysed the complications after the Abramson procedure, graded according to the Clavien-Dindo classification. Patients were enrolled in the time period between August 2013 and December 2015. In the prospective part of this study health questionnaires (EQ-5D- 5L, SF-36 and Single Step Questionnaire) were sent to the patients after consent of our local ethical committee. Results 20 patients, all male, were included in the study. Median age at time of surgery was 14.92 years. In all of the patients low self-esteem was an indication for surgery. All patients received a patient-controlled epidural analgesia for 5 days. Median length of stay was 7 days. In 12/20 patients the bar is already removed after a median treatment duration of 1.95 years. There were 23 complications early postoperatively, mostly pneumothorax (n=17). One patient needed revisional surgery for bar dislocation. During the two-year treatment 9 patients had an uncomplicated treatment pathway. 10 patients had grade I complications (breakage of cable). Two patients had neuropathy treated with medication. Mean EQ- 5D-5L-VAS-score in our population was 87.31 compared to 82.8 in the Flemish control group (p=0.017). SF-36 revealed that the mean value for each domain was above the norm. Conclusions Our initial experience with the Abramson procedure shows a good complication profile for this minimal invasive technique. Results of the three health questionnaires (EQ-5D-5L, SF-36 and Single Step Questionnaire) demonstrate a good influence of this new surgical technique on the postoperative quality of life. Postoperative quality of life is at least at the same level of the control group.

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Background The optimal perioperative fluid management during esophagectomy is still not clear. Liberal regimens have been associated with higher morbidity and respiratory complications. Restrictive regimens might raise concerns for kidney function and increase the need to associate vasopressors. Recently, perioperative care is changing towards goal-directed fluid regimens as part of early recovery programs. The aim of this study was to investigate retrospectively the perioperative fluid administration during esophagectomy and to correlate this with postoperative respiratory outcome. Methods All patients who underwent esophagectomy between January-December 2016 were retrospectively analyzed. Patient characteristics, type of surgery and postoperative course were reviewed. Fluid administration and vasopressor use were calculated intra-operatively and during the postoperative stay at the recovery room. Fluid overload was defined as a positive fluid balance of more than 125 ml/m2/h during the first 24 hours. Patients were divided in 3 groups: GRP0 (no fluid overload/no vasopressors); GRP1 (need for vasopressors); GRP2 (fluid overload with/without vasopressors). Postoperative complications were prospectively recorded according to Esophagectomy Complications Consensus Group criteria. Multivariable analysis (binary logistic regression) for "any respiratory complication" was performed. Results 103 patients were analyzed: 35 (34%) GRP0, 50 (49%) GRP1 and 18 (17%) GRP2. No significant differences were found for age, treatment (neoadjuvant vs. primary), type of surgery (Open / MIE), histology nor comorbidities. There were significant (p≤0.001) differences in fluid balance/m²/h (75±21 ml; 86±22 ml and 144±20 ml) across GRP0, GRP1 and GRP2 respectively. We found differences in respiratory complications (GRP0 (20%) versus GRP1 (42%;p=0.034) and GRP0 (20%) versus GRP2 (61%;p=0.002)) and ‘Comprehensive Complications Index’ (GRP0 (20.5) versus GRP1 (34.6;p=0.015) and GRP0 (20.5) versus GRP2 (35.1;p=0.009)). Next, we performed a logistic regression analysis for the overall respiratory outcome. Patients who received fluid overload (GRP2) had a 10.24 times higher risk to develop postoperative respiratory complications. Also, when patients received vasopressors alone (GRP1), the chances of developing these complications were 3.57 times higher compared to GRP0. Conclusion Among patients undergoing esophagectomy, there is a wide variety in the administration of fluid during the first 24 hours. There was a higher incidence of respiratory complications if patients received higher amounts of fluid or if vasopressors were used. Type of surgery (open versus MIE) did not impact respiratory outcome. We believe that a personalized and protocolized fluid administration algorithm should be implemented and that individual risk factors for patients at risk should be identified.