Objective: To describe outcome after pancreatic surgery in the first 6 years of a mandatory nationwide audit. Background: Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described. Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014–December 2019). Patient, tumor, and treatment characteristics were compared between 3 time periods (2014–2015, 2016–2017, and 2018–2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue (FTR) and in-hospital mortality. Results: Overall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.50–0.80, P<0.001] and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95% CI 0.54–0.86, P=0.001), despite operating on more patients with age >75 years (18%–22%, P=0.006), American Society of Anesthesiologists score ≥3 (19%–31%, P<0.001) and Charlson comorbidity score ≥2 (24%–34%, P<0.001). The rates of textbook outcome (57%–55%, P=0.283) and major complications remained stable (31%–33%, P=0.207), whereas complication-related intensive care admission decreased (13%–9%, P=0.002). After distal pancreatectomy, improvements in FTR from 8.8% to 5.9% (OR 0.65, 95% CI 0.30–1.37, P=0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95% CI 0.45–1.72, P=0.711) were not statistically significant. Conclusions: During the first 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.

Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

The Rite of Spring Briefly Revisited: Thoughts on Stravinsky’s Stratifications, the Psychology of Meter, and African Polyrhythm

http://www.thelancet.com/article/S0140673622018967/pdf

Reconsidering the COVID-19 vaccine strategy in West and Central Africa

The need for a common education and training track in surgical oncology across Europe has been emphasized. ESSO provides several hands-on courses for skills training and face-to-face discussions. The core curriculum provides a framework for the overall theoretical requirements in surgical oncology. The UEMS/EBSQ fellowship exam is designed to test core competencies in the candidate's core knowledge in their prespecified area of expertise. A core set of points for each cancer type is lacking. Hence, a condensed outline of themed expected to be covered in the curriculum and relevant to an optimal practice in surgical oncology is provided. This article outlines pancreatic cancer. 

Pancreatic cancer.

Rescue pancreatectomy for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is associated with high mortality. However, in-depth literature is scarce and hard to interpret. This study aimed to evaluate the indications, timing and perioperative outcomes of rescue pancreatectomy for severe POPF after PD.Retrospective single-centre study from all consecutive patients (2008-2020) with POPF-C after PD (ISGPS 2016 definition). Major morbidity and mortality during hospitalization or within 90 days after index surgery were evaluated. Time from index surgery to rescue pancreatectomy was dichotomized in early and late (≤ 11 versus > 11 days).From 1076 PDs performed, POPF-B/C occurred in 190 patients (17.7%) of whom 53 patients (4.9%) with POPF-C were included. Mortality after early rescue pancreatectomy did not differ significantly compared to late rescue pancreatectomy (13.6% versus 35.3%; p = 0.142). Timing of a rescue pancreatectomy did not change significantly during the study period: 11 (IQR, 8-14) (2008-2012) versus 14 (IQR, 7-33) (2013-2016) versus 8 days (IQR, 6-11) (2017-2020) (p = 0.140). Over time, the mortality in patients with POPF grade C decreased from 43.5% in 2008-2012 to 31.6% in 2013-2016 up to 0% in 2017-2020 (p = 0.014). However, mortality rates after rescue pancreatectomy did not differ significantly: 31.3% (2008-2012) versus 28.6% (2013-2016) versus 0% (2017-2020) (p = 0.104).Rescue pancreatectomy for severe POPF is associated with high mortality, but an earlier timing might favourably influence the mortality. Hypothetically, this could be of value for pre-existent vulnerable patients. These findings must be carefully interpreted considering the sample sizes and differences among subgroups by patient selection. 

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Surgical management of severe pancreatic fistula after pancreatoduodenectomy: a comparison of early versus late rescue pancreatectomy

Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: an open-label, nationwide, stepped-wedge cluster-randomised trial

The Rite of Spring at 100

Abstract:This analytical essay focuses on Burleigh's creation of an atmosphere of restlessness in his arrangement of the spiritual "Sometimes I Feel like a Motherless Child," giving attention to aspects of texture, chromaticism, and ambiguity. Further, it argues that certain chromatic processes operate at levels below the musical surface and invite appreciation from a structural perspective.

Harry T. Burleigh's Art-Song Spiritual "Sometimes I Feel like a Motherless Child"

This article focuses on a pa ern of harmony and voice leading that appears, elaborated, in several fugue expositions (and generically related passages) by J. S. Bach. I contextualize this pa ern in examples of “schematic” Baroque fugal writing and suggest that for Bach it functions as a sort of “proto-theme,” with respect to which certain expositions stand as “variations.” These expositions eschew normative I–V–I progressions of Stufen and thus offer a challenge to William Renwick’s exhaustive methodology for fugue analysis. Bach’s variations may respond motivically and energetically to a sense of retrogression implicit the proto-theme, as I demonstrate with an analysis of the Fugue in A minor from Book II of The Well-Tempered Clavier, BWV 889. DOI: 10.30535/mto.26.4.7 Volume 26, Number 4, December 2020 Copyright © 2020 Society for Music Theory

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John Reef

Papers

Algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection in the Netherlands: an open-label, nationwide, stepped-wedge cluster-randomised trial

The Rite of Spring at 100

Harry T. Burleigh's Art-Song Spiritual "Sometimes I Feel like a Motherless Child"

A “Proto-Theme” in Some of J. S. Bach’s Fugal Works