| 2. |
- van Hilst, Jony, et al.
(author)
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Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)
- 2019
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 269:1, s. 10-17
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC).Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC.Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival.Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60–400) vs 300 mL (150–500), P = 0.001] and hospital stay [8 (6–12) vs 9 (7–14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8–22) vs 22 (14–31), P< 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22–34] versus 31 (95% CI, 26–36) months (P = 0.929).Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.
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| 3. |
- Mesbah, A., et al.
(author)
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Least costly closed-loop performance diagnosis and plant re-identification
- 2015
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In: International Journal of Control. - : Taylor & Francis. - 0020-7179 .- 1366-5820. ; 88:11, s. 2264-2276
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Journal article (peer-reviewed)abstract
- The inherent time-varying nature of dynamics in chemical processes often limits the lifetime performance of model-based control systems, as the plant and disturbance dynamics change over time. A critical step in the maintenance of model-based controllers is distinguishing control-relevant plant changes from variations in disturbance characteristics. In this paper, prediction error identification is used to evaluate a hypothesis test that detects if the performance drop arises from control-relevant plant changes. The decision rule is assessed by verifying whether an identified model of the true plant lies outside the set of all plant models that lead to adequate closed-loop performance. A unified experiment design framework is presented in the least costly context (i.e., least intrusion of nominal plant operation) to address the problem of input signal design for performance diagnosis and plant re-identification when the performance drop is due to plant changes. The application of the presented performance diagnosis approach to a (nonlinear) chemical reactor demonstrates the effectiveness of the approach in detecting the cause of an observed closed-loop performance drop based on the designed least costly diagnosis experiment.
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